The website, AA Agnostica, recently re-published an article originally written by Dr. William Silkworth (author of "The Doctor's Opinion" in AA's Basic Text) and published in 1947 in AA's Grapevine magazine that I think worth setting forth here. The article basically says that slips or relapses are the result of normal human failings in recovering alcoholics who allow themselves to engage in faulty ("stinking") thinking and stop following the sound directions of the AA program. So, here is Dr. Siklworth's article: "The mystery of slips is not so deep as may appear. While it does seem odd that an alcoholic who has restored himself to a dignified place among his fellow-men, and continued 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 very simple. People are inclined to say: “There is something peculiar about alcoholics. They may 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 techniques 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 just like other human beings – then we can safeguard ourselves intelligently against most of the slips. Both in professional and lay circles, there is a tendency to label everything that an alcoholic may do as “alcoholic behavior.”

The truth is, it is simply human nature! It is very wrong to consider many 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 nonalcoholics, too. Actually they are symptoms of mankind! Of course, the alcoholic himself tends to think of himself as different; someone 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 which is found in all human beings, whether they drink whiskey or buttermilk. he patient must have full knowledge of his condition, keep in mind the facts of his case and the nature of his disease and follow directions.

To be sure, alcoholism like every other disease does manifest itself in some unique ways. It does have a number of baffling peculiarities which differ from all other diseases. At the same time, many of the symptoms and much of the behavior of alcoholism are closely paralleled and even duplicated in other diseases. The alcoholic “slip,” as it is known in Alcoholics Anonymous, furnishes a perfect example of how human nature can be mistaken for alcoholic behavior. The “slip” is a relapse! It is a relapse that occurs after the alcoholic has stopped drinking and started on the AA program of recovery. “Slips” usually occur in the early stages of the alcoholic’s AA indoctrination, before he has had time tolearn enough of the AA technique and AA philosophy to give him solid footing. But “slips” may also occur after an alcoholic has been a member of AA for many months, or even several years, and it is in this kind, above all, that one finds a marked similarity between the alcoholic’s behavior and “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 which 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 directions for the way he is to live when he gets home. He must be in bed every night by, say, 8 o’clock. 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 10 p.m. When he does this, nothing untoward happens. The next day he still feels good. He does it again. 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 rest schedule. Frightened, he naturally follows directions obediently for a long time. He, too, goes to bed early, avoids exercise such as walking up stairs, 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 the tubercular cases, the acts which led to the relapses were preceded by wrong thinking. The patient in each case rationalized himself out of a sense of his own perilous reality. He deliberately turned away from this knowledge of the fact 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 AA – who has a “slip.” Obviously he decides again to take a drink sometime before he actually takes it. He starts thinking wrong before he actually embarks on the course that leads to a “slip.” There is no more reason to charge the “slip” to alcoholic behavior than there is to lay a tubercular relapse to tubercular 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. And that’s human nature! It’s life! It’s happening all the time, not merely among alcoholics but among all kinds of people. The preventative is plain. The patient must have full knowledge of his condition, keep in mind the facts of his case and the nature of his disease and follow directions. For the alcoholic, AA offers the directions. A vital factor, or ingredient, of the preventative, especially for the alcoholic, is sustained emotion. The alcoholic who learns some of the technique or the mechanics of AA 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, negative. The philosophy of AA, 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 nervous 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 t.b. 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!" Copyright © The AA Grapevine Inc. January 1947.

As always, comments are invited. Jan Edward Williams, 05/06/2013.

It sure looks as if events are leading in the future to marijuana having the same legal status as alcohol, that is, legality, a source of tax revenue, and a danger when driving a motor vehicle under the influence thereof. Science Daily reported on April 25, 2013, on a study exploring the feasibility of using a breathalyzer type instrument to detect the presence of substances of abuse. Researchers found that substances such as methamphetamine, methadone, benzodiazepines (for ex., Xanax), and tetrahydrocannabinol (marijuana), can be detected in breath samples. Much work needs to be done to establish impairment levels and other technical details, but I suspect that in the future marijuana will be legal, first as an FDA approved medication, and later for recreational use. Not only will legality result in tax revenue, but also in a boon to lawyers (DUI of marijuana) and the addictions treatment industry as increased availability of the drug leads to more use and abuse. Anecdotally, I can report from talking to many college students over the past 24 years that marijuana users mostly consider it OK to drive after smoking. Research is also clear that availability of a substance with addiction potential leads to increased use and increase in development of addiction. As always, comments are invited. Jan Edward Williams, 04/27/2013.

