# What is "the phenomenon of craving," and what is the "allergy"?

**In short:**
- Both phrases come from Dr. William D. Silkworth's statement in "The Doctor's Opinion" at the front of the Big Book, kept as he wrote it in 1939 (p. xi). He suggests that alcohol's action on chronic alcoholics is "a manifestation of an allergy" and that "the phenomenon of craving is limited to this class and never occurs in the average temperate drinker" (p. xxviii).
- In his account the craving is set off by drinking. These alcoholics "cannot start drinking without developing the phenomenon of craving" (p. xxx). The only relief he knows is "entire abstinence" (p. xxx).
- Quoted alone, "allergy" can sound like settled medicine. In its setting it's a theory: Silkworth says the craving "may be the manifestation of an allergy" (p. xxx), and the A.A. members who introduce him call it "The doctor's theory," saying that as laymen their opinion of it "may, of course, mean little" (p. xxvi). They add that it "makes good sense" to them (p. xxvi).
- The familiar pairing of an allergy of the body with an obsession of the mind isn't in the Doctor's Opinion. In the Big Book it's in two members' stories (pp. 261, 355). Bill W. credits it to Silkworth in *A.A. Comes of Age* (1957, after 1950).

## The craving, in the doctor's words

Silkworth's longer statement (pp. xxvii–xxxii) comes back to the craving again and again:
- **It's physical, and it's treated first.** An alcoholic ought first to be freed from his physical craving for liquor, which often takes a hospital procedure, before psychological measures can be of most benefit (pp. xxvii–xxviii).
- **It's the mark of a type.** The craving belongs to chronic alcoholics and never occurs in the temperate drinker. "These allergic types can never safely use alcohol in any form at all" (p. xxviii).
- **It takes over once drinking starts.** He describes men who worked for months on a deal, took a drink a day or two before it closed, and "the phenomenon of craving at once became paramount to all other interests" (p. xxix), so they missed the appointment. "These men were not drinking to escape; they were drinking to overcome a craving beyond their mental control." (p. xxx)
- **It's what all types share.** He lists several kinds of alcoholic, then says they have "one symptom in common" (p. xxx): they can't start drinking without the craving developing. It "has never been, by any treatment with which we are familiar, permanently eradicated" (p. xxx).

## How sure the book is about the allergy

The text is careful:
- Silkworth: "We believe, and so suggested a few years ago" (p. xxviii) that it is a manifestation of an allergy; and later, the craving "may be" one (p. xxx).
- The A.A. members: "The doctor's theory that we have an allergy to alcohol interests us." (p. xxvi) As laymen they can't judge its soundness, but as ex-problem drinkers "his explanation makes good sense" (p. xxvi).

What they're sure of is the physical side itself. They write that "the body of the alcoholic is quite as abnormal as his mind" (p. xxvi), and "any picture of the alcoholic which leaves out this physical factor is incomplete" (p. xxvi).

## Body and mind together

The allergy isn't the doctor's whole picture. Between drinks, he says, the alcoholic is "restless, irritable and discontented" (p. xxviii) until he can feel again the ease a few drinks bring. After the spree comes remorse and a firm resolution, repeated over and over (p. xxix). He doesn't think alcoholism is "entirely a problem of mental control" (p. xxix), but he also says there is very little hope "unless this person can experience an entire psychic change" (p. xxix).

Chapter 2 says the same from the members' side. Once the alcoholic takes any alcohol, "something happens, both in the bodily and mental sense" (p. 22). But because the cycle can't start without the first drink, "the main problem of the alcoholic centers in his mind, rather than in his body" (p. 23).

## Where the allergy-and-obsession pairing comes from

The two-part phrase, often quoted as if it were the Big Book's own definition, doesn't appear in the Doctor's Opinion or the 1939 chapters. In the Big Book it turns up in members' stories. In "He Sold Himself Short" (Part I), the writer recalls being told that drinking was "a fatal illness made up of an allergy plus an obsession" (p. 261). In "It Might Have Been Worse" (Part II), the writer says the explanation of alcoholism as "an allergy of the body and an obsession of the mind" (p. 355) cleared up a lot for him. The 1939 chapters do speak of obsession in their own words: the idea that he will somehow control and enjoy his drinking "is the great obsession of every abnormal drinker" (p. 30).

Bill W., writing in 1957, credits the pairing to Silkworth: "the obsession of the mind that compels us to drink and the allergy of the body that condemns us to go mad or die" (*A.A. Comes of Age*, 1957). *Pass It On* (1984) reports that Bill later said Silkworth used "allergy" knowing it wasn't exact: "He knew this was a misnomer" (*Pass It On*, 1984). Both books are after 1950, and both give Bill's later recollection; they're useful for where the phrase came from, not as part of the 1939 text.

## Does the context change the reading?

It complicates it. The phrases are quoted accurately and Silkworth means them. But the book offers the allergy as a theory, hedged by both the doctor and the members, while holding firmly that the alcoholic's body is abnormal. The craving it describes starts with drinking, and the book pairs it with a mind that is "without defense against the first drink" (p. 24) and with Silkworth's own view that recovery takes a psychic change. For the section as a whole, see *What is "The Doctor's Opinion," and who wrote it?*

## Read it yourself
- "The Doctor's Opinion" (pp. xxv–xxxii), free from A.A.: https://www.aa.org/sites/default/files/2021-11/en_bigbook_foreworddoctorsopinion.pdf
- Chapter 2, "There Is a Solution" (pp. 17–29): https://www.aa.org/sites/default/files/2021-11/en_bigbook_chapt2.pdf
- Related: *What is "The Doctor's Opinion," and who wrote it?* · *What does the Big Book mean by alcoholism as an illness?* · *Who said "restless, irritable and discontented," and about what?* · *Does the Big Book say alcohol is "but a symptom"? Is drinking the real problem?*
- *A.A. Comes of Age* and *Pass It On* are sold by A.A. World Services at https://onlineliterature.aa.org.

## Sources
| Source | Pages | First published |
|---|---|---|
| *Alcoholics Anonymous*, "The Doctor's Opinion" | xxvi–xxx | 1939 |
| *Alcoholics Anonymous*, Preface | xi | fourth edition, 2001 |
| *Alcoholics Anonymous*, Chapter 2, "There Is a Solution" | 22–23 | 1939 |
| *Alcoholics Anonymous*, story "He Sold Himself Short" (Part I) | 261 | personal story in the fourth edition (2001); our sources can't date it further |
| *Alcoholics Anonymous*, story "It Might Have Been Worse" (Part II) | 355 | personal story in the fourth edition (2001); our sources can't date it further |
| *A.A. Comes of Age* (Bill W.) | — | 1957, after 1950 |
| *Pass It On* | — | 1984, after 1950 |

Page numbers are from the fourth edition (2001). The Preface says "The Doctor's Opinion" has been "kept intact" since 1939 (p. xi).

*Recovery Starts is independent and not affiliated with Alcoholics Anonymous. Quotations are brief and cited; the Big Book,* A.A. Comes of Age *and* Pass It On *are © A.A. World Services, Inc.*