Foreword to Silkworth Biography -by Recovering Physicians

As a member of the recovering community and a physician working in addiction medicine, I have often looked back at the formation of Alcoholics Anonymous and marveled at how everything came together at just the right time. When the "Big Book," Alcoholics Anonymous, was first published in 1939, there were only a few hundred members of AA, most of whom had been sober for relatively short periods of time. Despite this, Dr. William Duncan Silkworth, in his "Doctor's Opinion," boldly postulated that alcoholism was an allergy of the body coupled with an obsession of the mind.
At the time he made this statement, Silkworth had no real proof for his theory except his own experiences. Amazingly, sixty-two years later medical science has verified every principle put forth by Silkworth in 1939. All drug addiction, includingnalcoholism, is a neurochemical brain disease that causes alcoholics to react differently to alcohol than normal individuals.
For reasons known only to Silkworth, he was attracted to the treatment of alcoholics from the very beginning of his medical career. He did this at a time when working with drunks was a job no "self-respecting" physician would even approach. Silkworth received more than his fair share of disdain from his medical colleagues. Alcoholism was then considered to be a character weakness, and physicians wanted no part of treating addicted individuals. Despite these difficulties, Silkworth not only continued to treat alcoholics but also came to love them—no mean feat when you consider how unlovable the active alcoholic appears in the throes of the disease.

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      The knowledge of alcoholism that he slowly gathered was of immense significance, but his greatest contribution was his ability to say to alcoholics the right thing at exactly the right time. This enabled all who followed Bill Wilson to lead happy and productive lives. As Bill lay in Towns Hospital, he had an experience that impressed him and changed his life. Silkworth knew full well that Bill's hallucination of floating in a cloud with a bright light was brought on by the belladonna being used to treat withdrawal. When Bill asked Silkworth what was happening, the doctor could have told Bill the truth and AA might never have been established.
      Instead Silkworth reassured Bill that Bill was not insane and that he should hang on to what he had seen. This statement, at just the right time, ensured the formation of AA. Silkworth eventually established one of the first AA-oriented treatment centers at the Knickerbocker Hospital in New York City. He insisted on medical care for alcoholics but relied completely on members of AA to treat the patients after the detoxification period was concluded. Bill consulted him continually during the writing of the "Big Book." Bill and Dr. Bob Smith conceived the baby that was to become AA, but it was Silkworth who delivered it and nurtured it into its adulthood. Bill himself referred to Silkworth as a cofounder of AA.
      All of us whom have been blessed by the miracle of recovery owe our lives to Bill, Dr. Bob, and especially the "little doctor who loved drunks," Dr. William Duncan Silkworth.

Bob L., M.D.
Saint Paul, Minnesota

With the failures of the many temperance movements, as well as Prohibition, in dealing effectively with alcoholics, an approach incorporating alcoholism's medical aspects was incorrporated into the "Big Book" of Alcoholics Anonymous.
By offering support and enthusiasm based on his own years of experience, Dr. Silkworth helped win the confidence of skeptical physicians (who had had little luck in their treatment of alcoholics) with his comments in "The Doctor's Opinion" and his associated talks and writings.

Foreword by Recovering Physicians

Silkworth was a visionary. Physicians today are very likely to recommend AA to their alcoholic patients, but Silkworth remains first and foremost among those of us who use the Twelve Steps with our patients and ourselves.

Donald G., M.D.
Greenville, South Carolina

William Duncan Silkworth, M.D., one of the first addiction medicine specialists, exemplified the physician as clinician, teacher, and healer with his indefatigable devotion to the care and treatment of alcoholics and addicts. This book thoroughly documents his remarkable role in the formation and development of Alcoholics Anonymous.
Silkworth's contributions to AA are found in his recognition that alcoholism is a disease, and that recovery requires a spiritual solution. His extensive experience treating alcoholics facilitated the formation of these fundamental principles. He documented the successful outcomes of alcoholics who engaged in AA in an attempt to inform physicians about a treatment for what had been considered a hopeless condition.
Silkworth was unable to determine any therapy that was more successful than AA in addressing alcoholism, just as we cannot in the twenty-first century, and with this recognition supported and influenced the entire process.

Marv S., M.D.
Portland, Oregon

Alcoholics Anonymous was twenty years old when I began medical school. I was fortunate to have attended a fine medical school and trained in some of the best teaching hospitals in the country. I received a great deal of information on the deleterious effects of beverage alcohol on the body and came away with the conviction that when taken in excess ethyl alcohol is an extremely toxic substance.
I cared for and presided over the death of many patients who inexplicably continued to drink despite warnings that it was killing them. During a stint on the medical service of a Veterans Administration

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hospital, I discovered that we could not admit patients with a diagnosis of alcoholism. We were forced to disguise the diagnosis under another term such as gastritis or cirrhosis. Even delirium tremens was acceptable, but not alcoholism. I do not begrudge my medical education. It was otherwise excellent and has served me well over the years. But it was no surprise that as my drinking progressed over the ensuing years I had great difficulty in accepting the fact that I was suffering from an illness called alcoholism.
I can still recall the great sence of relief I had when I realized that I had an illness for which a very effectice form of therapy existed called Alcoholics Anonymous. The words of Dr. Silkworth in "The Doctor's Opinion" rang true, and still do. I believe that he was a genuine pioneer and far ahead of his time in his understanding alcoholism.
Mainstream medicine has come a long way but has still not completely caught up with some of Silkworth's valuable observations and deductions. Not only I, as a sober member of AA, but also the entire medical profession owe a great debt of gratitude to this patient, kind, and wise physician who devoted his life to the treatment of alcoholics.

