Week 1 – The Doctor’s Opinion


[READ AFTER: Page XXVI, Paragraph 3]

ALLERGY: We as laymen have a basic understanding and definition for the word “allergy”.
If you have an allergy to something, it would always be indicated or manifested by some physical reaction.

For instance, say you are allergic to strawberries and you eat them.  You break out in a rash.

If you are allergic to penicillin and you take a shot, you will break out in welts all over your body.

If you are allergic to milk or dairy products and you drink or eat them, then you get a form of dysentery.  These are physical manifestations of an allergy.

When I came to the AA they told me I had an allergy to alcohol and I could never drink it safely again.  How can I have an allergy to alcohol?  I drank a quart of a day!  How can you drink that much of something if you are allergic to it?  Besides that, it never made me break out in a rash.

It doesn’t put welts on my body.  I didn’t understand and ask them to explain it to me.  They said “You don’t need to understand.  All you need to know is that you are allergic and you can’t drink.”  Today I know why they told me that: because they didn’t understand it either.

Being an inquisitive alcoholic, I needed to know.  So, I went to a source which never fails me: Webster’s dictionary.  I looked it up and it states:  “An allergy is an abnormal reaction to any food, beverage or substance of any kind.”  An ABNORMAL REACTION!

I tried to see where I was abnormal when it came to alcohol.  To my amazement, I didn’t know what was normal or abnormal. For me to find out, I had to go to those ‘normal people’: the nine (9) out of ten (10) people considered to be ‘normal, socially moderate, temperate drinkers’ …Those who drink alcohol and do not get in trouble with it.

I asked if they would describe to me what happens when they take a drink.  They said they get a warm comfortable relaxing feeling after one or two drinks… and they don’t want any more for the rest of the night.  I don’t feel that way when I drink.  I don’t understand a warm, comfortable, relaxing feeling.  I get a ‘get up and go somewhere and do something’ feeling.  I think it is one of the reasons I love to drink.  It makes me feel different than it does for a normal social drinker. They said something else that absolutely amazed me.  When they have two (2) or three (3) drinks, they get a slightly tipsy, out of control and the beginnings of a nauseous feeling.  They don’t like that tipsy, nauseous feeling, so they only want one or two drinks.  Today I realize that is a normal reaction to alcohol.

ALCOHOL IS A TOXIC DRUG.  It is a destroyer of human tissue.  Normally the mind and the body, when you put something in it that is going to destroy it, will sense what’s there and react by wanting to “throw it up” and “get it out”.  The normal reaction to alcohol is a nauseous feeling in the body.  My physical reaction, instead of nausea, is a craving for more of the same.  That is a physical craving and it is so strong that it overcomes the ability of my mind to stop me after I start.  I react entirely abnormally.  The difference between normal and abnormal is: the majority of people
(nine (9) out of ten (10) people) don’t get the physical craving.

We react abnormally in two ways: 1) It makes us feel different than normal people; and

2) It produces the phenomenon of craving.  That physical craving ensures we will continue until we get drunk every time we take a drink.


Chronic: “Reacting over and over again”

Phenomenon: “Something we do not understand”.

Craving: Usually you are dealing with the mind, but in the context of the Big Book, you are dealing with the body.  Craving is what happens after we put one (1) or two (2) drinks in our body.  It produces a physical craving for more of the same.

[CONTINUE READING: Page XXX, Paragraphs 1 – 5]

In the era this book was written medical science had not yet uncovered the chemical breakdown that occurs in the body.  That is why Dr. Silkworth called it a phenomenon of craving.  Today, science has discovered the exact reaction that takes place when we ingest alcohol.

{LEADER EXPLAINS DISEASE CONCEPT OF ALCOHOLISM: By reading pages 12–13 while the group looks at diagram on page 15}

NORMAL PERSON: For the normal social drinker, (this is approximately 8 people out of 10, today) you have a line on the drawing that represents these people who can drink safely and are at ease with alcohol.  Alcohol is no problem for them.  They take a drink and put it in their system and the mind and the body recognizes what it is.  The enzyme production begins and the enzymes start to attack the alcohol and begin to metabolize or break it down.  The enzymes break it down to the first state, a chemical called acetaldehyde.  Later, after a time, it is broken down to a chemical called diacidic acid and finally over more time to acetoneAcetone is rapidly broken down to a simple carbohydrate which is made up of water, sugar and carbon dioxideIn normal people, the break down of acetone to simple carbohydrates occurs quickly. The body can use the sugar.  Sugar has calories and it has energy.  Interestingly enough they are empty calories.  They are not any of the things necessary for life, such as, amino acids, vitamins, etc., but it is a form of energy the body can use. The body burns up the sugar and stores the excess as fat, the water is dissipated through the urinary and intestinal tracks and the carbon dioxide is expelled through the lungs.  For the normal person, alcohol is broken down (metabolized) at a rate of about 1oz per hour.

