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My Recovery Response Plan

Identify personal risk situations, write a first response and backup, and plan support.

First page preview of My Recovery Response Plan

Actual first page · 2 printable US Letter pages in the complete PDF. These are printable files, not interactive fillable forms.

Participant worksheet
Format
PDF · 2 pages · US Letter
Audience
Adults in recovery, with a counselor or support person.
Time
About 5-25 minutes; follow the sheet
Cost
Free · No email required
Download PDF ↓Preview full PDF ↗

Inside this resource

  • Identify a personal risk situation and early warning signs.
  • Write a first response, backup, and support plan.

How to use it

  1. Complete with a counselor or support person.
  2. Choose realistic actions and reachable support contacts.
  3. Review the medical safety notes and update the plan with your care team.

Print for personal use or your own professional sessions. Do not resell or redistribute the files. Educational content, not individualized treatment. Guides are original session plans, not validated protocols.

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Read the complete text version
PAGE 1
© 2026 Breaking the Bond | Original educational resource | 1
Print for yourself or your professional sessions. Do not resell or redistribute the files.
RELAPSE PREVENTION / PARTICIPANT WORKSHEET / 1 OF 2
My Recovery Response Plan
20-25 minutes with your counselor or support person. Plan for your own goals and risks. Keep completed
contact details private.
1 / What I want to protect
What matters to my recovery right now? What is one reason to ask for help early?
2 / A situation I want to prepare for
Who, where, and when? Include thoughts or feelings that may increase my urge to use. No detailed use stories are
needed.
3 / Changes I can notice
What personal warning signs have I noticed before? Example: withdrawing from support or skipping appointments. Signs
differ across people.
4 / My first response and backup
If __________ happens, I will __________. If that is not enough, I will __________. Where can I go safely?


PAGE 2
© 2026 Breaking the Bond | Original educational resource | 2
Print for yourself or your professional sessions. Do not resell or redistribute the files.
RELAPSE PREVENTION / PARTICIPANT WORKSHEET / 2 OF 2
Connection Before Isolation
Use this alongside your treatment plan. Coping skills do not replace medical care, prescribed treatment, or
a response to immediate danger.
5 / People and services I can contact
First contact / number: ____________________. Backup: ____________________. After-hours or program support:
____________________.
6 / If I return to use
I can tell __________ and contact my treatment team by __________. What would help me reconnect promptly without
hiding?
7 / One action in the next 24 hours
My action: __________. When: __________. Support: __________. I will review this plan on __________.
Medical safety
Tolerance can drop after a period without opioids, increasing overdose risk if use resumes. Ask a
clinician or pharmacist about naloxone and an individualized overdose prevention plan. Do not
change prescribed medication based on this worksheet.
Suspected overdose or immediate danger
Call 911. If opioid overdose is suspected, give naloxone if available, follow product and dispatcher
directions, and stay until help arrives. Severe withdrawal also needs urgent medical attention; do
not attempt an unsupervised detox.
Safety references: CDC, What to Do If You Think Someone Is Overdosing (2024); CDC, Risks and How to Reduce Them. See
companion guide for links.
Use them together

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