E264: It's Not Your Fault (But It Is Your Responsibility)

Matt and Steve dive deep into Dr. Silkworth's groundbreaking work on alcoholism and why understanding the medical nature of addiction changes everything. They explore a fascinating discovery: Silkworth published his "allergy theory" in a 1937 medical journal—two years before the Big Book—challenging the common AA legend about why he initially hesitated to put his name in print.

The hosts discuss why the Doctor's Opinion matters less for its 1939 medical accuracy and more for what it tells newly sober people: you have a condition, not a character flaw. Matt and Steve get real about the difference between the physical reality of addiction (not your fault) and the actions taken while drinking (your responsibility to address).

Steve shares his own parallel journey with weight management and GLP-1 drugs, drawing powerful connections between different types of medical conditions that were once viewed as moral failings. The conversation unpacks why self-knowledge alone isn't enough to stay sober, the role of dopamine in addiction, and why removing shame is the first barrier that needs to fall.

Whether you're brand new to sobriety or years into recovery, this episode offers a compassionate, science-informed perspective on what's really happening in your brain and body—and why that understanding is the foundation for everything that follows.

Links to the two articles Silkworth wrote in 1937:

Alcoholism as a Manifestation of Allergy

Reclamation of the Alcoholic

Transcript

Matt: 0:40

Today's sober friends podcast is brought to you by Pete B who bought us five coffees. Pete said, keep up the great work you guys. You make a real difference. If you want to be like Pete, Pete, and you think we make a real difference, why don't you head over to buymeacoffee.com/sobrefriendspod. Welcome to the sober friends podcast. Hey, you're in the right place if you're sober curious. If you're living the sober lifestyle, my name is Matt Jay. Steve is over there. What's up, Steve?

Steve: 1:17

How much, Matt? How are you doing today?

Matt: 1:18

I'm doing great. Good times here. I want to talk a little bit about Dr. Silkworth because we did this chapter this week in our big book meeting. And I have a lot of thoughts on how that chapter is relevant where it's not, but just in digging around while we started the chapter, I dug in a little bit to Dr. Silkworth because I kind of wanted to figure out how long did he live after the big book came out and he only lived about 12 more years. He was at the end of his life, he died in town's hospital where he worked. But I found a footnote there that he had an article written in Medical Review, which sounds like it's one of those journals like A Long Line of Jama, Journal of American Medicine, those type of things. And he wrote an eight page opinion about alcoholism in 1937. It is a much more expanded view on the doctor's opinion. The doctor's opinion is basically a much more truncated version of what he wrote. And what caught me off guard is that story we always hear about, in Joan Charlie, that Silkworth didn't put his name in the book because this was a radical opinion and he didn't want the medical community to come after him or lose his credibility, and later on, he said, you can put this in. But he already had this opinion written two years prior, which is one of those things that in Joan Charlie, they seem to, they seem to really fall in love with the legends in the big book, not the truth. They never really dig dug under the surface. Maybe that's why he didn't want his name in there. I don't know, but I know there's no internet in 1939, but if I'm a medical doctor, if I'm an addiction doctor, and I read that, I would be able to reference. I probably would have been able to figure this out. And he wasn't he wasn't so, he wasn't so scared about his name being out there that he didn't write about this opinion. And if you I glance through it during the meeting, it's eight pages, but it's just the more detailed opinion that there is an allergy mechanism that causes addiction. It's not a moral failing, which he was way ahead of his time. So I'll I'll link to it in the notes. It was you can find it in his Wikipedia article. It's there. It's just fascinating that you can go 1937 and there, there it is all of its glory in much more detail version of the of the doctor's opinion. What I would love to see, and this is I'm not an absolutist with the big book. I am of I know this is going to be sacrilege, heresy. I'm not wedded to the first 164 pages. I may not remove stuff. I think it is worth adding some stuff in there. And in the medical opinion of alcoholism is one of those things. We would never look at the medical opinion from 1939 on anything else and hold it near and dear today. It's not necessarily that how do we put this? The way I look at medicine and science is one opinion and and advances are built on the last thing. So you get incremental change over time. You take what the first person did and you build on it and you grow from there. But even even the study of the flu, we wouldn't look and say, okay, what we believed in 1939 is how we're going to treat the flu today. Just wouldn't do that. We've learned more. But we get stuck on, well, it's the it's the allergy, the allergy is what does it? I would love to know more about what is the real medical science of alcoholism. Having said that pivot point here, there's a different reason for why the doctor's opinion is important. And we'll talk about that because this is especially important for you if you're brand new. There is a medical thing going on inside of you mentally and physically that causes your addiction, not because you're weak-willed and can't drink like a gentleman. Something goes on and that's why it's important.

