History of Drugs Substance Abuse Addiction Treatment,
Running head: History of Drugs
An Early History of Drugs, Substance Abuse, Addiction Treatment, and the Psychological Perspectives of Addiction Treatment in America
A Research Paper
The Faculty of the Department of Psychology
East Carolina University
In Partial fulfillment
of the Requirements for the Degree of the Substance Abuse and Clinical Counseling program
Eric K. Mason
An Early History of Drugs, Substance Abuse, Addiction Treatment, and the Psychological Perspectives of Addiction Treatment in America
The use of drugs has been a part of the human experience for as long as there has been a human experience. People have been using drugs to alter their consciousness, reduce pain, deal with harsh surroundings, facilitate religious experiences, and heal the sick since ancient times (Inaba & Cohen, 2000). Although mind-altering substances in ancient times were naturally occurring and less potent than today’s synthesized drugs, they were—nevertheless—used to achieve an altered state.
Many contend that the consumption of drugs in order to alter one’s state of consciousness is simply a fundamental or inherent drive of all humans in all corners of the globe. For example, Weil notes that drug use and conscious-altering activities are prevalent in virtually all cultures, across all societies and socioeconomic levels, as well as in most age groups. For example, the casual use of epená snuff as a recreational drug by the Waiká Indians, the ubiquitous consumption of alcohol in nearly every society (outside of traditionally Islamic societies), Harvard professor Timothy Leary’s endorsement of LSD, and the common sight of children at recess continually whirling themselves in circles until they become dizzy are all support for the assertion that humans have a fundamental drive to alter their consciousness (Weil, 1972).
Perhaps, the desire to achieve altered states of consciousness goes hand in hand with our efforts to understand the mankind’s internal experience—the mind, brain, and consciousness. Priests, philosophers, psychologists, as well as other prominent figures throughout history and modern times, have struggled to grasps the complexities of consciousness. For example, John Locke’s 1689 publication, “An Essay Concerning Human Understanding,” was a scientific attempt at exploring the human consciousness. In so doing, Locke helped to lay the foundations of psychology—the science of the internal human experience (Watson & Evans, 1991). For many, the use of drugs has been but another pathway of exploring the workings of consciousness.
In the following paper, I will give a brief description of the history of drugs, as well as their uses and misuses. I will explore the societal impact of drugs from a historical perspective, and how our cultural values regarding their uses and misuses have changed and evolved over time. In addition, I will discuss the rise of addiction treatment in America, and progression through time. In discussing treatment, I will provide a historical analysis of psychological perspectives regarding the topic, with a special focus on the rise of applied psychology and psychoanalysis, as well as how they have contributed to the treatment of addiction.
Drugs in History
Drugs are woven into our history. Indeed, they have played a significant role in many significant historical events. Wars have been fought, lands conquered, and people enslaved all for the purposes of attaining or preserving the use of psychoactive substances (Inaba & Cohen, 2000). The historical events which were the result of, or were precipitated by the attainment of mind altering substances is rich, to be sure. A full description, however, of such historical events is well beyond the scope of this paper. Certainly, such a description could fill several books.
Throughout history drugs have served to define the Zeitgeist—acting as a sort of cultural barometer. At different points in history, in most societies, attitudes towards drugs have flexed and fluxed. At times they have been either tolerated or disdained. For example, occasional drunkenness was seen as normal or even as a healthy outlet in colonial America. However, when George Washington began to view it as disruptive to the Continental Army, a decree of condemnation was issued to the soldiers. Upon the issue of the decree, public drunkenness became less tolerated (White, 1998).
The sociopolitical aspects of drugs have been influential in defining American culture, as well. For example, in the early 1900’s marijuana, which had been relatively tolerated, became simultaneously vilified and associated with Mexican immigrants. This systematic approach was an attempt to thwart the influx of Mexican immigrants who were seeking work in the U.S. at a time when jobs in the southwest were in short supply (Gahlinger, 2004).
Likewise, at about the same time, opium was demonized in the San Francisco area (Gahlinger, 2004). However, the case of opium may have been more racially motivated. Dr. Hamilton Wright, known as the “Father of American Narcotics Laws,” stated that “One of the most unfortunate phases of the habit of smoking opium in this country [is] the large number of women…cohabitating with Chinese in the Chinatowns of our various cities” (Gahlinger, 2004). Beyond their potentially real physical and social dangers, drugs, or rather the dramatic storylines associated with them, were used to thwart immigration and justify racism. In short, they were as a means of attaining sociopolitical ends (Gahlinger, 2004).
The precursors of most modern-day drugs are psychoactive plants that have been around for millions of years. Although there are some 4,000 plants with known psychoactive properties, only about 150 have been used for such purposes throughout history. About 60 plants are still used in their natural forms (i.e., not synthesized) for their psychoactive properties. This includes tobacco, coffee, coca, marijuana, and opium (Austin, 1979).
