History of AddictionAlixandra Kaiser“A nation corrupted by alcohol can never be free”-Rush

Benjamin Rush• Benjamin Rush (1746-1813)• Educated at Princeton, London and Paris• Often called the “father of American psychiatry” • First American authority on alcohol and alcoholism.• Father was an alcoholic, parents divorced=interest in alcohol

and alcohol related problems. • Rush noticed s problem with drunkenness among soldiers in

the continental army. • 1777-issued strong condemnation on use of distilled spirits• 1784- An Enquiry into the Effects of Spirituous Liquors Upon

Human Body, and Their Influence Upon the Happiness of Society.

Rush and Treatment• Believed that health and disease were determined by the

balance of the four humors- blood, phlegm, black bile, yellow bile

• Rush would attempt to re-establish balance by inducing perspiration and vomiting, inducing fright, and bleeding the patient

• Poisoned his patients with mercury-laden calomel• Dehydrated patients by excessive purging• Risked lives by bleeding• Inflicted painful blisters• Decrease of his use of medical treatment due to refusal of

benign medical treatment

Pathway to Alcoholism Recovery• Rush laid out several

remedies• Christian conversion• Acute guilt or shame• Linking of drink with painful

impression• Vegetarianism• Cold baths• Acute disease• Blistering at ankles• Witnessing the death of a

drunkard• Swearing on oath of

abstinence • Use of Pavlovian Psychology

• Saw the failures of hospitals and jails

• Called for the creation of a “Sober House”

• Only thing he didn’t anticipate was the increase consumption (highest use in history) of alcohol for the next 40 years

Before Asylums: Mid 19th Century

• Addicts and alcoholics were placed it the almshouse, the charitable lodging home, the jail, the workhouse, and lunatic asylum

• None of these were equipped to treat addictions• Fail of temperance-prevent the creation of new drunkards and

let the old drunkards die off• Failure rose the need for specialized institutions to reach

alcoholics on a medical and moral basis

Second half of 19th Century• Rapid growth in number of

institutions• 1878 only 32 institutions• 1902 more than 100 facilities in the

U.S. specializing in treatment of alcoholism and other addictions

• This included New York State Inebriate Asylum, Pennsylvania Sanitarium for Inebriates, Washington Homes in Boston and Chicago, Kings County inebriates’ Home, and Walnut Lodge.

• Most institutions fell under two categories: inebriate homes and inebriate asylums. • Inebriety: captured the cravings of

addicts and the social consequences the coincide with it.

Treatment Methods • Inebriety Specialist believed in continuum of care• Most important technologies within these homes and asylums

was enhancing treatment retention: this became difficult when patients didn’t want to stay around

• Isolation: patients were isolated to rid them of stress and temptations of normal life. First step.

• Detoxification: methods used were “cold turkey”, soap-suds, enemas and other purgatives.

• Physical restoration: Turkish baths, massages, phototherapy (exposure to sunlight), electrotherapy, nourishing meals, vitamin supplements, and lots of fresh air.

Treatment Methods Cont.• Religious/ Spiritual Influences: use of chaplains, daily religious

services, bible readings and prayers. • Social Support: encouragement from other people in a similar

circumstance. Also clubs were created to increase support.• Work and Recreation: manual labor and recreational activities

such as croquet and games. Goal to create an environment both socially and intellectually stimulating.

• Music: therapeutic value, pianos, violins and harps. They would also partake in self-reflection- self inventory

• Moral Suasion: exposure to motivational talks, inspirational literature and information on addiction.

• Counseling was rarely provided

Treatment Methods Cont.• Induced Inversion: Benjamin? Aversion to alcohol by classical

conditioning or post hypnotic suggestion. Whiskey with everything example.

• Hydrotherapy• Electrotherapy

Fall of Inebriate Asylums • 1922 decline in institutions due to the decreased demand in

treatment. • Most institutions closed down out of 184 only 27 remained• Decrease number of patients• By mid-1920s, most inebriate homes, asylums, and private

sanitaria specializing in addiction were gone.

Eugenics!• Darwin and Galton (cousins) 1883: improve race through

manipulation of heredity. • Goal was to create a gifted race through marital partners

across successive generations.• “negative eugenics”: decrease or eliminate breeding of those

people deemed unfit (alcoholism, insanity, laziness, crime and poverty)

• Purification of the race would result in less need for state institutions and services.

• What was the most radical idea of eugenics?

“Surgical Solution”• Involuntary Sterilization of

particular groups of people. • Sterilization laws: 1922, fifteen

states passed sterilization laws and then two thirds of all states went on to pass some sort of sterilization law.

