Historical Perspectives of Addiction


The research and writing of this article were partially supported by a grant from the National Institutes of Health, National Institute on Drug Abuse, entitled “Current Smokers: A Phenomenological Inquiry” (R01 DA015707–01A2) and a grant from the Engelhard Foundation, “Sophomore Year at Emory Living and Learning Experience: An Interdisciplinary Seminar Course/Internship in Addiction and Depression.” Some of the material in this chapter appeared previously in Howard I. Kushner, “Taking Biology Seriously: The Next Task for Historians of Addiction?” Bulletin of the History of Medicine 80 (Spring 2006): 115–143. I thank Carol R. Kushner and Robert Cormier for editorial assistance.

Histories of Addiction

In the past quarter century, historians of addiction have focused on contextualizing the political, social, and cultural meanings of addiction. Building on Harry Gene Levine’s classic 1978 article, “The Discovery of Addiction,” historians have suggested that the classification of certain substances as illicit or licit tells us more about social norms and power relationships than about the psychopharmacological properties of the substances themselves. Historians have contextualized the definitions of addiction, alerting us to the extent to which alcohol prohibition and the criminalization of narcotics and stimulants reflected dominant cultural values rather than robust scientific findings. These studies pose an intellectual challenge to the treatment and control of addiction. So far, however, they have made a less significant impact on addiction policy and treatment. In a recent article, I argued that historians of addiction should take biology seriously. Here I hope to persuade addiction scientists and practitioners of the value of these recent histories for their research and practice.

Doing so requires an appreciation of historical methods. Academic historians are not simply engaged in telling a chronological story; nor, since the late 19th century have they assumed that they can uncover “facts” that recreate the past as it was. Rather, academic historians insist that historical sources do not speak for themselves, but are subjects of contested interpretations framed by current and past cultural and political contexts. From this perspective, there can never be one final “factual” reading of the past; today’s landmark interpretation is regularly subjected to tomorrow’s reinterpretation because, odd as it may sound to the nonacademic historian, the past is always subject to change as historians redefine the contexts in which events occur. The current scientific paradigm that addiction is a brain disease is placed in social and cultural contexts. The implicit message is that, whatever the biological substrates of addiction, by acknowledging social, cultural, and political forces, addiction scientists, policymakers, and practitioners can develop more effective policies and interventions.

Brain Disease Redux

Often, writes historian Nancy Campbell, what has been learned in addiction science has been ignored in succeeding paradigms. More than a half century ago, Campbell found that addiction researchers Maurice S. Seever and Abraham Wikler had independently concluded that addiction was a chronic relapsing/remitting condition, a view presented in 2000 by then National Institute on Drug Abuse (NIDA) director, Alan Leshner, as novel. Campbell also points to a rhetorical resilience of a traditional “moral lexicon” of addiction. Citing the work of current NIDA director, Nora Volkow, and her colleagues as exemplars, Campbell finds that their notion of “disrupted volition” parallels 19th century constructs of addiction “as a ‘disease of the will’ subject to voluntary control.” Thus, writes Campbell, with “amnesiac gesture toward its own repressed past, the addiction enterprise comes full circle into the present.”

As Campbell suggests, the claims that addiction is a brain disease would sound familiar to 19th century neurologists. In many respects, current views resemble degeneration theory as expounded by the French physician Théodule Ribot in his 1883 study Les Maladies de la Volonté (which was reissued in 32 subsequent editions in French and English). Degeneration theory offered a hereditarian explanation for a variety of disorders including retardation, depression, depravity, and sterility. Behaviors that today would include addictions such as alcoholism, diet, and sexual addictions were alleged to have a cumulative destructive impact on the nervous system that was inherited by succeeding generations. Practitioners took extensive family histories and prepared elaborate pedigrees that sought to explain a current disorder by uncovering patterns of disease and behavior in a patient’s family. Adherents sought to portray degeneration as organic, but much like addiction practices today, treatment revolved around an array of psychological and moral interventions under the rationale that alterations in habits had a direct physiological influence on the nervous system.

