Friday, March 17, 2023
Thursday, March 16, 2023
Allergy to alcohol
The Doctors Opinion, AA Big Book, pages xxviii-xxxi
We believe, and so suggested a few years ago, that the action of alcohol on these chronic alcoholics is a manifestation of an allergy; that the phenomenon of craving is limited to this class and never occurs in the average temperate drinker. These allergic types can never safely use alcohol in any form at all; and once having formed the habit and found they cannot break it, once having lost their self confidence, their reliance upon things human, their problems pile up on them and become astonishingly difficult to solve.
Frothy emotional appeal seldom suffices. The message which can interest and hold these alcoholic people must have depth and weight. In nearly all cases, their ideals must be grounded in a power greater than themselves, if they are to recreate their lives.
If any feel that as psychiatrists directing a hospital for alcoholics we appear somewhat sentimental, let them stand with us a while on the firing line, see the tragedies, the despairing wives, the little children; let the solving of these problems become a part of their daily work, and even of their sleeping moments, and the most cynical will not wonder that we have accepted and encouraged this movement. We feel, after many years of experience, that we have found nothing which has contributed more to the rehabilitation of these men than the altruistic movement now growing up among them.
Men and women drink essentially because they like the effect produced by alcohol. The sensation is so elusive that, while they admit it is injurious, they cannot after a time differentiate the true from the false. To them, their alcoholic life seems the only normal one. They are restless, irritable and discontented, unless they can again experience the sense of ease and comfort which comes at once by taking a few drinks—drinks which they see others taking with impunity. After they have succumbed to the desire again, as so many do, and the phenomenon of craving develops, they pass through the well-known stages of a spree, emerging remorseful, with a firm resolution not to drink again. This is repeated over and over, and unless this person can experience an entire psychic change there is very little hope of his recovery.
On the other hand—and strange as this may seem to those who do not understand—once a psychic change has occurred, the very same person who seemed doomed, who had so many problems he despaired of ever solving them, suddenly finds himself easily able to control his desire for alcohol, the only effort necessary being that required to follow a few simple rules.
Men have cried out to me in sincere and despairing appeal: "Doctor, I cannot go on like this! I have everything to live for! I must stop, but I cannot! You must help me!"
Faced with this problem, if a doctor is honest with himself, he must sometimes feel his own inadequacy. Although he gives all that is in him, it often is not enough. One feels that something more than human power is needed to produce the essential psychic change. Though the aggregate of recoveries resulting from psychiatric effort is considerable, we physicians must admit we have made little impression upon the problem as a whole. Many types do not respond to the ordinary psychological approach.
I do not hold with those who believe that alcoholism is entirely a problem of mental control. I have had many men who had, for example, worked a period of months on some problem or business deal which was to be settled on a certain date, favorably to them. They took a drink a day or so prior to the date, and then the phenomenon of craving at once became paramount to all other interests so that the important appointment was not met. These men were not drinking to escape; they were drinking to overcome a craving beyond their mental control.
There are many situations which arise out of the phenomenon of craving which cause men to make the supreme sacrifice rather than continue to fight.
The classification of alcoholics seems most difficult, and in much detail is outside the scope of this book. There are, of course, the psychopaths who are emotionally unstable. We are all familiar with this type. They are always ”going on the wagon for keeps.“ They are over-remorseful and make many resolutions, but never a decision.
There is the type of man who is unwilling to admit that he cannot take a drink. He plans various ways of drinking. He changes his brand or his environment. There is the type who always believes that after being entirely free from alcohol for a period of time he can take a drink without danger. There is the manic-depressive type, who is, perhaps, the least understood by his friends, and about whom a whole chapter could be written.
Then there are types entirely normal in every respect except in the effect alcohol has upon them. They are often able, intelligent, friendly people.
All these, and many others, have one symptom in common: they cannot start drinking without developing the phenomenon of craving. This phenomenon, as we have suggested, may be the manifestation of an allergy which differentiates these people, and sets them apart as a distinct entity. It has never been, by any treatment with which we are familiar, permanently eradicated. The only relief we have to suggest is entire abstinence.
