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The Evolution Of Addiction And Rehab

Addiction: A Historical Perspective

Alcohol and Drug Addiction

Drug and alcohol use dates back thousands of years.  In 3000 BC, as ancient farmers discovered the intoxicating powers of certain crops, they also created other products from those crops.  Barley was used to make beer, which was widely consumed.  Around the same time, opiates were being cultivated from opium poppy seeds, and used largely among the aristocracy. 

In ancient Greece, certain types of mead, fermented honey, and beer were found to have hallucinogenic properties.  Thus began the harvesting of plants containing these naturally occurring chemicals that induce hallucinations.  Like beer and opium, the primary reason to consume mead was for relaxation, but other uses would evolve over time, in particular to relieve pain, as more was learned about their effects.

This practice was widespread and accepted by society, so there was no attempt to curb use or seek any form of rehabilitation. 

When explorers discovered the Americas, they also discovered a thriving drug trade.  Merchants were involved in selling and trading cargo around the world, including drugs.  Tobacco leaves, containing nicotine, were dried and smoked, again primarily for recreation.  This highly addictive substance was then introduced to England, reportedly by Sir Walter Raleigh.   

With better built ships and little control, the sale of drugs and alcohol grew.  This led to rampant addiction to gin in Britain, and to rum, beer and cannabis among American colonists, as well as to the transportation and sale of other more problematic drugs. 

By the early 1800’s, the pain relieving properties of opium were well known by physicians.  New derivations of opium began to appear, including morphine in 1804.  The lack of governmental controls over the production and sale of morphine, coupled with its highly additive pain-relieving and euphoria-generating properties, resulted in epidemic levels of addiction.

Cocaine was believed to have healing powers, and was being used to treat any ailment, including morphine addiction and alcoholism.  An early example of using one drug to treat addiction to another without considering the effects of the cure on patients, cocaine was prescribed for decades by medical professionals, including Sigmund Freud. 

Heroin, also an opiate derived from the opium seed, soon followed, and was marketed as a non-addictive alternative to morphine.  Like cocaine, heroin is as addictive and dangerous as the drug it was supposed to replace, resulting in dependence for countless addicts.  No regulations existed to protect consumers, and the dangers of addiction were not fully understood. 

This lack of policing, combined with the thriving drug trade, resulted in a dramatic increase in the development and use of chemical, or synthetic, drugs.  LSD, a hallucinogenic, and methamphetamine, a stimulant, as well as synthetic opiates such as Fentanyl, are all relatively new drugs, but their use quickly led to widespread abuse and addiction. 

Methadone, a synthetic opioid, was first introduced in the 1960’s and used to treat severe pain and addiction to other opioids.  Methadone was formulated as a long acting medication.  It lasts significantly longer than short acting drugs like heroin, oxycodone, fentanyl and hydromorphone, so fewer doses are needed throughout the day.  When taken correctly, methadone prevents withdrawal symptoms, reduces cravings, and does not create the feeling of euphoria that is so addictive in other opioids.    

Stricter drug laws have been developed, social attitudes toward addiction have shifted, and more has been learned about substance abuse.  However, the production of synthetic drugs has flourished, and new drugs continue to appear at an alarming rate.  Law enforcement agencies, addiction researchers and medical practitioners are struggling to manage their use as millions remain addicted worldwide. 

Addiction to Other Substances

What individuals are consuming in order to become intoxicated has expanded to include substances that are not drugs or alcohol.  Everyday household products like glue, paint, aerosol sprays, whipped cream, nitrates, moth balls, bath salts, hand sanitizer, and over the counter medications like cough syrup and motion sickness pills, ingested in high enough quantities, can produce a high that is extremely addictive. 

Ingesting these substances is also extremely dangerous and can cause brain damage, respiratory distress, heart palpitations, hallucinations, and death. 

Food Addiction and Eating Disorders

Addiction to food has recently been recognized by medical experts, although it is not yet fully understood.  Individuals who are addicted to food are unable to monitor their intake, and eat excessively throughout the day.  This leads to morbid obesity and all of the associated health problems, as well as the same shame and stigma experienced by addicts who abuse drugs. 

