See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/258821350

History of Substance Abuse Treatment

Chapter · January 2014

DOI: 10.1007/978-1-4614-5690-2_278

CITATION READS
1 10,486

2 authors:

Alana Henninger Hung-En Sung

RTI International City University of New York - John Jay College of Criminal Justice
9 PUBLICATIONS   33 CITATIONS    97 PUBLICATIONS   1,172 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

When Does Police Use of Deadly Force Become Deadly? View project

Cross-Cultural Differences in Human Agency, Self-Control, and Aggression View project

All content following this page was uploaded by Hung-En Sung on 30 May 2014.

The user has requested enhancement of the downloaded file.

History of Substance Abuse Treatment
History of Substance Abuse
Treatment
Alana Henninger1 and Hung-En Sung2
1
John Jay College of Criminal Justice, New York,
NY, USA
2
Department of Criminal Justice, John Jay
College of Criminal Justice, New York,
NY, USA
Synonyms
Evolution of substance abuse treatment
Overview
Efforts at combating the negative health and
social consequences of substance abuse and
dependence have always existed in the United
States. Often swinging between the rival con-
texts of moralistic and positivistic discourses,
these efforts have led to the articulation of the
major therapeutic paradigms in the field of sub-
stance abuse treatment. The earliest interven-
tions were grassroot interventions focusing on
individuals with drinking problems whose goals
shifted from moderation to abstinence over
time. As the patterns of substance use and
abuse quickly diversified along the processes
of immigration and urbanization, a wider variety
of substances and a more diverse assortment of
users became targeted for an even richer array of
therapeutic experiments. The gradual involve-
ment of the state in the planning and administra-
tion of substance abuse treatment has resulted
in the growing use of institutionalization and
coercion to trigger and maintain the recovery
process. The emerging consensus that substance
addiction is a chronic and relapsing brain
disease represents a redefinition of an old prob-
lem and will determine the direction of the sci-
ence and art of substance abuse treatment in the
years to come.
2257 H
Introduction
Mind-altering substances have been a part of the
human experience since the beginning of civili-
zation (Katcher 1993; Saah 2005). Many of the
psychotropic effects enjoyed by recreational drug
users today were sought by ancient civilizations
as a means of increasing their chances of survival
(Saah 2005). Ancient civilizations also realized,
however, that it was possible to enjoy and
become addicted to certain substances. Five-
thousand-year-old Egyptian records report that
individuals suffering from alcohol addiction
were often cared for in the private homes of
people who provided treatment. Records from
ancient Greek and Roman sources recommended H
that alcoholics receive treatment in “public or
private asylums” (White 1998). This chapter
will provide an overview of American substance
abuse treatment from the 1700s to the present.
The Early Years of America: 1600 to 1900
Americans have consumed alcohol since colonial
times, making alcohol the earliest use of an intox-
icant by the settlers. Alcohol was an integral part
of culture at the time, but public drunkenness was
not tolerated (Levine 1978; Stolberg 2006). The
production and consumption of alcohol increased
steadily between colonization and the late eigh-
teenth century. By 1810, the number of distiller-
ies in the United States had increased
exponentially to a staggering 14,191, with the
average person drinking four and a half gallons
of alcohol per year (White 1998). The level of
alcohol consumption had reached its zenith by
1830, with the average American consuming
approximately five to seven gallons of alcohol
per year (Stolberg 2006). Alcohol had become
easily accessible to, and affordable for, the gen-
eral population, resulting in deleterious effects on
society (especially the family) due to increased
alcohol abuse (Katcher 1993; White 1998;
Stolberg 2006). Treatment of addiction in the
United States, therefore, began with alcohol
addiction (Lemanski 2001).
H 2258
Early Institutional Care for Addiction
In the late eighteenth and early nineteenth centu-
ries, individuals suffering from an addiction to
alcohol were grudgingly housed in a variety of
locations. Individuals who were considered
drunkards were frequently incarcerated in local
jails (Rosenberg 1995; White 1998; Rothman
2001), which is especially interesting because
alcohol was often served in early American jails
(Rothman 2001). Hospitals were an option for
medical care but were limited in number during
the eighteenth and nineteenth centuries. Both
almshouses (places for the poor, sick, or destitute
to seek refuge) and asylums for the mentally ill
also provided a place for alcoholics to stay but,
like jails and hospitals, failed to provide treat-
ment for addiction (Rosenberg 1995).
Benjamin Rush, a prominent physician and
activist beginning in the latter half of the eigh-
teenth century, proposed that “sober houses” be
used to treat alcohol addiction through medical
treatment as well as “religious and moral instruc-
tion” (Levine 1978; Baumohl 1990; White 1998).
Rush, who initially advocated for moderation
rather than abstinence, went on to describe the
symptoms and potential social consequences of
alcohol abuse in pamphlets that were distributed
to the public in 1784 (Levine 1978; Katcher
1993; Lemanski 2001; Stolberg 2006). Early
treatments of alcoholism used by Rush ranged
from cold baths, vomiting, and aversion therapy
to the practices of bleeding, blistering, and sweat-
ing the patient (White 1998).
Physicians in the early nineteenth century
made significant contributions to the identifica-
tion of key physical consequences of alcoholism,
such as liver, stomach, muscle tissue, and nerve
tissue damage. Delirium tremens (or the “D.T.s”)
were first described prior to 1819 as “alcohol-
induced brain fever,” and then later articulated
by Dr. Walter Channing and Dr. John Ware
between 1819 and 1831. The two physicians pro-
vided the first American documentation of
a variety of symptoms of delirium tremens, such
as hand tremors, hallucinations, vomiting, and
loss of appetite. The term “alcoholism” was also
coined in the mid-1800s by Dr. Magnus Huss,
a Swedish physician who chronicled the
History of Substance Abuse Treatment
development in global knowledge of alcohol
addiction (White 1998).