Evidence suggests that psychedelic plants were used for religious purposes by Neanderthals in Europe and Asia as far back as 50,000 years ago. Many Native American tribes used hallucinogenic mescal beans and sophora seeds for religious and spiritual purposes some 15,000 years ago (Furst, 1976). When nomadic tribes began to form agricultural communities 10,000 to 20,000 years ago, the first crops they cultivated were wheat and barely for making bread and beer (Ganeri, Martell, & Williams, 1998). Neolithic jars from 5000 BC that contained wine residue were found in the Middle East, while the first references to alcohol were found on Sumerian clay tablets that date back to 4000 BC (O’Brien & Chafetz, 1991). Similarly, people have cultivated many other psychoactive substances, such as marijuana, opium, and coca for thousands of years.
Of course, drugs have been prevalent in relatively more recent times, as well. In 1492, Christopher Columbus noted the use of tobacco and cohoba (a hallucinogenic substance) by the natives in Hispaniola (Benowitz & Fredericks, 1995). Soon thereafter, the recreational use of tobacco began in Europe. In 1605, Portuguese sailors brought tobacco to Japan where it began to be cultivated. The widespread use of tobacco was noted in 1620 by Francis Bacon who stated that “the use of tobacco is growing greater and conquers men with certain secret pleasure, so that those who have once become accustomed thereto can later hardly be restrained therefrom” (Benowitz & Fredericks, 1995).
The complexity of human drug use is fascinating, to say the least. We have used them to heal, comfort the dying, and for spiritual enlightenment. Indeed, we are inquisitive beings. It is little wonder that drugs were abused and misused in humanity’s quest to understand itself. Nevertheless, with drug abuse came drug addiction and, in turn, addiction treatment.
History of Addiction Treatment
For as long as there have been drugs, there have probably been those who notice their dangers. Thousands of years ago, ancient Egyptians described opium as both a medicine and a poison—noting it potential to be habit forming (Ganeri, Martell, & Williams, 1998). In 2200 B.C., the renowned Emperor YU brought forth a tax on wine in order to curtail its consumption (Cherrington, 1924). Another documented case of an attempt to alcohol consumption can be found in the Babylonian “Code of Hammurabi.” This code was used to establish a guideline for drinking measurement, as well outline the responsibilities for tavern owners. (O’Brien & Chafetz, 1991). Much later–in the 1800’s–China banned opium use as a result of crime, corruption, and addiction that the drug had been shown to cause. China’s ban of the drug ultimately led to do “Opium Wars” (Latimer & Goldberg, 1981).
Recognizing the downside of drug use hardly constitutes the treatment of drug addiction. Treatment for drug addiction began with those who attempted a set systematic approaches that they hoped would “cure” the person of his or her addiction (White, 1998). Addiction treatment has almost as rich of a history as drugs. The following highlights some of the most interesting aspects of addiction treatment.
One of the pioneers of addiction treatment was Benjamin Rush (1746-1813). Rush was one of the first and most prominent physician in colonial America. Rush was highly concerned with all aspects of public health. He was a prolific writer, an educator, and a social activist. He is often referred to as the “father of American psychiatry” (White, 1998). Indeed, he may rightly be referred to as the “godfather of alcoholism treatment.”
Rush’s interest in addiction treatment was personal. His father was an alcoholic, which led to his parents’ divorce. Rush’s mother remarried a distiller who drank and abused her (White, 1998).
Rush published one of first condemnations of alcohol in a 1782 newspaper. His article, “Against Spirituous Liquors,” called on local farmers to stop the practice of providing daily rations of liquor to their laborers. Rush contended in his article that the rations hurt the workers’ health, and being a true American pragmatist, their productivity, as well (White, 1998).
Rush’s greatest contribution to the field of addiction treatment was published in 1784 in the form of a 36-page pamphlet called “An Enquiry into the Effects of Spirituous Liquors Upon the Human Body, and Their Influence Upon the Happiness of Society.” “Enquiry” was published just as the consumption of alcohol was on the rise. In 1792, the annual per-capita consumption of alcohol was 2.5 gallons. In 1810, it was 4.5 gallons (White, 1998). In “Enquiry,” Rush interwove morality, science, and psychology to make his point against excessive alcohol consumption (Rush, 1785).
Rush’s views on addiction were before his time to say the least. Rush was, perhaps, the first to allude to alcoholism as a disease. He is considered to be the originator of the disease model of alcoholism (Maxmen & Ward, 1995). Furthermore, Rush believed that many alcoholics used alcohol to self-medicated—noting that many alcoholic women began drinking, hoping to get relief from menstrual cramping. This notion of self-medicating would be revived by psychoanalytic theories many years later. He proposed the building of “Sober Houses,” the equivalent of our modern day rehabilitation centers. The idea that alcoholism was a disease to be treated, and controlled through abstinence was seen as ridiculous by many contemporaries of Rush (White, 1998).
