Form 4A

Marijuana Use Self-Awareness Record

As a way to increase awareness about your patterns of use, we’ll use this form to identify the kinds of situations, thoughts, feelings, and consequences that are associated with your marijuana use. It may be difficult initially, but once you get accustomed to paying more attention, you will become skilled at discovering the ways in which you typically use marijuana.

Trigger (What types of events tend to make you want to use? For example, an argument, disappointment, loss, or frustration; spending time with friends who use; having marijuana easily available to you; recalling positive memories of past use.)

1.___________________________________________________________________________

2.___________________________________________________________________________

Thoughts and Feelings (What were you thinking or how were you feeling in relation to the triggers you have identified? For example, thinking you were incompetent or stupid or that you could never achieve a particular goal; feeling angry, sad, frightened, or glad.)

1.___________________________________________________________________________

2. __________________________________________________________________________

Behavior (What did you actually do when you were thinking and feeling in these ways? For example, smoked marijuana, went out to dinner, isolated yourself from people.)

1.___________________________________________________________________________

2.___________________________________________________________________________

Positive Consequences (What good came out of your response to the situation? For example, I

felt much better for a short period.)

1.___________________________________________________________________________

2.___________________________________________________________________________

Negative Consequences (What negative things happened as a result of your response? For example, I felt bad about myself for smoking; I couldn’t complete the work I needed to finish.)

1.___________________________________________________________________________

2.___________________________________________________________________________

Form 4B

Future-Self Letter

Optional Creative Expression Exercise

Sometime during the next week, imagine that a year has passed and that you haven’t used marijuana for a year. Making believe that it’s next year, write a letter to yourself (the old you). Write about your life as it has become. Include the reasons why you stopped a year earlier, what your lifestyle is like in the new year, and the benefits you enjoy from not smoking. Mention in your letter any problems you faced during the past year in giving up marijuana use. Describe yourself without marijuana as clearly as you can. As you visualize yourself in the future without marijuana, it may help to think about friendships, self-esteem, health, employment, recreational activities, and general lifestyle satisfaction.

If you prefer, draw, sketch, or paint a picture of this image of yourself in the future, rather than depict it in writing. Choose a medium that will allow you to see another possibility for yourself. This exercise is extremely useful. It helps you visualize your journey and your goal. Having a clear picture of where you’re going, why, and how you’re going to get there will be useful in the months ahead. At our next session, we’ll talk about the future you foresee for yourself.