HSR 1204 Chapter 2 (2016) R

Chapter 2
Historical Perspectives
3 Themes
• Ambivalence about the role of intoxicants in society
& the pleasure & pain associated w/ their use.
• Different reactions to the same drug over time
– Once medicine now criminalized
– Not chemical ingredients but race, gender and class
• Increase in potency once banned
Early History
• Alcohol back to 5000 BC Iran
– Given as part of war rations
– Time of 1st established permanent settlements &
domestication of animals
• Wine Gods
– Rome: Bacchus
– Greeks: Dionysus
• Used to pay wages; major export of Greece
Early History
• Egyptians
– Used alcohol as Rx
• Still used in religious ceremonies (Catholic)
• Unknown to world’s indigenous people
– Traders and soldiers brought alcohol
Early History
• Spaniards – Cannabis
• Native Americans - Peyote
Early History
• Arabian doctor discovered evaporated distilled spirits.
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Technology exceeded its grasp (alcohol strong; centuries to develop)
• Self-indulgence; food and alcohol
– Roman vomitorium
– Beginning of binge-purge
– Anorexia started w/ religious fasting
Early History
• Opium
– ( China) used as cure for everyday maladies
– Opium with alcohol “fashionable” cure for boredom
– Opium Wars of 1839 to keep market open for trade
Early History (Europe)
• Alcohol safer to drink than H2O (purification)
• 1575 -- distilling -gin.
• Great devastation from England, 1700-1750.
– Technology too fast
– Inability to adjust to displacement
– Availability of cheap gin
• Epidemic drunkenness
– Infant starvation & mortality
• Prevention of growth from 1700 - 1750
– Crimes of violence all social classes
• Industrial revolution: change; need for sober workers
North America (Colonial times)
• Puritan traditions
– More beer than water on Mayflower
– Blessing from god
– Men, women & children:
• all drink
• tavern as social hub
– Punishment for nuisance behavior
– Lack of concern of alcohol use disorder
– Used as antiseptic, solvent and pain killer
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Colonial Times
• Native Americans saw alcohol as part of ritual; peyote
– Drink to hallucination like peyote
– Colonials used this to trade unfairly with Native
Americans
• Alcohol
– Jamaican rum <molasses>
– used to trade for slaves
• 18th Century– Quakers/Methodists disapprove of hard liquor
• Morphine given as cure for alcohol
• Drinking now seen as problematic
Early 1900s
• 1900 prohibition of tobacco (illegal in 14 states)
– Opium, morphine & heroin sold O-T-C
• Addiction to morphine in medical text 1900
• Heroin replaced morphine
– Tobacco given to immigrants as they leave boat
• WWI given to soldiers
• Evil of foreign war not drugs
• Change in policy on drugs
Early 1900’s
•
Cocaine in Coke until 1903
– A popular “pick me upper”
– Cocaine was seen as a remedy for addiction
• New drugs to “Cure” from old drugs = just as addictive
Things are to change; growing concern over addiction
Early 1900’s
• 1914 Harrison Act –
– Restricted opioids & cocaine (must be prescribed)
– Inadvertently created a “drug underworld”
– Price of drugs increase
• heroin $6.50 per oz to $100
– Fear of drug dealers
Early 1900’s
• Marijuana - “substance bring pleasure” (medicinal)
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Mexican immigrants
Change in attitude following Mexican/American war
Selling to school children
1914 – 1931
• 29 states outlawed marijuana
– 1936 - “Reefer Madness”
– Marijuana Tax Act of 1937 : criminalization
Early 1900’s
• Ireland; two major developments
– Disease model of AA
– Harm reduction
• Ireland=Tee-totaler –
– “T” placed after men in social register who totally abstained
• German and Irish influence
– Lager beer
• ‘A wholesome alternative for Americans who wanted to give
up spirits without joining the tee-totalers”
– Whiskey = “water of life” in Gaelic
Early 1900’s
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• Needs to be continuity
Social Policy
Social
Belief
Systems
Integration
Theory &
Practice
Temperance Movement 1825-1919
• Against hard liquor
– Beer & wine ok
– Temperance = moderation
• Shift to abstinence
– Severe SUD = moral failing
• Family survival:
– Chronic drunkenness
– Violence
– Family poverty
• Temperance woman for:
– Women’s suffrage
– Ban on distilled beverages
• Fear if women vote then ban saloons
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U.S. Prohibition 1920-1933
Prohibition = “Nobel experiment” that:
• Glamorized crime;
– James Cagney “White Heat”, “Public Enemy”
• Corruption; creation of organized crime
– Now alcohol illegal; tobacco legal
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Prohibition
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Washington DC
Pre-prohibition Joseph Kennedy sold alcohol
Mafia; Lucky Luciano and Frank Costello
Link to Sam Giancana; mafia godfather
“Double Cross” by Chuck Giancana
Assassination of John and Bobby
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U. S. Prohibition
• Homicide rates almost doubled
• Death rates increase from:
– Alcohol poisoning
– Cirrhosis of the liver
• Shift to hard liquor
– Easier to get
– Drinking = drunkenness
• Women drinking in public
– Bad mothers
– Promiscuous
• Marijuana became popular
• 1933 – end of prohibition
– Depression = needed jobs = return to liquor industry
– Drinking age 21
– Dry counties
– No alcohol sale on Sunday
Modern War on Drugs
• Political underpinnings
– Toward immorality and deviance
– Away from economic inequality and injustice
• Nixon “War on Drugs”
– To separate from “War on Poverty” Lyndon Johnson
Modern War on Drugs
• Extensive exposure in media
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1960s – heroin
1980s – crack cocaine
1990s – designer drugs; ecstasy
2000s – methamphetamine
• Like Prohibition
– Poor
– Urban social disorder
• Racism
– 100:1 ratio:
– 500 g cocaine = 5 year incarceration
5 g crack = 5 year incarceration
Modern War on Drugs
• All drugs not treated the same
– Crack vs meth
– Punishment for crack vs treatment for meth
• Backfire
– Property seizure
– Need for more prisons
– Drug policies= increase $ dealer profit
increase city $ for enforcement (70%)
– Turn to cheaper drugs
– Publicity of ecstasy led to increased use
Why the Need for Treatment?
