The Doctor's Opinion

We dig into the Doctor’s Opinion from the AA Big Book and test its claims against our lived experience. We focus on physical craving, loss of control, and how to read the text line by line to see the truth without drama.

• Weird but important
• What “physical allergy” and  “phenomenon of craving” mean
• The five-step Vicious Cycle
• Best practice: Turn statements into questions
• Depth matters
• Using the set aside prayer to keep an open mind

Transcript

Why Start With The Doctor’s Opinion

SPEAKER_00 0:00

Hi, my name's Tom. I'm an alcoholic. So let's get something right out in the open. When you do the steps in AA, we always ask you to start with the doctor's opinion in the big book. And that's a bit weird. We have this big old book, goes on for hundreds of pages, and the first thing we ask you to do is read somebody's letters to the organization. I don't know about you, but for me that made no sense. Beyond that, let's be frank, I'm not the kind of guy who reads the forewords and the prefaces and shit like that. Starting at chapter one does not seem like skipping ahead to me. It seems like starting at the beginning. So who is this doctor dude? Why is he important? Well, Bill Wilson was in a group when he got sober, the Oxford Group. And they had their own six steps. Unlike AA, however, the Oxford group was for screw ups in general, while in AA we have a particular type of screw up, the alcoholic. And what the Oxford group didn't have was deep understanding, or maybe any understanding of what makes an alcoholic an alcoholic. So this doctor Silkworth actually did understand what it was that made an alcoholic an alcoholic. He was probably the first person to put it together. He figured out that alcoholics were different, physically different from normal folks. That's much of what we look at in the doctor's opinion. It's a short little piece of writing, less than eight pages, but it makes a big difference in one's understanding of the steps. So you with me so far? The doctor's opinion starts out with AA saying you should trust the doctor, and the doctor saying you should trust AA, neither of which I find particularly interesting myself. I've never seen a book's author say this person who is writing my introduction is an idiot, nor have I ever seen the authority at the beginning of a book say, yeah, this author is full of shit. Also, you should probably know that I ignore that it goes from the book speaking to the doctor speaking to the book, speaking to the doctor speaking who cares? So let's just look at what it says. On page XXVI, the book says the body of the alcoholic is quite as abnormal as his mind. It doesn't just say that. It also says that we who have suffered alcoholic torture must believe this. And the big book doesn't say must very frequently, so I was told I'd better pay attention when it does. When I read that, a question forms in my mind. Well, do I really believe that? Do I think that alcoholics are physically different from other people? It took me a while to swallow that one. Then some discussion with others, but eventually I came to believe that that must be true, because in talking to people who aren't alcoholic, I realized that they really don't drink like I do. It's not just that. They also do weird shit, like not finish a drink at a restaurant and walk away from it, or stop when they start to feel the effects of alcohol. Strange behavior. But I digress. Right after this it says in the book that the doctor's theory that we have an allergy to alcohol interests us. This word allergy is being used for the first time in the book. As you know, we talk about the physical allergy frequently. I have a separate podcast introducing the concept. Page XXVIII says the phenomenon of craving is limited to this class and never occurs in the average temperate drinker. This one threw me a little. My thoughts had been that everybody experienced that craving, and I kept that thought for a long time. By the time I got to AA, though, I was pretty comfortable with the idea that the craving was worse for me than most other people, and that was okay, but I had to get comfortable with the idea that my brother, so like me in so many ways, really had no idea what I was talking about when I talked about the physical allergy or physical craving. At the bottom of the same page, there's a really powerful paragraph that's worth spending some time on. The doctor starts out saying that men and women drink essentially because they like the effect produced by alcohol. That sentence is easy enough for me. The doctor goes on to say, though, that these alcoholic people, they cannot, after a time, differentiate the true from the false. I have to pause here and reflect on that. The truth is that over time I started to drink in ways that would have shocked me in previous years. Then the doctor says their alcoholic life seems the only normal one. And when I went back and read this section as part of my first step, I realized that I've been completely asleep as to how what was normal had changed for me. The end of that paragraph happens on the next page, XXIX. In it, Silkworth introduces the vicious cycle. Now here in Ventura, my home group is a men's group called Vicious Cycle, so it shouldn't be surprising that this concept seems important to me. Here are the five steps of the vicious cycle. One, the person succumbs to the desire to drink. Two, the phenomenon of craving develops. Three, the person drinks out of control. Four, the person emerges remorseful. Five, the person resolves never to drink again. That happened to me over and over. Those steps. I kind of didn't realize it was happening as it happened. I mean I knew some of it, but that my drinking could be so easily summarized by someone I never met in a book written more than twenty years before I was born is pretty damn trippy. But what about you? Does this describe you at all? Did you ever have the experience of not planning to drink, but then giving in to that desire? And once you got started, did it go from drinking just a little to drinking well more than a little? Did you lose control over how much you