the doctor's opinion we of alcoholics anonymous believe that the reader will be interested in the
medical estimate of the plan of recovery described in this book convincing testimony must surely come
from medical men who have had experience with the sufferings of our members and have witnessed
our return to health a well-known doctor chief physician at a nationally prominent hospital
specializing in alcoholic and drug addiction gave alcoholics anonymous this letter
to whom it may concern i have specialized in the treatment of alcoholism for many years
in late 1934 i attended a patient who though he had been a competent businessman of good
earning capacity was an alcoholic of a type i had come to regard as hopeless in the course
of his third treatment he acquired certain ideas concerning a possible means of recovery
as part of his rehabilitation he commenced to present his conceptions to other alcoholics
impressing upon them that they must do likewise with still others
this has become the basis of a rapidly growing fellowship of these men and their families
this man and over 100 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 md
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 layman our opinion as to its soundness may of course mean
little but as ex-problem 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
was very jittery or defogged more often than not it is imperative that a man's brain be cleared
before he is approached as he is 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 was 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 tempered 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 recreate 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've had many men who had for example worked a period of months on some
problem or a 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 a 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 cauldron 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 they're 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 willpower 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 md
you