Tune in to the thoughts of any addict or alcoholic deciding to take the first drink/drug of relapse. If you do not hear the exact words in the graphic, it often will be something very similar. You will hear these fateful clichés in first-time relapsers, chronic patients, those working at recovery, and those relying solely upon “willpower.” Cocaine, alcohol, heroin, marijuana, and virtually every other known addiction—the drug of choice doesn't matter.
The thoughts listed above share at least one common quality—falsehood. For an addict, sooner or later “just one” will always hurt. The addict won't “handle it—it will handle him. And “this time” will usually be different only by the degree to which it is worse. “No one will know,” in most instances, might as well be a flashing neon sign. And if the addict does “deserve it,” it is strange recompense, indeed, to invite the personal disasters that so consistently follow that thought.
Aaron Beck, MD, the father of cognitive therapy, and colleagues describe these thoughts, so characteristic of addiction, as “permission-giving be-liefs.”1 That is certainly an accurate description of what they do. Alcoholics Anonymous (AA) calls them “plain insanity,” comparing the decision involved to jumping repeatedly in front of streetcars.2 Cognitive-behavioral therapy and AA alike prepare the addict/alcoholic to recognize these thoughts for the symptoms they are. Both would counter them with the ultimate healer—the truth.
Yet there appears to be more to these self-deceptions than mere permissiveness and lack of veracity. To understand these relapse thoughts better, one should look at what has happened over time. Start with the addicted soul who has just made a sincere decision to abstain. Ask if he/she thinks “just one” will hurt. Generally, the person is fairly clear about it. Most people who have decided to quit an addiction carry a strong sense of abstinence being an all-or-nothing game. Unfortunately, that conviction so often turns out to be fragile. Not only does that belief fade over time, but the mental voice that surges or whispers in its place affirms the direct opposite—that abstinence doesn't have to be an absolute.
All permission-giving beliefs assert or assume no loss of control and no damage. “One won't hurt” implies that the person can and will stop there. “This time will be different” alludes to the existence of other times when it did not turn out so well. “I can handle it now” also acknowledges that one could not do so in some prior reality, but is now apparently altered by the healing power of time. “No one will know” merely assumes the control to manage appearances, after the drug has again in- vaded the brain. Distinguishing between “then” and “now” slams the door on the party pooper of past experience.
It is clear that these thoughts, explicitly or implicitly, deny the very reality that the word “addiction” denotes, and that the person believing them already has demonstrated the loss of control synonymous with addiction. The sweet nothings of permission ruthlessly deny the suffering about to recommence.
Why do addicts forget?
The likes of Terence T. Gorski and G. Alan Marlatt, PhD, have affirmed for decades that relapse is a process.3,4 Marlatt even coined the phrase “seemingly irrelevant decisions,” a wonderfully apt description that blows the whistle on choices made even before the fatal moment when “I'll just have one.”
But just what is a “process?” Is it not a recognizable sequence in which one thing changes into something else? For many addicts/alcoholics, the hard-won belief in the necessity for abstinence mysteriously transforms (back) into a belief in control (“I can control use”). How can this be? How can one who has “learned a lesson” do an about-face and “unlearn” it?
Are alcoholics and addicts just stupid? Are they like the kid who puts his left hand in the flame this time because he knows the fire would ignite the bandages on the right? But if that's the case, why do people with stupendous memories make the exact same mistakes? MDs, PhDs, attorneys, financiers, highly trained technicians—the list goes on and on. AA itself was founded by a proctologist and a financial analyst—their first recruit was an attorney! Such people are successful because they have formidable memories. Yet they relapse and find themselves back in treatment because they have forgotten one thing: their own suffering.
Ask yourself or people who have lived through this process to think back to the day they quit. Ask them to relive the awareness of their suffering that day. Using a scale from 1 to 10, have them rate that awareness as “10.” Then invite them to roll forward mentally to the day before the first drink or drug of relapse. Using the same scale, ask them to rate the awareness of suffering on that day. You will not hear a lot of 10s. And the minority who were still “10s” will not have said, “One won't hurt” as they poisoned themselves. Those who still remembered that one are likely to have barked an expletive of defeat and abdication. Only someone who has forgotten the last relapse can resume use with the comfortable assurance that he/she is certainly not going to do that again.
Some say the alcoholic/addict is just normally human in forgetting pain. No woman would have a second child and no country would fight a second war, the argument goes, if the human brain were not hardwired to forget pain. The practical problem, then, remains how to preserve the memory of suffering caused by use vividly enough to thwart the recurring idea that return to use will not create still more suffering.