This is the best description of the cause of relapse we have ever read. The following was published in the A.A. Grapevine, January 1947. Dr. Silkworth contributed the two letters included in “The Doctor’s Opinion” in the Big Book.
RELAPSE EXPLAINED: SLIPS AND HUMAN NATURE
By William D.”Silky” Silkworth, M.D.
The mystery of slips is not so deep as it may appear. While it does seem odd that an alcoholic, who has restored himself to a dignified place among his fellowmen and continues dry for years, should suddenly throw all his happiness overboard and find himself again in mortal peril of drowning in liquor, often the reason is simple.
People are inclined to say, “There is something peculiar about alcoholics. They seem to be well, yet at any moment they may turn back to their old ways. You can never be sure.”
This is largely twaddle. The alcoholic is a sick person. Under the technique of Alcoholics Anonymous he gets well—that is to say, his disease is arrested. There is nothing unpredictable about him any more than there is anything weird about a person who has arrested diabetes.
Let’s get it clear, once and for all, that alcoholics are human beings. Then we can safeguard ourselves intelligently against most slips.
In both professional and lay circles, there is a tendency to label everything that an alcoholic may do as “alcoholic behavior.” The truth is, it is simple human nature.
It is very wrong to consider any of the personality traits observed in liquor addicts as peculiar to the alcoholic. Emotional and mental quirks are classified as symptoms of alcoholism merely because alcoholics have them, yet those same quirks can be found among non-alcoholics too. Actually they are symptoms of mankind!
Of course, the alcoholic himself tends to think of himself as different, somebody special, with unique tendencies and reactions. Many psychiatrists, doctors, and therapists carry the same idea to extremes in their analyses and treatment of alcoholics.
Sometimes they make a complicated mystery of a condition that is found in all human beings, whether they drink whiskey or buttermilk.
To be sure, alcoholism, like every other disease, does manifest itself in some unique ways. It does have a number of baffling peculiarities that differ from those of all other diseases.
At the same time, any of the symptoms and much of the behavior of alcoholism are closely paralleled and even duplicated in other diseases.
The slip is a relapse! It is a relapse that occurs after the alcoholic has stopped drinking and started on the A.A. program of recovery. Slips usually occur in the early states of the alcoholic’s A.A. indoctrination, before he has had time to learn enough of the A.A. techniques and A.A. philosophy to give him a solid footing. But slips may also occur after an alcoholic has been a member of A.A. for many months or even several years, and it is in this kind, above all, that often finds a marked similarity between the alcoholic’s behavior and that of “normal” victims of other diseases.
No one is startled by the fact that relapses are not uncommon among arrested tubercular patients. But here is a startling fact—the cause is often the same as the cause that leads to slips for the alcoholic.
It happens this way: When a tubercular patient recovers sufficiently to be released from the sanitarium, the doctor gives him careful instructions for the way he is to live when he gets home. He must drink plenty of milk. He must refrain from smoking. He must obey other stringent rules.
For the first several months, perhaps for several years, the patient follows directions. But as his strength increases and he feels fully recovered, he becomes slack. There may come the night when he decides he can stay up until ten o’clock. When he does this, nothing untoward happens. Soon he is disregarding the directions given him when he left the sanitarium. Eventually he has a relapse.
The same tragedy can be found in cardiac cases. After the heart attack, the patient is put on a strict rests schedule. Frightened, he naturally follows directions obediently for a long time. He, too, goes to bed early, avoids exercise such as walking upstairs, quits smoking, and leads a Spartan life. Eventually, though there comes a day, after he has been feeling good for months or several years, when he feels he has regained his strength, and has also recovered from his fright. If the elevator is out of repair one day, he walks up the three flights of stairs. Or he decides to go to a party—or do just a little smoking—or take a cocktail or two. If no serious after effects follow the first departure from the rigorous schedule prescribed, he may try it again, until he suffers a relapse.
In both cardiac and tubercular cases, wrong thinking preceded the acts that led to the relapses. The patient in each case rationalized himself out of a sense of his own perilous reality. He deliberately turned away from his knowledge of the fact that he had been the victim of a serious disease. He grew overconfident. He decided he didn’t have to follow directions.
Now that is precisely what happens with the alcoholic—the arrested alcoholic, or the alcoholic in A.A. who has a slip. Obviously, he decides to take a drink again some time before he actually takes it. He starts thinking wrong before he actually embarks on the course that leads to a slip.
There is no reason to charge the slip to alcoholic behavior or a second heart attack to cardiac behavior. The alcoholic slip is not a symptom of a psychotic condition. There’s nothing screwy about it at all.
The patient simply didn’t follow directions!
For the alcoholic, A.A. offers the directions. A vital factor, or ingredient of the preventive, especially for the alcoholic, is sustained emotion. The alcoholic who learns some of the techniques or the mechanics of A.A. but misses the philosophy or the spirit may get tired of following directions—not because he is alcoholic, but because he is human.
Rules and regulations irk almost anyone, because they are restraining, prohibitive, and negative. The philosophy of A.A. however, is positive and provides ample sustained emotion—a sustained desire to follow directions voluntarily.
In any event, the psychology of the alcoholic is not as different as some people try to make it. The disease has certain physical differences, yes, and the alcoholic has problems peculiar to him, perhaps, in that he has been put on the defensive and consequently has developed frustrations. But in many instances, there is no more reason to be talking about “the alcoholic mind” than there is to try to describe something called the “cardiac mind” or the “TB mind.”
I think we’ll help the alcoholic more if we can first recognize that he is primarily a human being—afflicted with human nature.
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