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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:
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 one hundred
others appear to have recovered.
I personally know scores
of cases who were of the type with whom other methods had
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.
William D. Silkworth, M.D.
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 a laymen,
our opinion as to its soundness may, of course, mean little.
But as exproblem drinkers, we can say that his explanation
makes good sense. It explains many things for which we cannot
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 doctor writes:
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 connot 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 affect 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 people 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
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 familiar with this
type. They are always "going on the wagon for keeps." They
are over-remorseful and make many resolutions, but never
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
Then there are types
entirely normal in every respect except in the effect alcohol
has upon them. They are often able, intelligent, friendly
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 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. has 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
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
I earnestly advise every
alcoholic to read this book through, and though perhaps
he came to scoff, he may remain to pray.
D. Silkworth, M.D.