The Doctor's Opinion

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What is the cause of my drinking? When I begin drinking I never intend for it to get so out of control. When I sober up I vow that I'll never do it again but the day always comes when I drink again. What is wrong with me? Am I supposed to take the advice of a bunch of drunks? What does the medical community think of their program of recovery?

William Silkworth, M.D., a non-alcoholic, gives us his opinion of the soundness of the program of recovery outlined in this book. He also explains his theory of why alcoholics are unable to control their drinking. The doctor's description of alcoholism shows clearly the dire physical condition of the alcoholic. This illustration begins to explain why the alcoholic is seemingly beyond help.

Dr. Silkworth was the medical director, specializing in the treatment of alcoholics and drug addicts, at the Charles B. Towns Hospital located in New York. What better credentials could a person have to review this program of recovery? Dr. Silkworth's appraisal of A.A.'s program (xxvi:7) shows this great appreciateion for it's effectiveness. He recounts instances of alcoholics, whom he doubted could ever recover, being restored to health by the application of the principles set forth in this volume. (xxiii:6-11, xxv:7-11, xxix:3-xxx:3)

Dr. Silkworth's theory is that the craving an alcoholic experiences after the consumption of alcohol is the manifestation of an allergy (xxvi:1). This seems to make sense in light of our experience. The doctor's description of the physical symptoms of alcoholism helps us to diagnose ourselves (xxvi:8, xxvii:2, xxvi:15-xxviii:1). The doctor continues to describe the symptoms of alcoholism and the different types of alcoholics (xxvii:3-18). Dr. Silkworth plainly states that the general opinion among physicians is that chronic alcoholics are doomed (xxviii:20). The doctor finishes on a hopeful note describing how two early A.A. members, though seemingly hopeless, discovered and applied the solution offered in this book (xxix:1-xxx:3).

Dr. Silkworth's advice is for us to read the book through. His hope is that we will accept the solution offerd therein (xxx:4).

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Introduction: We can trust the opinion of a physician with qualifications such as these.

First Letter: The doctor's appraisal of the program suggested in the book lends authority to what the authors have to say.

Summary of the doctor's letters: Alcoholism is a three-fold malady that affects us mentally, physically, and spiritually.

Second Letter: Alcoholism is diagnosable, it has symptoms that can be recognized. It is progressive, it only gets worse never better. It cannot be cured. There is a solution, the adoption of the principles contained in this book will result in recovery.

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1879-1951

We begin to wonder why it is that we cannot control our drinking. We believe ourselves weak willed or morally deficent. Dr. Silkworth saw alcoholism as an illness, a manifestation of an allergy. The doctor's opinion gives us a rational basis from which to begin our examination of the problem of alcoholism. Our own experience validates his view of the physcial aspects of alchollism. When we begin to drink we develop a craving for more alcohol that is beyond our ability to control. Dr. Silkworth treated Bill W. for alcoholism the second, third, and fourth times he was admitted to Town's Hospital in New York. Dr. Silkworth explained to Bill the grave nature of his affliction. This information helped Bill to admit his powerlessness over alcohol so that he was open to the solution for alcoholism suggested to him by his high school friend Ebby T.

Following Bill's spiritual awakening, Dr. Silkworth allowed Bill to share his experience with alcoholic patients at Town's Hospital. Bill was having no success in passing on his life saving experience when the doctor suggested that he, "Stop preaching at them and give them the hard medical facts first." Bill followed this advice when he had his first meeting with Dr. Bob. Bill told Dr. Bob of what he had learned from Dr. Silkworth of the hopelessness of his own alcoholic condition.

Dr. Silkworth, a graduate of Princeton University, obtained his medical degree from New York University-Bellevue Medical School, he specialized in neurology. He treated 40,000 alcoholics during his career spending his last years at Knickerbocker Hospital in New York working with his nurse Teddy.

Dr. Esther Richards of Johns Hopkins Hospital in Baltimore suggested to Bill W. that an introduction by a specialist in the field of alcholism would be a benefit to the book. Nine days later Dr. Silkworth wrote the first letter of endorsement for this program of recovery that appears in this book.

Just three months after the book Alcoholics Anonymous was printed Dr. Silkworth published the first medical paper on A.A.: "A New Approach to Psychotherapy in Chronic Alcoholism" in Journal-Lancet in July of 1939.

Dr. Silkworth lent A.A. money to get started and spoke in favor of the fledgling society at meetings with potential financial backers. Dr. Silkworth was a great friend to A.A. throughout the remainder of his life.

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The Doctor's Opinion

An opinion is just that. Our acceptance of the doctor's hypothesis is based on over 60 years of successful treatment founded on this model of alcoholism, coupled with the program of action outlined in this book.


Source: Annotated AA Handbook
A Companion to the Big Book
by Frank D.

