Alcoholism as a disease

[tomvlll]

What is AA's position on alcoholism as a disease?

I know it's not referred to as such in the Big Book, and Wilson at one time stated that AA did not call it that, but it is referenced as a '"progressive disease" in a pamphlet " AA and the Newcomer".

[paulmh]

[IO Storm]

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 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 better 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 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. 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.

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, unless they can again experience the sense of ease and comfort which comes at once by taking a few drinks—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.

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 important appointment was not met. These men were not drinking to escape; they were drinking to overcome a craving beyond their mental control.

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. 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. 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.

All these, and many others, have one symptom in common: they cannot start drinking without developing the phenomenon of craving. 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.

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.

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.

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.

William D. Silkworth, M.D.

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[IO Storm]

I know that alcoholism was recognized as a disease by medical science until 1965.

I would have to research this as well.

Maybe someone else knows...pass the popcorn, paul.

[RufusACanal]

Does it really matter?

[MCake]

Originally Posted by RufusACanal

Does it really matter?

In the past, the disease controversy weighed heavy in my mind - and it was an excuse to keep drinking. These days I've formed my personal opinion, but it really all boiled down to whether I wanted to keep drinking or whether I was willing to change.

[FightingIrish]

Yes, I have a dis-ease.

That popcorn thing makes me laugh out loud every time!

[McGowdog]

Is alcoholism a disease? Gee, I do not know. I'm not a doctor. But when I get drunk, lock up your daughter, lock up your wife, lock up your back door, run for your life.

I think what Dr S was saying, if I had to paraphrase him, "Gee, I do not know. I'm not a doc-er wait! I don't know how to fix you guys. You need Divine Intervention. I can't fix you."

And that took onions to say what he did!

[Freedom1990]

Originally Posted by paulmh

Would you like some butter with that popcorn?

[joedris]

Hear I go again. YES! Alcoholism is a disease. It was recognized as such by the AMA in 1956. However, very little is known about alcoholism as a disease, and there is little or no agreement defining alcoholism. Pyschiatrists evaluate a person for being an alcoholic by using DSM IV - their diagnostic and statistics manual, 4th edition. The criteria the shrinks use is different than what ASMA uses. Look up "definiition of alcoholism" on Google and today you'll get 233,000 different hits. And none agree with any others. It's a tough thing to nail down as alcoholism has both physical and psychological symptoms. And it's treated by behavioral therapy, not medication.
Bill Wilson, in writing the Big Book, called alcoholism an allergy. But that was in the 1930's and he called it an allergy for lack of a better word. The best definition I've come across is "An adverse physical and psychological reaction to the drug ethenol" (which is what alcohol is). It is generally agreed upon that alcoholism is a primary disease (nothing causes it but alcohol consumption), it's progressive (gets worse over time), it's chronic (you'll always have it), and it's fatal. If left untreated, alcoholism will kill you.
Society, unfortunately, views alcoholism as a social evil due to how we act when we drink. Very little research is being done in the area as compared to other diseases such as cancer, yet alcoholism is responsible for more deaths each year than cancer. You'll never see a pretty pink bow on someone's bumper saying "Find a cure for alcoholism."
The most effective program for treatment of alcoholism is AA. That is, of course, getting into AA after detox and perhaps a residential treatment program. And the success rate for AA isn't very good, between 5 and 10 percent of those who enter AA are successful in recovery (maintaining sobriety for 5 years). But I don't think the low success rate reflects on the AA program as much as it reflects on the people who don't stay with it. "Seldom have we seen a person fail who has thoroughly followed our path."
And this is true. There's a 99% success rate for those who go to meetings, get a sponsor, work the steps and continue in the program to help others.
What causes one to be an alcoholic? No one is quite sure. Heredity plays a part - 60% of alcoholics have a family history of the disease. But then there's annoying 40% who have no family history, How come they're alcoholics? And alcoholism strikes 10 - 13% of those who drink. Why don't the other 90% get it?
But all of this really doesn't matter. If you're an alcoholic you need to deal with it and not worry as to why you have it. Because if you don't, your future narrows down to jail, a mental institution (wet brain or Wernikie/Karsacoff syndrome), or death. So don't worry if it's a disease or not. It doesn't matter.

[McGowdog]

Originally Posted by joedris

But that was in the 1930's and he called it an allergy for lack of a better word...

The above black letters on the grayish background above^ is where I decided to stop reading no further as I cannot agree with the words or their collective meaning.

I believe that Bill W. had all kinds of neat words to use and the 1930's in particular were a hotbed for a whole bunch of Divine Inspiration and they had that part of the book written just perfectly as it was.

I applaud the effort of the above post and it is very inspirational in parts, but the alcoholic who seeks recovery need not even get into the "social evil" judgement we potentially face when we drink. The world is gonna play their games and we're gonna play ours.

There are gonna be many many solutions to the recovery of alcoholism, but I need only pick one.

I know where I stand and I know what works. I don't need a certain definition of my malady which would give it more political clout in order to recover from it. I could go into further detail why I use the term "political clout", but I don't have time to get into it now.

And alcoholism strikes 10 - 13% of those who drink.