Although Rush was able to identify many scientific explanations for addiction–such as the disease model, the self-medicating theory, as well as a genetic component to alcoholism (noting that it appeared to be intergenerationally transmitted)–addiction was viewed in unscientific terms by most in the 18th Century. That is, it was usually regarded as a moral downfall of the individual–a “disease of the will.” Nevertheless, Rush’s description of addiction as a physiological disease ultimately prevailed—remaining influential for over 200 years later (White, 1998).
One of Rush’s recommendations for the treatment of alcoholism was remarkably Pavlovian. He claimed to have cured people of alcoholism by mixing tartar emetic with alcohol. When consumed, this mixture would induce vomiting. Rush stated that many of those who consumed the mixture could not stand even the smell of alcohol as far as two years after the act. Rush’s was using this overtly beahavioristic technique in 1700’s—well before the “behavioristic revolution” in the field of psychology(White, 1998; Watson & Evans, 1991).
Although Rush is generally not credited with influencing the field of psychology, some of his techniques and beliefs would show up in psychological literature over a 150 years later. For example, Dr. Walter Voegtlin is said to have pioneered aversion therapy for the treatment of alcoholism (White, 1998). Aversion therapy is a behavior therapy which combine an unpleasant stimulus with some behavior (in this case alcohol consumption), so that the behavior will become associated with the unpleasant stimulus; thus, reducing or eradicating the behavior (Maxmen & Ward, 1995). Voegtlin’s aversion therapy, however, is notably similar to Rush’s technique of using a noxious mixture to treat alcoholism (described above) (White, 1998).
One of Rush’s original hypothesis would show up later in the psychoanalytic literature. He hypothesized that alcoholism was “suicide perpetrated gradually” (White, 1998). “Rush postulated that some people’s drunkenness sprang from a hidden desire for self-injury, and he conceptualized the bottle as a potential instrument of self-harm” (White, 1998). This line of thought would be revived in psychoanalytic literature by Dr. Karl Menninger some 152 years later (White, 1998).
Rush has clearly played a very important role in the history of addiction treatment in the United States. Before Rush, addiction treatment never garnered much attention. Although some of Rush’s approaches to the treatment of addiction were clearly harmful, such as poisoning, bloodletting, and forced purging, his philosophical beliefs on addition treatment have been a tremendous contribution to the field (White, 1998).
Temperance and Treatment
The rising problem of alcoholism led many prominent colonial Americans to join Rush’s call for sobriety. For example, George Washington, Tomas Jefferson, Benjamin Franklin, and John Adams all began to address the issue of alcoholism in colonial America. The publicity such individuals brought to the troubles associated with alcoholism led to the beginnings of early temperance movements in America (Courtwright, 2001).
Billy Clark founded the Union Temperance Society in Moreau, New York in 1808—believed to be one of the first temperance groups in America (though Native American tribes are said to have formed such groups as early as 1772). Early temperance movements advocated the use of alcohol only in moderation, while encouraging complete abstinence from liquors, wines, and other distilled spirits. However, it was soon realized that drinking in moderation was a difficulty—if not impossible—feat for the typical alcoholic to conquer. This realization would have a profound effect on how addiction would be viewed and treated (Crowley & White, 2004).
In the 1830’s, Rev. W.H. Daniels, Elisha Taylor, and Dr. Justin Edwards were some of the first to not that temperance in the form of moderation was very successful. Daniels and Taylor found that out of 26 confirmed alcoholics, seven had relapsed into drinking distilled spirits through the consumption of non-distilled spirits, such as beer. Dr. Edwards created the American Society for the Promotion of Temperance, in which he set forth his aim to reform alcoholics by means of complete abstinences from alcohol (Crowley & White, 2004).
It was, perhaps, inadvertent; however, these individuals were instrumental in how we, as a culture, view addiction. Although Rush had tried to dispel the commonly held belief that alcoholics simply lacked willpower, he had not been able to sway public opinion. Daniels, Taylor, and Edwards, on the other hand, were more successful in persuading the public (by citing the failures of temperance societies that advocated moderation) that alcoholics could not “will” themselves to only drink moderately and, therefore, “will” themselves out of addiction (Crowley & White, 2004).
The conviction that alcoholics and addicts should struggle through addiction on their own and hope to cure themselves was on its way out. Ultimately, this would lead to the founding of self-help groups like the Washingtonians (a precursor of AA), treatment centers, and inebriate homes and asylums (early hospital-like settings for addicts). The stage for modern-day treatment of addiction was set, though it would take many years before evolving into what it is today (Crowley & White, 2004).