Degeneration theory meshed with the views of the influential neurologist James Hughlings Jackson, whose “dissolution theory” was based on his claim that lesions in the neocortex reversed the evolutionary process in which the “higher” cortical structures restrained the “lower” emotive, limbic functions. Jackson’s hydraulic theory reinforced the assumptions that addictions reflected a hijacking by these more primitive structures, often referred to as the “reptilian brain.” Thus addiction was a brain disease because the behaviors were enabled by damage to cortical censors. Because these behaviors appeared to run in families, it was a small step to connect Jackson’s dissolution with degeneration.

Both degeneration and dissolution were translated into early 20th century popular scientific explanations of the physical effects of alcohol and other drugs. For instance, historian Susan Speaker writes of Richmond P. Hobson, a retired naval officer and three-term congressman from Alabama, who published Alcohol and the Human Race in 1919 and portrayed it as based on the best “evolutionary science” of the time. Hobson, who founded the American Alcohol Education Association in 1921, wrote that alcohol was a toxin that paralyzed white blood cells, making them unable to “catch the disease germ” that was “devouring” the drinker. This led to the destruction of the “centers of the brain upon whose activities rest the moral sense,” resulting in what Hobson labeled “retrograde evolution.” For Hobson, “alcoholic beverages, even in moderation reverse the process of nature.” Ninety-five percent of “all the acts of crime and violence committed in civilized communities,” Hobson claimed, “are the direct result of men being put down by alcohol to the plane of savagery.”

Hobson’s “science” both influenced and was influenced by early 20th century prohibitionist sentiments. With the end of Prohibition, a new science of alcoholism emerged. Americans, according to Speaker, ceased “demonizing alcohol after Prohibition, and chose to deal with its risks largely through regulation, education, and harm-reduction strategies.” However, she writes, “they have resisted” treating users of most other psychoactive drugs in a similar manner. What emerged were distinct attitudes, policies, and sciences that separated alcohol from other addictive substances. However, Speaker implies, these distinctions were based less on objective evidence than on the cultural, social, and economic attitudes toward alcohol and other mind-altering substances. I begin with historians’ interpretations of the science of alcohol addiction and then move on to other substances.

Alcohol and Other Drugs

The federal government has created two separate divisions for addiction research: (1) the National Institute on Alcohol Abuse and Alcoholism, which has focused exclusively on alcohol, and (2) the National Institute on Drug Abuse, which has studied the use of all other addictive substances. Despite this official separation of alcohol from other drugs, in a recent collection, Altering American Consciousness: The History of Alcohol and Drug Use in the United States, 1800–2000 , historians Sarah W. Tracy and Caroline Jean Acker argue that bringing alcohol and other addictive substances together is justified: “Despite the chasm created by law, which separates them into legal and illegal categories, all psychoactive drugs share important commonalities.” “America’s drug habits cannot be understood, nor effective drug policy made,” they insist, “until we have a clearer picture of the range of drugs used yesterday and today, and the ways in which specific historical circumstances have shaped their use and regulation.”

The theme that runs through Altering American Consciousness is best summed up by the historian Alan Brandt, who writes that although the addictive nature of nicotine may today be seen as an undisputed fact of its chemical properties, nicotine’s classification as an addictive substance is rooted more in the history of attitudes toward smoking than in its neurochemical mechanisms. Brandt believes that the history of nicotine provides a window to understanding the meaning of addiction. He rejects what he calls “universal, transhistorical approaches to the mechanisms of addiction” in favor of “specific historical contexts” that illuminate “the social processes by which addictions are created and experienced, categorized, and treated.”

The history of nicotine provides a context for the increased labeling of a variety of substance uses and behaviors—from carbohydrates and coffee to shopping and sex—as addictions. Perhaps this has occurred because, as William L. White points out, there continues to be no consensus on the language and meaning of addiction itself. “The rhetoric of addiction,” White believes, “grew out of the multiple utilities” of the constituencies it served. Deconstructing the various definitions of inebriety, intemperance, drunkenness, and alcoholism, White argues that the contested rhetoric of addiction served as “a means of staking out professional territory.” At stake was which institutions and professions could claim “legitimate ownership of the problem.”