I totally agree with this, and this is a very, very controversial stance. Your stock just went up for me.

I have a snow storm to drive home in, so wish me well and have a nice weekend kiddies!

[laurie6781]

I know that alcoholism was recognized as a disease by medical science until 1965.

Actually IQ the AMA classified it as a disease in 1955, in part (a large part) on the papers that Dr. Silkworth had written over the years.

Personally, call it a disease, don't call it a disease, doesn't matter to this alkie. I have the affliction, I found a way for me to obtain and maintain sobriety based on a program of 12 steps. It's been almost 28 years now.

I can't drink and live. It is that simple for me.

Please pass some popcorn over here too Paul.

Love and hugs,

[CarolD]

Hmm....
I did catch the ....malady...hex...allergy...disease ...pox....illness ....sin



Now I live a fantastic life in the AA solution.

[navysteve]

Continue to speak of alcoholism as an illness, a fatal malady. Talk about the c onditions of body and mind which accompany it.

A malady is a disease. Did they mean it in the literal sense? Don't know and don't really care. The disease concept works. You can treat a disease. You can treat alcoholism. You do not have to suffer from it forever. You do not have to fight each day waiting for that next outbreak of alcoholism to occur. You can recover from a disease.

[Tommyh]

I see it referred to in the Big Book as a illness or malady.
AA does not define alcoholism but lists symthons of alcoholism.
Anyway,I have screwed around and caught the allergy.....

[joinedintime]

Having the popcorn as the second post in thread with a question like this is simply classic.

Maybe it's been done many times here at SR but it's the first time I've seen it.

Well done.

paulhm is hereby nominated for a....let's see, what should we call it? Emmy, Oscar, Espy and Grammy are taken...how about Sobey?

Yeah, that's it. I nominate paulhm for a Sobey in the category of "Saying the most with the least"

[tomvlll]

Thanks for the answers, but my questions wasn't whether alcoholism was a disease or not.

It was whether AA considers it a disease or not.

IOW , would it be contrary to trad. 10 for a member of AA ,speaking as a member of AA, to refer to it as a disease?

[navysteve]

AA has no opinion Tom, we are AA and aparently...
We vary

[24hrsAday]

i really don't know if it is or not.. i do know that the affliction will destroy whatever life i have left and then kill me.. if i continue to drink though..

[RufusACanal]

Tom,

Are you not asking for personal perceptive on individual adherence to the Tenth Tradition? Here is something that rather speaks for me;

Tradition Ten
"Alcoholics Anonymous has no opinion on outside issues; hence the A.A. name ought never be drawn into public controversy."
NEVER since it began has Alcoholics Anonymous been divided by a major controversial issue. Nor has our Fellowship ever publicly taken sides on any question in an embattled world. This, however, has been no earned virtue. It could almost be said that we were born with it, for, as one old-timer recently declared, "Practically never have I heard a heated religious, political, or reform argument among A.A. members. So long as we don't argue these matters privately, it's a cinch we never shall publicly."

As by some deep instinct, we A.A.'s have known from the very beginning that we must never, no matter what the provocation, publicly take sides in any fight, even a worthy one. All history affords us the spectacle of striving nations and groups finally torn asunder because they were designed for, or tempted into, controversy. Others fell apart because of sheer self-righteousness while trying to enforce upon the rest of mankind some millennium of their own specification. In our own times, we have seen millions die in political and economic wars often spurred by religious and racial difference. We live in the imminent possibility of a fresh holocaust to determine how men shall be governed, and how the products of nature and toil shall be divided among them. That is the spiritual climate in which A.A. was born, and by God's grace has nevertheless flourished.

Let us reemphasize that this reluctance to fight one another or anybody else is not counted as some special virtue which makes us feel superior to other people. Nor does it means that the members of Alcoholics Anonymous, now restored as citizens of the world, are going to back away from their individual responsibilities to act as they see the right upon issues of our time. But when it comes to A.A. as a whole, that's quite a different matter. In this respect, we do not enter into public controversy, because we know that our Society will perish if it does. We conceive the survival and spread of Alcoholics Anonymous to be something of far greater importance than the weight we could collectively throw back of any other cause. Since recovery from alcoholism is life itself to us, it is imperative that we preserve in full strength our means of survival.

Maybe this sounds as thought the alcoholics in A.A. had suddenly gone peaceable, and become one great big happy family. Of course, this isn't so at all. Human beings that we are, we squabble. Before we leveled off a bit, A.A. looked more like one prodigious squabble than anything else, at least on the surface. A corporation director who had just voted a company expenditure of a hundred thousand dollars would appear at an A.A. business meeting and blow his top over an outlay of twenty-five dollars' worth of needed postage stamps. Disliking the attempt of some to manage a group, half its membership might angrily rush off to form another group more to their liking. Elders, temporarily turned Pharisee, have sulked. Bitter attacks have been directed against people suspected of mixed motives. Despite their din, our puny rows never did A.A. a particle of harm. They were just part and parcel of learning to work and live together. Let it be noted, too, that they were almost always concerned with ways to make A.A. more effective, how to do the most good for the most alcoholics.

