THE DOCTOR'S OPINION

(pp. 11-20)

The members of Alcoholics Anonymous believe that anyone who reads this book will want to know the opinions of medical doctors. We say that our program works, but what do physicians think? Is there any proof of what A.A. claims?

We understand this. You may want this information before you commit to getting sober and decide to join the program. You may want evidence that it works from someone outside our organization. It helps to hear from doctors and other trusted professionals, who understand alcoholism and how it affects our health.

Sober/Sobriety:

The dictionary definition of these words focuses on one thing: NOT using mood-altering chemicals such as alcohol or narcotics.

The founders of A.A. understood this, too, and responded by getting input from a well-known expert. The Big Book includes several letters from Dr. William D. Silkworth, who is mentioned in the Foreword. Dr. Silkworth ran the Charles B. Towns Hospital for alcoholism and drug addiction in New York City during the 1930s. (One of his patients there was Bill W., one of the co-founders of A.A., whose story you will read in Chapter 1.)

Note

In A.A., we think about sobriety a little differently. First, in A.A. we focus only on alcohol. Second, our definition includes not drinking (or staying “dry”), but it also includes changing our outlook so that we can lead better, healthier, and more peaceful lives.

When A.A. was getting started, some alcoholics felt unsure about joining. They also wanted some sort of proof that the program could help them. So the co-founders asked for Dr. Silkworth's help. He wrote a letter saying that he'd seen the program work for many alcoholics. The co-founders knew they could show this convincing letter to anyone who had doubts. It could help them feel more comfortable about the program. It could help them be confident that it would be a positive force in their lives.

Below, you can read a plain language explanation of Dr. Silkworth's first letter. It is shown side-by-side with the original version that he sent to A.A. in the 1930s.

PLEASE NOTE:

The two versions contain all of the same information, but when you compare them the text may not line up exactly. It may help to read the plain language explanation first, and then read the original version.

Original	Plain Language explanation
To Whom It May Concern: 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.	I am a medical doctor who has worked with alcoholics for many years. In 1934, I had a patient who struggled to get sober. He was a businessman who made lots of money, so he seemed stable and successful in some important ways. He just could not stop himself from drinking. I had worked with alcoholics like him before, and sometimes felt like they could not be helped. This man came to my hospital three separate times to try to get sober. The third time I worked with him, he told me about an idea he had. I agreed to let him try it. He wanted to tell his story to the other alcoholics at the hospital. He wanted to explain to them why he drank and how he felt. He did this, and then he asked the other patients to do the same thing. Many of them agreed to try it. They shared their stories with each other, and continued to do so for many months. Now my businessman patient is sober. More than one hundred other people have joined his community of recovering alcoholics, and they have all stayed sober. Just by helping each other, they have changed their lives. I have worked with many patients who tried multiple methods to stop drinking, but nothing helped them. My patient's method seems to work, even for alcoholics who have struggled for a long time to get sober. Because of this, I believe he may be able to save thousands of lives. If you are reading this letter because you're not sure if his program can help you, I hope I have convinced you. You can trust this program and all the people who have joined it. This letter is signed: Very truly yours, William D. Silkworth, M.D.

Original

Plain Language explanation

To Whom It May Concern:

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.

I am a medical doctor who has worked with alcoholics for many years.

In 1934, I had a patient who struggled to get sober. He was a businessman who made lots of money, so he seemed stable and successful in some important ways. He just could not stop himself from drinking. I had worked with alcoholics like him before, and sometimes felt like they could not be helped.

This man came to my hospital three separate times to try to get sober. The third time I worked with him, he told me about an idea he had. I agreed to let him try it.

He wanted to tell his story to the other alcoholics at the hospital. He wanted to explain to them why he drank and how he felt. He did this, and then he asked the other patients to do the same thing. Many of them agreed to try it. They shared their stories with each other, and continued to do so for many months.

Now my businessman patient is sober. More than one hundred other people have joined his community of recovering alcoholics, and they have all stayed sober. Just by helping each other, they have changed their lives.

I have worked with many patients who tried multiple methods to stop drinking, but nothing helped them. My patient's method seems to work, even for alcoholics who have struggled for a long time to get sober.

Because of this, I believe he may be able to save thousands of lives.

If you are reading this letter because you're not sure if his program can help you, I hope I have convinced you. You can trust this program and all the people who have joined it.

This letter is signed:

Very truly yours,

William D. Silkworth, M.D.