Taking White’s view further, anthropologist Helen Keane’s What’s Wrong With Addiction? focuses on how addiction rhetoric is constituted in current discourses. Like Brandt, Keane eschews a universalist view, arguing instead that what has become characterized as addiction “is tied to modernity, medical rationality and a particular notion of the unique and autonomous individual.” Although addiction has been portrayed as restricting freedom and individual autonomy, Keane argues that discourses of addiction have tended to limit freedom, as they have authorized the prohibitive power of the family, the state, and the corporation.

Keane’s and White’s claims are best examined in historical context. We begin with histories of alcohol use and then move on to other substances.

Alcohol: Predisposed or Culturally Determined

The histories of alcohol addiction have much in common with those of other drug addictions, but unlike illicit and (still) legal drugs such as nicotine, alcohol putatively poses a danger only to predisposed alcoholics. The prevailing view in America is that moderate consumption of alcohol by those without a predisposition is safe and not addictive. In contrast, the dominant media and scientific view today holds that, although some people are more prone to addictive behaviors than others, no predisposition is necessary for addiction to illicit substances and nicotine; any exposure potentially places any user at risk.

Connected to the risk dichotomy is the widely accepted belief that alcoholism is a disease. Although a number of historians have pointed to a long genealogy supporting the notion that excessive and seemingly uncontrollable drinking was driven by forces beyond an individual’s power, most agree with Griffith Edwards, former chairman of the UK’s National Addiction Centre, that the modern concept defining alcoholism as a disease comes from the work of the director of the Yale Center for Alcohol Studies, Elvin M. Jellinek, in the 1940s. Not all experts have been persuaded by the disease paradigm. Two types of challenges emerged: the first questioned the almost universal belief that alcoholics must abstain from drinking for their entire lives, and the second was aimed at the validity of the disease construct.

In 1962, the renowned British psychiatrist D.L. Davies published a report of seven alcohol-dependent individuals who returned to normal drinking without reverting to alcoholism. Edwards, who trained under Davies, followed these alcoholics and concluded that Davies’ optimism was not sustained by their long-term behaviors. In the 1970s, California psychologists Mark and Linda Sobell claimed that behavior modification could enable recovered alcoholics to return to what they called “controlled drinking.” The Sobells’ research was the subject of a damning analysis published in the journal Science in 1982, which concluded that “a review of the evidence, including official records and new interviews, reveals that most of the subjects in the controlled drinking experiment failed from the outset to drink safely. The majority were hospitalized for alcoholism treatment within a year after discharge from the research project.” In fact, a 10-year follow-up revealed that only one of the original 20 subjects could be classified as having met the criteria of controlled drinking; four had died of alcohol-related causes.

When a number of studies attacking the construct of alcoholism as a disease appeared in the late 1980s and 1990s, the response of the alcohol research community was hostile. These critiques, including highly publicized ones written by Herbert Fingarette and Stanton Peele, have been the focus of sustained attacks from a wide range of alcohol researchers, and the authors have been marginalized and often stigmatized.

Although historians generally do not confront the controversy over controlled drinking, recent addiction histories can be read as providing support for the minority view, questioning the robustness of the claims that alcohol addiction is a disease. Building on the writings of Levine, they have concluded that the separation and classification of alcohol addiction as substantially different from other drug addictions is a cultural construct.

