Fact:

 

A healthy percentage of alcoholics/addicts voice their decision to pick up the first drink/drug of physical relapse with an expletive.

 

And all who do this have at least one other thing in common at that moment – brains which are alcohol and drug free. They curse. Then they pick up that fateful first drink or drug. “My Way or the Highway” builds on this shared experience. To help those who have done it see the specific change that may be necessary. Necessary, that is, if their sober mind is not to react this way again, ever. The exercise is described in enough detail that a trained counselor may facilitate or adapt it as she or he sees fit.

 

As with the exercise, “Expletive Deleted” (1) we start with a question that establishes the common experience in a group of addictive patients.

 

“How many of the people in this room have ever decided to abstain, thinking it was for good, only to change your minds and pick up the first “dose” with an expletive or curse, possibly starting with the letter ‘F’?”  It is a rare group in which fewer than half of the hands go up.

 

Now offer a possible “translation” of what they may have meant at the time.

 

“How many of you (patients) would identify with a translation of your expletive that goes like this: ‘if life does not give me what I want, or too much of what I don’t want, I am out of here! (And I know just how to leave!)’  Perhaps, punctuating this idea by bringing palms together and to one side, rapidly sliding one off the other in opposite directions.

 

The typical response is nodding heads and murmured agreement, often with sheepish looks.

 

Once your group seems to have digested this, you may summarize, “It is like you say to reality, ‘My way or the highway!’” Then, “It would appear that these expletive moments of picking up the first dose carry a bit of ‘attitude.’

 

Patients do not generally question whether there is any such thing as an “attitude,” which makes them willing to participate in the next step.

 

Dividing the whiteboard in half, the facilitator asks, “What else have you observed and/or experienced about yourself or anyone else with this attitude?”  Writing “relapse attitude” above the column on the left.   Making the question more concrete, “What other attitudes, reactions, feelings, actions might also appear in someone who is on their way to a curse, or some more polite expletive, and picking up the first dose of physical relapse?” Someone who is in the “process” of an expletive relapse?

 

 

You may have to prompt a bit, depending on group size and verbosity, but an exhaustive list will look like this:

 

Relapse Attitudes

 

Rigid

Tense

Stubborn

Angry

Arrogant

Egotistical

Impatient

Resentful

White-knuckling

Isolated

Selfish or self-willed

Type A

Aggressive

Controlling

Bitter

Demanding

 

 

 

 

 

Once you have their list, you might check, “How many of you identify with at least two –thirds of these qualities at the time of your “expletive” relapse?  Again, most of the hands will go up.

 

To continue, “So how are people in recovery different?  More to the point, what needs to replace the relapse attitudes if we are not to repeat this reaction?”  Now you can create a second column beside the list you already have, calling it “recovery attitudes.”

 

 

Then you go right down the list with them, asking for the opposites and/or alternatives in the column under “recovery attitudes.” “Rigid” becomes “relaxed” or “flexible.”  “Resentful” might become “forgiving.” “Arrogant” becomes “humble.”

 

Reflecting questions come next, “Do you see this as a big change or a little change?”  Most will readily concede the magnitude of the change.

 

“And is this big change in your abstinent self, the one who happens to be sitting here and the one who existed up to the moment you cursed and took that first drink/drug, or in your using self?”   Yes, this is a rhetorical question, but let it sink in.

 

The question that puts them back to work is, “Can you come up with a word for such a big change in a human being, big enough to get rid of the “relapse attitudes” and generate the “recovery attitudes.” Another list, depending on size and vocabulary of the group.

 

Metamorphasis

Maturation

Transformation

Growing up

Being “born again”

Enlightenment

Psychic change

Spiritual change or awakening

 

 

Continuing, “So we seem to be agreed that this big change can have some big names.  What about an action word that describes someone actually doing it?  A word for someone participating actively in the change from “relapse attitude” to “recovery attitude?”  Anything come to mind?

 

 

Your group may or may not come up with words like “detach,” “practice” (a spiritual path), or “surrender.”  “Acceptance” and “letting go” are also possible, as is (now) “practicing mindfulness.”  While surrender is probably the most precise and universal word for this action, the experience is more important than the label for it. At this point, you have helped your group develop the “motivational discrepancy” (2) between their cursing relapse attitude and an attitude necessary for recovery/survival.

 

Turning back to their personal experience, detailed looks at prior relapses and other life experiences may reinforce the danger of an attitude that does not take “no” for an answer. Does your group identify with this “egocentric” attitude as the relapse attitude, a problem they are up against in themselves? What are their reactions to the idea of surrender as necessary, if they are not to fall into yet another frustrated, cursing relapse. Individual and group “decisional balance” exercises may become possible – what are the good things about a life based on stubbornness and/or “self-propulsion.”  Short term?  Long term? The question of how to change life-long attitudes, prior attempts, even successes may be explored in writing and/or in group. Homework!

 

 

The author has always performed this exercise in programs which at least encourage  Twelve Step participation.  In such programs, the passage about “self-will run riot” in Chapter Five of the AA “Big Book” (3) might be read, as well as the description of the “deliberate relapse” in Chapter Three.  Other possible readings include Beck (4) on “Low Frustration Tolerance,” even the early articles of Harry Tiebout (5).

 

Of course, some clients and more than a few counselors will turn off when the subject of “surrender” comes up. Make it a primary goal of treatment?  Really?  A cognitive whiteboard exercise, combined with group processing, can only hope to awaken some patients to their internal sense of the needed change. To give them a direction that makes sense to them.  Yet the act of surrender seems to be a fundamental acceptance of reality, a transition from resistance to non-resistance. At the deepest level of “schema,” not mere thought or intellectual insight.  The word “change” does not seem to quite do justice to this transformation of the person’s orientation toward reality.  It is not just “behavior” that changes.  It is the person. As the AA newcomer is so often told, “You only need to change one thing – everything!”

– 30 –

 

 

References

1. DuWors, G.M. “Expletive Deleted, A group Motivational Exercise.”  Counselor Magazine, 2010/Nov-Dec
2. Miller, W.R. & Rollnick, S. (2002). Motivational Interviewing, Preparing People for Change.  New York, NY: The Guilford Press.
3.  Alcoholics Anonymous, The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism. New York, Anonymous (2001).
4. Beck, A.T., Wright, F.D., Newman, C.F., & Liese, B.S. (1993). Cognitive Therapy of Substance Abuse. New York, NY: The Guilford Press.
5. Tiebout, Harry.  “The Ego Factors in Surrender In Alcoholism.” Quarterly Journal of Studies in alcoholism, Volume 15, pp 610-621,1954.