• Result? 60,000 Americans were subjected to involuntary sterilization

• Sterilization of alcoholics was “voluntary”• Case were alcoholic women in a

psychiatric facility in the 1940s and 50s could not be release until they submitted to “voluntary” sterilization.

Hydrotherapy• Hydrotherapy: Well ..hydro

=water, application of water as healing agent

• Brought to US from Europe by Dr. Simon Baruch.

• baths would reduce excitement, to reduce pain, to improve circulation, and induce sleep.

• Water was taken into and drawn out of the body through every possible orifice.

• During same period Benjamin Rush was cold showers in treatment.

Drug Therapies: “Equisine”• Certain antibodies were produced in response to alcohol• These antibodies could prove useful in treatment• Poor horses….• Gave horses high doses of alcohol until they became

dependent• Draw the blood from them and injected into non alcoholic

dependent horses, they would respond with revulsion for alcohol

• Method proved inconclusive in humans

No to Alcohol, Yes to Morphine!• Idea brought by Dr. J.R. Black• Replace alcohol with opium• Morphine is cheaper • Less socially and economically devastating to alcoholics family

and themselves• Morphine is less damaging to the body• Less hereditary degeneration compared to alcohol• The problem?• Dr. W.H. Bently advocated the use of cocaine for morphine

addiction in 1878

Convulsion Therapies• 1934 by Dr. J.L. Meduna• Seizures induced through

administration of drugs• Depression and agitation would

decrease following treatment• Ended due to the horrors

patients were experiencing before going into the seizure

• Electroconvulsive therapy “shock therapy”- electric current would pass through the brain

• Widely used in 1940s• Stories of institutional staff using

ECT if the alcoholics embarrassed or challenged them

Psychosurgery• 1902 Dr. H.A. Rodebaugh• Treat addictions through treatment of physical medical

conditions such as hemorrhoids and rectal fissures• When fixed, use of anesthetizing drugs would cease• 1935-Egas Moniz introduces lobotomy• 15th patient of Freeman and Watts• 1944-1960: 100,000 psychosurgery procedures were

performed on alcoholics and addicts.• Conclusion?• Psychosurgery in treatment of addiction provides evidence on

how great harm can be done in the name of good

Narcotic Farm: Lexington, Kentucky, 1935

“Drug Addicts Have a Future”• First united States Narcotic

Farm, also known as “Narco” by locals

• Dr. Lawrence Kolb, the institutes first director proclaimed “ new era”.

• Goals: discover a permanent goal for drug addiction. Social rehabilitation for addicts.

• Functioned not only as a humane hospital for drug addicts, but it is also a place where drug addicts can be incarcerated… Prison

• People sent to Narco often resisted treatment.

“Using” Addicts• They would experiment on addicts using morphine and even

LSD in hopes to discover a cure for addiction.• Even cocaine, alcohol, marijuana, tranquilizers, and heroin was

used. • Luckily nobody died during this process.• Inmates would get time off their sentence for volunteering.• Would have to go through 6 month rehabilitation and drug

independent before being released.• Later using patients for practice was banned.

Lexington Cure• Inmates would be immediately

detoxed upon entering the facility.• Include giving doses of morphine,

or methadone, and slowly take them off to avoid harsh withdrawal.

• “flow baths” were used to calm and soothe nerves of inmates going through withdrawal.

• Hygiene was important part of “the cure” keeping up with personal health.

• “Talking cure”: Psychotherapy was administered to either individual or groups at a time.

• Also yielded an insight to addiction

The Farm• Inmates would learn hard work• Rose before dawn to milk cows and harvest crops• Award-winning dairy• Farm also had pigs and horses• Work was used as therapy• Prison bars were cut down• Inmates vs. residents• Population vs. Therapeutic communities

Less Success• 93% who completed “the cure” went back to using drugs

immediately after being released. • Despite efforts they could just not make change to addicts. • One thing that came from Narco?• The changed view society had on drug dependency. • Just not be treated just like criminals, but get the help they

need. • Narco shut down in the 1970s

Bibliography • Campbell, Nancy D., JP Olsen, and Luke Walden. The Narcotic

Farm: The Rise and Fall of America's First Prison for Drug Addicts. New York: Abrams, 2008. Print.

• White, William L. Slaying the Dragon: The History of Addiction Treatment and Recovery in America. Bloomington, IL: Chestnut Health Systems/Lighthouse Institute, 1998. Print.