Santa Maria Hostel

History on Drug Treatment

The face of addiction, the perception of those battling addiction, and the treatment of drug addiction have changed a lot throughout the years in the United States. The most recent national survey, which was completed in 2013, published that 24.6 million Americans (over the age of 11) were considered current illicit drug abusers and had used an illicit drug in the month before the survey, and 21.6 million people were considered to have a substance abuse or dependency issue in the previous year.[1]

Those addicted to drugs have been vilified, criminalized, or subjected to many questionable “cures” over the years, as the public and medical concept of addiction has been rather fluid. The current definition of addiction postules that it is not a failing of moral character, but rather a disease of the brain that impacts the reward system, willpower, and emotional regulation of a person. Addiction requires specialized treatment for recovery and to avoid episodes of relapse.[2]

Addiction today is thought to be the result of genetics, biology, and environmental influences. A combination of pharmacological and behavioral treatment methods may prove beneficial. Treatment can be found at one of the more than 14,500 addiction treatment programs in the United States.[3] Addiction and drug treatment in America has come a long way over the centuries and continues to evolve with the introduction of new research and scientific evidence.

Rise of Addiction in the US and the Need for Treatment

During the Civil War, opioid drugs were dispensed freely for all kinds of medical ailments. Since opioid drugs are highly addictive, this may have given rise to the spread of drug addiction in the United States following the war.[4] Before this, it is likely that people addicted to mind-altering drugs were considered a scourge to society and likely part of the undesirable “underground,” comprised of gamblers, prostitutes, and criminals. Drug addiction may have been relatively uncommon and possibly perpetuated in Chinese opium dens.[5]

Opioid drugs were used to treat a variety of medical issues and injuries during and after the war. By the late 19th century, Civil War soldiers comprised a number of those addicted to opioids; however, large-8 medium-12 columns of those battling opioid addiction at this point were likely upper- and middleclass white women who may have been initially prescribed the drugs for menstrual issues.[6] Drug addiction was no longer confined to those considered morally dysfunctional. The estimated 300,000 people addicted to opioids in America may have been treated with sympathy and been prescribed more opiates or sent for a “cure” at a sanatorium.[7]

Individuals suffering from alcoholism or drug addiction may have been confined to an inebriate asylum for a period of time to help them “dry out,” as treatment may have focused primarily on detox, withdrawal, and physical stabilization.[8] The New York State Inebriate Asylum, built in 1858, actually may have been one of the first institutions to attempt to treat alcoholism as a disease, catering to the upper-crust society of New York in the late 19th century until such belief was shunned. The government-run treatment center was forced to close and later reopen as a psychiatric hospital for the “chronic insane” where it employed heinous treatments like prefrontal lobotomies, hydrotherapy, and electroshock therapy.[9] Inebriate asylums and sanatoriums kept patients onsite, likely even against their will, for a variety of different addiction treatment methods that in today’s times might even be viewed as barbaric.

Methods Used for Treating Drug Addiction over the Years

· 1930s- 1950s : Criminal offenders who suffered from addiction and were housed in the Colorado State Penitentiary were infected with blisters on their abdomens that were then drained. The resulting fluids were re-injected into their arms as a “cure” for addiction.[18]

· 1935 : Medical withdrawal may have been managed with codeine or subcutaneous morphine injections.[19]

· 1935:  Aversion therapy for alcoholism was introduced at the Shadel Sanitorium in an attempt to condition individuals to dislike anything to do with alcohol. This therapy involved introducing unpleasant stimuli every time alcohol was presented, possibly by inducing nausea and relating it to alcohol intoxication.[20]

· 1940-1950 : Addiction was considered to be caused by a dysfunction in the endocrine system, and individuals suffering from addiction were injected with adrenocorticotropic extracts from the adrenal gland.[21]

· 1948-1952 : Addiction and addictive behaviors were tied to the prefrontal cortex. Frontal lobotomies, or the surgical removal of the frontal lobe of the brain, were performed on individuals addicted to drugs or alcohol.[22]

· Mid-1950s : Electroshock therapy (ECT), where individuals were repetitively shocked with wires attached to their heads and bodies, was performed on individuals battling addiction.[23]

· 1950-1960:  LSD, the hallucinogenic drug, was used to treat individuals suffering from alcoholism.[24]

· Present day:  Even today, the Internet gives rise to a plethora of strange and aversive techniques and “cures” for addiction that can not only make people sick, but are also largely ineffective.

