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"THE CHEMOPHILIC SOCIETY": ADDICTION RESEARCH AFTER THE CLASSIC

PERIOD OF NARCOTIC CONTROL, 1957-1975

A Thesis

Presented to

The Faculty of Graduate Studies

The University of Guelph

YVAN CRAIG PRKACHIN

In Partial Fulfillment of requirements

for the degree of

Master of Arts

April, 2008

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"THE CHEMOPHILIC SOCIETY": ADDICTION RESEARCH AFTER THE CLASSIC PERIOD OF NARCOTIC CONTROL, 1957-1975

Yvan Craig Prkachin Advisor: University of Guelph, 2008 Dr. Catherine Carstairs

This thesis examines the scientific investigation of drug addiction in the United

States and Canada between 1957 and 1975, following the Classic Period of Narcotic

Control. It argues that during this period the definition of 'addiction' changed from one emphasizing individual susceptibility and psychopathology to one emphasizing broad susceptibility based on the principles of behavioral psychology. This new paradigm of addiction gained widespread popularity in the scientific community because it provided compelling explanations for the new patterns of drug use and relapse that were observed in society during the 1960s and 1970s. The new field of addiction studies used this definition to advance the use of behavioral therapy for treatment, and to link together different drugs of abuse; this linking of different drugs also led neuroscientists to develop the neuropharmacological theories of addiction. The Addiction Research Foundation of

Ontario is also examined as a case study of these trends. Acknowledgements

It is something of a cliche to say that a scholarly thesis is the product of many people whose names do not appear on the title page. In the case of this thesis, however, such a notion is eminently true; this being the situation I have a rather large number of people to thank.

First and foremost I must offer my deepest thanks to my advisor, Dr. Catherine

Carstairs. Catherine provided me with support and encouragement even before I became a student at Guelph, and during our professional relationship she continually confirmed her reputation as one of the most helpful, encouraging and enthusiastic scholars working in Canada today. She is not only a gifted historian in her own right, but also a profound example of everything that a scholar ought to be, and I am truly grateful for the opportunity to have worked with her. I would also like to extend my thanks to Dr. Sofie

Lachapelle and Dr. Wendy Mitchinson, who served on my committee, and whose contributions were extremely helpful. Thanks also to Dr. Karen Racine, who chaired my defense, and Dr. Peter Goddard, who helped me navigate the Guelph graduate program.

The faculty and staff of the Guelph History Department deserve considerable praise for their professionalism and support.

It is also a cliche to thank one's parents and family; again, special circumstances intrude. I would like to thank my parents, Ken and Glenda Prkachin, not only for providing exemplary moral support, but also for their considerable technical wisdom and insight. Both of my parents have extensive experience in the fields of psychology and neuroscience, and their contribution to the final product was not inconsiderable. Thanks also to my sister, Eva, for her wisdom and support.

1 I would also like to take the opportunity to acknowledge the support of a number of my colleagues in the Guelph History Program. In particular, I would like to thank

Ryan Davidson, Natalie Dube, Jennifer Fraser-Lee, Emmanuel Hogg, Tom Hooper,

Jeanna Hough, Jill McMillan, Natalie Rocheleau, Camille Shieh, Ashley Shifflet and

Jessica Steinberg, all of whom at one point or another dealt with my characteristic neuroses.

Finally, I would like to extend my thanks to both the Social Sciences and

Humanities Research Council of Canada (SSHRC), and the Ontario Student Assistance

Program (OSAP), who provided me with, respectively, a Canada Graduate Scholarship and an Ontario Graduate Scholarship. Without such financial assistance my graduate education would not have been a possibility, and I am deeply grateful for their support.

I will conclude by saying that, while this thesis was a collaborative effort, all errors remain my own.

n Table of Contents

Acknowledgements i

Table of Contents iii

Introduction - "Medical Education Has Utterly Failed": The End of the Classic Period of Narcotic Control and the Modern Concept of Addiction 1

Chapter 1 - "Drug Addiction: Crime or Disease?": Drug Addiction and the Birth of Addiction Science, 1957-1965 21

Chapter 2 - "Drug-Seeking Behavior": 'Drug Addiction,' 'Drug Abuse' and Addiction Research Journals, 1965 - 1975 50

Chapter 3 - "On The Forefront of Knowledge": The Addiction Research Foundation and the Idea of Addiction, 1961-1975 80

Conclusion - "The Chemophilic Society": Addiction, Society, Science and Human Nature 105

Bibliography 113

in Introduction - "Medical Education Has Utterly Failed": The End of the Classic Period of Narcotic Control and the Modern Concept of Addiction

In December of 1973 the Final Report of the Commission of Inquiry into the Non-

Medical Use of Drugs was made available to the Canadian people. The Royal

Commission of Inquiry into the Non-Medical Use of Drugs, commonly referred to as the

Le Dain Commission, after its chairman Gerald Le Dain, began its work in March of

1969. Over nearly four years, the commission received 639 submissions from individuals and organizations, conducted public hearings in 27 cities, and released four reports;1 at the time it constituted one of the largest state-run research initiatives into drug use in the world. Today the commission is mostly remembered for its recommendation that cannabis be removed from the Canadian Narcotic Control Act.2

Less well-remembered is the LeDain commission's report on the treatment of drug addiction. The report authors stated:

Traditionally, drugs have been among the most powerful weapons in the therapeutic armamentarium of most doctors. And traditionally, doctors have been assumed to be experts in all matters concerning the effects of drugs on human beings. This was a reasonable assumption 30 or 40 years ago. Today, however, with the number of drugs used in the treatment of specific diseases increasing constantly, and with so many new drugs appearing which are not used primarily for the treatment of diseases, no physician can reasonably claim to be an expert on all drug effects.. ..[T]he entire subject of psychotropic drugs has left the medical profession divided, indecisive, and poorly prepared to deal with it, or even understand it. It is, in fact, the first large scale public health problem in which medicine has not assumed a major leadership role and which few individual physicians have faced squarely. Medical education, both undergraduate and continuing, has utterly failed, in terms of its response to psychotropic medical and non-medical drug use, to keep up with the rate at which this problem of public health has grown in recent years.. ..Drug education and even treatment are now

1 Government of Canada, Royal Commission of Inquiry into the Non-Medical Use of Drugs, Final Report of the Commission of Inquiry into the Non-Medical Use of Drugs, (Ottawa: Information Canada, 1973), 3- 11. 2 For a detailed discussion of the Le Dain Commission's history and recommendations regarding cannabis, see Marcel Martel, Not This Time: Canadians, Public Policy and the Marijuana Question (Toronto: University of Toronto Press, 2006), 120-155.

1 being left largely in the hands of users and former users, detached street workers and other paramedical personnel who are often well informed and able to provide constructive help, but who in such cases provide information and advice that are questionable and controversial. The very emergence of innovative services.. .is a dramatic indicator of how relatively inept and unresponsive the medical profession has been.3

In many ways this quotation from the Le Dain Commission Treatment Report captures much of the spirit of confusion and concern that characterized the public and professional discourse surrounding drug use in the English speaking world in the 1960s and 1970s.

Growing use of traditionally illicit drugs by middle-class youth during these decades, combined with an upsurge in the use of licit psychoactive drugs, prompted greater concern among politicians, professional researchers and the public, resulting in an eruption of scientific and sociological literature examining drug use and drug users.

What was the character of this scientific and intellectual endeavor? How did the notion of drug addiction change as more and more scientists and intellectuals became interested in that phenomenon? What contemporary intellectual, social and political trends and developments informed the new understanding of addiction, and what implications did these new understandings have for the treatment of addiction?

Before the importance of the preceding research questions can be properly understood, some background is necessary. Historical examination of drug use began in earnest during the 1960s, and early drug historiography was deeply enmeshed within the social, political, and historiographical circumstances of that decade. In particular, the historiography of the New Left encouraged scholars to examine the history of drugs and drug users. A concern developed among Western historians to recover the histories of

3 Government of Canada, Royal Commission of Inquiry into the Non-Medical Use of Drags, Treatment: A Report of the Commission of Inquiry into the Non-Medical Use of Drugs (Ottawa: Information Canada, 1972),!. Emphasis added.

2 neglected segments of the population; this led to numerous eminent scholarly works of

'history from the bottom up.'4 At the same time, a growing cynicism regarding Cold-

War politics and the perceived injustices of Western society encouraged a flourishing of historical enquiry that was meant to expose the mechanisms of exploitation and oppression found in Western capitalist democracies. As Michael Bentley observes, "the

1960s acquired an historiographical mood. It was nothing so tight as an agenda, far less a list of specified topics or approaches. But it wanted answers, crystalline conclusions, whether they came as numbers or prosaic certainties."5 Historians of the 1960s, then, were concerned with producing politically engaged history that would expose, in a positivist, Marxist fashion, the contradictions and oppressive practices of Western society. Again, Bentley summarizes: "Chief among the 1960s certainties came a from- the-heart leftism which denounced imperialist wars, espoused a youth culture in dress and music, and dallied with soft drugs."6

This cultural and academic milieu spawned the earliest scholarly works on drug use and drug laws. While strictly historical works were somewhat slower in coming, the arguments made by scholars and activists were frequently historical in nature. The so- called 'criminalization' thesis held that the introduction of drug laws in Western countries in the early-part of the twentieth century had transformed a previously tolerated activity into a crime, and in so-doing, created a new criminal class. As David Courtwright summarizes:

4 The most famous example of this is, of course, E.P. Thompson, The Making of the English Working Class (New York: Vintage Books, 1963). Also worthy of note are Eric Hobsbawm, Christopher Hill and Perry Anderson, and the majority of the contributors to the History Workshop Journal. For a pithy discussion of 1960s historiography generally, see Michael Bentley, Modern Historiography (New York: Routledge, 1999), 137-9. 5 Bentley, 137. 6 Ibid, 138.

3 the prevailing liberal version of events.. .held that the 1914 Harrison Narcotic Act [the first American federal law regulating the non-medical use of narcotics], as interpreted by the Treasury Department and federal courts, had forced addicts to become criminals by denying them a legal supply. Legislators, bureaucrats, and judges had turned what should have been - and, implicitly, could still be - a minor social problem into a national tragedy.7

In the Canadian context, a handful of published articles argued a similar thesis, but with a particular emphasis on the racist nature of Victorian Canada. In particular, Sinophobic attitudes in Canada were cited as contributing directly to the criminalization of opium and other drugs in the early twentieth-century.8

Changes in historiographical fashion in the 1970s and 1980s were reflected in the slowly-developing field of drug history; in particular, an interest in statistical history, and the influence of the so-called 'new social history' informed one of the most foundational works of drug history, David Courtwright's Dark Paradise: A History of Opiate

Addiction in America (1982). Courtwright's aim was not to examine the legal history of drug prohibition, but rather the social history of drug use in late nineteenth- and early twentieth-century America; in particular, Courtwright explored the extent of drug use, and the degree to which demographic changes in the drug-using population altered popular conceptions of drug use and addiction. Courtwright's book contains extensive statistical analysis, including sophisticated use of statistical correlation.9 The book also reflects the growing emphasis on interdisciplinarity in its use of traditional printed

7 David Courtwright, Dark Paradise: A History of Opium Addiction in America, Revised Edition (Cambridge, Mass.: Harvard University Press, 2001), xi. See also the first preface to David Musto's 1973 book The American Diease for a contemporary account of this debate. David Musto, The American Disease: Origins of Narcotic Control Third Edition (New York: Oxford University Press, 1999), xiii-xiv. 8 The most explicit example of this interpretation is Shirley Jones Cook, "Canadian Narcotics Legislation, 1908-1923: A Conflict Model Interpretation," Canadian Review of Sociology and Anthropology 6 (1969), 36-46. Also, see G.E. Trasov, "History of the Opium and Narcotic Drug Legislation in Canada," Criminal Law Quarterly, 4 (January 1962), 274-82. Musto makes similar arguments about the American context, Musto, 24-68. 9 Courtwright, Dark Paradise, 7. The first chapter of the book is devoted to an extensive statistical overview of drug use in the United States.

4 sources to supplement its statistical data; indeed, Courtwright notes in his introduction that traditional printed sources are used in an effort to avoid "reducing human experience to mere numbers and charts."10

Courtwright's investigation centers on the demographic shift in the American drug-addict population occurring between the late nineteenth and early-twentieth century.

As Courtwright describes the shift:

During the nineteenth century the typical opiate addict was a middle-aged white woman of the middle or upper class.. ..But from roughly 1895 to 1935 [these addicts] were supplanted by a new and radically different sort of user. Lower- class urban males, down-and-outs.. .became increasingly conspicuous and were identified in the public mind with the problem of opiate addiction.11

Courtwright argues that this shift was not, in fact, the result of the criminalization brought about by the Harrison Act, but rather had been occurring already for decades. Perhaps even more provocatively, Courtwright persuasively argues that this change in the addict population also brought about a change in the way both the public and the medical community conceived of the 'drug addict.' The new view of the addict as a working- class or underworld criminal was responsible for the abandonment of numerous treatment programs in the 1920s, and the criminalization of drug use. As Courtwright pithily observes in the preface to the most recent edition of Dark Paradise, "A recurring theme in the recent literature is that it is impossible to separate the social history of drug use from its political history. Knowing why certain drugs were prohibited requires knowing who used them and in what circumstances."12

The demographic shift in drug users, combined with careful lobbying by anti- narcotic activists, led to the passage of the Harrison Act in 1914, which effectively

10 Ibid. 11 Ibid, I. 12 Ibid, xi.

5 prohibited the sale of narcotic drugs in the United States.13 In Canada, the situation was somewhat different, but similar trends were apparent; instead of lower-class morphine addicts, Chinese opium smokers constituted the stigmatized drug-using population.

Following an anti-Asiatic riot in Vancouver in 1907, the then-deputy-minister-of-labour

William Lyon Mackenzie King was sent to investigate the riot and award compensation to injured parties. While in Vancouver, Mackenzie King discovered that opium was being sold and used extensively, not only by the city's Chinese population, but by

European users as well. In a report tabled in parliament a number of weeks later, King identified the use of opium as dangerous both to individuals, and to the "manhood of a nation."14 In this respect, the early prohibition of drugs in Canada was deeply linked to concerns over public health, as well as gendered conceptions of nationality. The 1908

Opium Act passed with little debate or discussion in parliament or the senate, and prohibited the manufacture, importation or sale of opium for non-medical use. In 1911, following Mackenzie King's attendance of the International Opium Convention in

Shanghai, the first law restricting the possession of narcotics, the Opium and Narcotic

Drugs Act (ONDA), was passed. The ONDA introduced criminal penalties for possession of restricted narcotics. In the 1920s, a series of anti-Chinese 'drug panics' on

Canada's west-coast led to stricter penalties against narcotic users, including mandatory minimum sentences, mandatory deportation of immigrants convicted of drug offenses, and vastly expanded police search-and-seizure powers. In 1923, codeine and marijuana were added to the schedule of restricted drugs without debate. As Catherine Carstairs has

13 David Courtwright, Herman Joseph and Don Des Jarlais, Addicts Who Survived: An Oral History of Narcotic Use in America, 1923-1965 (Knoxville: University of Tennessee Press, 1989), 1-7 W.L. Mackenzie King, Report by W.L. Mackenzie King, C.M.G., on the Need for the Suppression of the Opium Traffic in Canada (Ottawa: Sessional Paper 36b, 1908), 6.

6 written, "by the mid-1920s, drug use had been thoroughly criminalized, both by the law and in the mind of the public."15

The situation in Great Britain sharply contrasts with that in the United States and

Canada. From 1924 to 1926 the British government's Rolleston Committee prepared a report that would hand control of addicts over to doctors. While trafficking and possession of certain drugs remained illegal, addicts themselves could be withdrawn from opiate based drugs, or even maintained on such drugs if their doctor felt that this would be good medical practice. It is crucially important to note, however, that such an approach was only possible because of the character of the drug-using population in

Britain; the number of British addicts was small, and most were originally addicted through medical prescription. Moreover, the political power of doctors in Britain was considerably greater than in the United States or Canada. The Rolleston report was widely cited as creating the so-called 'British system' or narcotic control, which contrasted sharply with the American penal approach. In the 1960s, American reformers would mistakenly argue that the British system had prevented the kind of explosion of drug addiction seen in the United States in the 1950s, as part of their campaign against the criminalization of addiction.16

The criminalization of narcotic addiction, and the popular conception of the addict as an undesirable criminal, made the medical treatment of addiction an unlikely proposition both in the United States and Canada. In 1915 the American Department of

15 Catherine Carstairs, Jailed for Possession: Illegal Drug Use, Regulation and Power in Canada, 1920- 1961 (Toronto: University of Toronto Press, 2006), 19. For a thorough discussion of the criminalization of narcotics in Canada, see Carstairs, Jailed for Possession, 16-34; Daniel J. Malleck, '"It's Baneful Influences are Too Well Known': Debates over Drug Use in Canada, 1867-1908," Canadian Bulletin of Medical History 14 (1997), 263-88. 16 Virginia Berridge, Opium and the People: Opiate Use and Drug Control Policy in Nineteenth and Early Twentieth Century England Revised Edition (New York: Free Association Books, 1999), 271-8.

7 Treasury stated that doctors would not be allowed to prescribe maintenance doses of narcotics for addicts, and this policy was upheld by a series of Supreme Court decisions in 1919.17 In Canada, a similar situation prevailed.18 While a number of American states established clinics for the organized treatment of addicts, continual harassment by the

Treasury Department forced their closure by 1923.19 The closure of the American treatment clinics, and the anti-maintenance policy of both the American and Canadian governments, marked the beginning of what historians have termed the 'Classic Period' of narcotic control. During this period, lasting until approximately the mid-1960s, the narcotic policies of both the Canadian and American governments were, to use

Courtwright's phrasing, "unprecedentedly strict and punitive."20

The Classic Period spawned a considerable paradigm shift in the scientific and popular understanding of narcotic addiction. Prior to the demographic shift in the drug addict population in the early twentieth century, narcotic addiction was commonly conceived of as the manifestation of a psycho-physiological condition known as

'inebriety.' This condition, which was thought to commonly affect professionals and

'brain workers,' could be passed along to future generations, thus contributing to 'race degeneration' and 'race suicide.' Drawing upon contemporary medical theories such as

'neurasthenia,' 'diathesis' and 'degeneration,' this conceptualization of addiction suggested that, with repeated use of alcohol or narcotics a person would develop a

'morbid craving' for the substance. Furthermore, addiction to one vice substance could lead easily to addiction to another, as addiction to any substance was the manifestation of

17 Courwright et al, Addicts Who Survived, 8. 18 Carstairs, 115-8. 19 Courwright et al, Addicts Who Survived, 9.

8 a single root-cause. Thus, it was easy for Charles Towns, a popular American author on the subject of addiction, to write in 1915 that tobacco use would lead to alcohol and opium use.21

The notion of 'inebriety' held particular appeal in the late nineteenth and early twentieth centuries because of its appeals to culturally and intellectually popular ideas such as neurasthenia and race degeneration. However, a series of events would lead to the end of the inebriety paradigm of addiction by the 1920s. First, medical researchers were ultimately unable to delineate the biological mechanism whereby vice substances produced addiction. As Courtwright pithily observes, the "proponents [of the inebriety theory] failed to deliver the scientific goods."22 Moreover, as social-Darwinism lost its intellectual currency in the Western world, before and after World War II, so too did the notion that acquired traits like alcoholism could be passed to offspring. Finally, the shift in the demographics of American drug users allowed for the conceptual separation of opiates and other drugs. As a generation of medically-addicted middle-class women began to die and disappear in the early twentieth century, this popular image of the drug user was replaced by that of the working-class heroin or morphine junkie. This demographic shift, and the failure to prove a connection between vice substances, would ultimately lead to collapse of the inebriety paradigm and the creation of a new conception of addiction.

As the first inebriety paradigm of addiction disintegrated, a conceptual hole appeared that needed to be filled. Moreover, as cigarettes and alcohol gained a

21 David Courtwright, "Mr. ATOD's Wild Ride: What Do Alcohol, Tobacco and Other Drugs Have in Common?" The Social History of Alcohol and Drugs 20 (2005), 106-10. It is also worth noting that one of the earliest medical journals relating to addiction, the Quarterly Journal of Inebriety, began publication in 1876. 22 Ibid, 110.

9 considerable degree of social acceptability during the interwar years, a concurrent

separation of these substances from 'drugs' occurred.23 As Caroline Acker has shown,

the work of the American Public Health Service psychiatrist Lawrence Kolb gained

considerable authority in explaining the cause of narcotic drug addiction.24 Kolb's

numerous publications, beginning in 1925, would explain addiction as the result of

. inherent personality defects that were exacerbated by the conditions of modern life. For

Kolb, the failure of heroin addicts to remain abstinent after withdrawal symptoms had

ended was a symptom of a psychopathic personality defect. While individuals who

became addicted through medical prescriptions (iatrogenic addicts) were, according to

Kolb, 'accidental addicts,' and thus inherently psychologically healthy, the pleasure-

seeking criminal addict found extensively at the Lexington hospital was something else

entirely. According to Kolb,

The psychopath, the inebriate, the psychoneurotic, and the temperamental individuals who fall easy victims to narcotics have this in common: they are struggling with a sense of inadequacy, imagined or real, or with unconscious pathological strivings.. .and the open make-up that so many of them show is not a normal expression of men at ease with the world, but a mechanism of inferiors who are striving to appear like normal men.25

As Acker has demonstrated, this model of addiction, formulated by Kolb while

working at the Public Health Service Narcotics Hospital in Lexington, Kentucky,

reflected the disciplinary concerns of a psychiatric profession seeking to expand its

purview and legitimate itself as a social force, as much as it did a psychological or

23Ibid, 111. 241 am considerably indebted to the work of Caroline Jean Acker, not only for her analysis of addiction research during the Classic Period, but also for providing the intellectual point-of-departure for much of my own investigation. The following description of addiction research during the classic period is drawn extensively from Caroline Jean Acker, Creating the American Junkie: Addiction Research in the Classic Era of Narcotic Control (Baltimore: Johns Hopkins University Press, 2002). 25 Lawrence Kolb, "Types and Characteristics of Drug Addicts," Mental Hygiene 9 (April 1925), 300-13, as quoted in Acker,. 141.

10 physiological reality. Moreover, the sample-base from which Kolb formulated his theories of addiction most likely influenced the content of those theories; the pleasure- seeking criminal addict found at Kolb's Lexington hospital heavily informed Kolb's construction of addiction as a pathological condition with a poor prognosis for treatment.

Concurrently, the conceptual separation of medical and non-medical drug addiction allowed American pharmaceutical researchers to concentrate their investigations on the search for a non-addicting analgesic, and allowed the medical profession, best represented by the American Medical Association, to distance itself from the treatment of drug addiction. This confluence of institutional concerns and intellectual paradigms both supported federal narcotics policy, and prevented addiction treatment from becoming a widespread option until the end of the Classic Period.

How, then, did the Classic Period of narcotic control come to an end? Following

World War II, the international narcotic supply lines, which had been disrupted during the war, were reestablished. The resurgence of heroin addiction that followed resulted in a considerable disillusionment regarding American narcotic control policy. This disillusionment was initially expressed in a number of sociological studies of narcotic users; for instance, the foundational study of heroin addicts in New York City, The Road to H, expressed considerable skepticism regarding the effectiveness or desirability of

America's anti-maintenance stance. Based on a study of New York City heroin users in the late 1950s, and published in 1964, Isidor Chein et al recommended not only a pro- maintenance position based on the British model, but also the establishment of addiction- treatment clinics.26 Perhaps the most widely read critique of American narcotics policy

26 Isidor Chien, Donald L. Gerard, Robert S. Lee and Eva Rosenfeld, The Road to H: Narcotics, Delinquency and Social Policy (New York: Basic Books Inc, 1964), v-x, 369-86. The Road to His a

11 was Alfred Lindesmith's The Addict and the Law (1965), which argued that American narcotics laws had not only caused undue harm to addicts, but they had actually encouraged the spread of narcotic addiction. Like Chein, Lindersmith looked favorably upon the British system, and suggested that such a system ought to be examined more thoroughly as an alternative to deal with the American narcotics problem.27

While sociologists and ethnographers critiqued the prohibitionist and anti- maintenance policies of the American government from a liberal perspective, a campaign had been initiated by legal scholars to expose the questionable foundations of anti- maintenance legislation. In 1958 the American Bar Association and the American

Medical Association collaborated to produce Narcotic Drugs: Interim Report of the Joint

Committee of the American Bar Association and the American Medical Association, which argued that the punitive approach against drug addicts was ineffectual, and that outpatient clinics should be established on an experimental basis. The report was eventually published for the public as Drug Addiction: Crime or Disease? in 1961. In

1962 the Supreme Court, perhaps influenced by the recent discussions of the flimsy legal basis for anti-maintenance laws, struck down a California law that made narcotic addiction a misdemeanor. In its ruling, Justice Potter Stewart stated that "It is unlikely that any state at this moment in history would attempt to make it a criminal offense for a

particularly interesting example of late-Classic Period thinking. An extensive study of New York City heroin users, the authors even went so far as to recommend the legal availability of narcotics in order to reduce overall demand, and thereby strike a blow against the illicit market and its often dangerously adulterated drugs. It is also worth noting that the authors' source of information on the so-called 'British system' was the widely popular work of Edwin Schur. Schur's Narcotic Addiction in Britain and America (1962) seems to have been widely influential in clarifying the British system in North America, as it is frequently cited in literature from this period. Edwin Schur, Narcotic Addiction in Britain and America (Bloomington: Indiana University Press, 1962). 7 Alfred Lindesmith is also responsible for one the first sociological studies of narcotic addiction. Alfred Lindesmith, The Addict and the Law (Bloomington: Indiana University Press, 1965); Alfred Lindesmith, Opiate Addiction (Evanston, Illinois: Principia Press, 1947).