Earlier histories of alcohol use have detailed the battles between pro- and antiprohibitionists, but sociologist Ron Roizen believes that this focus has obscured the more important story of the depoliticization of alcohol. The construct of alcoholism as a disease, according to Roizen, meshed with the values of both the “spiritual orientation” of Alcoholics Anonymous and the “disinterestedness, objectivity, and empiricism” of contemporary science. Ironically, the notion that alcoholism was a disease “also offered destigmatization to the alcoholic and a measure of new symbolic legitimacy for [the] beverage alcohol itself.” From the disease perspective, alcohol “harbored little more responsibility for alcoholism or alcohol related troubles than did sugar for the disease of diabetes.” The dominant belief remains that moderate drinking is safe for all but the potential and actual alcoholic. For Roizen, “the story of modern alcoholism” reveals “its strongly social-constructionist character and flimsy science base” and “invites our attention to the relationship between alcohol science and the wider society.” Roizen also has been particularly vocal in his opposition to what he sees as a new public health campaign to demonize alcohol.

One of the linchpins for the notion of alcoholism as a disease is the widespread popular belief that Native Americans are genetically vulnerable to alcoholism. This view has been challenged by a number of recent studies. In 2000, in the American Journal of Public Health , John W. Frank and his colleagues emphasize that beyond obvious “risk factors in contemporary life,” there is the need to consider the historical sources of Native American drinking problems. “In contrast to other explanatory factors,” they write, “the role of history seems to have been underemphasized in the voluminous literature attempting to explain the problem of drinking among Native Americans.” For instance, one must acknowledge “the extraordinary barrage of inducements to drink heavily in the early years after European contact. The harmful drinking patterns established during those years have largely persisted.” Thus they conclude that “the cultural dimensions of Native American drinking must be considered far more important than the notion that Native Americans’ propensity for heavy and dependant drinking is primarily genetic.”

Although the historian Peter C. Mancall does not cite Frank et al., he endorses their findings. Mancall agrees that some individuals “seem to possess an inherited predisposition toward alcohol abuse,” but he insists that “there is no convincing evidence suggesting that Indians as a group are more inclined to possess these traits than the general American population.” Historical research, according to Mancall, reveals that “there has been no single Native American response to liquor. Consumption patterns have differed over time by region and even in specific communities.” They also have varied by age and gender. “Patterns of alcohol-related illness, disease … and trauma are not uniform within the Native American population today, and were not in past centuries either.” Europeans, Mancall reminds us, who had been exposed to alcohol for centuries, “had developed rules for its consumption.” Nevertheless, they too experienced “periods of wide-spread alcohol-related problems,” including the so-called gin craze in the mid-18th century, which “occurred in part because of wider availability of more potent alcohol during the early phases of the industrial revolution when the English and other Europeans drank more alcohol” in an attempt to “escape from the disorienting social changes of their everyday lives.” For Mancall then, like Frank et al., “history, not biology, holds the key to understanding Native American drinking patterns, just as history, not biology holds the key to understanding alcohol consumption in other American populations.”

Mancall’s thesis is built on a number of studies, including the 1969 cultural anthropology classic, Drunken Comportment: A Social Explanation , by Craig MacAndrew and Robert B. Edgerton, which explored variations in behaviors observed in different populations when they are drunk. In relatively simple societies, people learn how they are supposed to behave when intoxicated; in more complex societies, the cultural expectations may vary, but the same principle holds. Edwards supports MacAndrew and Edgerton’s anthropology. Acknowledging that “alcohol is a drug which has the inherent capacity to interfere with brain function and produce a state of intoxication,” Edwards, nevertheless, argues that “intoxication is not, however, a fixed and monolithic state.” Rather, based on narratives of South African and Bolivian drinking behaviors, Edwards explains behavioral reactions to alcohol intoxication as “plastic.” By this he means that “drunkenness behavior can be molded by influences which include the immediate context, the way people react to drunkenness, the drinker’s personality, and the expectations given by culture and society.” From this perspective, “drunkenness is more like clay than concrete.”