The Washingtonian Society, a movement among alcoholics which started in Baltimore a century ago, almost discovered the answer to alcoholism. At first, the society was composed entirely of alcoholics trying to help one another. The early members foresaw that they should dedicate themselves to this sole aim. In many respects, the Washingtonians were akin to A.A. of today. Their membership passed the hundred thousand mark. Had they been left to themselves, and had they stuck to their one goal, they might have found the rest of the answer. But this didn't happen. Instead, the Washingtonians permitted politicians and reformers, both alcoholic and nonalcoholic, to use the society for their own purposes. Abolition of slavery, for example, was a stormy political issue then. Soon, Washingtonian speakers violently and publicly took sides on this question. Maybe the society could have survived the abolition controversy, but it didn't have a chance from the moment it determined to reform America's drinking habits. When the Washingtonians became temperance crusaders, within a very few years they had completely lost their effectiveness in helping alcoholics.

The lesson to be learned from the Washingtonians was not overlooked by Alcoholics Anonymous. As we surveyed the wreck of that movement, early A.A. members resolved to keep our Society out of public controversy. Thus was laid the cornerstone for Tradition Ten: "Alcoholics Anonymous has no opinion on outside issues; hence the A.A. name ought never be drawn into public controversy."

[Music]

Originally Posted by paulmh

I'm wondering if it's time to get out the rope!!

[McGowdog]

Originally Posted by tomvlll

...It was whether AA considers it a disease or not.

IOW , would it be contrary to trad. 10 for a member of AA ,speaking as a member of AA, to refer to it as a disease?

You know the bummer about the 1st Edition BB? No traditions. Not until about 1950 during that World Conference? I don't remember. That was pre-McGowdog.

Well anyways, if I'm gonna throw out a tradition, I like to go LF, which mentions, "...controversial issues- particularly those of politics, alcohol reform, or sectarian religion."

So with that in mind, I go off the ranch and don't speak for AA when I feel I have to defend it.

So to defend AA without violating traditions and hopefully not causing harm, I merely ask anybody who DOES think AA calls it a disease to merely state your sources please.

[Tommyh]

my second sponsor cautioned me about speaking of alcoholism as a disease in a meeting...
careful,he said,half this crowd will run over you after the meeting trying to get to the doctors office to get pills

the term,or word disease, can insulate medical treatment [pills] in the minds of some people,and that is one reason I do not use it.

for me,my jackass got in a big ditch,my main concern is getting the heck out

[LauraS]

New to all of this, but not new to this controversy as I've seen a number of friends run screaming from AA because they couldn't accept the disease model of alcoholism.

So, FWIW, here is my own unofficial opinion. Yes, it is a disease. A disease does not need to be caused by a bacterium or virus. Perhaps it would be more clear to call it a syndrome or a condition or something else, but for me that is not important.

I have far more difficultly with the allergy concept, as it seems contrary to what we know, medically, about allergy today. When I read the BB, I have to compartmentalize this term as a quaint and old-fashioned term for addiction, which was based on the limited understanding of the day. It's a little like using the term "consumption" for tuberculosis. I do not think it is an appropriate medical term to use in 2009 in the way the book uses it and, unfortunately, things like this provide convenient stumbling points for people who might be looking for an excuse to jettison the program. However, as long as I accept it as outdated terminology for addiction, I am okay with what is being said.

What is important is that we know that certain things work in leading us to recovery. The rest, to me, seems to be a matter of semantics, changes in the way we use language and changes in our understanding of medical conditions. Let's not get bogged down in these things and forget to do the work of recovery.

[paulmh]

What I love about AA is that all of us who are in it have not only a common solution, but a solution in common.

We've found a way that works for us. We've also got a book which provides a common benchmark for us all. No-one has to agree with some, any or all of what's in the book. But if you want to be a member of AA you accept, tacitly or not, that the solution we have in common is described, warts, flaws, imperfections and all, in the first 164 pages of the BB, and it is to this, rather than Stanton Peele, Jack Trimpey, Terence Gorski or whoever that we refer when we are talking about our "common solution".

Part of our common solution is described in step one - that we were powerless over alcohol. Part of that powerlessness is physical, and this is one of the things that sets us apart from "normal" drinkers. The physical differences have been described by geneticists, neurologists, biochemists. Some of the differences are acquired, some might be acquired and could also be "unacquired", and some of them are acquired or inherent and will never change. I wasn't able to get sober until I began to treat my alcoholism as a condition which I had and which required stringent management. At the time I called it a disease. In AA I call it a disease. In front of the world health organisation could I make the case that it's a disease? No. Could I make the case that thinking of it as a disease was critical in me getting sober? Hell yeah. Thinking of alcoholism as a condition over which I have no control, which I need to manage and which I can't "unacquire" is a part of the common solution I share with the recovering alkies in my life. The word we use to describe that where I come from is "disease" - but I've met plenty of people who have shown me that that might be very lazy shorthand. But thinking of it as a "disease", is, as far as I can see, completely consistent with the spirit and the message of AA - and so, for those of us who have benefitted from this common solution, it's completely acceptable and commonly understood language.