Relapse Prevention
After five months without using, Jordan says he has no cravings. However, he has stopped eating regularly, avoids sober friends, skips group, and spends more time remembering only the “good parts” of using.
What is the best way to understand what may be happening?
A. An early relapse process may be developing even though Jordan has not decided to use.
B. Jordan may be ready to test whether he can maintain recovery with less structure.
C. These behaviors become relapse warning signs only when they are followed by strong cravings.
D. The changes are more likely signs of ordinary stress because Jordan still wants recovery.
Correct answer: A
Relapse often begins with changes in self-care, thinking, honesty, and connection before a person physically uses.
Luis drinks before social events because alcohol quickly lowers his anxiety. The next day, his anxiety is often worse, but he continues drinking before social situations.
What most strongly teaches his brain to repeat the drinking?
A. Alcohol makes social situations more enjoyable and rewarding.
B. The immediate relief from anxiety strengthens the urge to drink again.
C. His body has developed enough tolerance that he needs alcohol to feel normal.
D. Social events have become automatic reminders of previous drinking experiences.
Correct answer: B
Several processes may be involved, but the immediate removal of anxiety most directly reinforces the drinking behavior.
Nina drinks when she feels depressed because alcohol temporarily numbs her sadness. The next day, she sleeps poorly, feels guilty, isolates, and becomes even more depressed.
Which explanation best describes the cycle?
A. Alcohol is reducing the depression, but Nina’s guilt is canceling out the benefit.
B. Depression and alcohol use are separate problems that happen to occur at the same time.
C. Short-term relief reinforces drinking, while the aftereffects and isolation deepen the depression.
D. Nina’s depression will probably resolve once she learns to drink without feeling guilty afterward.
Correct answer: C
Alcohol may briefly numb sadness while worsening sleep, motivation, guilt, isolation, and mood afterward.
Tanya attends several recovery meetings each week and has many phone numbers. However, she usually contacts people only after she has already used.
What would make her support network more protective?
A. Attend meetings from more fellowships so she receives a wider range of advice.
B. Choose the person with the longest sobriety to make most recovery decisions for her.
C. Tell more people the complete details of her substance-use history.
D. Decide whom to call for specific risks and practice reaching out before the situation becomes a crisis.
Correct answer: D
A support list becomes protective when a person knows whom to contact, why to contact them, and is willing to reach out early.
Samantha receives an insulting text and immediately feels rage. She begins typing a message that could seriously damage the relationship.
Which response most accurately uses the DBT STOP skill?
A. Stop, step back, observe thoughts, body sensations, urges, and facts, and then choose a goal-based response.
B. Write the complete angry response but wait until the next morning before sending it.
C. Ask a support person to decide whether the other person deserves a response.
D. Distract from the anger and return to the issue only if it continues to feel important.
Correct answer: A
STOP creates space between an emotional urge and an action so the person can respond intentionally.
At a family celebration, someone offers Carla one drink. She thinks, “It would only be one. I could stop after the toast.”
Which thought best uses Think the Drink Through?
A. “I should immediately leave because thinking about drinking means I am already relapsing.”
B. “I can wait 20 minutes and see whether the desire becomes weaker.”
C. “I need to remember the single worst consequence alcohol has caused me.”
D. “Let me follow the likely chain from the first drink through tonight, tomorrow morning, and the next several days.”
Correct answer: D
Think the Drink Through means mentally following the full likely sequence—not stopping the picture at the first drink or the immediate relief.
After several months without alcohol, Brianna walks past a sports bar and smells beer. She suddenly experiences vivid memories, salivation, and a strong craving, even though she had not been thinking about drinking.
Which statement is most accurate?
A. The reaction means part of Brianna has already decided to relapse.
B. The craving is most likely delayed physical withdrawal from alcohol.
C. A learned cue can activate a craving without Brianna choosing or intending to drink.
D. The reaction shows that Brianna entered the situation before she was ready for recovery.
Correct answer: C
Places, smells, people, music, and emotions can become learned cues. A cue-triggered craving is not the same as a decision to use.
Kevin drinks before social situations because alcohol quickly lowers his anxiety. Over time, he becomes more convinced that he cannot socialize without drinking.
What most likely strengthens this belief?
A. Immediate relief reinforces drinking, while avoiding sober social experiences prevents Kevin from building confidence.
B. Alcohol lowers anxiety so effectively that Kevin’s original anxiety has become less important.
C. Kevin’s increased anxiety is mainly caused by needing larger amounts of alcohol to feel relaxed.
D. Social anxiety becomes permanent when a person repeatedly uses alcohol to manage it.
Correct answer: A
Alcohol provides short-term relief, but relying on it prevents the person from learning that anxiety can be tolerated and managed sober.
Marcus is most likely to drink between leaving work and arriving home. He usually has not eaten, feels overwhelmed, and passes the liquor store on his normal route.
Which plan gives him the strongest protection?
