White Knuckles and Wishful Thinking: Learning from the Moment of Relapse in Alcoholism and Other Addictions / Edition 2

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Overview

What’s new about the second edition?
  • Completely revised and updated -- over 100 pages longer.
  • Includes “Learning from Relapse Workbook.”
  • Includes “SPARROW” model for coping.
  • Student exercises for every chapter.
  • Recovery exercises for every chapter.
  • Connects spirituality and relapse.
  • Develops concept of “subliminal craving.”
  • Connects moment of relapse to tools for recovery as never before.

The book contains black-and-white illustrations.

This book aims to explain the moment of relapse, and to provide practical help for counsellors and clients struggling to avoid relapse. The ideas and techniques are compatible with Alcoholics Anonymous and other Twelve Step Programs. After more than 20 years' experience as a front line practitioner treating and counselling alcoholics, the author has revised his clearly, lucidly written text, introducing new ideas and techniques that have been proven in practice.

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Editorial Reviews

Booknews
Written for therapists, therapists-in-training, and patients of chemical dependency treatment, a chemical dependency specialist discusses relapse itself, including a dissection of what happens and what leads up to it; the processes of denial; acceptance; and coping, including what it is and how to do it better. Annotation c. Book News, Inc., Portland, OR (booknews.com)
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Product Details

  • ISBN-13: 9780889372245
  • Publisher: Hogrefe & Huber Publishers
  • Publication date: 4/1/2000
  • Edition description: REVISED
  • Edition number: 2
  • Pages: 393
  • Sales rank: 1,152,803