Joseph P., M.D.
Rockford, Illinois

My initial reaction as a physician, during the early days of my recovery, to Dr. Silkworth's description of alcoholism of alcoholism as an allergy was skeptical. In my medical training, I had been taught that the term allergy describes a typical atopic reaction such as a skin rash or urticaria. As many of us do, in our first introduction to the AA program, I dismissed "The Doctor's Opinion" and other ideas of AA. I, as a physician, really wasn't ready to admit my powerlessness or my false sense of superiority in medical matters.
A physician, who had been in AA for many years, helped me by quoting from Stedman's Medical Dictionary, which defines allergy as "a hypersensitivity of the body cells to a specific substance that results in various types of reaction." I then realized Silkworth was accurate, and my recovery began. As a grateful member of AA, I pass on

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my knowledge of the AA program to the patients I meet who are in trouble with alcohol.

Jim G., M.D.
Saint Paul, Minnesota

Through his compassionate perseverance in the care of patients suffering from a seemingly hopeless condition, insightful observations into its nature, humble admission of the limitations of available therapy, and recognition and cautious introduction of an emerging new remedy, Dr. William D. Silkworth evinced the finest qualities of the physician. Silkworth was able, in 1934, to communicate to Bill Wilson his concept of the specific nature of alcoholism. Bill melded Silkworth's cogent definition of the problem, the spiritual solution suggested by C. G. Jung, M.D., and the spiritual tools of the Oxford Group into a program able to effect the phychic change Silkworth deemed to be requisite to recovery. Silkworth is, thus, truly a founding father of Alcoholics Anonymous.
When I came to AA in 1992, having given up in my fruitless attempts to live with or without alcohol, Silkworth's few pages of introduction to the "Big Book" provided me a succinct and penetrating understanding; his words explained me and my struggles in a new way, a way that rang true. Recognizing the validity of his insights in my own experience, I was able to surrender to the AA program. Silkworth brought me to recovery and a new life. Today I join with many thousands of other recovering alcoholic physicians in great gratitude to this exemplary man of medicine.

Jim W., M.D., Ph.D.
Little Rock, Arkansas

Early in my recovery I was exposed to "The Doctor's Opinion." In his writings, Dr. Silkworth spoke of hopeless and doomed men who were able to overcome their craving for alcohol. I had often used the word hopeless and doomed to describe myself, but in Silkworth's letter, I first became aware of the possibility of sobriety in my life.
Months passed before I was able to comprehend his understanding

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of alcohol as an allergy in the alcoholic and his idea of the psychic change that was the basis of the improvement in the alcoholic. What I did understand initially was that the same things that had failed Silkworth's patients had also failed me. On some level, I was able to understand that these alcoholics had found a way that worked to keep them sober.
I found in "The Doctor's Opinion" the first of many great gifts: the gift of hope.

Rick P., M.D.
Asheville, North Carolina

I so look forward to the publication of the book Silkworth, which will flesh out and add color to the character of William Duncan Silkworth, M.D., "the little doctor who loved drunks" and who convinced Bill and me that alcoholism is a disease. I've been drawn to these old black-and-white photographs of "Silky" in both Alcoholics Anonymous Comes of Age and Pass It On, and I can see him telling Bill to hold on to what he had as a spiritual experience. That and his writing in our basic text tell me he was in touch with the spiritual essence of our program.
I'll never forget buying my first Big Book at the Hazelden bookstore on a cold, snowy January day in 1980. I took it back to my unit and read selections, later highlighting and outlining my copy like I did my medical texts. It was the key passage, "The Doctor's Opinion," that gave me the deep and solid knowing that I had a disease. I'm glad my selections then jibe with my favorite quotes from Silkworth now.
In my interaction with a lot of alcoholics, including more than 7,500 doctors in recovery, I always try to keep in mind two Silkworth tenets. First, as he reminded Bill, we must dwell on the physical aspects of the disease: the anatomical and biochemical changes that differentiate alcoholics and set them apart as a distinct entity. These changes cannot be permanently reversed or eradicated. However, once the alcoholic has experienced a phychic change, Silkworth observes, he "suddenly finds himself easily able to control his desire for alcohol, the only effort necessary being that required to follow a few simple rules." Then we can begin to be managed by entire

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abstinence. Second, Silkworth gifted us with my favorite passage. He delivers the telling message that "frothy emotional appeal seldom suffices. The message which can interest and hold these alcoholic people must have depth and weight." He then delivers the punch line: "In nearly all cases, their ideals must be grounded in a power greater then themselves, if they are to re-create their lives." Having lived as an alcoholic among alcoholics, I can attest firsthand to seeing the miracle of re-created lives, such as I, along with our first medical friend, can hardly recognize the recovered person as one whom I previously knew. I am truely grateful to be alive in this time and place. I thank the GOD of our understanding for all the giants like our little doctor who went before us to make our way not necessarily easier, but certainly more clear and understandable.
I'm responsible for the maintenance of my sobriety and for carrying the message with authority given me by Alcoholics Anonymous. I am further girded with the knowledge that William Duncan Silkworth, M.D., imparted to Bill and others he treated, as well as to the millions he taught through "The Doctor's Opinion."

Dick McK., M.D.
Augusta, Missouri