Psychological Perspectives on Addiction and Addiction Treatment
Although psychology did not originate as an addiction treatment method, some psychologists of the early 20th century would come to see psychology’s relevance in regards to addiction and addiction treatment. The role that psychology has come to play in addiction and its treatment grew out of the rise of applied psychology. The rise of applied psychology was the result of psychologists who sought take psychology beyond academia, and apply psychological principles to problems encountered by everyday people, business, governments, etc (Watson & Evans, 1991).
The treatment of mental disorders by clinical psychologists was one aspect of applied psychology. Psychoanalysis, a form of clinical psychology, also dealt with the treatment of mental disorders (Watson & Evans, 1991). Substance abuse and addiction have long been regarded as types of mental disorders. Indeed, the DSM-IV-TR currently regards substance abuse and addiction as types of mental disorders (American Psychiatric Association, 2000). To be sure, there is strong correlation between mental illness and addiction, with most addicts having a mental disorder (other than addiction) (Evans & Sullivan, 2001).
Psychoanalysis and Addiction Treatment
Throughout most of the 20th Century, psychoanalysis proved to be influential in the addiction treatment field (White, 1998). Psychoanalysis was introduced to the United States in the early 1900’s. Its ideas were infused into the American cultural consciousness, thanks in part to Sigmund Freud’s lectures at Clark University in 1909 (Watson & Evans, 1991).
Though a complete description of Psychoanalysis is beyond the parameters of this paper, a brief description is necessary. Psychoanalysis dealt with the unconscious, hidden motives or drives, and how they pertained to mental disorders. In addition, psychoanalysis placed a great deal of importance on sexual factors, psychosexual stages, and how they relate to mental disorders. For example, an individual who had difficulties passing through a psychosexual stage may experience problems—if not a mental disorder—later in life (Corey, 2005).
Karl Abraham was the first person to address chronic drunkenness from a psychoanalytic perspective. He did so in the form of a 1908 essay, in which he stated that alcoholism was the result of an unresolved oral dependency (White, 1998). Psychoanalysis asserts that oral dependency often results from a failure to adequately pass through the oral stage of psychosexual development (Corey, 2005). Abraham went on to state that alcoholics used alcohol as a replacement of women as a sexual object, and that drinking was the alcoholic’s sexual activity (White, 1998).
Freud and his followers believed that addiction was a symptom of an underlying problem with the addict’s personality. That is, it was the not the main problem. They believe that personality problems in addicts steamed from distorted psychosexual development—most notably, a distorted oral stage of development (Musto, 2002). Many Neo-Freudians purported that addicts had a propensity towards homosexuality, and that alcoholics drank as a means of coping with their impending infertility (White, 1998).
There were many other psychoanalytic theories of addiction. William Stekel believed that drug use was a way of coping with paraphilias, such as pedophilia and necrophilia. Ernst Simmel stated that it was an effort to cope with castration anxiety, while Sandor Rado claimed that drug use was the addicts longing for magic (White, 1998). “Karl Menninger viewed alcoholism as a vehicle of self-cure, as a strategy of infantile revenge, and as a medium of self-destruction (chronic suicide)” (White, 1998). On the other hand, Alfred Adler, an early follower of Freud who later broke away, believed that addiction came as a consequence of the addict’s intense feelings of inferiority, and that drug use was a way of coping with such feelings (White, 1998).
Although psychoanalysis has fallen out of favor as a whole, it has made a lasting impact of the field of addiction treatment. The psychoanalytic notion that drug abuse and addiction could result from some underlying mental and/or personality dysfunction continues to garner attention among addiction treatment professionals. In other words, it often assumed that addicts were experiencing problems in their lives before their addiction. Many hold the belief that many addicts use drugs as a way of self-medicating their depression, anxiety, or neuroses (Evans & Sullivan, 2001). Indeed, psychoanalysis was a key aspect of the development of addiction treatment in America.
Drugs have been a part of the human experience for thousands of years. For nearly as long as there have been drugs, certain individuals have recognized their dangers. Although there were those long ago who were aware of the problems associated with drug use, formal treatment of drug abuse and addiction would begin until much later. Benjamin Rush is, perhaps, the most influential figure in the development addiction treatment. Furthermore, psychological perspectives—most notably psychoanalysis—have greatly contributed to our understanding of addiction.
Humans will surely continue to use and abuse drugs. In recent years, drug use and addiction have been on the rise in the United States (Evans & Sullivan, 2001). Understanding the phenomenon of addiction is now more important than ever. Indeed, tremendous gains in addiction treatment have been made in recent years. However, the recent gains of contemporary researchers would not have been possible without the foundation laid down by those early researchers who investigated that all-too-human struggle, addiction.
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