Psychoactive drugs have been used since the earliest human civilizations. Problematic use of substances was observed as early as the 17th century.1
The evolution of addiction treatment, from the mid-18th century to the present, is outlined below. Several pioneers of treatment during these times contributed to a rich body of scientific knowledge that continues to influence our understanding of addiction today.
- Alcoholic mutual aid societies, sobriety circles provide early recovery (1750 to early 1800s). These groups were originally comprised of various Native American tribes, and some evolved into abstinence-based Native American revival movements.2 Native Americans used native healing practices to treat alcoholism.3
- Benjamin Rush argues that alcoholism is a disease that should be treated (1784). Rush was a physician committed to educating the public about the hazards of alcohol. Excessive use of alcohol in the late 18th and early 19th centuries was a major public health problem.4 His written works helped launch the beginning of the temperance movement.2
- Lodging Homes and Homes for the Fallen (inebriate homes) open (1850s). These homes provided short, voluntary stays that included non-medical detoxification, isolation from drinking culture, moral reframing, and immersion in newly formed sobriety fellowships.5 The first inebriate homes opened in Boston in the 1850s and were modeled after state-operated insane asylums.2,5
- New York State Inebriate Asylum opens (1864). This facility opened in 1864 under the direction of Dr. Joseph Edward Turner. It was the first medically monitored addiction treatment center in the U.S. and is considered the first alcohol rehab center.6
- Keeley alcoholism cures spread (1870s). Founded by Dr. Leslie Keeley, who opened more than 120 Keeley Institutes in North America and Europe, these consisted of addiction cure institutes and proprietary home cures, such as bottled “Double Chloride of Gold Cures for drunkenness.”5
- Freud recommends cocaine to treat alcoholism and morphine addiction (1880s). Sigmund Freud began using cocaine himself, calling it the “magical drug.”7 Freud and other American physicians used cocaine to treat alcoholism and morphine addiction. However, in the last of Freud’s writings, he backed off his former defense of using cocaine to treat morphine addiction.2,7
- Inebriate homes and asylums close, alcoholics are sent to drunk tanks, wards, and foul wards of hospitals (1890s). Poorly evaluated clinical therapies, ethical abuse, economic depressions, stigma, de-medicalization, and criminalization of alcohol/drug problems led to the shuttering of inebriate homes and the first generation of addiction treatment.5 After inebriate homes and asylums closed, alcoholics are sent to city drunk tanks, public hospitals, and insane asylums.2
- Charles B. Towns Hospital opens (1901). Charles Towns, in collaboration with Dr. Alexander Lambert (Theodore Roosevelt’s personal physician), opened this New York City substance abuse hospital in 1901, which treated affluent alcoholics with its famous belladonna elixir. Bill Wilson, founder of Alcoholics Anonymous, was a patient at Charles B. Towns Hospital 4 times. The cost of treatment was $350 a day, equivalent to $5,610 today.8
- Emmanuel Clinic in Boston begins lay therapy for treatment of alcoholism (1906). The Emmanuel movement was a church-based form of psychotherapy to heal addictions with a combination of spirituality and psychological interventions.9 The Emmanuel movement’s groundwork was instrumental to the establishment of Alcoholics Anonymous.10
- Passage of state laws that call for the sterilization of the mentally ill, developmentally disabled, and alcoholics and addicts (1910s). Legislation granted the medical supervisors of asylums and prisons the authority to “asexualize” a patient or inmate if such action would improve his or her physical, mental, or moral condition. Among those affected were alcoholics and addicts, who were considered degenerate and feeble-minded.11
- Morphine maintenance clinics created (1919-1924). Communities established morphine maintenance clinics to treat people with morphine addiction. Most eventually close for legal reasons.2
- Narcotics farms open (1935). The first federal narcotics farm opened in Lexington, Kentucky in 1935.2 Lexington was a center for drug treatment and federal research, and provided free treatment to addicts and alcoholics, including the “Lexington Cure.” The Narco farm was a prison where research on human subjects could be conducted.12