Early Criminalization of Addiction and Negative Effects on Treatment

During the mid to late 1800s, cocaine, chloral hydrate, chloroform, and cannabis became widely prescribed and used, and addictions to these drugs, as well as to opioids, grew.[25] Society as a whole may have looked the other way and felt that since a large majority of those addicted to these narcotic drugs were upper-class white women, and therefore were not a threat to society, their drug addiction may have been largely tolerated.[26] Things began to change, however, as the United States became more of an international power, and drug abuse internally became less acceptable to the outside world. Physicians were also beginning to understand the potential dangers of drug abuse and addiction, and change in the population of individuals addicted to drugs may have forced the hand of the government to enact legislation controlling the prescription, sale, and abuse of narcotics.[27]

Public perception began to change as drugs increasingly found their way into urban, poor, and minority populations. Society perpetuated the idea that drugs were the cause of many criminal acts, including rape, committed by this demographic and cited drug abuse as one of the main reasons. In concern for the safety of women and children, and the growing domestic drug and narcotic drug problem, politicians may have taken notice.

In 1914, the Harrison Act was passed, which regulated the importation, sale, and even prescription of narcotics.[28] Physicians were no longer allowed to prescribe opiates for maintenance purposes, and individuals addicted to these drugs may have been left to withdraw painfully on their own or commit criminal acts to try and obtain these drugs illegally. Doctors were also arrested for prescribing opioids if they were not deemed medically necessary, and physicians were no longer able to treat those addicted to opioids with maintenance doses out of their offices directly.[29]

Prohibition in the 1920s sought to remove alcohol and mind-altering substances from society overall, although this was found to be ineffective, and the laws were repealed by the early 1930s. During this time period, community clinics that had been the go-to for individuals battling opioid or narcotic addiction were shut down. “Ambulatory” opioid addiction treatment, as well as the new specialty of addiction science, was all but wiped out for several years, and many suffering from addiction ended up in prison instead of getting the help they needed.[30]

Shift to Medical and Supportive Treatment Between 1924 and 1935, those battling addiction to narcotic drugs may not have had many resources unless they belonged to the upper classes of society and could afford the new private hospitals’ detoxification services.[31] In 1929, in the face of extreme federal prison overcrowding and no real answers for addiction treatment, the Porter Act was passed that mandated the formation of two “narcotics farms” to be run by the U.S. Public Health Service. In 1935, one such prison/hospital providing addiction treatment for prisoners or those voluntarily seeking services opened in Lexington, Kentucky, while the second opened in Forth Worth, Texas, in 1938.[32] Up until the late 1950s, these two “farms” provided the majority of the addiction treatment services in the United States. They offered a three-pronged approach, including withdrawal, convalescence, and then rehab, all perpetuated by a medical and mental health team of experts.[33]Treatment for addiction moved out of the community-based and “goodwill” type facilities to a more clinical setting. As a result, addiction treatment services began to shift to a more medical approach.[34]

In 1935, the Oxford Group, a religious movement that believed in self-improvement methods enhanced by spirituality and shared within the community, was likely the beginnings of 12-Step support programs like Alcoholics Anonymous (AA).[35] Narcotics Anonymous may have originated in one of the federal “narcotics farms” and may have started out as “Addicts Anonymous” that was slow to catch on but, over time gained popularity using AA models and methods of support.[36] By 1950, the Minnesota Model, which is a method of treating chemical dependency by both professional staff and supportive individuals in recovery themselves, had been introduced. The Minnesota Model was adopted by the not-for-profit Hazelden Foundation and employed an individual treatment plan that viewed addiction as a treatable disease through education, family involvement, a 28-day residential stay, and continuing support through AA participation.[37]

Consequences of Legislation and Laws on Drug Treatment

The possession and sale of narcotics were further criminalized in 1952 and 1956 with the passage of the Boggs Act and the Narcotic Control Act respectively, which came with high penalties for drug possession and the sale of narcotics.[38] Young people addicted to opioids, and particularly heroin, became increasingly more prevalent, especially in New York City, in the 1950s, and fueled the need for juvenile and adolescent drug treatment programs along with the concept that addiction was indeed a disease.[39] In 1952, New York City opened the Riverside Hospital specifically for adolescents addicted to drugs, although the programs proved largely ineffective, and the facility was not even open for 10 years.[40] Long-term residential options were considered, as relapse rates were so high, and therapeutic communities (TCs) were born – the first of which may have been the Synanon in California in 1958.[41]

TCs were, and still are today, residential communities where individuals struggling with drug addiction stayed for a long period of time with groups of people with like circumstances. They are self-supporting communities that maintain abstinence through self-help and supportive methods. When they first appeared, TCs did not allow for any type of mind-altering medications, much in the vein of AA methodology; however, today, TCs may allow for the use of maintenance medications when necessary.[42]