Slips and Human Nature

AA Grapevine® - Our Meeting in Print Online Volume 20 Issue 5 October 1963
This article is reprinted from the January, 1947, issue of The Grapevine, because it seems as timely and useful now as it was then. The late Dr. Silkworth was for many years medical chief at Towns Hospital and Knickerbocker Hospital in New York City, where he treated more than 40,000 alcoholics, including Bill W. in the last stages of the co-founder's active alcoholism. Some of the great contributions to AA made by "the little doctor who loved drunks" are described in the books "Alcoholics Anonymous" and "AA Comes of Age."

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 fellowmen 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 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 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, then we can safeguard ourselves intelligently against most "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, 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 which 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 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 "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 to learn enough of the AA technique and AA philosophy to give him a 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 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 rest 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 aftereffects 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, 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 his knowledge of the fact that he had been the victim of a serious disease. He grew over-confident. 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 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, AA 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 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 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.

William Duncan Silkworth, M.D.