Disease Concept of Alcoholism

 "God will constantly disclose more to you and to us." (BigBook page 164)

"Most of us have been unwilling to admit we were real alcoholics. No person likes to think he is bodily and mentally different from his fellows ... We learned that we had to concede to our innermost selves that we were alcoholics. This is the first step in recovery. The delusion that we are like other people, or presently may be, has to be smashed." (Big Book page 30)

"...an allergy which differentiates these people, and sets them apart as a distinct entity." (Big Book - "The Doctor's Opinion" pagexxviii)

The following material is designed to elaborate on the disease concept of alcoholism as put forth by Dr. Silkworth in "The Doctor's Opinion." When the Big Book was first published in 1939, the suggestion that alcoholism is a disease was so radicall that Dr. Silkworth declined the use of his name. It is amazing to note, that in the subsequent decades, our ever-widening knowledge base has not been able to contradict or erode the doctor's original premise. On the contrary, it has provided an even greater opportunity to understand the essential differences between us and non-alcoholics. We have come to believe through experience that without a thorough understanding of the 'exact nature of the malady' or THE PROBLEM -there is little hope we will dare to take the action necessary to experience THE SOLUTION .

" In our belief, any picture of the alcoholic which leaves outthis physical factor is incomplete ." (AA's view in "The Doctor's Opinion" page xxiv)

We are confident that with a deeper awareness of what is REALLY meant with "We admitted we were powerless over alcohol" we will be more likely to come to terms with the unmanageability of our lives, described so well on page 52 of the Big Book. "We were having trouble with personal relationships, we couldn't control our emotional natures, we were prey to misery and depression, we couldn't make a living, we had a feeling of uselessness, we were full of fear, we were unhappy, we couldn't seem to be of real help to other people." We add "We were not comfortable with our sex life," and think of these as the "criteria" for untreated alcoholism.

The first part of Step 1 helps us 'buy into' Sobriety.

The second part of Step 1 helps us 'buy into' Recovery .

Approached with a 'beginner's mind', we have found this material indispensable in showing" other alcoholics precisely how we have recovered from a seemingly hopeless state of mind and body."

The following information comes from an article written by Dr. David L. Ohlms, entitled "The Disease Concept of Alcoholism." Dr. Ohlms has developed a national reputation in the field of alcoholism, taking off from Dr. Silkworth's" theory." We offer it here In the spirit of the Big Book (page 31)"Science may one day accomplish this..."

"There is good news about one of mankind's oldest diseases - alcoholism. Not too many years ago nearly everybody thought it was hopeless. We don't think so any more.

"The story begins in the late 1930's when people who were suffering and dying from alcoholism got tired of going to professionals because the professionals couldn't seem to help them - the alcoholics just kept on dying. Or wound up in lunatic asylums or jails. So alcoholics banded together and formed an organization to help themselves - Alcoholics Anonymous - and lo and behold, they did discover a way to stop dying and make themselves better.

"AA members not only stopped dying and got healthier, they discovered a method that let them give up drinking and lead as normal a life as anyone else. That's the second part of the good news. But in order to help fellow alcoholics, AA first had to decide that alcoholism was a treatable disease. Let's go back to that half of the good news now.

"You have to remember that early AA members weren't research scientists - they were businessmen, salesmen, carpenters, waitresses - and they were all seemingly hopeless drunks who only recently had been able to stop drinking. But the AA program was so successful that finally after several decades, medical science felt forced to take a good look at it. Why did it work? Why was it that these ordinary people, doing what they did, were able to get well, while we professionals, treating medically and psychiatrically, seemed to make them sicker rather than better?

"The first thing we noticed was that AA people were saying that alcoholism is a primary disease. It is its own disease. It causes its own symptoms it is not itself a symptom of some other disease - and AA treated it this way. And medical science finally had to admit that AA was right! In 1956 the American Medical Association officially recognized alcoholism as a true disease- an entity of and by itself, that created its own problems, its own symptoms, that had its own treatment - and the AMA published this view in a major paper.

"Now in order to go on with our story, we need to say something here about disease. I think we need to define it, and that's not easy to do. Here's one I like out of a 99 cent pocket dictionary: "A disease is anything that interferes with the ability of the human being to function normally". Whatever it is, however you caught it, a disease prevents you from living your life as efficiently as you ordinarily would.

