By: Bart Ross, Recovery Services Manager
I like to call the Doctor’s Opinion the most important piece of useless information in the Big Book of Alcoholics Anonymous. In this article, I’m going to focus mainly on the physical craving that Doctor Silkworth writes about in the Big Book. I’m not going to focus much on the main problem, the obsession of the mind. But remember, I did say important information, and this article will explain why.
I’ve witnessed many alcoholics relapse because they do not understand the physical factor of addiction.
“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.” (THE DOCTOR’S OPINION)
I have personally done 12-Step work with alcoholics who have relapsed from the use of mouthwash, salad dressing that contained alcohol, non-alcoholic beer, or cough medicine.
All of them said they did not see it coming and that it did not work out with good results. But there was good that came out of it, the hard lesson of never using alcohol in any form.
“The physician who, at our request, gave us this letter, has been kind enough to enlarge upon his views in another statement which follows. In this statement he confirms what we who have suffered alcoholic torture must believe that the body of the alcoholic is quite as abnormal as his mind.” (THE DOCTOR’S OPINION)
Why do alcoholics drink more than others? What’s different about an alcoholic’s body?
Any alcoholic can share, from their own experience, how the Doctor’s Opinion makes perfect sense. My own experience with the craving started quickly. I started drinking with friends just to fit in. I didn’t understand why I always drank more than others and did stupid things. I promised myself that next time I would not drink to the point of losing control and embarrassing myself or my family, but I always failed to control the amount I drank. I can’t count how many times I made an honest promise to myself and others that I wouldn’t get drunk. But once I started, I could not stop. I can really identify with the following statement from The Big Book’s chapter More About Alcoholism, pg. 30:
“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.”
After many years of my own experience and of the privilege of getting to help hundreds of other alcoholics, I can say that the allergy to alcohol is real.
I have met alcoholics that are financially stable and others who struggle financially, some with co-occurring disorders and others without. I’ve met alcoholics from all walks of life. Yet, whether or not an alcoholic takes the first drink to cope with life, to socialize, or innocently ingests alcohol, the result is the same—a craving beyond their mental control.
It would be unethical to experiment purposely to see what would happen if they drank again, but ask any alcoholic who is armed with facts about themselves, and they will tell you the same thing. Once I would put alcohol of any type in my body, I would crave more. It can be a day after sobriety or after years of sobriety, but the craving still occurs.
“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 DOCTOR’S OPINION)
Today, there are many medical thoughts on what Doctor Silkworth called a phenomenon of craving; that the body function of the alcoholic is physically different.
It is apparent to the medical field today that some sort of craving happens in the alcoholic. Scientific research continues to explore the exact nature of how the brain of a person with alcoholism might differ from those who do not have this allergy. As with many phenomena related to the brain, many questions remain. For example, try to find someone to explain precisely why Acetaminophen works. What you will find out is we still don’t fully know. (3,4) However, as we work to learn the exact mechanisms of how it works, we have a plethora of research helping us understand that it does work. Current research suggests that people who develop alcoholism and other addictions have a genetic predisposition to these conditions.(1)
Dr. Judith Grisel, a behavioral neuroscientist with expertise in genetics and pharmacology, describes the brain of a person with addiction as being “…especially tuned to hear signals from drugs and other things.” Though there is no single easy explanation of why this is, a person with alcoholism will always have a brain that is especially tuned to respond to alcohol because they were born with it. Active alcoholic drinking over time may increase the sensitivity, but even when someone stops drinking, their brain continues to have that “special tuning” and will respond differently to alcohol in the future.
Only 6% of the population seek help for their alcoholism, and an even smaller percentage succeed in obtaining longevity because of the lack of education about alcoholism. They are not bad people; they are sick people that deserve to be treated the same as someone with diabetes. A person with diabetes processes sugars differently than others; a person with alcoholism process alcohol differently than others. Yet, there is still a stigma about alcoholism.(2)
What is an Allergy? – A Simple Definition
An allergy occurs when a person reacts to substances that are harmless to most people. These substances are found in dust mites, pets, pollen, insects, ticks, molds, foods, and some medications.
Here are some of the products that alcoholics can make the common mistake of ingesting due to lack of knowledge around their allergy: Non-alcoholic beer, some cough medication and other medications, certain foods, Kombucha, and mouthwash. Alcohol is not digested like food once its swallowed. A small amount is absorbed by the tongue and mucosal lining of the mouth. Then, once in the stomach, alcohol is absorbed directly into your bloodstream through the stomach and small intestine tissue lining.
- Non-alcoholic beer contains alcohol. It’s not really alcohol-free; therefore, it’s for non-alcoholics. Most beers labeled as non-alcoholic or alcohol-free do contain alcohol – up to 0.5%.
- Commonly Dispensed Prescription and OTC Medications can contain anywhere from 3.5% – 25% Alcohol. Read labels, ask your doctor or pharmacist, or look it up online. A common OTC medication is NyQuil which contains 10% alcohol, making it 20-proof. As a result, this popular cold medicine is higher in alcohol content than beer or wine.
- Certain foods may have alcohol that has not been cooked out. The temperature and amount of time cooked are important. For example, by FDA standards, pure vanilla extract contains a minimum of 35% alcohol, which is the same proof as Captain Morgan rum.
- Wine-based vinegars also have trace amounts of alcohol in them, particularly when used uncooked as dressings.
- Kombucha is a fermented beverage that produces alcohol during the fermentation process. The alcohol is produced from yeast consuming and fermenting sugar into CO2 and ethanol. Kombucha’s alcohol content with most commercially available brews is around 0.5%. However, a Canadian study revealed that some store-bought kombucha brands tested above regulatory limit, even in excess of 3%.
- Some common alcohol-containing mouthwashes are between 14% and 26.9% alcohol. Beer is typically 3% to 7% alcohol, and wine is usually around 12% alcohol. This means that between 2 and 4.5 ounces of these mouthwashes could equal one standard drink. There are plenty of alcohol-free mouthwash options that contain 0% alcohol. Alcohol is also a common ingredient in breath sprays.
Although some of these things may be a greater risk than others, they are still a risk, and it’s not worth taking the chance of relapse.
Being armed with knowledge about what everyday products we may use contain alcohol can help reduce the risk of relapse from an unexpected source.
(1) Demery-Poulos, C., & Chambers, J. M. (2021). Genetic variation in alcoholism and opioid addiction susceptibility and treatment: a pharmacogenomic approach. AIMS Molecular Science, 8(4), 202. 2 A Neuroscientist Explores The Biology Of Addiction In “Never Enough.” Fresh Air. February 2019. Accessed January 11, 2023.
(2) Taken from the article Alcoholism – The Jigsaw Puzzle by Dr. Sandra Cabot M.D.
(3)Valerie Gerriets; Thomas M Nappe (2019) Acetaminophen. Statpearls publishing.
(4) Acetaminophen data sheet, ebi.ac.uk
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