1. Slaying The Dragon Catherine Przybyl

2. Early History Benjamin Rush: 1746-1813 Father of American Psychiatry and first American authority on alcohol and alcoholism Viewed drunkenness as a progressive medical condition ▫Drunkenness was transmitted between generations Described alcoholism as a disease Could spring from many conditions ▫Beer, wine and opium as alternatives Continued abstinence only hope for drunkard Sobriety included odd remedies ▫Linking drink with painful impression ▫Vegetarianism ▫Cold baths ▫Blistering the ankles

3. Temperance Movements Initial goal: replace excessive drinking to moderate drinking Encouraged to substitute wine and beer for distilled spirits Tried to convert whiskey-drinking drunkards to temperate beer-drinkers

4. Washingtonian Societies Shift from moderation to total abstinence No ideology of nature of alcoholism and its recovery, but activities to turn away from alcoholism First woman’s society opened in 1841 ▫Martha Washington Society Moderation Societies: 1879

5. Pre-Inebriate Homes and Asylums Samuel Burton Pearson and John Armstrong described alcohol-induced “Brain Fever” ▫Later known as delirium tremens Legends of drunkards spontaneously combusting ▫1850: Mary Clues

6. Inebriate Homes and Asylums 1860-1925 Inebriate Homes provided minimal level of treatment Inebriate Asylums large medically directed facilities ▫Used Lower and Middle class with industrial plan Private Sanataria had affluent clientele seeking place to dry-out

7. Philosophies, Methods and Outcomes of Inebriate Homes and Asylums 1880s Staff intoxicated while caring for inebriates Inebriates were placed into categories for treatment Excluded criminal degenerates or reckless characters Affluent seen as victims of a disease ▫Working class and poor seen as willful misconduct deserving punishment

8. 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 Women ▫Inebriety view ▫Slaves to cologne ▫Aides to nursing

9. American Association for the Cure of Inebriates: 1870 Intemperance is a disease It is curable in the same sense that other diseases are Its primary cause is a constitutional susceptibility to alcoholic impression Constitutional tendency may be inherited or acquired

10. Critics of the Association Philadelphia’s Franklin Reformatory Home for Inebriates withdrew from the Association Critics viewed inebriety as a hereditary weakness and advocated alcoholics should be left to die so alcoholism would eventually disappear Quarterly Journal of Inebriety from 1876-1914 ▫Advertisements for cures

11. Institutional histories New York State Inebriate Asylum 1864 Boston Washingtonian Home 1858 Chicago Washingtonian Home 1863 San Francisco Home for the Care of the Inebriate 1859

12. Keeley Institution: 1880-1920 1879 Dr. Leslie E. Keeley: proclaimed “Drunkenness is a disease and I can cure it” Saw drunkenness as biological in nature Double Chloride of Gold remedy for inebriety, tobaccoism and neurasthenia (nervous exhaustion) ▫Four daily injections  Alcohol, Stychnine, apomorphine, aloin, willow bark, ginger, ammonia, belladonna, atropine, hyoscine, scopolamine, coca, opium, and morphine

13. Miracle Cures Drugs promised treatment in secrecy, treatment at reduced costs, no institutionalization, didn’t interfere with daily activites Hangover Remedies 1930: Good Samaritan Alcoholism cures 1860-1930: ▫Hay-Litchfield Antidote 1868 Drug Habit Cures: Mrs. Baldwin’s Home Cure Appeals to Wives and Family Members: White Star Secret Liquor Cure

14. Fraudulent Cures Carney Common Sense Opiate Cure: contained morphine Harrison’s Opium Cure: 20% Alcohol, 5% opium Normyl Treatment for Alcoholism: contained 75.5% alcohol St. Anne’s Morphine Cure: contained morphine and caffeine

