How Alcoholics Anonymous Prevents Relapse: Part I, The “Casual” Relapse

George DuWors

All human decisions are made in an actual moment of time, based on what is real to that mind at that moment. True for everyone, not just alcoholics, and not just alcoholics “deciding” to take the first drink (of relapse.) But the authors of the AA “Big Book” (Anonymous 2001) do not flinch from the challenge of that moment of decision, how to understand it and how to prevent it. They bluntly observe,

 “The fact is that most alcoholics, for reasons yet obscure, have lost the power of choice in drink.” (AA page 24, original in italics)

What does it mean to actually have “the power of choice?” At a minimum, it would seem to require the freedom to choose among options. And those options must be real to the person who is making the so-called choice. But what is real to the addict or alcoholic relapsing “casually,” (AA page 37) believing (from clinical observation, not the book) “One won’t hurt,” or “No one will know,” much less “This time will be different?” The intolerable suffering that told the person to quit three weeks or three months or three years ago, may have still seemed real yesterday. But if that suffering is not real at the moment of the decision, it does not factor in. It has little or no voice, not enough to make a difference.

And what is real to the mind howling (or moaning) an expletive (not spelled out in the Big Book, often observed in practice and in AA itself) and reaching for the first drink? Beginning use “deliberately instead of casually” (AA page 37.) Yesterday the same person may have preached all the alternatives to taking that first drink when upset. But if no alternatives are real to that person at this very moment, if the only relief that seems real is alcohol, so-called knowledge of tools or alternatives just does not factor in. No effective voice.

The entire AA program may be seen as a system for preventing these two kinds of relapse decision, “casual” and “deliberate.” For eradicating the sense of reality, the consciousness, that can make either decision, for “restoring it to sanity.” A consciousness in which other options are more real.

We have a name for the experience in which something that was unreal (to the person having the experience) becomes real. We use the same name when something that was real (to the person) now becomes unreal. The precise word for this prickly rose is “realization.” We may also recognize the actual experience as “waking up,” “aha!”, “gestalt closing,” “light bulb going on,” or (in the UK) “penny dropping.” Perhaps the most common name of all, often heard in AA, “getting it”.

Lasting Twelve Step recovery appears to depend on “getting” Step One: “We admitted that we were powerless over alcohol and our lives had become unmanageable.” These words summarize an experience that depends on five roughly sequential realizations. Each realization recognizes or admits something denied, often for years:

1. I realize that my drinking is causing me suffering.
2. I try to manage my drinking to eliminate the suffering and realize that I cannot do so.
3. I try to abstain from drinking to eliminate the suffering and realize that I cannot do so.
4. My suffering becomes intolerable to me and I realize, finally, it is impossible to continue to drink and live the life I would choose. If something that is not me does not help, I realize that my life will not be worth living.
5. I realize I am not alone in this struggle. “We” have the same problem and some of you have found a solution.

Yes, the dam of denial may seem to burst all at once, flooding the person with what seems like a single overwhelming, even miraculous, revelation. But the false starts and half measures documented by Bill Wilson in the very first chapter of the Alcoholics Anonymous seem to be more typical. No matter how they arrive, these realizations fuel the humbling work of Twelve Step recovery. If it was not real to me that drinking was causing my suffering, why did I try so hard to control it? If it was not real to me that I could not control my drinking, why did I even think about abstaining? If it was not real to me that I could not maintain abstinence by myself, why ask for help, much less do the “homework” of recovery? And if I do not recognize that others struggle, too, many of them successfully, why would I not give up hope and stop trying at all? But when I do realize all of these things, how could I not do this work?

Many AA meetings begin with reading from Chapter Five, “HOW IT WORKS.” The second paragraph lays out the conditions, “If you have decided you want what we have and are willing to go any lengths to get it—then you are ready to take certain steps.” (AA page 58) In other words (this writer’s!), “if the realizations of Step One are as real to you as they are to us, you will decide to do what we do to get what we get.” AA is not for people who merely need it. It is for people who feel the need desperately enough “to go to any length.”

In lamenting loss of “the power of choice in drink,” the AA authors go on to make one of the most powerful and important observations in all of the addiction field. “We are unable, at certain times, to bring into consciousness with sufficient force the memory of the suffering and humiliation of even a week or a month ago. We are without defense against the first drink.”  (AA page 24) In one italicized paragraph they account for one of the biggest factors in all relapse, the process of relapse itself: forgetting. Like a frog in water that is slowly heating to the boil, like a lightbulb that is being gradually dimmed, so gradually the victim does not notice until it is too late. Until the “casual” relapse has already happened.