"The definition I like to use for alcoholism is: a chronic, progressive, incurable disease characterized by loss of control over alcohol and other sedatives. Let's take a look at what this really means. CHRONIC is self-explanatory. It lasts a long time. PROGRESSIVE is fascinating. It's one of the unique features of the illness, and one of the reasons why most people in the helping professions - medicine, counseling, etc. - don't like alcoholics. It goes on and on and on. And it demoralizes everyone involved. It tends to make them say "What's the use?" almost from the beginning. So while the disease gets worse as the alcoholic continues to drink, what about the fellow who resumes his drinking after even a prolonged period of sobriety? Within a short period of time, the symptoms that the alcoholic will show are the same symptoms showed when drinking was stopped 10, 15 or 25 years before. And usually worse. It's as if those years meant absolutely nothing. I know this is shocking - it has almost a hint of the supernatural - but later I think I can give you a scientific explanation as to why it is a medical fact.

" INCURABLE disease simply means that an alcoholic cannot be taught to handle controlled social drinking. Science has so far given us no cure for alcoholism. LOSS OF CONTROL is what makes this disease different from other chronic, incurable diseases such as diabetes. Loss of control does not mean that when an alcoholic takes a drink - every time he takes a drink -he's going to drink to excess and get drunk. Loss of control means that once an alcoholic takes that first drink, he can't predict with any reliability whether he's going to have a normal or abnormal drinking episode. He's lost the ability to predict his drinking behavior. He no longer controls alcohol, as most of us do; it controls him.

"The alcoholic has lost control over not just the drug alcohol - for alcohol is basically nothing more than a widely-available, socially acceptable, non-prescription and inexpensive sedative. He's lost control over all other sedative drugs as well. Most alcoholics, in my experience, run back and forth from alcohol to some form of tranquilizer. It is a vicious cycle and a significant number of alcoholics will eventually have their minds destroyed by the disease . About 34 out of 36 will be killed by it in one way or another. One out of 36 will get treatment, will recover and get well. That's a tragic statistic. It's tragic because it's unnecessary. For middle-stage alcoholics, recovery rates are as high as 80%. Late-stage recovery rates run from 25% to 35%. By "recovery", I mean people regaining their health and going back to normal, functioning, working lives. There are very few chronic, progressive, incurable illnesses where 25% to 80% of those who have found treatment can get well again .

"The cause for alcoholism, like many other diseases, has yet to be proven. However, heredity studies, done all over the world, clearly show that genetics is far more significant in determining whether or not you'll be an alcoholic than any combination of social or environmental factors combined. Now I'm not saying a person is born an alcoholic. No. I've never met an alcoholic who didn't drink. But I think it's conclusive that some people are indeed predisposed to alcoholism because of their heredity; and if they ever start drinking, they run an unbelievably high risk of developing the disease.

"Of course, in medicine we have a lot of diseases that work that way. Diabetes has a high family predisposition, for example. When science notices a family predisposition toward a disease, it will look for some abnormality in body chemistry. What about the body chemistry of the alcoholic? They key discovery came by complete accident. A medical scientist named Virginia Davis was doing cancer research in Houston , Texas . For her studies, she needed fresh human brains - which are not widely available. So she'd ride out with the Houston police in the early morning and collect the bodies of winos who had died on Skid Row the night before. The warm bodies were rushed back to the hospital, where the brains were removed.

"One day Virginia was talking to some doctors in the hospital cafeteria. She was telling them about some finding of her laboratory studies, and she said: "You know, I never realized that all those winos used heroin as well as booze." The doctors laughed. " Come on, Virginia ," they told her. "These guys don't use heroin. They can barely afford a bottle of cheap muscatel." She had discovered in the brains of those chronic alcoholics a substance that is, in fact, closely related to heroin. This substance, long known to scientists is called Tetrahydrolsoquinoline- or (fortunately) THIQ for short. When a person shoots heroin into his body, some of it breaks down and turns into this THIQ. But then these people hadn't been using heroin; they had just been simple alcoholics. So how did the THIQ get there?

"When the normal adult drinker takes in alcohol, it's very rapidly eliminated at the rate of about one ounce per hour. The body first converts the alcohol into something called acetaldehyde. This is very toxic stuff, and if it were to build up inside us, we would get violently sick; and indeed we could die. But Mother Nature helps us to get rid of acetaldehyde very quickly. She efficiently changes it into acetic acid, which we will know as vinegar, and then changes it a couple of more times - into carbon dioxide and water which is happily eliminated through the kidneys and lungs. That's what happens to normal drinkers. It also happens with alcoholic drinkers, BUT they get what we might call a P.S.