The real alcoholic
There Is A Solution, AA Big Book, pages 20-22
You may already have asked yourself why it is that all of us became so very ill from drinking. Doubtless you are curious to discover how and why, in the face of expert opinion to the contrary, we have recovered from a hopeless condition of mind and body. If you are an alcoholic who wants to get over it, you may already be asking "What do I have to do?"It is the purpose of this book to answer such questions specifically. We shall tell you what we have done. Before going into a detailed discussion, it may be well to summarize some points as we see them.
How many times people have said to us: "I can take it or leave it alone. Why can't he?" "Why don't you drink like a gentleman or quit?" "That fellow can't handle his liquor." "Why don't you try beer and wine?" "Lay off the hard stuff." "His will power must be weak." "He could stop if he wanted to." "She's such a sweet girl, I should think he'd stop for her sake." "The doctor told him that if he ever drank again it would kill him, but there he is all lit up again."
Now these are commonplace observations on drinkers which we hear all the time. Back of them is a world of ignorance and misunderstanding. We see that these expressions refer to people whose reactions are very different from ours.
Moderate drinkers have little trouble in giving up liquor entirely if they have good reason for it. They can take it or leave it alone.
Then we have a certain type of hard drinker. He may have the habit badly enough to gradually impair him physically and mentally. It may cause him to die a few years before his time. If a sufficiently strong reason - ill health, falling in love, change of environment, or the warning of a doctor - becomes operative, this man can also stop or moderate, although he may find it difficult and troublesome and may even need medical attention.
But what about the real alcoholic? He may start off as a moderate drinker; he may or may not become a continuous hard drinker; but at some stage of his drinking career he begins to lose all control of his liquor consumption, once he starts to drink.
Here is the fellow who has been puzzling you, especially in his lack of control. He does absurd, incredible, tragic things while drinking. He is a real Dr. Jekyll and Mr. Hyde. He is seldom mildly intoxicated. He is always more or less insanely drunk. His disposition while drinking resembles his normal nature but little. He may be one of the finest fellows in the world. Yet let him drink for a day, and he frequently becomes disgustingly, and even dangerously anti-social. He has a positive genius for getting tight at exactly the wrong moment, particularly when some important decision must be made or engagement kept. He is often perfectly sensible and well balanced concerning everything except liquor, but in that respect he is incredibly dishonest and selfish. He often possesses special abilities, skills, and aptitudes, and has a promising career ahead of him. He uses his gifts to build up a bright outlook for his family and himself, and then pulls the structure down on his head by a senseless series of sprees. He is the fellow who goes to bed so intoxicated he ought to sleep the clock around. Yet early next morning he searches madly for the bottle he misplaced the night before. If he can afford it, he may have liquor concealed all over his house to be certain no one gets his entire supply away from him to throw down the wastepipe. As matters grow worse, he begins to use a combination of high-powered sedative and liquor to quiet his nerves so he can go to work. Then comes the day when he simply cannot make it and gets drunk all over again. Perhaps he goes to a doctor who gives him morphine or some sedative with which to taper off. Then he begins to appear at hospitals and sanitariums.
This is by no means a comprehensive picture of the true alcoholic, as our behavior patterns vary. But this description should identify him roughly.
Rocketed into a fourth dimension
There Is A Solution, AA Big Book, pages 22-26
Why does he behave like this? If hundreds of experiences have shown him that one drink means another debacle with all its attendant suffering and humiliation, why is it he takes that one drink? Why can't he stay on the water wagon? What has become of the common sense and will power that he still sometimes displays with respect to other matters?
Perhaps there never will be a full answer to these questions. Opinions vary considerably as to why the alcoholic reacts differently from normal people. We are not sure why, once a certain point is reached, little can be done for him. We cannot answer the riddle.
We know that while the alcoholic keeps away from drink, as he may do for months or years, he reacts much like other men. We are equally positive that once he takes any alcohol whatever into his system, something happens, both in the bodily and mental sense, which makes it virtually impossible for him to stop. The experience of any alcoholic will abundantly confirm this.
