THE DOCTOR'S OPINION

 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 one hundred 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, M.D.

There are multiple types of alcoholic: some are not hopeless; some are. The non-hopeless ones are the ones that can stop or moderate if sufficient desire arises. This perhaps coincides with the certain type of hard drinker referred to on pages 20 and 21 and the ‘potential alcoholic’ referred to several times in the early chapters. Arguably, the ‘hopeless’ type is the ‘real alcoholic’ or ‘true alcoholic’ referred to throughout the book.

I know I'm the hopeless type because (a) when I want, need to, or should keep my drinking within reasonable bounds I can't and (b) when I want, need to, or should stay entirely sober I can't.

Recovery is a chain reaction: I get well by having a spiritual experience then showing you how to have one. Rinse and repeat, down the chain.

Other methods fail completely: what does that mean? Drunk.

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.

Could not control my drinking = when I drank, drinking more than I wanted to or should, then, when realising this (through regret the next morning), being unable to subsequently adjust the quantity.

Why might this be?

Maladjusted to life (emotional immaturity): no, because other emotionally immature people do not necessarily drink like this, and other out-of-control drinkers are not necessarily emotionally immature. Furthermore, the drinking too much occurred whenever I drank, not just when I was out of sorts or disturbed.

Full flight from reality (mad or delusional): no, because I was not, at least not consistently, yet drinking too much occurred consistently.

Outright mental defective (very low IQ): no, because I was of normal intelligence.

Why did I drink too much?

If the reason lay not in the mind, it must have been physical, i.e. I’m simply built to drink too much.

That physical impulse overrides mental processes.

When I have a drink, I hand over the reins from the mind to the body, and the body takes over.

If that was the case, it will always be the case, as drinking too much occurred even when I was physically well: being physically well is not a defence.

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 ex-problem drinkers, we can say that his explanation makes good sense. It explains many things for which we cannot otherwise account.

Whether or not a theory satisfies me depends on whether it satisfactorily accounts for the facts (technically called ‘saving the phenomena’) whilst leaving few or no loose ends to tie up (Occam’s razor).

If I drank wildly because I wanted to, why did I do so when I didn’t want to?

If I drank wildly because it served me, why did I do so when it didn’t?

If I drank wildly because of depression / anxiety, why did I continue when it made them worse?

If I drank wildly because of a terrible childhood, why do some with a worse childhood not do so?

If I drank wildly because of a terrible childhood, why do some with a nice childhood also do so?

If I drank wildly because I was unhappy, why did I drink wildly when I was not?

If I drank wildly because I was stupid, how did I manage to learn Latin?

If I drank wildly because I was mad, how come I could systematically avoid other routine dangers (burning myself, falling down stairs, being hit by traffic)?

If I drank wildly because a mechanism is activated by drinking alcohol, such that the desire is amplified rather than satisfied …

Aha! That would explain everything!

Is this theoretically true? Who cares. It’s good enough for me. If someone presents a better explanation, I’ll buy it. They never have.

NB allergy = abnormal reaction; a reaction not shared by the majority; most people who drink find drink satisfies the desire, and the episode or bout halts before unacceptable consequences arise. Nothing to do with the immune system (modern meaning).

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.

1. Detox: get the mind clear of all substances interfering with thought, emotion, and consciousness.
2. Listen.
3. Understand (the content of the ideas and the actions to take, not why or how they work).
4. Accept (at face value: the solution does not need my seal of approval).

Accept what?

• The spiritual solution
  • Clean house
    • Inventory
    • Confession
    • Amends
  • Depend on God for direction and strength
• The altruistic solution
  • Abandon self
  • Serve God
  • By helping others as God sees fit

Work. Out. Not in.

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.

The answer to alcoholism is not merely about logic, reason, evidence, and common sense, although the solution is entirely consistent with these.

It’s about total recognition of personal failure and total abandonment of self in favour of God.

Neither can be brought about by explanation.

They’re brought about by identification:

Identification with failure and identification of one’s own desires with the outcomes others have achieved through total abandonment of self in favour of God.

Surrender One = admission of failure.

Surrender Two = submission to God.

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.

Take the ideas.

Put them into practical application.

At once.

As soon as I learn something: share it with others.

As soon as there is the opportunity to share: ask God what to share, and up goes the hand.