"What Virginia discovered in Houston , which has been extensively confirmed since, is that something additional happens in the alcoholic. In them, a very small amount of poisonous acetaldehyde is NOT eliminated; instead it goes to the brain where, through a very complicated biochemical process, it winds up as this THIQ. THIQ is manufactured right in the brain, and it only occurs in the brain of the alcoholic drinker; it does NOT happen in the brain of the normal social drinker of alcohol. THIQ has been found to be highly addictive. It was tried in experimental use with animals during W.W.II, when we were looking for a pain killer less addicting than morphine. THIQ was a pretty good painkiller, all right, but it turned out to be much more addicting than morphine. There are, as you might know, certain kinds of rats that cannot be made to drink alcohol. Put them in a cage with a very weak solution of vodka and water; they will literally thirst to death before they agree to drink it. But if you take the same rat and put an unbelievably minute quantity of THIQ in its brain - the animal will immediately develop a preference for alcohol over water. In fact he'll be happier if you mix his drink with less and less water. So we've taken a teetotaling rat and turned him into an alcoholic rat. All we needed was smidgen of THIQ.

"Other studies have been done with monkeys, our close animal relatives in medical terms. We've learned that once THIQ is injected into a monkey's brain, it stays there. You can keep a THIQ'ed monkey dry, off alcohol, for as long as 7 years; then when you study his brain, that weird stuff is still there. This takes us back to the progressiveness of the disease. Remember that person who's been sober for 10 or 25 years, and then suddenly starts drinking again? The alcoholic will immediately show the same symptoms displayed years before! - and it's no wonder. The human alcoholic is still carrying THIQ like those man-made, alcoholic monkeys and rats.

"Now alcoholics don't intend to make THIQ when they start drinking. They don't mean for their brains to manufacture something stronger than morphine. Most normal folks take a drink now and then, and the young alcoholics-to-be want to be normal. So they take a drink now and then, too. But they don't know about the predisposition toward THIQ-making their brain chemistry has inherited. In their drinking careers, as THIQ piles up, the alcoholic will cross over a shadowy line into a whole new way of life. Some predisposed people cross the line while they're teenagers - or earlier! It won't occur in others until they're 30 or 40or maybe even retired. But once it does happen, the alcoholic will be as hooked on alcohol as he would have been hooked on heroin if he'd been shooting that instead - and for very similar chemical reasons.

"Alcoholism is a disease - and that's good news. Alcoholism is not the alcoholic's fault - and that's good news too. The alcoholic patients I see are usually hugely relieved to hear that it's not their fault, because they've been carrying tons of guilt along with the alcoholism - and that guilt was often worse that useless. Now instead of guilt, the alcoholic person knows the facts, he or she can, with treatment, learn how to live like normal, healthy grown-ups again. That's good news for all of us. That's the best news any human being can ever expect."  

Food for thought:

Most alcoholics reach out or arrive at our doorstep with three things intact:"

(A) the illness of ALCOHOLISM,

(b) ignorance and misinformation as to the EXACT NATURE of the malady, and


There is a widely held misconception that taking a new person to a few AA meetings or giving them a Big Book will "plant the seed," and really "screw up their drinking." Our own experience has proven THIS IS NOT SO.

In our basic text, we will find the following statement: "But the ex-problem drinker who has found this solution ,who is properl yarmed with the facts about himself, can generally win the confidence of another alcoholic in a few hours." ( Big Book page 18 italics underline added)

It is interesting to note that in the "original manuscript" this read: "...who is properly armed with CERTAIN MEDICAL INFORMATION..." (caps and underlining added)

We find validation of this in Twelve Step sand Twelve Traditions: "It was then discovered that when one alcoholic had planted in the mind of another the true nature ofhis malady , that person could never be the same again." (Page 23)

"INA FEW HOURS" we can address two of the three items mentioned above! We can then, and only then, move on to discussions and sharing of the Spiritual Solution which will take care of the illness AND the "bag of secrets."

When this material is in place, and we are confidant that it is understood, we dare to go so far as to explain to the new person that though they may be held ACCOUNTABLE for their past actions, they are not RESPONSIBLE.

The other side of the coin is, now that they DO understand the "Disease Concept of Alcoholism" and that there is a "Spiritual Solution," they are 100% ACCOUNTABLE and 100%RESPONSIBLE.

"For if an alcoholic failed to perfect and enlarge his spiritual life through work and self-sacrifice for others, he could not survive the certain trials and low spots ahead." (Big Book ... you find the page !)