THE DOCTOR'S OPINION
WE OF Alcoholics Anonymous believe that the reader will
be interested in the medical estimate of the plan of
recovery described in this book. Convincing testimony
must surely come from medical men who have had
experience with the sufferings of our members and have
witnessed our return to health. A well-known doctor, chief
physician at a nationally prominent hospital specializing in
alcoholic and drug addiction, gave Alcoholics Anonymous
this letter:
To Whom It May Concern:
I have specialized in the treatment of alcoholism for many
years.
In late 1934 I attended a patient who, though he had been a
competent businessman of good earning capacity, was an
alcoholic of a type I had come to regard as hopeless.
In the course of his third treatment he acquired certain
ideas concerning a possible means of recovery. As part of
his rehabilitation he commenced to present his conceptions
to other alcoholics, impressing upon them that they must
do likewise with still others. This has become the basis of a
rapidly growing fellowship of these men and their families.
This man and over one hundred others appear to have
recovered.
I personally know scores of cases who were of the type with
whom other methods had failed completely.
These facts appear to be of extreme medical importance;
because of the extraordinary possibilities of rapid
xxv
xxvi The Doctor's Opinion
growth inherent in this group they may mark a new epoch
in the annals of alcoholism. These men may well have a
remedy for thousands of such situations.
You may rely absolutely on anything they say about
themselves.
Very truly yours,
William D. Silkworth, M.D.
The physician who, at our request, gave us this letter, has
been kind enough to enlarge upon his views in another
statement which follows. In this statement he confirms
what we who have suffered alcoholic torture must
believe-that the body of the alcoholic is quite as abnormal
as his mind. It did not satisfy us to be told that we could not
control our drinking just because we were maladjusted to
life, that we were in full flight from reality, or were outright
mental defectives. These things were true to some extent,
in fact, to a considerable extent with some of us. But we are
sure that our bodies were sickened as well. In our belief,
any picture of the alcoholic which leaves out this physical
factor is incomplete.
The doctor’s theory that we have an allergy to alcohol
interests us. As laymen, our opinion as to its soundness
may, of course, mean little. But as exproblem drinkers, we
can say that his explanation makes good sense. It explains
many things for which we cannot otherwise account.
Though we work out our solution on the spiritual as well as
an altruistic plane, we favor hospitalization for the alcoholic
who is very jittery or befogged. More often than not, it is
imperative that a man’s brain be cleared before he is
approached, as he has then a bet-
The Doctor's Opinion xxvii
ter chance of understanding and accepting what we
have to offer.
The doctor writes:
The subject presented in this book seems to me to be of
paramount importance to those afflicted with alcoholic
addiction.
I say this after many years’ experience as Medical Director
of one of the oldest hospitals in the country treating
alcoholic and drug addiction.
There was, therefore, a sense of real satisfaction when I
was asked to contribute a few words on a subject which is
covered in such masterly detail in these pages.
We doctors have realized for a long time that some form of
moral psychology was of urgent importance to alcoholics,
but its application presented difficulties beyond our
conception. What with our ultra-modern standards, our
scientific approach to everything, we are perhaps not well
equipped to apply the powers of good that lie outside our
synthetic knowledge.
Many years ago one of the leading contributors to this book
came under our care in this hospital and while here he
acquired some ideas which he put into practical application
at once.
Later, he requested the privilege of being allowed to tell
his story to other patients here and with some misgiving,
we consented. The cases we have followed through have
been most interesting; in fact, many of them are amazing.
The unselfishness of these men as we have come to know
them, the entire absence of profit motive, and their
community spirit, is indeed inspiring to one who has
labored long and wearily in this alcoholic field. They
believe in themselves, and still more in the Power which
pulls chronic alcoholics back from the gates of death.
Of course an alcoholic ought to be freed from his physical
xxviii The Doctor's Opinion
craving for liquor, and this often requires a definite hospital
procedure, before psychological measures can be of
maximum benefit.
We believe, and so suggested a few years ago, that the
action of alcohol on these chronic alcoholics is a
manifestation of an allergy; that the phenomenon of
craving is limited to this class and never occurs in the
average temperate drinker.
(See BB 20:5 - 21:1, 44:1, 108 Bottom - 109:1)
These allergic types can never
safely use alcohol in any form at all; and once having
formed the habit and found they cannot break it, once
having lost their self-confidence, their reliance upon things
human, their problems pile up on them and become
astonishingly difficult to solve.
No other kind of bankruptcy is like this one. Alcohol,
now become the rapacious creditor, bleeds us of all
self-sufficiency and all will to resist its demands. Once
this stark fact is accepted, our bankruptcy as going
human concerns is complete.
T&T 21 Step One
Frothy emotional appeal seldom suffices. The message
which can interest and hold these alcoholic people must
have depth and weight. In nearly all cases, their ideals must
be grounded in a power greater than themselves, if they are
to re-create their lives.
If any feel that as psychiatrists directing a hospital for
alcoholics we appear somewhat sentimental, let them stand
with us a while on the firing line, see the tragedies, the
despairing wives, the little children; let the solving of these
problems become a part of their daily work, and even of
their sleeping moments, and the most cynical will not
wonder that we have accepted and encouraged this
movement. We feel, after many years of experience, that
we have found nothing which has contributed more to the
rehabilitation of these men than the altruistic movement
now growing up among them.
Men and women drink essentially because they like the
effect produced by alcohol. The sensation is so elusive that,
while they admit it is injurious, they cannot after a time
differentiate the true from the false. To them, their
alcoholic life seems the only normal one. They are restless,
irritable and discontented,
The chief activator of our defects has been self-centered
fear-primarily fear that we would lose something we already
possessed or would fail to get something we
demanded. Living upon a basis of unsatisfied demands, we
were in a state of continual disturbance and frustration.
