EARLY ADDICTION TREATMENT ZACK POORE OUTLINE The development of - - PowerPoint PPT Presentation

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

• f 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
• ff 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

• ngoing 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
• utlet
• 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

Reform Clubs

• Osgood’s Reformed Drinkers

Club: Formed in 1871 by J.K. Osgood in Gardiner, Maine

• Reynolds’ Red Ribbon Reform

Clubs: Founded by Dr. Henry Reynolds in 1873 in Bangor, Maine after pleading with God to cure him of his alcoholism

“REFORMERS MEETING—There will be a meeting of reformed drinkers at City Hall, Gardiner, on Friday Evening, January 19th, at 7 o’clock. A cordial invitation is extended to all occasional drinkers, constant drinkers, hard drinkers, and young men who are tempted to

• drink. Come and hear

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

• f 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

• f 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,

• r 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
• f 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
• f Health temporarily revoked

Keeley’s medical license

• Due to “unprofessional”

advertising

“Drunkenness is a disease, and I can cure it.”

1890’S

The Keeley Institutes

• Keeley’s challenge to Joseph

Medill in 1891

• Medill sent a stream of

alcoholics to Keeley’s institute who he claimed “went away sots and returned gentlemen.”

• Franchised when the original

institute was overloaded with admission requests

• By 1893, 118 Keeley Institute

branches existed in the US and Europe

“Send me six of the worst drunkards you can find, and in three days I will sober them up and in four weeks I will send them back to Chicago sober men.”

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
• f 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

1900’S – 1960’S

The Decline of the Keeley Institutes

• Increasing criticism of Keeley’s cure
• Keeley spent his last years fighting to validate his treatment,

but would die in 1900 as a millionaire

• Franchises would number less than 50 by 1900
• During the 1940’s and 1950’s, Keeley’s “Double Chloride of

Gold” was replaced by a pink solution injection called “tonic medicines” and a bitter fluid taken orally

• By 1960, the Keeley Institute lowered its success rate to 50%
• A move toward government-oriented treatment led to the
• riginal Keeley Institute’s closure in 1966

1960’S

Keeley’s Legacy

• Composition of Keeley’s

treatment has never been revealed

• Was Keeley a deceitful

entrepreneur, or did he have an answer?

• Disease concept of

alcoholism

• Emphasized the importance
• f healthy social relationships

in recovery

DISCUSSION QUESTIONS

What do you think—was it Keeley’s secret formula that successfully treated his patients, or was it merely a placebo that tricked them into facing their addiction issues? If Keeley’s formula was only a placebo, was it ethical to mislead his customers in this way?

PHYSICAL METHODS OF TREATING ADDICTION

1840’S – 1950’S

THE EUGENICS MOVEMENT

Developed in the 1880s with the goal of improving the human race through genetic manipulation Acknowledged many of the biological consequences of addiction; claimed that this contributed to the degeneracy of the human race

• Children of addicts more susceptible to addiction themselves
• Miscarriages and other birth defects due to alcohol use

Some eugenists saw addiction as a form of natural selection, as it would kill off those weakest to the temptations of alcohol and drugs

FORCED STERILIZATION OF ALCOHOLICS

1905 Indiana law that prohibited habitual drinkers from marriage 1911 Iowa law made incarcerated or institutionalized addicts suitable for sterilization In the 1940s and 1950s, some institutionalized women not discharged until they complied with a “voluntary” sterilization In Nazi-era Germany, anywhere from 20-30,000 Germans were forcibly sterilized for alcoholism

EARLY DRUG THERAPIES

Morphine

• Dr. J.R. Black recommended inducing morphine addiction as a

substitute for alcohol in 1889

• Claimed its effects as being relaxing rather than causing

abrasiveness, less dangerous

Early attempt to find an alcohol vaccine

• 1899 – 1903
• Sepalier and Dromard’s experiment involved giving horses large

amounts of alcohol until they were dependent, then transferring blood into sober horses whose antibodies rejected it

• Inconclusive results when applied to humans

OTHER PHYSICAL TREATMENTS

Convulsive Therapies

• First utilized in 1934 when Dr. J.L. Meduna saw a decrease in

depression after a patient had a seizure

• Initially induced seizures through drugs; later with electrical

currents

• Sometimes used as a punishment to unruly alcoholics in

institutions who upset staff Lobotomies

• Largely ineffective in treating alcoholism
• Some addictions actually worsened following the procedure

OTHER PHYSICAL TREATMENTS

More Mysterious Treatment Methods

• “Typhoid fever therapy”
• “Colonic irrigation therapy”
• In 1900, one physician suggested infecting alcoholics with

gonorrhea

DISCUSSION QUESTIONS

http://www.vice.com/read/could-marijuana-help-addicts- recover-from-alcoholism-and-hard-drug-use-234 A 2009 study found that up to 50 percent of cannabis users used marijuana in place of alcohol. Some medical marijuana advocates have started discussing marijuana as a possible treatment option for alcoholism. Do you see this as an effective treatment for alcoholism? Why or why not? Is it ethical for medical and mental health professionals to substitute one addictive substance for another in addressing a client’s recovery?

VIDEO

https://www.youtube.com/watch?v=sGtzMbKOVts