Transcript Slaying The Dragon

Slaying The Dragon
Catherine Przybyl
Early History
• Benjamin Rush: 1746-1813
• Father of American Psychiatry
and first American authority
on 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
of 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
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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
often 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
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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 inbalance 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
of harm to sick person worthy
of 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
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Alpha
Beta
Gamma
Delta
Epsilon
Mid-Century Alcoholism Treatments
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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
operation 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?