The discovery of the physical side effects and
consequences of chronic alcohol use, as well as
the ineffective drive for abstinence during the
temperance movement, played a role in the push
for the institutional treatment of alcoholism
(Baumohl 1990; White 1998). The American
Association for the Cure of Inebriation (AACI)
provided the first attempt at the professionaliza-
tion of treatment services, arguing that addiction
was a disease that should be treated rather than
a vice or criminal offense that should be
punished. In 1870, six managers of inebriate
homes and inebriate asylums joined together to
form the AACI. Inebriate homes were small facil-
ities that provided some treatment for alcohol
addiction but functioned primarily as a shelter
for alcoholics. Inebriate asylums, on the other
hand, were often large private or state-sponsored
facilities that focused on the provision of medical
treatment for alcohol addiction. Private sanitaria
(often referred to as lodges or retreats) were also
developed at the end of the nineteenth century to
provide addiction treatment services to the
wealthy (White 1998).
Types of services provided at the different
types of addiction facilities included inpatient
treatment, short- or long-term stays for detoxifi-
cation, and the first attempts at outpatient ser-
vices. The first attempts at a “continuum of
care” were also made during the inebriate asylum
movement. A local physician would first refer
a patient suffering from alcohol addiction to an
institution for the purposes of detoxification.
After further evaluation, the patient would be
transferred to a facility that provided long-term
treatment for addiction. After the completion of
long-term treatment, the patient would be
returned to the care of their local physician, who
would then provide any necessary aftercare
(White 1998).
Specific treatment methods within individual
institutions varied. The most important feature of
early institutional treatment was isolating the
inebriate from society so that the inebriate
would no longer face the temptation of alcohol.
Once isolated, many institutions began the
History of Substance Abuse Treatment
process of detoxification. Detoxification could be
done abruptly and without the aid medication
(often referred to as “cold turkey”) or gradually
with medications prescribed to alleviate the
symptoms of withdrawal. Other types of psycho-
tropic substances, such as cannabis, coca, chloral
hydrate, and belladonna, were commonly pre-
scribed for detoxification during the nineteenth
century. Detoxification was often followed by an
attempt to restore the patient to a healthy physical
state, through the provision of medical treatment,
healthy meals, fluids, vitamins, and exercise. It
was also believed that massages, sunlight, and
electrotherapy would aid in the recovery process.
Music, counseling, aversion therapy, and reli-
gious instruction were other methods that were
occasionally offered, but were not the norm
(White 1998).
Construction of institutions for the treatment
of alcohol addiction in the United States
expanded to a total of one hundred facilities by
1902. This trend of expansion, however, was
short-lived. The majority of the inebriate homes
and asylums had either disappeared or been
reallocated for correctional or psychiatric pur-
poses by the 1920s. Contributing factors to the
demise of the inebriate homes and asylums were
lack of funding, technology, and professionaliza-
tion as well as a waning of the optimistic belief
that alcoholism could be cured. Although early
attempts at the treatment of alcohol addiction
were not successfully sustained, they conceptual-
ized addiction as a disease rather than
a personality disorder, revolutionized treatment
of addiction, and provided the foundation for the
continued development of future methods of sub-
stance abuse treatment (White 1998).
The Temperance Movement
The temperance movement played a pivotal role
in the evolution of substance abuse treatment by
sparking a new way of viewing addiction and
recovery. The temperance movement began in
1808 as a response to the social problems
resulting from the rapid increase in alcohol
abuse among the American population (White
1998; Lemanski 2001). Alcohol abuse was ini-
tially thought to be a moral affliction rather than
2259 H
a disease. The original goal of the temperance
movement, therefore, was to reduce alcohol con-
sumption. Early attempts at reducing alcohol
intake usually consisted of replacing spirits with
beer or wine (Hall 2010; Stolberg 2006).
Beginning in 1831, a variety of temperance
societies were created throughout the country in
an effort to promote a communal recovery pro-
cess rather than an isolated attempt at sobriety.
The Washingtonian Society, founded in 1840,
was one of the more well known of these temper-
ance societies. The purpose of the Washingtonian
Society was to provide a place for alcoholics to
meet, hear temperance lectures, and share their
experiences of alcoholism and recovery. Their
method of recovery required members to publicly H
acknowledge their addiction and commit to
recovery, share their experiences with other
members, and engage in leisure activities without
alcohol (White 1998). The Washingtonians also
attempted to assist their fellow members in times
of need, which is an aspect of the society that
made it different from other temperance societies
operating at the time. Efforts were made, through
charitable donations, to offer legal assistance,
shelter, food, and clothing to fellow
Washingtonians as needed (Lemanski 2001).
The rapid growth of the Washingtonian Soci-
ety, however, was met with an equally rapid
demise. The Washingtonian Society had failed to
establish a cohesive ideology, as well as an orga-
nized standard of practices for meetings, necessary
to support continued expansion of the movement
(Lemanski 2001). Perhaps more importantly, how-
ever, pledging abstinence was not a sufficient
method of treatment for individuals suffering
from alcoholism. By 1840, the goal of the temper-
ance movement had shifted from moderation to
abstinence (Katcher 1993). This shift in goals was
largely a result of the growing recognition that
alcoholism could not be cured through simple
will power. Advocates in the temperance move-
ment began to argue that the best way to fight
alcoholism was to prevent future generations
from drinking alcohol by prohibiting the consump-
tion of alcohol (Lemanski 2001; Stolberg 2006).
The temperance movement continued to flour-
ish until the Civil War began in 1861. Although
H 2260
the temperance movement stalled during the
Civil War, the movement regained its momentum
as a political endeavor after the war ended
(Lemanski 2001; Stolberg 2006). Women’s
groups, such as the Women’s Christian Temper-
ance Union, began to push harder not only for
temperance but also for prohibition. In 1869, the
Prohibition Party was formed in an effort to make
the distribution and transportation of alcohol ille-
gal in the United States (Lemanski 2001). This
policy initiative came to fruition with the adop-
tion of the Eighteenth Amendment to the Consti-
tution in 1920. As will be seen in the next section,
prohibition had a powerful impact on substance
use, abuse, and treatment among the American
population in the early twentieth century
(Katcher 1993; Lemanski 2001; Hall 2010).
Early Drug Treatment
While addiction treatment services focused pre-
dominantly on alcohol in the nineteenth century,
there was a burgeoning interest in the treatment
of other drugs (White 1998; Stolberg 2006). It is
important to note that the use of psychotropic
drugs was legal in the United States until the
enactment of the Harrison Act in 1914. The avail-
ability of drugs (especially opiates and cocaine)
greatly increased during this time period,
resulting in the first drug epidemic. Physicians
with experience in treating patients with drug
addictions (usually to opiates) began discussing
addiction in terms of disease rather than moral
failure (White 1998).
