IS RELIANCE UPON A HIGHER POWER INCOMPATIBLE WITH LEARNING SELF- MANAGEMENT SKILLS?

G. Alan Marlatt, Ph. D., Director,
Addictive Behaviors Research Center,
University of Washington

IS RELIANCE UPON A HIGHER POWER INCOMPATIBLE WITH LEARNING SELF- MANAGEMENT SKILLS?

Psychologists are often critical of A.A. as a psychologist trained in the behavioral tradition, I was taught to view alcoholism not as a physical disease but as an acquired behavioral disorder, a vicious habit cycle, locked in by layers of conditioning based on years of reinforcement, both positive (the high of the buzz) and negative (the relief from withdrawal). We were taught that alcoholics were made, not born, and that anyone is susceptible to developing a drinking problem, not just those with a genetic predisposition or "allergic reaction" to alcohol. In short, we believed in science and the experimental method of discovering the truth about alcoholism. As budding scientists and research-oriented clinicians, we rejected out of hand any approach that smacked of religion or any other nonscientific values.

Despite my scientific training, my intuition (perhaps based on early experiences with several alcoholics in my own family) told me that alcoholism was more of a psychological "disease" of the spirit than a physical disease of the body. I found some statements in the Big Book that seem to echo this philosophy e.g., "Therefore, the main problem of the alcoholic centers in his mind, rather than his body" (p.23), and Dr Bob's reputed claim that alcoholism "was more of a moral or spiritual illness than it was a physical one" (p.219). In addition, I cannot help but be impressed with the amazing success of A.A. over the past 50 years of its existence. If alcoholism is really a disease of the spirit (for which alcohol is no real solution), then it makes sense that the religious fellowship of A.A provides fulfillment of the alcoholic's underlying craving for union with a Higher Power. Especially if it keeps its members sober, which A.A often does.

But what about those who fail to maintain abstinence, those who relapse?

As the poet and writer John Berryman so aptly points out in his alcoholic autobiography, Recovery (N.Y., Farrar, Straus & Giroux, 1973), acceptance of the first step in A.A. is not always an easy task. For those fortunate individuals who experience a classical religious conversion experience similar to those described in the Big Book (e g., p.56 "In a few seconds he was overwhelmed by a conviction of the presence of God. It poured over and through him with the certainty and majesty of a great tide at flood"), all is well and they seem to be protected from further temptation by the protective umbrella of the Higher Power. As the Big Book states, "The alcoholic at certain times has no effective mental defense against the first drink. Except in a few cases, neither he nor any other human being can provide such a defense. 

His defense must come from a Higher Power" (p.43). Does this mean that those who return to drink have been abandoned by God? Does a slip mean a fall from grace or a moral sin in the eyes of God or the alcoholic? What factors precipitate a relapse? Here the Big Book and scientific data seem to agree. According to the Big Book, "The greatest enemy of us alcoholics are resentment, jealousy, envy, frustration, and fear" (p.145). Anger and resentment are frequently described throughout the Big Book as psychological precipitants of the first drink. In our own research on determinants of relapse, we found that the negative emotions such as frustration and anger, along with interpersonal conflict and social pressure, represent high risk situations that are associated with 75% of the initial relapse episodes reported by alcoholics. Frequently, these initial steps are preceded by certain psychological "early warning signals" such as rationalization excuses and unrealistic expectancies about the effects of alcohol as a means of coping with stress or transforming unpleasant mood states. To the extent that people can be trained to recognize and act upon these warning signals and learn to cope more effectively with high-risk situations for relapse, they may be able to prevent or minimize the severity of their relapses. Forewarned is forearmed, as the saying goes. These methods, along with research supporting the effectiveness of these procedures in the treatment of alcoholism, are described in a forthcoming book by Marlatt and Gordon (Relapse Prevention, N.Y.: Guilford Press, 1985).

There may be a way of resolving the apparent dilemma between relinquishing personal control to a Higher Power vs. learning self-management skills in the prevention of relapse. For those who experience a profound religious conversion experience, no coping skills other than a reliance on a Higher Power may be necessary. In Appendix II of the Big Book it is stated, however, that such religious "transformations, though frequent, are by no means the rule." Most of our experiences are what the psychologist William James calls the 'educational variety' because they develop slowly over a period of time" (p.569). It is for these latter individuals that coping skills for relapse prevention are particularly helpful. I would encourage A.A. members to share their "survival skills" with new members or with those who are experiencing setbacks. In this way, the "higher power" of group support and shared coping experiences can be made available to all members. As it says in the Big Book (p.135), "First Things First"