Many relapses are precipitated by a seemingly uncontrollable craving which can appear to come out of nowhere. Relapse can feel so automatic and instinctive that many who’ve suffered them say they were “struck drunk.” Sobriety training becomes unavailable. That’s how it felt to me.
I drank about six weeks out of rehab at the first cocktail party I attended when I encountered an uncontrollable craving. It was accompanied by amnesia, as if the memory of the lessons I learned in 32 days in rehab was wiped clean.
Sometimes when amnesia hit I could find a way to side-step disastrous results. This happened on my first sober trip shortly after my cocktail-party relapse. I’d discussed it in advance with my sponsor, my therapist, and the hospital’s Alumni group, and promised to go to a New York AA meeting every day. But midway through the flight I got a panic attack. All my good intentions went right out the window and I didn’t realize it. Three meeting-less days went by as I got more and more crazed but couldn’t figure out what to do about it. Desperate, it finally occurred to me I had to talk to someone before I did something disastrous. But despite the dozen phone numbers I’d brought specifically for that purpose, I initially blanked on whom I could call. Eventually I remembered the list and called an Aftercare mate. Fortunately, she was home. I went into a breathless description of how desperate I was, how I didn’t know what to do, I was at the end of my rope, I needed to talk to somebody, and I was sorry to dump this all on her, but …
She listened sympathetically. When I came up for air, allowing her to get a word in, she said something that nearly bowled me over. “Have you been to a meeting?”
“Yeah, a meeting. Have you been to a meeting since you got to New York?”
“Uh … no.”
“Maybe you should go,” she suggested.
Why the fuck didn’t I think of that?
It was as if my memory had been wiped clean. Every single lesson I’d learned at rehab and AA vaporized like steam rising from a subway grate on an wintry day. It was inaccessible and inconceivable. It took three days to realize I needed to make one phone call! Mention a meeting, and it’s as if I’d never heard the word! How many times had I promised to go to a daily meeting in New York? How hadn’t it once occurred to me?
The same amnesia struck when I relapsed for the second time almost two years later.
AA anticipates amnesia. The Big Book says: “We are unable, at certain times, to bring into our consciousness with sufficient force the memory of the suffering and humiliation of even a week or a month ago. We are without defense against the first drink.” When relapse occurs, “our sound reasoning failed to hold us in check, the insane idea won out. Next day we would ask ourselves, in all earnestness and sincerity, how it could have happened.” This is one of the reasons it’s a “we” program not meant to be done alone. We need others to help us identify and battle those unsound impulses.
But these are observations, not explanations. Indeed, The Big Book says AA doesn’t know why sound reasoning fails, declaring simply, “We cannot answer the riddle.”
One of the things repeated bouts of amnesia taught me was that it wasn’t enough to remember what I’d learned about the disease and how to defend myself from it. When a craving hit hard it was nearly impossible to remember. At those moments, I had to remember to remember. I had to recognize the amnesia and recall that I had tools to deal with it.
In early sobriety, this required an enormous effort. As my relapses attest, I wasn’t always successful. Obvious triggers like walking down the liquor aisle in the supermarket sent my mind into relief-in-a-bottle autopilot. With practice, though, I learned to recognize when amnesia hit and to prompt myself to take action to overcome it — make a phone call, go to an AA clubhouse and wait for the next meeting, at the vary least just get the hell out of the supermarket. Like any skill, repetition made it easier to remember to remember. I had plenty of occasions to practice as alcohol is ubiquitous.
Neuroscientists say my experience is typical. As sobriety lengthens into months and years, the reprogramming of the brain’s reward circuits caused by drug abuse remains, but its intensity – the toxic memory — fades. Cue-induced amnesia happens less often and less robustly. For the scientific explanation of why amnesia strikes, click on Amnesia Explained.
But sobriety is like what security experts say about terrorism: prevention has to be 100% successful 100% of the time, whereas “the Disease” only needs to succeed once to put your life back in danger. That’s why amnesia is so dangerous.