15. Religious Conversion as a Remedy Salvation Army William Booth, 1890: alcoholism was a disease often inherited, always developed by indulgence, but as clearly a disease as ophthallmia or stone Detox Cocktail: Raw eggs, Worcestershire sauce, Epsom salts Moved towards nature of alcoholism and appropriate treatment ▫SA members against disease concept because it reduced alcoholic’s ‘moral responsibility’

16. Charles B. Towns Hospital 1901 opened hospital ▫Tried to cure opium addictions in China in 1908 Alcoholism was the product of the body’s systematic poisoning by alcohol and other drugs Cure consisted of: ▫Belladonna, hyoscyamus and xanthosxylum

17. Eugenics as Alcoholism Remedy 1902: T.D. Crothers agreed with degeneracy of alcoholics as parents People thought alcohol contributed to natural selection Sterilization of addicted 1905 Indiana law

18. ‘Natural’ Therapies Water cures ▫Hydrotherapy Drug Therapies: 1860-1930 ▫Whiskey and beer ▫Cannabis indica ▫Coca ▫Hyosycamus ▫Belladonna ▫Atropine ▫Nauseants Morphine: Dr. J.R. Black 1889 ▫Cheaper and less socially and economically devastating to alcoholic and family Sedatives ▫Chloral Hydrate ▫Paraldehyde Convulsive Therapies: 1930s Lobotomies Miscellaneous treatments ▫Exposure to hot-air boxes and light boxes ▫Oxygen inhalation

19. Aversion Therapy 1935 Dr. Voegtlin ▫Injected emetine and drank alcohol ▫Patient vomited and continued to drink and vomit until nausea was stopped ▫Repeated every other day until four or five treatments completed

20. Drug Treatment for Narcotic Addiction 1884 Freud recommended use of cocaine as cure for addiction to morphine ▫Experimented on himself and those close to him Three approaches: ▫Cold Turkey ▫Step-down of drug dosage over short period of time ▫Gradual weaning over long period of time

21. Drug Treatment for Narcotic Addiction Continued Harrison Anti-Narcotic Act 1914 ▫Restricted use of opiates and cocaine to legitimate medical purposes ▫Became illegal for physicians to prescribe morphine to addict to keep them comfortable ▫Recommendations to keep addicts systems in- balance similar to those with Diabetes ▫Prosecution of 25,000 physicians who still prescribed narcotics to addicts

22. 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 laws Lexington Narcotics Farm 1935 ▫Fort Worth, Texas 1938 ▫Involuntary and Voluntary clients

23. Modern Alcoholism Movement 1930-1955 ▫Redefined alcoholic from morally deformed perpetrator of harm to sick person worthy of sympathy and support; disease was treatable 1930-1956 ▫1947 Shifted responsibility of care ▫American Medical Association 1956 declared chronic alcoholic should be viewed as a sick person

24. Mid-Century Treatment 1945-1960 Lack of hospital beds in 1950 made difficult for alcoholics to be admitted for detoxification Psychiatric hospitals were primary source of care during middle decades of the 20 th Century 1946: 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

25. Mid-Century Alcoholism Treatments 1960: Jellinek’s disease concept of alcoholism described five major species of alcoholism ▫Alpha ▫Beta ▫Gamma ▫Delta ▫Epsilon

26. Mid-Century Alcoholism Treatments Hypnosis 1950s Drug Intervention Nutrition and Vitamin Therapy ACTH: Adrenocorticotropic Hormones Tranquilizers, Anti-Depressants, Mood Stabilizers, and Sedatives Benzedrine Antabuse LSD Carbon Dioxide

27. Rise of New Approaches Narcotic addiction more as a problem of criminal deviance than a disease Boggs Act 1951 Narcotic Control Act 1956

28. Rise of New Approaches Continued Heroin Addiction was a chronic biological condition characterized by: relapse, incapable of abstinence, and needed narcotic maintenance for sobriety Blockade Treatment 1965 Narcotic Addict Treatment Act 1974: Guidelines governing operation of methadone detoxification and maintenance clinics

29. 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?