ABNORMAL PERSON: These are the 1-2 out of 10 who can not drink safely or who has
a “DIS”-“EASE” with alcohol.  By the way, that’s all the word disease means… something that separates you from a sense of ease, something that separates you from the normal thing that happens to most people.  When we alcoholics put a drink in our bodies, the same thing starts to take place for all of us.  The mind and body recognize what it is.  The enzyme production starts and attacks the alcohol and breaks it down first to acetaldehyde… then to diacidic acid, and finally over more time to acetone.  It seems that in the body of the alcoholic the enzymes, necessary to break it down from acetone to the simple carbohydrates, are not there in the same qualities in quantities as in the body of the non-alcoholic.  Therefore, the rate acetone is broken down to simple carbohydrates is a much slower operation which keeps the level of acetone up in our bodies for a longer period of time.  It is the acetone in our bodies that creates the physical craving. For the alcoholic, alcohol is broken down (metabolized) at a significantly slower rate of 3/4oz per hour, or 1/2oz per hour or even 1/5oz per hour depending on the enzyme production which is directly related to the stage of alcoholism we are in.

The medical profession today has proven beyond any shadow of a doubt that acetone ingested into the human system, that remains there for any appreciable period of time, will produce an actual physical craving for more of the same.  As the craving is produced, the body then begins to say to the mind, “let me have more of that stuff you just put in their”.  So, instead of having the one drink we intended to have, the body says, “Give me the second drink… the third drink… the fourth drink… the sixth drink.”  Now, the first drink was caused by the mindbut those after, were caused by the body.

We think that one of the most interesting things recently discovered is this: the medical profession has proven that alcohol ingested into the human system over a period of time is an actual destroyer of human tissue.  As we drink more and more, we destroy more and more human tissue in all parts of the body.  But it seems as though the first two (2) organs of the body that are attacked, in most cases, happens to be the liver and pancreas.  They have also proven today, that the enzymes necessary to metabolize alcohol come from the liver and the pancreas.  As we drink we begin to damage the organs of the body, the enzyme production becomes less and less and less and the phenomenon of craving becomes harder and harder and harder.

So you see we not only have a disease, we have a progressive disease, guaranteed to get worse as time goes by because we are destroying the organs of the body that are necessary to metabolize alcohol.  We also know that as we grow older, everything that the body produces begins to shut down.  So, as we get older, the enzyme production becomes less due to the age factor.  Therefore our disease is a progressive disease whether we drink or not.  The fact that we are allergic to alcohol is academic, if we don’t take the first drink.  We need to understand that the main problem and the solution are going to be within the mind, even though the body is going to get worse with age.  I think, sometimes in A.A., we don’t explain this to the new people about the physical factor of their disease.

{Leader reviews and describes “Alcohol’s Effects on the Brain and Behavior” page 16}

[READ: Page XXVIII Paragraph 4 to “Differentiate the true from the false.”]

We must understand, if we are going to deal with alcoholics, that practicing alcoholics can not differentiate the true from the false.  To most of them, what they are doing is aaaaaaabsolutely normal.  To the alcoholic mind, it is all the normal people who are abnormal.  We surround ourselves with people of our own kind, diluting our minds into thinking that we are different.  As far as the practicing alcoholic is concerned, it is the normal drinkers who are abnormal.  We can see that drinking is injurious and gets us into trouble, but we really cannot differentiate the true from the false, because to us, we are doing what we consider normal.

An obsession of the mind is an idea so powerful that it overcomes all other ideas to the contrary.  It’s so strong that it will make you believe something that isn’t true.  When we drank we had a couple of drinks and it made us feel better.  So our minds put those two (2) thoughts together.  Feel bad… take a drink and feel better.  That is a mental addiction not a physical one.  The mind says it’s OK to take a drink and the mind really believes it is OK.  The mind says it will be different this time… the mind believes it.  That is “BELEIVING A LIE”.