12 person to be mentally ill, or a leper, or to be afflicted with a venereal disease." Potter's language suggested the reemergence of the disease theory of addiction in the professional and public discussion of drug addiction. Indeed, by 1962 even Lawrence Kolb had grown weary of the criminalization of narcotic addiction; in that year, Kolb published

Drug Addiction: A Medical Problem, in which he voiced his doubts concerning the punitive American policy. While it is likely that Kolb's views on the actual nature of addiction had changed little, this volume suggests that by 1962 a considerable sea-change had occurred in North American thinking about the correct approach to narcotic addiction.

By 1963, maintenance treatment was again a possibility in the United States; in that year, psychiatrist Marie Nyswander and metabolic disease specialist Vincent Dole began their research into the possibility of using methadone, an opiate derivative that produced few euphoric effects, for maintenance treatment. Despite considerable harassment from the Bureau of Narcotics, Dole and Nyswander were able to publish their findings in the Journal of the American Medical Association in 1965, and in that same year, established an experimental clinic at Manhattan General Hospital.30

In Canada, a slightly different situation prevailed, but similar themes were evident. By the time of the Great Depression, most of the Chinese drug users who had incurred the legislative wrath of the Canadian government had either died or were deported. In the 1950s a brief moral panic erupted in the province of British Columbia

28 Quoted in Courtwright et al, 25. 29 The bulk of this analysis comes from Courtwright et al, Addicts Who Survived, 21-7. The supreme court quotation occurs on 25. 30 Courtwright et al, Addicts Who Survived, 21-27,331 -343; Vincent Dole and Marie Nyswander, "A Medical Treatment for Diacetylmorphine (Heroin) Addiction: A Clinical Trial with Methadone Hydrochloride," Journal of the American Medical Association (JAMA)193 (1965), 646-50.

13 when it was discovered that numerous young people were taking heroin. This episode led the Vancouver Community Chest and Council to issue a report calling for the establishment of narcotic clinics where addicts could receive maintenance doses. The

Division of Narcotic Control, which vehemently opposed the idea of narcotic maintenance, commissioned its own study by psychiatrist George Stevenson. The

Stevenson report opposed the idea of compulsory treatment, or providing narcotics for addicts, mostly on the grounds that these measures were unlikely to cure the addict of his underlying personality defects. While the views of Stevenson ultimately won out and were reflected in the 1961 Narcotic Control Act, by 1963 increasing pressure for viable treatment options led the Narcotic Addiction Foundation of British Columbia to offer methadone maintenance under the misleading name 'prolonged withdrawal.' This program was begun with the cooperation of the long-hostile Division of Narcotic

Control.31 The presence of a non-punitive treatment option in both the United States and

Canada, combined with a general cultural shift in both countries towards a less severe and more liberalized drug policy, signaled the end of the Classic Period of narcotic control.32

What effect did the end of the Classic-Period have on understandings of drug addiction and treatment? How did the idea of 'addiction' change with changes in science and patterns of drug use? These questions have received relatively scant scholarly attention. William White, in Slaying the Dragon: The History of Addiction Treatment and Recovery in America, touches briefly on the topic, but himself observes the paucity of literature on the subject:

31Carstairs, 126-7, 151-8. 32 Courtwright et al, Addicts Who Survived, 26-7.

14 The history of the rise and evolution of the modern system of addiction treatment in America is a complex one. It should be told, not it a chapter - but is a series of books capable of analyzing its many dimension.33

David Courtwright has also examined changes in thinking about addiction in the post-

Classic Period. Among his observations, Courtwright describes the reemergence of a paradigm of addiction research that closely resembles the 'inebriety' theory of the pre-

Harrison-Act Progressive Era. According to Courtwright, three major changes in addiction research were responsible for this. First, a series of discoveries in the field of neuroscience, particularly the discovery of endogenous opiate receptors and the increasingly sophisticated understanding of the mesolimbic dopamine system, finally began to show how psychoactive chemicals affect the human brain and behavior.34

Second, a series of studies in the later-1990s suggested that there is, as the inebriety theorists would have expected, a genetic predisposition to addictive behavior. Finally, a series of epidemiological studies in the last decades of the twentieth-century suggested that the 'gateway hypothesis' of the Progressive Era, which posited that so-called non- drugs such as alcohol and tobacco could lead to other drugs such as heroin and cocaine, was in fact partially correct.35 However, while Courtwright suggests that these discoveries resulted in a paradigm shift in ideas about addiction, he discusses the issue only briefly, and does not attempt to examine, using primary sources, how societal,

William White, Slaying the Dragon: The History of Addiction Treatment and Recovery in America (Bloomington, 111.: Chestnut Health Systems/Lighthouse Institute, 1998), 263. 34 Dopamine is one of the most abundant neurotransmitters found in mammalian brains. The mesolimbic pathway in the brain, which makes extensive use of dopamine, is involved in such phenomenon as reward, pleasure and motivation. A dopaminergic theory of addiction emphasizes the role of this neural pathway in the production of addiction. 35 David Courtwright, "Mr. ATOD's Wild Ride," 115-20. In this article Courtwright argues, among other things, that a modified version of the inebriety paradigm has emerged under the name 'ATOD' (Alcohol, Tobacco and Other Drugs).

15 cultural and intellectual factors may have influenced this paradigm shift. An intellectual history of addiction in the 1960s and 1970s, then, seems in order.

The present thesis will attempt to address this lacuna in the available historical literature. Beginning in 1957,1 will follow the concept of addiction through the turbulent

1960s and 1970s, ending in 1975. In Chapter One I will examine the notion of addiction as a 'disease' in the late-Classic Period, when reform-minded doctors and lawyers, particularly in the United States, employed this concept in order to argue against the penal approach to narcotic control, and for a medical approach to addiction treatment based on the example of the so-called 'British model'. The attempt to medicalize addiction was prompted by a number of demographic developments in drug usage patterns, the most important of which was the resurgence of heroin use among youth and in urban ghettos. The campaign to medicalize addiction also resembled the work of the modern alcoholism movement, which had sought, since the 1930s, to destigmatize problem drinking and legitimate the concept of alcoholism as a disease. Much like the disease theory of alcoholism, the disease theory of drug addiction had little scientific or clinical basis, but was promoted primarily for humanitarian reasons. Moreover, the etiological understanding of addiction in the late Classic Period was defined principally by reference to the opiate drugs, with an emphasis on tolerance, physical dependence, and the poorly defined concept of 'psychological' dependence. This opiate-centric theory of addiction was particularly problematic, since there was a growing awareness that people were compulsively using non-opiate drugs. Because addiction was conceived of as a two-part phenomenon, comprising pharmacological effects and psychological

16 predisposition, initial explanations of the nature of non-opiate addictions followed the same model, with attempts to determine what tolerance and dependence effects were engendered by amphetamines and other drugs, and what psychological and social conditions predisposed persons to their habitual use. The lack of in-depth knowledge of addiction was not particularly surprising since the subject was not considered a valid or important area for scientific inquiry until the early 1960s. Beginning in the 1960s, however, the combination of growing heroin addiction and the perceived surge in non- opiate drug use prompted a political change that would allow for the birth of addiction science. For example, the presidential administration of John F. Kennedy helped to create an environment that was amicable to addiction research and more humane treatment approaches. As addiction research became a viable scientific topic, scientists needed to determine how the subject was to be defined and investigated. Different paradigms of addiction competed for dominance.

Chapter Two utilizes addiction research journals to investigate the social and intellectual circumstances that led to the emergence of a paradigm of addiction based on neurobiology and behavioral psychology. The acceptance of this paradigm was not the inevitable outcome of scientific progress, but rather the result of a reciprocal interaction between scientific experts, addicts, and the broader society. Discoveries in behavioral psychology, particularly those involving animal experimentation, provided compelling answers for the questions that plagued addiction researchers, particularly those involving relapse and addiction to non-opiate drugs. In particular, the work of James Olds, J.R.

Weeks, Abraham Wikler and others provided model experiments for addiction researchers. By contrast, the other prominent theory of addiction, the psychosocial model

36 Acker, 215.

17 which had been crucial in the critique of the late-Classic notion of addiction, was unable to provide the same kind of compelling answers. Behavioral psychology allowed addiction researchers to set aside, for conceptual purposes, the issue of drug pharmacology, and instead focus on the role of psychological mechanisms in the genesis of the pathological condition of addiction. By defining addiction in behavioral, instead of pharmacological terms, scientists were able to expand their list of substances and activities that could be deemed 'addictive.' While this led some to radical formulations of addiction as a wholly learned phenomenon, concurrent discoveries in the field of neurobiology led other scientists to search for the common action that drugs of addiction had on brain mechanisms; the emergence of the dopaminergic theory of addiction was the end result of this process. The establishment of a biological-and-behavioral theory of addiction, which was ultimately as much a product of historical context as of scientific advance, constituted a radical paradigm shift in addiction science, and universalized the concept of addiction. In terms of treatment, the behavioral theory of addiction encouraged some clinicians to incorporate principals of behavior modification into their treatment regimens, which met with varying degrees of success. However, political circumstances made it unlikely that most addicts would receive treatment from trained professionals until the 1980s.

Chapter Three will examine the Addiction Research Foundation (ARF) of Ontario as a case study of the previously discussed trends and developments. At the time the

ARF constituted one of the leading addiction research organizations in the world, and although much of that reputation was built on alcoholism research, in the 1960s the foundation took a strong interest in other drugs as the phenomenon of youth drug use

18 exploded across Canada and the United States. Because of their early exposure to non- opiate and mixed addictions in their clinical practice, and because of their epidemiological research on drugs of all varieties, ARF clinicians and scientists were quick to embrace the behavioral formulation of addiction. The prominence of a behavioral-and-biological theory of addiction led ARF officials to advance treatment programs that emphasized principles of harm reduction and well-informed personal choice; this too was partially the product of contextual circumstances, as Canadian citizens debated issues of health and personal freedom during the investigations of the Le

Dain commission.

The central argument of this thesis is that the redefinition of drug addiction as a biological-and-behavioral phenomenon was as much of product of historical context as expanded scientific purview and investigation. In- The Structure of Scientific Revolutions,

Thomas Kuhn suggests that scientific paradigms, defined as "universally recognized scientific achievements that for a time provide model problems and solutions to a community of practitioners," are adopted "because they are more successful than their competitors in solving a few problems that the group of practitioners has come to recognize as acute."37 These problems do not necessarily have to be internal to the scientific discipline, but rather may be the result of social or cultural developments. In the 1960s and 1970s, drug use was perceived to be expanding to all levels of society; this contextual environment encouraged an understanding of addiction that made the phenomenon a product of basic human nature, rather than diseased personality or social

37 Thomas Kuhn, The Structure of Scientific Revolutions: Third Edition (Chicago: University of Chicago Press, 1996), x, 23.

19 condition. The first scientific paradigm of addiction research that was established by the mid-1970s was the product of a reciprocal relationship between science and a drug-using society.

20 Chapter 1 - "Drug Addiction: Crime or Disease?": Drug Addiction and the Birth of

Addiction Science, 1957-1965

For much of the Classic Period of narcotic control drug addiction attracted little critical research attention, and by the 1940s was an unchallenged and relatively stable concept. Beginning in the late 1950s, however, the psychiatric understanding of drug addiction would come under criticism as a result of a number of important legal, political, scholarly and medical developments. Most important among these developments was a challenge to the punitive nature of American drug policy, and the anti-treatment provisions of those policies. Chief among the critics were humanitarian doctors and lawyers, who argued that addiction ought to be treated as a medical disease, and not as a criminal offense. This change in the conceptualization of drug addiction followed the precedent set by the modern alcoholism movement, which had, since the 1930s, worked to redefine problem drinking as a disease. The disease theory of addiction had little scientific backing, but was bolstered by sociological studies which contradicted the psychiatric theory of addiction, and lent intellectual support for new treatment options.

Meanwhile, increased political concern surrounding drug addiction and the perceived growth of non-narcotic drug use led to a host of new questions for scientists to investigate. The increased concern, combined with a more permissive research atmosphere, led to the birth of addiction science - a new scientific field in search of its first paradigm.

The Second World War had a considerable impact on the worldwide consumption of illicit narcotics. As supply-lines were disrupted as a result of the war, the use of heroin and other opiates declined dramatically in both the United States and Canada. Following

21 the War, however, international trade rebounded considerably, as did the illicit traffic in opiate drugs.1 In the United States, the renewed availability of narcotics precipitated a considerable increase in their illicit use, particularly among ethnic minorities in urban slums. In Canada, a brief panic erupted when it was discovered that heroin use had become extensive among white youth in Vancouver. The use of narcotics also became more visible, and was the subject of considerable (and sensationalistic) media attention in both countries. In Canada, calls for a change in narcotic policy as a result of the

Vancouver panic were ultimately ignored, while in the United States harsher and more restrictive laws such as the Boggs Act (1951) were passed in an attempt to control the problem.2

While the 1950s are generally regarded as the most violently repressive time period for drug users, oppositional forces did exist, particularly among American doctors and lawyers. In 1954 the New York State Medical Society submitted a proposal to the

American Medical Association (AM A) which called for the legal distribution of narcotics to addicts. This proposal caused the AMA to appoint a special Committee on Narcotic

Addiction, which ultimately recommended that more research was necessary in order to determine whether legal narcotics distribution was advisable. In the meantime, the

American Bar Association (ABA) had been quietly opposing narcotics criminalization since the early 1950s, and had appointed its own standing Committee on Narcotics and

Alcohol. By 1955 the ABA and AMA were discussing the formation of some kind of

1 For a discussion of attempts to control the post-war international drug market, see William B. McAllister, Drug Diplomacy in the Twentieth Century (New York: Routledge, 2000), 156-211. 2 David Courtwright, Dark Paradise: A History of Opiate Addiction in America 2nd edition (Cambridge: Harvard University Press, 2001), 145-185; Catherine Carstairs, Jailed for Possession: Illegal Drug Use, Regulation and Power in Canada, 1920-1961 (Toronto: University of Toronto Press, 2006), 151-8.

22 joint research project on the problem, and in 1956 the Joint Committee of the ABA and

AM A on Narcotic Drugs met in Washington, DC.3

It is important to note that the work of the Joint Committee had a considerable focus on sociological, rather than medical, pharmacological, or scientific research.

Indeed, the Joint Committee received a $15,000 grant from the Russell Sage Foundation, whose "general program [was] aimed at increasing the utilization of the social sciences in professional practice."4 Moreover, the authors of the Joint Committee's interim report noted that "the need for medical research appeared limited and a larger part of the Joint

Committee's own work could.. .be concentrated on legal, administrative and sociological aspects."5 The research undertaken by the Joint Committee produced both an interim and final report, as well as two separate research reports: "Some Basic Problems in Drug

Addiction and Suggestions for Research" by Judge Morris Ploscowe, who served as the committee's director, and "An Appraisal of International, British and Selected European

Narcotic Drug Laws, Regulations and Policies" by Rufus King, chairman of the Joint

Committee.

The authors of the Interim and Final Reports were quick to point out the lack of a proper understanding of the process of addiction. In discussing the contemporary methods of treatment conducted at the few existing narcotics hospitals in the United

States, the authors of the interim report confessed that "the exposure of a few months to a minimum amount of psychiatry, social case work, educational and vocational activity, cannot eradicate the deep seated necessity and compulsion for drugs which most addicts

3 Joint Committee of the American Bar Association and the American Medical Association on Narcotic Drugs, Drug Addiction: Crime or Disease? Eighth Printing (Bloomington, Indiana: Indian University Press, 1971), 4-7. AIbid,S. 5 Ibid, 9.

23 seem to have. There are no magic cures at narcotics hospitals. We simply do not know enough about the processes of drug addiction to produce such cures."6 Indeed, in reviewing the available literature on the biological nature of addiction, the report's authors quoted Harris Isbell, head of pharmacology at the Lexington Narcotics Hospital, who noted that contemporary research had been unable to elucidate the link between the pharmacological effects of narcotics, and the behavior of the addicted individual.7 The mechanism by which drugs produced addiction was still a mystery.

How did the members of the Joint Committee define addiction? Without a satisfactory theory of addiction, the authors of the report were forced to rely on traditional theories. Ploscowe, in his review of drug addiction literature, began his discussion of the 'nature of drug addiction' with the definition formulated by the World

Health Organization in 1952, emphasizing "(1) tolerance, (2) physical dependence and

(3) emotional dependence."8 Here, tolerance refers to the frequently observed phenomenon among opiate users that an increasing dosage of a narcotic is required to obtain the same euphoric effect. Physical dependence was defined as "the development of an altered physiologic state which requires continued administration of a drug to prevent the appearance of.. .an 'abstinence syndrome.'" Emotional dependence received perhaps the most intriguing definition: "Emotional dependence is defined as a substitution of the use of the drug for other types of adaptive behavior. In other words, use of the drug becomes the answer to all of life's problems. Instead of taking

6 Ibid?, 88. 7 Harris Isbell, "Trends in Research on Opiate Addiction," Transactions and Studies of the College of Physicians of Philadelphia 24 (l)(June 1956), 5-6, as cited in Drug Addiction: Crime or Disease?, 41-2. 8 Drug Addiction: Crime or Disease?, 36.

24 constructive action about his difficulties, regardless of their type, the addict seeks refuge in his drugs."9

This theory of emotional dependence was reminiscent of the theories of Lawrence

Kolb, the Classic Period's most prominent expert on addiction. In 1925 Kolb published his classic explanation of addiction in Mental Hygiene. In that paper, Kolb argued that a mentally healthy person derived no pleasure from the use of a narcotic drug. A person in pain might experience what he called 'negative pleasure,' which was simply the relief one felt when pain was eliminated. However, only a psychopath could experience

'positive pleasure' from a narcotic. This positive pleasure was, in fact, the reduction of the psychic stress and pain felt by the psychotic or neurotic, but was interpreted and described by addicts as a pleasurable experience. This theory resembled the explanation for alcoholism postulated by Dr. G. Lolli, whose 1955 article for the Bulletin of the New

York Academy of Medicine, entitled "Alcoholism as a Medical Problem" postulated that the alcoholic was in fact an impulsive neurotic, whose insecurity and emotional instability required the use of alcohol as a 'crutch' to deal with the stresses of everyday life.10 It is worth noting here that the Kolb-ian psychiatric theory of addiction made the pursuit of pleasure irrelevant to an understanding or drug addiction and relapse. Under the Classic-Period formulation, drug addiction was ultimately a symptom of a deficient or under-developed personality.

9 These definitions are quoted in Drug Addiction: Crime or Disease?, 36-7. The source for the quotations is H. Isbell and W.W. White, "Clinical Characteristics of the Addictions," American Journal of Medicine, 14 (5) (May 1953), 558. Isbell was a member of the World Health Organization's Expert Committee on Drugs Liable to Produce Addiction, and assisted in redefining addiction for the WHO in 1964. 10 It is interesting to note here that both Lolli and Kolb used similar titles. Lolli proposed his theories in G. Lolli, "Alcoholism as a Medical Problem," Bulletin of the New York Academy ofMedicine 31(1955), 876- 886. Kolb's 1962 work, in which he reiterated his theory of addiction, was entitled Lawrence Kolb, Drug Addiction: A Medical Problem (Springfield, Illinois: Charles C. Thomas, 1962). In both instances the use of a psychiatric theory of personality deficit was critical to the medicalization of a substance abuse problem.

25 While the Joint Committee was reluctant to completely reject the role of personality in creating addiction, the theory that drug addiction was merely a symptom of psychopathy received considerable criticism in the report. According to Ploscowe, "it is easier to attach a psychopathological label to the drug addict than to explain how or why he became addicted or why he continues his addiction. Many with similar psychological difficulties do not become addicted to drugs. Some become alcoholics rather than drug addicts. The mere designation of a drug addict as a sick, unbalanced, disturbed or abnormal individual conceals more than it reveals."11 In support of this point, Ploscowe would again quote Isbell, who explained the problem more thoroughly:

Addiction is a complex process in which pharmacological, psychological, socio economic and legal factors play interdependent roles. It is viewed in two ways: (1) as a distinct disease; (2) as a symptom of an underlying personality disorder. Both views can be supported by evidence established so far.. ..The only common denominator among drugs abused by addicts seems to be that they all are compounds which exert powerful effects on the central nervous system. These facts suggest that there is nothing specific about the drugs that addicts take and, therefore, addiction is nothing more than a symptom of the personality disorder. This view cannot be accepted without reservation. The theories of personality that are used to explain addiction are the same theories that are used to explain neurosis, psychoses, character disorders, etc. Since it is known that many persons with personality characteristics similar to those of addicts never abuse drugs, it is apparent that factors other than personality must be operating.

Indeed, Ploscowe would also note that psychology and psychiatry had been unable to provide satisfactory explanations for "why specific individuals take to drugs and why others who may be similarly exposed do not take to drugs to resolve their personal problems." Ultimately, Ploscowe would cite the noted psychologist, social scientist and addiction expert Charles Winick, who noted:

11 Drug Addiction: Crime or Disease?, 35. 12 Isbell, "Trends in Research on Opiate Addiction," as cited in Drug Addiction: Crime or Disease?, 35-6. Emphasis added. 13 Drug Addiction: Crime or Disease?, 51-2.

26 [The addict] is responding to personality problems of great complexity. The drug addict is a person with certain personality characteristics who happens to have selected this way of coping with his problems for a variety of reasons, of which he is usually unaware. Not the least of these reasons is his access to a social group in which drug use was both practised and valued. He takes one drug rather than another because it provides satisfaction for him. Other people with exactly the same kind of personality substratum never become addicts and select other means of expression for their basic conflicts.14

Thus, addiction was now seen as the result of a peculiar interaction between personality and social environment. Two points are worth noting in regards to the above quotation from Winick. First, while the quotation is represented in Ploscowe's report as being an unbroken excerpt, the actual text is compiled from various separate sections of Winick's

1957 Law and Contemporary Problems in such a way as to deemphasize psychoanalytic theories of addiction. This would suggest that Ploscowe and the other members of the

Joint Committee had grown increasingly skeptical of psychoanalysis and psychiatric practice. Winick's original argument, that addiction was a mental illness stemming from non-psychopathic personality disorders, was somewhat distorted by Ploscowe to suggest that drug addiction was the result of sociological factors.'5

The role of sociology in altering notions of addiction is only hinted at in the Joint

Committee report, but becomes much clearer upon examination of the Winter 1957 issue of Law and Contemporary Problems in which key Joint Committee members presented preliminary accounts of their research findings. The table of contents from this issue lists some of the most important names in addiction research: among them, Rufus King, chairman of the Joint Committee, Charles Winick, leading addiction psychologist, Isidor

Chein and Eva Rosenfeld, co-authors of the massively influential sociological study of

Charles Winick, "Narcotics Addiction and Its Treatment," Law and Contemporary Problems, 22 (Winter 1957), 9-34 as quoted in Drug Addiction: Crime or Disease?, 59. 15 It is perhaps not a coincidence that Ploscowe follows this quotation from Winick by reviewing "Social Factors in Addiction." Drug Addiction: Crime or Disease?, 58-9.

27 heroin users, The Road to H, and Alfred Lindesmith, leading addiction sociologist, and one of the most vocal opponents of narcotics criminalization.16

Of particular interest is an article by John A. Clausen entitled "Social and

Psychological Factors in Narcotics Addiction." Clausen had previously been a chief researcher at the American National Institute of Mental Health, and was the author of

Sociology and the Field of Mental Health (1956) and The Impact of Mental Illness on the

Family (1955). In his article for Law and Contemporary Problems, Clausen argued that

"narcotics addiction [was] both a psychophysiological state and a social category. It is a product of behavior learned within a social context and cannot be adequately understood apart from that context."17 In this argument Clausen echoed the ideas of Howard Becker, one of the earliest sociologists of drug use, and author of the extremely influential

Outsiders: Studies in the Sociology of Deviance. In that book, and in a series of influential articles that preceded it, Becker argued that marijuana use was behavior that could only be understood within its sociological context; marijuana users had to learn to use the drug, and more importantly, had to learn to enjoy using the drug from other users.

Moreover, Clausen made note of a number of recent sociological studies of heroin users in New York and Chicago which suggested that drug addiction was most prevalent in urban slum areas. These studies noted that "areas with high rates of drug addicts were

Law and Contemporary Problems 22 (Winter 1957). Lindesmith would ultimately write the introduction to the published version of the Joint Committee Report, published in 1962 as Addiction: Crime or Disease? 17 John A. Clausen, "Social and Psychological Factors in Narcotics Addiction," Law and Contemporary Problems 22 (Winter 1957), 34. 18 Howard Becker, Outsiders: Studies in the Sociology of Deviance (New York: The Free Press, 1963). Much of Outsiders was published in article form in sociological journals in the 1950s. Among these were Howard Becker, "Marijuana Use and Social Control," Social Problems 35 (1955), which Clausen cites. Clausen, 40 nl6.

28 [also] areas of lowest socioeconomic status and of greatest urban blight."19 According to

Clausen, "we must look, then, to the conditions of life within these areas for clues as to the factors which make narcotics addi[c]tion so much more prevalent there than in the larger society."20 Even more radical was Clausen's claim that addiction might be a predominantly social creation: "The goal [of using a narcotic] need have little to do with the specific effects of the narcotic. Moreover, the motivation or goal of initial drug use must be sharply distinguished from the motivation to maintain a drug habit. The latter is a product of learning which seems to depend on the interaction between drug effects.. .and the self-conception of the drug user."21 Because residents of slum neighborhoods shunned the values of sobriety and delayed gratification held by the

American middle-class, they were more likely to use substances that gave immediate gratification. For Clausen, sociological factors were as important, if not more so, than personality in causing drug use and addiction.

