Slaying The Dragon
CatherinePrzybyl
Early History
Benjamin Rush: 1746-1813Father of American Psychiatry and first American authority on alcohol and alcoholismViewed drunkenness as a progressive medical conditionDrunkenness was transmitted between generationsDescribed alcoholism as a disease
Could spring from many conditionsBeer, wine and opium as alternativesContinued abstinence only hope for drunkardSobriety included odd remediesLinking drink with painful impressionVegetarianismCold bathsBlistering the ankles
Temperance Movements
Initial goal: replace excessive drinking to moderate drinkingEncouraged to substitute wine and beer for distilled spiritsTried to convert whiskey-drinking drunkards to temperate beer-drinkers
Washingtonian Societies
Shift from moderation to total abstinenceNo ideology of nature of alcoholism and its recovery, but activities to turn away from alcoholismFirst woman’s society opened in 1841Martha Washington SocietyModeration Societies: 1879
Pre-Inebriate Homes and Asylums
Samuel Burton Pearson and John Armstrong described alcohol-induced “Brain Fever”Later known as delirium tremensLegends of drunkards spontaneously combusting1850: Mary Clues
Inebriate Homes and Asylums
1860-1925Inebriate Homes provided minimal level of treatmentInebriate Asylums large medically directed facilitiesUsed Lower and Middle class with industrial planPrivateSanatariahad affluent clientele seeking place to dry-out
Philosophies, Methods and Outcomes of Inebriate Homes and Asylums
1880sStaff intoxicated while caring for inebriatesInebriates were placed into categories for treatmentExcluded criminal degenerates or reckless charactersAffluent seen as victims of a diseaseWorking class and poor seen as willful misconduct deserving punishment
Commitment Laws: 1903: Inebriates could be legally committed for up to one year to asylum after a legal hearing in which two physicians certified the need for such action
Addictions in WomenInebriety viewSlaves to cologneAides to nursing
American Association for the Cure of Inebriates: 1870
Intemperance is a diseaseIt is curable in the same sense that other diseases areIts primary cause is a constitutional susceptibility to alcoholic impressionConstitutional tendency may be inherited or acquired
Critics of the Association
Philadelphia’s Franklin Reformatory Home for Inebriates withdrew from the AssociationCritics viewed inebriety as a hereditary weakness and advocated alcoholics should be left to die so alcoholism would eventually disappearQuarterly Journal of Inebriety from 1876-1914Advertisements for cures
Institutional histories
New York State Inebriate Asylum 1864Boston Washingtonian Home 1858Chicago Washingtonian Home 1863San Francisco Home for the Care of the Inebriate 1859
KeeleyInstitution: 1880-1920
1879 Dr. Leslie E.Keeley: proclaimed “Drunkenness is a disease and I can cure it”Saw drunkenness as biological in natureDouble Chloride of Gold remedy for inebriety,tobaccoismand neurasthenia (nervous exhaustion)Four daily injectionsAlcohol,Stychnine,apomorphine,aloin, willow bark, ginger, ammonia, belladonna, atropine,hyoscine, scopolamine, coca, opium, and morphine
Miracle Cures
Drugs promised treatment in secrecy, treatment at reduced costs, no institutionalization, didn’t interfere with dailyactivitesHangover Remedies 1930: Good SamaritanAlcoholism cures 1860-1930:Hay-Litchfield Antidote 1868Drug Habit Cures: Mrs. Baldwin’s Home CureAppeals to Wives and Family Members: White Star Secret Liquor Cure
Fraudulent Cures
Carney Common Sense Opiate Cure: contained morphineHarrison’s Opium Cure: 20% Alcohol, 5% opiumNormylTreatment for Alcoholism: contained 75.5% alcoholSt. Anne’s Morphine Cure: contained morphine and caffeine
Religious Conversion as a Remedy
Salvation ArmyWilliam Booth, 1890: alcoholism was a disease often inherited, always developed by indulgence, but as clearly a disease asophthallmiaor stoneDetoxCocktail: Raw eggs, Worcestershire sauce, Epsom saltsMoved towards nature of alcoholism and appropriate treatmentSA members against disease concept because it reduced alcoholic’s ‘moral responsibility’
