The history of addiction and addiction treatment is as old as human history. Records from the Greeks indicate that those suffering from alcoholism were treated in specific homes. During the Middle Ages, recipes for dealing with hangovers were plentiful ranging from mixtures to drink, to using salt water to wash the genitals if male, and the breasts if female.
According to a study “History of Substance Abuse Treatment” Benjamin Rush, “a prominent physician in the latter half of the 1700’s …. advocated for moderation rather than abstinence in treatment and promoted a range of treatment modules: cold baths, vomiting, aversion therapy, ….bleeding, blistering and sweating the patient.”1
American Association for the Cure of Inebriation
During the mid-nineteen hundreds, there were attempts by the medical profession to address addiction. Symptoms of alcoholism were noted, and for the first time changes in liver, stomach, changes in the state of nerves and what was described as brain fever were discussed. Cures of many kinds were tried. Inebriate homes were founded as well as inebriate asylums, and in the mid-1800s they banded together to form the American Association for the Cure of Inebriation. This was the first attempt at institutional treatment of addiction.
Toward the end of the 1800s, “Miracle Cures” arrived on the scene in America. Heavy marketing (through magazines, newspapers, and public events) promoted the purchases of cures sold over the counter or through the mail. This ability fostered the movement toward treating the problem in the privacy of one’s home. Many of these cures combined alcohol, opium, and morphine. Opium, cocaine, and morphine became problematic in the United States in the late 1800s. These drugs were regularly prescribed to educated, wealthy, white women to manage hysteria. (Just as today the majority of anti-depressants and other addictive medications like sleep aids are prescribed to more women than men.)
In the early 1900’s, another attempt at temperance arose. This was prohibition. The rationale for prohibition was if people were unable to obtain alcohol, they could not become alcoholics. In the end, more people abused alcohol during prohibition, however, the ability to find alcohol treatment facilities became more difficult. It also leads to an increase in criminal behavior and gang wars. During this time, treatment facilities for alcoholism became scarce.
The War on Drugs
The Second World War, the Korean War, and the Vietnam War followed. Between the Second World War and the start of the Vietnam War, addiction and alcoholism were seen as a public health issue. New funds for research were allocated. One of the offshoots of this shift resulted in the identification of Post Traumatic Stress Disorder (PTSD). During and after the Vietnam War, drug abuse was rampant, and veterans were being imprisoned in record numbers as the public was just becoming aware of PTSD. However, in the 1970s the government implemented the War on Drugs. This resulted in the further criminalization of drug use, more young men being imprisoned, and perpetuated the myth that addiction was a moral lack, and therefore a sin.
Addiction as an Illness
Over the last fifty years, a vast amount of scientific research has altered our understanding of addiction and its progression. In the 1950’s, the Minnesota Model evolved and was based on the premise that recovery required respect rather than degradation. The underlying premise for degradation was and is rooted in the concept of moral lack, character weakness, and sinful behavior.
Sadly, controversy still exists, despite the increase in scientific research that demonstrates that addiction changes the brain’s chemistry and functioning and therefore is considered an illness. This body of research, which has grown exponentially in the last twenty years helped move treatment toward an integrated approach. No longer can treatment of addiction be relegated to one discipline. Researchers have found that the best approach is an interdisciplinary approach requiring a team of professionals to work together to develop an individualized treatment protocol. As the expression states, treatment should never be a one size fits all approach.
The underlying resistance to forging ahead with evidence-based treatment is grounded in the moral lack or character weakness argument. To that end, the country still has not dealt with the reality that millions of Americans suffer addictions and that millions of Americans cannot access treatment even if they wish to stop.
“Addiction treatment is still not designed to foster continuity of care. Detoxification, not followed by any continuing care is still an unacceptably large proportion of all public treatment episodes. Residential care, usually for periods of less than a month, is rarely followed by an active engagement in continuing outpatient care. This segmentation of care has been fostered by the fact that the various segments of the care continuum (e.g., detoxification, residential care, outpatient treatment) are often owned and operated by different organizations that have no obligation or financial incentives to integrate their care or to motivate the patient to continue in the next stage of care (See McLellan, Kemp, Brooks, & Carise, 2008).”2
Help can be obtained if someone you know suffers from addiction to substances or alcohol. Look for a licensed treatment facility that has a continuum of care, licensed medical staff, licensed therapists, and evidence-based treatment modules. Individualized care is crucial to the proper diagnosis of the patient, the constant re-evaluation of the treatment plan, and the long-term plan for the patient’s aftercare.