Horseless Carriages and Craving: Rethinking the “Allergy” in AA’s Big Book
Last night in a Melbourne AA Big Book meetin, we read two pages from Dr. Silkworth’s Doctor’s Opinion in the Big Book. Out of 25 people, only two of us clocked the main point: the “allergy.” The rest? Split between polite nods and partisan rebuttals—“It’s not an allergy!”—as if the word itself invalidates the insight.
But here’s the thing: you have to give AA credit. This was written in 1939. No MRIs. No neurotransmitter maps. No dopamine charts. Yet they nailed something that modern medicine still wrestles with: alcoholics react differently. Not just emotionally. Biologically.
Silkworth called it an “allergy of the body” and an “obsession of the mind.” Today, we’d call it dopaminergic dysregulation, reward circuitry hijack, or conditioned craving. But the mechanism—the abnormal reaction—is still there.
The label just changed. They once called cars “horseless carriages.” That didn’t make them any less real.
Some argue allergies must produce “bad symptoms.” Ironically, they’re rejecting craving as a symptom while calling drinking the symptom. That’s semantic gymnastics. Craving is the symptom. Drinking is the consequence.
There’s medical literature that both supports and challenges the allergy metaphor:
• Enzymatic dysfunction in alcohol breakdown
• THIQ deposits linked to addictive pathways
• Historical clinical observations of sensitization over time
Modern consensus avoids the term “allergy,” but doesn’t dismiss the phenomenon. It reframes it. And that’s the point: the metaphor still holds power. It’s not about being medically precise. It’s about being diagnostically useful.
This isn’t a post about having the answer. It’s about honoring the legs under the metaphor. The 1939 label doesn’t weaken it—it proves how far ahead they were. And maybe, just maybe, we’re still catching up.
About Jason Bresnehan
Jason is a fixer—of businesses, of broken momentum, and occasionally of entire spiritual frameworks gone sideways. He speaks fluent boardroom and AA, deploys Catholic doctrine with the subtlety of a scalpel, and isn’t afraid to lace his insights with both war-room metaphors and dad-sermon tenderness.
Founder of Evahan, a consultancy built on the idea that legacy and liquidity don’t need to fight, Jason draws on 30 years of commercial grit, tactical leadership, and emotional radar to help people rebuild what entropy took. He works with companies, communities, and recovery misfits alike—often using the same principles to sort both cap tables and chaotic lives.
Jason draws deep inspiration from historical figures who got results—especially those who led from the margins, built with scarce resources, and refused to be shackled by conventional wisdom. He’s known for assembling unorthodox teams of passionate experts to solve complex problems in chaotic environments. Whether in boardrooms, recovery communities, or legacy disputes, Jason’s approach is rooted in common purpose, tactical innovation, and the belief that clarity thrives when paradigms are challenged.
A strong advocate for freedom, limited government, and enterprise-driven progress, Jason also draws deeply from his personal recovery journey—an experience that reshaped his life and fuels his commitment to growth, contribution, and principled living. Through writing, speaking, and service, he continues to learn, share, and speak with purpose.
I can be engaged (on a remunerated or volunteer basis) to sit on Boards, Committees, Advisory and Reference Group Panels, and to speak to Business, Community, and Youth groups. I’m also open to providing comment to media on topics where I have relevant experience or insight. Please feel free to make contact.