Part I of this article surveys how AA helps the alcoholic remember “It is the first drink that gets you drunk.” In effect, “One WILL hurt. It will always hurt, probably worse than before.”

Let us count the ways:

1. Meetings, with endless repetition of the Steps, stories of disaster with one drink, success when “you work it.” Shaking newcomers and shining recoveries. The AA meeting provides its relapse-prone members with a prosthetic memory, a mnemonic device to give the memory of the venom in one sip “sufficient force.” But meetings are just the beginning.
2. Morning (and/or other) spiritual practice, with built-in reminders of problem and solution.
3. Sponsors as living examples that “it works,” and reality checks when the brain is fogged by craving or stress.
4. Sponsors also as guides to working the steps, all of them. But the steps that directly address forgetting (above) start with the “searching and fearless moral inventory” and peak with “making direct amends to those we have harmed.” A consciousness unburdened of shame and guilt, now eager for sharing its own story to help others, is a consciousness completely free to remember “one will hurt,” and just exactly why. This benefit is spelled out in the text, only as a “Step Nine Promise” – “We will not regret the past nor wish to shut the door on it.” (AA page 83)
5. But the biggest booster shot of all for the fading memory of past suffering? Working with newcomers, shaking, demoralized and ready or not. The sober alcoholic who walks away from brother or sister battered by active use, has been powerfully vaccinated against thinking “After all this time, surely I can have just one.”

We could go on. The power of the Serenity Prayer to calm and clarify consciousness, giving the mind two rules of thumb by which to take the measure of any problem. Accept it? Or change it? The recognition of the “phenomenon of craving,” (AA page xxviii) as a tool in itself and as a basis for identification, for the powerful experience of “we.” Slogans like “one day at a time,” shrinking the problem of endless abstinence and defining achievable success. Yes, of course, all the books and literature to read and discuss, too. And undoubtedly some tools the reader will add to the list. All of these tools have one thing in common: they turn attention away from beliefs that serve only craving. And they invite a “mental state” that is open to facts and alternatives. They restore “the power of choice!”

(In Part II, we will document how AA prevents the “deliberate relapse.”)

References:

1. (2001) Alcoholics Anonymous – The Story of How Many Thousands of Men and Women Have Recovered From Alcoholism, fourth edition. New York, NY: Alcoholics Anonymous World Services. Inc.
2. Beck, A.T., Wright, F.D., Newman, C.F., & Liese, B.S. (1993). Cognitive Therapy of Substance Abuse. New York, NY: The Guilford Press.

Bio for Counselor 12/2021

George DuWors is a Licensed Clinical Social Worker specializing in addictions since 1972. He has contributed to Counselor Magazine since the nineties. He wrote the classic White Knuckles & Wishful Thinking: Learning From the Moment of Relapse in Alcoholism and Other Addictions, Hogrefe:Seattle (2000). Most recently, he published the book, Getting it: Eight Facts That Fuel Recovery (Uh, If We Face Them), available at amazon.com as paperback or kindle. Maintaining an addictions practice in Everett Washington, he has presented “Motivation for Maintenance” workshops across North America and in the United Kingdom. An enthusiastic trainer, he also loves to do keynotes and consultations. You may read more of his articles at gettingitworkbook.com. Reach him at gduwors@yahoo.com

How Alcoholics Anonymous Prevents Relapse: Part II, The “Deliberate” Relapse

Part I published in Counselor Magazine October, 2021. Part I in December 2021.

In Part I, we laid out how AA prevents the “casual relapse,” distinguished by such thoughts as “One won’t hurt,” “I can handle it now,” “This time will be different.” In Part II we are looking at what the Big Book christened the “deliberate” relapse, most recognizable as some sort of expletive even in the pure of tongue.

What does AA say and do about preventing that state of mind, commonly revealed by the two-word obscenity, and the decision it generates? Explicitly, not too much. But two powerful generalizations define the problem and illuminate the solution:

1. Introducing the Third Step, commonly referred to as “surrender,” the AA authors characterize themselves, “The alcoholic is an extreme example of self-will run riot…” (AA page 62)

The founder of CBT, Aron Beck, called it “Low Frustration Tolerance (LFT).” Whatever you call this particular rose, her root is a demanding attitude that cannot take “No” for an answer from Life. As frustration accumulates (a relapse process separate from fading memory,) an expletive often announces the breaking point and a violent decision to drink. If this is to not to happen, it must be replaced by a different decision. Only a fundamentally different attitude can make that possible. Whatever your theology, actual AA experience is that “When I let go and let God, I think more clearly and wisely.” (footnote) Even the willingness to “let go” (of demand) opens a consciousness capable of making wiser decisions. One that can accept facts as facts and stop pounding the demands of desire and fear on the pitiless wall of reality.

