Alcoholics Anonymous, who strangely claims to have no official position on the disease theory of addiction, has been instrumental in promoting the theory that alcoholics have an allergy to alcohol which makes them drink. Since their “Big Book” was first published it contained a section titled “The Doctor’s Opinion” in which Dr. William Silkworth M.D. introduces this theory. It has been expanded upon and widely promoted over the years and much effort has been put into proving it scientifically to no avail. The theory now says that alcoholics have an allergic reaction to alcohol in which their body creates toxins which decrease inhibition and cause irresistible cravings for alcohol. This theory is the basis for the claim that moderation is impossible, and it has been applied to drugs other than alcohol as well. But as you’ll see, it falls apart when psychological studies show that alcoholics who supposedly have this allergy which leads to loss of control over drinking don’t lose control of their drinking when they don’t know they’re drinking alcohol!
In 1973 Alan Marlatt of the University of Washington’s Addictive Behaviors Research Center asked an important question.(XIX) He wondered if expectancy is a more influential factor in excessive drinking than the actual physical properties of alcohol. His team formulated an experiment in which both alcoholics and social drinkers were subjected to four different conditions. One group was told they’d be drinking alcohol and indeed were given alcohol. The next group was told they’d be drinking nonalcoholic beverages and that’s exactly what they were given. Another group was told they’d be drinking alcohol but were instead given nonalcoholic drinks. And the final group was told they’d be drinking nonalcoholic beverages but were given alcohol. Important to the study was the fact that the alcoholic drinks the researchers gave out were a mixture of vodka and tonic in which the alcohol was undetectable by taste. Here’s what Marlatt wrote summing up his study:
“The results showed that for both alcoholics and social drinkers, subjects who expected to sample a drink containing alcohol drank almost twice as much beverage as those who expected to receive only tonic, regardless of the actual presence or absence of vodka in the drink. The findings provided a challenge to the disease model theory of loss of control.”
If alcoholics really had the allergy to alcohol that disease proponents claim then it wouldn’t matter what they thought that they were drinking, they would drink uncontrollably once they had alcohol in their system- but they didn’t. This study shows that people don’t drink more because they’re under the control of alcohol, they drink more because they’re expecting the intoxicating effects of alcohol, therefore the allergy model of addiction is null and void. People drink more because they consciously want the effect of alcohol, not because some biological mechanism or supposed allergy is forcing them to do so.
This allergy model of addiction is yet another blatant abuse and bastardization of a medical term by the treatment and recovery world. An allergy is hypersensitivity to a specific substance such as pollen or a particular food, and one could quite possibly have an allergic reaction to alcohol, but the results would be far different than they’re portrayed within the recovery movement. According to the authorities on alcoholism, alcoholics have an allergy to alcohol which causes them to keep drinking uncontrollably after they’ve had one drink. This is apparently the only allergy that has purely behavioral symptoms, but unfortunately there is no reliable body of evidence to support these claims. An allergic reaction is an automatic physiological reaction, common allergic reactions include difficulty breathing, irritation of the eyes, swelling, skin rashes, et-cetera – all involuntary physiological responses. There are however documented cases of people who have severe anaphylaxis after consuming alcohol. The symptoms of this very real all encompassing allergic reaction include nausea, vomiting, headaches, cramps, sneezing, coughing, diarrhea, swelling, itching, breathing difficulties, a drop in blood pressure, and possibly fatal shock. If you had this reaction you might decide to get yourself to the emergency room pretty quickly, you probably wouldn’t choose to drink more alcohol. Allergies elicit automatic physiological responses, not behavioral ones.
If someone presents you with the allergy theory of addiction then you should ask them for scientific evidence of this theory, they will have none, because there is none. But they may spout out some random results from unreliable studies, or they’ll throw around some impressive medical jargon which is often the case with proponents of the disease theory. They may talk about neurotransmitters, THIQ’s, Alcohol Dehydrogenase, or other biological elements involved in the processing of alcohol, but all of this is meaningless when faced with the truths evidenced by studies such as Alan Marlatt’s (listed above). The facts are that people drink because they desire the effects of alcohol, not because a taste or whiff of alcohol sent their body into some auto-pilot mode in which they have no control over their behavior.
Citation:
G. Alan Marlatt, Current Contents. Number 18, May 16, 1985 P18. The study was originally published in the Journal of Abnormal Psychology. 81:233-41.1973.
