the doctor's opinion we have 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 but we 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 are 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 and
Herenton 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 de 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 the
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 X 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 plain we favor hospitalization for
the alcoholic who was very jittery or des fogged 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 would 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 recreate their lives if any field that has psychiatrists directing a hospital for
alcoholics we appear somewhat set a metal 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 as 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 and
sincere and despairing appeal doctor I cannot go on like this I have everything to live for I
must stop but I can you must help me faced with his 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 metal control I have 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 metal control
there are many situations which arise out of the phenomenon of craving which cause men to make
the supreme sacrifice rather than continued 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 were 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 was 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 yet but partially recovered from a gastric hemorrhage and seemed to be a case
of pathological mental deterioration he had lost everything worthwhile at 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 that 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 for 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 metal 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 as 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 de silkworth m.d.