Relapse Prevention Plan Template: Components and a Worked Example

A relapse prevention plan connects a person’s recovery goal with the situations that make it harder, actions they can take, people they can reach and a time to review what happened. A useful plan answers a practical question: “When I notice this, what will I do next—and what is my backup?”

The original template below is for adults planning substance-use recovery with their treatment team. It includes a completed fictional example and a later update when a support arrangement proves unreliable. SAMHSA’s maintenance guidance supports identifying triggers, developing coping responses and helping people re-engage after setbacks. SAMHSA TIP 35, Chapter 7, updated 2019

Sources checked October 28, 2026.

If there is a suspected overdose or another immediate medical emergency, seek emergency help rather than completing a worksheet or waiting for a callback. Alcohol withdrawal can be life-threatening after prolonged heavy drinking; get medical advice about safe changes if physical dependence may be present. NIAAA alcohol use disorder guidance

Copyable relapse prevention plan template

Copy these blank prompts into a private document or use them to prepare for a discussion with your clinician. Write in your own words. A blank or “not yet arranged” field is more useful than an invented contact or an action you cannot use. Add rows for additional situations and supports, and keep a short version of the immediate steps where you can find it.

Print-ready versions:

• Download the blank relapse prevention plan (PDF, 3 pages). It follows the eight sections below, with writing space and separate emergency and crisis-contact fields.
• Download the first-action and backup card (PDF, 1 page). Transfer the current plan’s first action, backup contact and emergency route, then cut along the border.

Both files use US Letter paper. Print at actual size on Letter, or choose “Fit” for A4. Write only the information you want to carry, confirm contact details with your treatment team, and replace older cards when the plan changes. You can still copy the text below into an editable document.

Copy the blank worksheet to record your own answers. Agree medication, withdrawal and other clinical instructions with the responsible clinician.

Start with the person’s goal

Begin with what the person wants to protect or regain: being present for family, keeping a job, sleeping more consistently, rebuilding trust or taking part in something they value. Then record the substance-use goal agreed with the treatment team. A clinician’s recommendation and the person’s preference can differ; document the discussion instead of silently presenting agreement.

SAMHSA describes recovery as person-directed and recognizes multiple pathways, including treatment, medication, peer support, family support and self-care. A plan should reflect the person’s strengths, culture and available resources rather than requiring one particular support group or family arrangement. SAMHSA, About Recovery

Ask what already helps. Someone may have a reliable morning routine but struggle during an unstructured evening; another person may need transport to attend care before a coping exercise becomes useful. Housing, work schedules, money, language and accessibility can determine whether a written step is feasible. Put a practical barrier beside the action it affects and identify who can help resolve it.

This planning conversation sits within a broader assessment. The biopsychosocial assessment example shows how physical health, emotional experiences, relationships and practical circumstances can inform a shared explanation. A relapse prevention plan turns that understanding into specific next steps.

Turn warning signs into usable actions

Separate three kinds of information. A trigger is a situation or cue the person associates with difficulty, such as a particular invitation. An early warning sign is a change they recognize in their own pattern, such as repeatedly missing planned support. A craving is an urge to use. They can overlap, but one generic list should not be treated as everyone’s sequence.

CAMH recommends identifying high-risk situations, considering alternative responses and examining what has helped before. Its guidance also emphasizes learning from a lapse and reassessing treatment when needed. CAMH, Preventing and managing relapse

Make the first action short enough to remember. A list of ten coping strategies can still leave someone choosing from scratch when distressed. Select one likely situation, one first step and one backup, then rehearse locating the contact or describing the route. Record any obstacle the rehearsal exposes and adjust the plan together.

RP-01: a completed relapse prevention plan

Fictional outpatient alcohol-recovery example. The dates and contact windows belong to Alex’s individual plan.

Information supplied before writing the plan

On October 28, Alex and an addiction clinician are reviewing continuing care. Alex’s chosen goal is to remain alcohol-free and protect a Saturday commitment to help at a community repair workshop. The clinician has already addressed withdrawal and acute safety needs in a separate care plan.

Alex identifies invitations to a bar after Friday shifts as a recurring difficulty. Alex also notices a personal warning pattern: skipping the workshop planning chat and thinking there is no point attending. Alex prefers a brief phone call to a long text conversation when an urge is increasing. A work phone is shared, so detailed recovery messages must not be left there.

With Alex’s agreement, friend Morgan confirms availability on Friday from 17:30 to 18:30. Peer worker Lee confirms a backup phone check-in window from 18:00 to 19:00 through the fictional program. Both contact details are saved in Alex’s private copy. The program’s after-hours route has also been confirmed.

Alex has a booked clinical review on November 2 at 10:00 and transport arranged. These are supplied facts of the scenario. The final plan must preserve the contact windows and privacy preference rather than shortening everything to “has good support.”

Completed plan matching the blank fields

The completed form turns supplied preferences and arrangements into instructions Alex can locate. Each support has a specific role and contact window, with a separate route for emergency help.

Follow-up: when the first contact does not answer

At the fictional November 2 review, Alex reports receiving an invitation on October 30 at 18:10, declining it and heading toward the workshop. Alex reports a growing urge and calling Morgan at 18:15. Morgan did not answer. Alex then called Lee at 18:20, reached Lee and continued to the setup session. Alex reports no alcohol use that evening. The clinician did not observe the evening directly; the source is Alex’s account.