Most radical of all was Clausen's use of sociological evidence to refute the psychiatric theory of drug addiction. In addition to suggesting that "the very concept of the psychopathic personality is fraught with confusion and, to a large extent, discredited,"

Clausen suggested that psychiatrists were biased in their diagnoses, both by their training and their class status:

By virtue of his psychiatric training, [the psychiatrist] is likely to start with the hypothesis that drug addicts are, indeed, bearers of deep psychopathology. When the addict is interviewed within a narcotics hospital, it seems likely that his responses may be somewhat different that those of a person living a free life in the community. Moreover, the examining psychiatrist and the addict are nearly

19 Clausen, 37. The studies Clausen cited included Illinois Institute for Juvenile Research, Drug Addiction Among Young Persons in Chicago; Isidor Chein, "Studies in Narcotics Use Among Juveniles," Social Work 50(1)(1955); Bingham Dai, Opium Addiction in Chicago (1937). 20 Clausen, 38. 21 Ibid, 39.

29 always members of very different social worlds. They possess different life goals, conflicting values, antithetical loyalties. These several factors would seem to maximize the probability that a diagnosis or a label of psychopathology would be placed upon the addicts studied within the narcotics hospital.. ..In the present state of knowledge of psychiatric diagnosis, it is highly questionable whether valid classifications can be made within populations whose way of life is markedly different from the middle-class society in which psychiatric classifications have been molded.22

Clausen would go on to suggest that the social conditions found in urban slums, particularly poor familial structure and relationships, were likely to produce the kind of disturbed personalities that were prone to drug use and addiction. Clausen's article, then, suggests that at the end of the Classic Period, addiction was beginning to be conceived of as a social problem, and not as the manifestation of a psychopathic personality.

The shift from a medical or psychiatric explanation for addiction to a more socially oriented one is somewhat ironic, considering that the oft-repeated goal of the

Joint Committee report was to create a policy environment where drug addiction would be treated as a disease. However, this conflict is more apparent than real. For the authors of the Joint Committee report, the primary conflict was not between psychiatric and sociological explanations of drug addiction, but between the moralistic legal and medical approaches to dealing with addiction. As Ploscowe writes:

The law has largely acted on the premise.. .that drug addiction was largely a vice, which an effort of the will could conquer. Severe penalties were necessary to compel the will to make the effort to conquer the vice. Medical writers, on the other hand, have taken the view that drug addiction was a disease and that the drug addict was a sick person.

This disease was chronic and possibly incurable. However, the definition of 'disease' advanced by Ploscowe gives one pause:

Ibid, 45. Drug Addiction: Crime or Disease?, 33.

30 Drug addiction may be considered a disease if the focus of attention is the pathologic process in the human organism created by addiction. A healthy human organism does not need morphine or heroin to ward off withdrawal symptoms.24

In this tautological definition, the disease of drug addiction was seen as the presence of withdrawal symptoms; therefore, the disease of drug addiction was the presence of addiction. This understanding of drug addiction might also be said to be 'opiate-centric,' since only opiate-based drugs such as morphine and heroin were known to produce physical dependency and withdrawal symptoms. For members of the Joint Committee, and indeed for the majority of researchers of narcotic drug use at the end of the Classic

Period, the adoption of the disease model was primarily the result of a compassionate choice bolstered by sociological investigation, and not a decision based on a scientific understanding of the addiction process.

It is here worth pausing to consider the similarities between the efforts of the

AMA-ABA Joint Committee to advance a disease theory of drug addiction, and the efforts of the so-called 'modern alcoholism movement' to advance a disease theory of alcoholism and problem drinking. William White and others have traced the development of the modern alcoholism movement from 1930 to 1955, during which a core group of scientists, doctors and advocates shifted American thinking about alcohol problems from a predominantly morality-based framework to one that focused on disease and treatment. This shift was concurrent with social changes in America that saw alcohol achieve greater social acceptability, and considerable expansion of the alcoholic beverage industry.25

2%id, 51. 25 Alcoholism and the modern alcoholism movement have an extensive historiography. Some of the key works that have informed this brief summary are: William White, Slaying the Dragon: The History of Addiction Treatment and Recovery in America (Bloomington, Illinois: Chestnut Health Systems, 1998);

31 One of the most significant contributions of the modern alcoholism movement was the promulgation of a modern disease theory of alcoholism. While dangerous alcohol consumption had been labeled a 'disease' in the past, most notably by eighteenth- century physician Dr. Benjamin Rush, the modern disease theory of alcoholism reached new heights of acceptance. The scholar most commonly linked with the disease theory was Dr. E.M. Jellinek of Yale University, whose 1960 book The Disease Concept of

Alcoholism is still regularly cited. In that work, Jellinek identified five different types of alcoholisms, each identified with a Greek letter, and noted that the 'gamma' alcoholic, characterized by a psychological dependence on alcohol and a 'loss of control' over his drinking behavior, was the most prevalent type of alcoholic in the United States. It is crucially important to note, however, that scientific support for alcoholism as a disease was slim-to-non-existent; the disease theory was primarily advanced by those who wished to take alcohol problems out of the domain of religion and morality, and place them in the secular world of medicine. While certainly motivated by humanitarian intentions, the disease theory tended to focus discussion of the etiology of alcoholism on the psychopathology of the user.26 Although the authors of the AM A-ABA Joint

Committee reports make no mention of the disease theory of alcoholism, the similarities of language and timing suggest an overlap in ideology between the modern alcoholism movement and the work of the Joint Committee. If alcoholism was a disease that could be treated, perhaps drug addiction was as well.

What implications did such an understanding of drug addiction have for possible treatment? It would be fair to say that the AMA-ABA Joint Committee report was

Mariana Valverde, Diseases of the Will: Alcohol and the Dilemmas of Freedom (Cambridge: Cambridge University Press, 1998). 26 White, 178-198,

32 written with a specific political agenda regarding the American system of de facto prohibition of ambulatory and maintenance treatment.27 Major recommendations of the

Joint Committee included the establishment of an experimental outpatient clinic for the treatment of drug addicts and an investigation into the legal precedent for the prohibition of ambulatory treatment. A major impetus for these recommendations was the investigation by the Joint Committee chairman Rufus King into the so-called 'British system' of treating drug addicts. From July to August of 1957, King, with funds from the

Russell Sage foundation, investigated the drug situation in Great Britain.28 His conclusions ran contrary to the prevailing wisdom circulated by the Bureau of Narcotics, which stated that there was no difference between the British and American law, and that

Britain too had a serious drug problem. King correctly refuted these claims, and in particular noted that British physicians were able to distribute narcotics if such an action was concurrent with medical need. What was important to note was that, in the conception of British physicians, the alleviation of withdrawal symptoms from opiate drugs was regarded as legitimate medical practice.29 Once again, in the medical conception of addiction advocated by the Joint Committee, addiction was defined primarily as the presence of withdrawal symptoms. Such an understanding made possible the treatment of a self-perpetuating disease.

Meanwhile, Ploscowe would condemn as ineffective the institutional treatment of addicts both within prisons and federal narcotic hospitals. Prisons, it was argued,

Such an interpretation is shared by David Courtwright and Herman Joseph and Don Des Jarlais, Addicts Who Survived: An Oral History of Narcotic Use in America, 1923-1965 (Knoxville: University of Tennessee Press, 1989), 24. 28 Drug Addiction: Crime or Disease?, 10, 121, 130-131.

33 provided no deterrence to drug addicts. Federal hospitals such as the one at Lexington provided thoughtful treatment, but the observed high rate of relapse suggested that this treatment approach too was ineffective.31 As such, the Joint Committee also recommended that research be conducted into the causes of addiction, and the causes of relapse, since little was known about these processes.32 Finally, the AMA report attached to the Joint Committee report recommended, among other things, that "continue[d] support should be given for the expansion of mental health programs. Because of the importance of psychiatric factors in addiction, such programs should eventually have an effect in reducing addiction even though not specifically aimed at that problem."33 Such a recommendation reflects not only the residual belief that addiction was ultimately the result of poor mental health, but also reflects the increasing interest being taken in

American society towards issues of mental health. It is also worth noting that the AMA report also recommended that "support should also be given not only to 'basic' laboratory investigations but also to continuation of sociological studies".34

Thus, as the Classic Period drew to a close, addiction stood as a reconceived but still poorly understood phenomenon. The emphasis on opiate drugs resulting from the resurgence of heroin use following World War II reinforced an opiate-centric model of addiction, which made withdrawal symptoms the definition of, and explanation for, addiction; addiction as a 'disease' was the presence of addiction. The shift away from a criminal theory of addiction that emphasized dangerous personalities and personal responsibility, and towards a disease theory that emphasized treatment, was more the

30 Ibid, 19. 31 Ibid, 88-92. 32 Ibid, 11. 33 Ibid, 172. 34 Ibid.

34 result of compassionate sociology than a scientific understanding of the causes of addiction. Sociological investigations, such as those that influenced the ABA and the

AMA, challenged the psychiatric explanation of drug use and addiction. No scientific theory, however, could fill the gap. As such, sociological explanations, emphasizing poverty, the alienation of minority groups, and poor familial structure gained increasing popularity, particularly among those who challenged the laws which prevented ambulatory treatment. How could one punish a person for having a disease which he had contracted as a result of living an unfortunate life?

Perhaps the most significant recommendation of the Joint Committee, for our purposes, was their repeated call for additional research into the causes and nature of drug addiction. In particular, the problem of frequent relapse after detoxification at federal hospitals posed significant challenges to the model of addiction held by the members of the Joint Committee; after all, if addiction was defined as the presence of withdrawal symptoms, and if a patient were successfully coached through the withdrawal process, than the addiction ought to be cured. Unfortunately, the authors of the Joint

Committee reports frequently noted the high rate of relapse from such forms of treatment; the causes of relapse needed to be uncovered.35 The authors of the reports also noted that the current legal situation, and particularly the draconian enforcement of the Bureau of

Narcotics, made such research difficult-if-not impossible:

In making these recommendations [for research] the joint committee is aware that they may encounter opposition from those who tend to view the drug problem as essentially a problem of criminal law enforcement, and specifically that the United States Narcotics Bureau has indicated that it will oppose them. The Joint Committee regrets this attitude.. ..The narcotics problem is too important to be insulated from intensive study and investigation.36

35 Ibid, 108-9. 36 Ibid, \62.

35 It was certainly true that in the United States research into the possibilities of maintenance had been prevented for some time by the Bureau of Narcotics, who ran considerable propaganda and intimidation campaigns to prevent maintenance from becoming a viable option. Moreover, the Bureau of Narcotics was ultimately successful in preventing maintenance from occurring for an additional seven years after the Joint

Committee report was authored.37 Meanwhile, however, the AMA-ABA Joint

Committee reports were published under the instructive title Drug Addiction: Crime or

Disease?, adding to the growing national debate on the issue. Ultimately the inauguration of President John F. Kennedy would result in significant changes for

American narcotics policy and research.

The short-lived Kennedy administration had a significant impact on both

America's drug policies and on research into the causes and treatment of drug addiction.

In 1962 Kennedy presided over the retirement of Harry J. Anslinger, head of the Bureau of Narcotics, and the man most responsible for preventing research into addiction and treatment.38 Kennedy himself had a considerable interest in both drug addiction and problems of mental health, which, given the psychiatric theory of addiction, were seen as complementary phenomena.39 In September of 1962 the Kennedy administration sponsored the White House Conference on Narcotic and Drug Abuse, chaired by

Attorney General Robert Kennedy, which ultimately produced the 1963 President's

David Musto, The American Disease: Origins of Narcotic Control 3r edition (Toronto: Oxford University Press, 1999), 232-4. 38 White, 252; Courtwright et al, 25-6. 39 White, 263.

36 Advisory Commission on Narcotic and Drug Abuse. The conference itself was a

veritable who's-who of addiction research and drug-law administration. Some of those in

attendance included: Anslinger, Harris Isbell, Morris Ploscowe, Edwin Schur, author of

Drug Addiction in Britain and America (1962), a highly influential comparison of the two

nation's addiction problems, Chein, and numerous law enforcement officers.41

The 1962 White House Conference and Presidential Commission produced more

questions than answers. These questions were expressed most explicitly in the discussion

of research in the Presidential Commission's Final Report. That report noted that "basic

knowledge is lacking about the causes of drug abuse." The report went on to ask such

questions as: In what way do culture and personality interact to produce drug use and

addiction? What is the typical personality of the drug abuser? What is his family

background and in what family structure does the drug abuser grow up? If personality is

so crucial to drug addiction, why do some juveniles who fit the observed personality type

of an addict not become addicted? What unique and psychological needs does the

subculture of the drug abuser fulfill? One oft-repeated observation at the 1962

conference was the recognition that addiction rates seemed to drop-off substantially after

the age of forty. What were the causes of this inexplicable phenomenon? The Final

Report poignantly noted the implications for treatment of this prevailing lack of

knowledge: "There is at present no fully established course of treatment because the basic

Both of these texts were ultimately published. U.S. Government, The White House Conference on Narcotic and Drug Abuse (Washington D.C.: Government Printing Office, 1962); U.S. Government, The President's Advisory Commission on Narcotic and Drug Abuse - Final Report (Washington D.C.: Government Printing Office, 1963). 41 White House Conference, ix-xiii.

37 research is lacking to provide guidelines as to what it should be." What should be the definition of a 'cure' for addiction?42

A number of important points should be noted about the White House Conference and Presidential Commission. First, the term 'drug abuse' was introduced in this document as a way of describing drug use that did not lead to addiction, but was nevertheless deemed problematic. Specifically, the Final Report described drug abuse in the following way:

Abuse occurs when.. .drugs are used for their psychotoxic effects alone and not as a therapeutic media prescribed in the course of medical treatment. Some psychotoxic drugs, marihuana is an example, have no practical medical use and any use of such drugs is abuse.. ..The abuse of some psychotoxic drugs leads to a psychological dependence upon them. The abuse of others leads to true addiction, with physical as well as psychological dependence.. .In general, only the drugs that cause a physical dependence with an acute physical distress on withdrawal.. .are considered to be truly addictive drugs. But addiction and the addicting drugs are only a part of the much greater problem of drug abuse which includes all of those psychotoxic drugs that produce psychological but not physical dependence.. ..Drug abuse today involves not only the narcotic drugs and marihuana, but to an increasingly alarming extent other drugs such as the barbiturates, the amphetamines and even certain of the 'tranquilizers.'43

This statement was based on the literature review conducted by the ad hoc scientific panel of the White House Conference. The ad hoc panel elaborated further:

.. .when additional types of [drug] abuse have arisen as a result of the increasing availability of many new euphoriant and tranquilizing drugs, the terms habituation and addiction have been applied without much discrimination.44

Unfortunately, according to the ad hoc panel, this misunderstanding of addiction had been enshrined both in law, and within the public imagination; "the user of opiates, cocaine, or marihuana is legally designated as an addict.. ..In common parlance, therefore, the term addiction implies nothing more than illegal abuse of drugs which

President's Advisory Commission on Narcotic and Drug Abuse - Final Report, 21-3. Ibid, 1-2. White House Conference, 276.

38 affect the nervous system." The expansion of drug use, particularly habitual use of drugs that did not fit the prevailing opiate-centric theory of addiction, had led the ad hoc panel to expand their definition of the problem of drug use; drug addiction was only one example of 'drug abuse.' An explanation was required not simply for opiate addictions but for all forms of habitual drug use.

What explanation was offered for such a complex phenomenon as 'drug abuse'?

Moreover, what could explain the continued relapse of opiate addicts? The ad hoc panel offered the concept of 'psychological dependency' as a possible explanation.

Psychological dependency represented "an uncontrollable craving and compulsion to experience the drug effects at almost any cost."46 In contrast to physical dependency and tolerance, both of which were verifiable biochemical phenomena, psychological dependency existed as an entirely abstract and mental phenomenon. Instead of deemphasizing the psychoactive effects of a drug, as the sociological theories of addiction tended to do, the theory of psychological dependency emphasized the desire of the user to 'experience the drug effects,' instead of avoiding the withdrawal symptoms.

However, it is important to note that little explanation could be offered as to the nature of

'psychological dependency.' Indeed, in its discussion of 'the drug abuser,' the ad hoc panel recycled the same personality-based theories found in the AMA-ABA Joint

Committee Report to explain why someone might begin to use a drug. In a telling passage, the ad hoc panel wrote: "this fact [that only individuals with personality disorders are susceptible to drug abuse] should serve to allay the widespread fear that drug abuse, like many other diseases..., can prey upon any individual in society without

45 Ibid. 46 Ibid, 277.

39 discrimination."47 The widespread use of drags by middle-class society in the later 1960s and 1970s would considerably challenge the assumption that only those with personality disorders could become drug abusers.

The concept of 'psychological dependency' placed a considerable burden on the behavioral sciences to offer an explanation for such a phenomenon. What did the behavioral sciences have to offer? The only psychological explanation offered at the

White House Conference was that made by Dr. Abraham Wikler of the Lexington hospital, whose actual area of specialization was neuropsychiatry. The explanation offered by Wikler repeated both the opiate-centric and psychopathological theories of the past, but expressed them using the language of behavioral psychology. Addiction could be understood within the "reinforcement theory" of behavioral psychology, which stated that a psychopath would be "driven" to experiment with substances that would reduce the

"primary drives" of pain and sex. Once the addict had become physically dependent on heroin, reinforcement theory could not provide an explanation for his behavior, since the loss of euphoric effects engendered by tolerance removed the possibility of "positive pleasure." However, during the period of physical dependency, the addict was conditioned to desire the drug by reinforcement engendered in an attempt to avoid withdrawal symptoms. Wikler's theory attracted little attention at the White House conference, but this would change later in the decade.48

The lack of a sufficient psychological theory of addiction is best explained by a lack of overall interest in the problem of addiction among scientists prior to the 1960s.

Perhaps the most significant recommendations to come out of the Presidential

47 Ibid, 294. 48 Ibid, 148-53.

40 Commission, for our purposes, were those that expanded research into the causes and nature of drug addiction. According to the report:

While federal funds are available to finance worthwhile research projects, there does not appear to be sufficient researchers or research organizations willing and able to carry them out.49

There were three reasons for this shortage of researchers: first, drug abuse had not yet become a widespread problem of national concern. Second, the 'dope fiend' stereotype deterred potential clinical researchers, and third, the enforcement practices of the

Narcotics Bureau had created a fear among researchers that they might be prosecuted for engaging in addiction research. The report authors also suggested that the National

Institute of Mental Health (NIMH) should take the initiative in training researchers and sponsoring research projects.50 The most significant outcome of the Presidential

Commission was an increase in federal interest in, and funding for, addiction research.

Moreover, the expanded definition of the problem, from one of drug addiction to 'drug abuse,' furnished a larger number of questions for the burgeoning field of addiction science.

What kind of treatment options did the 1963 Presidential Commission offer? It is worth noting that the disease concept of addiction was plastic in its implications for the treatment of drug addicts. Edward Carey, Deputy Chief of Police for New York City, and a speaker at the 1962 White House Conference, argued that, if addiction was a disease, then the addict ought to be thought of as the vector for that disease; ".. .we are convinced that the addict himself is the 'typhoid Mary' who spreads addiction to others

President's Advisory Commission on Narcotic and Drug Abuse - Final Report, 27.

41 and not the pusher." In this statement, Carey reflected the general consensus of the

White House Conference, that drug use was generally spread by drug users, and not by nefarious drug pushers. For Carey, this fact justified extended involuntary commitment for drug addicts, including compulsory 'health camps', and extended police powers.52

Voices such as Carey's, however, were in the minority. The major treatment recommendations of the Presidential Commission were consistent with the growth of the community psychiatry movement of the 1950s and 1960s, which emphasized community-based approaches to mental health, as opposed to institutionalization and imprisonment; as such, the Commission recommended that funding be made available for states and municipalities to develop local treatment centers. In addition to providing extensive psychotherapy and vocational training, these treatment centers were to treat addiction as a medical problem, with the medical community responsible for determining what constituted good-faith treatment. No longer would law-enforcement officers decide what qualified as proper medical procedure. However, the Commission stopped short at recommending the adoption of the British system of medical maintenance. The reasons given for this were twofold: first, there was no known method to maintain an addict at a stable dose of a narcotic; tolerance would necessitate increasing the dose. Second, according to the Commission, "it would be an unwarranted admission of failure to resort to maintenance doses when research is just beginning to indicate more promising developments in the treatment and rehabilitation of addicts."53 The authors did not elaborate on the research to which they were referring. Moreover, there was recognition on the part of the Commission authors that withdrawal, and an opiate-centric program of

51 White House Conference, 49. 52 Ibid, 49-53. 53 President's Advisory Commission on Narcotic and Drug Abuse - Final Report, 58.

42 treatment, would not be successful in combating the 'abuse' of non-addictive drugs.

With abstinence as the professed goal, and with experimental treatment programs as the de facto proposal, the recommendations of the Presidential Commission read more like a cry for help than a thorough plan of action.

Despite the unsubstantial recommendations for treatment, the 1963 Presidential

Commission served as a turning point for the conception of addiction and addiction research. The commission expressed a strong desire for viable treatment alternatives based on a thorough and scientific understanding of the addiction process. Moreover, the popularization of 'drug abuse' as an additional drug problem expanded the purview of scientists interested in drug research. The notion of 'psychological dependence,' which would ultimately be enshrined in the World Health Organizations definition of drug addiction in 1964,55 would further draw psychologists and other behavioral scientists into drug research. Most importantly, the Presidential Commission created an encouraging atmosphere for both clinical and laboratory-based research. As the old psychiatric and legal paradigm of addiction was overturned, a new paradigm became necessary, one which could answer the types of questions that were being asked. What was 'addiction'?

How did it start, and why? Could it be 'cured', and if so, how?

As discussed in the introduction to this thesis, the insights of Thomas Kuhn can help us to understand the changes that occurred in addiction science after the Classic

Period. In The Structure of Scientific Revolutions, Kuhn argues that, in a period before a new paradigm is established, numerous theories and paradigms compete for dominance.

The period under examination, from 1957 to 1975, could best be described as a pre-

54 Ibid, 53-66. 55 Nathan Eddy, H. Halback, Harris Isbell and Maurice Seevers, "Drug Dependence: Its Significance and Characteristics," Bulletin of the World Health Organization 37 (1965), 721-33.

43 paradigmatic period for the burgeoning field of addiction science. Nowhere is this more vividly captured than in a 1963 issue of Comprehensive Psychiatry, in which the topic of drug addiction was discussed at length. In that issue H.E. Lehmann, medical doctor at

Verdun Protestant Hospital and professor at McGill University, outlined out the competing models of addiction. These included: the cellular model, the neurophysiologic model, the personality model, the psychoanalytic model, the conditioning model, the sociological model, the law enforcement model, the iatrogenic model, and the pharmacodynamic model. While space does not permit a detailed discussion of each model, a few points are worth noting. First, Lehman acknowledged the deficiencies of an opiate-centric model of addiction in the form of the cellular model, which emphasized physical tolerance and could not explain addiction to drugs such as marijuana and alcohol, which did not produce a physical tolerance. Second, the behavioral psychology of Abraham Wikler made an appearance in the form of the conditioning model, which was the only model that explicitly attempted to explain the frequent relapse of heroin addicts after they had been successfully withdrawn from the drug. Wikler had, in true behaviorist fashion, recently conducted rat experiments to test his theory of conditioned responses to opiate addiction.57

Perhaps most interesting of all was the neurophysiological model, which made use of the recently published experiments of James Olds, one of the founders of the discipline of neuroscience. In particular, Lehman saw Olds' 1958 article in the prestigious journal Science as having considerable potential to explain addictive

56 H.E. Lehmann, "Phenomenology and Pathology of Addiction," Comprehensive Psychiatry 4 (3)(June 1963), 168-80. 57 Abraham Wikler. "Studies on conditioning of physical dependence and reinforcement of opiate drinking behavior in morphine addicted rats." 1st Annual Meeting of the American College of Neuropsychopharmacology, Washington D.C. Jan 24-27, 1963.

44 behavior. The article, "Self-stimulation of the brain: Its use to study local effects of hunger, sex and drugs," described Olds' experiments with rats that had electrodes implanted at various points within their brains. In 1956 Olds had discovered that, contrary to conventional thinking, rewarding sensations and emotions could be localized to certain brain tissue; in particular, areas along the mid-brain, such as the rhinencephalon, when stimulated by an electric current, produced what appeared to be pleasure within rats. Moreover, Olds discovered that, when left to their own devices, rats would rather self-stimulate these pleasure centers than eat food, drink water, or engage in sexual behavior. Olds convincingly argued that his findings contradicted the classic theory of reward, which stated that all human motivation stemmed from the desire to relieve certain painful or unpleasant conditions such as hunger or thirst. These conditions produced drives, and pleasure was merely the satisfaction of one of these drives.59 In many ways the classic theory of reward resembled the classic theory of addiction, since both denied the existence of positive pleasure as a meaningful motivation for behavior.

Lehman's discussion of Olds' discoveries is worth quoting at length:

An intriguing prototype of compulsive "pleasure-seeking" behavior which may well serve as a paradigm of addiction is provided by the recent experiments of Olds and his co-workers. These investigators have demonstrated that rats and other animals with electrodes implanted in the septal region of the brain or in the anterior part of the hypothalamus will stimulate these areas when given an opportunity to do so by activating a switch which allows an electric current to flow to the electrodes. They will, in fact, ceaselessly and rapidly indulge in repeated cerebral self-stimulation of this kind which they may prefer to feeding or drinking even when in a state of food or water deprivation. A model of addiction based on these observations would conceive of the addicting agent as being a suitable stimulator of the pleasure or award centers in the brain and inducing a self-perpetuating cycle of behavior which is characterized by the continuous

James Olds, "Pleasure Centers in the Brain," Scientific American 195 (1956), 105-117; James Olds, "Self-Stimulation of the Brain: It's Use to Study Local Effects of Hunger, Sex and Drugs," Science 3294 (127)(1958), 315-324. 59 Olds, "Self-Stimulation," 315.