Read an Excerpt

Dr. Jekyll and Mr. Hyde -- The Devilish Links of Disownership

The Jekyll-Hyde Split

Dr. Jekyll, Meet Mr. Hyde -- An Exercise

The first question of the author’s favorite group exercise is always the same: “How many of you have been told you are a ‘Jekyll-and-Hyde’ when you drink?”
The answer today is typical.
Twelve of the sixteen alcoholic inpatients raise their hands. “How many have at least been told you are a different person when you drink?”
All the hands go up.
“Okay, what I’m going to do is divide the blackboard in half. I want each person here to share one example of what you are like sober. And how it changes when you drink.”
Several hands go up immediately:
“I’m polite when I’m sober and belligerent when I drink. Nobody can tell me anything.”
“I never miss a day of work sober.”
“I’m shy sober -- when I drink, I’ll ask anyone to dance.”
The examples flow freely and the counselor’s job is to keep them as specific as possible.
One man offers, “I lie a lot when I’m drinking.”
“Could anyone in the group give me some examples of the lies you tell?”
Again, they come through with their personal cover-ups and excuses. But one of them looks a little puzzled and embarrassed. “When I’m drunk,” he shares, “I’m likely to tell any damn story. Hero in the war. Test pilot. Private eye.”
“Anyone else like that?”
There are a few sheepish grins around the room and some nods.
It seems helpful to clarify that alcoholism generates two kinds of deception. The “survival lie” to get booze or to escape consequences of drinking it. And the seemingly harmless “fantasy lie” to seem to appear larger than one really is. Both sides of the board are full now, so it is time to start looking at the meaning of the facts we have laid out.
“If most drinkers experience similar kinds of personality change when they drink, what does this tell you about the problem? How does it help?”
A slim, young black man voices a reasonable and frequent conclusion. “The Mr. Hyde side of the board gives you a lot of reasons to not drink.”
“Dis-incentives -- good reasons not to?”
There are usually murmurs of agreement.
“That makes sense -- but see if this does. How many years have each of you known about your personality change. How many years ago did you first hear about it?”
We add up there answers, one by one. The total for the group of sixteen is over one hundred fifty years.
It’s time to take off the kid gloves.
“It would be reasonable to think Mr. Hyde’s self-destructive behavior is a strong reason not to drink. Yet the group has continued to drink for almost ten years, on an average, being aware of it. How do we make sense out of this?”
The room is very still. It is as if each alcoholic/addict there stopped breathing or moving at the same instant. However, a tougher question remains. “Try thinking of it this way. The goal of all chemical dependency treatment is to help you not do one thing. Take that first drink or drug. Have you ever asked yourself, who takes that drink, the “dry” Dr. Jekyll or the “wet” Mr. Hyde?”
Several of them mutter, “Dr. Jekyll” shifting in their seats. The air has left the room again and people need to catch their breath, to let it sink in. At this point, it is important to have a question we can work with. “Dr. Jekyll, without a drop of alcohol in his brain, picks up the first drink and changes himself back into the monstrous Mr. Hyde. There must be something about being Mr. Hyde that he prefers -- what is it?”
The group comes back to life.
Doctor Jekyll “gets bored”, “can’t relax”, “gets fed up with being a people-pleaser.” Mr. Hyde “has all the fun,” “gets the sex,” “never worries.” Now, we can circle back to the most important question of all.
“How might your answers help?”
One of the more verbal members of the group articulates it perfectly: “It tells you what Dr. Jekyll has to work on, sober.”
At this point the war hero/test pilot/private eye puts up his hand.
“Think it’s gonna be kinda dull around here if I just gotta be me all the time,” he comments.
“You fear you will miss the fantasies?”
He nods.
“Let me put it another way. You are not just saying good-bye to a liquid chemical, ethyl alcohol. What Dr. Jekyll loves most about living in Mr. Hyde’s fantasy world is the “powerful illusion of power” [1], power to recreate your self and universe at will. This is, of course, the power of God. Anybody here remember Step One of the AA Twelve Steps?”
One of them sees the connection.
“Admitted we were powerless!”
Sometimes the beginning is just the right place to end.
____________________________________________________________ This exercise works at the beginning of treatment with virtually any group of alcoholics. But with primary alcoholics, the results are consistent and the identification is built-in.
A caution: Cocaine addicts who do not identify as alcoholics may complicate it, either because they feel powerful all the time, or because their paranoid personality changes go so far beyond the loss of reality experienced by an alcoholic Mr. Hyde. Heroin addicts may identify with the radical change in behavior when using, not so much with the personality shift. The author has only tried the exercise once in an inpatient dual-diagnosis program. Never again! The most consistent group reaction is dismay at the realization that “the good guy” takes the first drink, that moment of silence. The goal of the exercise is to help newly sober alcoholics see and feel -- to “realize” -- what so many have never really grasped, to think about what it means when the sober person takes the first drink/drug of relapse. The separation of the “good guy” from the act of taking the first drink turns out to be crucial. Without understanding how this works, you will never fully understand what makes continued drinking possible. The distancing of the “good self” from the actions of the “bad self” robs the real self of an internal reason to change.
Exploring the emotional reactions to this truth can be productive and healing, even though shame and guilt often surface first. But if they are faced, it becomes possible to face how the disease controls the sober mind, and to do the work that will prevent the diseased control from coming back.
This is true “relapse prevention.”
The mental separation between self and action we see here creates an illusion for the person. It may actually feel like a “demon” somehow took over, that something other then the self is in control. But this experience is a direct result of the mental separation. In exploring further, we may call it: The Devil of Disownership

A hard-drinking man gets bored one night and drops by his favorite beer joint. He sits down beside a pretty woman but feels too self-conscious to speak. Drinking more and more beer, he finally loses his shyness. The man feels so different that it seems as if he has actually become another person. Smiling, he starts to flirt with the woman and she is delighted. Sound familiar?
Kris Kristofferson [1] evoked this familiar scene much more colorfully in his song “The Silver-Tongued Devil and I:”

I took myself down to the Tally-Ho Tavern
To buy me a bottle of beer.
And I sat me down by a tender young maiden
Whose eyes were as dark as her hair.
And as I was searching from bottle to bottle
For something unfoolish to say,
That silver-tongued devil just slipped from the shadows
And smilin’ he stole her away.

It is no secret that people drink alcohol to release inhibitions, to become more outgoing, and to get what they want from the opposite sex. But the drinker’s illusion of becoming another person can evade the most observant eye. Kristofferson not only spells out the illusion. His tongue-in-cheek chorus captures the fatal conviction that this “other person” is responsible for all alcoholic shenanigans:

You know, he’s a devil, he’s everything that I ain’t,
Hidin’ intentions of evil, under the smile of a saint.
All he’s good for is gettin’ in trouble
And shiftin’ his share of the blame
And some people swear he’s my double,
And some even say we’re the same.

