Foundations of Addictions Week 2 Glenn Maynard M.Ed., LPC
Alcohol in Colonial Period • Social past time • Estimated per capita consumption 7.1 gallons • Rush- alcoholism as a progressive medical disease; intergenerational; abstinence and spiritual conversion
Temperance • First temperance society started in New York in 1808 • Goal was to replace excessive drinking with moderate drinking • Moved to abstinence by 1830; growing recognition that craving and compulsion were not affected by personal will power • 1840- call for prohibition
Temperance • Most alcohol consumed was in the form of wine and beer/ale • After 1800, spirits became more available • Early Temperance thinkers advocated harm reduction- stop spirits and drink only wine or beer/ale • Recognized that this strategy would not work
Washingtonians (1840-47) • Public confession • Public commitment & abstinence pledges • Visits from older members (sponsors)
• Ongoing participation in experience sharing • Support and service toward other alcoholics • Sober entertainment
• Economic assistance
Failure of the Washingtonians • Charismatic leaders and no sustainable leadership • Lack of organization or guiding principles • No sustainable recovery program
• Changing economic conditions- recession to prosperity • Interference by political issues • Resistance from Temperance Movement- criticized for no religious basis
Reform Clubs/Fraternal Societies • Followed the Washingtonian Movement until 1900 • Emphasis on small groups of drunkards • Managed by people in recovery
• Met in secret and required anonymity • Over time some clubs became exclusionists • Clubs had organizational structure and succession
Inebriate Asylums and Houses • Early 19th C. medicine recognized the physical effects of alcohol abuse • Gastritis • Cirrhosis • Polyneuropathy • Wernicke’s Syndrome (B 1 deficiency) • Korsakoff’s psychosis • DTs • Violence
Inebriate Asylums • Prior to 1860’s chronic drunkards sent to alms houses, work camps, jails • 1864- first inebriate asylum opened in NY • Began as a private venture and then became public • Asylums considered chronic drunkenness to be a biological disease
Inebriate Asylums • Organization differed in different parts of the country • Staffed by physicians, clergy, recovered persons • Biologic treatments and moral suasion • Private asylums would “cream” the best of the crop
Demise of the Inebriate Asylum • Economics • Social and political forces- American society as a whole considered addiction to be a moral failure/character defect • No coherent theory of addiction or clinical protocols • Modality bias- only sickest went to asylum • Conflict with medicine and Temperance
Competition with Asylums • Patent medicine movement- frequently contained alcohol, morphine or opium, cocaine • Inebriate homes • Temperance drive toward prohibition
Drug Treatment • Freud and cocaine • Cocaine, morphine and opium commonly used to increase energy, creativity, to relax • White middle class addicts and Chinese opium dens • AMA would not endorse the disease model until after the Harrison Act
Drug Treatment • Withdrawal- cold turkey to prolonged withdrawal • Non-narcotic substitute- cannabis, strychnine, atropine, belladonna, cocaine, whiskey, coffee • Sedatives- chloral hydrate, bromides • Aversion- tartar emetic • Plant derivatives to destroy craving
Drug Regulation • 1905- IRS required that any medical product with alcohol required liquor license • 1906- Pure Food and Drug Act- patent medicines had to list all ingredients • 1914- Harrison Act • Efforts to amend the Harrison Act opposed by AMA
Effects of the Harrison Act (1914-1925) • Criminalization of addiction • Prisons filled with addicts • 3000 MDs sent to prison; another 20,000 were fined • Addiction as a disease was trumped by moral failure/character defects • By 1926, Supreme Court reversed itself
Social Effects of the Harrison Act • Drug use had shifted from the middle class to lower classes • Men exceeded women in morphine use • Anarchists and socialists coming to the US were perceived to be drug users • Federal campaign against narcotics and MJ
Porter Act 1929 • Created Federal Narcotic Farms • Farms opened in Lexington and Fort Worth • Continued to isolate drug addict when at the same time alcoholics would return to mainstream
1930s • • • •
Metabolic cycle of alcohol defined Research Council on Problems of Alcohol QJAS founded at Yale University Medical Societies advocated moving the care of addicts from criminal Justice to hospitals and medical settings • AA founded in 1935
1940s • Minnesota Model- creation of and funding for addictions treatment • Combined AA with medical models • Defined alcoholism as a progressive, chronic disease • AMA began to debate adding addiction to the its diagnostic groups
1950s • • • • •
Antabuse Methadone Maintenance LSD NA Community Movements- Synanon. Stripped culture of addict from the addict • Civil commitment to treatment
1960-2000 • Recognition of addiction as a separate field from psychiatry • Professionalization of addictions counselors • Biopsychosocial model • Biology and genetics- endorphins and dopamine • Technology transfer • A return to criminalization
Medicalization of Addiction • Sociologists define diagnoses as labeling of deviance from social and cultural norms • American medicine has adopted the disease model and has taken control of addictions treatment • OARs
Drug Trafficking is BIG Business • 100 billion dollar a year business • Columbia, Laos, Afghanistan, Peru and Turkey are major importers • Domestic traffic in MJ and amphetamine • Federal government practices supply reduction (War on Drugs) • Public Health advocates demand reduction
Spirituality • Early temperance movement guided by clergy and belief that religion was the only cure • Public confession adopted from the evangelical church movement • William James- Varieties of Religious Experience
Spiritual Experience • Gradual and non-dramatic- Bob Smith • Sudden and dramatic (born-again)- Bill Wilson • LSD and other hallucinogenics