T&T 76 Step Seven
unless they can again experience
The Doctor's Opinion xxix
the sense of ease and comfort which comes at once by
taking a few drinks
(See BB 73:2)
-drinks which they see others taking
with impunity. After they have succumbed to the desire
again, as so many do, and the phenomenon of craving
develops, they pass through the well-known stages of a
spree, emerging remorseful, with a firm resolution not to
drink again. This is repeated over and over, and unless this
person can experience an entire psychic change there is
very little hope of his recovery.
On the other hand-and strange as this may seem to those
who do not understand-once a psychic change has
occurred, the very same person who seemed doomed, who
had so many problems he despaired of ever solving them,
suddenly finds himself easily able to control his desire for
alcohol, the only effort necessary being that required to
follow a few simple rules. (See BB 50 Bottom)
Men have cried out to me in sincere and despairing appeal:
“Doctor, I cannot go on like this! I have everything to live
for! I must stop, but I cannot! You must help me!’’
Faced with this problem, if a doctor is honest with himself,
he must sometimes feel his own inadequacy. Although he
gives all that is in him, it often is not enough. One feels that
something more than human power is needed to produce
the essential psychic change. Though the aggregate of
recoveries resulting from psychiatric effort is considerable,
we physicians must admit we have made little impression
upon the problem as a whole. Many types do not respond
to the ordinary psychological approach.
I do not hold with those who believe that alcoholism is
entirely a problem of mental control. I have had many men
who had, for example, worked a period of months on some
problem or business deal which was to be settled on a
certain date, favorably to them. They took a drink a day or
so prior to the date, and then the phenomenon of craving
at once became paramount to all other interests so that the
xxx The Doctor's Opinion
important appointment was not met. These men were not
drinking to escape; they were drinking to overcome a
craving beyond their mental control.
(See BB 2:1, 5:3, 174:2)
There are many situations which arise out of the
phenomenon of craving which cause men to make the
supreme sacrifice rather than continue to fight.
The classification of alcoholics seems most difficult, and in
much detail is outside the scope of this book. There are, of
course, the psychopaths who are emotionally unstable. We
are all familiar with this type. They are always “going on the
wagon for keeps.’’ They are over-remorseful and make
many resolutions, but never a decision.
There is the type of man who is unwilling to admit that he
cannot take a drink. He plans various ways of drinking. He
changes his brand or his environment.
(See BB 109:1)
There is the type
who always believes that after being entirely free from
alcohol for a period of time he can take a drink without
danger.
(See BB 33:1, 154:3)
There is the manic-depressive type, who is,
perhaps, the least understood by his friends, and about
whom a whole chapter could be written.
Then there are types entirely normal in every respect
except in the effect alcohol has upon them. They are often
able, intelligent, friendly people. (See BB 7:2, 21:2, 22:2, 107:3)
All these, and many others, have one symptom in common:
they cannot start drinking without developing the
phenomenon of craving.
(See BB 22:4)
This phenomenon, as we have
suggested, may be the manifestation of an allergy which
differentiates these people, and sets them apart as a
distinct entity. It has never been, by any treatment with
which we are familiar, permanently eradicated. The only
relief we have to suggest is entire abstinence. (See BB 31 Top)
This immediately precipitates us into a seething caldron of
debate. Much has been written pro and con, but among
physicians, the general opinion seems to be that most
chronic alcoholics are doomed.
The Doctor's Opinion xxxi
What is the solution? Perhaps I can best answer this by
relating one of my experiences.
About one year prior to this experience a man was brought
in to be treated for chronic alcoholism. He had but partially
recovered from a gastric hemorrhage and seemed to be a
case of pathological mental deterioration. He had lost
everything worthwhile in life and was only living, one might
say, to drink. He frankly admitted and believed that for him
there was no hope. Following the elimination of alcohol,
there was found to be no permanent brain injury. He
accepted the plan outlined in this book. One year later he
called to see me, and I experienced a very strange
sensation. I knew the man by name, and partly recognized
his features, but there all resemblance ended. From a
trembling, despairing, nervous wreck, had emerged a man
brimming over with self-reliance and contentment. I talked
with him for some time, but was not able to bring myself to
feel that I had known him before. To me he was a stranger,
and so he left me. A long time has passed with no return to
alcohol.
When I need a mental uplift, I often think of another case
brought in by a physician prominent in New York. The
patient had made his own diagnosis, and deciding his
situation hopeless, had hidden in a deserted barn
determined to die. He was rescued by a searching party,
and, in desperate condition, brought to me. Following his
physical rehabilitation, he had a talk with me in which he
frankly stated he thought the treatment a waste of effort,
unless I could assure him, which no one ever had, that in
the future he would have the “will power’’ to resist the
impulse to drink.
His alcoholic problem was so complex, and his depression
so great, that we felt his only hope would be through what
we then called “moral psychology,’’ and we doubted if even
that would have any effect.
xxxii The Doctor's Opinion
However, he did become “sold’’ on the ideas contained in
this book. He has not had a drink for a great many years. I
see him now and then and he is as fine a specimen of
manhood as one could wish to meet.
I earnestly advise every alcoholic to read this book through,
and though perhaps he came to scoff, he may remain to
pray.
It has been well said that “almost the only scoffers at prayer are
those who never tried it enough.”
T&T 97 Step Eleven
William D. Silkworth, M.D.