45 seeking of the special addicting agent. It should be noted, however, that until now the presence of such award centers in the human brain has not been demonstrated.

The significance of Olds' experiments is considerable. By opening Up the possibility of pleasure which the classic theory of addiction had denied, the developing field of neuroscience had the potential to dramatically shift the focus of addiction research away from deviant behavior, and towards all activities that were habit-forming because of their pleasurable effects. However, it is important to note that because of the relative newness of the self-stimulation experiments, and because the mechanism by which drugs might affect these pleasure centers was unknown, the neurophysiological model remained only one model among many in the pre-paradigmatic period of addiction research.

The period from 1957 to 1963, then, saw considerable changes in the way that drug addiction and addiction treatment were studied, conceived of and implemented in the United States. As the AMA-ABA Joint Committee challenged the punitive nature of

American drug policy, they were aided by a number of sociological studies which challenged the decades-old psychiatric theory of addiction. However, the 'disease theory' which replaced the psychiatric theory was not founded on any breakthrough in the scientific understanding of the addictive process; rather, it was the product of medical compassion combined with a series of research studies which noted the extremely high relapse rate of treated addicts. These studies, combined with the increasing use of non- opiate drugs, led politicians to expand the purview of the 'drug abuse problem,' and compelled scientists to seek new answers as to the origins of compulsive behavior. With old paradigms discarded, new paradigms in science and treatment could compete for

60Lehmann, 173. Emphasis added.

46 dominance. In the newly emerging field of addiction science, the behavioral psychology and neuroscience of B.F. Skinner, James Olds and others competed with sociology and pharmacology to form a non-opiate-centric theory of addiction. Of course, such academic competition was only possible because of an increasingly permissive and supportive research atmosphere. One final example, the story of the birth of methadone maintenance, will display many of these major trends.

Marie Nyswander and Vincent Dole, the inventors of methadone maintenance treatment for heroin addicts, came from considerably different educational backgrounds.

Although both were medical doctors, Nyswander was trained as a surgeon and psychiatrist, while Dole was a metabolic disease specialist who had already achieved some notoriety for his research endeavors. While at the federal hospital at Lexington,

Nyswander had grown increasingly skeptical of the psychiatric theory of addiction as a result of her close contact with addicts. Meanwhile, Dole had become increasingly concerned about the lack of scientific understanding of addiction. As Dole put it, "I said what a shame it was that there was none of the scientific thought in the field of addiction that I had encountered in my other researches. It didn't have recognition as a scientific problem. Certainly there wasn't any research talent in it."61

Dole and Nyswander met in 1962 while Dole was the chair of the Rockefeller

Health Research Council's Committee on Narcotics. In 1963 the two set out to begin a trial of methadone maintenance at Beth Israel Hospital in New York City. While maintenance treatment using heroin or morphine had been roundly rejected in the past, methadone, which had been used at Lexington for withdrawal treatment, possessed a considerable pharmacological advantage over other drugs. As Dole and Nyswander

61 As quoted in Courtwright et al, 332.

47 discovered, heroin addicts could be stabilized on a consistent dose of methadone which did not need to be increased as a result of the tolerance phenomenon. Patients on methadone were able to function 'normally,' without the euphoric effects of a heroin dose, or the unpleasant effects of the withdrawal symptoms. Freed from the specter of withdrawal and able to obtain such relief legally, patients were able to engage in social rehabilitation, including school, work and psychotherapy. It is worthwhile to note here that Dole himself spent several hours a day talking with his experimental subjects, who were able to relate to him without the stigma of a prison environment. Put another way,

Dole was able to take the experiences of addicts seriously as part of his research. This led to a considerable redefinition of the addiction process in his mind. This redefinition is hinted at in Dole and Nyswander's 1965 article for the Journal of American Medical

Association {JAMA) in which they reported their experimental findings:

.. .patients who before treatment appeared hopelessly addicted are now engaged in useful occupations and are not using.. .heroin. As measured by social performance, they have ceased to be addicts.62

This comment indicates a developing theory of addiction which would emphasize social adjustment and behavior, and deemphasize abstinence as a form of treatment. Such a change in thinking was made possible because of the open-and-interdisciplinary research environment in which Dole and Nyswander worked. While it is true that Dole and

Nyswander faced considerable harassment from the Bureau of Narcotics, it is also important to note that, in their 1965 JAMA article which detailed their research, they made explicit reference to both the AMA-ABA Joint Committee study and the

62 Vincent Dole and Marie Nyswander, "A Medical Treatment for Diacetylmorphine (Heroin) Addiction," Journal of the American Medical Association 193 (8)( 1965), 80.

48 Presidential Commission as having encouraged them to undertake their research. The success of Dole and Nyswander's research program indicated that the door was now truly open for scientific addiction research, and that such research would proceed with the cooperation of the addict.

Ibid, 80n2-6.

49 Chapter 2 - "Drug-Seeking Behavior": 'Drug Addiction,' 'Drug Abuse' and Addiction Research Journals, 1965 - 1975

While the concept of the psychopathic addict came under considerable criticism from sociologists and proponents of the 'disease' theory of addiction, it was still the prevailing wisdom that drug addicts suffered from some kind of psychopathology.

Delegates at the 1963 Presidential Commission on Narcotic and Drug Abuse still considered drug addiction to be a manifestation of deeper underlying personality disorders which afflicted only a segment of the population.1 By way of contrast, the

Final Report of the Royal Commission of the Inquiry in the Non-Medical Use of Drugs

(1973) stated that "it is incorrect to assume that all drug use has some underlying psychopathology, but it is equally incorrect to assume that some people are not more prone to excessive use than others." Indeed, in contrast to the psychiatric and sociological theories of the late Classic Period, which emphasized individual susceptibility to addiction and argued against pleasure as a motivating factor, the Royal

Commission argued for broad susceptibility to addiction, and emphasized pleasure and hedonism as explanatory factors in the perceived recent surge in drug abuse. By 1975, however, members of the scientific community were making even more radical statements about the causes and extent of drug addiction. In a 1975 article for the British

Journal of Addictions surveying recent discoveries in pharmacology and the behavioral sciences, Lorenz Ng, Steven Szara and William Bunney would remark that "it is probably safe to say that under 'optimal' conditions, almost any individual can be made to become

A note on terminology may be useful here. Psychopath refers to a specific kind of personality disorder characterized by antisocial behavior. Psychopathologic refers to a person who suffers from any kind of pathologic personality disorder, such as neurosis or hypochondriasis. Government of Canada, Royal Commission of Inquiry into the Non-Medical Use of Drugs, Final Report of the Commission of Inquiry into the Non-Medical Use of, (Ottawa: Information Canada, 1973), 25. 3 Ibid, 23-35.

50 dependent on opiate drags. Such a conclusion is supported by considerable experimental evidence and further attests to the importance of the pharmacological properties of these drugs in the development of drug-seeking behavior.,"4 Thus, in just over a decade the prevailing wisdom on drug addiction had shifted from a psychiatric paradigm that emphasized susceptibility of certain ill persons, to a paradigm based on psychology and neurobiology that made any person a possible candidate for drug addiction. What brought about this change in scientific discourse?

The 1963 Presidential Commission on Narcotic and Drug Abuse had signaled the desire of the American public to have scientific answers for the problem of drug addiction, leading to the creation of a new research field for scientists and scholars interested in the problem. The lack of scientific interest and writing on addiction noticed by Vincent Dole in the early 1960s was about to be addressed. However, it is critically important to note that the new field of addiction science would come to maturity during a period of considerable change in the way people in Western countries used and thought about psychoactive substances. Substantial growth in the use of marijuana and other hallucinogenic drugs by middle-class youth, combined with a growing perception that problematic drug use was not limited to minorities and the lower-class, popularized the concept of 'drug abuse,' and led to considerable confusion between that phenomenon and drug addiction. Moreover, the concept of addiction was expanded to include habitual use of psychoactive substances which produced no physical dependency; this reflected a growing recognition of the non-medical use of amphetamines and barbiturates. Since no overarching theory of addiction had been convincingly proposed by any major scientific

4 Lorenz Ng, Stephen Szara and William Bunney, "On Understanding and Treating Narcotic Dependence: A Neuropsychopharmacological Perspective," British Journal of the Addictions 70(1975), 315. Emphasis added. British Journal of the Addictions henceforth cited as BJA.

51 field, the various interested disciplines jockeyed for dominance of the newly created field of addiction science. While sociology had been pivotal in challenging the psychiatric theory of addiction, it was unable to offer a compelling alternative, and in many cases simply repeated the conclusions of the psychiatric theory in sociological language; this became the 'psychosocial' theory of addiction. Sociology, however, remained a relevant discipline for examining the growth of recreational drug use. Addiction, however, took another path. A series of experiments and discoveries in the behavioral sciences provided compelling explanations for the two most frequently noted problems in addiction research and treatment: first, the frequent relapse of addicts following treatment, and second, the habitual use of non-opiate drugs. The behavioral psychology of B.F. Skinner, and in particular, experiments that demonstrated the power of conditioned responses to stimuli, provided compelling explanations for addictive behavior and relapse. By the

1970s, researchers began to examine the pharmacological effects of psychoactive substances on the brain. The experiments of behavioral scientists and neurobiologists would serve to link different psychoactive substances and suggest a common mechanism of addiction. The discovery that widely different drugs affected the same brain systems provided further compelling evidence for linking different addictive substances. Most importantly, however, the perception that man was entering a 'chemical age' of widespread drug use resulted in addiction science that emphasized mass-susceptibility to addiction and drug abuse; behavioral psychology, in particular, was crucial for this reciprocal relationship between science and broader society. Equally important to note is the relationship between these new understandings of addiction, and proposals for

52 treatment; as understandings of drug use became more sophisticated, the goals of treatment became more complex and required more sophisticated training.

The professional journals of addiction researchers provide an excellent source for examining how ideas of addiction, drug abuse and treatment have changed over time. In addition to publishing a number of important original articles detailing the work of prominent researchers, these journals regularly reviewed monographs which had a significant impact on the field. For the purposes of this chapter, two international addiction research journals will be examined; the British Journal of Addiction (BJA), and

The International Journal of the Addictions (IJA). It is worthwhile to note that the IJA began life in 1966, not long after the call was sounded to begin scientific investigation of addiction problems, while the BJA changed its name from The British Journal of

Inebriety in 1965, suggesting an increased concern with non-alcohol addictions.5 The presence of professional journals signified that addiction was now a legitimate scientific topic.

The initial issues of the IJA speak volumes about the world-view and prevailing ideas of early addiction researchers. The first editorial written by Stanley Einstein,

Executive Director for the Institute for the Study of the Addictions and editor of the IJA, explicitly discussed two linked themes that would recur in subsequent addiction literature. The first theme was that drug addiction had become a stereotyped phenomenon; all drug addicts were thought to be working-class or criminal males with

5 The InternationalJournal of the Addictions was the official publication of the recently organized Institute for the Study of Drug Addiction. Executive Officers, "The Institute for the Study of Drug Addiction," InternationalJournal of the Addictions, 1 (1)(1966), 3-4. InternationalJournal of the Addictions henceforth cited as IJA.

53 poor self-control and psychopathic personalities. The second theme involved the

demographic changes in habitual drug use that had been observed in recent years.

According to Einstein "the belief has persisted that addiction is a problem of the slum

child, of the broken home child. We have been surprised and even shocked to discover

that urban drug misuse has spread to suburbia. We have been forced to recognize that

addiction is not a monopoly of the off-whites or impoverished groups."6 This

stereotyping of the addict had resulted, according to Einstein, in poor or non-existent

scientific research on addiction, which was primarily responsible for the failure of most

treatment programs. As Einstein pithily observed, "inadequate information, unwarranted

generalizations, and a lack of clarity in defining our goals, have led to nearly universal

failure in our attempts to treat the problem."7 In particular, Einstein criticized the

emphasis placed on abstinence as a treatment goal, which he argued was a confusion of

goals with techniques.8

Einstein's sentiments were echoed by Leon Brill, a social worker and Project

Director for the recently opened Washington Heights Rehabilitation Center in New York

City. Brill, in articles for both the IJA and the BJA, argued that addicts had been

incorrectly cast as a homogeneous group, owing to poor empirical study, and further, that

social factors had been given short-shrift as potential causes of addiction; drug addiction

ought to be conceptualized as a 'social problem.'9 Indeed, Brill argued that the

sociological concept of 'anomie' advanced by Emile Durkheim - a state of confusion or

despair caused by the rapid change of modern society - was at the root of most narcotic

6 Stanley Einstein, "The Narcotics Dilemma: Who is Listening to What?" IJA 1 (2)(1966), 2. 7 Ibid, 3. 8 Ibid, 5. 9 Leon Brill, "Drug Abuse as a Social Problem," IJA 1 (2)(1966), 7-21; Leon Brill and Jerome Jaffe, "The Relevancy of Some Newer American Treatment Approaches for England," BJA 62 (1967), 375-86.

54 use. According to Brill, sociological investigations had suggested that addicts used narcotics as part of an effort to produce an indifference to such anomie. In support of such an argument, Brill made explicit reference to The Road to H, the highly influential sociological study of New York heroin users.10 However, it is important to note here that addiction was still characterized as being the result of personality disorders. As Brill put it:

We believe that most addicts, even the anti-social ones, are sick, troubled or highly immature persons rather than simply criminals.. ..From this perspective, drug use is seen as a symptom of both the individual's personal pathology and the social disorganization of the culture in which he lives.1

In its emphasis on individual susceptibility, the psychosocial model of drug addiction echoed many of the ideas of the disease theory of alcoholism. For Brill, social conditions aggravated existing mental health problems, which varied from person to person. The prescription for research offered by Brill was to engage in "socio-cultural studies of the addict in his own 'tribal-culture,' his outlook and private goals, resistance to abstinence and the 'square' culture."12 Perhaps most importantly, such socio-cultural studies would examine not only heroin users, but middle-class drug users as well. As Brill put it:

We are finally realizing that the problem of narcotic addiction has been oversensationalized [sic] rather than subjected to objective study and research. We are only now beginning to see it in better perspective as part of the far more pervasive and serious problem of drug abuse, which probably affects a much larger part of our population, including the middle class, than does the addiction to opiates and their derivatives.13

10 Brill, 8-9. In their 1968 article for the IJA entitled "Models of Addiction," Miriam Siegler and Humphrey Osmond explicitly identified The Road to Has being the originator of the psychosocial model. Miriam Siegler and Humphrey Osmond, "Models of Addiction," IJA 3 (1)(1968), 10n5. 11 Brill and Jaffe, 375. 12 Brill, 20. 13 Ibid.

55 Brill would go on to suggest that barbiturate and amphetamine use had been ignored as subjects for investigation, and that this situation ought to be rectified. This psychosocial perspective on drug addiction was echoed by numerous other contributors to the IJA and

BJA in the late 1960s.14

What forms of treatment were suggested by supporters of the psychosocial theory of addiction? First-and-foremost, the goal of abstinence was attacked as being unrealistic. Demands for immediate abstinence were viewed as 'simplistic' and "based on a misunderstanding of the nature of addiction."15 Because addicts were viewed as a heterogeneous group, different therapeutic approaches for different types of addicts would be necessary. In particular, Brill and other advocates of this new, sociologically informed understanding of addiction were strong proponents of methadone maintenance, treatment with the narcotic antagonist cyclazocine, and the use of 'rational authority,' which in practice meant integration of parole and treatment services.16 It is also worth noting that adherents to the psychosocial theory of addiction were generally staunch opponents of institutional forms of treatment such as those practiced at United States

Some examples of articles espousing or influenced by the psychosocial approach include: Edward Preble, "Social and Cultural Factors Related to Narcotic Use Among Puerto Ricans in New York City," IJA 1 (1)(1966), 30-41; Arthur K. Berliner, "Narcotic Addiction, The Institution and The Community," IJA 1 (1)(1966), 74-85; Mario Fortunato et al, "Predicting Type of Discharge from a Narcotic Detoxification Service," IJA 1 (1)(1%6), 124-130; Robert Chase, "Cessation Patterns among Neophyte Heroin Users," IJA 1 (2)(1966), 23-32; Jordan Scher, "Patterns and Profiles of Addiction and Drug Abuse," IJA 2 (2)(1967), 171-190; Basil J. Sherlock, "Career Problems and Narcotics Addiction in the Health Professions: An Exploratory Study," IJA 2 (2)(1967), 191-206; Harold Alksne, Louis Lieberman and Leon Brill, "A Conceptual Model of the Life Cycle of Addiction," IJA 2 (2)(1967), 221-240; Walter C. Bailey; "Naline Control of Addict-Probationers," IJA 3 (1)(1968), 131-137; Irit Friedman and liana Peer, "Drug Addiction Among Pimps and Prostitutes," IJA 3 (2)(1968), 271-300; Rita Volkman, "Differential Association and the Rehabilitation of Drug Addicts," BJA 61 (1965), 91-100; Carole Pina, "Drug Dependence in the United States," BJA 63 (1968), 143-7; Herbert Halstead and C. David Neal, "Intelligence and Personality in Drug Addicts: A Pilot Study," BJA 63 (1968), 237-40; C. I. Backhouse and I. Pierce James, "The Relationship and Prevalence of Smoking, Drinking and Drug Taking in (Delinquent) Adolescent Boys," BJA 64 (1969), 75-9; M. M. Glatt, "Rehabilitation of the Addict," BJA 64 (1969), 165-82. 15 Brill, 8. 16 Brill and Jaffe, 376-84. Cyclazocine is a non-specific opiod antagonist which, when administered, blocks the effects of opiod drugs, including euphoria and analgesia. It was later discovered to cause hallucinations.

56 Public Health Service hospitals at Lexington, Kentucky and Fort Worth, Texas and instead favored an approach based on the newly-developed principles of 'community psychiatry.'17 This is perhaps not surprising given the fact that the rise of the psychosocial theory of addiction was concurrent with the rise of the so-called anti- psychiatry movement, which argued, among other things, that psychiatric medicine and treatment had constituted a coercive and repressive force in modern life.18 Indeed, it is worthwhile to note that the first book review published in the IJA was written by Thomas

Szasz, the most well-known figure of the anti-psychiatry movement. In that review Szasz argued that the treatment of addiction as a 'disease' was as problematic, and potentially as dangerous, as was treating it as a criminal problem. Moreover, Szasz praised the treatment approaches taken by such non-medical organizations as the ex-addict directed therapeutic community of Synanon, which eschewed scientific understandings of addiction.19

Ultimately, however, the treatment goals of the psychosocial model of addiction were elusive and nebulous. Proponents of the model offered suggestions for improved understanding of the social causes of addiction, and persuasively argued for a community-oriented perspective for treatment; simultaneously they denounced compulsory treatment and the goal of abstinence. Unfortunately, specific proposals for a

17 Brill, 20. 18 A discussion of the anti-psychiatry movement can be found in Peter Sedgwick, Psycho Politics: Laing, Foucault, Goffinan, Szasz and the Future of Mass Psychiatry (New York: Harper & Row Publishers, 1982), 3-42, 149-184; W.F. Bynum, Roy Porter and Michael Shepherd eds, The Anatomy of Madness: Essays in the History of Psychiatry (New York: Tavistock Publications, 1985), 1-24. 19 In addition to Szasz's most influential book, The Myth of Mental Illness, Szasz also produced an entire volume on the relationship between psychiatry and drug addiction in 1974, containing such essays as "The Discovery of Drug Addiction." This makes some sense, given the hostility displayed by Szasz towards such psychiatric labels as 'psychopath.' Thomas Szasz, "Book Reviews - The Addict and the Law by Alfred Lindersmith," IJA 1 (1)(1966), 150-155; Thomas Szasz, The Myth of Mental Illness: Foundations of a Theory of Personal Conduct (New York: Dell, 1961); Thomas Szasz, Ceremonial Chemistry: The Ritual Persecution of Drugs, Addicts and Pushers (New York: Anchor Press/ Double Day, 1974).

57 treatment agenda were infrequent. Some attempt was made to provide a sociological rationale for Synanon, the ex-addict directed therapeutic community located in

California, but such attempts were rare.20 The difficulties of the psychosocial model for treatment were made explicit in a 1968 article by Miriam Siegler and Humphrey

Osmond, members of the New Jersey Neuro-Psychiatric Institute. In their discussion of various models of drug addiction, Siegler and Osmond noted of the psychosocial model:

It is not exactly clear how addicts should be treated. They should receive medical care from physicians, social casework, sheltered workshop assistance and psychotherapy. Therapy cannot be compulsory, as that does not work.. ..Social change of some kind must occur before addicts can be successfully treated.21

For Siegler and Osmond, the psychosocial model of addiction suggested not specific treatment programs, but rather that broader changes in society were necessary to address the problem of drug abuse and addiction. Such sentiments were echoed by Stanley

Einstein, whose editorials for the IJA repeated similar themes well into the 1970s. For instance, in 1971 Einstein argued that the increasing use of marijuana among middle- class youth was simply a reflection of the tendency of modern people to turn to psychoactive substances rather than to work out their problems and attain emotional support from their fellow man. Of course, this vague analysis led to equally vague recommendations, such as Einstein's proposal to ".. .give up marijuana and get high on people."22 Ultimately, the psychosocial model of addiction was unable to provide meaningful answers for those who were looking to develop treatments for the new problems of 'drug abuse.'

20 One such attempt was made by Rita Volkman of the University of California, Los Angeles, who argued that Synanon essentially put into practice the sociological theories of Edwin Sutherland. Volkman, 91-100. Another lengthy sociological discussion of Synanon occurs in Lewis Yablonsky, Synanon: The Tunnel Back (Baltimore, Maryland: The Macmillan Company, 1965). 21 Siegler and Humphrey, 10. 22 Stanley Einstein, "Editorial," IJA 6 (3)(1971), 2.

58 While the psycho-social model of addiction gained considerable popularity in the major addiction research journals, another model was proving to be even more effective at answering the pressing questions of the day. Issues of the IJA and BJA published in the 1960s and 1970s record the increasing influence of behavioral psychology and conditioning theory on the rapidly expanding field of addiction science. In particular, the experiments of University of Kentucky psychiatrist Abraham Wikler would provide support for behavioral explanations for addiction and relapse, and would encourage numerous researchers to examine possible behavioral explanations for addiction to non- opiate drugs.

Space does not permit an extended discussion of behavioral psychology, but a few salient points should be mentioned. For much of the nineteenth century, the discipline of psychology was preoccupied with the workings of consciousness and mental processes.

The chief methodological tool of nineteenth-century psychologists was introspection, defined as the critical self-observation of one's own thoughts and feelings. One example of introspective psychology is the work of American psychologist and philosopher

William James. In the early twentieth century, however, American psychologist John B.

Watson launched an attack on the introspective study of psychology. Watson argued that behavior, and not consciousness, was the proper subject matter of psychology, since only behavior could be empirically studied. Moreover, Watson argued that psychologists ought to reject 'mentalistic' explanations of behavior, which depended upon introspective accounts of mental states, on the grounds that they were untestable by the scientific method. Watson himself was heavily involved in animal experimentation, and had been strongly influenced by the experiments of Russian psychologist Ivan Pavlov. Pavlov, in

59 his most famous experiment, had demonstrated the existence of the phenomenon of

classical conditioning. In his experiment, Pavlov paired an unconditioned stimulus

(food) with a conditioned stimulus (the ringing of a bell), and presented the two to dogs.

He found that the salivation engendered by the food would later occur if only the ringing bell was presented, suggesting that this autonomic function could be triggered by any

stimulus.

The ideas of Watson were taken further by highly influential American psychologist B.F. Skinner. Skinner's radical behaviorism introduced the idea of operant

conditioning, which dealt with voluntary responses, as opposed to classical conditioning,

which dealt with involuntary responses. According to Skinner, voluntary actions should

not be explained by hypethetico-deductive, or mental, explanations, but should instead be understood as a consequence of environmental stimulus which reinforced a specific behavior. Skinner's most famous methodological contribution was the operant-

conditioning chamber, or Skinner box, which could be used to perform laboratory

experiments on animal behavior. With this device, Skinner conditioned a pigeon to press

a bar to obtain a food pellet; the food pellet had thus reinforced the bar-pressing behavior,

and the pigeon had 'learned' to associate the two events. According to Skinnerian

behaviorism, learning was simply a process by which a response became associated with

an outcome; most references to 'learning theory' are direct references to Skinnerian

behaviorism and reinforcement theory. While a discussion of the finer points of behavioral psychology could continue ad nauseum, for our purposes the most significant

developments were the rejection of the mentalistic explanations and psychodynamics, the

emphasis on conditioned responses and learning theory, the insistence on laboratory

60 experimentation, and the frequent comparison of animal and human behavior.

Contextually, it is also crucial to note that, for much of the mid-twentieth century, behaviorism constituted the dominant paradigm of psychology, and was only challenged by the so-called 'cognitive revolution,' which did not reach its zenith until the 1980s.23

Behavioral experiments addressing drug addiction had, of course, been conducted prior to Wikler's seminal paper of 1965. In a paper published in Scientific American in

1964, James R. Weeks reported that he had induced physical dependence to morphine in rats and monkeys using a self-injection mechanism of his own design.24 Weeks explicitly linked his experiments to the behaviorist tradition by noting the similarities between his experiments and those of B.F. Skinner.25 An important fact about Weeks' experiments is worth noting. Weeks' primary finding was simply that, once physically addicted, rats would self-administer morphine to ward-off withdrawal symptoms. He denied the possibility that the rats 'liked' or took pleasure in the use of the drug. His conclusions were limited to the general statement that morphine acted as reinforcer for drug-seeking behavior. The experiments of Abraham Wikler had considerably more far-reaching implications.