Any alcoholic who believes he can drink successfully believes a lie.

The obsession of the mind causes us to believe a lie and take the first couple of drinks.  As soon as we put the first drink in our bodies, the allergy of the body takes over triggering the phenomenon of craving and we cannot stop.  The one thing that you and I can do for the practicing alcoholic is to help them see the allergy of the body and the obsession of the mind that they are experiencing.  I didn’t know about these two (2) problems when I was drinking.

[READ: Page XXVIII Paragraph 4 at “To Them” to end of top Paragraph Page XXIX]









PAGE 355, Paragraph 2

“Study the AA Book, don’t just read it.”

READ QUESTIONS: Answer questions as a group, stopping for questions and answers.  Discuss any reservations people are having that they are alcoholic.

Figure 1 – Disease Concept of Alcoholism

Alcohol’s Effects on Brain and Behavior

Figure 2 – Alcohol’s effect on the brain

As alcohol takes effect, it stimulates and suppresses different areas of the brain This leads to: reduction in anxiety; euphoria; aggression and memory loss. No Obsession Obsessive
Cerebellum Controls basic motor function

Controls balance

Controls visual cortex (rear-brain)

OK, as long as rate of consumption is 1 drink/hr. Once started, little or no control over the amount or rate of consumption. Obsession turns to craving.
Midbrain (limbic) Generates feelings of:

v       Stimulation

v       Pleasure

v       Euphoria

Had enough I like this feeling!

(Craving takes over and
is in control)

Basal Ganglia Disrupts:

v       Normal Motor Skills

v       Coordination

v       Thinking

No Thanks…

I’m feeling it.

I want MORE!
Left Brain (Controls Language Processing)
Frontal Cortex (Controls motor skills, and reasoning.)
Words become slurred.

Vision is distorted.

Rarely reaches this stage.

Remembers vomiting and hangovers.

Cannot stop drinking.

Table 1 : Effects on Areas of the Brain – Non-Alcoholic vs. Alcoholic


1) Read “STEP ONE” in the “Twelve and Twelve” book – USE HIGHLIGHTER!!!

2) Read Chapter 1 “BILL’S STORY” in the “Big Book” (1st Time) — USE HIGHLIGHTER!!!
(Just read and highlight the 1st time through the Bill’s Story.)

3) Read Chapter 1 “BILL’S STORY” in the “Big Book” (2nd Time).   Be prepared to discuss this matter as it applies to your life in the second week.  Continue to write how you are powerless over alcohol and how your ideas have changed as a result of reading the “Dr’s OPINION”. Answer the work assignment questions below as outlined for “Bill’s Story” and be prepared to discuss them.


[Page 1]

  1. Did alcohol work for you?
  1. Did alcohol affect the way you thought and felt?

[Page 3]

  1. Did alcohol take an important and exhilarating part of your life?
  1. Did your drinking later assume more serious proportions?

[Page 5]

  1. Did you ever ask: “Was I crazy?”
  1. Did alcohol cease to be a luxury and become a necessity?
  1. Did things gradually get worse?
  1. Do you still think you control it? (Alcohol or the situation – your life?)

[Page 6]

  1. Did you ever feel remorse, horror and/or hopelessness the next morning after drinking?
  1. Did you your mind ever race uncontrollably?
  1. Did you ever seek oblivion?

[Page 7]

  1. Can self-knowledge fix you?


[Page 8]

  1. Did you ever feel lonely?
  1. Did you ever feel fear?
  1. Can fear keep you sober?
  1. Did alcohol overwhelm you?
  1. Was alcohol your master?

[Page 10]

  1. What was your reaction to religion, the church and God?

[Page 12]

NOTE: Note what happened to Bill’s prejudice against “their God” when he began to apply
his own conception of God.

  1. Did you know that “nothing more was required of me to make my beginning…”
    than willingness or a willingness to believe?

[Page 13]

  1. Can you admit for the first time, that of yourself, you are nothing and without God you are lost?
  1. Does Bill, essentially, take the First through the Eleventh Step at this time?