- Alcoholics Anonymous formed (1935). The 4 founding members of Alcoholics Anonymous (AA), Bill Wilson, Ebby Thatcher, Rowland Hazard, and Dr. Bob Smith, were highly influenced by the pioneers of the Emmanuel Movement.10 Wilson and Dr. Bob were both alcoholics in the 1930s, unable to achieve sustained abstinence despite their Christian faith and membership in the Oxford Group, a Christian organization whose principles heavily influenced the creation of the 12 steps.13 The meeting between Bill W. and Dr. Bob in 1935 marked the formation of AA, and the famous blue book, Alcoholics Anonymous, was published in 1939.2 AA separated from the Oxford Group in the 1930s.13
- Minnesota Model created (1948-1950). The Minnesota Model was a self-help model intertwined with the AA philosophy. Its primary treatment goals were abstinence and behavioral change.14
- Disulfiram and other drugs are used to treat alcoholism (1948-1950). Disulfiram, otherwise known as Antabuse, was introduced in the U.S. as a supplemental treatment for alcoholism. Antabuse created feelings of nausea and unpleasant reactions to alcohol. Other drugs used to treat alcoholism during this time included barbiturates, amphetamines, and LSD.2
- AA membership surpasses 90,000 (early 1950s). The reach of AA membership grew exponentially, and in 1951, AA won the Lasxfker Award from the American Public Health Association (considered to be America’s equivalent to the Nobel prize).15 AA’s success was due to several factors, including an increase in alcoholism-related films and a wider acceptance of those suffering from the illness.2
- American Medical Association defines alcoholism (1952). In 1952, the American Medical Association (AMA) first defined alcoholism.2 Eventually, the committee agreed to define alcoholism as a primary, chronic disease with genetic, psychosocial, and environmental factors influencing the condition’s prognosis.16
- Veterans Administration establishes alcoholism treatment units (1957). The Veteran’s Health Administration began developing alcoholism treatment units within its national network of VA hospitals.2
- Halfway House Association founded (1958). The halfway house movement peaked in 1958 with the founding of the Association of Halfway House Alcoholism Programs of North America.2 Halfway houses provided safe, recovery-focused housing for individuals who were suffering from substance abuse problems.
- E.M. Jellinek promotes alcoholism as a disease (1960). E.M. Jellinek, a 1960s alcoholism researcher, published The Disease Concept of Alcoholism.2
- Insurance industry begins to reimburse treatment of alcoholism (1964-1975). When the medical community emphasized alcoholism as a chronic disease, policymakers responded, leading to a rise in inpatient rehabs and an upswing in medication for alcoholism/addiction.2,17 In turn, the insurance industry began reimbursing alcoholism treatment in line with other illnesses.2
- Methadone introduced (1964). Vincent Dole, an endocrinologist, and Dr. Marie Nyswander, a psychiatrist, introduced methadone to treat narcotic addiction. The FDA approved it to treat heroin addiction in 1972.2 Methadone is a slow-acting opioid agonist that prevents harsh opioid withdrawal symptoms.18
- Lincoln Recovery Center uses acupuncture to treat addiction (1970). Lincoln Recovery was initially an outpatient treatment center in the 1970s that used methadone. In 1973-74, a community-based demand for natural, non-pharmaceutical treatments for heroin and opioid addiction spurred the use of acupuncture in the clinic. The alternative treatment proved to be highly successful, and many of the founding staff went on to study acupuncture.19
- The Controlled Substances Act passes (1970). The Controlled Substances Act (CSA) placed all regulated substances into 5 schedules, or classifications, based on the substance’s medical use, potential for abuse, and dependence liability.20
- FDA approves Narcan (1971). Narcan could counter opioid overdose effects, usually within 2 minutes. It was first made available as an injectable solution, but is now available as a nasal spray.21,29
- Betty Ford Clinic founded (1982). Former First Lady Betty Ford sought treatment for alcohol and prescription pill addiction at age 60. In 1982, Ford co-founded the first Betty Ford Center in Rancho Mirage, CA.22
- Cocaine Anonymous founded (1982). Cocaine Anonymous (CA) adopted the 12-step philosophy embraced by Alcoholics Anonymous.2