As soon as a new person walks in the room: go over and introduce oneself.

As soon as I do something wrong: admit it.

As soon as I harm someone: amend it.

As soon as I resent: drop it.

As soon as I fear: drop it.

As soon as I remember: talk to God.

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.

Some principles to follow:

• Unselfishness
• Elimination of profit motive (in any part of my life: including work, where I am to simply perform my work well)
• Community spirit (in all my endeavours: with not against)
• Belief in oneself when under the yoke of God

Recalling that, without God, I am nothing, and that I am to devise no ideas or plans of my own but merely to ask God what to do and do that, even if it is difficult, disagreeable, or appears not to benefit me: my job is merely to do what is right, the ‘right’ being synonymous with God’s will.

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.

When I’m in active addiction, there’s not a lot of point in talking to me. Even physically sober, if addictive patterns are in operation, likewise.

Total abstinence comes first. God (and sometimes medicine) makes this possible.

Only once I’m weaned off and now defenceless do I listen.

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.

Chronic = long-term

Alcoholic = doomed to drink, doomed to over-drink

Allergy = abnormal reaction to alcohol: nothing to do with the immune system (a subsequent narrowing of the term)

Abnormal = shared by a minority

Allergic reaction = phenomenon of craving

What is that?

Absolutely having to have more. Not because more is desirable or necessary, but just because that is the nature of the effect. Any statement beginning, ‘I drank [drink no. 2, drink no. 3, etc.] because [insert preceding condition, situation, purpose]’ is a false rationalisation of an automated event. Even if another drink is desirable, that is not the reason I have to have it: the absolutely having to have it occurs even when I do not want to have it or know it’s a terrible idea or have good reason to remain in command of my faculties or am stocious and therefore entirely insensible (boiled as an owl). That’s how I know it was not an ordinary desire: the absolutely having to have it was sometimes aligned with desire and sometimes at odds with both desire and need.

Any alcohol can kick it off: the alcohol in a brandy butter, a chocolate, or a clafoutis is enough.

The ordinary exertion of will (‘let’s keep a lid on it this evening; sure, drink plenty, but don’t get sick, don’t get weird, get home by 10’) fails (even if strong in other areas). The ordinary ‘human things’ (assessment + decision, wit + wherewithal, intelligence + might, direction + power, intention + implementation, thought + action) fail in the face of this automated pattern.

Why do problems pile up?

Being drunk causes problems. Being hung over causes problems. Being drunk and hungover prevent me from solving these problems. The progression is towards increased problems.

Why are they astonishingly hard to solve?

Because scooping water out of the bottom of the boat is a waste of time if there are holes in the bottom of the boat.

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.

I did not stop drinking or stay stopped because I was asked to, because my sentiment was appealed to.

I stopped and stayed stopped because (a) I saw the fatality of my course and (b) I was offered a concrete, workable alternative.

Who re-creates my life?

I do. God won’t do it for me.

But I can’t do it without God as the source of all direction and the source of all power.

The ideals (the ideas, values, objectives, and philosophical conception of the universe and my place in it) must be based on God as the “Creative Intelligence, a Spirit of the Universe underlying the totality of things” (page 46).

I must not be the centre and main objective of my life (“Pride is putting self in the place of God as the centre and objective of our life, or of some department thereof. It is the refusal to recognise our status as creatures, dependent on God for our existence, and placed by Him in a specific relationship to the rest of His creation.”)

My thoughts, my feelings, my desire, my wants, my needs: all to be thrown into the crucible.

Instead: “God, what should I do next?” (Not: “What should I do with my life?”)

One tiny act at a time, with a jot of a plan for the day and a tittle of a plan for the week and beyond.

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.

Altruistic: the sacrifice not of my being but of futile pursuits, in favour of contribution to the whole, which is the best thing both for me as the individual and for the whole.

The programme is not a selfish programme: it is a selfless programme.

When?

All day.

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.

Men and women drink because they like the effect. Not ‘alcoholic men and women’ but ‘men and women’.

In: ‘The sensation is so elusive that, while they admit it is injurious, they cannot after a time differentiate the true from the false,’ the ‘they’ is not the ‘men and women’ of the previous sentence but the broader subject matter of the passage: alcoholics. Obviously the following statements about alcohol’s injurious nature, the failure to differentiate the true from the false, and the apparent (but spurious) normalcy of the alcoholic life refer to alcoholics, not normal drinkers.

