Reprinted in "Best Of The Grapevine."


Slips and Human Nature

by William Duncan Silkworth, MD

January 1947


The mystery of slips is not so deep as it 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.

In both 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
non-alcoholic, 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 those of 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
that of "normal" victims of other diseases.

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
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 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 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 to take a drink again some time 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 TB mind."

I think we'll help the alcoholic more if we can first recognize that
he is primarily human being -- afflicted with human nature.