Steve: 6:28

Yeah, I, I know when I first came in and read the Doctor's opinion, not not so much when I read it, when I read it with someone else. I was just thinking about this video today. a different book, uhm, at a meeting and how and I said like I don't read this book regularly and then I thought I don't read any of these books regularly by myself because I think they read better with other people. When I, so when I read the Doctor's opinion with someone else and sort of tried to understand it, it did help me understand, like I said, I don't know if I believe, believe it all just like you said, like I'm not sure that I believe we've talked about this before, that I believe all of it. But it sort of made sense, right?

Matt: 7:11

Reading

Steve: 7:11

That, that's my whole point, like when I looked at what happens to me and I look at what happens to me after I put alcohol in my body and how all of a sudden it triggers something. Right? Something, you want to call it analogy, call it whatever you want, trigger something that makes me want to drink more and more and makes me want to drink till just till I'm drinking destructively right? I mean, there's something to get triggered mentally and physically. And again, I talk about it all the time I live with an an alcoholic went out to dinner with her tonight. She had one class of wine and went home and went to bed and she won't wake up in the middle of the light thinking, how I need some more. So it really helped me. The thing about Dr. Silkworth was he studied alcoholism for 40 years.

Matt: 8:06

Yes,

Steve: 8:08

you know, 40 years, which meant that he was, he was studying it long before he met Bill Wilson and saw what was happening. And we talked about this Monday night and I think one of the problems, one of the things that he had with not putting his name in there was, I think he was nervous about being connected to that movement more than medical opinion, right? And more than like you said, he had a medical pin, he worked in the he worked in recovery for 40 years. So it wasn't like he was new to it. I don't think he was afraid of, I mean, that's what we hear in Joan Charlie. I don't think we he was afraid of the medical opinion, the medical community coming down on him. I think he was afraid of, now, if this, if this thing goes sideways, I don't want my name

Matt: 9:06

him.

Steve: 9:06

attached to like a lot of things, we always talk about it only go to the book, the forward to the second edition is really long because they was written in 1955. And I always call it the, oh shit, this worked forward.

Matt: 9:27

And

Steve: 9:27

Like they were shocked. This has to be out this assess of that program and certainly by that time, long before that, he could see that the program was working. And I shared about this, like I said, can you imagine that this guy had worked for years, not 40 years at that point, but maybe 20 years or maybe even 15 years, whatever it was. Trying to get people sober and just had failure after failure after failure, after failure, and then this guy comes in and he says, hey, you know, I think this might work. I'm sure Dr. so far said, go ahead, give it a try. Come and talk to another alcoholic and then once he saw that maybe it does work, he was as shocked as anyone. So, and I like your take on it, where we would never listen to anything, like there's probably, you're probably almost exactly right. Well, there's a few things, right. We may look back at, like penicillin maybe something like it's pretty much the same since it was

Matt: 10:36

The pancreatic cancer, curative

Steve: 10:40

right.

Matt: 10:40

surgery is the same surgery as from that. Actually, it had probably been around about 10 years. The whip will proceed,

Steve: 10:46

right,

Matt: 10:48

was was perfected in the 1930s and it's what we still have.

Steve: 10:53

Right. So there are times where that works, but I like that take on it is that we need to think about that. And I do think, right. I do think that recovery as a whole does think about that. I think what we're talking about tonight is that that, sometimes, sometimes not all the time, not all the people that sometimes, some time, sometime, narrow vision of some people in AA.

Mayor Frank Rizzo: 11:23

Right. I want to fight you.

Steve: 11:25

That guy, right. That little bit like, right, that guy that we have to follow that first 164 pages, not a word can be changed, nothing can be deviated from. And certainly you and I have made our views known that we don't feel that way. I don't feel that way. I don't know what the changes should be. I just know that there's some things in there. For a lot of reasons that that need to be updated changed, whatever you might say. So...

Matt: 12:06

Maybe

Steve: 12:08

we'll be part of But you know, there are other people in other areas of recovery who do look at the science differently,

Matt: 12:19

this.

