Those who enter recovery at a step-based treatment center will often be handed a copy of Alcoholics Anonymous (also known as “the Big Book”) almost as soon as they are admitted and processed. This will become a staple of their foray into sobriety, and they will be expected to learn its contents backward and forward. This is not surprising by any means; AA has been helping people ever since its creation back in the 1930s.
And while the volume contains many personal stories that may be of use, the core writings are the Big Book’s first twelve chapters. The first of these is a prologue of sorts, entitled “The Doctor’s Opinion.”
The Doctor’s Opinion
“The Doctor’s Opinion” contains two letters written by William D. Silkworth, M.D., a man whose name is well-known to those who have been studying the lessons of AA for quite some time. There is also some brief writing by Bill Wilson, the founder of Alcoholics Anonymous. Bill W. penned the bulk of the Big Book’s core chapters, but “The Doctor’s Opinion” primarily belongs to Silkworth.
It was written at a time when AA was just beginning to establish itself as a new outlet of recovery for people afflicted with what was rapidly becoming viewed as a disease. Some may think that AA is just for alcoholics, but many who are addicted to other substances will learn much of their condition from the views espoused by Silkworth in “The Doctor’s Opinion.”
Below, we will analyze the primary lessons in each of Silkworth’s letters, as well as how lessons from “The Doctor’s Opinion” can be applied to our own lives. This is the chapter that is meant to first establish a basic understanding of recovery.
Summary of Silkworth’s First Letter
For those who don’t know much about the history of alcoholism, there was a time when the alcoholic was considered to be more or less insane. We were treated in asylums, and those who treated us had little hope for our recovery. In his first letter, Silkworth counts himself among such physicians; however, he details his experiences with one patient in particular who began to open his eyes to reveal a possible path toward sobriety. In “The Doctor’s Opinion,” Silkworth recounts his experiences with said patient thusly:
“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.”
Silkworth is speaking, in a not-so-veiled fashion, about the principles of AA. Through the fellowship and sense of unity that composes the First Tradition, as well as AA’s focus on service work and on sharing our stories, Silkworth believed that Alcoholics Anonymous presented a solution to a disease for which other cures had failed.
And while AA is by no means a panacea, the fact that it had already cured hundreds so early in its making was remarkable. These numbers are quite small to the number of people who have gotten sober today, a fact which Silkworth all but predicted in his own writing:
“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.”
It is well worth noting that a man of science would refer to a spiritual remedy as one of “extreme medical importance.” Silkworth had been working with alcoholic patients for years when he penned this portion of “The Doctor’s Opinion,” and he had seen few—if any—recover by any other means.
For him, the benefits of a spiritual remedy had been demonstrated through empirical evidence. Treating alcoholics as asylum patients had done little good; the only suitable remedy in Silkworth’s eyes was for alcoholics to unite together so that they may share with one another their experience, strength, and hope.
In other words, it is not without reason that 12-step meetings are often suggested as a part of any suitable relapse prevention plan. We may stay sober for some time on our own, but isolation will inevitably get us nowhere.
From day one, AA has proven successful largely due to its focus on fellowship. Silkworth saw this right away, and he knew that it was through the strength and power of sheer unity, love, and tolerance that AA would remain successful for many years. And it was after he was proven right on this fact that he was gracious enough to compose a second letter.
Summary of Silkworth’s Second Letter
Silkworth’s second letter is important for a number of reasons, primarily in the way it approaches the disease model of addiction. While his first letter gave praise for the spiritual remedy, his second letter gears its focus toward the physical and mental components of the disease. Those who refer to alcoholism as an “allergy” are, whether they know it or not, more or less referring to the theories proposed by Silkworth in “The Doctor’s Opinion.”
This allergy consists of two parts—the physical craving and the mental obsession. According to Silkworth, it is generally best that the physical component is handled first.
“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.”
In other words, the alcoholic needs time to undergo the detoxification process before their mind will truly be in the right place to begin healing on a mental, emotional, and spiritual level. This is not a surprising theory by any means.
Not only will the addict or alcoholic generally be quite foggy (and sometimes in a great deal of pain) while they are undergoing withdrawal, but it is also important to note that the physical craving and the mental obsession are fairly linked to one another.
“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.”
What Silkworth describes in this portion of “The Doctor’s Opinion” sounds rather grim, but it is also integral to our sobriety. This is the downward slope of the Jellinek Curve, the point at which we hit rock bottom and allow ourselves to finally take Step One.
