Sex addict client gamely tried the exercise, “Possible facts and conditions” in the workbook.  Scored 17 of 21!  But had trouble translating the significance of being “sober” when starting a “bottom line behavior.”  Showed him the list of “wishful thinking” found in alcoholic/addicts taking the first drink and he identified with that.   Also got that he was not nearly as “intoxicated” at his moment of first bottom line behavior as he was by the time his family caught him in the out of control act.  The key issue seems to be to recognize being in a state of delusion at the very start, and needing to prevent that delusion from returning. That the now abstinent person is the one who either recognizes the delusion or does the work to prevent its return. Ownership.

Going through the workbook with two bright and successful men, separately.  One “gets it” that the memory problem has tripped him up in the past, even concedes that his odds for remaining sober would be significantly better if he attended AA.  The other came back from a disastrous relapse, chastened and humbled.  You could not ask for more emphatic “change talk” – He identified completely with the description of “selfishness” and “self-will run riot ” in the AA Big Book. But neither will go to meetings or commit to anything that includes asking for help from others. They seem to think they see the problem.  The fact they do not see the solution suggests otherwise.  Neither has reached the point of the businessman, in chapter three of the Big Book, when “….hopelessly defeated.  I knew then. It was a crushing blow.” It seems so simple and clear.  Those who embrace AA think they need it.  Those who reject it do not. The belief in “willpower” and “self-control” dies hard. Hard to say how much of that is just another face of craving. For these two gentleman, at any rate, the workbook appears so far to be an exercise in contemplation.

Note: I do realize I am assuming that some form of asking for help is going to be necessary. In a recent workshop with Dr. Rollnick, he emphasized affirming the client’s ability to change.  As a public health psychologist with no apparent understanding of addiction as a disease, that appears similar to affirming that an epileptic can change without medication, or a Type I diabetic can change without insulin.  Much of his work, in fact, involves motivating people to comply with their medical proscriptions. I would like to think we can affirm a person’s ability to change and grow, without reinforcing the idea that they can “pull themselves up by their bootstraps,” an absurd image used by Abraham Lincoln to affirm the need for education of the previously enslaved to compete in an industrial society.

Eight names for the Wishful Moment of Relapse:

The original “Joe and Charlie” tapes posited that Bill W. hated to use the same words for the same thing more than once.  How many spirited AA discussions of the difference between “shortcomings” and ‘defects of character” would never have happened without this stylistic preference?  “Moral inventory?” “Exact nature of our wrongs?”  Are these not four ways of saying the same thing, different pointers to the same object? And he appears to have been no less averse to repetition when  discussing the most critical moment in the life of an alcoholic, deciding to take that first drink.

Chapter two refers to (1) “that old threadbare idea.”  What idea?  That somehow, some way, he will “control and enjoy his drinking.”  This is also referred to as (2) “the great obsession.”  Chapter three brings us three relapses and an analogy.  The first relapse, twenty-five years after quitting for the sake of financial ambition, reports  (3) “that peculiar mental twist,” of that doomed man who thinks he will now be able to control and enjoy his drinking. The second relapse example, abetted by milk in the whiskey and  food in the stomach, is evaluated as (4) “plain insanity.”  Just for good measure, this thinking is further labeled as a (5) “curious mental phenomenon.” Before moving on the jaywalker analogy, the original authors concede that there is another way to make the decision to pick up that first drink, christening this as the “deliberate” relapse – what I have been calling the “expletive” relapse.  They distinguish it from the aforementioned (by five other names!) (6!) “casual” relapse. Then we get to the jaywalker, whose similarity to the alcoholic repeatedly picking up the first drink leads to the observation that the alcoholic is (7) “strangely insane” in this repeated decision/action. The third relapse illustration falls on a man who had been Twelve-Stepped by Bill and Bob, specifically warned about this alcoholic thinking at the moment of picking up the first drink.  Utterly confident he will do no such thing, now that he knows, this man’s decision to do it yet again earns the title of  (8) “strange mental blank spots.”  That gives us, at least, eight different ways of referring to the same thoughts at the same moment, leading to the same fateful action.

But there is an exception that proves Bill W’s no-repeat rule.  On page 92, the Twelve Step instructions are clear and specific:  Be sure and talk to the newcomer about “the peculiar  mental twist” before the first drink.  The instruction is repeated twice; the phrase, only once.   Must have killed Bill to do even that much!

