EARLY ADDICTION TREATMENT ZACK POORE
OUTLINE The development of treatment options for addiction has involved the input of many different people, practices, and eras Examine three different developments in addiction treatment: • Early attitudes toward alcohol and drug use, and the first attempts to address addiction • The development of homes and asylums for a more regimented approach to treatment • Physical attempts at treating addiction Draw connections between how past treatment methods have influenced modern recovery efforts
EARLY RECOVERY MOVEMENTS LATE 1700’S – 1870’S
LATE 1700’S – EARLY 1800’S Native Americans • Did not consume alcohol before Europeans settled • Psychoactive drug use for religious reasons • Some objected to alcohol, others incorporated it Early slave populations • Moderate to little use of alcohol • Initially thought immune • Later, forced to drink heavily as punishment
LATE 1700’S – EARLY 1800’S Benjamin Rush • Member of Continental Congress, signed Declaration of Independence, Physician General of Army • Personal reasons for interest in alcoholism • Father an alcoholic • Stepfather abused mother under the influence • Recommended soldiers, farm laborers, quit receiving daily rations of alcohol
LATE 1700’S – EARLY 1800’S Benjamin Rush, continued • First to suggest chronic drunkenness a medical issue • Defined typical behaviors of the alcoholic • Tendency to pass through generations • Criticized harshly for this • Radical treatment by today’s standards (bleeding, inducing vomiting, etc.) • Permanent sobriety • Necessary component of treating alcoholism • Achieved through “religious, metaphysical, and medical” means • Proposed a “Sober House” in 1810
LATE 1700’S – EARLY 1800’S The Early Temperance Movement • Public drunkenness and Rush’s work caused role of alcohol to be questioned • Total ban or encourage moderation? • By 1825, complete abstinence advocated for • Alcohol addiction portrayed as unavoidable if used • Addressed sober individuals and social drinkers • Felt alcoholics would die off on their own; no need to treat
1830’S – 1840’S The Temperance Movement • In decline due to support of prohibition, advocacy of abstinence over moderation, and its abolitionist stance on slavery The Washingtonian Total Abstinence Society • Formed at a Baltimore tavern by four working class men in 1840 • Met weekly to engage in experience sharing • Discussed consequences of alcohol use and how each member had learned from their experiences
1840’S The Washingtonian Total Abstinence Society, continued • Welcomed new members, who were asked to tell personal story and sign an abstinence pledge • Growth was a crucial part to the society’s mission: • “Let every man be present, and every man bring a man.”
1840’S The Washingtonian Total Abstinence Society, continued • Initially oriented toward working-class society • Soon found society elites among its ranks • Eventually, the group attracted non-alcoholic, but abstinent members to its meetings • Equally moved by the emotional aspect of meetings
MID- 1840’S The Washingtonian Society’s Decline • Despite its growth across the US to over 600,000 members strong by 1843, the group became almost obsolete by 1847 • High-energy and emotion at the beginning, but lacked ongoing support to sustain it • No recovery program to assist in maintaining sobriety • Little focus or organization
MID- 1840’S The Washingtonian Movement’s Legacy • First widespread support option created by and for recovering alcoholics • Recognition of committed sobriety as an emotionally powerful act • Use of fellow recovering alcoholics as a social and support outlet • Religious/spiritual references
LATE- 1840’S Fraternal Temperance Societies • Secret recovery groups • Followed many Washingtonian principles, but open only to recovering alcoholics • Some chapters opened membership to women; a few chapters formed exclusively for women • Also lacked a defined recovery component, and membership declined by the late 1800s
1870’S “REFORMERS Reform Clubs MEETING — There will • Osgood’s Reformed Drinkers be a meeting of reformed Club: Formed in 1871 by J.K. drinkers at City Hall, Osgood in Gardiner, Maine Gardiner, on Friday Evening, January 19 th , at 7 o’clock. A cordial invitation is extended to • Reynolds’ Red Ribbon Reform all occasional drinkers, Clubs: Founded by Dr. Henry constant drinkers, hard drinkers, and young men Reynolds in 1873 in Bangor, who are tempted to Maine after pleading with God to drink. Come and hear cure him of his alcoholism what rum has done to us.”