The attitude, my actions are not really mine because I’m not really me when I’m drunk, is called “disownership.” This becomes a way of looking at self that enables the person to live with sick and destructive behavior. In effect, “It’s not really me that’s doing all those horrible things.
Why should I change?”
The alcoholic/addict may be the last to become aware of this subtle attitude. A largely subconscious defense, disownership accounts for much of what is “cunning and baffling” about addiction. It also accounts for the fact that so much treatment “bounces off.” Sure, the client believes what we are saying in our groups and classes, but without even being aware, he or she assumes we are talking about that “other.” You know, the one who drinks and does all that crazy stuff, not the good soul sitting here in treatment, a model citizen. Kristofferson’s “I” begins sliding off the hook in the first three lines of the song. He describes his “self” as a separate being he “takes” to the bar. His “me” is someone for whom he buys a beer or pulls out a chair.
This use of language effectively separates the doer and the deed. In treatment, people often attempt to separate themselves from their behavior. Perhaps the most common way is to talk about what “you” do when drinking, not what “I” do. “‘You’ get loose and say anything and don’t go to work,” says one.
“‘You’ just don’t give a damn when you drink.”
“‘You’ get more opinionated, won’t listen,” says another.
In this way, “you” may avoid talking about what “I” actually do. The silver tongue slithers away from the truth on a string of casually misplaced pronouns. AA speakers and stories certainly do not share what “you” were like, what happened, and what “you” are like now. Can there be any real acceptance as long as the person subtly displaces the alcoholic behavior away from self? As we saw above, another way a person may disown alcoholism is by claiming to be a “Jekyll and Hyde.” This implies being a “saint” when sober -- that evil Mr. Hyde is the “devil” who causes all the trouble! A man convicted of killing several people while driving under the influence, shares his story.
He looks the audience in the eye and says, “I wouldn’t hurt a fly.” If he didn’t, who did?
A person holds his or her real behavior apart from what they consider to be their real self. In a word, “disownership.” Even the disease concept of alcoholism can be distorted as a way of disowning behavior. “I can’t help it -- I’m sick.” Or, “My disease made me do it -- it wasn’t really me.” To be sure, the drinking personality is not “the real me.” What comes out under the influence is a part of the personality that is inhibited without alcohol. To be inhibited means an impulse is stopped by something else inside yourself, usually something rigid, automatic, self-conscious. Apparently, the part of the person that does the stopping disappears with alcohol, put to sleep by the drug. But who took the drug and knocked the “inhibitor” out? Who took the real drug into my real body and put Mr. Hyde in control of my real behavior? Something behind the wall of sober inhibition may have reached out and said “One won’t hurt,” or “F--- it.” That something may well be neurochemical.

It may be neurotic, unconscious, or some “bio-psycho-social” brew. But that mysterious something belongs to the sober self who lives behind the wall. I “own” it. And until I digest this emotional and physical reality, I have no “motivation” to do anything about it.
Father Joseph Martin [2], in his classic film Guidelines, made a powerful and relevant statement. “Pain,” he says, “is the greatest gift God can give an alcoholic. The pain of looking in the mirror of self and wanting to throw up.” Here is the picture: the silver-tongued devil stares back from the mirror in silence, mask off, eyes wide with horror and grief. “Saint” and “devil” meet for the first and last time. Neither survives, but the person who remains will take one of two forms. A real human being with one self and a powerful thirst for life and growth. Or a corpse.