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2-3

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 prominet hospital specializing in alcoholic and drug addiction, gave Alcoholics Anonymous this ltter:

The authors hoped that the opinion of a physician with such appropriate experience would help convince us that their program of recovery will work for us.

*NOTE:
Dr. Silkworth's proper title was Medical Director.

6.

About four years ago I attended a patient who, though he had been a competent business man 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.

Though this man would be respected, he nevertheless has become a hopeless alcoholic. Alcoholism affects people of every race, creed, nationality, religion, social and economical class, moral standing, ability, intelligence and occupation.

*NOTE:
Bill W. is the patient referred to.

Bill W. was in the treatment center for the third time! There they would dry him out, nurse him back to health, explain to him the grave nature of his malady, suggest that he refrain from further drinking and send him home. After varying lengths of time, he would resume drinking and require further treatment.

Bill gained knowledge of the nature of alcoholism from Dr. Silkworth. He was presented with the solution to his problem by his friend Ebby T. He combined these two components with a practice of carrying this solution to others.


Source: Annotated AA Handbook
A Companion to the Big Book
by Frank D.

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1.

These men may well have a remedy for thousands of such situations.

The doctor recognized this program for what it is: the most successful treatment for chronic alcoholics that has ever existed. He saw that carrying this message to those who still suffered would ignite a great fire of recovery bringing this solution to alcoholics everywhere.

5-9

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 taht 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 beilef, any pictures of the alcoholic which leaves out this physical factor is incomplete.

This "must" can be taken in two ways. (1)Our bodies are as abnormal as our minds. This is the inescapable conclusion of anyone who has experienced alcoholic addiction and the phenomenon of craving. (2)The authors might also be expressing to us that this conviction is a necessary component of our recovery.

The doctor's theory explains why we are unable to stop drinking once we begin. We stop off after work for one drink and wind up staying till closing. We decide to have one drink to relax and end up drunk. Understanding the physical reason for this is as important as understanding the mental causes. When alcoholics drink, we develop a physical craving for alcohol compelling us to continue drinking.

10-13

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 ex-alcoholics, we can say that his explanation makes good sense. It explains many things for which we cannot otherwise account.

Reading this chapter helps us to take the first step in recovery from alcoholism. Admitting we are powerless over alcohol is not so difficult when the physical aspect of the illness is so clearly illustrated.

*Definitions:
Allergy: an abnormal reaction, an increased sensitivity.

14-15

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 authors saw the value of medical care during withdrawal from alcohol. Application of the theories and techniques presented in this volume can best begin after we emerge from the fog of our last drunk.

What this book has to offer is a simple kit of spiritual tools. These tools are offered to us rather than forced upon us.


*Definitions:
Altruistic: an action taken due to an unselfish concern for others.
Imperative: mandatory

Souce: The Annotated AA Handbook
A companion to the Big Book
By Frank D.

Source: Annotated AA Handbook
A Companion to the Big Book
by Frank D.

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2.

The subject presented in this book seems to me to be of paramount importance to those afflicted with alcoholic addiction.

What could be more important to a practicing alcoholic than the hope of a solution? We decieve ourselves about what the problem with our lives really is. We think our spouse is the problem or our children or the pressures on the job. Though we may have many troubles, the one we must address first is our alcoholism.

Definition:
Paramount: First and foremost. Primary.

3.

I say this after many years experience as Medical Director of one of the oldest hospitals in the country treating alcoholic and drug addiction.

This doctor's many years of experience lends weight to his endorsement of this program of recovery.

*Historical Note:
The doctor has been at Town's Hospital for approximately nine years at the time he wrote this letter.

5-7.

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 standard, our scientific approach to everything, we are perhaps not well equipped to apply the powers of good that lie outside our synthetic knowledge.
About four years ago one of the leading contributors to this book came under our care in this hospitatla and while here he acquired some ideas which he put into practical application at once.

If doctors were able to relieve us of our alcoholism, they would. If we do not respond to medical care, we may be beyond human help. Dr. Silkworth perceived that a complete change in an alcoholic's ideas and attitudes about life is what is needed for recovery. He thus concedes that medical science is nto effective at bringing forth this change. The doctor further concedes that this may be beyond the realm of human ability.

Bill W. was under Dr. Silkworth's care at Town's Hospital when Ebby T. showed him this simple program of action. This together with the knowledge of the physical aspects of alcoholism and the pactice of carrying the solution to others led to Bill W's recovery. Now that we are being presented with the solution are we willing to put the program into practical application at once?

10-12

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 believed 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 definate hospital procedure, before psychological measures can be of maximum benefit.

For these exact reason Alcoholics Anonymous is phenomenally successful at carrying this solution to millions of suffering alcoholics.

Medical science is skilled at drying drunks out. Keeping them dry is the difficulty. Quitting is not our problem, many of us are very good at quitting, having done it many, many times. Our problem is that we can't stay quit.