I’m allergic to seafood & beestings, and believe me, the last thing I would seek out for a big night of fun is either a big plate of shellfish or an angry beehhive. I’ve had occasion to be unknowingly exposed to seafood [example 1 - shrimp in guacamole...who does that? example 2 - burger fried on same grill as fish] & my face began to tingle & swell. I reached for Benadryl, not for another shrimp. Interestingly, after accidental consumption of seafood and occasions when I’ve been stung by insects, I didn’t have any urges to steal, defraud or assault anyone, or cheat on my spouse.
Real allergies are miserable to have, not improved or worsened by behavior, and very frightening to experience.
My son has recently been diagnosed with allergies to wheat and milk. He doesn’t have what most people would consider a typical “allergic response” to these foods when he eats them. Meaning, He doesn’t sneeze, break out in a rash, tingle or swell. His symptoms were more internal — stomach upsets, headaches, sluggishness, etc., that he didn’t relate to these foods. He also craved the foods that contained what the products that cause his allergy. So why couldn’t a person with an allergy to the grains or fruits in alcohol also have these same internal reactions and cravings from drinking and not realize it’s the drink that’s the culprit?
Quick answer, JJ–see the study above. There is no evidence whatsoever for this being the case for alcohol. Period.
I don’t fully understand what point JJ is trying to make, or rather how it’s relevant to the above discussion. Yes, you may be allergic to the ingredients in some alcoholic beverages, and you would have the allergic reactions that come along with those ingredients, which I think is commonly gas in the case of gluten. And yes, people often want to eat the foods to which they’re allergic, because they enjoy the taste. And yes, you may be unaware of what’s actually causing an allergic reaction. Many people go through great pains to determine which foods they’re allergic to. But none of this is news.
The question here is: is there an allergic reaction that causes you to involuntarily consume something? I don’t think so. Strong believers in Dr Silkworth’s allergy model of addiction presented in The Big Book Of Alcoholics Anonymous claim to have an allergy to alcohol which causes them to lose all control over consumption after the first drink – yet the study above calls this notion into question. It shows that expectancy is more important than an actual exposure to alcohol in the matter of how much one chooses to drink. People drink excessively because they want the effect of the alcohol – the pleasur or buzz that it produces – not because a drop of alcohol has set off a chain reaction in their body over which they’re powerless.
Do have another study, besides this one to support this claim? If it doesn’t, then the study cannot be verified as accurate. One study not a “truth” make.
There certainly are other studies which poke holes in the allergy model, and I could do the work to dig them up, but before I do, 2 questions:
1) What in your opinion, is wrong with this study?
2) Are there are any studies (that aren’t based on merely subjective claims by alcoholics within an organization which has taught them that they have no control) which confirm the allergy/loss of control theory?
As far as I’ve been able to find, there are no studies which confirm loss of control as a real phenomenon. If there are, please enlighten me.
I don’t object to this study at all. I was asking for more verification. Now, if the scientific method is to be used then the process is check and recheck. I see but one study and no collaborating or extended study mentioned. That is all I’m saying.
Telling an alcoholic he has a choice to drink or not is like giving a man a box of laxatives and telling him not to poop.
I’m an alcoholic and there where many nights I could go out and have two drinks but there where times when I did not resurface for two days and in one instance I did not breath a sober breath for two years. The reality is that I do not know what will happen if I drink but I do know the difference between an alcoholic and a hard drinker. With the hard drinker, when the drink is removed the problem goes away, with an alcoholic when the drink is removed the problems begin. An alcoholic has two choices in my “opinion” as this study is an “opinion” also.
1) they will be irritable, discontented, and restless unless they drink
OR
2) they can except spiritual help …… I chose number two (2) after 22 years of listening to clinical, scientific, “legal-minded, and spiritually dead opinions.
Today my life is so big and bright I need to wear shades.. Thank you God, and Thank you friends of Bill W. and thank you Dr. Silkworth for you medical opinion. It might just be a theory but so is the above. And the theory of an allergy saved my life…
Congratulations on your sobriety. AA has nothing to do with it. It was a choice you made. By the way, the anology you provided in the first sentence only works one way and so therefore is meaningless. You also say, “they will be irritable, discontented, and restless unless they drink.” Do you think telling someone this, perhaps like one of your sponsees, could in any way influence any of their future behavior and/or present conception of their self? If the answer is no, then you deny that verbal communication (especially in the downward direction) has no influential bearing on anyone so why even say anything to begin with. If the answer is yes, then telling someone this, besides being a gross generalization that you possibly couldn’t know for sure (unless you are a fortune-teller), is really just endorsing excessive drinking. Someone may need to call their sponsor.