Before the first Big Book was published, A.A.'s co-founders asked Dr. Silkworth to write more about his thoughts on the program. He said yes, and his second letter is printed below.

In this second letter, he says he believes that both the bodies and minds of alcoholics are affected by their alcoholism. This is something that many alcoholics already believed to be true. It was a huge relief to hear an expert agree.

A.A. members and other people who struggle with drinking are often told that we are unstable. We are told we are running away from our real lives. For some of us, those things are definitely true. But we felt certain that our struggles weren't just mental, but also physical. Alcoholism wasn't just in our heads and hearts. It was in our bodies, too. We are grateful to Dr. Silkworth for confirming this in his letter.

Chronic:

A problem or condition that lasts for a very long time, is difficult to change, and may come back after going away temporarily. A “chronic alcoholic” is someone who has been drinking for a long time. They may have stopped drinking for a little while, but they cannot stop permanently.

The A.A. program helps alcoholics work through their problems with beliefs and spirituality. But we do believe anyone whose mind is still foggy from alcohol should consider spending time in the hospital before joining A.A. Being clear-headed helps alcoholics understand and accept what we are teaching.

Here is Dr. Silkworth's second letter. Again, you will find a plain language explanation next to the original version that he wrote for publication in the first version of the Big Book.

Original	Plain Language explanation
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.	The ideas in this book are extremely important to anyone who struggles with alcoholism. I believe this because I have spent many years working with alcoholics. I work as the director of one of the oldest hospitals in the country. I help people recover from their alcoholism and drug addiction. When I was asked to write my opinion in this book, I was very happy to do it. I believe this book explains ideas that may help people who struggle to stop drinking. For a long time, doctors like me have believed that our patients needed more than just science and medicine to get sober. They needed some sort of mental or emotional system. They needed a way to understand themselves, forgive themselves, and rebuild their lives. Medical doctors like me knew this, but we didn't know how to create a system that would work. Then someone came along who knew how to do it. He knew exactly how to offer the kind of help that hospitals and doctors could not. Many years ago, one of the authors of this book came to the hospital where I work. He was trying to get sober himself and had a new idea about how to do it. He believed his idea could help other alcoholics, too. Later on, he asked my permission to tell his story to the other patients at my hospital. I wasn't sure how it would help anyone, but I let him try it. Since then, I have studied the cases of some of the people he met. The stories of these people are very interesting. Many of them are amazing. They are completely unselfish and work very hard to help each other defeat their alcoholism. It is inspiring to me, since I have worked long and hard in the field of alcoholism. After struggling for so long, they finally believe in themselves and the community they have built. They also believe in a Higher Power that can save them from more suffering … and maybe even death. We still believe that many alcoholics need to deal with their physical cravings for liquor before they can use a program like this. Here's why: We believe that alcohol affects chronic alcoholics differently from how it affects normal drinkers. It interacts with their bodies like an allergy. It forces them to behave in unpredictable ways. Regular drinkers never get the strong cravings that chronic alcoholics get. People with this alcohol allergy have cravings all the time. These cravings can feel impossible to control. This means that chronic alcoholics cannot safely drink alcohol of any kind. It means they can never drink. Once they know how it feels to drink and get drunk, they will form a drinking habit quickly and find it impossible to stop. They will lose self-confidence and ruin their relationships. They will watch their problems pile up and feel totally unable to solve them. Begging these people to stop drinking never helps. The only messages they are willing to hear must be logical and powerful. They also need to find a way to believe in a power greater than themselves. Doing this will help them rebuild their lives. If anyone reading this feels that I am being overly emotional, let me explain. I am a psychiatrist who runs a hospital for alcoholics. I have seen the intense and life-destroying tragedies that alcoholism creates. These include desperate spouses and partners, scared little children, families torn apart. Every day, I work to help alcoholics leave drinking behind them. It is work that I do all year, around the clock, without tiring. And in all my years of work I haven't found anything as helpful as A.A. No other tool, program, or idea has ever helped more struggling alcoholics find their way to sobriety. People drink because they like how drinking alcohol makes them feel. Alcoholics enjoy that feeling so much that they begin to need it more and more often. At first, they may understand that their drinking is harmful, but over time they begin to ignore that knowledge. Eventually, their alcoholic life seems completely normal. Being drunk becomes more important than anything else. Alcoholics are anxious and frustrated unless they feel the comfort they get from drinking. Once they have a drinking habit and the cravings for alcohol begin, they get stuck in a cycle. They will go on a drinking spree, then feel terrible about what they've done, and then swear they'll never drink again. But they do drink again. And this cycle keeps repeating. These alcoholics feel alone, overwhelmed, and unsure how to make permanent change in their lives. Recovery feels impossible to them unless they are able to