Do alcoholics suffer from "Alcoholic Behavior" or are they simply
victims of human nature?
by the late William D. Silkworth, M.D.
The mystery of slips is not as deep as it 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 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 technique 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 these same quirks can be found among
non-alcoholics also. Actually they are symptoms of mankind;
ORDINARY PEOPLE. 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.
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.
"SLIPS" IDENTIFIED
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 solid footing. But "slips"
may also occur after the alcoholic has been a member of AA for
many months, or even after 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 there 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, eight 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 ten o'clock. 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.
IN CARDIAC CASES
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 had been feeling good for months, or several years,
and has recovered from his fright. If the elevator is out of repair
one day, he walks up 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-affects 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
relapse 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 own knowledge of the fact 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 had a "slip".
Obviously he decides again to take a drink some time before he
actually takes it. He starts thinking wrong before he actually
embarks on the course leading to a "slip".
NOT ALCOHOLIC BEHAVIOR
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 is nothing "screwy" about it at all. The patient 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 preventive 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 orders.
For the alcoholic, AA offers some directions. A vital factor, or
ingredient, of the preventive, 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.
PSYCHOLOGY NO DIFFERENT
In any event, the psychology of the alcoholic is not as different as
some people try to make it. 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 "TB mind". I think we will help the alcoholic more if
we can first recognize that he is primarily a human being - afflicted
with human nature.
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