The history of psychology has an almost overwhelming historiography. The above sketch of behaviorism is drawn from C. James Goodwin, A History of Modern Psychology 2nd Edition (Hoboken, NJ: Wiley, 2005), 278-342. For an excellent discussion of the philosophical and epistemological issues raised by Pavlov, Watson and Skinner, see J.D. Keehn, Master Builders of Modern Psychology: From Freud to Skinner (New York: New York University Press, 1996), 114-166. Useful sketches of B.F. Skinner, J.D. Watson and others can be found in Ernst Keen, A History of Ideas in American Psychology (Westport, Conn.: Praeger, 2001). 24 J.R. Weeks, "Experimental Narcotic Addiction," Scientific American 210 (1964), 46-52; see also J.R. Weeks, "Experimental Morphine Addiction: Method for Automatic Intravenous Injections in Unrestrained Rats,"-Science 138 (1962), 143-4. 25 Weeks, "Experimental Narcotic Addiction", 48. 26 Ibid.

61 Wikler had initially suggested a behavioral model of addiction and relapse at the

1963 White House Convention on Narcotic and Drug Abuse.27 But it was his experiments published in a 1965 edited collection entitled simply Narcotics that had the most significant impact on the field.28 Although trained as a psychiatrist, Wikler had been deeply influenced by Skinnerian behaviorism. In his introduction to "Conditioning

Factors in Opiate Addiction and Relapse," Wikler decried the 'mentalistic' and unscientific explanations of opiate addiction proffered by psychoanalysts. In particular,

Wikler argued that psychoanalysts had placed too much emphasis on the desire for euphoria as an explanatory mechanism for addiction, and had not properly investigated the phenomenon of relapse; Wikler proposed to do this by using animal experimentation, the staple method of the behaviorists.

Wikler's results were surprising. After addicting a series of experimental rats to etonitazene, a morphine-like drug, Wikler and his colleagues observed that, long after the rats had been physically withdrawn from the drug, they could be compelled to experience withdrawal symptoms by placing them in physical settings where they had been given the drug. The abstinence syndrome, it seemed, could be conditioned experimentally, and triggered long after withdrawal had actually occurred. Moreover, the rats, once they began to experience the conditioned withdrawal syndrome, would self-administer morphine in order to alleviate the withdrawal distress. Wikler had, for all intents and purposes, experimentally reproduced the phenomenon of relapse which had perplexed commentators on addiction for some time, and moreover, had offered a compelling

27 Abraham Wikler, "Psychological Bases of Drug Abuse," in The White House Conference on Narcotic and Drug Abuse (Washington D.C.: Government Printing Office, 1962), 148-53. 28 Abraham Wikler, "Conditioning Factors in Opiate Addition and Relapse," in eds. Daniel Wilner and Gene Kassebaum, Narcotics (New York: McGraw-Hill Book Company, 1965), 85-100.

62 explanation for that phenomenon. It is worth noting that relapse in human heroin addicts had served as the inspiration for Wikler's study. As Wikler put it:

Statements occasionally made by postaddicts to the effect that they have experienced symptoms resembling those of acute abstinence from morphine long after withdrawal of the drug led the author to hypothesize that physical dependence may become conditioned to environmental situations specifically associated with availability of morphine, and hence "abstinence distress," or something very much like it, may be reactivated long after "cure" when the postaddict finds himself in a similar situation, thus providing an unconscious motivation to relapse and renewed self-maintenance of addiction.. .29

Wikler's study, then, demonstrates the reciprocal influence of the drug addict on the direction taken by addiction researchers; he talked to addicts, took their descriptions seriously, and then used them to formulate hypothesis that were testable by behavioral methods.

In discussing his results, Wikler argued that, if correct, his experiments suggested that traditional methods of treatment for opiate addiction were fundamentally flawed. As

Wikler put it, withdrawal followed by abstinence would no more 'cure' an addict than

"satiating a rat with food and keeping it away from the Skinner box [a reference to the operant conditioning experiments of B.F. Skinner]... will 'cure' it of its lever-pressing

'habit,' previously reinforced by food rewards under conditions of starvation." Wikler went on to argue for the development of new forms of chemotherapy that would manipulate the abstinence syndrome so as to break the addict of these conditioned responses. However, Wikler shied away from explicitly suggesting changes to contemporary treatment programs; he saw the primary contribution of his work as allowing for the scientific testing of "mentalistic" ideas about drug addiction.

29 Ibid, 88. 30 Ibid, 96. 31 Ibid, 96-7.

63 The influence of Wikler's study was considerable; the significant number of citations to it in the IJA and BJA suggests that it had a substantial impact on the new field of addiction science. Moreover, the implications of Wikler's theory for treatment were not lost on those investigating new treatment options. In 1966 Jerome Jaffe and Leon

Brill made direct reference to Wikler's study while investigating the possibility of using cyclazocine to treat heroin addicts; they argued that cyclazocine, which conferred immunity to the pharmacological effects of opiate drugs, could be used to assist in undoing the conditioned responses of heroin addicts.33 A similar argument was made one year later in the IJA by researchers at the Addiction Research Center at Lexington,

Kentucky.34 Beyond its implications for treatment, however, the ultimate significance of

Wikler's experiments was to popularize a behavioral model of drug addiction which made no reference to concepts of personality or psychopathology. This simultaneously universalized the process of drug addiction to all humans (and, arguably, all animal species) and de-stigmatized the addiction and relapse phenomenon by placing them beyond the control of the individual addict.

Wikler, of course, was not the only behaviorist attempting to understand addictive processes. In his review of Narcotics published in the IJA, David Laskowitz of the

Albert Einstein School of Medicine noted that one of the major problems faced by the

A brief list of early citations from IJA is here provided: Jerome Jaffe and Leon Brill, "Cyclazocine, A Long Acting Narcotic Antagonist: Its Voluntary Acceptance As a Treatment Modality by Narcotics Abusers," IJA 1 (1)(1966), 102-23; W.R. Martin and C. W. Gorodetzky, "Cyclazocine, an Adjunct in the Treatment of Narcotic Addiction," IJA 1 (2)(1967), 85-93; Jordan Scher, "Patters and Profiles of Addiction and Drug Abuse," IJA 2 (2)(1967), 171-190; Harold Alksne, Louis Lieberman and Leon Brill, "A Conceptual Model of the Life Cycle of Addiction," IJA 2 (2)(1967), 221-240. In 1981 Wikler's study was declared a classic in the field of addiction research, and was cited as the study that first introduced behavioral psychology to the field of addiction science. Howard Shaffer and Milton Burglass eds., Classic Contributions in the Addictions (New York: Brunner/Mazel, 1981), 337-8. 33 Jaffe and Brill, 102-6. 34 W. R. Martin and C. W. Gorodetzky, "Cyclazocine, an Adjunct in the Treatment of Narcotic Addiction," IJA 2 (1)(1967), 85-93.

64 psychosocial theories of addiction advanced by such scholars as Alfred Lindesmith was that these theories "[did] not explain habituating behavior to substances which may not involve a clearly defined abstinence syndrome."35 Behavioral psychologists, however, were about to address this very problem. By 1968 a slew of experiments had been conducted investigating addiction in animals, and the IJA devoted much of an issue to reporting the results of these experiments. Travis Thompson of the University of

Minnesota, in his survey of behavioral experiments, reported a number of intriguing findings. Of particular interest were the experiments of Deneau, Yanagita and Seevers,

Schuster and Woods, and Pickens and Thomson. These scientists had conducted experiments showing that drugs such as cocaine and amphetamines, which did not produce physical dependence like the opiates, were still self-administered by monkeys.

These drugs thus acted as "unconditioned positive reinforcers."36 In essence, these experiments provided an explanation for addictive behavior that addressed the questions so often raised about the opiate-centric theories of addiction devised during the Classic

Period; why did people habitually use non-opiate drugs? This question had taken on considerable importance in the 1960s because of the perception of widespread drug use in contemporary society. It is worthwhile to note that much of the inspiration for the animal experiments of the behaviorists was taken from clinical interaction with human drug

35 David Laskowtiz, "Book Reivews - Narcotics," IJA 2 (1)0967), 154. 36 Travis Thompson, "Drags as Reinforcers: Experimental Addiction," IJA 3 (1)(1968), 200. The Denau, Yanagita and Seevers experiments had not yet been published at the time that Thompson's article was published in the IJA, and Thompson based his discussion of their work on a personal communication. Denau, Yanagita and Seevers' work would ultimately be published as G.A. Deneau, T. Yanagita, and M.H. Seevers, "Self-administration of psychoactive substances by a monkey - a measure of psychological dependence," Psychopharmacologia 16 (1969): 40-48. The other studies referenced by Thompson are: C.R. Schuster and J.H. Woods, "Morphine as a reinforcer for operant behavior." Reported to the Committee on Problems of Drug Dependence, 1967; R. Pickens and T. Thompson, "Cocaine-reinforced behavior in rats: Effects of reinforcement magnitude and fixed-ratio size." Journal of Experimental Animal Behavior, 1967.

65 addicts. For instance, an article examining the reinforcing effects of barbiturate drugs cited numerous clinical studies of barbiturate addicts as providing inspiration for the design of the study.37

The behaviorists made a number of crucial contributions to the emerging field of addiction science. First, the behavioral theory of addiction did not depend on the presence of withdrawal symptoms. In their discussion of barbiturate addiction, David,

Lulenksi and Miller stated that "to demonstrate addiction it is necessary to show that the self-administered drug will maintain its reinforcing effectiveness...." Addiction is here defined simply as reinforced self-administration of any psychoactive substance.

Moreover, the behavioral theory of addiction tied together widely different psychoactive substances. As Woods and Schuster put it in their discussion of cocaine, morphine, barbiturates, nicotine and SPA:

A number of studies demonstrate that drugs of different pharmacological classes will act as positive reinforcers when delivered intravenously. Morphine acts as a reinforcer in both morphine-dependent rats.. .and morphine-dependent monkeys.. ..Amobarbital reinforces lever-pressing responses if rats are subjected to a series of noncontingent electric shocks.. ..In monkeys, cocaine.. .and nicotine.. .have been shown to be strong and weak reinforcers respectively. Each of these drugs has the common property of reinforcement in animals, and each is abused by man?

In postulating a non-opiate-centric theory of addiction, the behaviorists simultaneously addressed the problems of relapse and the emerging phenomenon of 'drug abuse.'

Moreover, the idea that certain drugs could be an unconditioned positive reinforcer reopened the issue of pleasure as a possible motivator for habitual drug use.

John Davis, Gary Lulenski and Neal Miller, "Comparative Studies of Barbiturate Self-Administration," IJA 3 (1)(1968), 207-14. 38 Ibid, 208. 39 C.R. Schuster and J.H. Woods, "Reinforcement Properties of Morphine, Cocaine, and SPA as a Function of Unit Dose," IJA 3 (1)(1968), 231. Emphasis added.

66 Most importantly, however, the behavioral theory of drug addiction posed an alternative to the theories of addiction that emphasized personality disorders and individual susceptibility. This is best seen in the work of Paul Gendreau and L.P.

Gendreau, who disputed the notion of an 'addiction-prone personality' in their classic

article for the Canadian Journal of Behavioral Science. In that article, Gendreau and

Gendreau attacked the work of psychologists and psychiatrists who had used the

Minnesota Multiphasic Personality Inventory (MMPI) to attempt to identify an addict personality, which had been a popular avenue of research in the mid-1960s.40 Gendreau

and Gendreau, after identifying a number of methodological flaws in previous personality

studies, conducted their own study of Canadian heroin addicts using the MMPI, and

found no significant difference between the scores of addicts and non-addicts. In discussing their results, Gendreau and Gendreau endorsed the behavioral explanations of

addiction advanced by Weeks and Wikler, and argued that "with the occurrence of

increased usage of stimulants and hallucinogenics, research resources [ought to] be used

optimally, rather than attempting to discover an 'amphetamine' personality. Hopefully,

30 years of failing to identify an addict personality will generalize caution to research

carried out on drug-dependent subjects who use drugs other than heroin derivatives."41

What is clearly seen here is the universalizing tendency of the behavioral theory of

addiction and drug dependence, which made it relevant to the changing nature of

substance use in contemporary society. Some further examples from the IJA and BJA

40 For instance, see Charles Haertzen and James Panton, "Development of a 'Psychopathic' Scale for the Addiction Research Center (ARCI)," IJA 2 (1)(1967), 115-127; Norman Cavior, Richard Kurtzberg and Douglas S. Lipton, "The Development and Validation of a Heroin Addiction Scale with the MMPI," IJA 2 (1)(1967), 129-137; Charles Haertzen, Haris Hill and Jack Monroe, "MMPI Scales for Differentiating and Predicting Relapse in Alcoholics, Opiate Addicts, and Criminals," IJA 3 (1)(1968), 91-106. 41 Paul Gendreau and L.P. Gendreau, "The 'Addiction-Prone' Personality: A Study of Canadian Heroin Addicts," Canadian Journal of Behavioral Science 2 (1970), 25.

67 will demonstrate the relevance of behavioral theories for contemporary addiction researchers.

Stanley Einstein's 1966 editorial in the second issue of the IJA had announced the

context for birth of addiction science; his 1970 editorial, "Drug Use and Misuse in the

1970s," announced the context in which behavioral theories of addiction would come to

dominate the field.

In the 1960's middle- and upper-class white America could no longer take solace in believing drug use belonged to a particular group or part of town. More and more we turned to a variety of addicting and habit forming drugs in order to cope with living. "Ups" for depression and for slimming down; "downs" for too much up; tranquilizers for anxiety; LSD to expand consciousness; sleeping pills to block it out. The decade of addiction [the 1950s] gave way to the decade of drug misuse. In the 1950s we thought that particular personalities - addict personalities - were likely to turn to drugs, particularly if they came from a deprived past with little hope for the future. The 1960s seemed to be the decade of both young and old people feeling distant from each other. Alienated. What will happen in the 1970s? If the past is any indicator of the future, it looks like more and more people will be turning to drugs. It would seem that people in positions of leadership and policy-making feel that way. There has been a marked tendency to increase treatment, research, educational and preventative programs, as well as to develop more legal approaches to control drug misuse.42

Einstein, for his part, clung to components of the psycho-social model, as did many other

contributors to the IJA and BJA; however, more than a few researchers publishing in both

of those journals began to link the theory of reinforcement to the expanding use of non-

opiate drugs. For instance, a 1970 article in the IJA discussing self-injection of

barbiturates in rats made explicit reference to problems of modern living that might

reinforce drug use. As the author, J. Steven Richardson put it:

In the modern human life style of continuous aggravations, frustrations, and deprivations, a state of almost constant aversive stimulation is not unusual. Thus the situation in which barbiturate abuse occurs might best be analyzed in terms of the aversive preconditions and the resulting self-reinforcement of the drug-taking

Stanley Einstein, "Editorial - Drag Use and Misuse in the 1970s," IJA 5 (2)(1970), 169-70.

68 behavior. Techniques used in Behavior Therapy.. .for the elimination of obsessive-compulsive neuroses (also self-reinforcing behavior) might be used to good advantage in the treatment of habituation to barbiturates.43

In this instance, the behavioral theory of addiction is directly linked to the perceived increase in the use of drugs to deal with modern life.

Scientists who subscribed to the behavioral theory of addiction had even begun to suspect a link between reinforcement of drug use and the neurophysiologic research of

James Olds. One area where this connection was made was in discussions of the possible addictive qualities of nicotine. In an article published in the BJA in 1969, Richard

Eisinger reviewed the available science on the question of nicotine addiction and habitual smoking. In 1964 the U.S. Surgeon General's Report on Smoking and Health had declared that addiction to smoking was primarily of psychological origin, since nicotine was not known to produce tolerance or dependence in the same manner as opiate drugs.

As Eisinger put it, ".. .the nature of the relationship between psychological and physiological or pharmacological addiction to nicotine has remained an enigma.. .."44

However, Eisinger noted that another researcher, M.E. Jarvik, had proposed a plausible theory that tied together behavioral reinforcement and recent psychopharmacological research. As Eisinger described it:

The most recent proposal concerning the effect of nicotine is that nicotine produces reinforcing effects by stimulation of reward centers in the brain, most likely by directly or indirectly releasing norepinephrine....Although plausible and interesting, Jarvik's proposal is only speculation. 5

43 J. Steven Richardson, "The Self-Injection of Amobarbital by Rats During Non-Reward," IJA 5 (4)(1970), 745. 44 Richard Eisinger, "Nicotine Addiction and Cigarettes," BJA 66 (1971), 152. 45 Eisinger makes reference to an unpublished paper delivered by Jarvik at symposium for the American Cancer Society; the paper was ultimately published in an edited collection from that symposium. Eisinger, 151; Murray E. Jarvik, "The Role of Nicotine in the Smoking Habit," in ed. William A. Hunt, Learning Mechanisms in Smoking (Chicago: Aldine Publishing Company, 1970), 155-90.

69 While described as 'speculation,' Jarvik's theory was based on important developments in psychology and neurophysiology. In particular, since James Olds had illuminated the brain sites of emotion and self-stimulation behavior, scientists had been attempting to determine the neurophysiological basis of reinforcement. These scientists had suggested that the reinforcement phenomenon might result from changing the concentration of mood-affecting catecholamine neurotransmitters, particularly epinephrine, norepinepherine and dopamine, in the brain. Put more simply, these scientists had identified the neurochemical mechanism by which self-stimulation of the brain's pleasure centers might occur, in the same way that Olds had done through electrical stimulation.46 Jarvik argued that nicotine reinforced smoking behavior by affecting these same pleasure centers. Specifically, nicotine was thought to cause the release of norepinephrine, which would provide a rewarding, and hence reinforcing, effect. It is critical to note that Jarvik made his argument concerning reinforcement through direct reference to heroin addiction; however, instead of emphasizing the phenomenon of tolerance and relapse, Jarvik utilized an entirely behavioral definition of addiction, emphasizing the reinforcing potential of both heroin and nicotine, and stating explicitly that he "[did] not believe that drug addiction requires either physical dependence or tolerance.. .."47 The universalizing nature of the behavioral theory of addiction allowed Jarvik to draw links between different psychoactive substances. In

Jarvik references the following papers which support this theory: James Olds and P. Milner, "Positive Reinforcement Produced by Electrical Stimulation of Septal Area and Other Regions of Rat Brain." Journal of Comparative and Physiological Psychology Al (1954), 419-27; J.J. Schildkraut and S.S. Kety, "Biogenic Amines and Emotion," Science 156 (1967), 21-30; L. Stein and CD. Wise, "Relapse and Hypothalamic Norepinepherine by Rewarding Electrical Stimulation or Amphetamine in the Anesthetized Rat," Federation Proceedings 26 (1967), 651; CD. Wise and L. Stein, "Facilitation of Brain Self- Stimulation of Central Administration of Norepinepherine," Science 163 (1969), 299-301. 47 Jarvik, 182-3.

70 subsequent years other researchers would postulate similar theories for other classes of psychoactive substances.48

Two scientific discoveries in 1973 and 1975 would lend additional support to this new biological perspective on addiction. In 1973 Candace Pert and Solomon Snyder of

Johns Hopkins University published their discovery of endogenous opiate receptors within the human brain and nervous tissue; two years later, John Hughes and Hans

Kosterlitz announced that they had discovered a naturally occurring substance in mammalian brains that behaved pharmacologically like morphine. This substance, labeled 'endorphin,' was discovered to provide natural analgesia and pleasurable effects in all mammals. Avram Goldstein, an American addiction researcher, proposed a number of theories that suggested that endorphin-deficient individuals might be predisposed to opiate addiction, but this theory was ultimately abandoned. However, the additional discovery that endorphins not only acted as neurotransmitters, but also interacted with catecholamine neurotransmitters such as dopamine, would further support the emerging notion of addiction as a 'brain disease.'49 The behavioral theory of addiction, made popular because of the changing and heterogeneous nature of drug use in the 1960s and

1970s, had universalized the addiction process, leading to a new biological understanding of addiction.

What forms of treatment were advanced by adherents of the behavioral theory of addiction? Issues of the IJA from 1973 to 1975 record an explosion in discussion of

48 See for example: N. Bejerot, "The Nature of Addiction," in ed. M. M. Glatt, Drug Dependence: Current Problems and Issues (Baltimore: University Park Press, 1971), 69-96; Ng, Szara and Bunney, 311-324; T. J. Crowley, "The Reinforcers for Drug Abuse: Why People Take Drugs," Comprehensive Psychiatry 13 (1972), 51-62. 49 William White, Slaying the Dragon: The History of Addiction Treatment and Recovery in American (Bloomington, Illinois: Chestnut Health Systems, 1998), 289. See also Avram Goldstein, Addiction: From Biology to Drug Policy (New York: W.H. Freeman, 1994).

71 behavioral therapy techniques for both drug addiction and alcoholism, which were increasingly coming to be viewed within the scientific community as related

en phenomenon. Types of behavioral therapy for drug and alcohol dependence varied considerably. In addition to support for cyclazocine and other narcotic antagonists, numerous forms of aversive conditioning therapy were proffered; this therapy would attempt to negatively condition the addict away from his drug of choice, or paraphernalia associated with it. One extreme example of aversive conditioning was proposed in the

IJA as early as 1971, when Peter Blachly proposed the use of an electrical needle for the aversive condition of the oft-observed compulsive needle use among heroin addicts; however, most mainstream programs for behavioral therapy were somewhat more benign.51

Proposals for behavioral therapy for narcotics addicts in the early 1970s usually broke down into two components: first, some form of chemical, electrical or verbal aversive conditioning would decrease the reinforcement of the particular drug; second, the addict would be taught behavioral techniques that would allow him to deal more

5 For example, see: David C. Droppa, "Behavioral Treatment of Drug Addiction: A Review and Analysis," IJA 8 (1)(1973), 143-61; John Teasdale, "Conditioned Abstinence in Narcotic Addicts," IJA 8(2)(1973), 273-92; Earl X. Freed, "Drug Abuse by Alcoholics: A Review," IJA 8 (3)(1973), 451-73; Alban J. Coghlan and Edward F. Dohrenwend, "A Psychobehavioral Residential Drug Abuse Program: A New Adventure in Adolescent Psychiatry," IJA 8 (5)(1973), 767-777; Frances E. Cheek, Theresa Tomarchio, John Standen and Robert S. Albahary, "Methadone Plus - A Behavior Modification Program in Self-Control for Addicts on Methadone Maintenance," IJA 8 (6)(1973), 969-996; John A Ewing, "Behavioral Approaches for Problems with Alcohol," IJA 9 (3)(1974),389-99; Barry M Maletzky, "Assisted Covert Sensitization for Drug Abuse," IJA 9 (3), 411-429; G. J. Steinfeld, "Group Covert Sensitization with Narcotic Addicts (Further Comments)," IJA 9 (3)(1974), 447-464; Ralph Elkins, "Aversion Therapy for Alcoholism: Chemical, Electrical or Verbal Imaginary," IJA 10 (2)(1975), 157-209; Joseph R. Cautela and Anne K. Rosenstiel, "The Use of Covert Conditioning in the Treatment of Drug Abuse," IJA 10 (2)(1975), 277-303; ranees E. Cheek, Theresa Tomarchio, Vasanti Burtle, Harold Moss and Donald McConnell, "A Behavior Modification Training Program for Staff Working with Drug Addicts," IJA 10 (6)(1975), 1073-1101. 51 Peter Blachly, "An 'Electric Needle' for Aversive Conditioning of the Needle Ritual," IJA 6 (2)(1971), 327-8.

72 effectively with the various interpersonal and social triggers of relapse.52 It is worth

noting that this two-pronged behavioral treatment program was similar to that proposed by Wikler in 1965. It is also interesting to note that the use of chemical aversion therapy

for drug addicts mirrored the use of disulfiram (Antabuse) in the treatment of

alcoholism.53 Other techniques included relaxation training, covert conditioning, self-

image training, systematic desensitization, assertive training, and use of a 'token

economy' for contingent reinforcement of abstinent behavior.54 While space does not

permit a discussion of each of these types of therapy, a review of available clinical

studies published in the IJA in 1975 reported generally positive outcomes for numerous

clinical studies using different varieties of behavioral therapy.55

The ultimate impact of the behavioral theory of addiction on the actual practice of

addiction treatment is hinted at by the experiences of the New Jersey Neuro-Psychiatric

Institue (NJNPI), which were reported in the IJA. In 1973 the IJA published an article

recounting the experiences of the NJNPI with using behavioral therapy as an adjunct to

methadone maintenance. In 1971 the NJNPI had developed a behavioral treatment

program that was designed to desensitize alcoholics and their wives to the sort of

interpersonal strife that often led to relapse. The success of this program in instilling self-

control and interpersonal skills encouraged the staff of the NJNPI to apply the program to

other forms of "addictive disorder," 56 in this case, heroin addiction. Addicts were

52 Peter M. Miller, "Behavioral Treatment of Drug Addiction: A Review," IJA 8 (3)(1973), 511-19. 53 Disulfiram, when administered to an alcoholic patient, caused the patient to experience intense discomfort and nausea when the patient consumed alcohol. Treatment staff at the Shadel Sanitarium in Seattle, Washington, beginning in the 1940s, used emetine, and later disulfiram, for aversive conditioning of alcoholics. Ralph Elkins, "Aversion Therapy for Alcoholism: Chemical, Electrical or Verbal Imaginary," IJA 10 (2)(1975), 157-209. 54 Miller, 518-19. 55 Cautela and Rosenstiel, 289-91. 56 Cheek et al, "Methadone Plus," 971.

73 trained in various forms of relaxation and behavior modification therapy, with the goal being to help the addicts deal with the sort of anxiety and emotional stress that was known to provoke relapse. The study was evaluated as being a success, and the addicts

who participated reported that they found the training very useful in maintaining their recovery.57 In particular, the authors of the study noted that, unlike psychotherapy or

encounter groups like Synanon, the techniques taught in their behavior modification program could be practically applied in real-life situations.