The increased understanding of food addiction in general has altered the perception of obesity and chronic overeating.  Medical experts are beginning to view them through the lens of addiction, and to treat them accordingly, which should result in better outcomes for those affected by these conditions.

More is known about anorexia, bulimia, binge eating disorder, avoidant and restrictive food intake disorder, and other specified feeding and eating disorders.  These are serious mental illnesses and should be treated by specialists in a clinical setting

Any substance abuse or eating disorder requires immediate intervention by a medical practitioner.  Fortunately, society’s understanding of addiction, and the approaches to treatment, have changed dramatically since those first few sips of mead.

The History of Addiction Treatment

Alcohol and drug use was tolerated, even celebrated for centuries, but as awareness of the risks associated with substance abuse increased, so did the stigma.  As society struggled to understand addiction, often in the absence of medical research and expertise, that understanding, or model of addiction, continued to evolve.

Addiction As A Moral Failing

Prevalent in the 18th and 19th centuries, the moral model viewed addiction as a direct result of the addict’s weak moral character.  It was a criminal offense, with addicts being jailed.  Believed also to be a sin, cures included intensive prayer or placement in a mental institution.  Those facilities differ greatly from modern day rehab centres, and served more as prisons than hospitals.

Society’s perception of alcoholism and drug addiction as a moral failing, and as a crime, made any meaningful treatment impossible, as addicts would fear imprisonment, institutionalization and public humiliation if they admitted they had a problem.  With little to challenge the prevailing view, society’s lack of empathy for the struggle of the addict strengthened.

The temperance movement in the United States in the 1800’s began as a result of this viewpoint of addiction as a sin, and of addicts as degenerates.  Alcohol became something to be feared, and the only way to protect society was to remove anyone who drank.  Addicts were placed in drunk tanks in the local jail or an insane asylum.  Many states passed laws mandating sterilization of the mentally ill, the developmentally challenged, and those suffering from drug or alcohol addiction.

The New York State Inebriate Asylum, founded in 1864, was the first hospital to view alcoholism as a medical condition.  Dr. J. Edward’s idea was ground breaking at the time, but it was largely unsuccessful as it met with significant resistance.  He resigned in 1867, and his approach was declared a failure by the state not long after. 

Conditions and treatment of the patients here were also far from those in modern day facilities, and included regular, long-term use of restraints, but the philosophy was a shift from the moral model of addiction. 

The Effect Of Prohibition

Prohibition finally made the production and sale of alcohol illegal.  In Canada, this was relatively short-lived, but in the U.S. it spanned two decades, from 1920-1933.  Throughout those years, and the years leading up to prohibition, addiction was viewed by society and the government as a social problem, rather than a medical one. 

With the repeal of prohibition, the temperance movement and the moral model began to lose popularity.  This was the first step toward real reform in drug addiction treatment.

Addiction As A Disease

In the disease model, addiction is a medical condition that can be treated.  The early acceptance of this of this model began in 1864 with Dr. J. Edward and other medical pioneers who named addiction a disease, but it really rose in prominence with the founding of Alcoholics Anonymous in 1935 by Bob Wilson and Dr. Bob Smith. 

Alcoholics Anonymous (AA) provided a welcoming environment and a spirituality based approach.  The goal of the program was to treat addiction without punishment or shame.  The fact that AA members felt the need to remain anonymous is evidence of the prevalence and failure of the moral model to treat addiction. 

AA was the first to use the approach that has become synonymous with drug rehabilitation.  The 12 step program involves having each member complete a set of tasks in a specific order with the support of the group, accountability in the form of a sponsor, and regular attendance at meetings.  AA is strictly for those suffering from alcoholism, and is not intended to address any other addiction. 

Narcotics Anonymous (NA), Cocaine Anonymous (CA), and Marijuana Anonymous (MA) all support members with those specific addictions, and any combination of those with alcohol.  Gamblers Anonymous (GA) is one of countless groups treating compulsive behaviour as an addiction, and with the 12 step program. 

