A brief cognitive behavioural intervention for regular amphetamine users: a treatment guide

Phase 4: Seemingly irrelevant decisions

Page last updated: 2003

Rationale behind seemingly irrelevant decisions

Previous exercises have helped the client to identify situations in which they are most likely to use speed. Explain to the client that one useful way of avoiding these situations, and hence the trigger for a speed craving, is to become aware of the 'seemingly irrelevant decisions' they make that can lead to them being in a situation of high-risk for using. Present the following rationale for the client:

"Many of our daily decisions and choices on the surface seem to have nothing to do with using speed. Although your decisions may not directly involve choosing whether or not to use, they may slowly move you closer to such behavioural/emotional states that are associated with using. It is often through seemingly irrelevant decisions that we gradually work our way closer to entering high-risk situations that may lead to using speed.

People often fall victim to their situations (e.g. "I always end up using at parties and can't help it"). Although it is difficult to recognise choices made when in the middle of the decision-making process, each small decision you make over a period of time can gradually lead you closer to your predicament. The best way to combat this is to think about each choice you make, no matter how seemingly irrelevant it is to using speed, so you anticipate potential dangers ahead.

Choose the lowest-risk option when faced with a decision, to avoid putting yourself in a risky situation. When you become aware of seemingly irrelevant decisions, you will be better able to avoid high-risk situations. It is easier to simply avoid the high-risk situation before you are actually in it."

Exercise 4: Seemingly irrelevant decisions 10

  • Ask the client to think about their last relapse and to describe the situation/events that preceded the relapse.
  • With the client, determine what seemingly irrelevant decisions led up to the relapse.
  • Take the client through the steps on the reminder sheet below. Then, give a copy of the sheet to the client to take away with them.
When making any decision, whether large or small, do the following:
  • Think about what different options you have.
  • Think ahead to the possible results of each option. What are the positive or negative effects you can think of, and what is the risk of relapse?
  • Select one of the options. Choose one that will give you the lowest chance of relapse. If you decide to choose a high-risk option, plan how to protect yourself while in the high-risk situation.
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"Seemingly irrelevant decisions" exercise sheet

Think back to your last lapse to speed use and describe the situation/events that preceded the lapse.
  • What situations led up to the lapse?
  • What decisions led up to the lapse?
  • What stopped me from recognising these signs?
  • What would have been a more low-risk option?
  • Plan to manage high-risk situations


10 Exercises in Phase 4 are based on Monti, Abrams, Kadden & Cooney (1989)