Steve: 12:19

right? And we talk about it all the time in this podcast. There are lots of different ways to get sober today. And some of them are based on other scientific methods. So they're out there. I don't know if there's one that anybody says works better than the other ones, right? There's not one they say, 'Oh, this is the one that works'. Like, nothing compares to AA. I mean that honestly, right? Nothing goes like AA works if you work it. That whole, that saying, it works if you work it, it works 100% of the time. If you go in there and you work it 100% I don't think there's anything out there scientifically that could say, 'Oh yeah, this is the best scientific way. Take this pill and you're guaranteed to have success.' I mean, you're not guaranteed to have success in AA either. So anyway, it's a great take. It's a great take and I know it immediately started you thinking one night when we read it. And that's the beauty about going to these meetings over and over and over and over and over is that you get these revelations, right? You get this point where you've read, okay, this is the 40th time we've read the Doctor's opinion at this meeting.

Matt: 13:36

And

Steve: 13:38

something brand new jumps out of you. And it's enough to talk about it on our podcast.

Matt: 13:45

It's

Steve: 13:46

good

Matt: 13:46

stuff. I've had a lot of thoughts about some of this stuff as I started taking GLP one drugs. There is a doctor who I'd like to follow Dr. Terry Simpson. He's on Twitter. No, I'm sorry, he is on TikTok and he has a substack and he he's pretty traditional when it comes to medicine. He's by trade. He is a gastroentonologist. He does weight loss surgery. He does lap bands. And he is very traditional when it comes to medical advice. Take your vaccines, take your medication, get movement, don't eat processed foods. That is the path to health. There's no magic bullet. There is no special oil. In the end, it's pretty traditional. And he talked about how he finally came forward and said, I've been taking a GLP one. I've been taking Zepound for the past year. And I'm just waiting now to tell you about it. And I've lost a bunch of weight and he goes, I thought I was a hypocrite because I'm a weight loss surgeon. And I couldn't lose the weight and I could do it for a period of time and I couldn't keep the weight off. And I have great willpower as a surgeon. And you can tell like his especially when does his live TikToks because he can be a little crusty. He is very impatient with some of the people asking him questions, very impatient. I think he has a dry, sense of humor, but I see when he's starting to get irritated. And he talked about it and it sounded and I'm bringing this up because it sounds like alcoholism that he talked about, you know, I had all this willpower as a surgeon. I could plow through getting up really early, doing surgery, coming home, doing a TikTok. I knew all of the food I was supposed to eat and yet I couldn't lose weight because I couldn't, it's, you know, he said biology, how is he put it? Biology always beats willpower and that there is a biological aspect of this is why I can't stop eating. This is why I'm craving this type of food and when somebody can have a scoop of ice cream, I can't. And I'm like, damn it, that's the same thing as alcohol is that biological aspect, it's not that you have a willpower issue. Because we all know those stories of the people who are high achievers and they have, well, you know, the people in the rooms who have this will, the stubbornness to them that they, they will hold their breath and turn blue just despite someone else. And yet no power over alcohol and I thought a lot about this is I took the gel P one drugs where there are times I just not hungry during the day or I love a coke zero. There are times I can't finish the bottle and it's like, okay, I'm my second bottle I can't finish the bottle now because I'm like, you know, what I'm done. He talked about how he would eat really, really fast....He took a smoothie with him and it's like, 'I'm I drive to work, I don't even finish it.' And that, wow! ... We kinda know now that it is something in the pleasure center of the brain. But ozempic, wagovii, zepbound, whatever these drugs are, may be a cure for addiction. Because now something happens that I don't need to trigger that reward center as much anymore. And that really proves that because you take this shot and it works, that it really is a biological thing. You're not doing something wrong. There is a biological aspect to this, which also makes me realize why so few people find success in a recovery program. It's just sort of like, how many people do you know that I've lost a whole bunch of ton of weight and then they keep it off for years and years and years? It's really the exception to the rule. And it's kinda like that with alcoholism. It's not everyone who can stay sober. It's for whatever reason that shows in few who find what works for them and then they don't drink anymore. Otherwise, there'd be tons of people who we'd have to keep creating meetings. And that's not the case.

Steve: 18:59

We talk about it all the time. If it was easy, everybody would do it.

Matt: 19:06

Yes.

