There is a belief in AA that alcohol addiction is an allergy. This stems from an explanation in the Big Book about why some people are incapable of drinking alcohol in moderation. Dr. William Silkworth describes alcoholism as an allergy in ‘The Doctor’s Opinion’. He writes, ‘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’.
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The characterization of alcohol addiction as an allergy is somewhat confusing because there is such a thing as an alcohol allergy and it is very different from alcohol addiction. True alcohol allergies are rare but they do exist. The symptoms include rash, trouble breathing, stomach cramps, collapse, and anaphylaxis, which includes rapid pulse, nausea, and vomiting. If you or someone you know experiences these symptoms, call an ambulance immediately.
Far more common is alcohol intolerance. Symptoms of intolerance include flushing, diarrhea, headache, rash, heartburn, stuffy nose, stomach pain, nausea, and vomiting. Typically, this is a reaction to something in the drink other than alcohol itself. It could be wheat, yeast, barley, hops, egg proteins, sulfites, or some other common allergen.
If you get diarrhea and a rash every time you drink alcohol, you are not likely to drink often or much. Clearly, Dr. Silkworth had a different idea of allergies than the one we have today.
Although it’s not technically accurate to call alcohol addiction an allergy, it may still be useful. For one thing, no one chooses to have an allergy, especially one that’s life-threatening. In this sense, calling an addiction an allergy moves it more toward the disease model and farther from the moral failing model. However, an allergy is perhaps a better metaphor than a disease because addiction only manifests when you have contact with alcohol. Not only does it reduce the stigma of addiction, but it reinforces the importance of abstinence for people trying to quit. No one with a shellfish allergy would ever say, ‘One prawn couldn’t hurt, right?’
It is perhaps unfortunate that AA has adopted the term ‘allergy’. Not only is it confusing, but it may also damage the organization’s credibility in the eyes of scientifically oriented people. It may fail as a diagnosis, but as a metaphor, it’s pretty good. You can refuse any food by saying, ‘No thanks, I’m allergic’. If you are addicted to alcohol, it can kill you, just like an allergy, but it might take a little longer.