Normal drinkers like the overall (as well as immediate) effect of drinking: the benefit outweighs the cost.

In the alcoholic, the cost (‘injurious’) outweighs the benefit (‘they like the effect’), but they cannot see it (‘differentiate the true from the false’).

‘The sensation is so elusive’ is, ironically, an elusive phrase. ‘The sensation’ has a definite article, implying we’re continuing to talk about the same thing as before. What we have been talking about: the effect. This is simply a case of elegant variation: talking about the same thing with a new word to avoid repetition. In other words, the effect is so elusive (hard to discern) he cannot differentiate the true from the false. In other words, the alcoholic cannot correctly weigh up the benefit and the cost and incorrectly concludes the benefit outweighs the cost. The alcoholic is now drinking not because of but despite the effect.

‘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.’

This might appear to suggest that an alcoholic who is having a nice day will not drink. That’s not the case though (cf. Fred on page 41). It might also appear to suggest that an alcoholic who is restless, irritable, and discontented will necessarily drink. That’s not the case either (cf. Bill on page 15 and on page 154). The Big Book is very clear that we do not drink because we have an emotion, we discern in alcohol a solution, we apply the solution, and, voilà, problem solved: that would be ordinary, rational human decision-making, not alcoholism. Alcoholism is by definition drinking under compulsion, against reason and against one’s interests. Any description of pre-drinking reasoning is therefore a description of rationalisation not a presentation of grounds. Note in particular that the certain American businessman (page 26) is not unhappy, the man of thirty (page 32) is not unhappy, Jim (page 35) is not unhappy, and Fred (page 39) is not unhappy, yet they drink, whilst Bill (page 15, page 154) is unhappy and yet does not drink. Restlessness, irritability, and discontentment are not a necessary precursor to drinking and their absence is not reassuring as far as drinking is concerned.

What on earth is meant, therefore?

Well, firstly, the three terms restlessness, irritability, and discontentment are not attempting to describe some sort of general state of unhappiness to which alcohol is the solution. They’re very specific roster and, even together, leave a lot out. Where are fear, anxiety, resentment, grievance, guilt, shame, envy, jealousy, dejection, depression, disappointment, despair, bitterness, regret, remorse, and a dozen other descriptors of the workaday unhappiness of the untreated alcoholic? They’re nowhere to be seen. The page 52 bedevilments are a much better description of general unhappiness.

When, in a sober alcoholic, the mental obsession (the overwhelming impulse to drink) hits, if it is surrendered to promptly, the alcoholic will experience no restlessness, irritability, or discontentment. As Grady O’H says, to have a craving you have to not drink. She said she never had a craving because, as soon as she thought of drinking, she drank. The alcoholic may be in a bad mood generally or in a good mood generally or on the day in question. If, however, the impulse is resisted (consciously or unconsciously), the mental obsession starts to turn the screws. Now, the three very specific mental conditions of restlessness, irritability, and discontentment make entire sense. I would experience this when I resisted drinking or was prevented from drinking. When I was neither, I was fine before the thought occurred, the thought occurred, I drank, and I was fine. No phase of restlessness, irritability, and discontentment. By contrast, I’ve had the experience, whilst drinking, of having a perfectly nice day, things motoring along nicely, everything on track, on a bit of a high, then, suddenly, the thought of a drink occurs, at, say, eleven in the morning. I dismiss it and try to get on with my day. The day is ruined, however. A dark sensation grows, which is the awareness that I’m going to throw a spanner in the works and go and drink, with devastating consequences for the schedule. My only two options are to give in now or give in later. I would tend to give in right then and there, because it was the least painful course of action.

In other words, the only relief that alcohol was really providing was relief from the pain of resisting the impulse to drink. That was the ease and comfort. Those weren’t the only or even the main emotions produced by drinking. Drinking also engendered in me nervous excitement, and a further restlessness, irritability, and discontentment: the next drink, the next bar, the next adventure, the next scrap, the next stranger; wherever I was drinking was not good enough for me; I needed to find somewhere else, different people, something new, something edgy. I was much spikier drunk than sober (when I was sullen and docile). Wherever I was not enough for me (restless), it got on my nerves (irritable), and I lacked something (discontented). The alcoholism produces a symptom to which alcohol appears the cure but makes the symptom worse.