drank? At least as you look back on it? For me it never felt like I was out of control, it just felt like I was changing my mind. Except that I changed my mind exactly the same way over and over again. When you got sober, were you embarrassed? Did people sometimes tell you you did things you didn't remember? Did you have to make apologies? Did you ever decide that you weren't going to drink anymore? Cause I did. I didn't stop, but I did decide to stop, and I decided to stop more than once. I just didn't stay stopped. I remember clearly that in the years between starting to have a real problem with drinking and committing to AA, I had this thought that I was somehow different from people who really had this alcoholic thing, because I could stop long enough the alcohol would leave my body. I could stop for twenty four or forty eight or seventy two hours, and in my head, people who are alcoholic can't do that. Of course, there came a period of time where it was exceedingly difficult for me to stop for twenty four or forty eight hours, let alone seventy two. Later on in that page, doctor Silkworth makes something like a confession when he says if a doctor is honest with himself, he must sometimes feel his own inadequacy. He continues by saying that we physicians must admit we have made little impression upon the problem as a whole. I'm going to rephrase that. Said more simply, he means we physicians must admit our treatments haven't worked. That's a hard thing to own up to. I call this out because Silkworth is leaving an opening for AA as an approach to the treatment of alcoholism. He's saying medicine hasn't worked and leaving space for something else to work, like a spiritual experience. On the next page, doctor Silkworth spends a couple of paragraphs talking about different types of alcoholics. I remember when I was new, I didn't see myself as somebody who couldn't admit he couldn't take a drink, nor did I see myself as the manic depressive type. Instead I put myself in with a type which was entirely normal in every respect, except in the effect alcohol has upon them. In retrospect, I think I was being pretty kind to myself. Anyway, the conclusion he comes to is that alcoholics all have one symptom in common. They cannot start drinking without developing the phenomenon of craving. So there you have it. Then he says something that doesn't seem all that important, but it sure is. He says that there has never been a treatment for alcoholic craving. He concludes that quote, the only relief we have to suggest is entire abstinence. So what does that mean? It means that if this doctor and AA have no solution at all that works after an alcoholic starts drinking, then that means that alcoholics anonymous can't teach me how to drink like a gentleman. It means that if I have this disease, then I can never drink safely. It means that I don't have the kind of brakes on my car that are required to save my life and the lives of others. This sucks. I spent years trying to drink better and now I find out that a guy like me can't drink better. All that energy, all that time. But the way I'm built physically means that I've lost the power of choice. If I start drinking, my control goes away. That's me, not you. I think one of the worst things you can possibly do in the steps is to agree that you're an alcoholic too easily. Too many people decide they're alcoholic in this step, go forward, and then end up drinking again. Frequently, the reason is that they glossed over this stuff. And I get it. When I was new, I wanted to say yeah, yeah, yeah, I got it, let's move on. The doctor's opinion introduces some of the most important concepts in AAA, but they're only important if I apply them to my life and my experience. Did that happen to me? Was I able to exercise control over alcohol on a consistent basis? Or did it just seem like I was making up my mind when in reality I was doing the same damn thing over and over again? Only you can answer that question. If you skim off all the drama from the doctor's opinion, if you skim off the weird dated language, then when you look at the things the doctor's saying, do they apply to you at all? Some of the time? All the time? What is your experience? I think I'm a bright guy. I certainly spent a bump load of time in various schools, but until I got to Alcoholics Anonymous and did the steps out of the big book, I had never thought rigorously about what happened to me when I drank, and I needed to really know. For the record, before AA, I talked openly with a therapist about my problems with alcohol, but I didn't examine my experience the same way. I didn't know what my patterns were. I hadn't reflected in such a way that I could figure out if I was lying to myself or not. And I needed to know. Just because I'm an alcoholic doesn't mean you are. Just because you go to meetings and have a sponsor doesn't make you an alcoholic. I think all of us we need to know. Reading the doctor's opinion and examining it line by line became really important to me, foundational. Part of what led to a really solid step one. This is one of those times to do everything you can to have an open mind and to let yourself have a new experience. Use the set aside prayer. Go sentence by sentence. Yes, there's some more in the doctor's opinion, but I think I need to stop and let you go out and make some discoveries on your own about that piece of the book and about yourself. I may have said too much already. God knows I've talked long enough, way more than I intended to. So let me go back to the beginning here. We've got ourselves a bit of a weird book, but damn if it hasn't helped me like nothing else in learning about my disease. So if you think you might be alcoholic, please spend some time in the doctor's opinion. Not because doctor Silkworth is right, but because each of us, if we think we might be alcoholic, needs to reflect on exactly what happened. The doctor's opinion is short. I go sentence by sentence. I turn statements into questions, and then I get to see the truth about myself. Thanks for sticking with me in a long podcast. If you like, shoot me an email more soon.