A Highly Successful Approach To The Alcoholic Problem
Confirmed in Medical and Sociological Results
William D. Silkworth
New York, N.Y.
Medical Record, Vol. 154, August 1941
Contemporary literature contains a wealth of information about chronic alcoholism, with here and there accounts of satisfactory methods of treatment.
While we assume that these methods must represent some progress, yet as long as physicians are consulted in increasing numbers by worried mothers and heartsick wives and thousands of letters are written by victims of alcohol following an article suggesting possible help. One appreciates that the whole picture is still one of desperation.
Scientific investigation of causes and problems of relief as undertaken by The Research Council on Problems of Alcohol should receive our earnest support. This scientific and unbiased group is almost certain to render a great service to humanity in the future. But what of the present, of the problems of alcohol as they are presented today? What of the alarming number of important men, victims of alcohol, or at least laboring under diminished efficiency?
This paper will endeavor to answer some part of these questions. We are dealing with a complex human problem not very well understood by any of us, so it might help a little if we first attempt to clear up some of the confusion by stating a few facts, at least they seem to be such to us. Any accurate attempt at grouping alcoholics is difficult, as one type frequently blends into another. Subject to this qualification we may classify these problem drinkers as follows:
1. Those who do not wish to stop. They generally admit the fallacy of their position and are a source of annoyance to all.
2. The constitutional psychopaths. They have a wealth of resolutions but a paucity of results.
3. The manic-depressive type. They often end their own lives.
4. This leaves roughly speaking the majority of alcoholics who prior to developing an alcoholic problem were average men and women of neurotic tendency and often great intelligence.
Another source of confusion it seems to us is that these people have a physical as well as a mental problem. The physical problem is that they cannot drink in moderation either by the use of will power, application of intelligence or any other form of persuasion.
In 1937 I suggested, based on clinical evidence, that the phenomenon of craving, limited to this type of drinker, was an allergic manifestation. This man is the true alcoholic. He is generally the “spree drinker.” Whether this theory will stand the test of further research, it is a fact that when free from alcohol the physical condition returns to normal; but the patient is still alcoholic conscious.
Another source of confusion is the difficulty found to persuade man while drinking to undertake any helpful measure. After thorough detoxication, by hospitalization, they can be approached.
We shall now try to tell very briefly the most satisfactory answer to chronic alcoholism after detoxification that we know, although the psychic phenomenon that transfers a person from an alcoholic to a nonalcoholic could be more easily discussed if we understood better the original cause of his compulsion to drink. Also, we must emphasize that unfortunately in presenting a possible relief for the alcoholic, reservation must be made as to its application, and suitable types must be selected. Not over fifty percent can or will follow the mental discipline that must be experienced to obtain relief by the method we are about to describe.
Moreover, to introduce a semi-religious note into a medical article there must be enough solid sense behind the sentiment to make it really practical.
Some seven years ago an alcoholic developed an idea which while not new in itself was unique in its application. It would take too long to tell the story here but perhaps the fundamental principle of this plan is that the alcoholic for reasons best understood by psychiatrists is not sufficient unto himself. He is not the captain of his own soul.
The approach to this plan, by means of which forces within the man are put to work, must be through the medium of a former alcoholic who has received help by the same means. You will be gratified at the confidence these ex—alcoholic men and women instill into the skeptical or reluctant alcoholic.
These men and women form into groups, the agreed purpose of which is not only to help themselves but to convey the plan to others in distress and in this way come again to realize the real joy of living. Through their efforts to help others they become true extroverts. It has proved so successful that groups have formed in over a hundred cities throughout the United States in seven years, and there have been approximately thirty— five hundred men and women relived of their alcoholic problems. What is true in the realm of science is true in the personal lives of these men and women. They readjust the principles by which they shall live. With intelligence, faith, and the cooperation of the group subject to the limitations stated above, this man becomes the captain of his own soul and victory is certain. The power these men and women learn to draw from, provided they have this desire and faith, is apparently sufficient for their purpose. The Rev. Harry Emerson Fosdick, speaking of this group, says with his usual clarity, to quote in part:
“Now comes a movement, an astonishing, apt and pertinent movement, where men who have been in the thick of this thing, who have faced the hopelessness of the situation, who have felt they never could get well, have found resources of strength, and have come out and there is not a thing about alcoholism they do not know. I think that, psychologically speaking, there is a point of advantage in the approach that is being made in this movement that cannot be duplicated. There is another element in this movement that interests me – its tolerance, its breadth, its inclusiveness, its catholicity. Here is a movement that puts its arm around medicine on the one side, and religion on the other. I think the spirit in which this work is carried on is wise and promising. No one is a prophet but I suspect there is a long road ahead for this movement.”