completely change their way of thinking and being, something called a “psychic change.” This means that their personality and behavior have been completely transformed. When those same alcoholics experience psychic change, they are able to make huge, healthy changes in their thought patterns about drinking. After that, recovery suddenly feels possible. The same people who felt doomed and overwhelmed by their problems experience hope. Just by following a few simple rules from A.A., they can control their need for alcohol and change their behaviors. Many alcoholics feel deep confusion and powerlessness. This leads them to ask for help from their medical doctors. I've had many patients come to me and say, “Doctor, I can't go on like this. I'm ruining my life. I want to stop drinking, but I just can't. Please help me!” When this happens, most doctors struggle to be truly helpful. We are eager to support and heal our alcoholic patients, but we don't have the right kind of knowledge. Medical doctors know all about physical pain and sickness, but becoming sober seems to take something much deeper. Many times, our alcoholic patients need a type of wisdom and healing that we just can't give to them. They need something to help them make that psychic change. Something that another human being may not be able to give them. Some psychologists have helped their patients get sober. But not all alcoholics can heal themselves this way. I believe this is because psychology focuses on the mind and emotions, and alcoholism is a disease that affects both mind and body. As a medical doctor, I've worked with alcoholics who have shown me exactly how hard it is to control their physical cravings for alcohol. For example, I've seen patients work for months to achieve a specific goal in their lives. If they take one drink a few days before reaching their goal, they can't stop themselves from getting drunk. Then they can't reach the goal they've worked so hard to achieve. They feel awful about that, but they cannot stop the cravings. They cannot resist getting drunk, even if getting drunk destroys their own hard work. I don't believe these people were drinking to escape anything. I believe they were drinking because they just could not control their craving for alcohol. For some of them, fighting against their cravings became so hard and exhausting that they ended their lives instead of continuing to fight There are many different types of alcoholics in the world. There are alcoholics who constantly promise to get sober, but never do it. There are alcoholics who refuse to admit that drinking is bad for them. There are alcoholics who think that taking a break from drinking for a little while makes it safe to start drinking again later. There are alcoholics who seem normal and friendly until they drink, and then turn into completely different people. There are alcoholics who cannot control their emotions, or struggle with mental illness on top of their problems with drinking. This book will discuss many of these types of alcoholics. Here's what ALL of these types of alcoholics have in common: If they start drinking, their cravings will become so strong that they will not be able to stop. Just one drink will trigger this strong and unstoppable reaction. As I mentioned earlier, I believe this makes alcoholism a type of allergy to alcohol. Like other allergies, alcoholism can't be permanently stopped or removed from the sufferer's body. The only way to deal with it is to stop drinking, and never drink again. Since “never drinking again” is extremely hard for chronic alcoholics, many medical doctors believe they cannot do it. They believe these people will always struggle and never get permanent relief. If abstinence, or “never drinking again,” isn't the solution to alcoholism, what is? I'll answer that question by sharing a story from my own medical practice. I once worked with a patient who was struggling with chronic alcoholism. He had already healed from major health problems caused by his drinking, but still struggled to control his thoughts and feelings. His drinking had destroyed everything good in his life and ruined his most important relationships. He was just “living to drink” when he came to see me. He told me he had lost all hope that he could overcome his alcoholism and get sober. While at the hospital working with me, this man stopped drinking and got all of the alcohol out of his system. We found that he had no permanent brain damage. He began following the A.A. program described in this book. One year later he came to see me, and I couldn't even recognize him. He looked and acted completely different from the hopeless, sick, nervous man I had seen just a year before. He was confident, happy, and putting his life back together. A long time has passed since I saw him, and he has stayed sober that whole time. Whenever I'm feeling overwhelmed or sad, I think about another patient I worked with. He knew that he was a chronic alcoholic and believed he would never recover. He decided to hide in an empty barn and allow himself to die. He was rescued by a search party before that happened, and he came to my hospital very sick and weak. Once he was physically recovered, we had a talk. He told me he believed any sort of treatment for his alcoholism would be a waste of time. He said he needed the willpower to resist drinking forever, and didn't know how to get it. His alcoholism was strong and complicated, and he was also struggling with serious depression. Because of this, I believed the only way he might become sober was through what we used to call “moral psychology.” He needed something that combined ideas about morals and beliefs with psychology. But I worried that would not work either. However, this man adopted the practices described in this book, and he has not taken a drink in many years! I see him sometimes, and he is as healthy and happy as anyone I've ever known. I would strongly recommend this book to every alcoholic. Even if you begin reading with doubts in your mind, my hope is that you will continue reading and find your way to understanding the nature of your problem. William D. Silkworth, M.D.