More women than men used psychotropic
drugs during this time period, most likely because
opiates were the popular treatment for “female”
maladies such as menstruation and hysteria. Opi-
ate addicts in the nineteenth century were, more
often than not, educated white women of a higher
socioeconomic status. Due to the stigmatization
of substance abusers, especially during the
female-driven temperance movement, women
often hid their substance use and abuse from
their family and friends. When women did seek
out treatment, the reported ailment was usually of
a physical or psychological nature (White 1998).
Ironically, however, early treatments for phys-
ical, psychological, and substance abuse
History of Substance Abuse Treatment
disorders often included the prescription of
other drugs (Courtwright 2001). Opiates were
often prescribed for physical and psychological
maladies, while cocaine was often prescribed for
alcohol and opiate addiction. Additionally,
cocaine was frequently used as an anesthetic dur-
ing surgical procedures. Unfortunately, the treat-
ment of narcotics prior to the twentieth century
predominantly focused on easing the suffering of
withdrawal symptoms during the detoxification
process through the prescription of other highly
addictive psychoactive substances (e.g., codeine,
hypnotics, bromides, and chloral hydrate). Early
experimentation with maintenance programs
began at this time, but the programs were largely
ineffective because the narcotics used to maintain
the patient continued to provide a high (unlike
agonists that are used today, such as methadone).
The cycle of addiction, therefore, was often
sustained (White 1998).
The Miracle Cure
During the second half of the nineteenth century,
several coinciding circumstances provided the
perfect milieu for the sale of “miracle cures” for
addiction. Miracle cures were usually in the form
of a medication that could be taken for a short
period of time for the successful treatment of
alcohol (e.g., Mickey Finn Powders, White Star
Secret Liquor Cure, and the Hay-Litchfield Anti-
dote), hangovers (e.g., Alka-Nox, Wink, and
Sober-Up), tobacco (e.g., Nicotol, Tobacco
Redeemer, and Gustafson’s Tobacco Remedy),
or other psychotropic substances (e.g., Mrs.
Baldwin’s Home Cure for Cocaine, St. Anne’s
Morphine Cure, and Weatherby’s Opium Anti-
dote). A variety of tonics and syrups consisting of
various mixtures of alcohol, opium, morphine,
and cocaine promised to cure any addiction in
the privacy of one’s own home at a fraction of
the cost of institutional treatment (White 1998).
Miracle cures could be purchased over the
counter, through mail order services, and were
also provided in treatment facilities (e.g., inebri-
ate houses). Aggressive marketing strategies
were used to advertise miracle cures to the public
through the use of newspapers, magazines, bill-
boards, and speaking events. Gimmicks, such as
History of Substance Abuse Treatment
the use of the testimonial (e.g., 100,000 satisfied
customers), the money-back guarantee, and dis-
creet packaging, became very popular during this
time period (White 1998). Some of these miracle
cures, such as Leslie Keeley’s Double Chloride
of Gold Cure, actually became treatment fran-
chises (Baumohl 1990; White 1998). Doctors
and charlatans alike frequently attached their
names to the production and promotion of
a new, top-secret formula (e.g., Dr. Meeker’s
Antidote) that would purportedly revolutionize
the treatment of addiction. The sale of miracle
cures continued well into the mid-twentieth
century (White 1998).
1900 to the 1950s
The goal of prohibition was to make the distribu-
tion and transportation of alcohol illegal so that
the consumption of alcohol would become
impossible. If the consumption of alcohol could
be prevented, it was reasoned, then alcohol addic-
tion would cease to be a social problem necessi-
tating treatment (Hall 2010). Unfortunately,
alcohol abuse rose while treatment options
disappeared. The idea that alcohol was
a physical disease necessitating medical treat-
ment was once again replaced with the belief
that alcohol was a lapse in moral character that
could be cured by prohibiting inebriety. As
a result, religious groups such as the Salvation
Army continued to provide treatment services to
alcoholics, but the institutional treatment of
addiction completely disappeared until the late
1940s (White 1998; Lemanski 2001).
The Effect of Criminalization of Drugs on
Addiction Treatment
Although it is widely believed that the “war on
drugs” began with President Nixon in the 1970s,
it could be argued that the “war” began with the
passage of the Harrison Act in 1914. Prior to the
Harrison Act, access to opiates, cocaine, and
other drugs was unregulated. This lack of regula-
tion, combined with the overprescription of both
drugs, resulted in high rates of addiction. In 1912,
the first morphine maintenance clinics opened in
2261 H
an attempt to treat the many men and women who
had become addicted to opiates. Outpatient treat-
ment was provided through the prescription of
decreasing amounts of morphine for the purpose
of weaning patients off of drugs at a pace that
would allow them to avoid withdrawal symptoms
(White 1998).
When the Harrison Act was passed, the pos-
session of illicit substances was criminalized. It
was at this point in history that the treatment of
substance use and abuse shifted from a public
health model to a criminal justice model. The
passage of the Harrison Act limited the access
to opiates and cocaine to physicians, who were
then prohibited from prescribing the drugs to
addicts for the purposes of detoxification or main- H
tenance because the government believed that
too many addicts were remaining on maintenance
programs indefinitely rather than being
weaned off of drugs (Levine 1978; White 1998;
Courtwright 2001). By 1925, all of the
morphine maintenance clinics had been closed
(White 1998).
Thus, although the Harrison Act was intended
to address opiate and cocaine addiction, it made it
very difficult for addicts to receive any treatment
whatsoever. Shortly after drugs were criminal-
ized, the mandatory detention of substance users
and abusers began. Many individuals suffering
from addiction were sent to psychiatric hospitals
or special “colonies” for mandatory treatment.
Jails and federal penitentiaries were also flooded
with addicts who had violated the Harrison Act.
Between 1915 and 1929, the number of drug-
related incarcerations increased from 63 to
1,889. Overcrowding of correctional facilities
led to the creation of two federally funded and
managed “narcotics farms,” which served as sep-
arate facilities for drug offenders in need of long-
term treatment (White 1998).
Drug abuse and dependence treatments during
the first half of the twentieth century were often
experimental in nature. For example, treatments
for alcoholism were often applied to drug users.
