Timeline of changing attitudes toward addiction and treatment
One eminent thinker in his day, when comparing vice to drunkenness, said the former was a functional disorder, while the latter resulted from an organic disorder. The thinker was Aristotle, and the year was about 350 B.C. The debate on whether alcoholism and addiction are diseases or simply the products of the weak-willed has been raging since Aristotle instructed young Alexander in the art of rhetoric.
This article will examine the iterations of this debate throughout history. The reader will be spared elocutions from Erasmus, Calvin and the like, as this timeline begins at the turn of the 20th century. As this article will show, there has always been a voice – at times quiet, at times vociferous – arguing in favor of the disease concept of alcoholism and addiction. This article owes a debt of gratitude to the work of William White, Ernest Kurtz, Ph.D., and Caroline Acker, Ph.D., whose combined addiction disease chronologies provide a logical, cohesive structure to this debate.
1900 through 1919
With respect to opinions on alcoholism and addiction, the Progressive Era is anything but. At the end of the 19th century, a number of researchers, including T.D. Crothers and Sergei Korsakoff, argue that alcoholism is a disease and should be treated as such. But as America moves into the 20th century, genetics and eugenics are more in vogue.
Renewed interest in Gregor Mendel’s theory of genetics prompts a call for mandatory sterilization of addicts and alcoholics. Popular remedies of the day, such as Dr. Keeley’s Gold Cure, do nothing to advance the belief these individuals suffer from a disease. Even well-established scientists like Crothers are constrained by the zeitgeist of their era. In his book “Morphinism”, the good doctor argues that opiate addiction afflicts those who are active brain-workers: professionals, businessmen, educators, etc. Coincidentally, Crothers manages a sanitarium that caters to the well-to-do suffering from this affliction.
- Read more about the genetics of alcoholism in “Mental health challenges of children of alcoholics”
Eugene O’Neill and eugenics
“Long Day’s Journey Into Night” is Eugene O’Neill’s most autobiographical work. Taking place in Connecticut in 1912, the play tells the story of the Tyrone family. The patriarch is an alcoholic and the matriarch is addicted to morphine. It is fortunate that Mary, the mother, is past child-bearing age. From 1907 to 1913, a number of States pass mandatory sterilization laws that include addicts and alcoholics. The rationale is that these individuals will bear impaired children who will pose a burden to society. In an attempt to assert control over the use of opiates and stamp out quacks and con artists, the American Medication Association (AMA) publishes “Nostrums and Quackery” in 1911.
From 1912 through 1919, luminaries from opposite ends of the debate weigh in on the argument. In 1913, J.W. Cooper publishes “Pathological Inebriety: Its Cause and Treatment.” Cooper puts forth many arguments about alcoholism that are current today. He notes the true inebriate lacks the power to take alcohol and remain sober. He also goes so far as to suggest alcoholism may be inherited. But a year later we find Walter A. Bastedo, in “Materia Medica: Pharmacology, Therapeutics, Prescription Writing,” opining that addicts are liars and cannot be trusted.
The Harrison Narcotics Tax Act of 1914
This is the most significant piece of legislation pertaining to addiction passed during this era. The act restricts access to cocaine, opiates and other substances to physicians and pharmacists. The AMA endorses the act as a means to control the supply of opiates. The act is written as a revenue bill, allowing the Treasury Department to tax these substances. In subsequent years, interpreters of the act use it to remove the debate from the medical arena and place it in the criminal forum.
“Habits That Handicap”
This is the title of a book by C.B. Towns published in 1916. In it, Towns articulates the nightmare of addiction. He writes addicts want nothing more than to be free of addiction and fear nothing more than being deprived of their drug. Towns teams with future AMA president Alexander Lambert to create the Towns-Lambert treatment for opiate addiction. The treatment relies on large doses of hyoscine and belladonna to mask withdrawal symptoms. The treatment enjoys modest success until the full implementation of the Harrison Act makes any drug treatment that relies on other drugs an iffy proposition.
1918, WWI, and Webb v. United States
A 1918 Treasury Department survey of 1,000 health officials on addiction finds 415 physicians believe addiction is a disease, while 542 consider it a vice. When America enters World War I, psychiatrists screening enlistees are advised to look out for drug addicts. These individuals are classified as psychopaths, unreliable and completely unfit for duty.
The first test of the Harrison Act comes in 1919 in Webb v. United States. The Supreme Court interprets addiction maintenance programs in violation of the act and as an indictable offense. In an about-face from 1914, the Treasury Department uses the Court’s ruling as a mandate to shutter the few treatment clinics in operation and to go after any physician or practice treating addicts through maintenance. These activities usher in the era of narcotic control. As a result, clinics close, drug laws are vigorously enforced, and addicts have no recourse to treatment. This era continues until the advent of methadone maintenance in 1960.
Despite the government crackdown, William Butler opens the Shreveport Clinic in Louisiana in 1919. Butler is a strong advocate for maintenance. His clinic is one of the last to be shut down by the government. A bill before Congress to provide federal funding for community-based treatment for addicts fails. Finally, the AMA publicly opposes ambulatory treatment for addicts, thereby putting its stamp of approval on the Supreme Court’s interpretation of the Harrison Act in Webb v. United States.
The Volstead Act, Prohibition and a prelude to the Roaring Twenties
1919 marks the start of the nation’s march toward abstinence. The Volstead Act is passed. This legislation is the forerunner to the 18th Amendment. Under the act, the Treasury Department’s newly-minted Prohibition Unit includes the Division of Narcotics. These two agencies will become the nation’s police during Prohibition.
The 18th Amendment to the Constitution is passed and becomes law on January 16, 1919. The law makes manufacturing, selling, transporting and importing alcohol illegal. As will be shown in the next article in this series, bootleggers, home stills, gin mills and speakeasies keep the problem of alcoholism in full swing despite Prohibition.
About the author:
Darren Fraser is a content writer for Sovereign Health Group. He worked two and half years as reporter and researcher for The Yomiuri Shimbun until they realized he did not read, speak or write Japanese and fired him. Undeterred, he channels his love of research into unearthing stories that provide hope to those dealing with addiction and mental illness. Darren loves the Montreal Canadiens hockey club and horror films and would prefer to enjoy these from the comforts of his family’s farm in Quebec. For more information about this media, contact the author at firstname.lastname@example.org.