Sometimes, a bit of withdrawal will actually help with that. Most treatment centers, however, will provide patients with medicine to help ease their symptoms so that they might maintain a relative level of comfort.
To those who struggle with the disease model and the perception that it alleviates the alcoholic or addict of all responsibility for the choices they have made, Silkworth’s description of the mental obsession may help to explain how allergy and choice are somewhat intertwined.
“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.”
Silkworth notes that there are numerous forms of alcoholics. Among those he points out are those who are mostly normal yet react more strongly to alcohol to others, those who suffer from extreme stubbornness and refuse to seek help, and “the psychopaths who are emotionally unstable.”
He also notes those with co-occurring disorders such as manic depression and those who suffer from overconfidence once they are a year or so past their sobriety date.
But they all have one thing in common according to Silkworth, which is that their reaction to alcohol appears to signal an allergy that sets them apart from others. Having never discovered a true “cure” for this allergy, Silkworth recommends two palliative methods of care.
The first is the spiritual remedy provided by AA, which should help for the mental obsession. As for the physical craving, Silkworth recommends complete abstinence. If one cannot relieve themselves of their cravings and obsessions through these means, they are almost guaranteed to resort to drugs and alcohol again.
Lessons from “The Doctor’s Opinion”
The lessons of “The Doctor’s Opinion” should be quite clear, but let us examine another one of Silkworth’s stories before going deeper into them. The following story is told near the very end of “The Doctor’s Opinion,” as Silkworth’s second letter is drawing to a close. It outlines the story of a patient who heeded the suggestions that have already been discussed.
“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 it was there that 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.”
This man was able to start over on a clean slate and become an entirely new person, all because he sought recovery through fellowship while maintaining his abstinence. If this does not show the value of unity, service work, and the willingness to give up our need for control, what does? This patient would not have recovered if he had held on to his belief that the addict may one day learn to both control his habit of drinking and also enjoy it.
Anyone who fears that abstinence is beyond their capabilities should most certainly begin building a strong and sober support system, a network of people in whom one can confide so as not to risk taking another drink. If you are a drug addict, call a family member or a friend in recovery (preferably a sponsor) whenever you are tempted to call your dealer. Never be afraid to ask for help.
If nobody had the strength to ask for help, groups like AA and NA would cease to exist. A fellowship is a powerful thing, but you have to meet people halfway and demonstrate your willingness to contact them when you are in need. If you are willing to reach out, someone will be there for you.
A fellowship is at the very heart of “The Doctor’s Opinion,” because it allows us to maintain our abstinence while also freeing ourselves to undergo the psychic change that Silkworth believes is so necessary to our endurance.
Those who read “The Doctor’s Opinion” in full should become utterly convinced of this fact. If you are already in recovery, Silkworth’s writing will help you to strengthen what you already know. If you are not on the water wagon at this time, then hopefully his lessons will help you to open your eyes. Because at heart, “The Doctor’s Opinion” is about more than one man’s views on recovery. It is about the lessons we have all learned far too many times for our own good.
If you’re ready to stop learning these painful lessons over and over again, stop now and take them to heart. Your allergy will not cure itself. The only path to recovery is a spiritual remedy that will help you to combat both the physical and mental components of the disease. Contact us if you are ready to embark upon this path, and we will do everything within our power to ensure that you find the remedy you seek.
where did the term relapse prevention come from? I don’t think there’s any such thing. unity, recovery, service: that is relapse prevention aka Recovery.. I did enjoy reading this page though, some really good stuff in there. thanks
“Relapse prevention” is a term you often hear in the treatment community, specifically in regards to your general plan for maintaining sobriety. If you think of Unity, Recovery and Service as the three pillars of sobriety, think of your relapse prevention plan as the specific actions you take on a daily basis to invoke said pillars. For instance, you might practice Service by taking on a commitment at your local AA group, such as GSR or Treasurer. You might practice Recovery by reading a passage from the Big Book every day, likely either preceding or following your daily prayer/meditation. And you practice Unity by attending meetings, talking to other attendees and calling your sponsor. So think of it just as a course of action. If you prefer more positive rhetoric, just replace “relapse prevention” with “sobriety maintenance plan” and there you have it.
Where did the second part of the Dr Opinion come from? I know the first part was a letter written to Bill W to help him get funds for the Big Book. But I have now clue where to find information on the second part that starts with “The subject presented”.
Dr opinion chapter found in the AA big book page XXVII
I love the doctor’s opinion. It taught me the need for a “psychic change” and to live an “altruistic life”. Just what a drunk needs!!!!!!