Charles B. Towns Hospital
1901 opened hospitalTried to cure opium addictions in China in 1908Alcoholism was the product of the body’s systematic poisoning by alcohol and other drugsCure consisted of:Belladonna,hyoscyamusandxanthosxylum
Eugenics as Alcoholism Remedy
1902: T.D. Crothers agreed with degeneracy of alcoholics as parentsPeople thought alcohol contributed to natural selectionSterilization of addicted1905 Indiana law
‘Natural’ Therapies
Water curesHydrotherapyDrug Therapies: 1860-1930Whiskey and beerCannabisindicaCocaHyosycamusBelladonnaAtropineNauseants
Morphine: Dr. J.R. Black 1889Cheaper and less socially and economically devastating to alcoholic and familySedativesChloral HydrateParaldehydeConvulsive Therapies: 1930sLobotomiesMiscellaneous treatmentsExposure to hot-air boxes and light boxesOxygen inhalation
Aversion Therapy
1935 Dr.VoegtlinInjected emetine and drank alcoholPatient vomited and continued to drink and vomit until nausea was stoppedRepeated every other day until four or five treatments completed
Drug Treatment for Narcotic Addiction
1884 Freud recommended use of cocaine as cure for addiction to morphineExperimented on himself and those close to himThree approaches:Cold TurkeyStep-down of drug dosage over short period of timeGradual weaning over long period of time
Drug Treatment for Narcotic Addiction Continued
Harrison Anti-Narcotic Act 1914Restricted use of opiates and cocaine to legitimate medical purposesBecame illegal for physicians to prescribe morphine to addict to keep them comfortableRecommendations to keep addicts systems in-balance similar to those with DiabetesProsecution of 25,000 physicians who still prescribed narcotics to addicts
Federal Narcotic Farms
1929 Porter Act: allocated funds for U.S. Public Health Service to construct and operate two “narcotic farms” which would house and rehabilitate addicts/offenders who had been convicted of violating federal drug lawsLexington Narcotics Farm 1935Fort Worth, Texas 1938Involuntary and Voluntary clients
Modern Alcoholism Movement
1930-1955Redefined alcoholic from morally deformed perpetrator of harm to sick person worthy of sympathy and support; disease was treatable
1930-19561947 Shifted responsibility of careAmerican Medical Association 1956 declared chronic alcoholic should be viewed as a sick person
Mid-Century Treatment 1945-1960
Lack of hospital beds in 1950 made difficult for alcoholics to be admitted for detoxificationPsychiatric hospitals were primary source of care during middle decades of the 20thCentury1946: APA recommends improvements for institutions; every hospital that received alcoholics and addicts to provide specialized unit for their care and provide adequate staffing levels for administration of specialized care
Mid-Century Alcoholism Treatments
1960:Jellinek’sdisease concept of alcoholism described five major species of alcoholismAlphaBetaGammaDeltaEpsilon
Mid-Century Alcoholism Treatments
Hypnosis 1950sDrug InterventionNutrition and Vitamin TherapyACTH:AdrenocorticotropicHormonesTranquilizers, Anti-Depressants, Mood Stabilizers, and SedativesBenzedrineAntabuseLSDCarbon Dioxide
Rise of New Approaches
Narcotic addiction more as a problem of criminal deviance than a diseaseBoggs Act 1951Narcotic Control Act 1956
Rise of New Approaches Continued
Heroin Addiction was a chronic biological condition characterized by: relapse, incapable of abstinence, and needed narcotic maintenance for sobrietyBlockade Treatment 1965
Narcotic Addict Treatment Act 1974: Guidelines governing operation of methadone detoxification and maintenance clinics
Questions
Why do you think the Government passed so many laws to guideline the use of certain narcotic drugs but not ever alcohol?Why do you think physicians put their job on the line during the 1900’s to help maintain addicts addiction?Why do you think the view of addiction changed so often throughout history of treatment?
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