• 2005
– 3.9 million aged 12 or older received tx
– 1.5 million for both alcohol and other drugs
– 700,000 for other drug problems
– 1.3 million for alcohol
• 2007
– 23.2 million aged 12 or older
• 2-3% gambling problem
History of Addiction Treatment
• 1933 – end of prohibition
– Shift to illness vs. low morals
• William White, Slaying the Dragon.
– Mistreatment to those mentally ill and alcoholic in asylums.
History of Addiction Treatment
• “Getting Better” by Nan Robertson
• Bill W. and Dr. Bob (Bill listed in 100 most influential)
• Big Book (1939)
– 2 million members in AA worldwide today
– Organized supporters in 12 Step programs
– Reduced stigma away from “snake pit” treatment
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History of Addiction Treatment
• Jellinek (The Disease Concept, 1960) Statistician
• 5 types of Severe Substance Use Disorder
• Alpha –
– undisciplined drinking; relieve emotional stress
– psychological dependence; no progression
• Beta –
– heavy drinking; medical problems; no dependence
• Gamma – tolerance; loss of control; withdrawal; progression; interpersonal prob.
– Great Britain, northern European countries, AA members
– Basis for Jellinek chart; primary; chronic; progressive; fatal if no tx
• Delta – inability to abstain; no loss of control (woman .26 BAC)
– France
• Epsilon -periodic; binge drinking; physical & emotional damage
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Treatment History continued
• 1956 AMA declared Severe SUD (alcoholism) a disease
• Harold Hughes –founded NIAAA (1970)
– National Institute on Alcohol Abuse and Addiction
– Research and improved treatment for Substance Use Disorders
• National Institute on Drugs Abuse (NIDA)
– Concern of Vietnam vet’s drug use
• Hazelden adapted 12 Step approach
– Minnesota Model of treatment (multidisciplinary)
– psych, therapy, clergy, spirituality, self help, 12 – step & group tx
• Late 1970’s Betty Ford
History of Addiction Treatment
• Backlash 1980 - 1990
– Peele & Fingarette: addiction as bad habits not disease
– Legal system; not a disease but willful misconduct
– Funding cuts; tx out of reach $ for client
• Positives
– Furthering of professionalism in the field
– Third party payer; licensed = insurance will pay
– Widen scope; gambling, sex, internet and Rx addiction
History of Addiction Treatment
• Current:
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Motivational interviewing (1996)
‘Stages of Change’ – Prochaska and Di Climente (1982)
Transtheoretical model
Change in stages not all at once
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History of Harm Reduction
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1980s Netherlands - AIDS
– To save lives & modify drug behavior
– Those unwilling or unable to abstain
– Strength based
• Positive possibility
• Hope
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Harm reduction in action:
• Heroin, methadone or morphine prescribed
• Needle exchanges-U.S. 150 cites in urban areas
• Education
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Britain, 1960s and later
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Harm reduction outcomes (2004)
– NY City infection rate of 60% (without)
– Liverpool rate of 0.1% (with)
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Alcohol Harm reduction
– Designated driver
– Moderation vs. binge drinking
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Treatment in Norway
• “Treatment in Norway”—universal health care for support
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Little paperwork
Clients get paid leave as needed
100% literacy
“Pure” alcohol misue- no other drugs
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Norway Treatment (continued)
• Multi-treatment influences
– Western
• Individual and family disease model
• Feelings; communication; personal sharing
– Eastern
• Detox naturally; acupuncture
• Meditation with music
• Nutritious diet
– Welfare state
• 5 weeks paid inpatient tx
• Family week programs
• Paid aftercare
– Trauma and mental health
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