Other extremely invasive methods were also
used, such as insulin-induced comas, electrocon-
vulsive therapy (ETC), aversion therapy, psycho-
surgery (i.e., lobotomy), and serum therapy
H 2262
(where serum was withdrawn from blisters that
were raised on the abdomen of a patient and then
reinjected). Psychological approaches for the
treatment of alcohol and drug addiction were
also developed during the early nineteenth cen-
tury, with psychoanalytic approaches being the
predominate format. Although the prohibition of
alcohol was eventually deemed a failed social
experiment, the criminalization of other psycho-
active substances remains to this day (White
1998; Lemanski 2001).
The Modern Alcoholism Movement
After the enactment of the Twenty-first Amend-
ment to the US Constitution in 1933, prohibition
ended and a new phase in the treatment of alcohol
addiction began (White 1998; Lemanski 2001).
A third paradigm shift in the treatment of addic-
tion occurred between 1933 and 1955. This
period is often referred to as the “Modern Alco-
holism Movement” (p. 178). During this time,
alcoholism was once again reconceptualized as
a disease and public health issue rather than
a moral weakness. Professionals and members
of society alike began to believe that alcoholism
could be treated. This new belief in the merits of
treatment opened the door for the allocation of
funds for new research on addiction to be
conducted by professionals in the medical, psy-
chological, and social work fields (White 1998).
The Modern Alcoholism Movement was not,
however, a unified process. The activities of
a variety of institutions and interest groups,
often with very different agendas, worked sepa-
rately to achieve social change. Three of the
most prominent professional groups to exact
change during this period were the Research
Council on Problems of Alcohol, the Yale Cen-
ter of Alcohol Studies, and the National Com-
mittee for Education on Alcoholism. These three
groups collectively succeeded in redefining
alcoholism; changing policies and treatment
practices relating to addiction; convincing gov-
ernment and private sources to invest money in
research, education, and intervention; and initi-
ating alcohol treatment in the workplace.
Another interest group, Alcoholics Anonymous,
used a grassroots approach to become an
History of Substance Abuse Treatment
especially integral part of the Modern Alcohol-
ism Movement (White 1998; Lemanski 2001).
Alcoholics Anonymous
Treatment options for alcoholics had all but
disappeared in the United States by 1930. In
1935, Bill Wilson and Dr. Robert Smith devel-
oped a self-help recovery group called Alcoholics
Anonymous (A.A.) in an effort to fill this treat-
ment void (Hubbard et al. 2009). A.A. evolved
out of a nondenominational group, known as the
Oxford Group, who sought to encourage positive
societal change through individual spirituality.
Although alcoholism was not the primary con-
cern of the Oxford Group, many group members
believed that religion could provide a strong
foundation for individuals seeking sobriety.
A small subgroup of alcoholic members, led by
Wilson and Smith, formed within the Oxford
Group to provide support to one another during
their struggle for sobriety. The nonalcoholic
members of the Oxford Group disagreed with
this focus on sobriety, which led to the separation
of this subgroup in 1937 (White 1998; Lemanski
2001; Alcoholics Anonymous 2012). The group
was christened Alcoholics Anonymous in 1939
(White 1998; Alcoholics Anonymous 2012).
While the early years of A.A. consisted of
relatively unstructured group meetings, Wilson
and Smith soon began to focus on building
a financially independent group with a guiding
ideological framework. In 1938, Wilson began
writing a book (called Alcoholics Anonymous)
that outlined how he wanted the program to func-
tion and recorded the stories of the recovery of
many of the group members. What began as six
guiding principles eventually turned into the
twelve-step program that A.A. is known for
today. The twelve-step program provides an out-
line for the course of recovery that an alcoholic
will follow as a member of A.A. (e.g., the mem-
ber must admit that they have a problem and that
they need help, put their faith in God, make
amends, acknowledge that sobriety is a lifelong
commitment). In this way, the focus was not on
how or why the individual became an
alcoholic. The focus has always been on how
the individual will achieve sobriety, and the
History of Substance Abuse Treatment
identity reconstruction that must occur for
the individual to remain sober (Alcoholics
Anonymous 2012).
After the publication of their book in 1939,
A.A. gained a great deal of press coverage, which
resulted in enormous popularity. Membership
quickly grew to 100 members within that first
year and then skyrocketed to 8,000 members by
the end 1941 (White 1998; Lemanski 2001; Alco-
holics Anonymous 2012). A.A. then began to
play a pivotal role in the medical treatment of
alcoholism. Hospitals had always grudgingly
treated (or refused to treat) alcoholics because it
was believed that alcoholism was the result of
a moral weakness rather than a disease. Alco-
holics also tended to be very difficult and frus-
trating patients, in already overcrowded facilities,
who did not pay their bills. Members of A.A.
made it their mission to change the perception
of alcoholism from an untreatable moral weak-
ness to a disease with the potential for successful
treatment, and they succeeded (White 1998).
Through tireless advocacy, A.A. (1) convinced
local hospitals that alcoholism could be treated,
(2) showed hospitals how to treat alcoholism,
(3) suggested that separate wards be established
for the sole treatment of alcoholism, (4) suggested
that these wards be managed by A.A. members to
take the stress off of hospital employees, and
(5) promised to pay the bills of any patient that
A.A. had sponsored for alcohol treatment. A.A.
then began to extend their treatment model to
private, psychiatric hospitals, and prisons, thus
playing a major role in the return to the disease
model of addiction treatment (White 1998).
In 2011, it was estimated that there are
2,057,672 members worldwide (Alcoholics
Anonymous 2012). A.A. has evolved into “the
most fully developed culture of recovery that has
ever existed- a culture with its own history,
mythology, values, language, rituals, symbols,
and literature” (White 1998, p. 162). The foun-
ders of A.A. chose to use the personal experi-
ences of group members who have experienced
alcoholism to provide support and guidance in the
recovery process rather than utilize the services
of professionals in addiction treatment. Never-
theless, Alcoholics Anonymous revolutionized
2263 H
addiction treatment in the first half of the
twentieth century and has continued to influence
social policy well into the twenty-first century
(White 1998).
1950s to the Present
The Minnesota Model
The Minnesota Model of addiction treatment
began with the establishment of a new method
of alcoholism treatment in three Minnesota cen-
ters in the late 1940s: Willmar State Hospital,
Pioneer House, and Hazelden. Willmar State
Hospital functioned as an inebriate hospital
beginning in 1912 but was converted into H
a psychiatric facility as a result of prohibition.
