Last week’s “Here’s To Your Health,” was about issues outside AA and it was delivered during a medical doctor’s scientific presentation he made before other professionals, but before we cover another hot-button issue (marijuana), I’d like to share with you another doctor’s opinion written about relapses in people recovering from alcoholism. This week’s article originally appeared in the AA Grapevine, January 1947 and it was written by the late, William Duncan Silkworth M.D, he writes:


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 fellows and continued dry for years, should suddenly throw all his happiness overboard, often the reasons are 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 about an alcoholic?

This is largely twaddle. The alcoholic is a sick person and under the techniques of the book Alcoholics Anonymous he can get well, and 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.

Lets get it clear, once and for all, alcoholics are human beings, and 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 does as alcoholic behavior. The truth is, it is simply human behavior.

It’s very wrong to consider many of the personality traits observed in liquor addicts as peculiar to alcoholics. Emotional and mental quirks are classified as symptoms of alcoholism merely because alcoholics have them, yet those same quirks can be found among non-alcoholics too. Actually they are symptoms of mankind!

Of course the alcoholic himself tends to think himself as different, somebody special, doctors and therapists often carry this same idea to extremes in their analysis 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, but 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 the AA program of recovery. Slips usually occur in the early stages of the alcoholic’s recovery program, before he has had time to learn enough of the AA techniques and philosophy to give him a solid footing. But slips may occur after an alcoholic has been a member of AA for many years, and it is in this kind, above all, that one finds the marked similarity between the alcoholic’s behavior and that of victims of other fatal 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 causes, which lead to relapse for the alcoholic. It happens this way: when a tubercular patient recovers sufficiently to be released from the sanitarium, the doctors give them careful instructions for the way they are to live when they get home. They must drink plenty of milk. They must refrain from smoking and they must obey other stringent rules.

For the first several months, perhaps for several years, the patient follows directions. But as their strength increases and they feel fully recovered, they become lax and there may come the time when they decide they can stay up late and when they do this and nothing untoward happens, they soon disregard all the other directions too, and they relapse.

This same tragedy can be found in cardiac cases where after the patient’s heart attack, the patient is put on a strict schedule. Frightened, they naturally follow directions obediently for a time. They go to bed early, avoid stress, quit smoking and live a Spartan life, but eventually, there comes a day they’re feeling good and they’ve regained their strength and recovered from the initial fright. Or they decide to party and do some smoking and a cocktail or two, and if no bad effects follow their departure from a rigorous prescribed schedule, their wrong thinking continues until they relapse.

Wrong thinking preceded the acts that led them to relapse. These patients rationalized themselves out of a sense of their own perilous reality. They deliberately turned away from the knowledge of the serious and fatal nature of their disease. They grew over-confident and decided they didn’t have to follow directions.

Now that’s precisely what happens to alcoholics who have a slip, obviously they decide to take a drink before they actually took it. Alcoholics start wrong thinking and quit doing “right actions,” before they relapse and so do cardiac, tubercular and other patient’s with potentially fatal diseases. 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!


by William Duncan Silkworth M.D.

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