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New Approach to Psychotherapy in Chronic Alcoholism
W.D. Silkworth, M.D.
New York, New York
Vol.46, July, 1939
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. As this development is one, which has
sprung up among alcoholic patients themselves and has been
largely conceived and promoted by them, it is felt that
this new treatment can be reported freely and objectively.
central idea is that of a fellowship of ex-alcoholic men
and women banded together for mutual help. Each member feels
duty bound to assist alcoholic newcomers to get upon their
feet. These in turn work with still others, in an endless
chain. Hence there is a large growth possibility. In one
locality, for example, the fellowship had but three members
in September, 1935, eighteen months later the three had
succeeded with seven more These ten have since expanded
is much more than a sense of duty, however, which provides
the requisite driving power and harmony so necessary for
success. One powerful factor is that of self-preservation.
These ex-alcoholics frequently find that unless they spend
time helping others to health they cannot stay sober themselves.
Strenuous, almost sacrificial work for other sufferers is
often imperative in the early days of their recovery. This
effort proceeds entirely on a good will basis It is an avocation.
There are no fees or dues of any kind, nor do these people
organize in the ordinary sense of the word.
ex-alcoholic men and women number about one hundred and
fifty. One group is scattered along the Atlantic seaboard
with New York as a center. Another, and somewhat larger
body, is locate in the Middle West. Many walks of life are
represented, though business and professional types predominate.
The unselfishness, the extremes to which these men and women
go to help each other, the spirit of democracy, tolerance
and sanity which prevails, are astonishing to those who
know something of the alcoholic personality. But these observations
do not adequately explain why so many gravely involved people
are able to remain sober and face life again.
principle answer is each ex-alcoholic has had, and is able
to maintain, a vital spiritual or "religious" experience.
This so-called "experience" is accompanied, by marked changes
in personality. There is always, in a successful case, a
radical change in outlook, attitude and habits of thought,
which sometimes occur with amazing rapidity, and in nearly
all cases these changes are evident within a few months,
the chronic alcoholic has sometimes recovered by religious
means is a fact centuries old. But these recoveries have
been sporadic, insufficient in numbers or impressiveness
to make headway with the alcoholic problem as a whole.
conscious search of these ex-alcoholics for the right answer
has enabled them to find an approach, which has been effectual
in something like half of all the cases upon which it has
been tried. This is a truly remarkable record when it is
remembered that most of them were undoubtedly beyond the
reach of other remedial measures.
essential features of this new approach, without psychological
The ex-alcoholics capitalize upon a fact, which they have
so well demonstrated, namely: that one alcoholic can secure
the confidence of another in a way and to a degree almost
impossible of attainment by a non-alcoholic outsider.
After having fully identified themselves with their "prospect"
by a recital of symptoms, behavior, anecdotes, etc., these
men allow the patient to draw the inference that if he
is seriously alcoholic, there may be no hope for him save
a spiritual experience. They cite their own cases and
quote medical opinion to prove their point. If the patient
insists he is not alcoholic to that degree, they recommend
he try to stay sober in his own way. Usually, however,
the patient agrees at once. If he does not, a few more
painful relapses often convince him.
Once the patient agrees that he is powerless, he finds
himself in a serious dilemma. He sees clearly that he
must have a spiritual experience or be destroyed by alcohol.
This dilemma brings about a crisis in the patient's life.
He finds himself in a position, which, he believes, cannot
be untangled by human means. He has been placed in this
position by another alcoholic who has recovered through
a spiritual experience. This peculiar ability, which an
alcoholic who has recovered exercises upon one who has
not recovered, is the main secret of the unprecedented
success, which these men and women are having. They can
penetrate and carry conviction where the physician or
the clergyman cannot. Under these conditions, the patient
turns to religion with an entire willingness and readily
accepts, without reservation, a simple religious proposal.
He is then able to acquire much more than a set of religious
beliefs; he undergoes the profound mental and emotional
change common to religious "experience" (See William James'
Varieties of Religious Experience). Then too, the patient's
hope is renewed and his imagination is fired by the idea
of membership in a group of ex-alcoholics where he will
be enabled to save the lives and homes of those who have
suffered as he has suffered.
The fellowship is entirely indifferent concerning the
individual manner of spiritual approach so long as the
patient is willing to turn his life and his problems over
to the care and direction of his Creator. The patient
may picture the Deity in any way he likes. No effort whatever
is made to convert him to some particular faith or creed.
Many creeds are represented among the group and the greatest
harmony prevails. It is emphasized that the fellowship
is non-sectarian and that the patient is entirely free
to follow his own inclination. Not a trace of aggressive
evangelism is exhibited.
If the patient indicates a willingness to go on, a suggestion
is made that he do certain things which are obviously
good psychology, good morals and good religion, regardless
That he make a moral appraisal of himself, and confidentially
discuss his findings with a competent person whom he trusts.
That he try to adjust bad personal relationships, setting
right, so far as possible, such wrongs as he may have
done in the past.
That he recommit himself daily, or hourly if need be,
to God's care and direction, asking for strength.
That, if possible, he attend weekly meetings of the fellowship
and actively lend a hand with alcoholic newcomers.
is the procedure in brief. The manner of presentation may
vary considerably, depending upon the individual approached,
but the essential ingredients of the process are always
much the same. When presented by an ex-alcoholic, the power
of this approach is remarkable. For a full appreciation
one must have known these patients before and after their
the presence of the religious factor, one might expect to
find unhealthy emotionalism and prejudice. This is not the
case however; on the contrary, there is an instant readiness
to discard old methods for new ones, which produce better
results. For instance, 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 at the time. The ex-alcoholics frequently insist,
therefore, that a physician first take the patient in hand,
placing him in a hospital whenever 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, during which time the patient has
been thoroughly detoxicated, the physician brings up the
question of permanent sobriety and,' if the patient is interested,
tactfully introduces a member of the ex-alcoholics group.
