There are many questions surrounding addiction and how treatment has evolved into what it is today. Some scholars have shaped the history of addiction treatment. One of them being William White, who wrote the book “Slaying the Dragon: The History of Addiction Treatment and Recovery in America.”
Based on his research, we now know that addiction is defined and treated according to societal interpretations of the current time. For example, during medieval times, the clergy condemned excessive drinking. Yet, drinking was no worse than, say, gluttony. The idea that excessive intoxication might be a health issue wasn’t well known until many centuries later.
So, how has treatment developed into what it is today, and who helped shape it?
Origins of Commonly Used Terminology
In 1974, Dr. Benjamin Rush, a signer of the American Declaration of Independence, first wrote that excessive drinking was a medical disease. Magnus Huss, a Swedish Physician, is credited for coining the term alcoholism. The term addiction, as referring to compulsive drug use only, became popular in the 1890s.
The idea of treating excessive drug use was a relatively new idea during that time – Rush thought the answer was abstinence. Professional treatment would have to wait for more than a century to be conceptualized.
Today, there are more than 70 professional journals published based on addiction research. In 2012, the National Institute on Drug Abuse reported there were 13,000 treatment centers in the US alone. There are no reliable statistics for Canada, but there is a lot of money and effort put into understanding and treating addictions.
The road to new scientific interpretation was paved by some notable milestones. In this blog, we examine a few of these. We will cover a few major and complex historical events that have contributed to addiction treatment models.
Towns Hospital & Biological Treatments
Charles Towns was convinced that drinking excessively poisoned a person; a matter of cell pathology. The Towns cure (also known as the Towns-Lambert) was to have patients drink a concoction of various substances, including Belladonna, each hour for 50 hours.
William White, in his book Slaying the Dragon, provided one patient’s description, “I could check-in for a week in Towns Hospital, where bored, but expert doctors and nurses knew how to tide you over the horrors of a hangover if you had the price… You walked out of Towns a bit shaky, but clear-minded with the alcohol wrung out of your tissues, ready to face the world—until your next binge.”
Of course, cell pathology was only one interpretation. The popularity of Charles Darwin’s ideas led to another way to treat alcoholism. Eugenics, or sterilizing alcoholics, was soon considered to be the best way for inhibiting the passing on of inebriation and its defectiveness. This idea was not limited to alcoholics. Feeblemindedness, insanity, laziness, crime, and many other conditions were considered to have been passed on to the next generations by bad seeds.
Other ideas used were vitamin-enriched diets, exercise, work, or exposure to sun, bark, iron, steel and gold (known as the “elements”). Hydrotherapy, drug therapies (e.g. morphine for alcoholism), inducing seizures, and prefrontal lobotomies were also popular methods performed on alcoholics.
Psychoanalysis & Psychological Treatments
Americans were particularly fond of Sigmund Freud’s theory and practice of psychology, known as psychoanalysis. Freud seemed to believe that all addictions were substitutes for masturbation and that alcoholics were stuck in what he called the “oral stage” of human psychosexual development. He suggested that alcoholics were repressing their homosexuality.
Of course, we don’t believe this today. If it sounds a bit odd, we have to give Freud a break. Compared to what people thought before him, Freud’s ideas were quite revolutionary. The basic idea of psychoanalysis was to help the patient become aware of unconscious motivations, which led to drug use.
Perhaps the most famous psychoanalyst in the addictions field was Harry Tiebout, a Connecticut psychiatrist, who was a friend of AA and Bill W’s therapist for a while. Tiebout wrote several journal articles on alcoholism, arguing that alcoholics had a defiant individuality, expressed as arrogance and narcissism. Tiebout’s work was heavily influential, with the Hazelden Treatment Center re-publishing his work in 1990.
The Minnesota Model
In the US, it is generally accepted that the dominant model for treatment is the Minnesota Model or one of its many variations. A commonly used code word for the Minnesota Model is 12-step-based. According to the model, addiction is a disease and addicts have powerful coping skills to protect their addiction, such as denial. But the model also suggests that they need to address biological, psychosocial, and spiritual issues.
The model is remarkably pervasive in the US and even in Canada. Basically, it borrows some AA steps and principles and adds to medicine, psychology, and AA spirituality. The Minnesota Model has no pretense that it offers, clients achieve no more than physical and emotional stability. It leaves the agent of change to the 12-step program, which is why clients are introduced to the program in treatment.
Today’s Mainstream Scientific Psychology Treatment
Surprisingly, treatment based on scientific psychology is relatively new. For decades, addiction treatment has split off from mainstream mental health models, leaving mental health professionals quite happy about this. The famous psychiatrist, Irvin Yalom, said that he was quite happy to leave alcoholics to AA after finding them difficult to work within therapy.
Credentials for those working with people with addiction were much less stringent than for working with those with, for example, depression, bipolar disorder, or schizophrenia. Generally, an addiction therapist was a person recovering from his or her own addiction; little training was required.
Today, however, many regulatory bodies require those offering therapy to have the same credentials as mental health professionals. Past interpretations, for example, “only an addict can help other addicts”—have been proven to be inaccurate.
New ways of thinking are based on scientific theories and evidence-based outcome studies.
This blog is also available in a 4-part video series!