Unfortunately, a major challenge to the successful implementation of behavioral

therapy was hinted at in the NJNPI article. In their introduction, the authors of the NJNPI

study noted:

While several recent studies.. .suggest that methadone maintenance can considerably facilitate the addict's attempts to free himself of his heroin dependence, the drug itself will obviously not provide the new life style that might be expected to reinforce and maintain that independence. This fact probably accounts for the fact that, although earlier methadone maintenance programs that also emphasized social rehabilitation reported high success rates, in later treatment situations where the drug has been given out more or less 'over the counter,' strikingly less favorable results have appeared.. ,.58

What the authors of the NJNPI article were referring to was the proliferation under the

presidential administration of Richard Nixon of methadone maintenance programs as part

of an effort to counter exploding inner-city crime rates. As part of the Nixon's 'law and

order' platform, federal methadone programs expanded dramatically between 1971 and

1973, with the belief that such programs would greatly decrease the amount of heroin-

induced crime in American cities. Regrettably, the methadone services that were

provided under the new federal plan seldom included rehabilitative services. Those

services that were included were usually run by ex-addict 'paraprofessionals' who were

57 Ibid, 969-996. 58 Ibid, 969.

74 not trained in counseling techniques or behavior modification. By diverting federal

dollars towards such 'quick-fix-style' methadone programs, the Nixon administration prevented the widespread adoption of behavioral modification techniques in the treatment

community.

One notable exception to the anti-rehabilitative trend of the Nixon years comes,

again, from the NJNPI. In 1971 the NJNPI began a program to teach behavior

modification principles and techniques to its staff of addiction treatment

paraprofessionals. The reasons given for instituting this program were as follows:

Therapy for the heroin addict has proven to be a highly problematical area in which, as in alcoholism, one of the most viable approaches has been formulated by the addicted themselves. However, while therapeutic communities such as Daytop and Synanon have achieved remarkable success with many addicts, programs such as these have tended to socialize individuals into a life style that is not readily transferable to the general community. On the other hand, physiological treatments such as methadone maintenance, now in widespread use, have suffered from the fact that it is impossible to hand out the necessarily new life style "over the counter," so that, where supportive therapy is not offered, results have proven unimpressive....Thus a need has appeared for a form of rehabilitative therapy which will enhance the ability of the addict to function flexibly and autonomously and which may be safely and effectively used by paraprofessionals.60

Noteworthy here is the comparison with alcoholism treatment, made possible by a

behavioral definition of addiction, and the overt references to the perceived failure of

methadone maintenance to rehabilitate the addict. The program itself was a considerable

success, training over 800 staff members and paraprofessionals from other treatment

organizations. The response from the professional and paraprofessionals who attended

the training was overwhelmingly positive. One letter in particular, from a nurse with

extensive experience with addicts and alcoholics, is worth quoting at length:

White, 254-256. Cheek et al, "A Behavior Modification Training Program," 1074.

75 I am a converted skeptic and now a firm believer in behavior modification as a therapeutic tool. I have found that it offers the patients a tangible tool for handling stressful situations, thus helping to create a therapeutic atmosphere in a hospital situation. It was not the therapist who convinced me that it could really work, but the results of her efforts. I noticed that my more aggressive overbearing drug addicts were more receptive and easier to manage; and that my shy, withdrawn, passive female alcoholics were more spontaneous and assertive. Feedback from family members concerning their relationships was even more positive. They felt that their weekly visits were more pleasurable. Discharged drug addicts and alcoholics reported, on their return visits, how much better they were able to maintain self-control at home, with the help of behavior modification. Patients who usually were profane, verbally abusive and argumentative, when their desires were interfered with, gradually started to express their displeasures in a more positive manner. Even though I was encouraged to sit in on the sessions, I always managed to find a legitimate excuse not to attend. In view of so many changes in the patients' behavior, my curiosity was aroused. When I started to attend the sessions on a regular basis and really became involved, my attitude changed completely. I not only gained more insight into the patient's problems but learned how to relax myself. I also was able to gain insight into patient/personnel problems and how to handle them more appropriately. I no longer believe that behavior modification is a waste of time because I have witnessed that it will work with or without chemo-therapy or group therapy with alcoholics and addicts.

Despite the success of the NJNPI program in training paraprofessional drug counselors in behavior modification techniques, it would not be until the 1980s that behavioral

approaches began to make serious inroads into treatment practice. In the field of

alcoholism treatment the Community Reinforcement Approach (CRA) emerged in the

1970s and 1980s as a positively evaluated, but infrequently used, form of treatment that

stressed the development of self-control through behavioral techniques. ' Perhaps most

significantly, in 1985 psychologists G. Alan Marlatt and J. Gordon published their

seminal work Relapse Prevention. Based almost entirely on behavioral studies conducted

in the 1960s and 1970s, this work suggested that the phenomenon of relapse after

treatment was consistent across the addictions, and that this treatment problem could be

White, 308.

76 countered by the application of specific behavioral techniques. By the late 1980s and

early 1990s, the concept of relapse prevention would form an important component of most addiction treatment programs.62

To conclude, the period from 1965 to 1975 saw a revolution in the emerging field

of addiction science, as its first major paradigm was established. Kuhn, in The Structure

of Scientific Revolutions, argues that paradigms "gain their status because they are more

successful than their competitors in solving a few problems that the group of practitioners

has come to recognize as acute." Certainly, the behavioral theory of addiction filled

such a role, providing compelling answers for the problems of relapse and 'drug abuse'

that had become exceedingly prominent as drug-use patterns shifted during the 1960s and

1970s. Kuhn has also likened a paradigm shift in a scientific field to a Gestalt switch in

perception; that is to say, much like a Gestalt switch allows a person to see an object or

image in a completely different way, a paradigm shift causes scientists to view a problem

or phenomenon from an entirely different perspective that is incompatible with the

previous perspective; the experiments of Abraham Wikler and other scientists informed

by behavioral psychology brought about such a Gestalt switch in addiction science. At

the end of the Classic Period, addiction was viewed as a symptom of an abnormal

personality, which suggested limited susceptibility and poor prognosis for treatment.

Following the behavioral experiments of the 1960s and 1970s, addiction gradually came

to be viewed as a problem of human nature, to which all persons were potentially at risk.

Discoveries in the field of neuroscience gave additional support to this universalistic

62 Ibid, 310. 63 Thomas Kuhn, The Structure of Scientific Revolutions: Third Edition (Chicago: University of Chicago Press, 1996), 23.

77 perspective, as they suggested that the process of addiction was rooted much more deeply within the human brain than had been previously realized. The effect of this paradigm shift on treatment was small at first, given political circumstances and the notoriously poor communication between research and clinical practice. By the late 1970s and

1980s, however, behavioral theory and techniques led to forms of addiction treatment that were more complex, sophisticated and sensitive to the problems of individual addicts.

Of course, the transformation to a behavioral perspective on addiction was not instantaneous or without opposition. The pages of the IJA and BJA in the mid-1970s record numerous attempts, both sociological and psychological, to identify the personality of drug users.64 However, the bulk of sociological research in this period moved in the direction of identifying the reasons for rebellious drug use among youth, as opposed to explicating societal causes of addiction. Perhaps the most well-known example of this type of sociology comes in the form of Erich Goode's 1970 monograph,

The Marijuana Smokers. Goode, who was heavily influenced by Howard Becker's The

Outsiders, argued that it was impossible to draw a sharp distinction between non-users, occasional users, and heavy users of marijuana, and that those who used marijuana at all did so for reasons ranging from political rebellion to simple recreation.65 Numerous additional examples of similar research can be found in the pages of the IJA and BJA.66

Some example from the IJA for a samples year (1972 include: Eileen Henriques, Jean Arsenian, Henry Cutter and Albert Samaraweera, "Personality Characteristics and Drug of Choice," IJA 7 (1)(1972), 73-6; R.A. Steffenhagen, C.P. McAree and H.L. Nixon, "Drug Use among College Females: Socio-Demographic and Social Psychological Correlates," IJA 7 (2)(1972), 285-303; George English and Jack Monroe, "Comparison of Personality and Success Rates of Drug Addicts Under Two Outpatient Supervisory Systems" IJA 7(3)(1972), 451-460. 65 Erich Goode, The Marijuana Smokers (New York: Basic Books, 1970), 27-49. 66 Examples from the IJA for a sample year (1971-1972) include: B.S. Greenwald and M.J. Luetgert, "A Comparison of Drug Users and Non-Users on an Urban Commuter College Campus," IJA 6(1)(1971), 63- 78; Lawrence Linn, "Social Identification and the Use of Marijuana," IJA 6(1), 79-107; Stanley Grupp, Minta McCain and Raymond Schmitt, "Marijuana Use in a Small College: A Midwest Example," IJA 6

78 Moreover, sociologically-informed researchers progressively came to focus on the epidemiology of drug use, in an attempt to understand the intricacies and extent of this new public health issue. All of these trends will be observed in the Chapter 3, in which a single research organization, the Addiction Research Foundation of Ontario, will be examined extensively.

(3)(1971), 463-485; Emily Garfield, Michael Boreing and Jean Paul Smith, "Marijuana Use on a Campus, Spring, 1969," IJA 6 (3)(1971), 487-491; Erich Goode, "cigarette Smoking and Drug Use on a College Campus," IJA 7(1)(1972), 133-140; Walter Bailey and Mary Koval, "Differential Patters of Drug Abuse among White Activists and Nonwhite Militant College Students," IJA 7 (2)(1972), 191-199; Nechama Tec, "Differential Involvement with Marijuana and Its Sociocultural Context: A Study of Suburban Youths," IJA 7 (4)(1972), 655-669.

79 Chapter 3 - "On The Forefront of Knowledge": The Addiction Research Foundation and the Idea of Addiction, 1961 - 1975

The Ontario Addiction Research Foundation (ARF) began life as the Ontario

Alcoholism Research Foundation in 1951 as an agency of the Ontario government.

While its initial focus was on treatment and education, it rapidly became one of the world's premier alcoholism research institutions, and is still considered a leader in the field. In the early 1960s, at the behest of the Minister of Health Matthew Dymond, the organization began to examine the issue of non-alcoholic drug addiction, and to consider possible approaches to treatment. In 1961 the Alcoholism Research Foundation changed its name to the Alcoholism and Drug Addiction Research Foundation (ADARF) and in

1967 changed its name again to the Addiction Research Foundation (ARF);1 in 1969 the

ARF was asked to provide pivotal scientific material for the Canadian Royal Commission on the Non-Medical Use of Drugs (the LeDain Commission), which was at the time the largest government-sponsored investigation of drug use in the world. The ARF, then, serves as an excellent opportunity for a case study of the ways in which ideas about addiction and treatment changed in the post-Classic Period of narcotic control, and provides a glimpse of how addiction was understood by some of the world's top research scientists during an era of considerable change and upheaval in drug usage patterns and attitudes towards drugs.

The significance of these name changes will hopefully become clear in due course. In 1998 the ARF merged with the Clarke Institute of Psychiatry, the Donwood Institute and the Queen Street Mental Health Centre to form the Centre for Addiction and Mental Health (CAMH), which is still located in downtown Toronto. 2 While a proper history of the ARF has yet to be written, brief sketches can be found in: Greg Marquis, "From Beverage to Drug: Alcohol and Other Drugs in 1960s and 1970s Canada," Journal of Canadian Studies 39 (2)(2005), 60; Marcel Mattel, Not This Time: Canadians, Public Policy and the Marijuana Question, 1961-1975 (Toronto: University of Toronto Press, 2006), 80; H. David Archibald, The Addiction Research Foundation: A Voyage of Discovery (Toronto: Addiction Research Foundation, 1990), 1-14. Professors Martel and Marquis appear to disagree on the date for the founding of the Alcoholism Research

80 The activities of the ARF in the 1960s and 1970s have a brief historiography.

Professor Greg Marquis has examined the role of ARF in promoting the notion that alcohol constituted a 'drug' in Canadian public discourse and policy in the 1960s and

1970s, while Professor Marcel Martel has examined how the ARF helped to shape the conclusions of the Le Dain Commission regarding marijuana.3 However, no one has yet examined the intellectual or scientific basis of ARF research into drug use, or its conclusions regarding the nature of addiction and treatment; this chapter will explore how the intellectual milieu of one of the world's top research institutions changed over time.

In a letter to Minister of Health John Monro, the ARF's director, H. David Archibald, would describe their research into drug use as being "on the forefront of knowledge";4 this is indeed an accurate characterization of the ARF's place in the burgeoning field of addiction science. Although the ARF made its most significant research contributions in the area of alcoholism, it was nevertheless extensively involved in drug addiction research, and reflected a number of the important changes in the conception of addiction the occurred during the 1960s and 1970s. While the ARF initially repeated many of the prejudices of the Classic Period in its approach to drug addiction, ARF researchers were quick to embrace changes in the scientific conception of addiction, primarily because of their regular exposure to multiple-drug use, mixed addictions and addictions to non- opiate drugs; their work examining amphetamine addiction is particularly illustrative of this principle. Moreover, the open-minded and collaborative nature of the ARF research

Foundation; Martel states 1949, while Marquis states 1951. I have opted for Professor Marquis' date only because it coincides with the date advanced by the organization's director, H. David Archibald. However, Archibald also notes that discussions for the founding of an alcohol research organization had begun in the late 1940s, lending credence to Martel's date. 3 Marquis, 57-79; Marcel, 80-91. 4 H. David Archibald to John Monro, as quoted in Archibald, A Voyage of Discovery, 90-1.

81 atmosphere led researchers to more complex and nuanced understandings of addiction, in

many cases significantly before much of the rest of the field of addiction science had

done the same. By the 1970s ARF researchers were strong proponents of a combined behavioral and biological approach to drug addiction which stressed similarities between

psychoactive substances, to the point where an ARF researcher would publish one of the

most radical behaviorist explanations for addiction yet advanced. In terms of treatment,

the ARF would advance an early form of harm-reduction policy, and would argue against

the dogmatic insistence on abstinence, in favor of a more sophisticated treatment

apparatus.

The ARF became involved in drug addiction research in 1961 at the behest of

Minister of Health Matthew Dymond, who requested that the Foundation address the

perceived growing problem of drug abuse and addiction. The senior staff of the ARF

agreed somewhat reluctantly. Since the 1950s, proponents of the disease theory of

alcoholism had attempted to remove the moralistic stigma that had previously been

associated with alcohol addiction; some members of the foundation felt that by

associating their work with drug addiction, which still had a predominantly negative

public image, they might undo some of the progress they had made in destigmatizing

alcoholism. However, in 1961 the foundation ammended their founding legislation to

include drug addiction research and treatment, and the tone of the new Alcohol and Drug

Addiction Research Foundation (ADARF) publications was optimistic about the

possibility of a combined approach. Following the mandate change in 1961, Archibald

suggested a number of possible avenues of research for the Foundation regarding drugs

82 other than alcohol; these included pharmacological comparisons of 'addiction-producing' drugs, literature-reviews, and epidemiological investigation of drug use and addiction in

Canada. Robert Popham, Assistant Research Director of the Foundation, concluded that

"relatively rapid progress can be expected, since we can profit greatly by the decade of experience which we have had in the alcohol field."5

There was indeed some reason for optimism, since ARF researchers and clinicians had been dealing with drugs other than alcohol for some time. As Archibald recollected years later:

In a number of ways, we were already involved with other drugs. Many patients were coming into our treatment facilities with a mixed addiction - alcohol and barbiturates, principally. This was frequently referred to as the "suburban housewife's" problem - unfairly, because surveys, during the 70s particularly, revealed that barbiturates were fairly extensively used by many people. In the early 60s, however, the general public's notion of drug problems was pretty well restricted to narcotics, primarily heroin.6

Indeed, Archibald and the AD ARF research staff noted that non-narcotic addictions were the second-most widespread addiction problem in Canada, following alcohol and preceding narcotic addiction.7

The initial treatment and research activities of the AD ARF strongly reflected the late-Classic Period debate concerning whether addiction was a 'crime' or a 'disease,' as well as the intellectual formulation of addiction as a psychosocial problem. In 1962 the

AD ARF received a proposal from Dr. Jack Holmes, a psychiatrist formerly of the

Mimico Reformatory, to form an experimental narcotic treatment clinic. Holmes'

5 Alcoholism and Drug Addiction Research Foundation, Annual Report of the Ontario Alcoholism and Drug Addiction Research Foundation 1961 (Toronto: Alcoholism and Drug Addiction Research Foundation, 1961), 60. Hereafter, the ARF Annual Reports will be referenced as ARF Annual Report followed by the appropriate year and page numbers. 6 Archibald, A Voyage of Discovery, 85. 7 ARF Annual Report 1964, 9.

83 explanation of narcotic addiction and treatment reflected many of the Classic Period formulations of the nature of drug addiction. Holmes made explicit reference to the recent changes in the 1961 Canadian Narcotic Control Act which provided for greater autonomy for doctors and scientists in treatment and research. Moreover, the act initially provided for compulsory treatment of narcotic addicts, who were, in Holmes' words, "a menace to society.. .."8 Failure in the past had been the result of "moral-punitive approaches," and according to Holmes, all future methods were doomed to failure unless the "custodial atmosphere" was removed from treatment facilities. Some sort of new treatment plan was necessary. Holmes argued for the use of methadone and even heroin for maintenance purposes "based on the fact that in such an unbridled personality the application of a narcotic bridle would permit the personality to be more accessible to a learning situation."9 This 'narcotic bridle' would allow for the maturing of the addict personality, who would be able to engage in such therapeutic activity as group psychotherapy and occupational training. Holmes was a particularly vocal advocate for milieu therapy, a form of psychotherapy designed to encourage proper social development in children, suggesting that he conceived of the addict personality as immature or childlike. This attitude resembled the approach to therapy taken by such

Synanon-style therapeutic communities as New York City's Daytop Village.10 Holmes

The provisions for the compulsory treatment of addicts was later removed from the Narcotic Control Act. Holmes' proposal is attached to a letter from H.D. Archibald to J.K.W. Ferguson. Center for Addiction and Mental Health Archives (hereafter CAMH Archives), Box 62, File 10, H.D. Archibald to J.K.W. Ferguson, 2. 9 Ibid, 4. 10 The therapeutic approach of Daytop Village, an offshoot of the Synanon therapeutic community of California, was summarized in an article for Psychology Today in 1968. According to that article, "The psychological basis for treating drug addicts at Daytop Village differs radically from conventional methods. Neither punishing the addict by jailing him for extended periods nor slobbering over him with sympathy and pit has shown any great rehabilitative value. Nor has it helped to regard the addict as a sick person, a 'medical problem' as some well-meaning folk put it. The Daytop philosophy is to consider the addict and

84 based these opinions on his experience at the Drug Addiction Clinic he had ran at the

Mimico Reformatory for a number of years; it is worthwhile to note here the similarity between the situation at Mimico, where the addicts encountered would have been criminals, and the situation at the USPHS hospital at Lexington, Kentucky, where the concept of the psychopathic addict had been developed.

In his proposal, Holmes also noted the recent publicity of Lady Isabella Frankau of England, who had gained some notoriety for her controversial treatment of providing maintenance doses of heroin for addicts. It was primarily Frankau's publications in The

Lancet that led ADARF officials to set up a conference in Niagara Falls in 1963 to examine the issue of narcotic addiction. At the conference, Lady Frankau presented her treatment methods, and the importance of medical treatment was again articulated. It is important to note that addiction was still conceived of as being a symptom of underlying personality disorders. The Annual Report that described the Niagara Conference noted that "Regardless of the type of drag used by the individual, his treatment, where indicated, deals with his underlying personality disorder, of which his addition is sometimes a symptom."11

Indeed, Holmes repeated this perspective in the ADARF publication Addictions, when he argued that underlying psychopathology was the root cause of addiction to most drags, including the barbiturates. According to Holmes, "The psychopathic personality uses [barbiturates] to obtain intoxication rather than sleep, and such a person tends to

an adult acting like a baby, childishly immature, full of demands, empty of offerings." This article was latter reprinted in the ARF journal Addictions. Alexander Bassin, "Daytop Village," Psychology Today 2 (7)(1968), 49; Alexander Bassin, "Daytop Village," Addictions 17 (2)(1970), 30-44. 11 ARF Annual Report 1963, 21.

85 elevate the dose rapidly from the onset."12 In his 1964 article, "Chemical Comforts and

Man," Holmes argued that the new chemical substances available to modern man were being used in greater numbers to quell the stresses of modern living:

In the inner as well as the outer world of man, upheavals have taken place. Old faiths have crumbled, new ones have not been created. In the resulting vacuum man is lost. Tied to the minute hand of the clock, a servant of steel machines whose laws are inflexible, faced by the insecurities of automation, goaded by ambition and aspirations, scrambling for gain in a crowded, jostling, materialistic world, harassed by the ever-pressing need to keep up with the Joneses, and disturbed by conflict over his aggression and sex feelings, modern man can hardly be blamed if he counts ulcer and neuroses instead of his blessings, and if he cries out to his physician for the relief of his inner tension - for something that will give him tranquility and peace of mind. Or he may take some other form of self- protection which may involve anti-social patterns of living and/or the use of chemicals. However it may be, it is possible that the individual becomes exposed to chemicals, either depressant or stimulant, narcotic or non-narcotic. The chemicals help man in his external and internal environmental adjustments; as a result of this satisfaction, man forms a chemical dependency which may progress to habituation or addiction to these drags.13

While Holmes acknowledged that the nature of drug use was changing, he continued to

repeat theories of addiction from the Classic Period, which emphasized psychopathology

and psychodynamics.

The ADARF narcotic clinic began operation in October of 1963 under Holmes'

direction, offering outpatient withdrawal using methadone, and counselling and

psychotherapy services. By 1964 the foundation had consolidated most of their

outpatient services to a single facility on Toronto's Elizabeth Street, and that same year

began offering maintenance and prolonged withdrawal for heroin addicts whom they felt

required such treatment approaches. The clinic received some opposition from the

Narcotic Division of the Department of National Health and Welfare. On 15 February

12 S.J. Holmes, "Barbiturates -Friend or Foe," Addictions 9 (4)( 1963), 31. 13 S.J. Holmes, "Chemical Comforts and Man," Addictions 10 (4)(1964), 16. 14 S.J. Holmes, "Treatment of Narcotic Addicts," Addictions 13 (2)(1966), 28-30.

86 1967 Archibald sent a memo to the Foundation's physician-in-chief, J.L. Silversides, informing him of a telephone call he had recently had with Mr. R.C. Hammond, Chief of

Narcotic Division. Archibald noted in his memo the "general feeling of antipathy often expressed by Mr. Hammond.. .regarding the methadone program undertaken by our unit."15 Archibald went on to say:

..the only specific information that is currently provided for the policy makers in Ottawa is information.. .that tends to support the view that methadone should not be used in the treatment of narcotic addicts. In part, therefore, the responsibility rests with this Foundation in the sense that we have not provided them with a clear and specific body of data to indicate that there is some merit in the methadone program. If I am to adequately support and interpret this particular phase of our work to relevant authorities, then I must have at my disposal specific documentation which I can use. I do not think we are going to make very much progress in maintaining support for our work in this field if we rest our case on essentially philosophical or theoretical positions. What I needed now is "hard" data. Personally, I was very pleased and impressed with the meeting the other day in which the staff of the Narcotic Unit presented their experiences and observations. I believe that a positive outcome in 20% of the cases in this very difficult area is to be commended. Indeed, it is considerably beyond what I had personally forecast at the inception of this experiment. However, I need very specific data now, and I therefore ask you to have your staff provide me with a report which would be in effect a case by case documentation of the 20% who have done well ,16

Archibald was not alone in noting the inability of ADARF researchers to obtain 'hard

data' from the narcotic unit. Reflecting on his time at the ARF, former researcher Gus

Oki recalled that the narcotic clinic staff were reluctant to collect any type of data on their patients because they felt that this would be an intrusion on the patients' privacy, and

would perpetuate the kind of coercive atmosphere so characteristic of institutional

CAMH Archives, Box 63, File 27, H.D. Archibald to J.L. Silversides.

87 treatment of narcotic addiction. The difficult, and rather ironic, situation at the narcotic

clinic was also noted by ARF Board of Management Secretary Henry Schankula:

The Mimico staff we acquired were disenchanted, they said, by the Mimico Reformatory experience because of the penal approach. But quickly after coming here, they began to establish a similar program with penal characteristics.18

Despite the problems with the narcotic clinic, the failure of any authority to have the

facility shut down signaled a new openness towards treatment for drug addicts in Canada,

which was a considerable departure from the anti-treatment regime of the Classic Period.

However, the researchers and clinicians at the ARF began their endeavors to treat drug

addiction within the intellectual climate of the early 1960s, which viewed addiction

within the artificial dichotomy of 'crime or disease.' The majority of AD ARF staff members still subscribed to the notion that narcotic and non-narcotic drug addicts possessed a deep psychopathology; this would slowly begin to change in 1965, with the

ascent of a combined approach to different addictions. Behavioral psychology would

again facilitate this combination, and would provide compelling answers for the forms of

addiction and drug use being observed by AD ARF scientists and clinicians.

The initial research projects into the nature of drug addiction launched by the

AD ARF reflected many of the sociological and anthropological preoccupations of the

late Classic-Period. The first original research project concerning drugs launched by the

AD ARF was a project undertaken by sociology student Shirley Jones Cook entitled "The

Social Background of Narcotics Legislation."19 Not long after, the AD ARF employed

Gopala Alampur as an undercover ethnographer to study the popular hippie scene in

17 Quoted in Archibald, A Voyage of Discovery, 98. 18 Ibid. 19 ARF Annual Report 1963, 16.

88 Toronto's Yorkville community. Simultaneously, Harold Kalant, the ARF's top research biologist, and others began to investigate the epidemiology of drug use. At the same time, however, ADARF researchers had been in contact with behavioral psychology for some time. As early as 1960, ADARF scientists had been examining the possibilities of behavioral therapy techniques in the treatment of alcoholism.22 The ARF

Annual Report for 1963 noted that the ARF was expanding its own work in the behavioral sciences; in that connection, an animal laboratory was built to be run as a part of the Foundations psychological research program.23

In March 1'965 the ADARF sponsored an interdisciplinary conference on drug dependence at the University of Toronto. The proceedings of the conference were later published by the ARF as Experimental Approaches to the Study of Drug Dependence?*

It would be fair to describe the contents of Experimental Approaches to the Study of Drug

Dependence as extraordinarily advanced for the period. Following papers on the behavioral effects and pharmacology of psychoactive drugs, the volume records the freewheeling speculation of a number of the research specialists from such organizations as the University of California's Brain Research Institute, the Harvard Medical School, and numerous university departments of psychiatry, psychology and pharmacology.