Original

Plain Language explanation

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.

The ideas in this book are extremely important to anyone who struggles with alcoholism.

I believe this because I have spent many years working with alcoholics. I work as the director of one of the oldest hospitals in the country. I help people recover from their alcoholism and drug addiction. When I was asked to write my opinion in this book, I was very happy to do it. I believe this book explains ideas that may help people who struggle to stop drinking.

For a long time, doctors like me have believed that our patients needed more than just science and medicine to get sober. They needed some sort of mental or emotional system. They needed a way to understand themselves, forgive themselves, and rebuild their lives. Medical doctors like me knew this, but we didn't know how to create a system that would work.

Then someone came along who knew how to do it. He knew exactly how to offer the kind of help that hospitals and doctors could not.

Many years ago, one of the authors of this book came to the hospital where I work. He was trying to get sober himself and had a new idea about how to do it. He believed his idea could help other alcoholics, too.

Later on, he asked my permission to tell his story to the other patients at my hospital. I wasn't sure how it would help anyone, but I let him try it.

Since then, I have studied the cases of some of the people he met. The stories of these people are very interesting. Many of them are amazing. They are completely unselfish and work very hard to help each other defeat their alcoholism. It is inspiring to me, since I have worked long and hard in the field of alcoholism. After struggling for so long, they finally believe in themselves and the community they have built. They also believe in a Higher Power that can save them from more suffering … and maybe even death.

We still believe that many alcoholics need to deal with their physical cravings for liquor before they can use a program like this. Here's why:

We believe that alcohol affects chronic alcoholics differently from how it affects normal drinkers. It interacts with their bodies like an allergy. It forces them to behave in unpredictable ways. Regular drinkers never get the strong cravings that chronic alcoholics get. People with this alcohol allergy have cravings all the time. These cravings can feel impossible to control.

This means that chronic alcoholics cannot safely drink alcohol of any kind. It means they can never drink. Once they know how it feels to drink and get drunk, they will form a drinking habit quickly and find it impossible to stop. They will lose self-confidence and ruin their relationships. They will watch their problems pile up and feel totally unable to solve them.

Begging these people to stop drinking never helps. The only messages they are willing to hear must be logical and powerful. They also need to find a way to believe in a power greater than themselves. Doing this will help them rebuild their lives.

If anyone reading this feels that I am being overly emotional, let me explain. I am a psychiatrist who runs a hospital for alcoholics. I have seen the intense and life-destroying tragedies that alcoholism creates. These include desperate spouses and partners, scared little children, families torn apart. Every day, I work to help alcoholics leave drinking behind them. It is work that I do all year, around the clock, without tiring. And in all my years of work I haven't found anything as helpful as A.A. No other tool, program, or idea has ever helped more struggling alcoholics find their way to sobriety.

People drink because they like how drinking alcohol makes them feel. Alcoholics enjoy that feeling so much that they begin to need it more and more often. At first, they may understand that their drinking is harmful, but over time they begin to ignore that knowledge. Eventually, their alcoholic life seems completely normal. Being drunk becomes more important than anything else.

Alcoholics are anxious and frustrated unless they feel the comfort they get from drinking. Once they have a drinking habit and the cravings for alcohol begin, they get stuck in a cycle. They will go on a drinking spree, then feel terrible about what they've done, and then swear they'll never drink again. But they do drink again. And this cycle keeps repeating. These alcoholics feel alone, overwhelmed, and unsure how to make permanent change in their lives. Recovery feels impossible to them unless they are able to completely change their way of thinking and being, something called a “psychic change.” This means that their personality and behavior have been completely transformed.

When those same alcoholics experience psychic change, they are able to make huge, healthy changes in their thought patterns about drinking. After that, recovery suddenly feels possible. The same people who felt doomed and overwhelmed by their problems experience hope. Just by following a few simple rules from A.A., they can control their need for alcohol and change their behaviors.

Many alcoholics feel deep confusion and powerlessness. This leads them to ask for help from their medical doctors. I've had many patients come to me and say, “Doctor, I can't go on like this. I'm ruining my life. I want to stop drinking, but I just can't. Please help me!”