EXERCISE: Have you done the exercise with the first eight (8) pages?  In so doing, in these areas as you relate to them, are you as hopeless as Bill?  If so, is there hope for you on Page 17, Paragraph 1?
[Optional Reading: Additional Information from “Wikipedia” and
the “National Institute on Alcohol Abuse and Alcoholism”]

Metabolism is the body’s process of converting ingested substances to other compounds.

Metabolism results in some substances becoming more, and some less, toxic than those originally ingested. Metabolism involves a number of processes, one of which is referred to as oxidation.

Through oxidation, alcohol is detoxified and removed from the blood, preventing the alcohol from accumulating and destroying cells and organs. A tiny amount of alcohol escapes metabolism and is excreted unchanged in the breath and in urine. Until all the alcohol consumed has been metabolized, it is distributed throughout the body, affecting the brain and other tissues.

When alcohol is consumed, it passes from the stomach and intestines into the blood, a process referred to as absorption. Alcohol is then metabolized by enzymes, which are body chemicals that break down other chemicals. In the liver, an enzyme called alcohol dehydrogenase (ADH) controls the conversion of alcohol to acetaldehyde. Acetaldehyde is rapidly converted to acetate by other enzymes and is eventually metabolized to carbon dioxide and water. Alcohol also is metabolized in the liver by the enzyme cytochrome P450IIE1 (CYP2E1), which may be increased after chronic drinking. Most of the alcohol consumed is metabolized in the liver, but the small quantity that remains un-metabolized permits alcohol concentration to be measured in breath and urine.  The liver can metabolize only a certain amount of alcohol per hour, regardless of the amount that has been consumed. The rate of alcohol metabolism depends, in part, on the amount of metabolizing enzymes in the liver, which varies among individuals, especially in heavy drinkers and alcoholics.

Drinking heavily puts people at risk for many adverse health consequences, including alcoholism, liver damage, and various cancers. But some people appear to be at greater risk than others for developing these problems. Why do some people drink more than others? And why do some people who drink develop problems, whereas others do not?

Research shows that 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. Alcohol metabolism is controlled by genetic factors, such as variations in the enzymes that break down alcohol; environmental factors, such as the amount of alcohol an individual consumes and his or her overall nutrition; a person’s age; and for alcoholics how long their disease has progressed.

Differences in alcohol metabolism may put some people (especially alcoholics) at greater risk for alcohol problems, whereas others (“normies”) may be at least somewhat protected from alcohol’s harmful effects.

The Chemical Breakdown of Alcohol: Alcohol is metabolized by several processes or pathways. The most common of these pathways involves two enzymes—alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). These enzymes help break apart the alcohol molecule, making it possible to eliminate it from the body. First, ADH metabolizes alcohol to acetaldehyde, a highly toxic substance and known carcinogen (causes cancer). Then, in a second step, acetaldehyde is further metabolized down to another, less active byproduct called acetate (acetone), which then is broken down into water and carbon dioxide for easy elimination from the body.

Other enzymes: The enzymes cytochrome P450 2E1 (CYP2E1) and catalase also break down alcohol to acetaldehyde. However, CYP2E1 only is active after a person has consumed large amounts of alcohol, and catalase metabolizes only a small fraction of alcohol in the body [1] Small amounts of alcohol also are removed by interacting with fatty acids to form compounds called fatty acid ethyl esters (FAEEs). These compounds have been shown to contribute to damage to the liver and pancreas.

Acetaldehyde: a toxic byproduct — Although acetaldehyde is short lived, usually existing in the body only for a brief time before it is further broken down into acetate, it has the potential to cause significant damage. This is particularly evident in the liver, where the bulk of alcohol metabolism takes place. Some alcohol metabolism also occurs in other tissues, including the pancreas and the brain, causing damage to cells and tissues. Additionally, small amounts of alcohol are metabolized to acetaldehyde in the stomach and intestines, exposing these tissues to acetaldehyde causes damaging effects.

In addition, alcohol directly contributes to malnutrition since a pint of 86-proof alcohol (not an unusual daily intake for an alcoholic) represents about half of the daily energy requirement. However, ethanol does not have any minerals, vitamins, carbohydrates, fats or protein associated with it. Alcohol causes inflammation of the stomach, pancreas, and intestines which impairs the digestion of food and absorption into blood. Moreover, the acetaldehyde (the oxidation product) can interfere with the activation of vitamins.

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