Thursday, 31 July 2014

Dealing with relapsing sponsees

How do I respond as a sponsor when someone relapses?

I have experienced two types of relapsing sponsee.

Type I: the (partial) slacker.

With this type of bloke, it becomes immediately apparent upon quizzing him that he was not taking all the suggestions. I have a document called the 'triangle emergency pack', which, based on the premise that people who live in all three sides of the AA triangle of recovery, service, and unity, lists what actions an alcoholic would have to be taking on a daily basis to stay sober and recover. I go through this with him and he lists out what actions he was or was not taking.

Setting this against the original instruction I gave him, which was to take all said actions like his life depended in it, I ask why the actions were not being taken.

There are several possible reasons.

(I) He does not sufficiently, consistently want to stay sober (lack of rock-bottom).

(II) He believes he is an alcoholic but believes he can stay sober on only a proportion of the suggestions or that there is no urgency (lack of belief in what the Big Book says).

(III) He knows he will drink if he does not take the suggestions but believes that, if he slips, he will be able to come back to AA the next day, so it is no big deal (lack of belief in the physical craving, which extends beyond a bout and can trigger a relapse that persists for years or forever).

(IV) He does not believe that the suggestions will work for him, so does not even try.

(V) He lacks motivation because he knows the suggestions are required to stay sober and live but has an insufficient desire to live (this is usually similar to (IV): the Steps might keep him sober, he thinks, but will not afford him any quality of life).

Most people have a combination of these.

The most pernicious is (III), as slips that did not ultimately lead to permanent relapse may lull him into a false sense of security. Any long-term observation of slipping patterns in AA will reveal the chilling fact that a single slip will often open the door after a longish period of sobriety to a sequence of slips that then join up to become permanent relapse.

Essentially, as you can see, there is axiomatically a problem with one or more aspects of the first three Steps. Examine, therefore, with the sponsee where the problem lies, within the first three Steps, and in particular with the various characters outlined in the first few chapters: the man with the hammer, the jaywalker, the man of thirty, the certain American businessman, Jim, and Fred. I use a document that summarises the first three Steps, 'An exercise for reapproaching Step Four'. This may then lead on to more detailed work on the Big Book. I do not launch in straight away with rehashing every word of the Doctor's Opinion plus the next 62 pages, because there is a risk of not isolating the reservation due to a surfeit of information and material. The work, at this point, has to be very targeted.

The upshot of this is either: no change, with the sponsee eventually drifting away, or the sponsee identifying and eliminating the reservation, pulling up his socks, and staying sober permanently.

Type II: the chronic slipper

This type is baffling.

This character is typically highly willing, non-defensive, and open-minded. He absorbs information like a sponge. For a few days (and it is usually a few days) or weeks, he takes every single action diligently, and may even get as far as Step Six or the cusp of Step Nine. However, he will suddenly stop taking action and is drunk within a day. In contrast to Type I, where there is a gradual slide and a grace period often of weeks if not months, the switch from willing AA to rebel happens instantly, it seems.

The same procedure should be tried as in Type I, as this sometimes works.

This type, however, does not always respond to the above method, as the reservation seems to lie deeper. The Harry M. Tiebout M.D. essay 'Surrender versus compliance in therapy with special reference to alcoholism' describes well the issue: the individual has surrendered consciously but not subconsciously. There is a battle going on, and this individual is often characterised by obsessive analysis, a high degree of attention paid to and faith in his own feelings, perceptions, and thinking, a feeling of being 'special and different', and an unwillingness to experience the negative emotions associated, initially, with early sobriety.

Whilst examining the above considerations can be of some help in breaking the pattern, essentially an all-encompassing rock-bottom (a state of hopelessness that induces absolute surrender) is required, and I do not know of any way of inducing this in someone at a sub-conscious level.

In this case one can only hope and pray.

The Book 'Alcoholics Anonymous' describes those who 'cannot or will not' do what we do. This category is small but heart-breaking. It is difficult to tell with a chronic relapser who does not respond to every effort made to help him which of the two applies: cannot or will not. Gratifyingly, those who persist in sticking around AA will often, at some point, break and break for good, and a number of my friends, and I myself, fall into this catgory.

In other words, there is always hope.

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