Failure to differentiate the true from the false:

A drink gave me momentary ease and comfort, but it actually increased the restlessness, irritability, and discontentment. It is because alcohol did not satisfy me that I needed another, and another, and another. If the first drink had really satisfied me, I would have stopped there. Whatever in me wanted to drink was not satisfied by the drink I gave it, which is why it remained thirsty and kept asking for more.

Note that the firm resolution is part of the spree. Once I was in AA but not yet permanently sober, I would emerge from sprees with just such a resolution, but this resolution stopped short of a decision and so merely cleared away some guilt and earned some vouchers for the next alcoholic spree.

Entire psychic change: everything I think and believe must change. Everything.

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.

Psychic change: new beliefs, new thinking.

The desire for alcohol is still there but no longer overwhelms.

Effort required? Yes.

What effort?

The effort required to follow a few simple rules.

What are the rules? Living by the Twelve Steps.

When? All day, every day.

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!”

Five elements to any appeal:

(1) I do not want what I currently have
(2) I want something else
(3) Change is urgently needed
(4) I cannot bring about change
(5) Help!

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.

Psychic change: everything in the mind changes (its content, its operations, and its output). Yet I stay who I am. I am therefore not my mind: it is an instrument.

Ordinary psychological approach: knowledge + understanding facilitating the individual to change their beliefs, thinking, and behaviour.

The out-of-the-ordinary psycho-illogical approach: knowledge + understanding that one cannot change and needs God for inspiration, direction, and strength to change beliefs, thinking, and behaviour.

I can’t help another alcoholic. I can help the alcoholic see things clearly and then instruct what actions to take, namely the actions I took and others have taken. But both are prerequisites for help, not help. Help comes from God. They have to press the button. I help them find the button and then show them how to press it. They press the button and God swoops in.

God could just swoop in, but that would defeat the point. He does like to be asked.

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.

The first drink did not happen because escape was necessary and drink provided it.

The subsequent drinks did not happen because escape was necessary and drink provided it.

The first drink happened despite experience suggesting it would throw a spanner in the works.

The first drink happened because of an impulse that sound reasoning could not restrain.

The subsequent drinks happened despite their throwing a spanner in the works.

The subsequent drinks happened because of an impulse that sound reasoning could not restrain.

Alcoholic drinking does not take place because of unhappiness.

It takes place despite the fact it causes unhappiness.

The rationalisations of the alcoholic mind in the moment are no guide to anything.

Necessarily: the alcoholism must convince the alcoholic the first and subsequent drinks are a good idea.

The fallacious reasoning is not a reliable witness and need not be called to testify.

Alcoholism is explained not by cause, trigger, occasion, justification, or motivation but by:

Impulse plus a hamstrung mind.

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 things that I did when I was out of control were certainly enough to prompt suicide.

The fact of being unable to stop was certainly enough to prompt suicide.

I avoided that path by the skin of my teeth.

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.

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.

I used to have ‘massive realisations’ realisations almost daily.

I would yank the steering wheel.

Unstable. Erratic. Failing.

A couple of realisations a year will do.

Even those are to be taken with a pinch of salt.

A resolution is a commitment to action based on emotion.

When the emotion passes, the commitment passes.

It was not commitment at all.

A decision is a commitment to action based on a sound analysis of the facts.

Only if the facts change materially can the decision change.

And facts are sluggish creatures.

Once a decision is made, the decision-making period is over.

That means that the consideration of the facts is over.

Time to get on with it.

For how long?

Until a material, fundamental, and lasting change in the facts has occurred.

Don’t hold your breath.

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 written.

Some problems:

Firstly, denial of the truth.

What is the truth?

There is no way of drinking such that I get the prize I am after but avoid paying the price.

The price always outweighs the prize, sooner or later.

The house always wins.

Secondly, denial of the truth.

What is the truth?

Once I developed alcoholism, that was it: I had it forever.

I was never going to go back to the pre-alcoholism condition.

Either in relation to alcohol.

Or in relation to living life.

The past was gone; the door was shut.

I had to face the facts as they were.

The third problem:

Self-reliance: powered by ego, I was a rollercoaster with peaks and troughs, furious, manic, excited activity as I pursued my plots and endeavours, then depression as I repeatedly failed, at my own and the world’s hands.