Definition:
Chronic: 1. Habitual. 2 Physical and psychological disorders resulting from repeated and excessive use of alcohol.


Source:
The Annotated AA Handbook
A companion to the Big Book
By Frank D.

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1-3

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.

In 1937, Dr. Silkworth published his theory that alcoholism is the manifestation of an allergy. This allergy, which causes the phenomenon of craving, occurs only in alcoholics.

Once we develop the phenomenon of craving, we can never return to non-alcoholic drinking. Any amount or type of alcohol in any of it's forms or uses, beer, wine, hard liquor, aperitifs, wine in cooking, alcohol in desserts or medications, stands to trigger the overpowering desire for more alcohol.

Failing repeatedly to stop on our own destroys our self-confidence. Wives, parents, families, doctors, psychiatrists, and friends all fail in their attempts to help us break the cycle of addictive drinking. We are left facing the inability of human resources to give us release. Our lives become unmanageable. We are seemingly hopeless.

Everyone who loves or cares about us begins to plead with us to quit drinking. We may be angered with their meddling and ignore their pleas. We may sincerely want to quit and swear off for a time, but we always return to drinking. The authors have been where we are and offer to show us what they have done to recover. Perhaps we could listen. They propose to show us how to access a Power that will recreate our lives.

Definitions:
Allergy: an abnormal reaction, an increased sensitivity.
Phenomenon: an observable but unexplainable fact.
Temperate: moderate in indulgence.

5

In nearly all cases, their ideals must be grounded in a Power greater than themselves, if they are to re-create their lives.

We would not see the need to recreate our lives if we could just modify our behavior and were then able to manage our lives successfully once again. This is why the admission of powerlessness over alcohol ---- the unmanageability of our lives --- is essential to our recovery.

7-11

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.

Once again the doctor draws upon his years of experience to recommend Alcoholics Anonymous.

Definition:
Altruistic: unselfish concern for others.
Impunity: without punishment.

This description of alcoholism is here to help us take our first step. It describes our behavior so clearly that we can see that our own experience closely parallels that of an alcoholic. The description ends with an illustration of the baffeling nature of alcoholism -- that we continue to drink even when we truly desire to stop.

After a while we lose the ability to tell the true from the false. We go insane. Not being able to tell the true from the false is a perfect definition of insanity. Being insane, we are unable to see that our alcoholic life is abnormal to the extreme. Being insane, we believe the false to be true. We believe that we will be able to control our drinking and put our lives in order on our own. If this were the truth, then most of us would have done just that.

Alcohol was our solution to our feelings of restlessness, irritability and discontent. It was a solution that produced remorse a solution that caused even more trouble, a solution that failed.


Source:
The Annotated AA Handbook
A companion to the Big Book
By Frank D.

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1-7

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 repeated over and over, and unlesss 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 hs 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!

How many times have we started out to enjoy a few drinks and ended up drunk! We're insane to believe that "this time we will be able to control it." How many times have we vowed, while hungover, never to drink again?

This return to drinking is so common among alcoholics that the authors were able to develop a theory as to why a perfectly sober individual, having a thorough understanding of the severe consequences of drinking alcohol, would drink again (34:9-12).

This endless cycle must be broken or we will die. Much more is needed than intentions or vows to quit drinking. We must experience an entire psychic change. A complete change in the way we view the world around us and our place in it is required, if we are to gain victory over alcohol.

Doctor Silkworth's opinion was that alcoholics are unable to drink normally and that if they are incapable of maintaining total abstinence then there is little hope for their recovery. The doctor saw that an entire psychic change was the solution to this problem, but knew of no way to bring such a change about.

Do we seem doomed? The promise here is that our problem can be removed from us by following a few simple rules. What is this psychic change that will enable us to easily control our desire for alcohol? What are the rules we must follow?

When we realize that we can not stop, even though we honestly want to, we turn to the help of physicians, psychiatrists, and counselors. If we do not respond to their treatment, we may realize that we are beyond human aid.

Definition:
Despair: without hope.
Essential: necessary
Aggregate: total amount of.
Paramount: of primary importance.

13

I do not hold with those who believe that alcoholism is entirely a problem of mental control.

How well has mental control worked at keeping us from taking that first drink? How well does it work to control our drinking once we start?

15

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.

We can try to identify the phenomenon of craving in our own drinking patterns. Alcoholics cannot always control how much they drink. Non-alcoholics can always control the amount of alcohol they drink.


Source:
The Annotated AA Handbook
A companion to the Big Book
By Frank D.

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2-3

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 fo 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.

The hopelessness and self-loathing we feel when we find we can not use self-will to overcome our drinking problem leads many alcoholics to commit suicide.

Though we may not fit exactly into any specific category we may see that we have some similarites with one or more of Dr. Silkworth's classification of alcoholics.