2. “Resentment is the number one offender. It destroys more alcoholics than anything else.” (AA page 64)

Has anyone ever cursed and picked up a drink without resentment? A military member once shared his take on one variation of the experience, “I’ll show you.  I’ll swallow a grenade!” Not so visible to the naked eye, casual relapse thoughts may sometimes speak for buried resentment, neither faced nor felt. The idea of “just one” mysteriously bubbling up out of the blue. And those same steps that reduce shame and preserve memory, four through nine, also transform this poison of resentment. Step Ten, “continuous inventory,” keeps it from coming back.

Whatever else the “deliberate” relapse consciousness may be, it is a state of distress, anything but serene. A Big Book contributor posits eloquently, “My serenity is inversely proportional to my expectations.” (AA page 420) An equally pithy program truism, often quoted in meetings: “An expectation is a resentment waiting to happen.” How does AA help with the challenge of expectations and disappointment?

Step Three (and Step Eleven) to diminish demanding self-will, using prayer, meditation, writing, sharing, and even “acting as if.” Steps Four through Nine for the inevitable resentments and expectations themselves. And Step Ten, “continuous inventory,” to preserve and nurture the consciousness that will not use the foibles of others as an excuse to relapse. The alcoholic doing all of that has put several degrees of separation between self and first drink. No longer blinded by rage, resentment, or intolerable frustration, facts and alternatives reappear. Once again actively working the program restores of “the power of choice.”

The two states of mind, “casual” and “deliberate,” have much in common. At their source, a brain experiencing alcohol as a need and a consciousness dominated by craving. Work to prevent one almost always prevents the other. That said, other tools may prevent or reduce these states of mind. To name just a few, aversion therapy may strengthen the realization that alcohol is a poison, not a treat. Anti-craving drugs may lessen its appeal. Cognitive behavior therapy (CBT) may fine-tune awareness of thoughts that invite disaster. Mindfulness approaches reduce stress and cultivate “seeing clearly,” the exact opposite of “the mental states that precede a relapse.” Trauma therapies may diffuse intolerable memories that demand relief. And psychotropic medications may regulate energy and restore reason, creating a level playing field for those with other diagnoses. You get the idea.

To summarize, AA understood from the beginning that prevention of relapse requires avoidance of two states of mind, voicing two kinds of relapse decision. The “casual” attitude that alcohol is a friend, that there will be no loss of control and no “hurt” from taking “only” one drink. And the overtaxed consciousness in which alcohol promises the only relief possible. AA injects in those with the willingness to absorb it, a free, life-long, almost universally available antidote to the forgetfulness of the “casual” moment of decision. At the very same time, Twelve Step recovery also loads up a paradoxical toolbox for dealing with frustration by accepting the fact you cannot control life. For preventing the “deliberate” decision to drink when reality defies will. Finally, AA prevents relapse through a mighty force it brought into the world of addiction in 1935. The power of a tribal and spiritual energy that gathers from “one drunk talking to another.” Some call this barbless rose by yet another name, “Love.”

• 30 –

References

3. (2001) Alcoholics Anonymous – The Story of How Many Thousands of Men and Women Have Recovered From Alcoholism, fourth edition. New York, NY: Alcoholics Anonymous World Services. Inc.
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.

Bio for Counselor 12/2021

George DuWors, MSW, BCD, MAC is a Licensed Clinical Social Worker specializing in addictions since 1972.  He has contributed to Counselor Magazine since the nineties.  He wrote the classic White Knuckles & Wishful Thinking: Learning From the Moment of Relapse in Alcoholism and Other Addictions, Hogrefe:Seattle (2000). Most recently, he published the book, Getting it: Eight Facts That Fuel Recovery (Uh, If We Face Them), available at amazon.com as paperback or kindle.  Maintaining an addictions practice in Everett Washington, he has presented “Motivation for Maintenance” workshops across North America and in the United Kingdom. An enthusiastic trainer, he also loves to do keynotes and consultations. You may read more of his articles at gettingitworkbook.com. Reach him at gduwors@yahoo.com or (425) 213-2657.