Pioneer House opened its doors in 1948 in an
effort to offer a different type of treatment option.
Using A.A. as a program model, Pioneer House
provided residential treatment for men with alco-
hol addiction for two to four weeks (White 1998).
Hazelden Farm, a former retreat for alcoholic
men, was then established a year later to offer
A.A.-based residential treatment program
(Hazelden 2012).
What is known today as the “Minnesota
Model” evolved throughout the 1950s. One of
the primary tenets of the Minnesota Model that
emerged during this period was respect. The
Willmar team argued that patients would greatly
benefit from a recovery process built on mutual
respect rather than degradation, which was
a radical idea during this period. The staff at
Willmar then defined alcoholism “not as
a symptom of underlying emotional problems,
but as a primary, progressive disease” (White
1998, p. 203) that should be treated using
a multidisciplinary and holistic approach. They
also believed that professionalization of addic-
tion treatment was an integral part of this
approach. Medical treatment was to be provided
by doctors and nurses, counseling was to be pro-
vided by psychologists and social workers, and
spiritual guidance was to be provided by the
clergy. Perhaps more importantly, however,
recovered alcoholics were also professionalized
through training and the provision of credentials.
H 2264
The Willmar team believed that recovered alco-
holics were often the best counselors, but their
position as a part of the addiction treatment team
needed to be legitimized. The radical idea of
professionalizing recovered alcoholics was met
with a great deal of resistance but has become
routine in current treatment models (White
1998).
The Minnesota Model continued to flourish
and solidify during the 1960s at both Willmar
and Hazelden, with several core elements emerg-
ing during this period (White 1998; Hazelden
2012). A 28-day stay became the standard treat-
ment period, and patients were first prescribed
medication to aid in the detoxification process
(Lemanski 2001). A counselor, who often times
was a recovering alcoholic, was assigned to each
patient. Patients and counselors were usually
matched according to age and gender in an effort
to establish a supportive environment in which
the patient would feel comfortable engaging in
self-disclosure (White 1998). Individual counsel-
ing was supplemented by group counseling
(which combined support and confrontation), lec-
tures, and working through the twelve steps of A.
A. Patients also received aftercare upon their
return to the community (Quinn et al. 2004).
The Minnesota Model was immensely popular
and had been adopted by 114 state agencies that
provided addiction services by 1971. Presenta-
tion of the Minnesota Model at medical confer-
ences took the treatment approach nationwide.
Individuals suffering from alcohol addiction, as
well as practitioners who wanted to be taught the
treatment method, began pouring in from around
the country. This innovative approach of treating
chemical dependency is still followed today for
both alcohol and drug addiction (White 1998;
Lemanski 2001; Quinn et al. 2004).
The Resurgence of Drug Treatment
Treatment models for alcohol addiction and drug
addiction evolved in vastly different ways due to
the early criminalization of drug use. While treat-
ment options for alcoholics continued to evolve,
drug addicts began seeking treatment in psychi-
atric hospitals after the morphine maintenance
clinics closed in the 1920s because there was
History of Substance Abuse Treatment
literally nowhere else to go. Rapid withdrawal,
and perhaps some psychiatric treatment, was the
only help that drug addicts received in these
facilities. A slight resurgence in drug treatment
then began to occur in New York City in the
1950s, however, partly as a response to surging
rates of adolescent heroin addiction. A few
twenty-eight-day residential treatment programs
were established inside of hospitals. Upon admis-
sion, patients were detoxified and then partici-
pated in individual and group therapy. After
discharge, outpatient aftercare services were pro-
vided. Hospitals were still resistant to treating
individuals suffering from drug addiction, so
many individuals were committed for twenty-
eight-day cold turkey detoxification on Riker’s
Island Penitentiary. Correctional detoxification
continued until the practice was banned in the
early 1960s. Treatments options were bleak, but
both drug legislation and methods of treatment
were about to be revolutionized in the 1960s
(White 1998).
Narcotics Anonymous
In an effort to fill the treatment void, attempts to
use the philosophies of Alcoholics Anonymous
began in various locations in the late 1940s and
early 1950s. The leaders of A.A. did not want to
extend membership to drug addicts, so recover-
ing addicts created their own version of A.A. The
first of these meetings, which were called
“Addicts Anonymous,” took place in 1947 inside
the federal narcotics farm located in Lexington,
Kentucky. Addicts Anonymous meetings soon
spread to other treatment facilities and hospitals,
but when the organization established commu-
nity-based meetings, the name was changed to
“Narcotics Anonymous (N.A.)” to avoid confu-
sion with Alcoholics Anonymous. The two pro-
grams are almost identical, with only slight
differences in wording. Although N.A. got off to
a very shaky start, almost disappearing in the late
1950s, it is now a thriving international organi-
zation (White 1998).
Community-Based Treatment
The first attempts at community-based support
services for recovering addicts returning home
History of Substance Abuse Treatment
after institutional care began in the late 1950s (De
Leon 2000). Cities across the country attempted
to provide outpatient treatment via social workers
to individuals who had recently completed inpa-
tient detoxification. These early attempts were
largely unsuccessful, however, because follow-
up appointments were often missed by patients.
Continuing care for drug-addicted patients pre-
dominantly fell on private physicians, who often
treated patients who had overdosed or contracted
a sexually transmitted disease. Religious organi-
zations continued to provide outreach services for
drug addiction that often included medical and
psychological treatment. N.A. also attempted to
fill the void in community treatment, but it was
not until Synanon, therapeutic communities, and
new legislation permitting the use of agonist and
antagonist treatment in community facilities that
community-based treatment really took off
(White 1998).
Therapeutic Communities
In mid-1958, a member of Alcoholics Anony-
mous named Charles Dederich began holding
meetings at his home in California during
which he experimented with different methods
of group recovery for individuals addicted to
both alcohol and drugs. These methods of
group recovery were often confrontational, bor-
dering on verbally abusive, and were intended to
break down the defense mechanisms and excuses
of addicts. His experimentation led to the idea for
a therapeutic commune where drug addicts could
live together during the recovery process.
