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