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.