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Table of Contents

IntroductionREACTION CHAINS: PHYSICAL AND MENTAL
The Case of the Broken Shoelace
A Model, Not a Theory
Schools of Thought
Distillation of Purely Biochemical Theory
Putting Biochemistry in Perspective - Without Getting Rid of it!
What is a Hang-up?
How to Permanently Alter an "Automatic" Reaction
Links over Time and the Process of Relapse
The Tool: Reliving the Reaction
References
Recovery ExercisesTHE MOMENT OF RELAPSE - USING THE "LOST KEYS" APPROACH
Into the Moment
Predictable Resistance
Different Tools, Same Job
Recovery ExercisesEXPLORING LINKS OF THE WISHFUL RELAPSE (ONE WON'T HURT)
Why Look?
One Won't Hurt - Moment of Decision
Starting with the Obvious: Two Observations and an Exercise
Denial of Denial
Experience, a Missing Link
Desire, Another Missing Link
A Decision in the Dark
The Affirmation
One Drink of What?
The Wish for Wishes
Euphoria
Boredom
The Hidden Guilt
External Links: Living Problems
Psychological Core Links
Instant Regression and the "Adult Child" Connection
Links Over Time: The Process of the Wishful Relapse
References
Recovery ExercisesTHE LINKS OF THE WHITE-KNUCKLE RELAPSE (F- IT)
From Questions to Observations and Back
"I Quit"
"I've had it!" (With a Feeling of Snapping)
"What's the Use!"
"Who Cares"
Another Translation: "I Can't Cope"
Three P's: Partialization, Perspective, and Prevention
Prevention
Awareness, a Specific Role for Psychotherapy in Relapse Prevention
"My Way or the Highway": The Spiritual Significance of "F--- it"
References
Recovery Exercises
Three Tough Pills to Swallow - Forging the Links of Acceptance
Acceptance Reaction
The Myth of the Overnight Cure
The First Pill-Connecting Alcohol to Problems
The Second Pill-Eureka! It's the First Drink-How Come Nobody Told Me?
The Third Pill-"Power of Alcohol Equals Need for Help"
Something to Say Instead of "F--- it": "HELP!"
References
Recovery ExercisesTHE RELAPSE POST-MORTEM - LINKS OVER TIME
The Concept
Barry's Relapse
Early Abstinence
Midway in Abstinence
Barry's Moment of Relapse
Barry and Group Debrief
References
Appendix to Chapter Six: The Learning From Relapse (LFR) WorkbookTHE LINK(S) WE CALL DENIAL - A WALL AND A WILL
When Does Denial Exist?
The Wall Between Alcoholic Self and Others
Some Painful Reasons to Stay Out of the Other's Moccasins
The Wall Between Alcoholic and Self
The Will Behind the Wall
References
Recovery ExercisesDENIAL - FOUR WAYS TO CATCH IT IN THE ACT
Relapse Prevention as Denial Reduction
A Patient's Definition
Denial as Prejudice
Denial as "Not-Thinking-About-It"
Denial as "Isolation-of-the-Connected"
Pseudo-responsibility: "Beating Myself Up" as Denial
References
Recovery ExercisesDR. JEKYLL AND MR. HYDE - THE DEVILISH LINKS OF DISOWNERSHIP
Dr. Jekyll, Meet Mr. Hyde-An Exercise
The Devil of Disownership
For the Reader in Early Recovery
Two Cultural Supports for this Dualism
I. The Spirit Versus the Flesh
II. Pavement for the Road to Hell
Dr. Jekyll and the Wishful Relapse
Dr. Jekyll and the White-Knucle Relapse
References
Recovery ExercisesTHE IRON LAW OF OWNERSHIP - THE LINK THAT SETS US FREE
The Iron Law of Ownership
"So What" Number One-Ignorance Is No Excuse
Epitaph for a Sober Alcoholic
"So What" Number Two-Ownership is a Fact, Not a Should
"So What" Number Three-Two Things Only the "Owner" Can Provide
Ownership Versus Blame: a Parable
References
Recovery ExercisesACCEPTANCE: WHY WE NEED IT
The Moment of Relapse as a Moment of Rejection
When Do We Need Acceptance?
Powerless-The Problem of Where Wanting Comes From
Powerless-The Problem of Turning Off Unwanted Wanting
Spiritual Note
Acceptance: What is it? Some Descriptive Definitions
References
Recovery ExercisesACCEPTANCE: HOW TO DO IT
The "Sparrow" Method
"P" is for Prayer (and Meditation)
"A" is for action!
"R" is for "Read!"
The other "R" is for "Rethinking"
"O" is for "One Day At a Time"
"W" is for "Writing"
Tools for the Courage to Change
Conclusion
References
Recovery ExercisesDIRECT TREATMENT OF THE MINIMIZATION LINKS
I. How to Help a Minimizer Get Started
Recipe for Counter-Minimizing
II. Frustration Tag-Getting a Group to Talk
Recipe for Frustration Tag
Recovery ExercisesHOW TO SOLVE A PROBLEM, ANY PROBLEM
What Joe Wants
What Joe Got (Objective and Subjective)
What Joe Must Accept Versus What He Might Change
SPARROW and the Moment of Relapse
References
Recovery ExercisesWHEN THOSE RELAPSE THOUGHTS COME BACK
How Willpower Gets You Drunk
How Talking Keeps You Sober
Preparation For "Telephone Therapy"
A Tool-Role-Playing the Phone Call that Was Not Made
References
Recovery ExercisesLINKING THE LINKS: CHARACTER AND CRAVING
Fear of Abandonment as Craving
Character Defects as Craving
Transference as Craving
How to Use This Book
The Bottom LineAppendix for Chemical Dependency Students
Acknowledgements
Index
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