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Silkworth’s Rx for Sobriety
A.A. Grapevine, Inc., June 1945
who tried to impress a drinking alcoholic with the approach,
“You can’t have your cake and eat it, too,” would probably
draw a scornful, “So what! Who wants any cake? Tony, make
it a double this time.”
same idea expressed as, “You can’t have your bottle and
drink it, too,” might get his attention because to a drinking
alcoholic a fresh unopened bottle, brimming brightly with
abundance, is a symbol of good things to come. He knows
well enough, of course, that he can’t drink it and still
have it, but he blocks his mind to the inevitability of
that horrible moment when the last bottle will be empty.
untapped bottle remains a symbol to the non-drinking alcoholic,
at least to the alcoholic who has dried up in A.A. So long
as it stands unopened it represents drinks he has not taken,
and the good things of life he has found by not drinking.
now and then a persevering soul tries to have both the figurative
and the liquid contents of the bottle. He tries to make
an impossible compromise.
the opinion of a man who has administered personally to
at least 10,000 alcoholics, the attempt to make this kind
of compromise is one of the most common causes of failure
to get a safe hold on A.A.
W.D. Silkworth, genial and beloved little patriarch at Towns
Hospital, New York, for twelve years and now (1945) also
in charge of the new A.A. ward at Knickerbocker, also New
York, defines it as the “alcoholic double-cross.”
majority who slip after periods of sobriety,” says Dr. Silkworth,
“having double-crossed themselves into thinking that somehow
they can have the unopened bottle and drink it, too. Even
though they have been in A.A. and going to meetings, and
following parts of the program, they have accepted it with
reservations somewhere. They actually have been one step
ahead of a drink. Then they began playing around with the
notion they can drink a little and still have the good things
of A.A. The outcome is an inevitable as the bottle becoming
empty once it has been opened by the alcoholic.”
Dr. Silkworth discusses A.A. “slips” his usually cheerful
face becomes serious even a little grim. Through his long
years of practice in the field, he has become increasingly
sympathetic, but not case-hardened, to alcoholics. He understands
what they experience. Having been one of the first in his
profession to support A.A. and having guided scores of alcoholics
into A.A., he also appreciates the fact that a “slip” for
an A.A. involves an extra degree of remorse and misery.
Dr. Silkworth is particularly
emphatic on one point.
are not the fault of A.A. I have heard patients complain,
when brought in for another drying out, that A.A. failed
them. The truth, of course, is that they failed A.A.
this mental maneuvering to transfer the blame is obviously
another indication of fallacious thinking. It is another
symptom of the disease.”
quick way to get Dr. Silkworth’s appraisal of A.A. is to
ask him how he thinks “slips” can be prevented.
he explains, “let’s remember the cause. The A.A. who “slips”
has not accepted the A.A. program in its entirety. He has
a reservation, or reservations. He’s tried to make a compromise.
Frequently, of course, he will say he doesn’t know why he
reverted to a drink. He means that sincerely and, as a matter
of fact, he may not be aware of any reason. But if his thoughts
can be probed deeply enough a reason can usually be found
in the form of a reservation.”
preventive, therefore, is acceptance of the A.A. program
and A.A. principles without any reservations. This brings
us to what I call the moral issue and to what I have always
believed from the first to be the essence of A.A."
does this moral issue and belief in a power greater than
oneself appear to be the essential principle of A.A.? First,
an important comparison is found in the fact that all other
plans involving psychoanalysis, will-power, restraint and
other ingenious ideas have failed in 95 per cent of the
cases. A second is that all movements of reform minus a
moral issue have passed into oblivion.”
may be the opinions one professes in the matter of philosophy
-whether one is a spiritualist or a scientific materialist
- one should recognize the reciprocal influence which the
moral and physical exert upon each other. Alcoholism is
a mental and physical issue. Physically a man has developed
an illness. He cannot use alcohol in moderation, at least
not for a period of enduring length. If the alcoholic starts
to drink, he sooner or later develops the phenomenon of
this same alcoholic develops an obsessive type of thinking
which, in itself a neurosis, offers an unfavorable prognosis
through former plans of treatment. Physically - science
does not know why - a man cannot drink in moderation. But
through moral psychology - a new interpretation of an old
idea - A.A. has been able to solve his former mental obsession.
It is the vital principle of A.A., without which A.A. would
have failed even as other forms of treatment have failed."
be sure, A.A. offers a number of highly useful tools or
props. Its group therapy is very effective. I have seen
countless demonstrations of how well your ‘24-hour plan’
operates. The principle of working with other alcoholics
has a sound psychological basis. All of these features of
the program are extremely important.”
in my opinion, the key principle which makes A.A. work where
other plans have proved inadequate is the way of life it
proposes based upon the belief of the individual in a Power
greater than himself and the faith that this Power is all
sufficient to destroy the obsession which possessed him
and was destroying him mentally and physically.”
many years I faced this alcoholic problem being sure of
one scientific fact - that detoxication by medical treatment
must precede any psychiatric approach. I have tried many
of these orthodox psychiatric approaches and invented some
new ones of my own. With some patients I would be coldly
analytical, if they were of the so-called ‘scientific’ type
who is apt to have a superior attitude toward anything emotional
or spiritual. With others, I would try the ‘scare’ method,
telling them that if they continued to drink they would
kill themselves. With still others, I would attempt the
emotional appeal, working both the patient and myself into
a lather. He might be moved to the point of shaking hands
dramatically and telling me, with tears streaming down his
face, that he was never going to take another drink. And
I knew that the probability was he would be drunk again
within two weeks or less.”
I have been working with A.A. the comparative percentage
of successful results has increased to an amazing extent.”
percentage of success that A.A. has scored leaves no doubt
that it has something more than we as doctors can offer.
It is, I am convinced, your second step. Once the A.A. alcoholic
has grasped that, he will have no more “slips.”
© The A.A.
Grapevine, Inc., June 1945
practicing our Traditions, The AA Grapevine, Inc. has neither
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of The AA Grapevine, Inc.
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