How Alcoholics Anonymous Prevents Relapse, Part I: Loss of Choice

All human decisions are made in an actual moment of time, based on what is real to that mind at that moment. This is true for everyone, not just alcoholics, and not just alcoholics “deciding” to take the first drink of relapse. However, the authors of the Alcoholics Anonymous (AA) “Big Book,” or Alcoholics Anonymous (Alcoholics Anonymous World Services, 2001), do not flinch from the challenge of that moment of decision, and how to understand and prevent it. They bluntly observe, “The fact is that most alcoholics, for reasons yet obscure, have lost the power of choice in drink” (Alcoholics Anonymous World Services, 2001, p. 24).

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 people who are making the so-called “choice.” But what is real to the addicts or alcoholics relapsing “casually,” believing “that old threadbare idea” (Alcoholics Anonymous World Services, 2001)? Are the seductive thoughts counselors hear so often—“One won’t hurt,” “No one will know,” “This time will be different”—real? The intolerable suffering that told these individuals 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, and certainly not enough to make a difference.

What is real to the minds resuming use “deliberately, instead of casually” (Alcoholics Anonymous World Services, 2001, p. 37)? Yesterday the same people may have preached all the alternatives to taking that first drink when they were upset. But if no alternatives are real to those people at this very moment, and if the only relief that seems real is alcohol, the knowledge of tools or alternatives just does not factor in. There is no effective voice.

The entire AA program may be seen as a system for preventing these two kinds of relapse decisions: casual and deliberate. Its entire structure and function appear to be eradication of the sense of reality and consciousness that makes either disastrous decision—for restoring it to sanity, to rephrase Step Two (Alcoholics Anonymous World Services, 2001, p. 59). If nothing else, this would seem to require a new consciousness in which other options are more real to those who might otherwise relapse.

The Big Book defines and embraces this challenge in “Chapter Three: More about Alcoholism,” in which the anonymous authors promise, “. . . we shall describe the mental states that precede a relapse into drinking, for obviously this is the crux of the problem” (Alcoholics Anonymous World Services, 2001, p. 35). In the chapter specifically about Step Twelve in Twelve Steps and Twelve Traditions, they could not be more explicit about the benefit for an alcoholic who has faithfully worked these steps: “. . . a new state of consciousness and being. . . . In a very real sense, he has been transformed” (Alcoholics Anonymous World Services, 1952, p. 107). A change of consciousness implies individuals live with a different view of reality, does it not?

We have a term for when something that was unreal to people having an experience becomes real. We use the same term when something that was real to people now becomes unreal. The precise word for this prickly rose is “realization.” We may also know realization as “waking up,” an “aha! moment,” “gestalt closing,” the “lightbulb going on,” or in the UK, the “penny dropping.” Perhaps the most common name of all, often heard in AA and almost any adult learning environment, is “getting it.” When the reality in question has been resisted, we also call it “facing facts.”

Lasting Twelve Step recovery appears to depend on “getting” Step One: “We admitted that we were powerless over alcohol—our lives had become unmanageable” (Alcoholics Anonymous World Services, 2001, p. 59). These words summarize an experience that appears to depend on five roughly sequential realizations. Each realization recognizes or admits something denied, oftentimes for years, and each seems to arise directly from the painful failure of the one before it:

I realize that my drinking is causing me suffering.
I try to manage my drinking to eliminate the suffering and realize that I cannot do so.
I try to abstain from drinking to eliminate the suffering and realize that I cannot do so.
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.
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 individuals with what seems like a single overwhelming, even miraculous, revelation. However, the false starts and half measures documented by Bill Wilson in the very first chapter of the Big Book seem to be more typical. No matter how they arrive, these realizations fuel the humbling work of Twelve Step recovery. If it were not real to them that drinking was causing their suffering, why did they try so hard to control it? If it were not real to them that they could not control their drinking, why did they even think about abstaining? If it were not real to them that they could not maintain abstinence by themselves, why ask for help or do the “homework” of recovery? And if they do not recognize that others struggle too (many of them successfully), why would they not give up hope and stop trying at all? But when we do realize all of these things, whether cumulatively or in a single blinding flash, how could we not do the work?

Many AA meetings begin with reading from Chapter Five (i.e., “How it Works”) of the Big Book. 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” (Alcoholics Anonymous World Services, 2001, p. 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. It is often said that 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” (Alcoholics Anonymous World Services, 2001, p. 24). In one paragraph they account for one of the biggest factors in all relapse, which is the process of relapse itself: forgetting. Like a frog in water that is slowly heating to the boil, like a lightbulb that is being dimmed, so gradually the victims do not notice until it is too late and until relapse has already happened.

Part two of this article will survey, at a practical level, how AA solves the problem of memory and relapse, as well as the challenge of restoring and preserving the power of choice in the face of accumulating frustration.

References

Alcoholics Anonymous World Services. (1952). Twelve steps and twelve traditions. New York, NY: Author.
Alcoholics Anonymous World Services. (2001). Alcoholics anonymous (4th ed.). New York, NY: Author.

George DuWors, MSW, BCD, MAC

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George DuWors, MSW, BCD, MAC, is a licensed clinical social worker specializing in addictions since 1972. He has contributed to Counselor since the nineties. DuWors authored White Knuckles and Wishful Thinking: Learning From the Moment of Relapse in Alcoholism and Other Addictions (2000), and most recently Getting It: Eight Facts That Fuel Recovery (Uh, If We Face Them) (2018). Maintaining an addictions practice in Everett, Washington, he has presented “Motivation for Maintenance” workshops across North America and in the United Kingdom. DuWors is an enthusiastic trainer who loves to do keynotes and consultations. Read his articles at gettingitworkbook.com.