Alcoholics Anonymous: A physician looks at the group

November 4, 1939

Dr. Silkworth

The first appraisal in a scientific journal of Alcoholics Anonymous, former drunkards who cure themselves by curing each other with the help of religious experience, was published in the July issue of the journal Lancet. It was “A New Approach to Psychotherapy [in] Chronic Alcoholism.: by W. D. Silkworth, M.D. physician in charge, Chas B. Town’s Hospital, New York City. A drunkard during a moment of [deep] depression had the spontaneous “religious experience” which started his cure. This was the seed from which came Alcoholics Anonymous. Dr. Silkworth was at first skeptical. He is no longer. Excerpts from his paper follow:

“The beginning and subsequent development of a new approach to the problem of permanent recovery for the chronic alcoholic has already produced remarkable results and promises much for the future. This statement is based upon four years of close observation. the principal answer is: Each ex-alcoholic has had and is able to maintain, a vital spiritual or ‘religious’ experience, accompanied by marked changes of personality. There is a radical change in outlook, attitude and habits of thought. In nearly all cases, these are evident within a few months, often less.

“The conscious search of these ex-alcoholics for the right answer has enabled them to find an approach effectual in something more than half of all cases. This is truly remarkable when it is remembered that most of them were undoubtedly beyond the reach of other remedial measures.

Religion

“Considering the presence of the religious factor, one might expect to find unhealthy emotionalism and prejudice. On the contrary, there is an instant readiness to discard old methods for new which produce better results. It was early found that usually the weakest approach to an alcoholic is directly through his family or friends, especially if the patient is drinking heavily. Ex-alcoholics frequently insist a physician take the patient in hand, placing him in a hospital when possible. If proper hospitalization and medical care is not carried out, this patient faces the danger of delirium tremens, ‘wet brain’ or other complications. After a few days’ stay, the physician brings up the question of permanent sobriety. If the patient is interested, he tactfully introduces a member of the group. By this time the prospect has self-control, can think straight, and the approach can be made casually. More than half the fellowship have been so treated. The group is unanimous in its belief that hospitalization is desirable, even imperative, in most cases…

“An effort is made for frank discussion with the patient, leading to self-understanding. He must make the necessary readjustment to his environment. Co-operation and confidence must be secured. The objectives are to bring about extraversion and provide someone to whom he can transfer his dilemma. This group is now attaining this because of the following reasons:

Reasons

1. Because of their alcoholic experiences and successful recoveries they secure a high degree of confidence from their prospects.

2. Because of this initial confidence, identical experiences, and the fact that the discussion is pitched on moral and religious grounds, the patient tells his story and makes his self-appraisal with extreme thoroughness and honesty. He stops living alone and finds himself within reach of a fellowship with whom he can discuss his problems as they arise.

3. Because of the ex-alcoholic brotherhood, the patient too, is able to save other alcoholics from destruction. At one and the same time, the patient acquires an ideal, a hobby, a strenuous avocation, and a social life which he enjoys among other ex-alcoholics and their families. These factors make powerfully for his extraversion.

4. Because of objects aplenty in whom he can vest his confidence, the patient can turn to the individuals to whom he first gave his confidence, the ex-alcoholic group as a whole, or to the Deity.

By Elrick B. Davis, Cleveland Plain Dealer