The history of attempts to treat drunkenness suggests that clay was often mistaken for concrete. This response can be seen in historian Katherine A. Chavigny’s discussion of 19th century drinking reform. She focuses on the emergence—from the antebellum period to the 1880s—of a consensus among a group of individuals whom she labels as “inebriety physicians” that drunkards were suffering from an inherited disease. If the cause of drunkenness was a degenerative inheritance, “those persons who had inherited a constitutional weakness for alcohol had little chance of becoming sober without long-term quarantine from temptation.” These physicians urged the construction and maintenance of facilities to house and treat the afflicted, many of whom were poor, homeless, and criminal. Legislatures were not persuaded, and other more traditional reformers rejected “hereditarian interpretations of inebriety,” because they “believed that such views discouraged drunkards from trying to reform and provided them with a ready excuse for backsliding.” Nevertheless, the failure of inebriety physicians to persuade legislatures and other reformers that drunkenness was a disease was a temporary setback.

In contrast, historian Sarah Tracy’s “Building a Boozatorium,” examines a successful attempt to medicalize habitual drunkenness in turn-of-the-century Iowa. Similar to the physicians discussed by Chavigny, Tracy’s reformers relied on degeneration theory and its eugenic offspring. Unlike the experts in Chavigny’s narrative, this cohort of clinicians, clergy, and social reformers persuaded the Iowa legislature to designate a facility for confinement and treatment of the disease of intemperance. Tracy connects this success to its context in wider Progressive social reform. “As much as any reform passed in turn-of-the-century Iowa,” writes Tracy, “the creation of inebriate hospitals embodied a diversity of elements that characterized Progressivism in America: the search for order.” These include “the rise of ‘issue-focused coalitions,’ the secular institution of Protestant moral values; the growth of an increasingly regulatory state with a well-articulated, efficiently organized, social reform mission; the maturation of the professions; and the expansion of scientific and medical authority.”

While Chavigny uncovers the roots of the contemporary triumph of the medicalization of alcoholism in the ideology of earlier reformers, Tracy finds a disconnect. A number of factors, writes Tracy, “worked against the wholesale adoption of the medical perspective” on alcohol abuse. Foremost was the failure of these institutions to demonstrate a robust cure rate. Moreover, these institutions “addressed a small percentage of the alcoholic population,” and, as a result, medical care never was able to supplant the criminal justice system. “Prohibition and World War I cut short the medical efforts of physicians, drying up much of the political concern for the drunks.” Thus, “Iowa’s efforts to medicalize habitual drunkenness were unsuccessful for as wide a range of reasons as they were initiated.”

Tracy’s 2005 volume, Alcoholism in America: From Reconstruction to Prohibition , finds no medical consensus that alcoholism was a disease. However, like Chavigny, Tracy uncovers a persistent attempt by practitioners and social reformers to attach drunkenness to forces beyond individual choice. Thus, reformers located the etiology of alcoholism in social forces, biological destiny, or some combination. Therefore, the current dominant discourse, in which alcoholism is considered a disease, has deep, if contested, historical roots.

Although, today, alcoholism is widely assumed to be organic, mid-20th century psychiatry focused on psychogenic etiologies, often tied to gender role confusion. Alcoholic males, writes Michelle McClellan, were characterized as effeminate with homosexual tendencies manifested by employment difficulties. In contrast, psychiatrists portrayed female alcoholics as displaying “masculine traits such as aggressiveness,” and they “were often promiscuous or frigid” women and inadequate mothers. Given the psychoanalytic paradigm that underpinned these views, gender identity and behavior issues were tied to childhood conflicts resulting from poor parenting. “Experts,” according to McClellan, found that “many alcoholic women had displayed masculine and therefore deviant behavior as children—some had acted like tomboys, for example, while others exhibited unfeminine temper tantrums.” When later life stressors and emotional difficulties arose, particularly those tied to sexual and reproductive issues, these vulnerable women turned to alcohol.