By this time the prospect has self-control, can think straight,
and the approach to him can be made casually, with no intervention
by family or friends. More than half of this fellowship
has been so treated. The group is unanimous in its belief
that hospitalization is desirable, even imperative, in most
has happened to these men and women? For years, physicians
have pursued methods, which bear same similarity to those
outlined above. An effort is being made to procure a frank
discussion with the patient, leading to self-understanding.
It is indicated that he must make the necessary re-adjustment
to his environment. His cooperation and confidence must
be secured. The objectives are to bring about extraversion
and to provide someone to whom the alcoholic can transfer
a large number of cases, this alcoholic group is now attaining
these very objectives because their simple but powerful
devices appear to cut deeper than do other methods of treatment
because of the following reasons:
Because of their alcoholic experiences and successful
recoveries they secure a high degree of confidence from
Because of this initial confidence, identical experience,
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
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.
Because of objects aplenty in whom to 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 the Deity. It is paramount to note that the religious
factor is all-important even from the beginning. Newcomers
have been unable to stay sober when they have tried the
program minus the Deity.
mental attitude of the people toward alcohol is interesting.
Most of them report that they are seldom tempted to drink.
If tempted, their defense against the first drink is emphatic
and adequate. To quote from one of their number, once a
serious case at this hospital, but who has had no relapse
since his "experience" four and one-half years ago:
after I had my experience, I realized I had the answer to
my problem. For about three years prior to December 1934
I had been taking two and sometimes three bottles of gin
a day. Even in my brief periods of sobriety, my mind was
much on liquor, especially if my thoughts turned toward
home, where I had bottles hidden on every floor of the house.
Soon after leaving the hospital, I commenced to work with
other alcoholics. With reference to them, I thought much
about alcohol, even to the point of carrying a bottle in
my pocket to help them through the severe hangovers. But
from the first moment of my experience, the thought of taking
a drink myself hardly ever occurred. I had the feeling of
being in a position of neutrality. I was not fighting to
stay on the water wagon. The problem was removed; it simply
ceased to exist for me. This new state of mind came about
in my case at once and automatically. About six weeks after
leaving the hospital my wife asked me to fetch a small utensil,
which stood on a shelf in our kitchen. As I fumbled for
it, my hand grasped a bottle, still partly full. With a
start of surprise and gratitude, it flashed upon me that
not once during the past weeks had the thought of liquor
being in my home occurred to me. Considering the extent
to which alcohol had dominated my thinking, I call this
no less than a miracle. During the past your pears of sobriety
I have seriously considered drinking only a few times. On
each occasion, my reaction was one of fear, followed by
the reassurance, which came with my new found ability to
think the matter through, to work with another alcoholic,
or to enter upon a brief period of prayer and meditation.
I now have a defense against alcoholism which is positive
so long as I keep myself spiritually fit and active, which
I am only too glad to do."
interesting example of reaction to temptation comes from
a former patient; now sober three and one-half years. Like
most of these people, he was beyond the reach of psychiatric
methods. He relates the following incident:
sober now for several years, I am still bothered by periods
of deep depression and resentment. I live on a farm, and
weeks sometimes pass in which I have no contact with the
ex-alcoholic group. During one of my spells I became violently
angry over a trifling domestic matter. I deliberately decided
to get drunk, going so far as to stock my guesthouse with
food, thinking to lock myself in when I had returned from
town with a case of liquor. I got in my car and started
down the drive; still furious. As I reached the gate I stopped
the car, suddenly feeling unable to carry out my plan. I
said to myself, at least I have to be honest with my wife.
I returned to the house and announced I was on my way to
town to get drunk. She looked at me calmly, never saying
a word. The absurdity of the whole thing burst upon me and
I laughed and so the matter passed. Yes, I now have a defense
that works. Prior to my spiritual experience I would never
have reacted that way."
testimony of the membership as a whole sums up to this:
For the most part, these men and women are now indifferent
to alcohol, but when the thought of taking a drink does
come, they react sanely and vigorously.
alcoholic fellowship hopes to extend its work to all parts
of the country and to make its methods and answers known
to every alcoholic who wishes to recover as a first step,
they have prepared a book called Alcoholics Anonymous*.
A large volume of 400 pages, it sets forth their methods
and experience exhaustively, and with much clarity and force.
The first half of the book is a text aimed to show an alcoholic
the attitude he ought to take and precisely the steps he
may follow to affect his own recovery. He then finds full
directions for approaching and working with other alcoholics.
Two chapters are devoted to working with family relations
and one to employers for the guidance of those who surround
the sick man. There is a powerful chapter addressed to the
agnostic, as the majority of the present members were of
that description. Of particular interest to the physician
is the chapter on alcoholism dealing mostly with its mental
phenomena, as these men see it.
contacting personally those who are getting results from
the book, these ex-alcoholics expect to establish new centers.
Experience has shown that as soon as any community contains
three or four active members, growth is inevitable, for
the good reason that each member feels he must work with
other alcoholics or perhaps perish himself.
the movement spread? Will all of these recoveries be permanent?
No one can say. Yet, we at this hospital, from our observation
of many cases, are willing to record our present opinion
as a strong "Yes" to both questions.
NOTE. The book, Alcoholics Anonymous ($3.50) may be secured
from The Alcoholic foundation, Post Box 658, Church Street
Annex, New York City.
Vol.46, July, 1939
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Silkworth index page.
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