INEBRIATE HOMES AND ASYLUMS FOR THE TREATMENT OF ADDICTS EARLY 1800’S – 1960’S
EARLY 1800’S Growing sense of physically detrimental effects of alcohol use • Withdrawal symptoms ( delirium tremens or “DT’s”) • Cirrhosis Recognition of mental effects of alcohol use • Some people prone to violence • “Drunken furor” or “pathological intoxication”
EARLY 1800’S Pre-Asylum Care Options • Undesirable places for alcoholics, such as jail or the lunatic asylum • Not equipped to treat addicts, nor desired to do so Samuel Woodward • Influential doctor specializing in mental diseases • Claimed in 1833 that institutionalization could cure half of America’s alcoholics
1870’S American Association for the Cure of Inebriates • Formed when only six institutions for addiction treatment existed • By the end of the decade, represented 32 institutions • By the 1900’s, over 100 US addiction facilities existed
LATE 1800’S Treatment Environment • Difference between inebriate “homes” and “asylums” • Homes provided less treatment, more comfort • Asylums emphasized medical treatment • Institutions often referred to themselves as lodges, institutes, or retreats • Allowed patients to remain discreet about their treatment • Encouraged upper-class clientele
LATE 1800’S Methods of Treatment • Some institutions treated on an outpatient basis • For research purposes • Patients came in to receive medicine multiple times a day, then returned to their home or a hotel • Staff • Comprised of medical and religious professionals, as well as reformed alcoholics
LATE 1800’S Methods of Treatment, continued • Voluntary homes could only support, encourage sobriety • Some, however, got creative in getting patients to detox • Isolation • Kept patients from temptations and stressors of daily life • Detoxification • Either “cold turkey” or phased out
LATE 1800’S Methods of Treatment, continued • Physical restoration • Rest, exercise, and treatment of medical problems • Social support • Sharing of feelings, thoughts with other patients • Clubs, recreational activities, daily upkeep • Counseling • Notably absent from the era’s treatment plans
LATE 1800’S Philosophies of Treatment • Inebriety • Craving, compulsion, consequences • Etiology • Examined cause(s) of addiction, whether it should be considered a crime or disease, biological or environmental • Voluntary or Coerced • Treatment or Cure • Treatment Goal • Complete and continued abstinence
1870’S – 1880’S The Beginning of the Keeley Institutes • Dr. Leslie Keeley sought a cure for addiction • Founded the first Keeley Institute in Dwight, IL in 1879 • Proclaimed that his finding of the “Double Chloride of Gold Remedies” would cure alcoholism • In 1881, the Illinois State Board “Drunkenness is of Health temporarily revoked Keeley’s medical license a disease, and I • Due to “unprofessional” can cure it.” advertising
1890’S The Keeley Institutes “Send me six of • Keeley’s challenge to Joseph the worst Medill in 1891 drunkards you • Medill sent a stream of alcoholics to Keeley’s institute can find, and in who he claimed “went away three days I will sots and returned gentlemen.” sober them up • Franchised when the original and in four weeks institute was overloaded with I will send them admission requests back to Chicago • By 1893, 118 Keeley Institute sober men.” branches existed in the US and Europe
1890’S The Four-Week Keeley Treatment • Mostly admitted on a voluntary basis • Few restraints unlike many asylums of the era • No confinement, free to socialize with almost no supervision • Only explicit daily requirement was to be in line for injections of Keeley’s remedy four times a day • Notably, whiskey was provided for patients until they lost the appetite for it after a few days
1890’S – 1900’S The Keeley Treatment – Did it Work? • Institute claimed a 95% effectiveness rate • Also said to cure opium and tobacco addiction • Reported relapse rate was 4.7% What was in Keeley’s Medication? • Founders pledged to keep composition a secret, although most alluded to it containing gold • One founding member claimed in 1907 that the injections were just a placebo to keep patients in- residence
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