Blog entry: The Mother of All discrepancies

Yes, I have identified (article, workbook) eight “motivational discrepancies, gaps between values or ideals and perceived decision/action.  But it occurs to me that all discrepancies are not created equal.  Is it not the very essence of “powerlessness” to be faced with the appalling fact that the values and ideals that “should” motivate my change utterly fail to do so. I know I will lose my job, am certain I would not jeopardize it, and I do anyway.  I know how much I hurt my spouse, how close s/he is to being done, and I drink or use again anyway.  The doctor’s warning? Another arrest and probation violation? Nothing seems to stop me!  Imagine the smoker described by Premack and used by Rollnick and Miller as the defining example of“motivational discrepancy.”  What if he had found himself smoking again anyway, just a few weeks or months after his life-changing “aha?”  Early COPD or emphysema, even hypertension or high cholesterol attributed to smoking?  Still smoking on!  Yet that inability to stop for “good” reason is exactly what the alcoholic/addict watches in him/herself.  Drinking in spite of consequences, unable to learn from experience, call it what you will. “Powerless” is still the best name for it.  And it is not just one thing – it is, at least, eight things.  No wonder almost no one “gets it” the first time!

Is picking up the first drink or drug of relapse a “conscious decision?” Those who resist the idea of being “powerless” often seem to argue this point. But a decision can only be as valid as the information on which it is based. In “wishful thinking,” the alcoholic/addict has forgotten his or her own suffering, the reason for quitting in the first place. Not only that, the person seems consistently unable to perceive the real consequences of the act. Add to this a blindness to the internal pain for which the pain killer may be sought, and an equal unawareness of just how strong a desire is clamoring for “just one.”  What you have is a decision being made in the absence of all of the most critical information!  The generally more emotional “expletive” relapse seems to lack a sufficient grasp of two things. The infinite number of alternative ways to deal with almost any upset. And the specific values that are ultimately more important to the person than the immediate frustration, things which will cause far more suffering when they are lost due to the relapse. Conscious, I don’t think so.

Exciting news!  I have been added to the program at the United Kingdom and Europe Symposium on Addictive Disorders – UKESAD –  in London, May 11.  The conference theme is on “a strong and stable recovery”  and my workshop will be on motivation for maintenance, an almost perfect fit.  I will try to develop the same eight “motivational discrepancies” that are the basis for the workbook.  My understanding of a motivational discrepancy is a moment of “getting it,” the realization that I cannot have some particular cake and eat it too.  Recently saw the movie “Ray” again, saw multiple people try to motivate him, trying to develop discrepancies  every single time.  At the end, his wife and imaginary mother were effective, with an assist from the FBI.

Have received some initial feedback on the workbook, very positive. It comes from people who know me and know my work with the two kinds of relapse thinking. One said,” there isn’t anything comparable out there that I have seen that personalizes relapse syndrome as this does.” However, this same person thought the workbook might require “a clientele that can engage in a little abstract thinking.” And a counselor who tried the workbook in a Suboxone support group reports that they rejected it out of hand, because they weren’t “college students.” Working with this version in individual sessions, I have seen clients struggle with the wording. At this point, I am striving to make it more and more user-friendly. I am actually more interested in the criticisms them the compliments, for that reason. One of my thoughts is to begin directly with the client’s personal experience of the moment of relapse. Another is to include illustrations from the book which give a visual depiction of what the client may be struggling to “get.” A facilitator’s guide, possibly posted on my website, might also help. At the same time, I have attended a workshop on self-publishing. I am very excited about the ability to have a first version out there, on a pay for printing basis, in the next few months.

An overlap between resentment and trauma: a fictionalized
client experienced restlessness and boredom and sometimes drank when her
boyfriend left her for the evening to do almost anything fun. Tennis. Poker
night. Bowling. The frequency of this was not great and she was sober most of
the time. When we explored the experience, we made a direct connection to her
being left alone as a child while her single mother drank at the local tavern.
Because of the helplessness involved, I treated this as a trauma and utilized
the “thera-tapper .”  Not only did the process not reduce the emotion we had activated, she became more and more aware of how much resentment she had. This, of course, could be dealt with by other means. The lightbulb that went on for me, as a clinician, was that trauma and
resentment have one major element in common. Reliving the earlier experience.  And both trigger their fair share of craving and relapse.

httpv://www.youtube.com/watch?v=XzbzqDLWv28

We start by acknowledging the importance of the process of relapse. However, it is clear from observation and experience that many people in recovery go in and out of the process of relapse without ever actually taking that first physical drink or drug. What is the difference? Those who relapse make a decision to actually pick up the first drink or drug, and do so. Universally, this decision is voiced in their own minds by two kinds of thinking, “wishful” and “expletive.” It is the thinking that reveals what has gone so terribly wrong. Whether by individual exploration or group exercise, we can help victims of this thinking to see what has happened to them and what to do about it. And that is why the moment of relapse is so important.