From – Thursday, December 4th, 2008
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. (Alcoholics Anonymous 4th edition pg xxviii)
In the Doctor’s Opinion, Dr. William Silkworth uses the analogy of an “allergy” to describe action of alcohol on a certain group of alcoholics. I describe this as a certain group of alcoholics because he does when he says this allergic reaction (allergy) “never occurs in the average temperate drinker.”
He also speaks of this on page xxix (4th edition) when he says: “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.”
What differentiates these “types” or “certain group” from other alcoholics/addicts? One clue can be found elsewhere in the Alcoholics Anonymous book. Pgs 20 and 21 give us some details:
“Moderate drinkers have little trouble in giving up liquor entirely if they have good reason for it. They can take it or leave it alone.
Then we have a certain type of hard drinker. He may have the habit badly enough to gradually impair him physically and mentally. It may cause him to die a few years before his time. If a sufficiently strong reason ill health, falling in love, change of environment, or the warning of a doctor becomes operative, this man can also stop or moderate, although he may find it difficult and troublesome and may even need medical attention
But what about the real alcoholic? He may start off as a moderate drinker; he may or may not become a continuous hard drinker; but at some stage of his drinking career he begins to lose all control of his liquor consumption, once he starts to drink.”
There are three types described here two of those types are destroying their lives and may kill themselves using: the “Hard Drinker” and the “Real Alcoholic”
The “Real Alcoholic” is the one that has the “allergy” according to what Dr. Silkworth describes. Here it is described with the words “he begins to lose all control of his liquor consumption, once he starts to drink.”
The first key understanding one must have to have any understanding of the “allergy” analogy is to understand that every alcoholic or addict does not have this problem and this is written to those that do. If you read the entirety of page 20 the point is that the people who do not have this “allergy” problem will say that all kinds of things will help the person who does have this “allergy” problem but these will not work for them in the same way because they suffer from a different problem.
The point Dr. Silkworth is making is not to try to describe a literal “allergy” (in spite of the fact that science has now been able to prove many similarities between chemical addictions and allergies) but is trying to describe what separates the most incurable alcoholics and addicts from other types from his own professional observations.
The “allergy” analogy is described as being manifested as something called the phenomenon of craving.
The word “phenomenon” is fancy sounding word that makes medical terms sound really official. The truth is this is a very simple word. Miriam-Webster’s Dictionary defines this word in this simple way: “an observable fact or event”. In other words this “craving” is simply something that is observable. Miriam-Webster’s Dictionary defines “craving” as “an intense, urgent, or abnormal desire or longing”.
Basically the “allergy” that we are speaking of is the observable fact Dr. Silkworth observed in some of the worst alcoholics, that at times they would have an intense abnormal desire to use. This is what was common in the alcoholics that could not be cured by regular means. On page xxx (4th edition) the rest of the details about this “allergy” analogy are made clear:
“…they cannot start drinking without developing the phenomenon of craving.” This “allergy” is only seen after encountering a drink (in terms of alcoholics). That is why he used the analogy of an “allergy.” If people in this group use, there is an abnormal response: They want to use more even though they may know from many experiences that this is certain misery and before getting any in their system they may have been desperate to never use again.
Now let’s complete the definition of the “allergy” analogy:
The observable fact Dr. Silkworth observed in some of the worst alcoholics, that upon taking in any alcohol they would have an intense abnormal desire to continue to use.
The basic idea is that if a person is using at this level if he or she gets something in his or her system that makes that person think about the possibility of being intoxicated the person is going to have an intense desire to continue or find some other way to get intoxicated.
Thus, on page xxx (4th edition) he draws the conclusion: “The only relief we have to suggest is entire abstinence.”
This is a very useful analogy that helps us understand why we can never use a little bit, or use something else (just smoke weed, drink light beer, etc.) and still consider ourselves sober. The fact someone would take the risk of using after all the evidence that states that person should never use again, in and of itself demonstrates the shaky nature of that person’s recovery.
This is not the totality of our problems, but it is a very important starting point. If this was the whole problem then the solution would simply be to never get anything that might get you intoxicated into your system and you will be fine. There is far more to the problem and thus there is far more to the book beyond “The Doctor’s Opinion.”
It is important to understand that if one wishes to be sober, total abstinence is a must for those in the group described by Dr. Silkworth. That means at some point a person in this group must stop and never use anything intoxicating again to avoid starting “an intense, urgent, or abnormal desire or longing” to be intoxicated (drunk or high) that is near to impossible for people in this group to not give in to.