A. Remind himself each afternoon that drinking would create serious consequences.
B. Eat before leaving, take another route, call support, and go directly to a planned recovery activity.
C. Drive the usual route so that he can become more comfortable resisting the liquor store.
D. Contact someone only if the craving rises above seven out of ten.
Correct answer: B
The strongest plan acts before the craving becomes intense and changes several parts of the high-risk chain.
After setting a respectful boundary, Jade feels intense shame and wants to hide from everyone. After checking the facts, she recognizes that the boundary was reasonable.
Which action best uses Opposite Action?
A. Stay home but write about why she had the right to set the boundary.
B. Ask several people to reassure her before deciding whether to attend group.
C. Attend group, use open posture, and discuss the boundary without unnecessary apologizing.
D. Apologize to the family member so that the shame decreases enough for her to attend.
Correct answer: C
When shame does not fit the facts, Opposite Action involves becoming visible, approaching rather than hiding, and avoiding unnecessary apologies.
Ava says, “I know marijuana increases my anxiety and makes me less motivated. I keep thinking that I should stop, but I am not ready to commit.”
Which step best fits where Ava is right now?
A. Begin a two-week abstinence period and remove all marijuana from her home.
B. Honestly compare what marijuana gives her, what it costs her, and how it fits with the life she wants.
C. Create a detailed trigger plan and choose three people who will hold her accountable.
D. Announce a quit date so she is less likely to change her mind later.
Correct answer: B
Ava is in the contemplation stage: she recognizes problems but remains divided. Exploring both sides helps her move toward a decision.
After one month without opioids, someone considers taking the same amount that was commonly used before entering treatment.
Which fact most directly increases the danger?
A. Cravings after abstinence usually indicate that withdrawal is beginning again.
B. The body may process opioids more slowly after a period without use.
C. Previous daily use means the person will probably need the former amount to feel an effect.
D. Opioid tolerance may have decreased, making the former amount much more dangerous.
Correct answer: D
Tolerance can drop during abstinence. Returning to a previously used amount can greatly increase overdose risk
Which situation is most concerning as a possible warning sign of a manic or hypomanic episode rather than an ordinary good mood?
A. Feeling unusually hopeful after receiving positive news about work
B. Sleeping poorly for one night and feeling exhausted the following day
C. Talking more than usual during an enjoyable celebration with friends
D. Sleeping two or three hours for several nights without feeling tired while making risky plans
Correct answer: D
Reduced need for sleep combined with increased energy, rapid thinking, impulsivity, or risky behavior is different from simply feeling happy.
Which statement most accurately demonstrates mindfulness of a craving?
A. “I notice tightness in my chest, an image of using, the thought ‘I need relief,’ and an urge around seven out of ten.”
B. “This craving is irrational, so I need to identify the thought that caused it.”
C. “I will focus on something else until I can no longer feel the craving.”
D. “A craving this strong shows that I am not ready to face this situation.”
Correct answer: A
Mindfulness means observing and describing the experience without judging it, fighting it, or automatically obeying it.
During group, two members whisper. Anthony immediately thinks they are talking about him, feels embarrassed, and wants to leave.
Which response best uses Check the Facts?
A. Leave briefly until the embarrassment decreases, then decide whether his interpretation was correct.
B. Separate what he observed from what he assumed, consider other explanations, and then choose a response.
C. Stay in the room because embarrassment is usually an emotion that should not be trusted.
D. Ask the two members whether they dislike him before examining his interpretation.
Correct answer: B
The fact is that two people whispered. The belief that they were criticizing Anthony is an interpretation that needs to be checked.
After eight months without alcohol, David drinks one evening. The next morning he thinks, “I destroyed everything. I am back at the beginning, so I might as well keep drinking.”
Which response gives David the strongest chance of preventing a longer relapse?
A. Stay away from treatment until the shame decreases enough for him to discuss what happened.
B. Create stricter rules for himself but avoid examining the episode so he does not dwell on it.
C. Contact support immediately, remove access to alcohol, review the chain, and return to recovery activities.
D. Treat the episode as unimportant because focusing on it could weaken his confidence.
Correct answer: C
A lapse becomes more dangerous when shame leads to secrecy, isolation, and continued use. Quick honesty and re-engagement interrupt that process.
Which statement about the Jellinek Curve is most accurate?
A. It is a model of common addiction and recovery patterns, but people do not all follow the same exact path.
B. It is an assessment that identifies whether an alcohol problem is mild, moderate, or severe.
C. It shows that lasting recovery generally begins only after a person reaches the lowest point on the curve.
D. It predicts which specific consequences will finally motivate someone to enter treatment.
Correct answer: A
The Jellinek Curve is a teaching model—not a diagnostic test, universal sequence, or prediction of when someone will change.
Darren has bipolar disorder. For several nights, he has slept fewer than three hours without feeling tired, stopped taking medication, feels “unstoppable,” and is thinking that cocaine would make the experience even better.