Gendered assumptions, according to historian Lori E. Rotskoff, also informed psychiatric views about the role that sober wives played in their husbands’ alcoholism. Underlying many of these observations was the tension of postwar readjustment of gender role expectations, with returning males displacing working women. The task, seen by many psychiatrists and social workers in the 1940s and 1950s, was to reestablish traditional gender roles within the American family. A number of psychiatrists suggested that “wives had a vested interest in maintaining their husbands’ incompetence.” Some practitioners suggested that a husband’s alcohol abuse was triggered by his wife’s neuroses, manifested in dominating their emasculated husbands. Others saw the domination as resulting from the stress of their husband’s addiction. Nevertheless, both of these perspectives suggested that alcoholism was a “family illness” and that “the whole family would need to convalesce.” Thus, by the 1950s, psychiatrists and social workers advocated group therapy for alcoholics’ wives. “Given the nation’s deep psychological investment in marriage,” Rotskoff concludes, “it is apt that alcoholism’s deleterious effects would increasingly be measured in marital terms. In large part, the cultural construct of the ‘recovering’ alcoholic marriage—comprised of sober husbands and supportive wives—gained public acceptance because it reflected and reshaped familial values in American society at large.”

What these historians have shown is that the theories that informed these arguments, interventions, and policies—degeneration, psychoanalysis, and eugenics—reflected dominant social values in the guise of science. One might argue that current scientific claims about alcoholism as a disease rely on a completely different science, informed by neurobiology, biochemistry, and genetics. However, having shown the culture-bound nature of earlier scientific theories supporting the idea that drunkenness is a disease, historians are skeptical of current scientific assertions that alcoholism is a disease.

Opiates and Other Illicit Drugs

The same science and psychiatry that have consistently viewed host predisposition as the trigger for alcohol addiction have, just as consistently, viewed opiates as posing an addictive risk for all who use them. According to Edwards, this is because alcohol intoxication “is remarkably susceptible to cultural prescriptions and proscriptions” and alcohol is “a widely accepted recreational drug,” whereas, “in contrast, intoxication with crack cocaine, or injected amphetamines, or with a heavy dose of lysergic acid diethylamide (known more commonly as LSD), is not so easily shaped, and these are not drugs which society is ever likely to accord a licit recreational status.”

Alcohol prohibition was attempted, and, despite some revisionist arguments that it reduced drunkenness and alcohol addiction substantially, Prohibition was a social and political failure. The contrast between the rejection of alcohol prohibition and the expansion of opiate prohibition is underscored by the triumph of the belief that alcohol use had a wide range of possible individual effects, from benign to deadly. Where these effects fell on the spectrum was a consequence of host differences and excessive drinking. The refusal to accept a similar range of possibilities for opiates and other mind-altering substances, including marijuana, stimulants, and amphetamines, framed both the official response and individual behavior of users. Nevertheless, there remains a deeply held belief that there is such a thing as an addictive personality that leads one to drugs. This concept, as we will see, has deep historical roots, often attached to an array of negative character traits. In contrast to the alcoholic, predisposition toward narcotic use became evidence that drug addicts were sociopaths. As a result, prohibition of drugs and punishment for dependence were framed by a combination of claims about the nature of the substances and that of the addicts.

In Creating the American Junkie (2002) and her subsequent publications, Caroline Acker traces this history of opiate prohibition through an examination of the experience of users as they negotiated a world in which opiate use increasingly became criminalized. Acker’s work reinforces David Courtwright’s study, Dark Paradise (2001), which, using similar narratives, demonstrates that “what we think about addiction very much depends on who is addicted.” In the early 20th century, addicts could seek medical treatment that included prescriptions of maintenance doses. Beginning with the Harrison Narcotics Act in 1914, however, nonmedical use or purchase of cocaine and opiates was restricted and all narcotics sold or prescribed were required to be registered. As a result, physicians were no longer able to treat addicts through maintenance, and ceased treating them altogether. This shift, writes Acker, transformed the context of opiate use and “as the context for the use of opiates changed, so did the meanings for those who used them.” Thus, “addicts developed their own strategies for maintaining their addiction,” which resulted in “a new form of addict identity as the behaviors to maintain addiction were criminalized.”