Because AA exploits language on par with Frank Luntz, not one bit of their doctrine should be taken seriously. They call the steps ‘suggestions’, religion ‘spirituality’ and desire to drink alcohol an ‘allergy’. The only way you could go through a pogram designed to break down your very understanding of basic word meaning is either by denial or sheer idiocy.
The “allergy” concept was brought up by a doctor in early 1900s. Medicine has come a long way since then. Is addiction a disease? I don’t have the answer, however, you might want to read up on THIQ (both for alcoholism and heroine addiction). There has also been studies involving a gene mutation.
Toby -
The allergy version of the disease concept is still extremely popular today, which is why I chose to address it here – it comes up all the time. The latest version of the disease model is the “brain disease” theory, which I’ve spent a good deal of time refuting elsewhere on the site.
Thanks for the advice, but I’m already quite aware of THIQ’s, adrenaline, dopamine, Delta FosB, the Blum-Noble Gene, etc. While I haven’t really addressed each one of these on the site yet, I don’t think any one of them poses a threat to the choice view of addiction. Citing the existence of such biological components is akin to citing the existence of acids in the stomach, and then declaring eating to be a disease.
-Steven
Mr. Slate
It seems that you are not really fond of Alcoholic Anonymous or the disease concept of addiction. That is absolutely ok with me. I am an addiction counselor and have been working in this field for years. I have seen thousands of patients in treatment struggling to have an ordinary life which most people take them for granted. I have asked that question from myself many times to whether to drink or not to drink is just a matter of choice or there is something else that pushes these people to destroy their lives. I do not believe that being homeless and sleeping on streets or public places in the middle of winter is a dream of anyone. How about losing the people you care about the most or being incarcerated over and over again. Have you spent a night in prison and not being able to close your eyes for the fear of being raped or your teeth being broken so you can give the best head? I don’t think so. The men and women I work with do not care about studies or opinions such as yours or anyone else. All they care about is to be able to hang on to something that makes sense to them because honestly, nothing else in their lives make sense to an alcoholic or a drug addict. Alcoholic Anonymous, Narcotic, Anonymous, the concept of an allergy, spirituality, and many other things that you may call them a fraud, unsubstantiated, unproven, or bogus has saved millions of lives since they were originated and still do.
Michael –
I was a homeless crack head. Now I’m not and am on the cusp of earning an MSW. I don’t go to AA or NA. I know, I know, I guess I’m really not a “true addict” right?
Michael, I’ve asked AA members this same question – why do you call yourself an alcoholic when you haven’t had a drink in x years? Some of them are convinced that once they pick up, they totally lose control. I don’t understand. Maybe there are different levels/types of addiction.
Addiction is a love affair with a substance, or a fear of living without it. A person in the throes of addiction is not choosing between giving head in prison or a successful career. The choice is, can I get through this minute or this situation without my crutch, my best friend? I’m afraid to live without it, so I need it.
Until we come to believe that a life without drugs is possible, we hold on dearly to that best friend. And yes, that best friend slowly destroys us.
So that is the understanding I reached for myself. I have presented this to 3 of my friends who believed they were powerless, and these 3 have said the love affair explanation makes much more sense.
So what do you think?
Dear ZSL and Kelly,
It is not my place to say whether you are an addict or not. Recovery from addiction is not one size fit all. People in the grip of addiction try to find a way that can help them to free themselves so they can re-build their lives. My point is that it is premature to state that if something did not work for me it will not help anyone else. Respectively, if something works for me, then it must help everyone. For every person that you say got help with the choice recovery, I can produce thousands who were helped by AA or NA. It is childish to bash a program just because it did not work for some people. In the treatment center I work, we help patients with CBT, reality therapy, self actualization, spirituality and mindfulness, and 12 step book studies. The patients receive information and follow what works for them. No one, absolutely no one can say “I know what works. ” I have been working in this field for years and I still can’t say what works and what doesn’t. The only thing I am positive that works is love, compassion, understanding, and lots and lots of patience. That is all I am saying.