The 12 traditions were added in 1950, and refer specifically to the group as a whole, rather than to the individuals, as the steps do.  They provide the framework for the group itself, as well as the governing principles.   

The effectiveness of AA and its affiliated organizations has been well debated.  The members are addicts, and essentially treat their addiction themselves.  They are assigned a sponsor, who is a member and not a medical professional, and the same treatment plan is provided to everyone.

The disease model viewed addiction as a medical condition for the first time, and removed a great deal of the stigma.  This was a fundamental shift in thinking. 

In Freud’s psycho-dynamic model, which is still used today, substance abuse can be linked to incidents that occurred in childhood, and how well the individual is able to cope them as an adult.  Treatment includes therapy to help the patient understand the root causes of their addiction, and to improve self-esteem. 

Until the 1970’s, addiction was understood to be a physical reliance on a drug.  That thinking shifted with the appearance of the social learning model.  In that model, for the first time, addiction came to be viewed as a psychological dependence, as well as a physical one.  The focus is on the users’ thoughts about the substance, and what it feels like to take the drug. 

SMART Recovery (Self-Management and Recovery Training) was founded in 1994.  Similar to AA, it is a self-help program with one treatment plan, the 4-Point Program, that all participants follow.  Members meet regularly and support one another with their rehabilitation.  The key differences are that the SMART program is based on research, and there are not separate organizations for each addiction.

In the new millennia, the social-cultural model gained popularity.  That model was different from other models as it considers the role of the societal conditions on addiction, especially socioeconomic factors, as well as the social stigma associated with drug use. 

Cognitive Behaviour Therapy (CBT), is a newer form of psychotherapy that has been quite successful in treating a variety of conditions, including drug addiction.  Based on the theory that an individual’s thoughts, beliefs and attitudes can influence feelings and behaviour, it involves helping patients develop an understanding of their feelings and the link to their behaviour.  Working with a therapist, typically one-on-one, patients identify triggers for their substance abuse, learn better strategies and set goals for their recovery. 

Addiction Treatment Now

Modern rehab involves a patient centred approach.  This begins with an assessment of the alcohol or drug use problems, as well as any other related conditions.  A team of health care providers, who are experts on addiction, work with the patient to create a treatment plan tailored specifically to each individual.

Sometimes, treatment can take place in a community setting such as a therapists’ office, as an outpatient. 

If the substance abuse is longstanding and complex, it is best treated at an inpatient rehab centre, or a residential treatment facility.  These are better equipped to assist with the withdrawal symptoms associated with detox and prescribe any necessary medications, while simultaneously providing therapy to address the underlying causes of the addiction.

In order to reduce the chances of a relapse, an important part of any plan is continuing care, or aftercare, so that there is support with recovery once treatment ends.  This is also individualized and should include ongoing monitoring of addiction medications by a qualified medical practitioner, as well as counselling.  

Other resources available to aid in maintaining recovery include peer support groups and sober houses.  These homes provide an alcohol and drug free environment, and assistance with adjusting to life after rehab. 

Addiction to any substance is very serious and potentially life-threatening, and requires immediate intervention by a medical professional.


Strengthening Canada’s Approach to Substance Abuse Issues
Report Prepared for Health Canada, Date Modified:  2018-09-1

The Evolution of Addiction Models:  How Drug Rehab Thinking in Canada has Evolved
Posted by CDC Help Desk, May 14, 2018

A History of Drug Addiction and Treatment in the U.S.
Published July 11, 2012Cognitive Behavioural Therapy CAMH
Centre for Addiction and Mental Health, 2019

Archives and History Alcoholics Anonymous
Copyright 2019 by Alcoholics Anonymous World Services

SMART Recovery
Copyright, 2019 by SMART Recovery

New York State Inebriate Asylum
United States National Park Service
Last Updated July 26, 2017

Types of Eating Disorders

National Eating Disorder information Centre (nedic)
Copyright, 2019

Do You Know Methadone – CAMH
Centre for Addiction and Mental Health, 2012

Picture Credit:  PopScreen:  1901 Vintage Ad Cocaine Morphine Opium Home Cure