Under the Influence and Ending the Drug Addiction Pandemic by Dr. James Milam

Reviewed by John Lauritsen

Dr. James R. Milam has almost singlehandedly revolutionized alcoholism treatment.  He is creator and champion of the “biogenic model”, which holds that alcoholism is a physical addiction to the drug, ethyl alcohol.

The older “psychogenic” model placed the blame on alcoholics — on their moral weakness, sinfulness, or in AA language, “character defects”.  According to the psychogenic model, alcoholism is a symptom or consequence of underlying character defects, a destructive response to life problems, a bad habit.  Since alcoholism was considered a psychological disorder, psychiatrists were considered the experts, and they dominated the alcoholism field.

In contrast, Milam’s biogenic model blames the disease itself, the result of alcohol intake in a biologically susceptible body, with the susceptibility being largely inherited.  Alcoholism itself is the primary problem; it is not a merely a symptom of psychological problems — nor is alcoholism a sin or moral weakness, as the clergy-led temperance movement believed — nor is alcoholism just a bad habit, as some current therapists claim.  Rather, alcoholism is a progressive disease, which is fatal unless arrested through total abstinence.

There are forerunners to Dr. Milam’s biogenic model. I date the beginning of the alcoholism recovery movement from the founding of the Washingtonian Movement in 1840.  The Washingtonians not only believed that inebriates could be saved, they proved this, by restoring seemingly hopeless drunks to health and happiness.  And this they did by demanding total abstinence, staying away from the fatal first drink.

In 1970 Milam self-published The Emergent Comprehensive Concept of Alcoholism (ECCA), which attained an underground celebrity.  Then, in order to reach a larger audience, he collaborated with Katherine Ketcham, who helped him translate the technical ideas of ECCA into simpler language.  Their book, Under the Influence (UI), was published in hardback in 1981 and then as a mass market paperback, which has sold well over a quarter of a million copies.

In my opinion UI is the best book ever written on alcoholism.  This new book, Ending the Drug Addiction Pandemic: Discovering the Liberating Truth (EDAP), is complementary to UI.  Milam on his own is a fine writer, clear and concise.  Very little of EDAP is overly technical for a good reader.

Dr. Milam is now ninety-three years old, living in Seattle and recovering from lung cancer.  I’ve spoken to him several times in the past few months.  He describes himself as an agnostic, rejecting the dogmatism of either religionists or atheists.  His Higher Power is The Wisdom of the Body.  He believes in the power of positive thinking, in which sense religious faith can sometimes be beneficial.

Milam is strongly pro-AA, but not uncritically. Recovering alcoholics need the support of other people, and here AA is the best option.  On the other hand, he rejects AA’s (or Bill W.’s) insistence that alcoholism is a symptom of character defects:

Despite its moralistic foundation, however, A.A. worked as no other approach to alcoholism had before, and as a long-term sobriety maintenance program, there still is not even a distant rival.  Thus A.A. stands as a colossal paradox.  The fellowship has undoubtedly been the most powerful force in getting society to accept alcoholism as a treatable disease.  Yet at the same time, it has become a powerful obstacle to accepting the otherwise overwhelming evidence that biological factors, not psychological or emotional factors, usher in the disease. (UI p, 140)

In these two books Milam explains how psychological problems are the consequences, rather than the cause, of alcoholism.  According to Milam, alcoholism turns good people (Dr. Jekyll) into bad ones (Mr. Hyde), by injuring the brain and other organs:

Within the biogenic paradigm Jekyll is the real person, Hyde a neuropsychological distortion created by the addictive chemical.  Hyde exhibits the same kind of deterioration of personality and character as victims of such other progressive brain pathologies as brain syphilis or a brain tumor.  Body mind, and spirit (including willpower) are biologically compromised and subverted to serve the addiction.  Given time for healing, in alcoholism the brain syndrome is reversible.  The task of therapy is to restore Jekyll to sanity and selfhood, and to start him on a path that will preclude a return to the addictive, transforming chemical.  (EDAP p. 3)

Therapists treating alcoholism routinely confound the physical effects of alcohol damage with psychological problems:

One of the main semantic strategies for hiding the biological truth is to purport to be measuring psychological traits of the alcoholic person without mentioning which of the constantly changing biological states he is in at the time the measurement is made, e.g., whether in the acute or protracted withdrawal period, and whether in the early, middle, or late state of alcoholism.  The resulting potpourri of bogus descriptions in the alcoholism literature misrepresents the personality of the alcoholic as inconsistent, irrational and incomprehensible.  (EDAP p. 35)

For example, what is considered “anxiety”, a psychological term, may actually be physical “anguish” caused by injured and recovering nerve tissue.

With total abstinence and time the good personality (Dr. Jekyll) re-emerges. This does take time — sometimes years — and may need the help (experience, strength and hope) of other people — but it happens mainly from the healing of the body and all of its organs, including the brain.

In addition, Milam is critical of AA’s belief that an alcoholic must “hit bottom” and that it is good to eat sugar.  AA’s emphasis on “spirituality” goes along with a neglect of the physical aspects of recovery, especially nutrition.

Although Ending the Drug Addiction Pandemic is a short book, it has a wealth of information, much of it new.  To me one of the most important chapters is “Actions of Alcohol & Onset of Alcoholism”, in which Milam describes in detail what alcohol does, and the differences between alcoholics and nonalcoholics.  It is neither obvious nor easy to make distinctions between alcoholics who are at an early stage of alcoholism, or temporarily drinking within the limits of their tolerance, and nonalcoholics, who may drink too much on occasion or even for a long time.  But Milam does make the distinctions convincingly.

Aside from alcoholism, Milam discusses the pandemic of addiction to harmful prescription psychoactive drugs.  I was shocked to learn that in the United States ten million little boys have been put on Ritalin, a harmful drug closely related to “speed”, on the basis of a phony psychiatric diagnosis, “Attention Deficit Disorder” (ADD), “for which no organic causes have ever been found.”

Milam’s ideas went against powerful interests: psychiatrists, as well as the liquor, sugar, and pharmaceutical industries, which fought back covertly:

It was easy to reassert the psychogenic belief about alcoholism because it had always been the default position and it still appeared to the public as the obvious truth.  As the abundant scientific and clinical evidence that it is false began to appear psychiatrists simply became more proactive…. They provided the media and the public with steady flow of disinformation, bogus research claims and unfounded opinions.

Along with AA, Milam insists that recovery from alcoholism requires total abstinence from alcohol.  For this position, both AA and Milam have been attacked by therapists, who claim that alcoholics can learn to drink “in moderation” if, with therapeutic help, they resolve their psychological problems.  Such therapists are promoting death for alcoholics.  It has been known for two centuries that drinking “in moderation” is not an option for true alcoholics.  This I know not only from my own experience, but also from the untold hundreds of experiences I’ve heard shared in AA meetings, of those who tried to moderate their drinking.  The lucky ones made it back to AA, staying away from the first drink; the unlucky ones died.

UI was not directly confrontational regarding psychiatry.  In EDAP the gloves come off.  Milam not only demonstrates that the psychiatric influence on alcoholism treatment has been disastrously wrong, but that psychiatry itself is anti-scientific: “Psychiatry is not even a profession.  It is an exploitative, self-serving secular cult masquerading as a profession.”

Amazingly, Milam was unable to find a major publisher for EDAP.  Random House told him that they would not look at his manuscript unless he obtained an agent.  This is not the way that publishers should treat a best-selling author, but it happens when powerful interests are threatened.  As it was, Milam had to fall back on a small press, which offered little editorial help.  Nevertheless, EDAP is a worthy successor to UI.

I recommend both books highly.  Read UI first and then EDAP, which brilliantly complements it.


Dr. James R. Milam and Katherine Ketcham.
Under the Influence: A Guide to the Myths and Realities of Alcoholism.
Bantam Books, 1983 (First publication 1981).
ISBN: 0-553-23788-8 (paperback).
Also available in Kindle format.