The physician while an earnest seeker after truth is in no position to recommend all the fads presented to him. Here is a plan emanating from no “authority,” no leaders, nothing to sell, strictly ethical, and asking for and receiving the cooperation of physicians. A statement from two physicians in Philadelphia, Dr. A.W. Hammer, surgeon, and Dr. C. Dudley Saul, chief resident of St. Lukes’s and Children’s Hospital will illustrate this growing sentiment, to quote in part:
“We can testify as physicians to the increasing interest in this movement among members of the medical profession, and we are grateful for the opportunity that the group has given us of aiding in the recovery of the unfortunate victims of alcoholism.”
To illustrate further the spirit of cooperation with physicians, a statement by William G. Turnbull,M.D., superintendent of the Philadelphia General Hospital:
“The Alcoholics Anonymous under the leadership of Mr. B. has been working in this institution for the past year. I feel that this organization has done definite good as several men whom I know have been chronic alcoholics have apparently stopped drinking. The organization has given no trouble in the institution, has fitted in well with our organization, and I am glad to endorse them to any institution where there is work for them to do.”
Also, Dr. John F. Stouffer, physician and psychopathologist of the same hospital, states in part:
“In our opinion this is a very worthwhile undertaking and we feel that your cooperation with them will be beneficial to those concerned.”
A letter written by Dr. R. E. Blaisdell, medical superintendent of Rockland State Hospital, New York, to a fellow physician, should interest those sincerely seeking the value of this movement. I quote in part:
“During the past year Mr. D. and others of the group have been interested in extending the benefits of Alcoholic Anonymous to recovered alcoholics of the hospital, who are about to leave the institution or prior to and after the return to their homes in the community. We think he has been of great assistance to us in bringing about personality adjustments among our recovered alcoholics to the end that a large percentage of them become total abstainers, take up their family responsibilities and become useful citizens again in community life.”
Mr. John D. Rockefeller, Jr. who has contributed so much to the advancement of medical science states:
“For some time I have been greatly interested in Alcoholics Anonymous, a movement by ex—alcoholics on behalf of others in need. Already outstanding results have been produced by their wise and self—sacrificing methods. I believe they are deserving of support. I am giving them mine.”
The Charles B. Towns Hospital, of New York City, one of the few hospitals specializing in the treatment of alcoholism, states, to quote in part:
“We have followed the development and growth of this movement from its inception. The attitude of the men of this group as we have observed them is above reproach. As ex-alcoholics we have found them to appreciate the necessity of proper medical treatment to eliminate the craving for alcohol, restore appetite and sleep, before the patient is ready for an introduction to a possible permanent relief. They have been of definite assistance in enabling us to lift men and women out of their alcoholic problem and return them as useful members of society.”
For further information of the methods used by this group I would urge all physicians to read a most interesting article by Dr. P. L. Smith, published in the July issue of the Psychiatric Quarterly, the official organ of the New York State Department of Mental Hygiene. Dr. Smith reports 50.1 percent recovery in a group of 111 alcoholics.
In conclusion, why men and women begin to use alcohol for pleasure or some sort of satisfaction peculiar to themselves and continue as problem drinkers is unknown. This mental state has many symptoms suggesting a neurosis with an obsessional trend. All those having to treat a neurotic personality with an obsessional type of thinking have found the prognosis unfavorable. This seems to be particularly illustrated in the alcoholic. While science is still seeking a remedy for this situation these men offer us at least a breathing spell that has proved fifty—percent efficient.
If a man can, through the ministrations of this group become a part of the Universal Process and knows that he is a part, that is security. He accepts ideas that have been subjected to tests of experience. Above all else, it means seeing the truth, acknowledging the truth, and following the truth at all times, regardless of consequences.