Dr Silkworth's Alcoholic Allergy: Fact or Fiction?

Historically, alcoholics have been viewed as weak, simply lacking the willpower to curb their drinking and live a normal life. Alcoholics were considered  “maladjusted to life, ...in full flight from reality, or ...outright mental defectives.(1)” Luckily, with the release of  The “Big Book” of Alcoholics Anonymous in 1939, our perception of alcoholism started to change. “Doctor’s Opinion” is a pivotal chapter in Alcoholics Anonymous in which Dr. William Silkworth proposed that “The body of the alcoholic is quite as abnormal as his mind.”(2) . After treating countless alcoholics in his career, Dr. Silkworth observed that alcoholics physically reacted differently to alcohol than normal people. He said “We believe...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.”(3)This theory, that alcoholics were physically different than their fellows, has survived since those early days in 1939.

While the mental aspects of alcoholism are widely accepted, the “allergy” theory has been debated for decades. An allergy is defined as an abnormal immune response to a foreign substance. Many say there is no physical evidence of an allergy in alcoholics. The telltale signs like rashes, inflammation, or even anaphylaxis are missing. Many say the alcoholic allergy theory is “illogical, inconsistent with what is known about allergies, and completely lacks any scientific supporting evidence.”(4) But what if the actual craving for alcohol is the allergic response? Or, perhaps more importantly, should we focus more on the alcoholic’s unique physiological response to alcohol rather than what this response is called?

In recent years, research has shown that the body of an alcoholic truly responds to alcohol differently than that of a normal person. According to the National Institute On Alcohol Abuse and Alcoholism, “alcohol use and alcohol-related problems are influenced by individual variations in alcohol metabolism, or the way in which alcohol is broken down and eliminated by the body.” (5) When alcohol enters the system, it is broken down by enzymes from the pancreas and the liver so the body can process it. First, the enzymes break the alcohol down into acetaldehyde. More enzymes turn the acetaldehyde into diacetic acid. From there, more enzymes turn diacetic acid into acetate. One theory postulates that It is at this phase that the normal person differs from the alcoholic.

Acetate has been proven to produce cravings for more acetate, especially in alcoholics. One study states that the glucose metabolism levels in the brain are lower in a heavy drinker while the acetate uptake is higher. The alcoholic “brain may rely on acetate as an alternate energy source during alcoholic intoxication and...a history of heavy alcohol consumption may facilitate this switch to acetate use.” (6) In short, consistent heavy drinking may change the way the brain processes energy. Thus, the brain craves more acetate to sustain itself.

The time span that acetate lingers in the system is the critical difference between the alcoholic and the temperate drinker. In a normal person, acetate is converted to sugar, water and carbohydrates at a rate of about an ounce an hour. Once this conversion occurs, the effects of acetate are neutralized. The normal drinker can stop after one or two drinks because the acetate has metabolized and causes no craving. In an alcoholic, this process is much slower. The acetate is metabolized three to ten times more slowly. So if a normal person breaks down one ounce of acetate in an hour, the alcoholic body could take 3-10 hours to metabolize the same amount. The acetate lingering in the system triggers cravings for more acetate (from alcohol) and each drink intensifies the effect. This makes it impossible for the alcoholic to stop drinking after the first or second drink.

In light of these facts, we can safely conclude that Dr. Silkworth was correct. While the use of the term “allergy” has been refuted, the scientific evidence that there is definitely a unique physiological response in alcoholics remains the same. The alcoholic is truly mentally and physically different than normal, temperate drinkers. As scientists have stated, the process by which the body filters alcohol renders the alcoholic helpless against the cravings begun with that first drink. And, as there is no medical cure, the only way for an alcoholic to combat the ruthless cycle of craving and addiction is to abstain completely from alcohol. As Dr. Silkworth put it, “These allergic types can never safely use alcohol in any form at all(7)” In other words, an alcoholic can never take that first drink if he or she wants to recover.

(1)(Alcoholics Anonymous, 2001, p. xxvi)

(2)(Alcoholics Anonymous, 2001, p. xxvi)

(3)(Alcoholics Anonymous, 2001, p. xxviii)

(4)Hanson, Ph.D. Prof. David J. "Is Alcoholism an Allergy to Alcohol?" Is Alcoholism an Allergy to Alcohol? N.p., n.d. Web. 08 Sept. 2016.

(5)"NIAAA Publications." U.S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 08 Sept. 2016.

(6)"Neuroscience for Addiction Medicine: From Prevention to Rehabilitation - Methods and Interventions." Google Books. N.p., n.d. Web. 08 Sept. 2016.

(7)(Alcoholics Anonymous, 2001, p. xxviii)