These observations would be academic and pointless if our friend never took the first drink, thereby setting the terrible cycle in motion. Therefore, the main problem of the alcoholic centers in his mind, rather than in his body. If you ask him why he started on that last bender, the chances are he will offer you any one of a hundred alibis. Sometimes these excuses have a certain plausibility, but none of them really makes sense in the light of the havoc an alcoholic's drinking bout creates. They sound like the philosophy of the man who, having a headache, beats himself on the head with a hammer so that he can't feel the ache. If you draw this fallacious reasoning to the attention of an alcoholic, he will laugh it off, or become irritated and refuse to talk.
Once in a while he may tell the truth. And the truth, strange to say, is usually that he has no more idea why he took that first drink than you have. Some drinkers have excuses with which they are satisfied part of the time. But in their hearts they really do not know why they do it. Once this malady has a real hold, they are a baffled lot. There is the obsession that somehow, someday, they will beat the game. But they often suspect they are down for the count.
How true this is, few realize. In a vague way their families and friends sense that these drinkers are abnormal, but everybody hopefully awaits the day when the sufferer will rouse himself from his lethargy and assert his power of will.
The tragic truth is that if the man be a real alcoholic, the happy day may not arrive. He has lost control. At a certain point in the drinking of every alcoholic, he passes into a state where the most powerful desire to stop drinking is of absolutely no avail. This tragic situation has already arrived in practically every case long before it is suspected.
The fact is that most alcoholics, for reasons yet obscure, have lost the power of choice in drink. Our so-called will power becomes practically nonexistent. We are unable, at certain times, to bring into our consciousness with sufficient force the memory of the suffering and humiliation of even a week or a month ago. We are without defense against the first drink.
The almost certain consequences that follow taking even a glass of beer do not crowd into the mind to deter us. If these thoughts occur, they are hazy and readily supplanted with the old threadbare idea that this time we shall handle ourselves like other people. There is a complete failure of the kind of defense that keeps one from putting his hand on a hot stove.
The alcoholic may say to himself in the most casual way, "It won't burn me this time, so here's how!" Or perhaps he doesn't think at all. How often have some of us begun to drink in this nonchalant way, and after the third or fourth, pounded on the bar and said to ourselves, "For God's sake, how did I ever get started again?" Only to have that thought supplanted by "Well, I'll stop with the sixth drink." Or "What's the use anyhow?"
When this sort of thinking is fully established in an individual with alcoholic tendencies, he has probably placed himself beyond human aid, and unless locked up, may die or go permanently insane. These stark and ugly facts have been confirmed by legions of alcoholics throughout history. But for the grace of God, there would have been thousands more convincing demonstrations. So many want to stop but cannot.
There is a solution. Almost none of us liked the self-searching, the leveling of our pride, the confession of shortcomings which the process requires for its successful consummation. But we saw that it really worked in others, and we had come to believe in the hopelessness and futility of life as we had been living it. When, therefore, we were approached by those in whom the problem had been solved, there was nothing left for us but to pick up the simple kit of spiritual tools laid at our feet. We have found much of heaven and we have been rocketed into a fourth dimension of existence of which we had not even dreamed.
The great fact is just this, and nothing less: That we have had deep and effective spiritual experiences which have revolutionized our whole attitude toward life, toward our fellows and toward God's universe. The central fact of our lives today is the absolute certainty that our Creator has entered into our hearts and lives in a way which is indeed miraculous. He has commenced to accomplish those things for us which we could never do by ourselves.
If you are as seriously alcoholic as we were, we believe there is no middle-of-the-road solution. We were in a position where life was becoming impossible, and if we had passed into the region from which there is no return through human aid, we had but two alternatives: One was to go on to the bitter end, blotting out the consciousness of our intolerable situation as best we could; and the other, to accept spiritual help. This we did because we honestly wanted to, and were willing to make the effort.
