September 24, 2007

Dr. Silkworth's Rx for Relapse Prevention

Dr. W.D. Silkworth, genial and beloved little patriarch at Towns Hospital, New York, for twelve years and now (1945) also in charge of the new A.A. ward at Knickerbocker, also New York, defines it [relapse] as the "alcoholic double-cross."

"The majority who slip after periods of sobriety," says Dr. Silkworth, "have double-crossed themselves into thinking that somehow they can have the unopened bottle and drink it, too. Even though they have been in A.A. and going to meetings, and following parts of the program, they have accepted it with reservations somewhere. They actually have been one step ahead of a drink. Then they began playing around with the notion they can drink a little and still have the good things of A.A. The outcome is an inevitable as the bottle becoming empty once it has been opened by the alcoholic."

When Dr. Silkworth discusses A.A. "slips" his usually cheerful face becomes serious, even a little grim. Through his long years of practice in the field, he has become increasingly sympathetic, but not case-hardened, to alcoholics. He understands what they experience. Having been one of the first in his profession to support A.A. and having guided scores of alcoholics into A.A., he also appreciates the fact that a "slip" for an A.A. involves an extra degree of remorse and misery.

Dr. Silkworth is particularly emphatic on one point.

"Slips are not the fault of A.A. I have heard patients complain, when brought in for another drying out, that A.A. failed them. The truth, of course, is that they failed A.A. But this mental maneuvering to transfer the blame is obviously another indication of fallacious thinking. It is another symptom of the disease."

A quick way to get Dr. Silkworth's appraisal of A.A. is to ask him how he thinks "slips" can be prevented.

"First," he explains, "let's remember the cause. The A.A. who "slips" has not accepted the A.A. program in its entirety. He has a reservation, or reservations. He's tried to make a compromise. Frequently, of course, he will say he doesn't know why he reverted to a drink. He means that sincerely and, as a matter of fact, he may not be aware of any reason. But if his thoughts can be probed deeply enough a reason can usually be found in the form of a reservation."

"The preventive, therefore, is acceptance of the A.A. program and A.A. principles without any reservations..."

From this 1945 AA Grapevine article

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