One Drunk to Another The Little Doctor
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Illustration · A meeting room today, set up before the meeting starts. Not a specific place.

After 1951

Legacy

His theory didn’t last. The way he saw his patients did, and so did his letter.

“…the benign little doctor who loved drunks, William Duncan Silkworth…”

Bill W., who also called him “very much a founder of A.A.” · Alcoholics Anonymous Comes of Age, 1957

What he left

William Silkworth died on March 22, 1951, at 77. He is buried in Glenwood Cemetery in West Long Branch, New Jersey, where his wife, Marie, was buried too.

He had spent the last two decades of his life treating alcoholics, when few doctors would. He did not live to see medicine catch up. In 1956 the American Medical Association for the first time called alcoholism a major medical problem and urged general hospitals to admit alcoholics.

Today alcohol use disorder is treated as a medical condition, and a major 2020 review found strong evidence that AA-based treatment helps people stay sober.

His letter still opens the Big Book. AA is preparing a fifth edition, and its plans say “The Doctor’s Opinion” will “remain as is.”

Listen Legacy About 1 minute

From the front of the Big Book

His words, still in use

Four phrases from his 1939 letter that are still part of how AA talks about alcoholism.

Short excerpts from “The Doctor’s Opinion.” Page numbers follow the fourth edition.

“…a manifestation of an allergy…”

His explanation for why alcoholics can’t drink like other people. Medicine dropped the idea; many AA members still use the word.

p. xxviii · see 5 · The papers

“the phenomenon of craving”

His name for what the first drink sets off in an alcoholic, and never, he wrote, in the ordinary drinker.

p. xxviii

“restless, irritable and discontented”

His picture of the alcoholic between drinks, until a few drinks bring back a sense of ease.

p. xxviii

“an entire psychic change”

What he said an alcoholic needs in order to recover. Bill W. had one at Towns in December 1934.

p. xxix · see 3 · The Bedside

Right and wrong

The allergy did not hold up. The rest has: alcoholism is treated as a medical condition, hospitals take alcoholics in, and the evidence now backs the program he vouched for in 1939.

For a closer look

Go deeper

A date that is often misquoted, what the research says now, and a claim about his influence that is still open.

What the AMA said in 1956

It is often said that the American Medical Association declared alcoholism a disease in 1956. What it did, as Justice Abe Fortas summed it up in 1968, was “for the first time designated alcoholism as a major medical problem and urged that alcoholics be admitted to general hospitals for care.”

The historian William L. White notes that the resolution stopped short of the word “disease.” That idea got its scientific push four years later, in E. M. Jellinek’s book The Disease Concept of Alcoholism.

The evidence today

In 2020 a Cochrane review, one of the most respected ways of weighing medical evidence, looked at 27 studies with 10,565 participants. Its authors, John F. Kelly, Keith Humphreys and Marica Ferri, concluded: “There is high quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence.”

In plain terms: structured programs that connect people with AA, called Twelve Step Facilitation, helped more people stay sober than other established treatments such as cognitive behavioral therapy.

The review says nothing about allergies. It measured what Silkworth watched for: people staying sober.

A founder of treatment?

After the war, AA’s ideas moved into hospitals and treatment centers, most famously in Minnesota: Pioneer House in 1948, Hazelden in 1949 and Willmar State Hospital in 1950. The approach became known as the Minnesota Model.

Some writers, including J. D. McPeake, see a straight line from Silkworth’s ward at Knickerbocker to that model. Histories of the Minnesota programs don’t mention him. We count it as an open question.

Sources