Alex says the alternate route helped, but waiting for Morgan to respond increased frustration. With Alex’s permission, the team confirms that Morgan’s work rota has changed and the Friday window is no longer dependable. Version 2 removes Morgan as the first Friday contact. Lee confirms the first-contact role during 18:00–19:00, with the program’s confirmed after-hours route outside that window or if Lee is unavailable. Alex’s clinician owns the contact-list update and checks it with Alex during this review. They book the next review for November 9 at 10:00, with earlier contact if use resumes, safety needs change or the revised route cannot be used.

One action was used, one contact failed and another was reached. Record the difference between a planned support, an attempted contact and support actually received, then identify the arrangement that needs to change.

Practice: what is wrong with this follow-up summary?

Draft: “Alex used all supports successfully, has no cravings and will continue the same plan.”

Correction: Alex reported an increasing urge, an unanswered call to Morgan and a completed call to Lee. The contact arrangement changed. Record the reported experience, the confirmed availability change, version 2 and the next review arrangement. Do not convert one reported evening without alcohol into a claim about future risk or remove the failed contact from the record.

A progress note can preserve that reasoning while the person’s copy stays brief. The BIRP note guide shows how to separate an intervention, the person’s response and the next plan.

Plan for a return to use and urgent help

Include this section before it is needed. Ask whom the person would contact, how they would access care and what could prevent them from seeking help. A return to use is a reason to review safety, circumstances and treatment needs, not to blame the person or abandon care. Do not assume that relapse is inevitable or that every episode has the same severity.

The treatment plan may include behavioral care, medication and mutual support. NIAAA describes these as distinct options that can be combined according to clinical needs; continuing follow-up can help treatment be adjusted. A peer contact does not take over the prescriber’s role, and a written coping step does not determine whether withdrawal management is needed. NIAAA, Treatment for Alcohol Problems

For people at risk of opioid overdose, the clinical discussion should address reduced tolerance after a period without use, access to an overdose-reversal medicine and a response plan. Confirm where the medicine is kept and how to use it before it is needed. SAMHSA Overdose Prevention and Response Toolkit, revised 2025

U.S. help routes: call 911 for an immediate medical emergency. Call or text 988 for suicide or mental-health crisis support. SAMHSA’s 1-800-662-HELP (4357) provides treatment referral and information; it is not the emergency-response route. SAMHSA, Find Help

Canada help routes — checked October 28, 2026:

• Immediate medical emergency: call 911 or go to the nearest emergency department. Health Canada’s emergency guidance and substance-use resources
• Substance-use treatment and ongoing support: use the same Health Canada directory to find national, provincial or territorial services. Confirm the chosen service’s hours, eligibility and contact route before adding it to the plan.
• Suicide-crisis support: Canada’s 9-8-8 Suicide Crisis Helpline provides phone and text support 24/7 in English and French. Call 988, text 988, or read what to expect from Canada’s 9-8-8 service.

Record emergency response, suicide-crisis support and routine treatment contacts as separate routes. The crisis line does not replace emergency care for an overdose or an ongoing treatment arrangement. Elsewhere, fill in the corresponding local services and confirm their hours.

Keep individualized safety instructions separate from coping prompts. If alcohol dependence or withdrawal is a concern, a clinician needs to assess safe management. Keep any separate suicide safety plan accessible, and use urgent clinical assessment when safety needs change.

The clinical record and the person’s copy

The person’s copy should make the next step easy to find. The clinical record has a different job: show who supplied the information, what was discussed, what the clinician assessed and what responsibility was accepted. Store sensitive details in the appropriate care system, and agree what a chosen supporter actually needs to receive.

For RP-01, a concise record could state: “November 2, Alex reports declining the invitation, an unanswered Morgan call, a completed Lee call and no alcohol use that evening. Alex identifies waiting for a reply as a barrier. With permission, contact availability confirmed and version 2 agreed. Updated private copy provided to Alex; agreed contact-role updates communicated to Lee and Morgan.” A separate clinical entry records any assessment and treatment decisions actually made. Do not add “no safety concerns” merely because the teaching packet contains no safety findings.

Record the next appointment or contact as booked, requested or awaiting confirmation. When a new referral is needed, identify who will check receipt and acceptance. The medical referral letter guide explains why sending a referral does not establish that another team has taken responsibility.

Respect a person’s decision not to share the whole plan. A support contact may need the agreed action and phone window without needing the full substance-use history. Check message wording and shared-device concerns. Document the applicable consent or other authority for clinical disclosures under local rules.

A practical plan review checklist

Before sharing the plan, check it with the person rather than inspecting only whether every box contains text:

• Ownership: Does the goal reflect the person’s words and the clinical discussion? Is any disagreement still visible?
• Specificity: Can the person recognize a situation and identify a first action without choosing from a long generic list?
• Feasibility: Are transport, cost, opening hours, accessibility and privacy barriers addressed?
• Contacts: Has each support agreed to the stated role and availability? Is there a backup and a separate emergency route?
• Care: Are treatment arrangements and prescriber questions accurate, with requested services distinguished from confirmed ones?
• Follow-up: Is there a date, responsible person and reason to review sooner? Will review ask what actually happened?
• Copies: Can the person locate the current version? Have authorized recipients received the relevant changes?

Try one short walkthrough: “It is the time of the situation we discussed; show me your first step and what happens if that contact does not answer.” Ask what wording or arrangement the person wants to change. Record the correction, then review the plan against real experience at the next agreed contact. A usable plan remains something the person can recognize and use, not simply a completed document in the chart.