The Doctor’s Opinion

June 16, 2021

By Andy F

Categories: AA literature

A newcomer’s reaction

I went to my first AA meeting in May 1984. It took several weeks for the alcoholic fog to clear. I was happy to be in the fellowship and to have found like-minded people. I felt an immediate sense of belonging.

That said, I didn’t like the AA Big Book. Its old-fashioned use of the English language put me off. Seeing words like “thy” and “thou” in the text was too Biblical. It stirred up my old resentments towards religion.

Frequent references to God and a Higher Power reinforced my ambivalence to the AA literature. A doctor’s opinion appeared as an introduction to the Big Book. The doctor’s opinion seemed oddly out of place, given the religious nature of the text that followed it. As a newcomer, I didn’t bother to read it.

Several years later, I eventually learned who Dr. Silkworth was and how involved he was with the fledgling fellowship. He was the chief physician of a prominent hospital in New York. Its purpose was the treatment of addiction. When asked to write a letter of support regarding AA’s work, he made the following statement:

How Dr Silkworth saw the rehabilitation of alcoholics

“We doctors have realized for a long time that some form of moral psychology was of urgent importance to alcoholics, but its application presented difficulties beyond our conception. What with our ultra-modern standards, our scientific approach to everything, we are perhaps not well equipped to apply the powers of good that lie outside our synthetic knowledge” *


With no interest in the Big Book or the Twelve Steps, I went into therapy and tried to stay sober just by attending meetings. In my mind, therapy was a much more appropriate intervention. I knew that I had unresolved issues from childhood. As far as I was concerned, only professionally trained therapists were competent enough to help a unique case like mine. At least, that’s how I saw it as a self-centered newbie.

AA – An Attitude Adjustment

After many years of relapse, I eventually had to reconsider my attitude to the program and the literature. Ten years of therapy were unsuccessful in keeping me sober. I was so angry and bitter that I was unlikely to survive much longer.

“We saw that we had to reconsider or die.”

(12&12 p.30)

I arrived at the ego-deflating admission that I couldn’t stay sober doing it my way. I limited my recovery to just going to meetings. It wasn’t enough to get well. Eventually, I received the Gift ODesperation (an acronym for GOD) and became teachable. I started to get more honest. One passage from the chapter on Step One in the 12&12 suddenly resonated with me.

……….”Then, and only then, do we become as open-minded to conviction and willing to listen as the dying can be”

(12&12 p.24)

Getting an agnostic-friendly sponsor

When all my “scorecards read zero” (12&12 p.29), I got myself a sponsor. He told me that if I didn’t believe in God, I could make AA itself my higher power. (See page 27 in the 12&12.)

From that day forward, AA, my sponsor’s suggestions, and the twelve steps became powers greater than me. My sponsor’s initial suggestion was to read the first 164 pages of the Big Book. Whenever I got to the “God” word, I replaced it with Group Of Drunks (Acronym for GOD). He assured me that I could stay happily sober using AA itself as a higher power.

Through no personal virtue, I gradually became well acquainted with the literature. To my great surprise, I began to see myself on every page. I realized that, in the doctor’s opinion, Dr Silkworth had a deep understanding of the destructive power of alcoholism.

The Doctor’s Opinion: a great source of information

It’s incredible how open-minded I became after receiving the Gift ODesperation. In my early years, I often used to hear people say at meetings that “there are no musts” in AA. The Twelve Steps are offered only as suggestions.

“Here are steps we took which are ‘suggested’ as a program of recovery.”

(BB p. 59)

For a serial relapser like me, the idea that I could get by without taking any suggestions set me on a path of serial relapse. My sponsor lovingly pointed out that “must” is mentioned six times in The Doctor’s Opinion alone. In The Big Book and 12&12, it appears a staggering 138 times!

Please see

He also pointed me to the following sentence:

“…the only effort necessary being that required to follow a few simple rules.” 

(BB p. XXIX)

For some reason, the word “rules” convinced me to stop paying lip service to the program. I began taking the suggestions seriously. If I wanted to survive, the good doctor declared I needed to work toward an “entire psychic change” (BB p. XXIX) to get well.

The entire psychic change

“…..unless this person can experience an entire psychic change, there is very little hope for his recovery.”

(BB p. XXIX).

What did Dr. Silkworth mean by an entire psychic change? Was it some religious conversion? Thankfully, my sponsor reassured me that “an entire psychic change” does not require believing in God. As an agnostic, I found this new awareness incredibly liberating. It freed me from the shackles of my former prejudice.

My sponsor defined the entire psychic change and pointed me toward two quotes that could have meaning for me as an agnostic. Perhaps not coincidentally, they are both from AA’s founders, Bill W and Dr. Bob.