Dederich left A.A. to pursue his new treatment
modality (which was essentially a residential
treatment program), which he called Synanon
(National Institute on Drug Abuse 2008; Janzen
2011). This first phase of development, known as
Synanon I, became immensely popular with both
the public and practitioners. By 1969, however,
Dederich decided to take Synanon I in a new
direction. While the goal of Synanon I was to
rehabilitate addicts, the goal of Synanon II was to
form an alternative lifestyle and to promote soci-
etal change. Synanon II evolved into Synanon III
in 1974, at which time Synanon was declared
a religion (Janzen 2011).
2265 H
Synanon may have come to a decidedly bizarre
end, but it did initiate a movement towards other
therapeutic communities. Five hundred therapeu-
tic communities using the early philosophies of
Synanon were operating in the United States by
1975 (De Leon 2000). These new therapeutic
communities focused on the rehabilitation and
sustained recovery by adjusting the lifestyle, rela-
tionships, and even the personality of individuals
suffering from drug addiction. Aggressive, con-
frontational, and even humiliating methods of
group recovery were often used within
a hierarchical system used to motivate patients to
work for higher-status positions within the com-
munity (De Leon 2000; Inciardi and McElrath
2008; National Institute on Drug Abuse 2008). H
Most early therapeutic communities progressed
their patients through three phases over a period
of 18 months to 3 years. Patients first received
isolated treatment within the therapeutic commu-
nity, were then employed outside of the therapeu-
tic community, and finally engaged in activities at
the therapeutic community while living and work-
ing on their own (White 1998).
Therapeutic communities continued to evolve
into the model that is used today. Residential
stays are similar but tend to be shorter, with
treatment methods that are not humiliating or as
confrontational and aggressive. Today, therapeu-
tic communities are also often linked to the crim-
inal justice system and outpatient centers. Many
jails and penitentiaries have therapeutic commu-
nities operating within their walls (De Leon 2000;
National Institute on Drug Abuse 2008). The
continued acceptance of therapeutic communities
and other evolving treatment options, however,
were contingent upon the wealth of new legisla-
tion that was occurring simultaneously through-
out the 1960s.
Civil Commitments and Other Legislations
By the late 1950s, individuals who were suffering
from drug addiction were viewed as people who
were immersed in a destructive lifestyle that they
were not willing, or able, to change. It was
believed that addiction was a social disease that
could be transmitted to other people; therefore,
the family and friends of drug-addicted
H 2266
individuals were considered to be in harms way.
Civil commitment, the court-ordered institution-
alization of a mentally ill individual, provided
a solution to these problems at the state level
(Inciardi et al. 1996).
Involuntary and voluntary civil commitment to
psychiatric institutions was extended to drug
addicts in the early 1960s as a way of ensuring
that substance abusers were treated rather than
incarcerated. It was thought that addicts would
be forced into the treatment that they may not be
ready to seek for themselves while also preventing
the spread of addiction to the community (Maddux
1988; White 1998). Patients were typically com-
mitted for 1 to 3 years, during which time they
were detoxified and then provided with medical
treatment and counseling. After discharge, the
patient was returned to their community and
received outpatient treatment (White 1998).
Civil commitment was not particularly suc-
cessful at initiating sustained abstinence. With
psychiatric facilities overburdened and patients
continuing to relapse, the government became
motivated to find different methods of treating
patients in noninstitutional settings. The Joint
Committee of the American Bar Association
and the American Medical Association on
Narcotic Drugs released a report in 1961 that
recommended treating patients in community
clinics. The more radical recommendation of
this report, however, was the suggestion that
investigations into maintenance programs be
resumed. This step towards a disease model of
addiction was further supported by several
Supreme Court decisions in the early 1960s that
prohibited laws that made addiction a crime,
framed addiction as a disease deserving treatment
rather than punitive action, and cautioned that
civil commitment should be used sparingly.
This paradigm shift made it possible for
researchers claiming that immediate and sustained
abstinence is not a realistic outcome for all drug
addicts to be taken seriously (White 1998).
Pharmacotherapy
Using narcotics to medically maintain individ-
uals suffering from opiate addiction was
prohibited in the United States by the Harrison
History of Substance Abuse Treatment
Act of 1914, but research concerning the practice
continued to evolve. German researchers began
developing a synthetic narcotic (White 1998;
Joseph et al. 2000; Inciardi and McElrath 2008),
called Dolophine, in the late 1930s. The use of
Dolophine was discovered by the United States in
the 1940s and was then marketed under several
names by Eli Lilly, Inc. beginning in 1947 (White
1998). What is now known in the United States as
methadone is an agonist that mimics the effects of
other opiates but without the associated high.
Methadone, therefore, can be prescribed in
decreasing doses to individuals suffering from
opiate addiction as way of weaning them off of
the opiate without suffering withdrawal symp-
toms (Inciardi and McElrath 2008; U.S. National
Library of Medicine 2009).
Methadone was used successfully for detoxi-
fication in a few US Public Health Hospitals in
the late 1940s, but the use of narcotics for main-
tenance was prohibited until the addiction legis-
lation of the 1960s called for research of new
treatment methods (Courtwright 2001; Hubbard
et al. 2009). In 1963, Dr. Marie Nyswander and
Dr. Vincent Dole argued that methadone could be
used not only to detoxify but also to maintain
heroin addicts while they acclimate to the meta-
bolic changes that occur during the recovery pro-
cess. They argued that stabilizing the patient
while their body underwent drastic physical
change could prevent relapse (White 1998;
Joseph et al. 2000; Courtwright 2001; Dole and
Nyswander 2008).
Early experimentation occurred in intense
inpatient settings. Patients received methadone
along with counseling, while dosage levels were
explored. Experimentation with dosage levels
finally paid off in 1964 when Nysander and
Dole discovered that one high dosage of metha-
done prevented intoxication, craving, euphoria,
dysphoria, and withdrawal for 24 hours or more
(White 1998; Joseph et al. 2000). Patients were
able to function normally with very few side
effects. Methadone became the wonder drug,
and outpatient clinics were constructed all over
the country. During the 1970s, federally funded
methadone programs were established at
record rates as a response to the return of
History of Substance Abuse Treatment
heroin-addicted Vietnam veterans and a surge in
urban crime. Today, methadone is provided in
outpatient clinics, usually in conjunction with
other addiction services (White 1998; Joseph
et al. 2000; Courtwright 2001).
