Marlatt & Gordon's Relapse Model: PDF Worksheet, Tools and Exercises

Patients in addiction recovery frequently arrive with a guilt-saturated narrative: one slip became weeks of use, and they cannot explain how. Naming the Abstinence Violation Effect verbally is rarely enough to interrupt that cycle. This fiche PDF gives the Marlatt & Gordon cognitive-behavioral relapse model a visual form that makes the chain legible, and breakable, within a single session.

Why the Relapse Chain Resists Verbal Explanation

The concept patients most consistently misread is precisely the one at stake: that relapse is not a discrete event but a sequence, and that the decisive moment is not the first lapse but the cognitive and affective response to it. When you describe the AVE in the abstract, most patients hear confirmation of their worst fear ("I'm weak, I've failed again") rather than a mechanism they can interrupt. The distinction between a lapse and a relapse sounds theoretical until they can see Path A and Path B laid out side by side.

Self-efficacy, outcome expectancies, and the shame spiral that converts a single slip into a full return to pattern: these are concepts that gain genuine traction through structure, not narration alone. The all-or-nothing thinking that drives the AVE is almost impossible to challenge without a shared visual reference that names it first.

What the Fiche Contains: A Visual Map of the Relapse Chain

The fiche organizes the model into five sequenced panels, grounded in the original Marlatt & Gordon (1985) framework and the Witkiewitz & Marlatt (2004) reformulation.

• "The fork in the road" maps Path A (a coping move is deployed, self-efficacy rises, risk drops) against Path B (no plan, expectancies activate, initial lapse occurs, AVE strikes). The side-by-side layout makes the branching moment visible in a way that a spoken explanation cannot match.
• "High-risk situations" lists twelve concrete recurring scenarios across emotional, interpersonal, and contextual domains: walking past the bar, alone on Friday night, unexpected happiness. For patients who struggle to identify personal triggers, the list functions as a recognition prompt rather than a blank page.
• The lapse-vs-relapse panel defines each briefly, contrasting "a single slip, painful but contained" with "a return to the prior pattern, built from a lapse plus the AVE story."
• "The Abstinence Violation Effect" renders the AVE's three attributional dimensions (global, stable, internal) visually, alongside the reframe: "A slip is data, not a verdict."
• "Build your plan before you need it" closes with four concrete preparedness prompts: mapping the top five high-risk situations, pre-deciding if-then implementation intentions, playing the tape forward past the first ten minutes, and monitoring early warning signs.

A "To discuss in session" checklist at the foot of the fiche gives patients explicit return triggers: a recurring high-risk situation without a plan, a live AVE script after a slip, or stacking early warnings.

> Key point: The fiche is a visual support that facilitates the explanation of the relapse chain in session. It is not a standalone self-monitoring form. The clinician uses it as a shared reference during psychoeducation, then the patient keeps it as a concrete anchor between appointments.

When and How to Introduce the Fiche

The fiche fits naturally into the psychoeducation phase, once the therapeutic alliance is established and the patient has articulated at least one high-risk situation. In motivational interviewing contexts, it pairs well with building discrepancy around change or a decisional balance exercise once ambivalence begins to resolve. You can also use it alongside lapse and relapse management tools when the chain has already partially played out.

Introduce it without pathologizing: "I'd like to show you a map of how most slips actually unfold, so we can locate where the chain usually breaks for you." Work through sections one to three together, pausing at the patient's own scenarios from the high-risk list. Section four (the AVE) is often most useful immediately after an actual lapse, when the shame response is live rather than theoretical.

For section five planning, coping skills for addictions and evaluating coping strategy effectiveness are natural complements. The early-warning monitoring aligns directly with identifying and coping with triggers, and the if-then structure connects cleanly to ACT choice point work for patients already familiar with that framework. When shame is the primary AVE driver, a guided shame exercise can deepen what the fiche opens.

One limit worth naming: patients in acute destabilization may need containment before the chain structure is clinically useful. In those situations, lead with coping in crisis strategies and return to the fiche once affect is regulated.

The fiche does not replace the case formulation or the treatment plan. It renders one of the most clinically essential models in relapse prevention visible, shared, and workable in the room.

Sources

• Marlatt, G. A., & Gordon, J. R. (1985). Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. Guilford Press.
• Marlatt, G. A., & Donovan, D. M. (2005). Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors (2nd ed.). Guilford Press.
• Witkiewitz, K., & Marlatt, G. A. (2007). Relapse Prevention. In G. A. Marlatt & D. M. Donovan (Eds.), Relapse Prevention (2nd ed.). Guilford Press.