What Does it Mean to be Allergic to Alcohol?
The “Big Book” of AA says that alcoholics can’t drink in moderation the way most people can because alcoholics are allergic to alcohol, and this is the basis for calling alcoholism a disease. The word “allergy” may be a bit confusing because we typically think of allergies as an inappropriate immune response that causes swelling, sneezing, itchy eyes, runny nose, and general misery. Those are symptoms we are more likely to associate with cat hair and shellfish than with alcohol addiction.
In fact, some people are allergic to alcohol in the way we typically think of allergies. This is called alcohol intolerance and it happens when the body lacks the enzymes to break down alcohol properly. Often an apparent intolerance is actually a reaction to something in the beverage, such as preservatives, grains, or histamines, which are a byproduct of fermentation. Symptoms of both include red skin, hives, runny nose, worsening of asthma, nausea, and diarrhea. Alcohol intolerance is common in people of Asian descent but others who experience a reaction to an alcoholic beverage are more likely allergic to another ingredient.
The use of “allergy” in the Big Book is idiosyncratic. It seems to be used more generally to mean an abnormal reaction to a substance. Whereas most people are satisfied with two or three drinks, alcoholics want to drink more the more they drink. There is a positive feedback loop that increases the desire for alcohol. Typically, when someone is allergic to something, he has no desire at all to have more contact with that thing.
“The Doctor’s Opinion” chapter of the big book was written in the 1930s and relies on the hypothesis of one doctor, William Silkworth. We know quite a bit more about the immune system and the brain than we did in the 1930s and so we can say unequivocally that alcoholics don’t suffer from an alcohol allergy. The notion of of alcoholism as allergy became canonical in AA and so it still remains in common use, despite not being medically accurate.
Although it isn’t technically accurate, the notion of alcoholism as allergy may persist because people find it useful. For one thing, people typically have no idea what you’re talking about when you tell them about GABA, glutamate, dopamine, down-regulation, and the prefrontal cortex. People do understand allergies and in particular they understand that an allergy is a reaction to a substance that only affects some people and may have life-threatening consequences. Furthermore, an allergy is not your fault. While it isn’t your fault, you still have to do whatever is necessary to avoid your particular “allergen.”
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