Experimentation with other drugs with the
potential for maintaining opiate-addicted patients
during recovery also occurred during the 1960s.
An agonist called LAAM was another viable
option discovered for maintaining patients with
opiate addiction programs, but methadone
remained the more popular of the two options.
The effects of another group of medications,
known as antagonists, were also explored. Antag-
onists, (e.g., nalorphine, naltrexone, and nalox-
one), block rather than mimic the effects of
opiates (White 1998; Nutt 2010). These drugs
work just as well as agonists (like methadone),
but have no street value because they are not
effective pain medications, which is a significant
advantage. Antagonists are not popular among
patients, however, because they do not suppress
cravings and they induce withdrawal if taken when
a patient has opiates in their system. Researchers
have also been experimenting with partial agonists
(like buprenorphine) and the combination of ago-
nists with antagonists (like Suboxone®) as a way
getting the best of both worlds (Nutt 2010).
Criminal Justice-Mandated Treatment
Prisons have always been major substance abuse
treatment facilities, and criminal justice referrals
have historically been the largest source of the
publicly funded drug treatment admissions in
local communities, accounting for 40–50 % of
referrals to community-based treatment pro-
grams (Farabee et al. 2004). These community
referrals and those admissions to prison- or jail-
based treatment programs are generally known as
coerced treatment. Coercive treatment
approaches for drug addiction have been applied
consistently throughout the twentieth century,
beginning with the morphine maintenance clinics
in some communities during the 1920s. The
1930s marked the establishment of the federal
narcotics treatment facilities in Fort Worth,
Texas, and Lexington, Kentucky. During the
1960s broad-based civil commitment, procedures
2267 H
were implemented in the federal system, as well
as in New York and California. The present sys-
tem, beginning in the 1970s, relies less on formal
civil commitment procedures and emphasizes
community-based treatment as an alternative to
incarceration or as a condition of probation or
parole. The inception of the drug court model in
1989 and of the prosecutor-led drug treatment
alternative to prison (DTAP) model effectively
propel the use of the threat of incarceration as the
leverage and the application of graduated sanc-
tions as the calibrator in the recovery process
(Sung and Belenko 2006).
Some earlier researchers (Hartjen et al. 1982;
Platt et al. 1988) have argued that little benefit
can be derived when a drug user is forced into H
treatment by the criminal justice system because
treatment can be effective only if the client is
truly motivated and ready to change. The alloca-
tion of limited treatment slots to drug abusers
who do not really want to be treated is perceived
as ethically unjust and clinically unwise. Other
researchers, on the other hand, posit that few
chronic drug users will enroll and stay in treat-
ment without some external pressure and that
legal coercion is as justifiable as any other moti-
vation for treatment entry (Anglin and Maugh
1992; Salmon and Salmon 1983). As a matter of
fact, most clients begin their treatment under some
type of pressure from their families or employers.
Legal coercion represents a range of options of
varying degrees of severity across the various
stages of criminal justice processing. It can be
used to refer to such actions as a probation
officer’s recommendation to enter treatment,
a prosecutor’s offer of a choice between treat-
ment and jail, a judge’s requirement that the
offender enter treatment as a condition of proba-
tion, or a correctional policy of sending inmates
involuntarily to a prison treatment program in
order to fill the beds. In all these instances, it is
hoped that the external motivation (i.e., legal
pressure or fear of punishment) may transform
into internal motivation (i.e., desire to change and
stop using drugs) and therapeutic engagement
during the treatment process (Sung et al. 2001).
Decades of evaluative efforts have concluded
that coercion in substance abuse treatment is both
H 2268
a therapeutic factor that can be planned and
manipulated for recovery purposes (Young
2002; Young and Belenko 2002) and that it is
particularly useful when administered as struc-
tured, incremental responses to treatment
noncompliance (Taxman et al. 1999). Studies
after studies have attested the effectiveness of
criminal justice-based treatment (National Insti-
tute on Drug Abuse [NIDA], 2012). However,
and most importantly, the fundamental lesson
learned from evaluation research remains this:
Coercion can create incentives to enroll and
remain in treatment, but coercive tactics by them-
selves contribute very little to a drug-free life-
style if they are not supported by evidence-based
therapeutic and service components.
Conclusion
Substance abuse treatment in the United States
has followed a spectacular trajectory over the
past 300 years that was largely influenced by
public perception of addiction, as well as social
and political movements. The popularity and
acceptance of medical models of addiction treat-
ment have ebbed and waned according to strict
moral climates, culminating in the interdisciplin-
ary system of treatment that we have today. With
the growing consensus that addiction to psycho-
active substances is “a chronic, relapsing brain
disease that is characterized by compulsive drug
seeking and use, despite harmful consequences”
(NIDA 2010, p. 5), treatment programs currently
attempt to use a holistic approach that addresses
the many facets of this public health challenge.
Research continues to explore the biological,
psychological, and sociological causes of addic-
tion in an effort to provide new interventions that
can treat addiction more successfully.
Recommended Reading and References
Alcoholics Anonymous (2012) Estimates of A.A. groups
and members. Retrieved May 24, 2012 from http://
www.aa.org/lang/en/subpage.cfm?page¼74
Anglin MD, Maugh TH (1992) Overturning myths about
coerced drug treatment. Calif Psychol 22:19–22
History of Substance Abuse Treatment
Baumohl J (1990) Inebriate institutions in North America,
1840–1929. Br J Addict 85:1187–1204
Courtwright DT (2001) Dark paradise: opiate addiction in
America before 1940, 2nd edn. Harvard University
Press, Cambridge, MA
De Leon G (2000) The therapeutic community: theory,
model, and method. Springer, New York
Dole VP, Nyswander M (2008) Methadone maintenance: a
theoretical perspective. In: Inciardi JA, McElrath K
(eds) The American drug scene: an anthology, 5th edn.
Oxford University Press, New York, pp 435–439
Farabee D, Shen H, Prendergast M, Cartier J (2004) The
effectiveness of coerced admission to prison-based
drug treatment. In: Knight K, Farabee D (eds) Treating
addicted offenders: a continuum of effective practices.
Civic Research Institute, Kingston, pp 1–12
Hall W (2010) What are the policy lessons of national
alcohol prohibition in the United States, 1920–1933?