On page 62 in Chapter Five of the Big Book, Bill makes this critically important statement:

“Selfishness – self-centeredness! That we think is the root of our troubles.”

Three months before his death, on July 30th, 1950, Dr. Bob gave a short talk at the First International A.A. convention in Cleveland, Ohio.

Here is a short excerpt from his talk:

“Our 12 Steps, when simmered down to the last, resolve themselves into the words love and service. We understand what love is, and we understand what service is. So let’s bear those two things in mind.”

Reprinted with permission of Alcoholics Anonymous

It struck me that “love and service,” as mentioned by Dr. Bob, are the polar opposite of “selfishness and self-centeredness,” as mentioned in Chapter Five by Bill. Any alcoholic who has undergone this radical change in “attitude and outlook” (Promises 12&12, p.84) has unquestionably undergone the “entire psychic change” mentioned by Dr. Silkworth in the Doctor’s Opinion.

In effect, my sponsor was steering me toward the realization that any alcoholic who has worked the twelve steps and is continuing to practice compassion and goodwill to others through the maintenance steps is continuing to experience the psychic change mentioned by Dr. Silkworth.

Restless, irritable and discontented  

In The Doctor’s Opinion, Dr Silkworth also states:

“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.”*


After being on a 13-year dry drunk in AA, it was evident that I was restless, irritable, and discontent pretty much most of the time. This painful state of being was normal, with or without a drink.

Why did abstinence from alcohol not relieve mental and emotional suffering? Was it really an illness that persisted into sobriety? Was my alcohol addiction a symptom of a much deeper “spiritual malady”? (BB p. 64) Moreover, did I need to believe in God to recover?

Dr. Silkworth continues:

“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.


I eventually came to understand that it was my alcoholic ego that condemned me to be restless, irritable, and discontent. Release from this condition requires a daily surrender of ego-driven self-will and a willingness to help others.

By learning to live like this, I found freedom from fear, anger, and self-pity. When I remind myself that I am “no longer running the show*” (BB p.88), I am released from the pain of untreated alcoholism. The greater my surrender and willingness to remain teachable, the more I glimpse the healing power of humility mentioned in Step Seven.

“It brought a measure of humility, which we soon discovered was a healer of pain.

(12&12 p.75)

From the false to the true

As an untreated alcoholic, I was undoubtedly both mentally and emotionally unstable. My dishonest way of seeing things would continuously warp my perception of reality. It poisoned how I saw my past, present, and future.

After ten years in AA, I discovered another name for the disease of alcoholism. I heard it described as “the disease of perception.” This expression immediately caught my attention. Why? Because I recognized this was my experience years after getting sober. The prism through which I experienced reality was driven by blame, resentment, and self-pity.

The dis-ease of alcoholism made it impossible to see the difference between honesty and dishonesty.

“They cannot after a time differentiate the true from the false.”


After years of drinking, the “true” had become “false,” and the “false” had become “true.”

The maladapted alcoholic ego

Rather than serving me, the maladapted alcoholic ego turned against me. I became my own worst enemy. Dr Silkworth revealed some essential information about alcoholism. So, what have I learned from all the step work I’ve done since coming to AA?

Unquestionably, left untreated, my alcoholic ego makes it very difficult for me to “differentiate the true from the false.” This dishonesty condemns me to be “restless, irritable, and discontent.” So, it would seem that Dr Silkworth knew what he was talking about.

I admitted that if I wanted to survive, it would be necessary to take the good doctor’s advice. Going through the twelve steps and taking a sponsor’s suggestions were the “few simple rules” that Dr Silkworth prescribed.

Remaining teachable by following Good, Orderly Direction helps me to stay humble. This Altered Attitude (Acronym for AA) has gradually taught me about love and service. I am happy to call this a non-God-centered spiritual awakening

.“This is how we react so long as we keep in fit spiritual condition.”

(BB p.85)

The AA program offers me the tools to overcome my alcoholic self-centeredness. This leads to freedom from the “bondage of self.” (BB p.63)

“Our very lives as ex-problem drinkers depend on our constant thought of others and how we may help meet their needs.”

(BB p.20)

As a result of becoming teachable and working the twelve steps, I am no longer “restless, irritable, and discontented.” (BB. p. XXVIII) When, to the best of my ability, I work the program, I am “happy, joyous and free.” (BB p 133)

Although I still don’t believe in the traditional idea of God, I have undoubtedly experienced the “entire psychic change” (BB p. XXIX) mentioned by Dr. Silkworth.

In fellowship,

Andy F

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