Courtwright has a slightly different take. With the decline of medical (iatrogenic) addiction in the late 19th century, “opiate addiction … began to assume a new form: it ceased to be concentrated in upper-class and middle-class white females and began to appear more frequently in lower-class urban males, often neophyte members of the underworld. By 1914 the trend was unmistakable.” For Courtwright, “the trend toward criminalization … was well underway before the basic narcotic statutes were enacted.”

Part of that identity, according to historian Timothy Hickman, was the emergence of “a double meaning of addiction,” in which some of the addiction was attributed to disease and some to hedonism and antisocial behavior. “The addiction concept of habitual narcotic use was embedded in the early 20th century paradigm of professionalizing medical authority” because it placed juridical addicts under medical authority and criminal addicts under criminal jurisdiction. Antinarcotic legislation, argues Hickman, reflected this dichotomy, and, by the early 1920s, “volitional addicts came to be defined as criminals ” while “juridical addicts … were defined as innocent patients ” because of their willingness to seek medical treatment. Hickman does not distinguish between alcohol and narcotic use, but his evidence and the wider historical record indicate that the division between those who were considered diseased and those who were classified as criminal mirrored the division between alcoholics and drug addicts.

Although Hickman does not make the connection, his essay provides a context for the emergence of the psychoanalytic construct of the “addicted personality,” which first appeared in Lawrence Kolb’s 1925 article, “Types and Characteristics of Drug Addicts,” and in his subsequent works. Despite Kolb’s insistence that addiction was a medical issue, federal officials adopted Kolb’s construct as evidence of the general character defects of addicts and as justification to extend the criminalization of drug use.

Speaker explains such results as almost inevitable given the rhetoric that informed drug addiction from the 1920s to the 1940s. Acknowledging that “drug abuse is a significant and difficult public health problem,” Speaker, nevertheless, points to accumulated evidence that suggests “that at least some persons can use drugs moderately without becoming abusers, that even heavy abuse may not be a lifelong pattern, and that many ‘outbreaks’ of drug abuse are self-limiting and fairly short-lived.” Illicit drugs and nicotine were demonized with similar, if not the same, adjectives and hyperbole that once framed alcohol prohibition campaigns: “The drugs in question are powerful, seductive, and rapidly addictive; that everyone is at risk for addiction; that drugs by themselves are sufficient to cause any imaginable deviant behavior and are directly responsible for most crime and violence.” Although, as Speaker asserts, with the end of Prohibition alcohol consumption was destigmatized, the use of other psychoactive drugs has not been. Indeed, made illicit, their use is not only illegal, but also considered immoral.

As medical treatment for alcohol addiction became the norm in the mid-20th century, maintenance clinics for the treatment of narcotics addiction became illegal. From 1923 to the opening of the first methadone treatment center in 1965 in New York City, writes Jim Baumohl, “addicts were demonized, hounded, subjected to draconian criminal penalties, and never treated except in the confines of a hospital or jail.” Aside from a very few wealthy private clients, “abstinence was the only legitimate goal of treatment.” By the 1930s, even the supporters of maintenance programs “believed most addicts to be incurable.”

It was in this context that in 1935 the U.S. Public Health Service established the Center for Drug Addiction at the federal prison hospital in Lexington, Kentucky. Informally labeled as “Narco,” the facility, which continued its addiction research until 1979, was designed to be a treatment hospital for incarcerated addicts. In 1948, the research unit became the first basic research laboratory of the newly formed National Institute of Mental Health, the Addiction Research Center. Inmates became voluntary participants in Addiction Research Center experiments that tested reactions to a wide variety of substances including alcohol, barbiturates, heroin, methadone, major and minor tranquilizers, and psychedelics. Campbell’s Discovering Addiction examines the Center for Drug Addiction and Addiction Research Center in detail. She found that inmates often were readdicted and some of the information obtained “was used by pharmaceutical companies seeking to bring drugs to market.” Nevertheless, Campbell concludes that “the research program yielded broadly distributed benefits to persons from the addicted class.”

