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LOCATION: Home > Tools > Functional Analysis

National Institute on Drug Abuse
Therapy Manuals for Drug Addiction

A Community Reinforcement Approach:
Treating Cocaine Addiction


 
Exhibit 14: Functional Analysis - Cocaine Behavior Form

Example of a completed form.

Consequences
Trigger Thoughts and Feelings Behavior Positive Negative
Exhibit 14: Functional Analysis - Cocaine Behavior Form (example)
  Consequences
Trigger Thoughts and Feelings Behavior Positive Negative
Bob comes over to apartment Looks like good stuff.
Could really get high.
I deserve a break
Do 1/2 gram, then another gram. Got really high.
Bob and I had a blast.
Didn't have to deal with wife
Blew $50.
Late to work next day.
Wife won't talk to me.
After work, guys say, "Let's go to the bar." I know I should go home. I'm tired and know that I'll do some coke and that will help. Go to bar.
Drink a few beers.
Shoot 1/2 gram.
Had a blast.
Reenergized
Good high.
Wife was mad.
Blew $30.
Arm is sore.
Saturday night. Time to party.
Feel like getting really high.
Staying home will be boring.
Go over to Tom's apartment.
Get a few 6-packs.
Buy an eight-ball.
High till 3 a.m.
Good coke, but really high.
Laughed a lot.
Blew $120.
Arm sore.
Missed kid's game in the a.m.
Wife mad.

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