Dr William D. Silkworth and the Phenomenon of Craving

When a brash New York stockbroker named Bill Wilson met the Akron physician and surgeon, Dr Bob Smith, an entire movement grew up around them and millions of lives across the globe have been saved.  Since then, the 12 Steps to recovery, as pioneered by Alcoholics Anonymous (AA), has been the most successful method of treatment for people wanting to recover from alcoholism and or drug addiction.

The meeting of Bill W and Dr Bob, as they are affectionately known, is AA folklore and both men are revered. The circumstances of their meeting are conveyed by recovered alcoholics to people seeking recovery as an example of how tenuous the conduit between sobriety and relapse can be.

But their respective journeys were anything but linear and both men had suffered from the false belief that their drinking was due solely to a lack of moral fortitude or mental frailty. And while it’s true to suggest that drinking contrary to the stark evidence of humiliating, harmful and even tragic events occurring is a peculiar form of insanity, the problem has additional dimensions that formed the substance of Bill W and Dr Bob’s initial, and subsequent conversations.

In the chronicles of alcoholism pre 1934, insanity preceding death was the outcome for most alcoholics. A lucky few, according to Dr Carl Jung, “experienced a conversion” and recovered after becoming affiliated with a religious organisation, but those cases were rare.

The mystical or mysterious definition of a conversion experience seemed desirable given the profound lack of success that every specialist working in the field of alcoholism and addiction in the 1920s and 1930s had experienced. But where were these experiences to be found and who, if anyone, had the skill and insight to effect such a transformation?

Prior to the two men meeting, Bill W had emerged from his most recent bout of treatment as a changed man. He’d been in the care of the renowned physician, Dr William D Silkworth, Director of the Charles B. Towns Hospital for Drug and Alcohol Addictions in New York City in the 1930s.

During his stay Dr Silkworth had passed on a vital piece of information that would not only change the way alcoholics could and would be treated, but also removed the long held view that alcoholics were, in his words: “Maladjusted to life” and in “full flight from reality”.

In Dr Silkworth’s opinion, the action of alcohol on chronic alcoholics manifests in a type of allergy or ‘phenomenon of craving’, that compels the drinker to keep drinking into intoxication, blackout and eventually unconsciousness.

These alcoholic sprees or binges can last anywhere from a few hours for those less affected, to multiples of days and even weeks for others. In time, it’s often the case that an alcoholic will drink around the clock and barely draw a sober breath.

In the basic text of Alcoholics Anonymous the doctor described the thinking that precedes taking the first drink this way:

That 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.

Dr Bob was 55 and 15 years older than Bill when they first met. He was hungover and unhappy about having to meet with yet another so called expert or do-gooder with a theory that might unlock the reasoning behind his chronic drinking. Dr Bob reluctantly agreed to the meeting on the condition that it would conclude after 15 minutes.

But Bill W was no self-proclaimed expert nor was he a do-gooder. He had a tenuous grip on sobriety and desperately needed to talk to one of his kind lest he take a drink to quell the nagging disappointment of a failed business opportunity. He was in Akron and the only tool he had to protect his sobriety was the knowledge that talking with another alcoholic might work if all else had failed.

Their first meeting commenced at five in the afternoon and concluded at 11pm. In the book “Pass It On”, the story of Bill Wilson and the growth of AA, Dr Bob said “he quickly realised that this Bill Wilson knew what he was talking about.”

And according to Dr Bob, the message Bill shared wasn’t theory, jargon or a prognosis designed to scare Dr Bob sober. Nor was it recycled information from the Oxford Group – an evangelical Christian organisation that prescribed absolute purity, honest, unselfishness and love.

The information that had the most impact was from Bill W’s own experience. According to Dr Bob, “he knew all the answers, and certainly not because he had picked them up in his reading.”

Dr Bob suffered from inordinate amounts of guilt due to his profession and standing in the community. Beyond being perplexed by his inability to control his drinking, his health was at breaking point and he was restless, on edge and medicated most of the time.

“It was a really horrible nightmare,” said Dr Bob in Pass It On. “Getting liquor, smuggling it home, getting drunk, morning jitters, taking large doses of sedatives to make it possible for me to earn more money, and so on, ad nauseam.”

When Bill shared the medical view that Dr Silkworth had stressed with him during his last stay at Towns Hospital it was the missing ingredient in Dr Bob’s understanding of alcoholism. He passed on to Dr Bob what Dr Silkworth had told him: That the illness was the combination of a physical compulsion or craving and an obsession of the mind. That the problem had nothing to do with vice or habit or lack of character

The surrender so strongly advocated for in the teachings of The Oxford Group and later adapted by AA was hitherto impossible because he thought control of his drinking was his own responsibility. Understanding that he was powerless to stop without intervention from a power beyond his own willpower changed Dr Bob’s life.

And so it is today. The power of one alcoholic sharing their experience, strength and hope with another. Since AA was founded in 1935, its success rates have far exceeded any other form of treatment. People who had given up hope of ever getting sober, have found recovery by admitting themselves to an alcohol rehab centre like The Sydney Retreat and applying the AA treatment program for alcoholism.

Unlike other private alcohol rehabilitation centres in Sydney, The Retreat bases its treatment programs for alcoholism on the 12 Step program of recovery as pioneered by Alcoholics Anonymous (AA) and the inspiration of one alcoholic sharing their experience, strength and hope with another.

The Retreat works on the simple principle of once an alcoholic, always an alcoholic. For time immemorial, alcoholics and addicts have been unsuccessfully trying to prove that they can drink or take drugs with impunity if they have abstained for a period of time. But alcohol is a subtle foe and denial, delusion and inconsistency are all persuasive opponents to the principles of recovery.

As a clinic for people who are seeking recovery, we consider that the best form of assistance to be the introduction and demonstration of the 12 Steps. Members of the recovery community will show you how to apply the recovery program to your daily lives and we connect you with a network of established members of the recovery community who will guide you on the path to long-term, content and purposeful sobriety.

The Sydney Retreat’s twelve step facilitated recovery model has an exceptionally high success rate compared to other forms of recovery.  If you have a problem with alcohol and or drugs, this is a unique and affordable opportunity that will change the direction of your life. Get help today.

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