Triggers are people, places, objects, feelings, and times that cause cravings.

For example, if every Friday night someone cashes a paycheck, goes out with friends, and uses stimulants, the triggers might be

* Friday night 
* After work 
* Money
* Friends who use 
* A bar or club

Your brain associates the triggers with substance use. As a result of constant triggering and using, one trigger can cause you to move toward substance use. The trigger–thought–craving–use cycle feels overwhelming.

Stopping the craving process is an important part of treatment. The best way to do that is to do the following:

1. Identify triggers.

2. Prevent exposure to triggers whenever possible (for example, do not handle large amounts of cash).

3. Cope with triggers differently than in the past (for example, schedule exercise and a 12-Step or mutual-help meeting for Friday nights).

Remember, triggers affect your brain and cause cravings even though you have decided to stop substance use. Your intentions to stop must translate into behavior changes, which keep you away from possible triggers.

What are some of the strongest triggers for you?

What particular triggers might be a problem in the near future?

The Losing Argument

If you decide to stop drinking or using but at some point end up moving toward using substances, your brain has given you permission by using a process called relapse justification.

Thoughts about using start an argument inside your head—your rational self versus your substance-dependent self. You feel as though you are in a fight, and you must come up with many reasons to stay abstinent.

Your mind is looking for an excuse to use again. You are looking for a relapse justification.

The argument inside you is part of a series of events leading to substance use. How often in the past has your substance dependence lost this argument?

Thoughts Become Cravings

Craving does not always occur in a straightforward, easily recognized form.

Often the thought of using passes through your head with little or no effect. But it’s important to identify these thoughts and try to eliminate them. It takes effort to identify and stop a thought.

However, allowing yourself to continue thinking about substance use is choosing to relapse.

The further the thoughts are allowed to go, the more likely you are to relapse.

The “Automatic” Process 

During addiction, triggers, thoughts, cravings, and use seem to run together. However, the usual sequence goes like this:

Trigger –> Thought –> Craving –> Use

Thought Stopping

The only way to ensure that a thought won’t lead to a relapse is to stop the thought before it leads to craving. Stopping the thought when it first begins prevents it from building into an overpowering craving.

It is important to do it as soon as you realize you are thinking about using.

  

Thought-Stopping Techniques

A New Sequence

To start recovery, it is necessary to interrupt the trigger–thought–craving–use sequence. Thought stopping provides a tool for disrupting the process.

This process is not automatic. You make a choice either to continue thinking about using (and start on the path toward relapse) or to stop those thoughts.

Try the techniques described below, and use those that work best for you:

Visualization. Imagine a scene in which you deny the power of thoughts of use. For example, picture a switch or a lever in your mind. Imagine yourself actually moving it from ON to OFF to stop the using thoughts. Have another picture ready to think about in place of those thoughts.

Snapping. Wear a rubberband loosely on your wrist. Each time you become aware of thoughts of using, snap the rubberband and say, “No!” to the thoughts as you make yourself think about another subject. Have a subject ready that is meaningful and interesting to you.

Relaxation. Feelings of hollowness, heaviness, and cramping in the stomach are cravings. These often can be relieved by breathing in deeply (filling lungs with air) and breathing out slowly. Do this three times. You should be able to feel the tightness leaving your body. Repeat this whenever the feeling returns.

Call someone. Talking to another person provides an outlet for your feelings and allows you to hear your thinking process. Have phone numbers of supportive, available people with you always, so you can use them when you need them.

ALLOWING THE THOUGHTS TO DEVELOP INTO CRAVINGS IS
MAKING A CHOICE TO REMAIN DEPENDENT ON SUBSTANCES.

External Trigger Questionnaire

Place a checkmark next to activities, situations, or settings in which you frequently used substances; place a zero next to activities, situations, or settings in which you never have used substances.

* Home alone  * Home with friends  * Friend’s home  * Parties
* Sporting events  * Movies  * Bars/clubs  * Beach
* Concerts  * With friends who use drugs  * When gaining weight
* Vacations/holidays  * When it’s raining  * Before a date
* During a date  * Before sexual activities  * During sexual activities
* After sexual activities  * Before work  * When carrying money
* After going past dealer’s residence  * Driving  * Liquor store
* During work  * Talking on the phone  * Recovery groups
* After payday  * Before going out to dinner  * Before breakfast
* At lunch break  * While at dinner  * After work
* After passing a particular street or exit  * School
* The park  * In the neighborhood  * Weekends
* With family members  * When in pain

List any other activities, situations, or settings where you frequently have used.

List activities, situations, or settings in which you would not use.

List people you could be with and not use.

External Trigger Chart

Instructions: List people, places, objects, or situations below according to their degree of association with substance use, from 0% to 100% Chance of Using :

Never Use [These situations are “safe.”]

Almost Never Use [These situations are low risk, but caution is needed.]

Almost Always Use [These situations are high risk. Staying in these situations is extremely dangerous.]

Always Use [Involvement in these situations is deciding to stay addicted. Avoid totally.]

--------

Internal Trigger Questionnaire

During recovery certain feelings or emotions often trigger the brain to think about using substances. Read the following list of feelings and emotions, and place a checkmark next to those that might trigger thoughts of using for you. Place a zero next to those that are not connected with using.

* Afraid  * Frustrated  * Neglected
* Angry  * Guilty  * Nervous
* Confident  * Happy  * Passionate
* Criticized  * Inadequate  * Pressured
* Depressed  * Insecure  * Relaxed
* Embarrassed  * Irritated  * Sad
* Excited  * Jealous  * Bored
* Exhausted  * Lonely  * Envious
* Deprived  * Humiliated  * Anxious
* Aroused  * Revengeful  * Worried
* Grieving  * Resentful  * Overwhelmed
* Misunderstood  * Paranoid  * Hungry

What emotional states that are not listed above have triggered you to use substances?

Was your use in the weeks before entering treatment
_____ Tied primarily to emotional conditions?
_____ Routine and automatic without much emotional triggering?

Were there times in the recent past when you were not using and a specific change in your mood clearly resulted in your wanting to use (for example, you got in a fight with someone and wanted to use in
response to getting angry)?
Yes _____ No _____ If yes, describe:

Internal Trigger Chart

Instructions: List emotional states below according to their degree of association with substance use, from 0% to 100% Chance of Using:

Never Use [These emotions are “safe.”]

Almost Never Use [These emotions are low risk, but caution is needed.]

Almost Always Use [These emotions are high risk.]

Always Use [Persisting in these emotions is deciding to stay addicted. Avoid totally.]

~ ~ ~

See original document for other chapters, diagrams, worksheets etc:

Client's Handbook: Matrix Intensive Outpatient Treatment for People with Stimulant Use Disorder (112 page PDF)