Steve: 19:06

It was easy to stop drinking then we wouldn't need meetings, right? And just to go down that little rabbit hole that you went down there with talking about the GLP1 drugs is that I stumbled upon that guy too. And I remember you talking about some of you filed. I just I never remembered the names of some of these guys. And I too was really impressed by him saying exactly what you talked about. Just like probably a month ago, maybe two months ago on my TikTok feed. And again, in this one of the things, matter of fact, I have my doctor's appointment on Monday coming up and I'm going to ask him about putting me on a GLP1. Among other things.

Matt: 19:52

It is worth having the conversation.

Steve: 19:55

Right. So anyway, so because I to have done this, I could show you catalogs of books and schedules and weight loss, I've done every program. So I do look at that. And I and one of the reasons why I mentioned that and I've mentioned this before is behind me, I have a bookcase, which I have a lot of my A, A stuff in there. And then there are three books that they use for OA because I was part of that fellowship. And they use three different books. And I have those books in that bookcase too. And we've talked about addictions other than alcohol on this podcast. We've had people on here. We've talked about some of the stuff. So I, to believe, I believe in the saying that you can't outrun your genetics, regardless of what they

Matt: 20:49

Right.

Steve: 20:49

are.

Matt: 20:50

Correct.

Steve: 20:50

I mean, it's the number one thing that affects your well-being in all aspects of life. Right. And I've always heard that the number one thing about heart disease, anything else? Genetics, genetics, genetics. And I too did it today, today, believe that there are, there's some type of genetic piece of me, which makes me struggle with addictive behavior. And again, we talked about it. I've talked about it. I can be addicted to food, to alcohol, to sex, to exercise. Like, I could really go off the rails on all of those things. And I have an at different aspects of my life. So there's something about me. I talk about it all the time in meetings that makes me, what I like to say, not normal. Whatever normal might be for the better. Like, and I look at, you know, other people and I see other people. And I'm like, oh, that person, you know, at least when it comes to eating, I look at it like, oh, that person is normal. And that aspect of their life. I'm not that person. So today I believe that there is new science. Right. That just like alcoholism, they have talked about obesity, being a disease. Rather than a lack of willpower, right. Like this is what you were saying. Right. It's not a rabbit hole. You're doing that comparison. Like they, they've gone where, just like in 1930s, they thought alcoholism was a lack of willpower and moral failing. up until the 2000s, well, not probably not that long because there's other people saying it wasn't that. But literally in the last 10 or 20 years, probably, they have said,"Listen, this is not a moral failing. This is not a willpower problem eating that is, an eating disorder, obesity. This is a clinical problem that can be solved with some help." And thus came out to GLP-1 drugs and other things. Because I know what to eat too. I've literally spent thousands of dollars

Matt: 23:17

and

Steve: 23:18

have the menus and know what to eat and I know the portion sizes. I know all of it. And just like when I talk about it in meetings, I shared it to that. Just like when I came into AA and the first time. And I wanted to quit drinking because my life was unmanageable. When I found out what the answer was that I could never drink again, I was like, "Oh, I get it. I can never drink again. I'm good. I have self-knowledge now. I have self-knowledge." You guys taught me that I can never drink again and I was like, "Good, I'm out of here." Right? And I've talked about it. That lasted for about 14 years before I could not do that anymore and I picked up. Because I'm an alcoholic that has a disposition to drink alcohol and without support and help or drugs or whatever it might be. There are some people who think that if you take a pill, there are certain drugs out there that maybe that could help you too. But for me, it's the support of a fellowship in a 12-step program that I can't do that. I cannot stay sober without that. That's my program, that's my medicine. I'm comfortable with that today. And I've become convinced that it probably is the same thing for me with living at a weight that I'm comfortable with. And when I say I'm comfortable with two things. Physically, so I could be as active as I want. And because I can't be that way today. And mentally, just so I feel good about myself. And that's the kind of stuff I'm going to talk about with my doctor. So that's why I think this really relates back to the doctor's opinion and doctor's...

Matt: 25:11

It absolutely does.

Steve: 25:13

Right. Because he was the one who saw that first, it was like, "Hey guys, this is more than more failing. This is more than lack of willpower. There's something else happening here." And again, whether it's an allergy, the way he describes it, I don't know, I don't even care. All I know is the way he describes it fits what happens to me when I drink. And that's all I need to know today.