Doctor Silkworth's
Classification of alcoholics

xxviii:4-7 ----------Psychopaths
xxviii:8-10----------Unwilling to admit.
xxviii:11------------Believe that after a time they can drink again
xxviii:12------------Manic depressive
xxviii:13------------Entirely normal except when drinking

All these, and many others, have one sympton in common: they cannot start drinking without developing the phenomenon of craving. This phenomenon, as we have suggested, may be the mainfestation 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, permanentally 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.

Definitions: Eradicated: removed completely. Removed at the roots.
Abstinence: refraining from alcohol

How or what we drink is not important. One of the most positive ways of determining if we are alcoholic is if we ever experience the phenomenon of craving after we start to drink.

Non-alcoholic drinkers are always able to control how much they drink. We can ask ourselves if we are different from non-alcoholics. Do we have this allergy that results in an overpowering craving for more alcohol once we start to drink?

Have we ever been able to stay abstinent before/ If we cannot control our drinking, cannot quit completely, and there is no treatment that will make us like the non-alcoholic drinker, what hope do we have?

An alcoholic who continues to drink will become chronic. Medical science has no cure and considers us doomed. We cannot drink and live and no human power, ours or our doctors, can enable us to quit. We are seemingly hopeless. Remember this book is authored by more than one hundred men and women who have recoverd from this seemingly hopeless state of mind and body.


Source:
The Annotated AA Handbook
A companion to the Big Book
By Frank D.

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1

What is the solution?

The good news here is that there is a solution! We are only seemingly hopeless. Where are we to place our hope if all our past experience proves to us taht we are beyond human aid? We can gain hope from the experiences of those who have gone before us.

3

About one year prior to this experience a man was brought in to be treated for chronic alcoholism.

Historical Note:
xxix:3 Henry P. is the man referred to here. Henry authored the chapter "To Employers" and wrote the story "The Unbeliever."

5-6

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.

How far down the road to ruin has our alcoholism taken us? Are we at the gates of death? Are we deteriorating physically and mentally? Have we lost everything worthwhile in life yet? Do we see these things approaching?

This man took his first step. The admission to ourselves that we are beaten, that the resources we have at our disposal are not going to save us, that unless we find a solution we will die, is a necessary first step in recovery. This admission is an essential precondition to recovery. This is a vital part of the solution to our problem.

16

The patient had made his own diagnosis, and deciding his situation hopeless, had hidden in a deserted barn determined to die.

Once again the first step in recovery is illustrated. We must make our own diagnosis of our condition. Are we alcoholic? Can we cure ourselves?

18

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.

Why would we continue to believe that willpower was the answer to our drinking problem? Is willpower effective against other physical ailments? Doctor Silkworth thought that our inability to control our drinking was the result of an allergy, an increased susceptibility to alcohol.

Separating the physical, mental and spiritual aspects of the alcoholic condition helps us to more clearly see what is happening. The impulse to begin drinking is a different issue from the craving that results after begining to drink. The chapters "There is a Solution" and "More about Alcoholism" explore the impulse to begin drinking in great detail.


Source:
The Annotated AA Handbook
a companion to the Big Book
by Frank D.

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1

However, he did become "sold" on the ideas contained in this book.

If we can't cure ourselves, are we willing to examine the solution presented in these pages? Are we looking for a solution? Where else do we have to turn? becoming "sold" is one way of expressing that the man made a decision to put this program of action to work in his life.

In this case, like the earlier one, the man admitted his powerlessness over alcohol and made the decision to accept and practice the program of action outlined in the book.

4

I earnestly advise ever alcoholic to read this book through, and though perhaps he came to scoff, he may remain to pray.

Are we willing to follow the doctor's advice? Are we finished with our attempts to control our drinking? Are we here to criticize and find the dissimilarites, or are we ready to accept this program of recovery with it's proven record of success?


3rd Edition Text Changes:
xxx:2--------...more than three years. (to) ...a great many years.

Expert Opinion
xxiii:6-------------Dr. William Silkworth,
xxviii:15-20-------Dr. William Silkworth,
27:3-4------------Dr. Carl Jung, Switzerland,
43:7-8------------Dr. Percy Polick, Bellevue Hospital, New York,
73:23-------------Reference to medical opinion by Authors.

Historical Notes:
1784-------Dr. Benjamin Rush, a singer of the Declaration of Independence, describes alcoholic addiction as a disease.
1849-------Dr. Mangus Huss, Swedish physician, is the first to use the term "alcoholism".
1937-------Dr. William Silkworth publishes his theory, "Alcoholism as the Manifestation of an Allergy" in the Medical Record.
1951-------American Public Health Association describes alcoholism as illness.
1957-------American Medical Association declares alcoholism to be a "highly complex illness"



Source:
The Annotated AA Handbook
a companion to the Big Book
By Frank D.

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