Addiction Medicine in the Twentieth Century: Part 2

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At the end of last week, I began a multi-part series on the history of substance use disorder treatment in the 20th century. I spoke about multiple early theories on what constituted the physical causes of addiction, and I talked about some things the US government did 85 years ago to try to curb the spread of addiction. Those early attempts did not have good results, and the medical reasons that some people became addicted to things like heroin and alcohol were still unknown. At the same time that doctors were working on that, the events that make up the early history of Alcoholics Anonymous were already taking place. The history of Alcoholics Anonymous, or AA, is much more widely known than the history of other addiction treatment in the same period. AA was founded by two doctors who both considered themselves alcoholics and found it helpful to speak with other alcoholics in order to stay sober together. One of those doctors was Bill W., the first AA member, the founder of the movement, and a man with an incredibly advanced case of alcoholism. When Bill W. was finally able to stop drinking, he had already been institutionalized multiple times, as institutions for alcoholics were common in the early 20th century. His physical health was failing him, and his wife was contemplating leaving him. Bill W. wrote the “big book”, or “Alcoholics Anonymous”, which is the book that the 12-step program is laid out in, and it is still the book that AA is based on today. Later in the century, other brother and sister organizations would begin that were closely tied to AA. Al-anon, a support group for friends and family of an alcoholic, and Narcotics Anonymous, a support group and 12 step program that covers drugs other than alcohol specifically. I will leave the rest of the history of AA for other people to explain. There are thousands of great sources of information on the founding and early days of AA, so it is not necessary for me to go over all of it myself when information on other treatments in the same time period is lacking so badly. 

As far as the timeline is concerned, late last week I left off talking about the 1930s through the late 1950s. In the early 1960s, we move out to the coastal areas of the United States. Cities like Los Angeles and San Francisco will play huge roles in the history of this time period, with New York being of particular importance beginning in 1960. In 1963, a study showed that the methods of the time were completely unsatisfactory, and 93% of opioid users returned to using after treatment at the “labor farms” that the government had built and used starting in 1935. We know from both research and anecdotal evidence that AA and the 12 step program is much more successful than that, and it is almost inarguable that AA was the standard-bearer for effective substance use disorder treatment before the use of methadone in the United States began. 

In New York, after World War 2 a new epidemic was on the rise amongst troops returning from war. The heroin epidemic that spread from New York to other places beginning in the 1940s and 1950s was the first sign that opioids could cause widespread addiction issues in society, as opium use and opium addiction were both ancient in origin yet limited in scope. Wilkie Collins and other famous writers of the 18th and 19th century were opioid addicts, but access to opioids was rare enough before the 20th century that most people had no exposure to the threat of addiction to drugs, other than alcohol. Alcohol had widespread usage going back millennia. The “beats” or “beatniks”, the group of creative types that began working in the fiction, non-fiction, and poetry fields in the early 1950s were some of the writers who brought heroin to the mainstream consciousness. William Burroughs and Allen Ginsberg both wrote about opiates in their popular works, and both faced pressure from the government to censor their own writing, with Ginsberg eventually facing an obscenity trial in San Francisco for his beloved poem, “Howl”. The opening two lines of “Howl” by Allen Ginsberg, below, are an early example of popular writing discussing heroin addiction.

“I saw the best minds of my generation destroyed by madness, starving hysterical naked,

dragging themselves through the negro streets at dawn looking for an angry fix.”

William Burroughs, the great American beat novelist, named his first novel in 1953 “Junkie”, and it was the first major fictional novel about the new American opioid epidemic. In many ways that epidemic never ended, and it eventually became the opioid epidemic we are seeing today, with more overdoses in the last 2 years than ever before in history. 

Now a quote on the early beginnings of the New York drug treatment evolution from Joseph and Woods, as many of the knowledge gained in that time and place would lead to breakthroughs that are still employed at the best drug rehabs in Florida and around the world, 

“In the early 1960s, the Health Research Council (HRC) of the New York City Department of Health under the leadership of Commissioner Leona Baumgartner established a narcotics committee with Dr. Lewis Thomas as Chair. In NYC complications with narcotics, such as heroin overdose was the major cause of death for young adults between the ages of 15 and 35 (Halpern & Rho, [18]).”

Dr. Lewis would soon enter a period of sabbatical, and a Dr. Dole, a metabolic doctor from The Rockefeller University, would take up the mantle of moving substance use disorder treatment into the modern era. According to Woods and Joseph, “Dole conducted an extensive review of the medical and social literature on narcotic addiction and concluded that existing studies on human addiction were inadequate. He was also aware of the Committee on Narcotic Drugs of the American Medical Association’s rejection of addiction as a medical disease within the purview of the medical profession.” Dr. Dole might have been the single greatest agent of change in this moralizing of addiction, along with a number of others he would help study and describe substance use disorder as a metabolic disease, a physical ailment caused by a chemical imbalance, which was largely correct. We still see widespread moralization of addiction and demonization of addicts, but none of that is normally coming from the medical establishment. This is a hugely important change, as medical professionals are the people who work directly with patients, although convincing other people of the new disease model of addiction is still an ongoing process that is necessary to make sweeping changes in addiction treatment law and legislation. 

I felt that it was important to go over the beginnings of AA and discuss some cultural changes relevant to the addiction treatment environment in the 1950s and 1960s, but tomorrow I will continue with the history of research and treatment of drug and alcohol dependence in the 1970s and later. This period will begin with Dr. Dole, and it will spread out widely to other researchers and practitioners in the 1980s and 1990s. If you or a loved one is in need of the best drug rehab in Florida or Alabama, check out this webpage or call us for more information on Florida Springs in Panama City, Florida. 

By T.A. Cannon (Contact me at TACannonWriting@gmail.com)

 

References

“Changing the Treatment Direction for Opiate Addiction: Dr. Dole’s Research”, Joseph, Herman; Woods, Joycelyn Sue. Substance Use & Misuse. 2018, Vol. 53 Issue 2, p181-193. 13p. 2 Charts. DOI: 10.1080/10826084.2017.1400069. Database: Psychology and Behavioral Sciences Collection

“Howl”, by Allen Ginsberg.

“Junkie”, by William S. Burroughs.