Slaying The Dragon Catherine Przybyl Early History Benjamin Rush: - - PowerPoint PPT Presentation

Slaying The Dragon

Catherine Przybyl

Early History

• Benjamin Rush: 1746-1813
• Father of American Psychiatry

and first American authority

• n 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

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

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

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

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

Philosophies, Methods and Outcomes

• f 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

• 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

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

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

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

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

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

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

Religious Conversion as a Remedy

• Salvation Army
• William Booth, 1890: alcoholism was a disease
• ften 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’

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

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

‘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

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

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

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

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

Modern Alcoholism Movement

• 1930-1955

▫ Redefined alcoholic from morally deformed perpetrator

• f harm to sick person worthy
• f 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

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 20th 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

Mid-Century Alcoholism Treatments

• 1960: Jellinek’s disease concept of alcoholism

described five major species of alcoholism

▫ Alpha ▫ Beta ▫ Gamma ▫ Delta ▫ Epsilon

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

Rise of New Approaches

• Narcotic addiction more as a problem of

criminal deviance than a disease

• Boggs Act 1951
• Narcotic 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 sobriety

• Blockade Treatment 1965
• Narcotic Addict Treatment Act

1974: Guidelines governing

• peration 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?