“I have been working in this field for years and I still can’t say what works and what doesn’t. The only thing I am positive that works is love, compassion, understanding, and lots and lots of patience.”
So, which is it?
Also, I don’t understand why it isn’t ok for people who have had a negative experiences with conventional treatment methods (AA, rehabs, etc) to voice their concerns. If I had diabetes and the doctors gave me medicine that didn’t work, I would critique that as well. Why are pro-12-step people so outraged and defensive whenever someone critiques the approach? If you really believed that “whatever works is cool – let’s just all get along”, then you wouldn’t feel the need to defend your position.
Hi Michael,
I know that points like ‘no one wants to be homeless’, or ‘no one wants to have a stroke from smoking crack’ or the one from the famous public service announcement “nobody ever says I wanna be a junkie when I grow up” are pretty attractive for people to use in this debate, but they’re flat out irrelevant. When someone spends too much money on their credit card, are they deliberately and directly choosing to have crippling debt? Does anybody want that? When I go skiing, do I want to break my leg?
There are plenty of bad outcomes in life that people don’t directly want and choose, but nonetheless are the result of behavior that they did choose freely for personal reasons. The debtor wants many material things, even though he can’t afford them. The guy with the broken leg just wanted to enjoy skiing. And the homeless substance user just wants to get that little bit of short-lived happiness provided by drugs and alcohol. So I obviously reject your point.
I find it particularly astounding that you could actually take the time to argue against me without arguing. That is, your last few sentences seem to concede that you have no argument for your vision of powerlessness and disease, and you seem to assert that it doesn’t matter whether these concepts are technically incorrect. You’re simply rejecting reality.
Perhaps you believe it’s just a metaphorical disease, and metaphorical powerlessness? If that is the case, I’ll ask you to stop pretending to treat a real medical disease.
If people want “to hang on to something that makes sense to them”, then why don’t you provide that? The disease, powerlessness, 12-step vision clearly does not make sense to most people. If it did, then 12-step programs wouldn’t have a 95% dropout rate within a year.
Also, and I gather from the other commenters that I’m not alone in this: it seems like you’re playing the “real addict” card. I sincerely wish we could get away from this foolish rhetoric and simply discuss the issues. I have no desire to jump on here and defend my status as a former “real addict”, nor do I think that would be relevant to a serious question as to whether or not people are actually powerless or ‘out of control’ (i.e. unable to choose) in regard to substances.
-Steven
Dear ZSL,
It seems that I was not clear enough in what I was saying. Let me say it clearly now that “I am not defending 12 steps programs.” If a medication that helps many others, does not work for you and causes you adverse reaction, you have a right to criticize your doctor or the medication. However, going on a crusade to ban the medication is just going over board. You have no way knowing that this medication does not work for anyone. That is it never did and never will. Statement like this are obviously wrong and short sighted. On the other hand, even going over board is your right as well and no one argues that. If choice recovery worked for you and you were able to get your life and your sanity back, it is great. I am very happy for you and wish you the best.
I’m a former 12 stepper who loves much about the program. The 12 step community offers a fellowship, a place to go anytime, and a place to share openly what is going on. The womens meetings opened my heart and gave me a place I felt understood. I certainly learned a lot there, and I am grateful AA and NA were there during my transition out of opiate addiction. Some of my biggest breakthroughs in personal discovery happened with my sponsor, a person who understood what it was like to be addicted. My husband and kids did not understand, so I really needed to be around others who did. My other biggest breakthrough came through learning about cognitive therapy, which I just stumbled across. That said, I have outgrown the rooms now, and the beliefs they hold are an obstacle to me. Still, the hugs and open sharing – that is not available in church or anywhere else I know.
I do wish that cognitive therapy and 12 step could be somehow blended. Many of the steps themselves are an obstacle to growth, for they don’t encourage individual choice and responsibility, and they tell me what I was rather than allowing me to discover for myself what my drug use was about, so that was a complete lack of freedom to self discover. They focus on character defects, instead of on courage, risks, dreams. The one day at a time is a step back – I live months at a time, I have goals. Serenity prayer is dumb – I can always change my thoughts or my actions or the environment I am in. You don’t need God to recover. And there is no proof it’s a disease. Still, the support and community provides encouragement and love.