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.

Frustratingly, it turns out that the consideration of the different subtypes of alcoholic is irrelevant, because the pertinent feature runs through all of them: the allergy (the reaction to alcohol that differs from the ordinary person’s reaction), namely the craving.

Note that the craving FOLLOWS the first drink. Each drink amplifies the desire rather than quenching it. Alcohol is like oil on a fire. Alcohol does not satisfy the craving. Any explanations of this phenomenon involving the assertion that the alcohol is doing what it is supposed to, hitting the mark, meeting a need, delivering the invoiced goods, misses the point: these are an illusion; the reason the next drink is wanted is because the previous drink has been drunk, not because of a chain of reasoning is identifying a need and identifying another drink as meeting the need. All of the discourse about what alcohol does ‘for’ me is irrelevant, because it implies that, if I can see through that, I won’t suffer from the phenomenon of craving. Also untrue: at the end of my drinking I saw through it, I no longer wanted to drink at all, I certainly no longer wanted to drink too much, but there was the phenomenon of craving, driving me daily into a stupor, unabated. It turns out that my reasons, triggers, and motivations for the first drink and the subsequent drinks were a cover story.

This passage does not say so, but there’s a second phenomenon: they cannot stop drinking without developing the phenomenon of the mental obsession (the unreasoning, overwhelming impulse to drink).

So why were these two phenomena there? Unfathomable and irrelevant. The fact that they are there is the only point that is irrelevant.

It will be well noted that alcoholics who are years sober and have successfully sorted out the past, sorted out the present, constructed an excellent and happy life in the material world, and are comfortable, mature, and competent in every way, if they do not rely on God and perfect and enlarge their spiritual life, tend to drink again, and, when they do, bang, there’s the physical craving, just as it was before.

It is rare in AA to hear descriptions of drinking that focus solely on the identification of these two phenomena; most sharing discourse on drinking focuses either on the sequence of unfortunate events, the lamentable consequences, and the alcoholic’s own rationalisations of why it was happening. Note that any explanation other than these phenomena is a denial of the phenomena. Any citing of childhood, emotion, circumstances, reasoning, motivation is a red herring.

An illustration of the insanity of the rationalisations for the first and subsequent drinks:

Why did you have the first drink? Why did you light the fire? To put out another fire.

Why did you have the second, third, fourth drinks? Why did you pour oil on the fire? To put the fires out.

Though there might be other little fires, alcoholism is THE fire.

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.

Chronic = long term.

Alcoholic = repeatedly drinks and drinks too much even though it’s a bad idea.

Prognosis = progressive, incurable, fatal.

To get well, I have to buck the trend, even in AA. If do what most people do, I will eventually drink. Most people in AA do not stay in AA, thriving, cheerful, helping others, being an example. That’s the exception.

To get well and stay well, therefore, I have to be exceptional.

However, the exceptional club has pretty clear and straightforward membership rules (do what it says in the book).

And those rules are the easiest and softest way.

The answer, therefore, is to give myself a break:

Shut up and do what it says in the book.

That’s how I’ve stayed sober and that’s how I trust I will continue to stay sober.

The only way to fail is really to make it up as I go along, to be myself.

The only way to succeed is really to have myself done away with by God.

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 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.

Solution:

• Accept the plan (the only two options are reject or accept; no negotiation; no carving up)
• Follow the plan

The result:

• Stay sober forever
• Be transformed.

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 “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 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.

Problem:

• Alcoholism
• Depression

Solution:

• Moral element
• Psychological element

How to go about the solution:

• Buy the ideas in this book
• Implement the ideas in this book

Result:

• Solution to the alcoholism
• Solution to the depression
• Solution to everything else

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, M.D.

Instruction:

• Read this book through.

All through?

Yes, including the stories.

AA is so powerful, and the book is so powerful, that my cynicism and objections were overcome.

Unwittingly I was moved from being a scoffer to a prayer.

The other element: the persuasiveness of John Barleycorn; the growing realisation that the impulse to drink was more powerful than me, and I could find nothing material or human that was more powerful than the impulse to drink.

When the only thing I hadn’t tried was God, and I really did not want to drink ever again but knew I was going to, prayer became the only option; all of the objections had melted away.