Methods we have tried
More About Alcoholism, AA Big Book, pages 30-31
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. Therefore, it is not surprising that our drinking careers have been characterized by countless vain attempts to prove we could drink like other people. The idea that somehow, someday he will control and enjoy his drinking is the great obsession of every abnormal drinker. The persistence of this illusion is astonishing. Many pursue it into the gates of insanity or death.
We learned that we had to fully 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.
We alcoholics are men and women who have lost the ability to control our drinking. We know that no real alcoholic ever recovers control. All of us felt at times that we were regaining control, but such intervals - usually brief - were inevitably followed by still less control, which led in time to pitiful and incomprehensible demoralization. We are convinced to a man that alcoholics of our type are in the grip of a progressive illness. Over any considerable period we get worse, never better.
We are like men who have lost their legs; they never grow new ones. Neither does there appear to be any kind of treatment which will make alcoholics of our kind like other men. We have tried every imaginable remedy. In some instances there has been brief recovery, followed always by a still worse relapse. Physicians who are familiar with alcoholism agree there is no such thing as making a normal drinker out of an alcoholic. Science may one day accomplish this, but it hasn't done so yet.
Despite all we can say, many who are real alcoholics are not going to believe they are in that class. By every form of self-deception and experimentation, they will try to prove themselves exceptions to the rule, therefore nonalcoholic. If anyone who is showing inability to control his drinking can do the right- about-face and drink like a gentleman, our hats are off to him. Heaven knows, we have tried hard enough and long enough to drink like other people!
Here are some of the methods we have tried: Drinking beer only, limiting the number of drinks, never drinking alone, never drinking in the morning, drinking only at home, never having it in the house, never drinking during business hours, drinking only at parties, switching from scotch to brandy, drinking only natural wines, agreeing to resign if ever drunk on the job, taking a trip, not taking a trip, swearing off forever (with and without a solemn oath), taking more physical exercise, reading inspirational books, going to health farms and sanitariums, accepting voluntary commitment to asylums - we could increase the list ad infinitum.
Jim - whiskey and milk
More About Alcoholism, AA Big Book, pages 34-37
For those who are unable to drink moderately the question is how to stop altogether. We are assuming, of course, that the reader desires to stop. Whether such a person can quit upon a nonspiritual basis depends upon the extent to which he has already lost the power to choose whether he will drink or not. Many of us felt that we had plenty of character. There was a tremendous urge to cease forever. Yet we found it impossible. This is the baffling feature of alcoholism as we know it - this utter inability to leave it alone, no matter how great the necessity or the wish.
How then shall we help our readers determine, to their own satisfaction, whether they are one of us? The experiment of quitting for a period of time will be helpful, but we think we can render an even greater service to alcoholic sufferers and perhaps to the medical fraternity. So we shall describe some of the mental states that precede a relapse into drinking, for obviously this is the crux of the problem.
What sort of thinking dominates an alcoholic who repeats time after time the desperate experiment of the first drink? Friends who have reasoned with him after a spree which has brought him to the point of divorce or bankruptcy are mystified when he walks directly into a saloon. Why does he? Of what is he thinking?
Our first example is a friend we shall call Jim. This man has a charming wife and family. He inherited a lucrative automobile agency. He had a commendable World War record. He is a good salesman. Everybody likes him. He is an intelligent man, normal so far as we can see, except for a nervous disposition. He did no drinking until he was thirty-five. In a few years he became so violent when intoxicated that he had to be committed. On leaving the asylum he came into contact with us.
We told him what we knew of alcoholism and the answer we had found. He made a beginning. His family was re-assembled, and he began to work as a salesman for the business he had lost through drinking. All went well for a time, but he failed to enlarge his spiritual life. To his consternation, he found himself drunk half a dozen times in rapid succession. On each of these occasions we worked with him, reviewing carefully what had happened. He agreed he was a real alcoholic and in a serious condition. He knew he faced another trip to the asylum if he kept on. Moreover, he would lose his family for whom he had a deep affection.