The Center for Drug Addiction’s benign approach to addicts was an exception, but the venue for its research, a federal prison, reflected the policies of Henry Anslinger, the influential director of the Federal Bureau of Narcotics (1930–1962). With bipartisan support, Anslinger advocated incarceration as the only deterrent. It did not matter to Anslinger, writes Baumohl, whether addicts were confined to a jail or a hospital, but “the more like a jail, the better he liked the hospital.”

Anslinger’s role in shaping and extending the criminalization of drug use policy, writes Rebecca Carroll, cannot be overestimated. Anslinger “influenced Americans’ attitudes toward narcotic drugs and drug users and sellers, depicting both users and sellers as criminals.” This is evident in Anslinger’s 1937 Congressional testimony in which he claimed that marijuana “is dangerous to the mind and body, and particularly dangerous to the criminal type, because it releases all of the inhibitions.” It causes some individuals to “have an increased feeling of physical strength and power,” which is dangerous because they “fly into a delirious rage, and they are temporarily irresponsible and may commit violent crimes.”

Although a number of influential experts, including leaders of the American Medical Association and the American Bar Association, argued for the medicalization and clinical treatment of addicts, Anslinger stifled their voices. In 1944, at the urging of New York City Mayor Fiorella La Guardia, the New York Academy of Medicine conducted a study on the effects of marijuana, the findings of which contradicted Anslinger’s claims. The commission found that cannabis did not cause violence and, despite Anslinger’s insistence otherwise, concluded that marijuana could be medically beneficial. Anslinger denounced the report and instructed the Bureau of Narcotics agents to investigate the commission members’ own drug use. Furthermore, he threatened prison sentences for anyone carrying out independent research on cannabis.

In the postwar era, Anslinger altered his views of marijuana’s effect on its users but not his policy toward its use. Testifying in Congress in 1948, Anslinger claimed that cannabis caused the user to become peaceful and pacifistic; thus, the Communists were recruiting Americans into cannabis use as part of a plot to weaken their will to fight.

Like Anslinger, those who continue criminalizing marijuana use in the United States today claim to base their views on scientific research, but, also like Anslinger, their antipathy toward marijuana use reflects deeper cultural values rather than robust science. A similar claim can probably be made about those who support unrestricted availability of marijuana. The point here, as much of recent addiction history reveals, is that the classification of substances as licit or illicit has less to do with science than with politics.

This political influence can be seen in attempts to control demand. Historian William B. McAllister’s examination of international drug control shows that increasing regulation and criminalization of drugs has ended up pretty much as it began, with incarceration of drug users and a failure to stem the activities of suppliers. What has changed, according to McAllister, is the “nature and scope” of antidrug efforts. “Governments and international agencies constructed massive bureaucracies, engaged in considerable legislative activity, and attempted to implement policies intended to change the behaviors of millions of individuals, with varying degrees of success.” Although McAllister finds that “since the late nineteenth century, the American drug experience has largely mirrored that of other Western industrialized nations,” he notes that the United States “has acted as the center of demand” for all types of drugs and has been the greatest force of “regulatory activism.” As a result, McAllister concludes, “policy-makers, legislators, and citizens of the United States, much like addicts, cannot escape their relationship to the global drug scene.” If, as a number of historians have indicated, the century-long activism failed to stem the drug addiction that it was aimed at curing. the rhetoric surrounding drug use, combined with the increasing classification of substances as addictive, has exacerbated the problem.

In a recent book, Richard Davenport-Hines argues that the criminalization and prohibition of drugs have resulted in an epidemic of use and an exacerbation of fatal encounters. The almost paranoid response of puritanical American policymakers has, according to Davenport-Hines, led to a black market and growth in all types of criminal activity. David Courtwright finds this argument unpersuasive: “What is unique about [Davenport-Hines’] The Pursuit of Oblivion is that it combines the simplification inherent to world history with the simplification peculiar to polemical exertion. The result is a book that, for all its length and erudition, is almost startlingly reductive: the story of a bad idea imposed upon a doubtful world by aggressive fools.”

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Jan 19, 2020 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Historical Perspectives of Addiction

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