What is the strongest recovery response?
A. Use Think the Drink Through and wait until the next appointment to discuss the sleep change.
B. Tell treatment staff and the psychiatric provider promptly, protect sleep, and reduce access to substances.
C. Attend an additional recovery meeting but keep the medication issue private until he feels calmer.
D. Use mindfulness to observe the elevated energy without making it seem more serious than it may be.
Correct answer: B
Very little sleep, medication nonadherence, elevated confidence, and substance cravings can quickly increase impulsivity and risk.
Which statement best describes urge surfing?
A. “I will challenge each substance-related thought until the urge becomes more reasonable.”
B. “I will distract myself completely so I do not notice any part of the craving.”
C. “I will observe the urge like a wave and allow it to rise, change, and fall without acting on it.”
D. “I will picture the worst consequence of using until fear becomes stronger than the craving.”
Correct answer: C
Urge surfing is not forcing the craving away. It is allowing the urge to change naturally without feeding it or acting on it.
Tyler’s friend has not answered a text. Tyler thinks, “They are ignoring me.” Underneath that thought is a deeper belief: “People reject me once they really know me.”
Which action most directly challenges the core belief, rather than only the unanswered text?
A. Make a list of practical reasons the friend may not have responded.
B. Distract himself until he stops thinking about the situation.
C. Repeat “People like me” until the negative belief becomes weaker.
D. Notice the larger pattern and gradually gather new evidence through safe, authentic relationships.
Correct answer: D
Alternative explanations can challenge one automatic thought. Core beliefs usually change through repeated experiences that challenge the broader pattern.
Monica has been making major progress. After receiving praise and being offered a promotion, she skips treatment, starts arguments with supportive people, and contacts friends she used to drink with. She says, “Whenever things go well, I ruin them.”
Which explanation best fits this self-sabotaging pattern?
A. Success may activate an old belief such as “I always fail,” leading Monica to recreate a familiar outcome.
B. The promotion has created enough stress that temporarily reducing recovery activities may protect her.
C. Her recent behavior shows that her earlier motivation was probably based mainly on pleasing others.
D. Monica has returned to precontemplation and must first decide whether she still believes addiction is a problem.
Correct answer: A
Success can feel unfamiliar or unsafe when it conflicts with a long-standing core belief. Returning to chaos may recreate what the person expects.
Isaiah repeatedly used opioids near the same convenience store. After entering recovery, passing the store caused strong cravings. He later passed it many times without using, and the cravings weakened. Months later, during severe stress, the craving suddenly returned.
Which explanation is most accurate?
A. The return of the craving shows that his previous coping skills were not genuinely effective.
B. New learning reduced the reaction, but the older cue association was not erased and can reappear under stress.
C. The craving returned because Isaiah had probably begun planning to use before passing the store.
D. Severe stress restarted physical withdrawal even though Isaiah had not recently used opioids.
Correct answer: B
Recovery creates new learning that competes with older associations. The older learning may still reappear during stress, exhaustion, or other high-risk conditions.
After reducing cannabis use, Alisha notices some improvement in motivation, but significant depression remains. She wonders whether the depression is “real” or caused entirely by cannabis.
Which belief is most accurate?
A. She should wait until she has several months of complete abstinence before seeking help for depression.
B. Because depression remains, cannabis probably has no meaningful effect on her mental health.
C. She can work on both concerns while tracking how mood, sleep, motivation, and cannabis use affect one another.
D. She should focus only on cannabis because mental-health treatment cannot work while any substance use continues.
Correct answer: C
Depression and substance use can affect each other. Working on both avoids assuming that one problem completely explains the other.
Renee plans to attend a family event where alcohol will be available and several relatives may pressure her to drink.
Which plan best uses Coping Ahead rather than relying mainly on willpower?
A. Arrive late, stay near a supportive relative, carry a nonalcoholic drink, and leave after dinner.
B. Drive separately, rehearse refusal responses, schedule support check-ins, and leave at early warning signs.
C. Avoid the bar area, focus on recovery reasons, and leave only if a strong craving develops.
D. Ask the host to keep alcohol out of sight, sit near the exit, and avoid discussing recovery.
Correct answer: B
The strongest Coping Ahead plan includes rehearsal, transportation control, support contact, and an exit before risk becomes overwhelming.
After the end of a meaningful relationship, Malik’s sadness fits the facts. However, he has stayed in bed for five days, stopped eating regularly, ignored sober supports, and missed treatment.
Which response best reflects effective emotion regulation?
A. Validate the sadness while taking small opposite actions against the ineffective withdrawal and isolation.
B. Wait until the sadness no longer fits the facts before changing his behavior.
C. Challenge whether the relationship was important enough to justify this level of sadness.
D. Continue isolating because accepting an emotion means allowing its action urge to run its course.
Correct answer: A
An emotion can be understandable while its intensity, length, or action urge becomes harmful. Malik can honor the sadness without continuing the isolation.