We’ve all watched the following scene in movies or on television. There’s a character who used to have a drinking problem but has been abstinent for a while. It’s usually a man, so let’s call him Stan. There’s a crisis in the episode or film, so naturally Stan’s thoughts turn to his drug of choice, usually whiskey. He walks into a bar and orders one. After the bartender serves the whiskey, usually neat, Stan stares at it. Tension mounts: will he or won’t he drink? The camera searches Stan’s face for clues, and the actor playing Stan obliges with tortured expressions. Eventually, Stan either downs the drink in one gulp or walks away. The scene closes with one of two shots: a full glass in front of an empty barstool or several empty glasses in front of a bleary-eyed Stan.
That video trope[1] has always seemed contrived to me, not at all like my experience of relapse—or near-relapse. Over the years, I’ve asked other relapse veterans whether it rings true for them, and the answer is always no, which raises at least two interesting questions. One, how does relapse really unfold? Two, why do the media get it wrong?
The first question matters more, but, before I address it, a disclaimer: my evidence is anecdotal. I looked for published research, but everything I found was asking different kinds of questions—useful ones, in some cases, but not relevant. So I’m just going to explain what I have observed in myself and discussed with others, and if it helps you, great. If it doesn’t, leave a comment describing your experience, so that I (and other readers) can learn from it. And forgive me in advance for not ending each sentence with “in my experience.”
If I were Stan, by the time I was sitting at the bar with a whiskey in front of me, it would be too late. Though I may not yet have a molecule of alcohol in my body, the relapse would be underway, like an oil tanker headed for a reef. The single most baffling fact about relapse, for me, is that I never consciously make a decision to drink. Instead, I become aware that a decision has already been made.
People who don’t have an alcohol use disorder may think what I just said is specious and self-indulgent. To them, if I’m sober but on my way to the liquor store, I’m Stan. I just have to exercise a little will power or pray or call my sponsor or meditate, and I’m just not willing to do those things, so I make up a lot of hooey about oil tankers and reefs to justify my inaction. I think, though, that it’s absolutely necessary to understand that I’m not Stan and to think about exactly what is going on in my head so that I have a real shot at not killing myself with alcohol.
For years, my friends and I have puzzled over this sense of belatedness, of coming to consciousness that a relapse is already underway even before it physically begins. Then last year I read a 2002 book by Timothy D. Wilson, a professor of psychology at the University of Virginia. The book is called Strangers to Ourselves: Discovering the Adaptive Unconscious.[2] Professor Wilson explains that human beings have two different but overlapping operating systems, one fast, crude, and unconscious, the other slower, more discerning, and conscious. They both drive perception and behavior, sometimes in congruent ways and sometimes in conflicting ways. To illustrate the difference, he uses the example of what happens when you’re hiking in the woods and you suddenly look down and see a long skinny thing coiled up by your foot. “Snake!” screams the fast, crude system, so you jump back before you’re even aware you’ve seen anything. Then the slower, more discerning system kicks in to weigh the evidence and conclude “Dead vine. No problem.”
The first system, the adaptive unconscious, does a lot for us. It’s what’s driving when we zone out during our commute and suddenly “come to” a block from home. It learns from what we do and how we feel, but it’s kind of a slow learner, so, when the conscious mind makes a decision, it doesn’t always go along, whether we are aware of the fact or not. It’s why well-meaning people who try hard to identify and eliminate racism in their thinking still show behavioral evidence of racism that they’re completely unaware of but that can be demonstrated in the lab.
Strangers to Ourselves is a fascinating book, well worth a read. Professor Wilson doesn’t talk about addiction per se, but his description of the adaptive unconscious helps explain why people who make a conscious decision to stop drinking may, at times, do just the opposite—and, frankly, it’s a better explanation than “because they’re alcoholics” or “because alcohol is cunning, baffling, and powerful.” It also explains that feeling of belatedness I talked about. The adaptive unconscious can make decisions, can put processes in motion, can steer the ship, just as it steers our car when our conscious mind is elsewhere.
So why the sense of inevitability? Why is it so hard, once we “come to” and realize that we have decided to drink, to change course? Recent research into the neurotransmitter dopamine offers a powerful answer. Scientists have long known that dopamine release accounts for much of the pleasure of drugs such as alcohol. A much more recent discovery is the release of dopamine before the drug is ingested. Rather than being the reward of a particular action, dopamine is what encourages us to seek that reward. In other words, once drinking or using becomes a likely prospect to the brain, which can happen unconsciously, anticipatory dopamine motivates us to see it through. The resulting momentum is very much like that of an oil tanker headed for a reef.
I find this explanation liberating. Just understanding what is going on in my head mutes the tirade of self-abuse unleashed by a relapse or near-relapse. Just as my adaptive unconscious cries “Snake!” over and over, no matter how many times the snake turns out to be a dead vine, it will try to push me in the direction of familiar comfort, which it knows can be found in drugs and alcohol. There’s no weakness, laziness, or “character defect” in that fact; it’s just how the adaptive unconscious works. My job is to stay aware of what it may be doing, which brings us back, yet again, to mindfulness.
The simple fact is that I am more likely to abort a relapse whose dynamic I understand than one that seems mysterious and perverse. And addiction science is more likely to make progress if it pays attention to addicts who pay attention to their experience, especially when it falls outside the clichés of the recovery industry. Non-judgmental awareness will take both addicts and the research that could help us a long way.
So why are TV and film obsessed with Stan and the will-he-or-won’t-he scene? I think it’s because the media love seeing recovery as a pitched battle: good versus evil in a moment of temptation. We’ve all watched Homer Simpson contemplate a bit of mischief with a devil on one side egging him on and an angel on the other crying “No, no no!” The psychomachia, or soul-battle, is an ancient genre that has appeared in many forms through the ages, including cartoons. It’s an essentially moral understanding of the mind: vices warring against virtues to control behavior. It’s dramatic, which is why media love it, but it’s not a useful model of how we decide what to do, possibly even a dangerous model.[3]
Stan also reinforces the idea that alcohol addiction is a private problem, a struggle in the soul of the individual addict. Stan never turns to the bartender and asks why so many people take refuge in dangerous drinking these days—or pulls out a baseball bat and smashes up the back bar. He just drinks or doesn’t drink, and there we have, in a nutshell, everything that’s wrong with the way we frame the conversation about relapse.
[1] Yes, I know the literary definition of a “trope,” but the battle to preserve it has been lost.
[2] Timothy D. Wilson, Strangers to Ourselves: Discovering the Adaptive Unconscious (Cambridge and London: Harvard University Press, 2002).
[3] See the essay “Grappling with the Serenity Prayer,” especially the end.