Yet he got drunk again. We asked him to tell us exactly how it happened. This is his story: "I came to work on Tuesday morning. I remember I felt irritated that I had to be a salesman for a concern I once owned. I had a few words with the boss, but nothing serious. Then I decided to drive into the country and see one of my prospects for a car. On the way I felt hungry so I stopped at a roadside place where they have a bar. I had no intention of drinking. I just thought I would get a sandwich. I also had the notion that I might find a customer for a car at this place, which was familiar for I had been going to it for years. I had eaten there many times during the months I was sober. I sat down at a table and ordered a sandwich and a glass of milk. Still no thought of drinking. I ordered another sandwich and decided to have another glass of milk.
"Suddenly the thought crossed my mind that if I were to put an ounce of whiskey in my milk it couldn't hurt me on a full stomach. I ordered a whiskey and poured it into the milk. I vaguely sensed I was not being any too smart, but felt reassured as I was taking the whiskey on a full stomach. The experiment went so well that I ordered another whiskey and poured it into more milk. That didn't seem to bother me so I tried another."
Thus started one more journey to the asylum for Jim. Here was the threat of commitment, the loss of family and position, to say nothing of that intense mental and physical suffering which drinking always caused him. He had much knowledge about himself as an alcoholic. Yet all reasons for not drinking were easily pushed aside in favor of the foolish idea that he could take whiskey if only he mixed it with milk!
Whatever the precise definition of the word may be, we call this plain insanity. How can such a lack of proportion, of the ability to think straight, be called anything else?
You may think this an extreme case. To us it is not far-fetched, for this kind of thinking has been characteristic of every single one of us. We have sometimes reflected more than Jim did upon the consequences. But there was always the curious mental phenomenon that parallel with our sound reasoning there inevitably ran some insanely trivial excuse for taking the first drink. Our sound reasoning failed to hold us in check. The insane idea won out. Next day we would ask ourselves, in all earnestness and sincerity, how it could have happened.
The jaywalker
More About Alcoholism, AA Big Book, pages 37-39
In some circumstances we have gone out deliberately to get drunk, feeling ourselves justified by nervousness, anger, worry, depression, jealousy or the like. But even in this type of beginning we are obliged to admit that our justification for a spree was insanely insufficient in the light of what always happened. We now see that when we began to drink deliberately, instead of casually, there was little serious or effective thought during the period of premeditation of what the terrific consequences might be.
Our behavior is as absurd and incomprehensible with respect to the first drink as that of an individual with a passion, say, for jay-walking. He gets a thrill out of skipping in front of fast-moving vehicles. He enjoys himself for a few years in spite of friendly warnings. Up to this point you would label him as a foolish chap having queer ideas of fun. Luck then deserts him and he is slightly injured several times in succession. You would expect him, if he were normal, to cut it out. Presently he is hit again and this time has a fractured skull. Within a week after leaving the hospital a fast-moving trolley car breaks his arm. He tells you he has decided to stop jay-walking for good, but in a few weeks he breaks both legs.
On through the years this conduct continues, accompanied by his continual promises to be careful or to keep off the streets altogether. Finally, he can no longer work, his wife gets a divorce and he is held up to ridicule. He tries every known means to get the jay-walking idea out of his head. He shuts himself up in an asylum, hoping to mend his ways. But the day he comes out he races in front of a fire engine, which breaks his back. Such a man would be crazy, wouldn't he?
You may think our illustration is too ridiculous. But is it? We, who have been through the wringer, have to admit if we substituted alcoholism for jay-walking, the illustration would fit us exactly. However intelligent we may have been in other respects, where alcohol has been involved, we have been strangely insane. It's strong language - but isn't it true?
Some of you are thinking: "Yes, what you tell us is true, but it doesn't fully apply. We admit we have some of these symptoms, but we have not gone to the extremes you fellows did, nor are we likely to, for we understand ourselves so well after what you have told us that such things cannot happen again. We have not lost everything in life through drinking and we certainly do not intend to. Thanks for the information."
That may be true of certain nonalcoholic people who, though drinking foolishly and heavily at the present time, are able to stop or moderate, because their brains and bodies have not been damaged as ours were. But the actual or potential alcoholic, with hardly an exception, will be absolutely unable to stop drinking on the basis of self-knowledge.
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