- Secular Organizations for Sobriety and Rational Recovery founded (1985-1986). Former serious problem drinker James Christopher founded Secular Organizations for Sobriety (SOS) in the mid-80s. Around the same time, recovered alcoholic Jack Trimpey founded Rational Recovery. These programs emphasize rational decision-making, not spirituality.2
- American Medical Association calls all drug addictions diseases (1987). The AMA passed legislation identifying alcoholism as a complex disease that merited the serious concern of all members of the health professions.2
- SMART Recovery founded (1994). SMART Recovery is a non-12-step program focused on self-empowerment. The program teaches skills for self-directed change and helps users cope with urges and manage thoughts, feelings, and behaviors that can drive addiction.23
- Naltrexone approved for alcoholism (1994). In late 1994, naltrexone became the second drug the FDA approved for alcoholism. Naltrexone is non-addictive and does not react with alcohol. It blocks opioid receptors in the brain, preventing the pleasurable effects.24
- Drug Addiction Treatment Act passed (1999). This bill was introduced in 1999 to amend the Controlled Substances Act with stricter registration requirements for practitioners who dispense narcotic drugs in Schedules III, IV, or V for maintenance and detoxification treatment.25
- FDA approves buprenorphine for clinical use (2002). In 2002, the FDA approved buprenorphine, a medication-assisted treatment (MAT) for opioid addiction. Unlike methadone, which is dispensed within a structured clinic, specially qualified physicians can prescribe buprenorphine.26
- The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 passed. This act required insurance companies and group health plans to provide similar benefits for mental health and/or substance use treatment and services as other types of medical care.27
- The Affordable Care Act (ACA) expands coverage for addiction treatment (2010). The ACA expanded MHPAEA’s criteria by making sure insurance plans offered through state health insurance marketplaces included behavioral health services, including substance abuse treatment.27
- American Medical Association petitions to drop pain as a vital sign (2016). In response to the opioid crisis and national addiction epidemic, the AMA met in 2016 to discuss dropping vital sign number 5 (pain) as a professional standard of medical care, a statute first implemented in the early 1990s.28
- Crocq, M.A. (2007). Historical and cultural aspects of a man’s relationship with addictive drugs. Dialogues in Clinical Neuroscience, 9(4), 355-361.
- White, W. Significant Events in the History of Addiction Treatment and Recovery in America.
- White, W. (2000). The history of recovered people as wounded healers: I. From native America to the rise of the modern alcoholism movement. Alcoholism Treatment Quarterly, 18(1), 1-23.
- Katcher, B. (1993). Benjamin Rush’s educational campaign against hard drinking. American Journal of Public Health, 83(2), 273-281.
- White, W. L. (2002). Addiction treatment in the United States: Early pioneers and institutions. Addiction, 97(9), 1087-1092.
- Crowley, J. & White, W. (2004). Drunkard’s Refuge.
- Grinspoon, L. and Bakalar, J. (1981). Coca and cocaine as medicines: an historical review. Journal of Ethnopharmacology, 3(2-3), 149-159.
- Markel, H. (2010). An alcoholic’s savior: God, belladonna or both? The New York Times.
- McCarthy, K. (1984) Psychotherapy and religion: The Emmanuel movement. Journal of Religion and Health, 23(2), 92-105.
- Dubiel, R. (2004). The road to fellowship: The role of the Emmanuel movement and the Jacoby club in the development of Alcoholics Anonymous. Lincoln, NE: iUniverse, Inc.
- Stern, A. (2005). Sterilized: In the name of public health. American Journal of Public Health, 95(7), 1128-1138.
- Kentucky Educational Television. (2017). Lexington’s narcotic farm: A pioneering institution in drug treatment.
- Dossett, W. (2013). Addiction, spirituality, and 12-step programs. International Social Work 56, 369-383.
- McElrath, D. (1997). The Minnesota model. Journal of Psychoactive Drugs, 29(2), 141-144.
- Kelly, J. (2016). Is Alcoholics Anonymous religious, spiritual, neither? Findings from 25 years of mechanisms of behavioral change research. Addiction, 112(6), 929-936.
- Morse, R. (1992). The definition of alcoholism. Journal of the American Medical Association, 268(8), 1012-1014.
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