Among the topics discussed were the neurochemical correlates of behavior, the success of J.R. Weeks in producing experimental addiction in animals, the possible role of

20 Alampur's research was ultimately reworked by the AD ARF's Reginald Smart and David Jackson, and published as Reginald Smart and David Jackson, The Yorkville Subculture: A Study of the Life Styles and Interactions of Hippies and Non-Hippies, prepared from the field notes ofGopala Alampur (Toronto: Addiction Research Foundation, 1969). 21 Ibid, 88. 22 ARF Annual Report 1960,10. 23 ARF Annual Report 1963, 5-6. 24 Harold Kalant and Rosemary D. Hawkins, Experimental Approaches to the Study of Drug Dependence (Toronto: University of Toronto Press, 1969).

89 classical and operant conditioning in addictive behavior, the possibility that addiction constituted an artificially induced drive, like the drives for sex and food, and the experiments of James Olds. All of these concepts would become increasingly popular over the next ten years. Conference participants had even begun to speculate on the possible role of neurotransmitters, including dopamine, in regulating addictive behavior.25

Of particular interest was a brief exchange between Kalant of the ADARF, Roger

Russell of Indiana University Department of Psychology and Peter Dews of the Harvard

Medical School. Russell, predicting the experiments of Abraham Wikler, advanced a theory of relapse that emphasized conditioning. Dews added to Russell's comments, noting that morphine must be reinforcing because of its effect on non-rational mental processes, and added that the tendency of addicts to move to methods of drug administration that provided a more rapid onset of drug effects was explained by reinforcement theory. Kalant asked whether reinforcement theory could explain the mixed addictions to alcohol, barbiturates and amphetamines; this question was likely prompted by the mixed addictions so often encountered by ADARF clinicians. While no definitive answer could be offered, Kalant was clearly intrigued by the possibility, and proposed his own theory that, following withdrawal of a particular drug, another drug might be taken up to fulfill the conditioned drive that had been created during the first addiction.26 Here, then, we see the appeal of behavioral psychology in explaining the kinds of changes in drug use that ADARF clinicians had been encountering. The preface, written by Kalant and Rosemary Hawkins, emphasized this point:

25 Ibid, 3-4, 24, 25-6, 32, 33, 137. 26 Ibid, 187-90.

90 Clinical and social experience made it perfectly clear that the addictive process has broad common features which are relatively independent of the specific pharmacological properties of the individual drugs in question: alcohol, opiates, barbiturates, other hypnosedatives, minor tranquillizers and stimulants. 7

Indeed, by 1965 ARF clinicians had been dealing extensively with mixed addictions to alcohol and other drugs.28 The emerging behavioral theory of addiction provided a theoretical framework which could explain this type of clinical observation.

Behavioral approaches began to penetrate AD ARF research and treatment not long after the 1965 Experimental Approaches conference. In June 1966 S.J. Holmes submitted a report to Archibald concerning the operation of the foundation's narcotic unit. While Holmes described attempts to use the Minnesota Multiphasic Personality

Inventory to identify addict personalities, he also made explicit reference to reinforcement theory, and argued that drug use ought to be defined as a learned 'habit' rather than an addiction.29 At the same time, the Foundation began a number of original research projects into drug use that were behavioral in orientation. In 1966 the

Foundation launched a survey of drug use in the Metropolitan Toronto Area; the language used to describe this project was behavioral in style, as it attempted to determine how individuals 'learned' to manage their tension and stress with drug use that was 'rewarding.'30 In 1966 the ARF Annual Report described the Foundation's animal laboratory, under the direction of Dr. J.R. Gibbins, who had begun investigations into the

Ibid, v. For instance, see ARF Annual Report 1965, 15. CAMH Archives, Box 62, File 10, Memorandum from S.J. Holmes to H.D. Archibald, 2, 10. CAMH Archives, Box 2, File 14, Current Intramural Research, 76.

91 behavioral effects of marijuana on rats.31 In that same Annual Report Archibald made the

context for such experiments clear in an editorial entitled "The Age of Drugs":

This is clearly "the age of drugs". There has been enormous development of the chemical industry during the past few years and one major result among many others has been a proliferation of drugs and compounds that affect profoundly the central nervous system. Drugs, including alcohol, are now used widely to promote relaxation, stimulation, sleep, energy, to change mood, to "expand the mind", to produce new and indescribable experiences, and to opt out of society. There is an increasing tendency to subscribe to the premise - whether implicit or explicit - that life cannot be lived, or enjoyed, without "chemical comforts". Used with discrimination, some of the drugs currently in vogue are valuable. However, the indiscriminate or careless use of drugs by ever increasing numbers of people results inevitably in an alarming increase in the number of people who develop drug dependence or addiction. The idea of "the age of drugs" must also be seen as "the age of drug dependence".. ..Barbiturates, amphetamines, tranquilizers and hallucinogens are being used in increasing quantities and by an increasing number of people. Canada's imports of short-acting barbiturates and of amphetamines doubled in a recent three-year period, and these are drugs that are not manufactured in Canada.... Apart from alcohol, these drugs - stimulants and sedatives which are legally available only on prescription - represent the largest problem of abuse and dependence in our society. Surveys are under way which should make possible more accurate estimates than we now have of persons dependent on these substances. Certainly they are far more numerous than narcotics addicts.. .32

As was seen in the previous chapter, the behavioral theory of addiction allowed for the

conceptual linking of different psychoactive drugs under a single theory of dependence.

It is worth noting here that, prior to the 1960s and 1970s, some clinicians had also made

the same link between alcohol and other drugs. In the late 1940s and 1950s, clinicians at

various alcoholism treatment facilities in Minnesota developed a practical theory of

'chemical dependence' which grew out of their regular interaction with patients battling

mixed addictions. This theory eschewed psychoanalysis, and instead focused on the

addiction itself as a pathological behavior. 'Chemical dependence,' however, was not

31 Ibid, 16-20, ARF Annual Report 1965, 19; ARF Annual Report 1966, 25. 32 ARF Annual Report 1966, 12-14.

92 widely discussed in the scientific or treatment literature. The reasons for this are most likely contextual. The confluence of the rise of behavioral psychology and the demographic changes in drug use which prompted fears of a 'chemical age' were absolutely crucial for the redefinition of addiction.

This redefinition of addiction not only matched the clinical experience at the

ADARF, but increasingly came to match their epidemiological and anthropological research as well. By 1969, the initial findings of the ADARF's investigations into the

Yorkville hippie subculture were reported. According to the undercover ethnographer, multiple-drug use was common among the Yorkville community, and there appeared to be no precisely identifiable type of user.34 In 1966, the ADARF also launched a three- phase epidemiological study of drug prescriptions in Metropolitan Toronto. The study suggested that as much as one-fourth of the prescriptions written in Toronto were for

'mood-modifying' drugs such as amphetamines, barbiturates and tranquilizers. These findings would lead an anonymous ADARF writer to state that "drug use by youth is just one aspect of the universal phenomenon of drug use for the purposes of mood modification."35 For the ADARF, drug use, abuse and addiction were coming to be viewed as universal and interrelated phenomenon.

Not long after the initiation of the above series of drug research projects, the

ADARF opted for a name change, dropping the distinction between alcohol and drug addiction, and instead becoming the Addiction Research Foundation. Other researchers

33 For a complete discussion of the Minnesota Model, see William White, Slaying the Dragon: The History of Addiction Treatment and Recovery in America (Bloomington, Illinois: Chestnut Health Systems, 1998), 199-212. 34 Smart and Jackson, 61. 35 This statement was made at the end of an ADARF Fact Sheet on Amphetamines, which was attached to a letter from H.D. Archibald to a Mr. Kent. CAMH Archives, Box 59, File 16, H.D. "Some Foundation Activities Re: "Speed" - Amphetamines", 4.

93 opposed this change. In 1967, American alcoholism expert David Pitman published "The

Rush to Combine: Sociological Dissimilarities of Alcoholism and Drug Abuse" in the

British Journal of Addictions. In his introduction Pitman cited the name-change at the

ARF as a major contributing factor to his composition of the essay. Pittman argued that alcohol and drug addiction were sociologically dissimilar, that the empirical basis for uniting the two phenomena was weak, and went on to enquire as to where such a trend would stop; ".. .in our study of addictions why not include obesity (food addicts), smoking (cigarette addicts), nymphomania (sex addicts), certain ulcers and coronary cases (work addicts), and frequent attenders of church (religious addicts)."36 While

Pitman's arguments were explicitly sociological, the response from the ARF evoked notions of behavioral addiction in defense of their new name. Robert Popham, Jan De

Lint and Wolfgang Schmidt, chief ARF researchers, responded that the only reason that their Foundation did not deal with all the "addictive behaviors" was primarily financial; the resources simply were not available. Moreover, Popham et al noted that a combined perspective on addictions might be useful in understanding the nature of addiction to new substances that were appearing on the scene:

Exclusive concern with drug use led to a narrow and stereotyped view of the nature of addiction. As a result, many workers were led erroneously to assume that the amphetamines.. .were non-addictive drugs.37

Indeed, changes in drug use patterns prompted Archibald to comment in the 1968 ARF

Annual Report:

Today's rapid growth in the number and variety of substances being abused has brought much more complexity into this field. At the same time, however, it has

36 David J. Pitman, "The Rush to Combine: Sociological Dissimilarities of Alcoholism and Drag Abuse," BJA 62 (1967), 338. 37 Robert Popham, Jan De Lint and Wolfgang Schmidt, "Some Comments on Pittman's 'Rush to Combine'," BJA 63 (1968), 26-7.

94 also resulted in growing recognition of apparent similarities in all processes of substance abuse and addiction. Such emphasis on process contrasts with earlier emphasis on either (a) the presumed toxic nature of each separate substance, or (b) the individual pathology which allegedly made certain individuals more susceptible than other to becoming misusers of certain substances.38

Archibald went on to note that such realizations should have an effect on treatment, although he was not specific about what the changes would be; instead, he argued that the emphasis should be placed on education and prevention of harmful drug using behaviors.39

The reconceptualization of drug addiction was beginning to be established when the Canadian government launched the Le Dain commission in 1969. The ARF worked extensively with members of the commission, and submitted a number of briefs for the commissioners' consideration on various scientific issues. In addition, the ARF circulated internal memoranda commenting on the different reports of the Le Dain commission as they were published. In their preliminary brief to the Le Dain commission, ARF researchers noted that "as the physiological and biochemical bases of behavior become better understood, it will be increasingly difficult to draw a meaningful distinction between physical and psychological dependence."40 Moreover, the authors noted that "Psychological dependence can occur with any type of drug and with many types of behavior not involving drugs."41 In their commentary on the Le Dain commission's Interim Report, which was overwhelmingly positive, the ARF authors nevertheless chastised the commission for not paying appropriate attention to the

38 ARF Annual Report 1968, 13. 39 Ibid. 40 CAMH Archives, Box 2, File 25, Preliminary Brief to the Commission of Inquiry into the Non-Medical Use of Drags, 16-17. 41 Ibid, 17.

95 implications of intravenous drag use as compared with other forms of drug administration. According to the ARF commentary:

The time relations between drug administration and onset of pharmacologic action are of critical importance for the reinforcing effect in the paradigms for behavioral conditioning. We believe that the role of this factor in the development of different patters of drug-taking behavior should be stressed much more than it

. is.42

In their commentary on the Le Dain commission's Treatment Report, which they referred to as a "disappointing" document, the ARF authors argued that treatment options that

"the Commission appears to be endorsing for fairly widespread use some procedures whose value is unsubstantiated.. ,."43 In particular, the ARF authors cited the Treatment

Report's discussion of amphetamine addiction, which the ARF had been investigating for some time, for particular scorn: The Commission's emphasis on half-way houses and therapeutic communities is very commendable however, the actual effectiveness of these approaches is at this time largely dependent upon theoretical assumptions for its support. The Commission apparently has not considered the evidence which suggests that prolonged amphetamine abuse produces biochemical changes, particularly cerebral changes, which long outlast the actual presence of drugs in the system. It does not emphasize strongly enough the interactional aspects of patient and community. From such consideration there naturally arises a treatment procedure which seeks to alter a patient's behavior by changes in the environmental influences and contingencies.44

All of the above examples suggest that the ARF was advancing a behavioral understanding of drug addiction, but that such a definition was met with resistance or misunderstanding by government officials interested in understanding the growing use of drugs in contemporary society. Such misunderstanding is captured in discussion of

CAMH Archives, Box 2, File 27, Comments on the Interim Report of the Le Dain Commission of Inquiry into the Non-Medical Use of Drugs, 5. 43 CAMH Archives, Box 2, Files 29, ARF Commentary on Treatment Section of the Le Dain Commission 1972,1,2. 44 Ibid, xxiii.

96 psychological dependence in the Le Dain commission's Interim Report. According to the report's authors:

Psychological dependence (also often called behavioural, psychic or emotional dependence, and habituation) is a much more elusive concept and is difficult to define in a satisfactory manner.. ..some scientists have identified behavioural dependence as repeated self-administration of a drug. This approach seems far too broad for most purposes since it only indicates that the drug is in some way reinforcing or rewarding to the user, and merely restates the observation that he takes the drug.45

This above quotation reflects the simplistic and incomplete understanding of the

behavioral theory of addiction possessed by the Le Dain commission. However, the

ARF's official response to the Le Dain commission reports, Harold and Oriana Kalant's

Drugs, Society and Personal Choice, advanced an explicitly behavioral explanation for

drug dependency. After noting that psychological dependency was much more serious

than physical dependency, because of the frequent relapse of withdrawn addicts, Kalant

and Kalant went on to propose a "modern psychological theory" of dependency which

was drawn explicitly from the presentation made by R.W. Russell five years earlier in

Experimental Approaches to the Study of Drug Dependence.

A striking illustration of the newfound dominance of the behavioral theory of

addiction comes in the form of the ARF's research into amphetamine addiction. In 1966,

Oriana Kalant published The Amphetamines: Toxicity and Addiction, a review of the

available scientific literature on amphetamines and their effects. The volume contained a

discussion of the possible addiction-producing qualities of amphetamines, and the

Government of Canada, Commission of Inquiry into the Non-medical Use of Drugs, Interim Report of the Commission of Inquiry into the Non-medical Use Of Drugs (Ottawa: Information Canada, 1973), 25. As a source for this definition, the report authors cite T. Thompson and C.R. Schuster, Behavioral Pharmacology (Englewood Cliffs, New Jersey: Prentice-Hall, 1968). 46 Harold Kalant and Oriana Josseau Kalant, Drugs, Society and Personal Choice (Toronto: Paperjacks, 1971), 75-81.

97 discussion centered around the issues of tolerance, physical dependence, and the personality type of addicts.47 Kalant concluded that amphetamines were addictive based on 'recently discovered' evidence of tolerance and physical dependence; the case, however, seemed rather weak. In 1973 the book was republished with a new preface and three appendices. The preface to the second edition noted that the intervening years had seen an explosive increasing in the non-medical use of amphetamines, leading to a

"'speed' problem."49 The new appendices were meant to address these most recent developments.

The second appendix, significantly titled "The Psychopharmacology of

Amphetamine Dependence," advanced an explicitly behavioral theory of amphetamine addiction that emphasized reinforcement and conditioning, and made little mention of personality as a causative factor. According to Kalant, "the essential feature of any drug dependence is psychological dependence.. .."50 Kalant cited the animal experiments of

Schuster and Thompson which indicated the primary reinforcing characteristics of amphetamines, and noted that, in contrast to theories which emphasized personality inadequacy as the primary motivation for drug taking, more recent investigations suggested that amphetamines activated a brain 'reward system' which provided the pleasure necessary for reinforcement.51 The behavioral theory of addiction, combined with discoveries in neuroscience, had once again brought pleasure back into the drug- addiction equation.

47 Oriana Kalant, The Amphetamines: Toxicity and Addiction - Second Edition (Toronto: University of Toronto Press, 1973), 77-121. 48 Ibid, 121. A9Ibid,ix. 50 Ibid, 151. 51 Ibid, 152.

98 Perhaps most significantly for our purposes, Kalant noted that recent epidemiological studies of Toronto's 'speed community' had lent considerable support to the behavioral theory of addiction. The epidemiological studies undertaken by the ARF's

J.R. Gibbins had indicated that, contrary to popular belief, the quality of amphetamine taken by members of the Toronto 'speed community' was no more pure than the low- dose amphetamines frequently prescribed by physicians. Kalant interpreted this to mean that the reason for such high levels of dependent behavior among 'speed' users was the presence of the intravenous injection; according to Kalant:

It is a clear maxim of behavioral analysis that the shorter the time that elapses between the making of a response and the delivery of the reinforcer.. .the stronger is the reinforcement. Intravenous injection is an excellent example because the desired effects are felt within seconds of the injection rather than the half an hour or more required after oral intake. It is therefore not surprising that the pattern of intravenous use rapidly becomes more intense, compulsive, and all-absorbing.52

Here again we see the behavioral theory of addiction providing a compelling answer for the type of drug use encountered by contemporary researchers.

By the mid-1970s the behavioral and biological theory of addiction had become firmly entrenched at the ARF. In 1973 the ARF hosted a conference entitled "Behavioral and Biological Approaches to Drug Dependence." In attendance was Avram Goldstein, who would later play a prominent role in linking the discovery of endogenous opiate receptors to the treatment of heroin addiction.53 At the conference Goldstein speculated on the role of neurotransmitters in reinforcing addictive behavior, and predicted the eventual discovery by Candace Pert of an endogenous opiate system in the human

Ibid, 155. White, 289.

99 brain.54 At the same time, David Downs, James Woods and Mark Llewellyn of the

University of Michigan Psychology Department presented a particularly amusing discussion of "The Behavioral Pharmacology of Addiction":

Rhesus monkeys will self-administer drugs. It is relatively simple to predict which monkeys will become drug-takers. First, find a drug that other monkeys will self-administer. Second, arrange a system so that a monkey can cause the drug to be delivered. Third, watch the monkey take the drug. Why does the monkey do this? If it is fair to extrapolate from humans to monkeys, we can paraphrase some answers from information about people: "The manifestation of some monkeys' dissatisfaction and loss of faith in the prevailing social system, making them feel there is a lack of meaningful alternatives to drug using behaviour." "The statements of proselytizing monkeys who proclaim the 'goodness' of drugs." "The search for different perception and ideas which some monkeys believe they can obtain from mind altering drugs." "The belief that 'medicines' can solve all problems." "Monkeys start and continue to use drugs because they want to do so, not because of some intrinsic nature of the drug." "Drug users are not necessarily immature, immoral, irresponsible, socially disadvantaged, alienated, rebellious, or mentally ill. Drug use is a part of the continuum of monkey existence."55

These explanations were, of course, rejected by Downs et al, in favor of a strictly behavioral explanation of drug addiction. At the same conference, a number of researchers suggested that, when one eschewed the goal of total abstinence, behavioral therapy that promoted controlled drinking behavior showed remarkable promise in the treatment of alcoholism. Goldstein advocated a similar approach for heroin addiction that would reduce harm to the addict by encouraging careful recreational use of the drug

(referred to by addicts as 'chipping') as opposed to the destructive cycle of abstinence

54 Avram Goldstein, "Are Opiate Tolerance and Dependence Reversible? Implications for the Treatment of Heroin Addiction," in Biological and Behavioral Approaches to Drug Dependence eds. H.D. Cappell and A.E. LaBlanc (Toronto: Addiction Research Foundatoin of Ontario, 1975), 27-41. 55 David Downs, James Woods and Mark Llewellyn, "The Behavioral Pharmacology of Addiction," in Biological and Behavioral Approaches to Drug Dependence eds. H.D. Cappell and A.E. LaBlanc (Toronto: Addiction Research Foundatoin of Ontario, 1975), 53.

100 followed by compulsive use. It is worth noting that Goldstein arrived at such a recommendation by comparing the results of animal experiments with the direct testimony of heroin addicts in a methadone program.56 Again we see the reciprocal relationship between behavioral science and the experience of the addict, a relationship which would have been unlikely during the Classic Period of narcotic control.

By the mid-1970s, a productive relationship had been established between the psychological and biological research departments at the ARF.57 However, the popularity of the behavioral theory of addiction led some ARF researchers to abandon biology and pharmacology entirely. In what is perhaps the most radical behaviorist explanation for drug addiction ever advanced, R.M. Gilbert argued that drug abuse was entirely a form of 'excessive behavior,' no different from compulsive eating or book- buying, and that addiction had nothing to do with the pharmacological effects of a psychoactive drug. Moreover, Gilbert drew a distinction between the use of a drug, which was obviously undertaken to obtain the psychoactive effects, and excessive use, which was a learned and conditioned process. Noteworthy is the fact that Gilbert compared such diverse substances as nicotine, heroin, alcohol, and even water in his analysis. Gilbert also noted an intriguing contemporary phenomenon that he felt supported his claim. In defiance of predictions, soldiers returning from the Vietnam war who had become heavy users of heroin did not, surprisingly, continue their use upon returning home, suggesting that environmental conditioning was responsible for such

56 Goldstein, 32-3. 57 Ominously, Archibald also noted that fiscal resources had become scarce in recent years ARF Annual Report 1974,1,7,9.

101 compulsive use. Gilbert's essay first appeared in a 1975 issue of Addictions, the ARF's

CO popular journal, based on a talk given at the Foundation's Clinical Institute.

In Chapter 2 it was argued that the establishment of a behavioral paradigm for addiction science slowly led clinicians towards forms of behavioral therapy for drug addiction. While this was true to a certain extent for the ARF, certain contextual factors led the ARF to emphasize preventative education rather than explicit treatment programs.

The period of the Le Dain commission highlighted for researchers and citizens the role of the state in regulating personal behavior and morality. Indeed, as Archibald noted in a speech in 1970:

When all the problems [of providing objective scientific knowledge] are resolved there remains the government dilemma, as policy makers, to achieve a reasonable balance between two goals - (a) The protection of the more vulnerable members of society perhaps with restrictive legislation, and (b) the protection of individual freedom.59

This sentiment echoed the thoughts of Harold and Orinana Kalant, who argued in their preface to Drugs, Society and Personal Choice that the goal of scientific research on drug addiction and abuse should be to provide objective information for the public, who would then be allowed to make their own decisions about drug consumption. ° This being the case, the ARF embarked upon a series of programs aimed at educating the public; one such program was the Connection phone service which was staffed by knowledgeable and sympathetic experts who could provide information about street drugs and counseling services. In the late 1960s the ARF opened a laboratory for the purpose of

The edited collection Classic Contributions in the Addictions erroneously lists the first publication of this essay as occurring in a 1976 issue of the Canadian Psychological Review. The essay was in fact first published in Addictions. R.M. Gilbert, "Drug Abuse as Excessive Behavior," Addictions 22 (4)(1975), 52- 72; R.M. Gilbert, "Drug Abuse as Excessive Behavior," in Howard Shaffer and Milton Burglass eds. Classic Contributions in the Addictions (New York: Brunner/Mazel, 1981), 382. 59 CAMH Archives, Box 2, File 26, The Non-Medical Use of Drugs in Canada - The Contemporary Situation, 27. 60 Kalant and Kalant, ix-xii.

102 testing the safety and purity of street drugs. While this service encountered some opposition from the RCMP, who felt it was promoting drug use, the laboratory ultimately survived into the mid-1970s, and is evidence of an early harm-reduction approach to drug addiction.61

To conclude, from 1961 to 1975, the ARF underwent a considerable shift in their conception of drug addiction. The ARF's initial forays into the expanding community of drug addiction research reflected many of the notions of the Classic Period, including emphasis on personality disorders and sociological causes for drug use and abuse. The repeated exposure of ARF clinicians and researchers to mixed addiction, the growing awareness of compulsive drug use at all levels of society brought about by ARF epidemiological research, and an open-minded and collaborative research atmosphere,- however, encouraged ARF researchers to embrace a behavioral formulation of addiction that could describe and explain the kind of substance abuse patterns they encountered in the 'age of drugs.' By the late 1970s, the ARF Annual Reports record the increasing influence of a combined biological and behavioral approach to addiction to diverse psychoactive substances, foreshadowing the emergence of the psychopharmacological theory of addiction in 1980.62 It is indicative of the arrival of a mature scientific paradigm when the general public can no longer easily grasp the implications of the new discoveries without simplification; perhaps the ignorance of the Le Dain commission

61 Archibald, A Voyage of Discovery, 86-95. 62 For instance, see ARF Annual Report 1975-6, 8; ARFAnnual Report 1977, 16-17', ARFAnnual Report 1978-9, 7. The mesolimbic dopamine reward hypothesis of addiction was first advanced by R.A. Wise in 1980 in Pharmacology, Biochemistry and Behavior. George Koob and Michel Le Moal, Neurobiology of Addiction (New York: Elsevier, 2006), 378-9,428; R.A. Wise, "Action of Drugs of Abuse on Brain Reward Systems," Pharmacology, Biochemistry and Behavior 13 (Supplement 1)(1980), 213-223.

103 authors of behavioral concepts in their understanding of drug addiction suggests that the first mature scientific paradigm of addiction had arrived. In any event, the case study of the ARF during the 1960s and 1970s demonstrates that the adoption of a new addiction paradigm was a historical event, dependent upon two major contextual developments: first, a perceived increase in drug use and a shift in drug-using populations, and second, the emerging authority of behavioral psychology.