James R. Milam, PhD.
Ending the Drug Addiction Pandemic: Discovering the Liberating Truth.
Strategic Book Publishing and Rights Co., 2013.
$11.50  ISBN: 978-1-62857-209-4 (paperback).
Also available in Kindle format.


About the Author

John Lauritsen. was born and raised in Nebraska.  He attended  Harvard College (AB 1963), majoring in Social Relations (Sociology, Anthropology and Psychology).  In New York City he worked as a market research executive, writing on the side.  He was in the antiwar movement since 1965 and the gay liberation movement since July 1969.  He founded Pagan Press in 1982.  For a decade, beginning in 1985, John was a leading writer for the New York Native, which was then the foremost gay paper.  He has twelve books to his credit.  John dates his alcoholism from his first bender in 1958 to his last drink in 1968.  He considers himself a loyal, but by no means uncritical, member of AA.  John now lives in Dorchester, Massachusetts.

Freethinker-AAJohn’s groundbreaking book, A Freethinker in Alcoholics Anonymous 

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John the DrunkardLaurie AChris G.Joe C. (@Rebellion_Dogs)John L. Recent comment authors

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John the Drunkard
John the Drunkard

I’ve just ordered the EDAP book. Searching for it, I notice that the publisher is essentially a vanity operation that solicits unvetted manuscripts. So I will anticipate and accept a level of editing and design that I might otherwise complain about. I’ve read Under the Influence, and the Ketchum-only followup Beyond the Influence. Sure the nutritional stuff is questionable. But I suspect it may have been driven by the really crazy promotion of sweets that flourishes in some circles of AA. I don’t think its possible to write about ‘moderation’ schemes, the Sobells, and Psychoanalysis honestly without unleashing outrage and scorn. The price alcoholics… Read more »

Laurie A
Laurie A

So, ‘Psychiatry is an exploitative, self-serving, secular cult.’ Is that so? Dr Silkworth wrote in the Big Book ‘We doctors have realised for a long time (1939!) that some form of moral psychology was of urgent importance to alcoholics’ but was suitably modest about the efficacy of the psychological approach. And he added, ‘Though the aggregate of recoveries resulting from psychiatric effort is considerable … many types (of alcoholic) do not respond to the ordinary psychological approach.’ The psychiatrist Max Glatt (a non-alcoholic) dedicated his professional career to helping problem drinkers, including hundreds of AA members.  And I am personally grateful for the immense support an… Read more »

Chris G.
Chris G.

EDAP: What a load of rubbish. The review had me very hopeful for a really good new book shedding medical light on alcoholism, so I immediately bought it and read it. Spent all day on it. Definitely not what I was expecting. Whether or not he had an agent, he certainly needed an editor. The book is written in an appalling style, difficult to follow, and has so many diversions down rabbit holes that it is really tedious. It is even full of typos, in the Kindle version at least. Almost the entire book is simply a diatribe against psychiatrists… Read more »

John L.

Chris G. — I don’t know what to make of your comment. You may disagree with James R. Milam on some things (as I do) and you may be irritated by stylistic shortcomings, but these hardly justify starting out your comment with “What a load of rubbish.”. Re-reading much of Ending the Drug Addiction Pandemic (EDAP) in order to see if I’ve been promoting rubbish, I found a few misspelled words and a few paragraphs that were difficult to understand, but on the whole I was more impressed than ever by Milam’s courage and clarity. He doesn’t mince words or… Read more »

John S

Thank you John for your contribution and for introducing me to these two books. I will make time to read them. I assumed that it was established that there’s a genetic component to alcoholism, that there were studies that actually isolated a gene. I guess the science isn’t as established as I had thought.

It makes intuitive sense to me that my character didn’t cause my alcoholism, rather my alcoholism chipped away at my character.

Again thank you. The talent we have in our community of heathen AA is really extraordinary.

Joe C. (@Rebellion_Dogs)

Totally enjoyed this (and the discussion that follows). I don’t agree with everything John says but I always love his candor and ability to support his thesis. Two thumbs up, John. UI was definitely a breath of fresh air in the 1980s. This new offering will be on my ‘to read’ list for sure.