When this happens, most doctors struggle to be truly helpful. We are eager to support and heal our alcoholic patients, but we don't have the right kind of knowledge. Medical doctors know all about physical pain and sickness, but becoming sober seems to take something much deeper. Many times, our alcoholic patients need a type of wisdom and healing that we just can't give to them. They need something to help them make that psychic change. Something that another human being may not be able to give them.

Some psychologists have helped their patients get sober. But not all alcoholics can heal themselves this way. I believe this is because psychology focuses on the mind and emotions, and alcoholism is a disease that affects both mind and body.

As a medical doctor, I've worked with alcoholics who have shown me exactly how hard it is to control their physical cravings for alcohol. For example, I've seen patients work for months to achieve a specific goal in their lives. If they take one drink a few days before reaching their goal, they can't stop themselves from getting drunk. Then they can't reach the goal they've worked so hard to achieve. They feel awful about that, but they cannot stop the cravings. They cannot resist getting drunk, even if getting drunk destroys their own hard work.

I don't believe these people were drinking to escape anything. I believe they were drinking because they just could not control their craving for alcohol. For some of them, fighting against their cravings became so hard and exhausting that they ended their lives instead of continuing to fight

There are many different types of alcoholics in the world. There are alcoholics who constantly promise to get sober, but never do it. There are alcoholics who refuse to admit that drinking is bad for them. There are alcoholics who think that taking a break from drinking for a little while makes it safe to start drinking again later. There are alcoholics who seem normal and friendly until they drink, and then turn into completely different people. There are alcoholics who cannot control their emotions, or struggle with mental illness on top of their problems with drinking. This book will discuss many of these types of alcoholics.

Here's what ALL of these types of alcoholics have in common: If they start drinking, their cravings will become so strong that they will not be able to stop. Just one drink will trigger this strong and unstoppable reaction. As I mentioned earlier, I believe this makes alcoholism a type of allergy to alcohol. Like other allergies, alcoholism can't be permanently stopped or removed from the sufferer's body. The only way to deal with it is to stop drinking, and never drink again.

Since “never drinking again” is extremely hard for chronic alcoholics, many medical doctors believe they cannot do it. They believe these people will always struggle and never get permanent relief.

If abstinence, or “never drinking again,” isn't the solution to alcoholism, what is? I'll answer that question by sharing a story from my own medical practice.

I once worked with a patient who was struggling with chronic alcoholism. He had already healed from major health problems caused by his drinking, but still struggled to control his thoughts and feelings. His drinking had destroyed everything good in his life and ruined his most important relationships. He was just “living to drink” when he came to see me. He told me he had lost all hope that he could overcome his alcoholism and get sober.

While at the hospital working with me, this man stopped drinking and got all of the alcohol out of his system. We found that he had no permanent brain damage. He began following the A.A. program described in this book.

One year later he came to see me, and I couldn't even recognize him. He looked and acted completely different from the hopeless, sick, nervous man I had seen just a year before. He was confident, happy, and putting his life back together. A long time has passed since I saw him, and he has stayed sober that whole time.

Whenever I'm feeling overwhelmed or sad, I think about another patient I worked with. He knew that he was a chronic alcoholic and believed he would never recover. He decided to hide in an empty barn and allow himself to die. He was rescued by a search party before that happened, and he came to my hospital very sick and weak.

Once he was physically recovered, we had a talk. He told me he believed any sort of treatment for his alcoholism would be a waste of time. He said he needed the willpower to resist drinking forever, and didn't know how to get it.

His alcoholism was strong and complicated, and he was also struggling with serious depression. Because of this, I believed the only way he might become sober was through what we used to call “moral psychology.” He needed something that combined ideas about morals and beliefs with psychology. But I worried that would not work either.

However, this man adopted the practices described in this book, and he has not taken a drink in many years! I see him sometimes, and he is as healthy and happy as anyone I've ever known.

I would strongly recommend this book to every alcoholic. Even if you begin reading with doubts in your mind, my hope is that you will continue reading and find your way to understanding the nature of your problem.

William D. Silkworth, M.D.

As you continue reading through this book yourself—and as you learn more about A.A.'s beliefs and practices—we hope that you will also find your way to acceptance of your problem.

Craving:

An irresistible urge to drink. Obsessive thoughts about alcohol that compel the drinker to start drinking and keep drinking.