PAC 320 Module 1 The History and Theory of Addiction Example

We Have Been Here Before: A History of Addiction Theory, Policy and Treatment in America for New Treatment Staff

Student Name

Psychology and Addiction Studies Program, Aspen University

PAC 320: Psychology of Addiction

Instructor Name

Month Day, Year

We Have Been Here Before: A History of Addiction Theory, Policy and Treatment in America for New Treatment Staff

Cedar Hill Recovery Center, an invented residential and outpatient program in Asheville, North Carolina, hires about a dozen new counselors, nurses and technicians each year. In orientation, many say that today's understanding of addiction is new: that only recently has anyone treated it as a disease, that harsh drug laws are a modern invention or that treatment began with Alcoholics Anonymous. None of these beliefs is accurate. This paper traces the history and theory of addiction in America for new staff, so that they can recognize old patterns in current debates. Cedar Hill and its staff are composites; the history is real.

Cycles of Tolerance and Intolerance

Musto (1991) described American drug history as a series of cycles. In the late nineteenth century, opium and cocaine were widely available in patent medicines, tonics and soft drinks, sold without prescription, and the typical opiate user was a middle-class woman taking medicine. As awareness of addiction grew, and as drug use became associated in public fears with minority groups and with crime, attitudes hardened. Federal regulation followed, most notably the Harrison Narcotics Act of 1914, which restricted opiates and cocaine to medical prescription. Cocaine use, widespread around 1900, declined over the following decades as its dangers became common knowledge and laws tightened, and the memory of the epidemic faded so thoroughly that later generations rediscovered cocaine as if it were harmless. Marijuana followed a similar path, with federal restrictions in the 1930s. Musto argued that each cycle moved from tolerance and enthusiasm through growing awareness of harm to intolerance and strict control, followed by forgetting.

The Disease Concept

Jellinek (1960) gave the twentieth century its most influential theory of alcoholism. Drawing on surveys of members of Alcoholics Anonymous and on international research, he described several types of problem drinking, which he labeled with Greek letters. Alpha alcoholism was psychological dependence without loss of control; beta involved physical complications without dependence; gamma was marked by tolerance, withdrawal and loss of control, the pattern most common among AA members in America; delta was marked by inability to abstain, more common in wine-drinking cultures; and epsilon was periodic binge drinking. Jellinek argued that only gamma and delta clearly qualified as diseases. His careful distinctions were often lost in popular use, where his work became shorthand for the idea that all alcoholism was a single, progressive disease.

A History of Treatment

White (1998) traced the history of addiction treatment in America. In the mid-1800s, a movement of inebriate homes and asylums treated alcoholism as a medical and moral condition, often in residential settings. Later in the century, commercial cures, such as the Keeley Institutes with their gold chloride injections, treated hundreds of thousands of people with remedies of little scientific basis. After 1920, with Prohibition, the decline of the inebriate asylums and the rise of punitive approaches, organized treatment largely collapsed, and many people with addiction were managed through jails and state hospitals. Alcoholics Anonymous, founded in 1935, offered a mutual help alternative. In the 1950s, programs in Minnesota combined professional staff, recovering counselors and twelve-step principles in a residential model that spread nationally and became the template for many programs, including the original design of residential programs like Cedar Hill's.

A Timeline of Ideas and Consequences

Cedar Hill in This History

Cedar Hill itself is a product of this history. It opened in the 1970s as a twenty-eight-day residential program on the Minnesota model, with recovering counselors, lectures on the disease concept and daily twelve-step meetings. In the 1990s, as insurers cut residential stays, it added outpatient care. In the past decade, it began offering medication for opioid use disorder, a change some longtime staff resisted because it conflicted with the abstinence philosophy they had been trained in. Each of these changes reflected a wider shift in ideas and policy, and each was debated inside the center as fiercely as it was debated outside. New staff join an institution whose own practices carry the marks of earlier theories.

Lessons for New Staff

History offers several lessons. First, ideas about addiction recur. The disease concept is not new; it appeared in the 1800s and again in the 1950s. The idea that addiction is a choice or a moral failing has also returned repeatedly. Staff will hear both in their careers, often presented as new. Second, public attitudes shift, and with them policy and funding. Musto's cycles suggest that today's attitudes toward opioids, cannabis or stimulants will change, and staff should expect the populations and drugs they treat to change too. Third, treatment has sometimes rested on weak evidence, as the Keeley cures did, and sometimes collapsed when public attitudes turned punitive. Cedar Hill's commitment to evidence-based practice is a protection against repeating both mistakes. Fourth, theories have often been simplified in popular use, as Jellinek's careful typology was. Staff should return to original sources when a theory is invoked to justify practice.

Conclusion

Addiction in America has been understood as sin, disease, crime and chronic illness, often more than once. Musto shows the cycles of tolerance and intolerance that drove policy, Jellinek shows how a careful theory became a slogan and White shows how treatment rose, collapsed and was rebuilt. For new staff at Cedar Hill, the history is practical: it explains where today's ideas came from and suggests that the field will keep changing.

References

Jellinek, E. M. (1960). The disease concept of alcoholism. Hillhouse Press.

Musto, D. F. (1991). Opium, cocaine and marijuana in American history. Scientific American, 265(1), 40-47. https://doi.org/10.1038/scientificamerican0791-40

White, W. L. (1998). Slaying the dragon: The history of addiction treatment and recovery in America. Chestnut Health Systems.