Matt: 25:38

He was decades ahead of his time. He didn't have the tools or the medical knowledge to get into the nitty-gritty of what it was. And the best that he could describe is an allergy. In the sense of a peanut allergy, I don't think it's the case. I suspect it has something to do with dopamine. Either we create too much or too little. Because if we look at all of the addictions, like gambling addiction, it's not that... Oh, I'm looking to make some money. That getting money gives me a rush in a dopamine head. But there's also that risk that if I lose, I could lose money and maybe a lot of it, that's a dopamine head. Everything that's sort of an addiction goes with that. It gives me a rush of dopamine that I wouldn't normally get. So I've got to figure out a way of how do I work around that. So I don't have to get the dopamine head through bad means. It doesn't mean that it's okay for you to be drinking alcoholically. When I say it's not your fault, it doesn't mean you're okay drinking alcoholically. It means you haven't done anything wrong that you have this condition. If you know you've got a problem, that's when you have a problem. You got to do something about it. And the road is uphill with headwinds at best. It's hard to initially stop. And it's hard for a long time. You've got to grind it out and then it gets better. And if you do the work that you need to do, you don't have to think about it. If you don't do, just set the foundation up. You're going to be shaky the whole time. But if you do all those things, little by little, it gets better. Just in listening to and reading through that chapter again, it just made me think a little bit more of I think it does help to learn a little bit more, but also we don't talk enough about why that chapter is in there. Because it gets stuck on the it's theology, it's theology. The purpose of the chapter is to let the reader know. Put it out of your mind that you've done something wrong that you have to read this book. You have a medical condition. That's what it is. You decided to stop. So don't don't decide not to stop because well, if I have to stop then I have to admit I'm a failure as a person. That's not it. It's admitting. I've got a medical condition and I have to take medical treatment. And that's what the 12 steps are. It's a type of medical treatment. It's to get that barrier out of the way. And then as the pages go past in the book, Bill is trying to take one barrier out of the way after another after another until you're willing to do some things that you normally wouldn't want to do. Like tell your moral failings to another person, things like that, where to say sorry to somebody you screwed over. Let's get the barriers down which is why the book is written in the order that it's written so that you can actually listen. And that's what is great about a chapter. We owe him. We really owe him a lot that Dr. Silkworth was ahead of the time that he was putting out medical journals, artificial journal articles and was in the right place at the right time to see that Bill was doing something different that seemed to work and was willing to however reluctantly it might have been thrown in with Bill.

Steve: 29:31

You know, Matt, something to drive home here that to make it clear, we're not talking about actions that you took while you're drinking. Like you may have done some real bad things or behave poorly. Like I certainly did when I was drinking, when I was struggling with alcohol and addiction. But that's not what we're talking about. Like that's some of that stuff you have to own up to, right? Which is part of the steps. But what we're talking about is the actual physical drinking part of it. The part that kept you drinking long past. Once we all knew, we all weeks at that point, we all reached it, where we knew drinking was not good for us and was harming our lives and the lives of people we loved, yet we continued to do it. Whether that was for a week or a month or a year or in my case years and years, right? We all knew it. That's what we're talking about. And then the behavior part of it is a different story. The actions that I took, the things that I did while I was drinking a whole other story. We're not talking about some of those things we have to own all that kind of stuff. We're talking about the being addicted to alcohol, being an alcoholic is not a moral failure

Matt: 30:43

failure.

Steve: 30:44

And it is not something that you have to have shame about. I have lots of shame and about things that I did in my past. But the fact that I was an alcoholic is not one of them. That's my point. It's not. And the truth is because I'm an alcoholic and I found a program of recovery that for me was life changing. I'm grateful that I was an alcoholic and found recovery.

Matt: 31:21

Yeah. I had a lot of gratitude too. It actually taught me that here was the thing that you couldn't you realize that there was something off about you. Here's what it was. You're not searching anymore. I'd love to hear from you. How does this land? What do you think about the medical idea of alcohol being a disease, the disease theory of alcoholism? What's your experience reading through Dr. Silkworth's chapter or learning different things, more up-to-date things on what alcoholism is. Matt at soberfriendspod.com, the website. soberfriendspod.com. Steve, see you soon.

Steve: 32:07

Yeah. Thanks, Matt.

Matt: 32:08

And we'll see you next week. Bye, everybody.