104 Conclusion - "The Chemophilic Society": Addiction, Society, Science and Human Nature

In 1972 Dr. Andrew Malcolm of the Addiction Research Foundation (ARF) published The Pursuit of Intoxication, a lengthy treatise on the topic of drug use in society. Beginning at the dawn of man, Malcolm traced the use of various drugs by human society until the modern era. While Malcolm argued that humans had always used psychoactive substances to alter their mood, enhance their performance, cure illness, and even kill one another, he also maintained that mankind had entered a new age with the explosion, in recent decades, of available drugs. Malcolm concluded that what had emerged in recent times was a "chemophilic society."1 Malcolm predicted that, in the future, humanity would become increasingly dependent on different chemicals to control one's mood and emotions, and made explicit references to the fictional dystopian society of Aldous Huxley's Brave New World, in which the populace is controlled by a constant stream of drugs. While the apocalyptic predictions of Malcolm may today seem far fetched, or perhaps eerily accurate, they reflected a certain worldview and sense of society that had penetrated one of the most advanced, and presumably dispassionate, addiction research institutions in the world.2 As has been seen in the preceding chapters, researchers working in the newly created field of addiction science were keenly aware that drug use, and excessive drug use, were much more prevalent phenomena than had previously been the case. While North-American society might not have been entering a

1 Andrew Malcolm, The Pursuit of Intoxication (Toronto: Paperjacks, 1972), 250-1. 2 Malcolm ultimately had a falling out with the ARF staff, although the details are not clear. Afterwards he published another book, The Case Against the Drugged Mind, in which he advanced not only his argument concerning the chemophilic society, but also his theory of 'chemical conversion,' which emphasized the use of drugs in brainwashing as an attempt to explain the hippie phenomenon. David Archibald, The Addiction Research Foundation: A Voyage of Discovery (Toronto: Addiction Research Foundation, 1990), 98-9; Malcolm, The Pursuit of Intoxication, 162-3; Andrew Malcolm, The Case Against the Drugged Mind (Toronto: Clark, Irwin and Company, Ltd., 1973).

105 new age, its members were certainly using more drugs, more openly, and in new ways than before. The changing understanding of addiction in the 1960s and 1970s reflected these historical developments.

In her book Creating the American Junkie, Caroline Jean Acker briefly notes that in the 1960s the definition of addiction changed from the psychiatric theory of the Classic

Period to a behavioral one. She provides little detail of this transformation, but suggests that it may have had something to do with the changing nature of drug use in that decade.4 In his article, "Addiction: The Troublesome Concept," Ronald Akers notes that in the 1980s, addiction was redefined as "any hard-to-stop habit and any drug that one wants to condemn."5 Akers suggests that this reasons for this redefinition are primarily political - those advancing such a broad definition are political conservatives who wish to get on the "right side of the war on drugs."6 Given that Akers published his article not long after the administration of American president Ronald Reagan, who intensified that country's drug war in response to an increase in cocaine use, it is perhaps understandable that Akers would see such a redefinition as politically motivated. However, Akers ignores the considerable historical circumstances that led to the redefinition of drug use, and his analysis is weakened considerably by this omission.

A 2004 Scientific American article, entitled "The Addicted Brain," highlights the most recent discoveries of how different drugs of addiction affect the mesolimbic

3 Arguably the true psychoactive revolution occurred with the rise of European imperialism in the fifteenth, sixteenth and seventeenth centuries, as the worlds psychoactive resources were now subjected to international trade and capitalism. For more on this fascinating process, see David Courtwright, Forces of Habit: Drugs and the Making of the Modern World (Cambridge: Harvard University Press, 2001). 4 Caroline Jean Acker, Creating the American Junkie: Addiction Research in the Classic Era of Narcotic Control (Baltimore: Johns Hopkins University Press, 2002), 216. 5 Ronald Akers, "Addiction: The Troublesome Concept," Journal of Drug Issues 21 (4)(1991), 777. 6 Ibid.

106 dopamine system of the brain in similar ways. The article's authors, Eric J. Nestler and

Robert C. Malenka, note that:

The realization that various drugs of abuse ultimately lead to addiction through a common pathway emerged largely from studies of laboratory animals that began about 40 years ago. Given the opportunity, rats, mice and nonhuman primates will self-administer the same substances that humans abuse.7

The authors, however, make no reference to the contextual circumstances that encouraged such experiments, and indeed, allowed this new paradigm of addiction to gain widespread acceptance. At the same time, David Courtwright, in his discussion of the emergence of the alcohol, tobacco and other drugs movement, notes that "Since the

1960s, scientists have worked out, in increasingly refined detail, how psychoactive drugs affected the mesolimbic dopamine system." However, Courtwright proposes that these discoveries were 'internal' to the scientific discipline. The preceding chapters have hopefully indicated that these developments were not so internal as Courtwright suggests.

The thesis has argued that the redefinition of addiction in the 1960s and 1970s as a behavioral phenomenon was a historical development, dependent upon a particular historical context. Beginning in the 1950s and early 1960s, growing concern over the extent of narcotic and non-narcotic drug use led to the creation of the new field of addiction science. Events such as the American Bar Association - American Medical

Association Joint Committee on Drug Addiction, the 1962 White House Conference on

Drug Abuse, and the retirement of Henry J. Anslinger from the Bureau of Narcotics allowed for the creation of a safe research environment. At the same time, widespread concern over the extent of drug use in contemporary society made addiction a valid

7 Eric J. Nestler and Robert C. Malenka, "The Addicted Brain" Scientific American 290 (3)(2004), 79. 8 David Courtwright, "Mr. ATOD's Wild Ride: What Do Alcohol, Tobacco and Other Drugs Have in Common?" The Social History of Alcohol and Drugs 20 (2005), 115.

107 scientific topic, attracting researchers and research money. Humanitarian doctors and lawyers advanced the notion that addiction was a disease, in much the same way as the modern alcoholism movement, but did so with little scientific evidence. Initial research emphasized the social factors that led to excessive drug use, but ultimately the psychosocial theory of addiction repeated many of the assumptions of the classic theory of addiction, which argued that addiction was itself a symptom of underlying psychopathology. Beginning in the mid-1960s, however, a series of experiments would suggest that different drugs produced similar forms of drug-seeking behavior. In particular, the experiments of James Olds, J.R. Weeks, Abraham Wikler, and others, all of whom were adherents to the behavioral psychology of B.F. Skinner, would provide compelling answers to two of the most prominent questions in addiction studies - relapse, and addiction to non-opiate drugs. What emerged from these experiments was the behavioral theory of addiction - a drug (or even an activity) is addictive if it is done repeatedly. The growth of this theory within the world of addiction science was critically dependent upon historical context; the behavioral theory of addiction seemed to provide a compelling explanation for what appeared to be the rapid spread of excessive drug use across all levels of society during the turbulent 1960s and 1970s. Although some radical behaviorists took the theory to its logical extreme and argued that addiction was entirely a learned behavior, others were encouraged to look for the common actions of psychoactive chemicals on the brain, and began to make links between neuroscience and the drug-seeking behavior they had observed, both within the lab and the broader society.

The ultimate end result of this process was the emergence of the mesolimbic dopamine theory of addiction, which is the most popular understanding of addiction within the

108 modern scientific community. By the 1980s, the neurobiological basis for drug addiction was given additional support by the firmly-established field of psychopharmacology.

Since the 1950s, the use of effective psychiatric drugs indicated that a number of mental illnesses could be chemically controlled, further corroborating the idea that many behaviors had a physiological basis.9 In terms of treatment, the behavioral theory of addiction suggested that the most positive treatment outcomes would result from the application of techniques of behavior modification such as aversive conditioning, controlled use training, and stress management. While initial clinical trials of behavioral therapy were encouraging, a gulf existed between the research and treatment worlds, a gulf which was occasionally widened by political circumstances. It would not be until the 1980s that behavioral therapy would become a hallmark of addiction treatment.

The case study of the ARF further supports the argument that the behavioral theory of addiction came to prominence because it addressed certain questions that had

.9 An inquisitive reader might wonder whether the emergence in the 1950s of psychopharmacology, anti psychotics and anti-depressant may have had an impact on the reconceptualization of addiction more broadly. This is certainly a plausible notion, and would support the argument that addiction researchers felt that humanity was entering a 'chemical age.' However, empirical evidence for such a notion is weak. Few of the prominent addiction researchers of the 1960s and 1970s discussed the emergence of psychiatric drugs in relation to theories of addiction. This may simply have been a result of the fact that many of these researchers were themselves psychiatrists, and did not wish to admit that their newest forms of treatment might pose significant problems; however, this also seems unlikely. Dependence on psychiatric medication was noted as early as the 1960s, but behavioral testing of such drugs as benzodiazepines revealed a low dependence potential; put simply, animals would not self administer benzodiazepines, and so the drugs was not thought to produce dependence. That being said, the addiction potential of other drugs that were used in psychiatric settings, such as amphetamines and barbiturates, was often discussed. A much broader discussion of the addiction potential of psychiatric drugs occurred with the explosion of SSRIs and anti depressants in the 1980s and 1990s. It is worth noting that in the 1980s Avram Goldstein proposed a theory of opiate addiction that mirrored a contemporary psychopharmacological theory of depression. According to Goldstein, opiate addicts failed to produce adequate endorphins, and thus needed an exogenous supply. This theory resembled the theory of depression which stated that clinical depression was caused by a lack of the neurotransmitter serotonin. Goldstein's theory was ultimately abandoned. For a discussion of the history of psychopharmacology and addiction to psychiatric drugs, see David Healy, The Creation of Psychopharmacology (Cambridge: Harvard University Press, 2002), 165-9, 171-3, 347. For Goldstein's theory of endorphin deficiency, see William White, Slaying the Dragon: The History of Addiction Treatment and Recovery in America (Bloomington, Illinois: Chestnut Healdi Systems, 1998), 289.

109 become acute for contemporary scientists. Beginning in the early 1960s, the ARF repeated many of the Classic Period notions of addiction as a symptom of individual psychopathology. However, as the decade wore on, ARF scientists increasingly came to embrace the behavioral definition of addiction because it so powerfully matched with both their clinical experience of mixed addictions, and with their epidemiological research. Growing concerns about an 'age of drugs' led ARF scientists to advance a combined biological-and-behavioral approach to addiction. For the ARF, addiction was basic to the human condition, and this universalizing of drug use led the ARF to embrace a harm-reduction approach to drug education and treatment. Whereas at the end of the

Classic Period addiction was confined to a small group of psychopaths, by 1975 anyone could be a drug addict.

Since the 1970s, continued experimentation has led an increasing refinement of the neurobehavioral theory of addiction. The mesolimbic dopamine system has also been implicated in other forms of self-destructive excessive behavior such as obesity, gambling and sex addiction. Meanwhile, the theory of an 'addictive personality' had remerged in the form of genetic studies. These studies have suggested that certain personality characteristics such as risk-taking tendencies can be passed on from parent to child, and that those who posses such characteristics are more likely to become addicts.

While these theories do emphasize personality in the development of addiction, they are a far cry from the kind of stigmatizing psychiatric theories of the Classic Period.

The behavioral experiments of the 1960s and 1970s, and the ensuing redefinition of addiction, constitute a powerful example of scientific revolution as defined by Thomas

Kuhn. The experiments of Wikler, Olds, Weeks and others provided models that helped

10 Courtwright, 116-118.

110 to define the area of scientific inquiry, and simultaneously addressed problems which had become acute within the new field of addiction science. In their 1981 edited collection

Classic Contributions in the Addictions Howard Shaffer and Milton Burglass also examined the emergence of addiction science through the lens of Kuhn; however, Shaffer and Burglass concluded that a dominant paradigm had yet to be established in that field."

With the considerable benefit of hindsight, I would like to respectfully disagree with these two authors, and suggest that the behavioral definition of addiction signaled the emergence of addiction studies as a mature science. The discoveries made in the open and enthusiastic research environment of the 1960s and 1970s set the tone for subsequent investigations for several decades. The insights brought about by the 'chemophilic society' have yet to be seriously challenged.

This study can hopefully contribute to the continuing debate about substance use and addiction within modern society. Moreover, the investigation of the intellectual history of science and medicine can contribute to contemporary debates by demonstrating the reciprocal relationship between science and society. While many critics have suggested that science is entirely a cultural product which reflects the values and prejudices of that culture, the present study suggests that science is also capable of . questioning those values and prejudices, and critiquing popular stereotypes and power systems. Addiction research after the Classic Period certainly accomplished this task by suggesting that addiction was a more basic problem that could afflict any person, regardless of their perceived moral strength or weakness. While drug use, and even dangerous drug use, are clearly also the result of social conditions and individual

11 Howard Shaffer and Milton Burglass, Classic Contributions in the Addictions (New York: Brunner/Mazel, 1981), 483-5.

Ill circumstances, the understanding that addiction is the result of processes that is basic to human nature should hopefully suggest that individuals suffering from such a condition are deserving of our compassion, our understanding, and our care.

112 Bibliography

Secondary Sources

Acker, Caroline Jean. Creating the American Junkie: Addiction Research in the Classic Era of Narcotic Control. Baltimore: Johns Hopkins University Press, 2002.

Akers, Ronald. "Addiction: The Troublesome Concept." Journal of Drug Issues 21 (4)(1991): 777-793.

Archibald, H. David. The Addiction Research Foundation: A Voyage of Discovery. Toronto: Addiction Research Foundation, 1990.

Bentley, Michael. Modern Historiography. New York: Routledge, 1999.

Berridge, Virginia. Opium and the People: Opiate Use and Drug Control Policy in Nineteenth and Early Twentieth Century England. Revised Edition. New York: Free Association Books, 1999.

Bynum, W.F., Roy Porter and Michael Shepherd, eds. The Anatomy of Madness: Essays in the History of Psychiatry. New York: Tavistock Publications, 1985.

Carstairs, Catherine. Jailed for Possession: Illegal Drug Use, Regulation and Power in Canada, 1920-1961. Toronto: University of Toronto Press, 2006.

Cook, Shirley Jones. "Canadian Narcotics Legislation, 1908-1923: A Conflict Model Interpretation." Canadian Review of Sociology and Anthropology 6 (1969): 36- 46.

Courtwright, David, Herman Joseph and Don Des Jarlais. Addicts Who Survived: An Oral History of Narcotic Use in America, 1923-1965. Knoxville: University of Tennessee Press, 1989.

-. "Mr. ATOD's Wild Ride: What Do Alcohol, Tobacco and Other Drugs Have in Common?" The Social History of Alcohol and Drugs 20 (2005): 105-140.

-. Dark Paradise: A History of Opium Addiction in America. Revised Edition. Cambridge, Mass.: Harvard University Press, 2001.

-. Forces of Habit: Drugs and the Making of the Modern World (Cambridge: Harvard University Press, 2001).

Goldstein, Avram. Addiction: From Biology to Drug Policy. New York: W.H. Freeman, 1994.

113 Goodwin, C. James. A History of Modern Psychology. Second Edition. Hoboken, NJ: Wiley, 2005.

Healy, David. The Creation ofPsychopharmacology. Cambridge: Harvard University Press, 2002.

Keehn, J.D. Master Builders of Modern Psychology: From Freud to Skinner. New York: New York University Press, 1996.

Keen, Ernst. A History of Ideas in American Psychology. Westport, Conn.: Praeger, 2001.

Koob, George and Michel Le Moal. Neurobiology of Addiction. New York: Elsevier, 2006.

Kuhn, Thomas. The Structure of Scientific Revolutions: Third Edition. Chicago: University of Chicago Press, 1996.

Lindesmith, Alfred. The Addict and the Law. Bloomington: Indiana University Press, 1965.

-. Opiate Addiction. Evanston, Illinois: Principia Press, 1947.

Malleck, Daniel J. '"It's Baneful Influences are Too Well Known': Debates over Drug Use in Canada, 1867-1908." Canadian Bulletin of Medical History 14 (1997): 263-88.

Marquis, Greg. "From Beverage to Drug: Alcohol and Other Drugs in 1960s and 1970s Canada." Journal of Canadian Studies 39 (2)(2005): 57-79

Martel, Marcel. Not This Time: Canadians, Public Policy and the Marijuana Question. Toronto: University of Toronto Press, 2006.

McAllister, William B. Drug Diplomacy in the Twentieth Century. New York: Routledge, 2000.

Musto, David. The American Disease: Origins of Narcotic Control. Third Edition. New York: Oxford University Press, 1999.

Nestler, Eric J. and Robert C. Malenka. "The Addicted Brain." Scientific American 290 (3)(2004): 78-85.

Sedgwick, Peter. Psycho Politics: Laing, Foucault, Goffman, Szasz and the Future of Mass Psychiatry. New York: Harper & Row Publishers, 1982.

114 Shaffer, Howard and Milton Burglass, eds. Classic Contributions in the Addictions. New York: Brunner/Mazel, 1981.

Thompson, E.P. The Making of the English Working Class. New York: Vintage Books, 1963.

Trasov, G.E. "History of the Opium and Narcotic Drug Legislation in Canada." Criminal Law Quarterly 4 (January 1962): 274-82.

Valverde, Mariana. Diseases of the Will: Alcohol and the Dilemmas of Freedom. Cambridge: Cambridge University Press, 1998.

White, William. Slaying the Dragon: The History of Addiction Treatment and Recovery in America. Bloomington, 111.: Chestnut Health Systems/Lighthouse Institute, 1998.

Published Primary Sources

Addictions 8 (1961) - 22 (1975).

Alcoholism and Drug Addiction Research Foundation. Annual Report of the Ontario Alcoholism and Drug Addiction Research Foundation 1961. Toronto: Alcoholism and Drug Addiction Research Foundation, 1960-1979.

Bassin, Alexander. "Daytop Village." Psychology Today 2 (7)(1968): 48-53.

Becker, Howard. "Marijuana Use and Social Control." Social Problems 35 (1955): 35- 44.

-. Outsiders: Studies in the Sociology of Deviance. New York: The Free Press, 1963.

Bejerot, N. "The Nature of Addiction." In M. M. Glatt Ed. Drug Dependence: Current Problems and Issues. Baltimore: University Park Press, 1971.

British Journal of Addiction 61 (1965) - 70 (1975).

Cappell, H.D. and A.E. LaBlanc. Biological and Behavioral Approaches to Drug Dependence. Toronto: Addiction Research Foundatoin of Ontario, 1975.

Chien, Isidor, Donald L. Gerard, Robert S. Lee and Eva Rosenfeld. The Road to H: Narcotics, Delinquency and Social Policy. New York: Basic Books Inc, 1964.

Clausen, John A. "Social and Psychological Factors in Narcotics Addiction." Law and Contemporary Problems 22 (Winter 1957): 34-51.

115 Crowley, T. J. "The Reinforcers for Drug Abuse: Why People Take Drugs." Comprehensive Psychiatry 13 (1972): 51-62.

Deneau, G.A., T. Yanagita, and M.H. Seevers. "Self-administration of psychoactive substances by a monkey - a measure of psychological dependence." Psychopharmacologia 16 (1969): 40-48.

Dole, Vincent and Marie Nyswander. "A Medical Treatment for Diacetylmorphine (Heroin) Addiction: A Clinical Trial with Methadone Hydrochloride." Journal of the American Medical Association 193 (1965): 646-50.

Eddy, Nathan, H. Halback, Harris Isbell and Maurice Seevers. "Drug Dependence: Its Significance and Characteristics." Bulletin of the World Health Organization 37 (1965): 721-33.

Gendreau, Paul and L.P. Gendreau. "The 'Addiction-Prone' Personality: A Study of Canadian Heroin Addicts." Canadian Journal of Behavioral Science 2 (1970): 18-25.

Government of Canada. Royal Commission of Inquiry into the Non-medical Use of Drugs. Final Report of the Commission of Inquiry into the Non-Medical Use of Drugs. Ottawa: Information Canada, 1973.

-. Interim report of the Commission of Inquiry into the Non-medical Use Of Drugs. Ottawa: Information Canada, 1970.

-. Treatment: A Report of the Commission of Inquiry into the Non-Medical Use of Drugs. Ottawa: Information Canada, 1972.

International Journal of the Addictions 1 (1966)- 10(1975).

Isbell, H. and W.W. White. "Clinical Characteristics of the Addictions."^ merican Journal of Medicine 14 (5) (May 1953): 558-565.

Isbell, Harris. "Trends in Research on Opiate Addiction." Transactions and Studies of the College of Physicians of Philadelphia 24 (l)(June 1956): 1-10.

Jarvik, Murray E. "The Role of Nicotine in the Smoking Habit." In William A. Hunt Ed. Learning Mechanisms in Smoking. Chicago: Aldine Publishing Company, 1970.

Joint Committee of the American Bar Association and the American Medical Association on Narcotic Drugs. Drug Addiction: Crime or Disease? Eighth Printing. Bloomington, Indiana: Indian University Press, 1971.

Kalant, Harold and Oriana Josseau Kalant. Drugs, Society and Personal Choice. Toronto: Paperjacks, 1971.

116 Kalant, Harold and Rosemary D. Hawkins. Experimental Approaches to the Study of Drug Dependence. Toronto: University of Toronto Press, 1969.

Kalant, Oriana. The Amphetamines: Toxicity and Addiction-Second Edition. Toronto: University of Toronto Press, 1973.

Kolb, Lawrence. "Types and Characteristics of Drug Addicts." Mental Hygiene 9 (April 1925): 300-13.

Kolb, Lawrence. Drug Addiction: A Medical Problem. Springfield, Illinois: Charles C. Thomas, 1962.

Lehmann, H.E. "Phenomenology and Pathology of Addiction." Comprehensive Psychiatry 4 (3)(June 1963): 168-80.

Lolli, G. "Alcoholism as a Medical Problem." Bulletin of the New York Academy of Medicine 31(1955): 876-886.

Mackenzie King, W.L. Report by W.L. Mackenzie King, C.M.G., on the Need for the Suppression of the Opium Traffic in Canada. Ottawa: Sessional Paper 36b, 1908.

Malcolm, Andrew. The Case Against the Drugged Mind. Toronto: Clark, Irwin and Company, Ltd., 1973.

-. The Pursuit of Intoxication. Toronto: Paperjacks, 1972.

Olds, James and P. Milner, "Positive Reinforcement Produced by Electrical Stimulation of Septal Area and Other Regions of Rat Brain." Journal of Comparative and Physiological Psychology 47 (1954): 419-27.

Olds, James. "Pleasure Centers in the Brain." Scientific American 195 (1956): 105-117. -. "Self-Stimulation of the Brain: It's Use to Study Local Effects of Hunger, Sex and Drugs." Science 3294 (127)(1958): 315-324.

Pickens, R. and T. Thompson. "Cocaine-reinforced behavior in rats: Effects of reinforcement magnitude and fixed-ratio size." Journal of Experimental Animal Behavior, 1967.

Schildkraut, J.J. and S.S. Kety. "Biogenic Amines and Emotion." Science 156 (1967): 21-30.

Schur, Edwin. Narcotic Addiction in Britain and America. Bloomington: Indiana University Press, 1962.

117 Schuster, C.R. and J.H. Woods. "Morphine as a reinforcer for operant behavior." Reported to the Committee on Problems of Drug Dependence, 1967

Smart, Reginald and David Jackson. The Yorkville Subculture: A Study of the Life Styles and Interactions of Hippies and Non-Hippies, prepared from the field notes of Gopala Alampur. Toronto: Addiction Research Foundation, 1969.

Stein, L. and CD. Wise. "Relapse and Hypothalamic Norepinepherine by Rewarding Electrical Stimulation or Amphetamine in the Anesthetized Rat." Federation Proceedings 26(1967): 651.

Thompson, T. and C.R. Schuster. Behavioral Pharmacology. Englewood Cliffs, New Jersey: Prentice-Hall, 1968.

U.S. Government. The White House Conference on Narcotic and Drug Abuse. Washington D.C.: Government Printing Office, 1962

U.S. Government. The President's Advisory Commission on Narcotic and Drug Abuse - Final Report. Washington D.C.: Government Printing Office, 1963.

Weeks, J.R. "Experimental Morphine Addiction: Method for Automatic Intravenous Injections in Unrestrained Rats." Science 138 (1962), 143-4.

-. "Experimental Narcotic Addiction." Scientific American 210 (1964): 46-52.

Wikler, Abraham. "Conditioning Factors in Opiate Addition and Relapse." In Daniel Wilner and Gene Kassebaum, eds. Narcotics. New York: McGraw-Hill Book Company, 1965.

-. "Psychological Bases of Drug Abuse." In The White House Conference on Narcotic and Drug Abuse. Washington D.C.: Government Printing Office, 1962.

-. "Studies on conditioning of physical dependence and reinforcement of opiate drinking behavior in morphine addicted rats." 1st Annual Meeting of the American College of Neuropsychopharmacology, Washington D.C. Jan 24-27, 1963.

Winick, Charles. "Narcotics Addiction and Its Treatment." Law and Contemporary Problems 22 (Winter 1957): 9-33.

Wise, CD. and L. Stein. "Facilitation of Brain Self-Stimulation of Central Administration of Norepinepherine. "Science 163 (1969): 299-301.

Wise, R.A. "Action of Drugs of Abuse on Brain Reward Systems." Pharmacology, Biochemistry and Behavior 13 (Supplement 1)(1980): 213-223.

118 Yablonsky, Lewis. Synanon: The Tunnel Back. Baltimore, Maryland: The Macmillan Company, 1965.

Szasz, Thomas. Ceremonial Chemistry: The Ritual Persecution of Drugs, Addicts and Pushers. New York: Anchor Press/ Double Day, 1974.

-. The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. New York: Dell, 1961.

Archival Primary Sources

Centre for Addiction and Mental Health Archives, Queen St site. Center for Addiction and Mental Health fonds. Boxes 2, 59, 62 and 63.

119