Addiction 105:1164–1173
Hartjen CA, Mitchell SM, Washburne NF (1981) Sentenc-
ing to therapy: some legal, ethical, and practical issues.
J Offender Couns Serv Rehabil 6(1–2):21–39
Hartjen CA, Mitchell SM, Washburne NF (1982) Sentenc-
ing to therapy: some legal, ethical, and practical issues.
J Offender Couns Serv Rehabil 6(1–2):21–39
Hazelden (2012) Hazelden history. Retrieved May 24,
2012 from http://www.hazelden.org/web/public/
hazelden_history.page
Hubbard R, Simpson DD, Woody G (2009) Treatment
research: accomplishments and challenges. J Drug
Issues 39(1):153–165
Inciardi JA, McElrath K (eds) (2008) The American drug
scene: an anthology, 5th edn. Oxford University Press,
New York
Inciardi JA, McBride DC, Rivers JE (1996) Drug control
and the courts. Sage, Thousand Oaks
Janzen R (2011) The rise and fall of Synanon: a
California utopia. The Johns Hopkins University
Press, Baltimore
Joint Committee of the American Bar Association and the
American Medical Association on Narcotic Drugs
(1961) Drug addiction, crime or disease? Interim and
final reports of the Joint Committee of the American
Bar Association and the American Medical Associa-
tion on Narcotic Drugs. Indiana University Press,
Bloomington
Joseph H, Stancliff S, Langrod J (2000) Methadone main-
tenance treatment (MMT): a review of historical and
clinical issues. Mt Sinai J Med 67(5):347–364
Katcher BS (1993) Benjamin Rush’s educational
campaign against hard drinking. Am J Public Health
83(2):273–281
Lemanski M (2001) A history of addiction and recovery in
the United States. Sharp Press, Tucson
Levine HG (1978) The discovery of addiction: changing
conceptions of habitual drunkenness in America.
J Stud Alcohol 39(1):143–174
Maddux JF (1988) Clinical experience with civil commit-
ment. In: Leukefeld CG, Tims FM (eds) Compulsory
 History of Technology in Policing
treatment of drug abuse: research and clinical practice.
National Institute on Drug Abuse, Rockville
National Institute on Drug Abuse (2008) Advances in
therapeutic communities. In: Inciardi JA, McElrath
K (eds) The American drug scene: an anthology,
5th edn. Oxford University Press, New York,
pp 421–434
National Institute on Drug Abuse (2010) Drugs,
brains, and behavior: the science of addiction
(Revised edition). National Institute on Drug Abuse,
Bethesda
National Institute on Drug Abuse (2012) Principles of
drug abuse treatment for criminal justice populations:
a research-based guide (Revised edition). National
Institute on Drug Abuse, Bethesda
Nutt DJ (2010) Antagonist-agonist combinations as ther-
apies for heroin addiction: Back to the future?
J Psychopharmacol 24(2):141–145
Platt JJ, Buhringer G, Kaplan CD, Brown BS, Taube DO
(1988) The prospects and limitations of compulsory
treatment for drug addiction. J Drug Issues
18(4):505–525
Quinn JF, Bodenhamer-Davis E, Koch DS (2004) Ideology
and the stagnation of aoda treatment modalities in
America. Deviant Behav 25:109–131
Rosenberg CE (1995) The care of strangers: the rise of
America’s hospital system. The Johns Hopkins
University Press, Baltimore
Rothman DJ (2001) The discovery of the asylum: social
order and disorder in the New Republic, 2nd edn. Little
Brown, Boston
Saah T (2005) The evolutionary origins and significance
of drug addiction. Harm Reduction J 2:8–14
Salmon RW, Salmon RJ (1983) The role of coercion in
rehabilitation of drug abusers. Int J Addict 18(1):9–21
Stolberg VB (2006) A review of perspectives on alcohol
and alcoholism in the history of American health and
medicine. J Ethn Subst Abuse 5(4):39–106
Sung H-E, Belenko S (2006) From diversion experiment
to policy movement: a case study of prosecutorial
innovation in the United States. J Contemp Crim
Justice 22(3):220–240
Sung H-E, Belenko S, Feng L (2001) Treatment compli-
ance and problem incidents among criminal justice
clients. J Subst Abuse Treat 20(2):153–162
Taxman FS, Soule D, Gelb A (1999) Graduated sanctions:
stepping into accountable systems and offenders.
Prison J 79(2):182–204
U.S. National Library of Medicine (2009) PubMed health:
methadone. Retrieved May 24, 2012 from http://www.
ncbi.nlm.nih.gov/pubmedhealth/PMH0000591/
White WL (1998) Slaying the Dragon. Chestnut Health
Systems, Bloomington
Young D (2002) Impacts of perceived legal pressure on
retention in drug treatment. Crim Justice Behav
29(1):27–55
Young D, Belenko S (2002) Program retention and
perceived coercion in three models of mandatory
drug treatment. J Drug Issues 32(1):297–328
View publication stats
2269 H
History of Technology in Policing
Mathieu Deflem and Stephen Chicoine
Department of Sociology, University of South
Carolina, Columbia, SC, USA
Overview
Technology has fundamentally changed the face
of society, and the effects that technological
advances have had on the form and function of
policing is no exception. In response to the
changing conditions of society brought about by
H
new developments in technology, law enforce-
ment agencies have in turn adopted new techno-
logical advances in order to fulfill their function
in the areas of crime control and order mainte-
nance. This has in turn led to the historical devel-
opment of the bureaucratization of law
enforcement, which has transformed the police
from a political enforcement apparatus to an
autonomous professional institution. Technology
has not only facilitated this transformation of
police within their respective nations, but has
also facilitated international police cooperation.
The institutional autonomy and the technological
advances in communications and transportation
enabled international cooperation between police
organizations which addressed, ironically, the
new forms of crime that were enabled by those
very same technological advances. Harnessing
new forms of technology would become a con-
stant theme in the efforts of international police
cooperation, with new initiatives and meetings
calling for the advancement of the means for
law enforcement agencies of different nations to
exchange information on criminals, suspects, and
new means of policing.
Technological changes have occurred for the
better part of a century, tracing back to, at least,
the early nineteenth century, when police were
highly connected with the political sphere and
walked their beats with whistles and batons, up
until the beginning of the modern era shortly after
World War 2. By this time, the police had become