Remember the controversy about individuals in recovery drinking “non-alcoholic” or “near” beer or wine (a misnomer because there are traces of alcohol in these drinks)? I always took the position that the recovering person NOT drink these “near” alcoholic beverages because it’s really a way to flirt with drinking alcohol and could be a trigger for relapse. The April 15, 2013 issue of Science Daily summarizes a research study that provides some science on which to base the position against the use of substances, by those in recovery, that taste like alcoholic beverages but ingestion of which does not result in detectable blood levels of alcohol (B.A.L.). The study found that even a sip of beer (resulting in no detectable B.A.L.) resulted in production of dopamine in the reward pathway of the brain. Dopamine is the feel good chemical that is produced when an individual uses any of the drugs of abuse, including alcohol. The researchers also found that there was an even stronger dopamine release effect in individuals with close blood relatives with alcoholism. So, two vital points seem to emerge from this research: 1) if you have a blood relative with alcoholism, the chances are that you will like the taste of alcoholic beverages more than those who don’t have such a family history because of the increase in dopamine produced in your brain upon consumption of alcohol; 2) if you are in recovery from alcoholism, merely tasting a near beer or other alcoholic beverage will give you a pleasurable reaction close to that you have when you drank, a clear relapse danger. As always, comments are invited. Jan Edward Williams, 04/19/2013.

Science Daily reported on April 11, 2013, that researchers are developing a drug treatment intervention for alcoholics that does not have abstinence as its goal but controlled drinking. Researchers administered to alcoholics a drug that blocks some of the effects of alcohol, resulting in less drinking by those taking the drug. The report stated that in traditional treatment programs where abstinence is the goal, relapse rates are high and that "a goal of abstinence is unacceptable to many patients." I have commented in this blog before that researchers, drug companies, and physicians are often seeking to accommodate the U.S. culture's demand for quick fixes through use of drugs to treat drug and alcohol addiction, and, of course, to satisfy the drug addicted person's drive to keep using and avoid complete abstinence. So, we have methadone maintenance, Suboxone (buprenorphine plus opiate antagonist) maintenance, and many maintenance drugs under study for other classes of drug addiction, all to allow the addict to continue to use his/her drug of choice. The dream of most alcoholics and drug addicts is to find some way to be able to use their drug. There are many problems with this non-abstinence approach. I will mention two: 1) use of a drug to treat drug addiction is only attempting (badly, in my view) to address one aspect of addiction, and does not address the mental/emotional and spiritual dysfunction always present in addiction; 2) most addicted individuals use more than one substance, and/or would substitute another drug for the one "controlled" by the medication given, that is, the goal of the addicted person is to get high; if their high is blocked by, say methadone or Suboxone, or an antagonist, they will seek their high through use of another drug. So, under the treatment philosophy behind the research approach under discussion, an alcoholic who also uses (or turns to use of) cocaine, amphetamines, opiates, or marijuana, would have to find a medication to replace all of the drugs named or to block the effects thereof. I suggest that the abstinence approach with treatment of the physical, emotional, and spiritual aspects of addiction is in fact a more simple approach, and one ultimately more effective. As always, comments are invited. Jan Edward Williams, 04/15/2013.

From time to time I will present here examples of my Addiction Recovery Tips. Here is one for those working on recovery from a relationship with an alcoholic or addict: Think!  Think! is a good tool for recovery from the effects of a relationship with an addict or alcoholic, meaning think about your own role in whatever the situation may be, and how you are thinking and reacting to it. Seeking an honest, positive examination of yourself and your own reactions is always an option for you. A good rule of thumb to stay centered in recovery is to remember that: “The only person I can change is me, basically how I choose to react to people, places and things.” As always, comments are invited. Jan Edward Williams, 04/08/2013.