37 ^ MQ/J //a "ags THE HISTORY OF ALCOHOLISM TREATMENT IN THE UNITED STATES DISSERTATION Presented to the Graduate Council of the University of North Texas in Partial Fulfillment of the Requirements For the Degree of DOCTOR OF PHILOSOPHY By Suzanne S. Brent, BA., M.H.R. Denton, Texas December, 1996 37 ^ MQ/J //a "ags THE HISTORY OF ALCOHOLISM TREATMENT IN THE UNITED STATES DISSERTATION Presented to the Graduate Council of the University of North Texas in Partial Fulfillment of the Requirements For the Degree of DOCTOR OF PHILOSOPHY By Suzanne S. Brent, BA., M.H.R. Denton, Texas December, 1996 Brent, Suzanne S., The History of Alcoholism Treatment in the United States. Doctor of Philosophy (Sociology), December, 1996, 369 pp., references, 339 titles. The treatment of alcoholism has had a unique historical development in the United States. This study provides a chronology of how the problem of alcoholism was defined and handled during various time periods in United States history. The process that evolved resulted in an abstinence based, comprehensive, multidisciplinary approach to the treatment of alcoholism as a primary disease based on the principles of Alcoholics Anonymous. This treatment modality, that developed outside of established medicine, is currently used by the majority of treatment providers. Seven individuals who have been actively involved in alcoholism treatment were interviewed. In addition to archival research, biographies and autobiographies were examined to gain a broad perspective. Because alcoholism is both a collective and an individual problem an effort was made to include a microsociological frame of reference within a broad sociological view. Alcoholism, or inebriety, was first perceived as a legal and moral problem. By the end of the 19th century, inebriety was recognized as an illness differing from mental illness, and separate asylums were established for its treatment. Alcoholism is currently accepted and treated as a primary disease by the majority of social institutions, but the legal and moral implications remain. National Prohibition in the early part of the 20th century targeted alcohol instead of the alcoholic delaying any progress toward treatment which was made in the 19th century. The advent of Alcoholics Anonymous brought the first widely accepted hope for alcoholics. The treatment process that developed utilized the principles of Alcoholics Anonymous in a setting of shared recovery which has been difficult to quantify. In 1970 the allocation of federal funds for treatment and research brought the involvement of new disciplines creating both conflicts and possibilities. Alcoholism recovery has elucidated the connection of mind, body, and spirit. Copyright by Suzanne S. Brent 1996 m ACKNOWLEDGMENTS I wish to express my gratitude to the members of my committee and especially to the chairpersons, Professor Paula Englander-Golden and Professor James Kitchens, who have been consistently encouraging and helpful. Dr. Englander-Golden has been a trusted friend and an inspirational mentor throughout all of my graduate studies. Dr. Kitchens supported the topic for this research and has constantly sustained my efforts. Dr. Rudy Seward served on my committee and also as my graduate advisor. Dr. Norma Williams provided the insight for the utilization of history and biography as relevant and important in sociological study. This work is a reflection of my involvement for the past 12 years in the field of alcoholism. I especially appreciate Patricia and Nicholas Colangelo who were there from the beginning. Lynn Hoke was immensely helpful and encouraging both in Houston and in New York. Penny Page and Valerie Mead assisted with many details at Rutgers Center of Alcohol Studies Library. Linda Travis, Lisa Berry, and Pat Heaton of the Harrington Library of the Health Sciences, Texas Tech University Health Sciences Center at Amarillo, searched diligently for numerous requests, and I appreciate their efforts and interest. I wish to thank my family for their faithful support in this endeavor. iv TABLE OF CONTENTS Chapter Page 1. INTRODUCTION 1 Background Rationale for the Study Purpose of the Study Methodology Significance of the Problem Organization of the Research 2. THE COLONIAL YEARS AND THE NEW REPUBLIC-- 1607-1870 16 The Colonial Years Post Revolutionary Years Summary 3. TEMPERANCE, DEPRESSION, AND WORLD WAR I~ 1870-1930 63 Organized Efforts to Treat Inebriety Lay Therapy Private Sanitoriums and Hospitals Government Hospitals for Addiction Treatment Summary 4. DEPRESSION, HOPE, ANOTHER WORLD WAR-- 1930-1940 119 Alcoholics Anonymous The Development of Other Methods of Alcoholism Treatment Development of Research Council on Problems of Alcohol The Yale Center for Studies of Alcohol The National Council on Alcoholism Summary v Chapter Page 5. DEVELOPMENT OF THE ALCOHOLISM TREATMENT CENTER--1940-1970 214 The Farm Concept-Shared Recovery Medicine and Alcoholics Anonymous The Minnesota Model Other Areas of Development Legislative and Civic Development Summary 6. TREATMENT, CORPORATE INTERVENTION, BIG BUSINESS, AND RESEARCH--1970-1996 287 Treatment Corporate Intervention Big Business Research Summary 7. SUMMARY AND CONCLUSIONS 328 APPENDIX 340 REFERENCES 342 VI CHAPTER 1 INTRODUCTION Background Alcoholism has become an increasingly serious social problem in the United States since the early years of colonial settlement. As the population expanded and the American lifestyle became more complex, problems created by alcoholism grew. The attempts to identify and define the problem, as well as the search for solutions, have caused more contention and confusion than in any other social dilemma. Alcohol has played many roles: in religion, as a sacred symbol; in medicine, as an antiseptic and a sedative; in society, as the spirit of celebration, and in families, as the spirit of a sharing ritual. It has served as the daily wage for the worker, and it has been the manifestation of evil and sin. Alcohol has symbolized wealth and prosperity and it also has been used by the helpless and oppressed for comfort. On few societal issues have emotions run so high or passions so deep. It is significant that the intensity of sentiments surrounding the issue of alcohol required the passage of a constitutional amendment outlawing its sale in the United States. The concept of identifying alcoholism as a disease has been a continuing source of confusion and conflict. A paradigm shift has occurred in the 20th century regarding the manner in which society deals with alcoholism. In the colonial period alcoholism was perceived as a sin, and those afflicted were often punished and publicly humiliated. Alcoholics were candidates for the poorhouse or the insane asylum. Now, at the end of the century, alcoholism has been recognized as a medically treatable disorder with attendant legal and moral ramifications. Kuhn (1962/1970) defined a paradigm shift as occurring at the point in the developmental process that he described as follows: When, in the development of a natural science, an individual or group first produces a synthesis able to attract most of the next generation's practitioners, the older schools gradually disappear. In part their disappearance is caused by their members' conversion to the new paradigm. But there are always some men who cling to one or another of the older views, and they are simply read out of the profession, which thereafter ignores their work. The new paradigm implies a new and more rigid definition of the field. Those unwilling or unable to accommodate their work to it must proceed in isolation or attach themselves to some other group, (pp. 18-19) Such a paradigm has emerged regarding the treatment of alcoholism. Alcoholism has been recognized and acknowledged as a malady that is receptive to treatment by major societal institutions: the national government, the medical establishment, institutions of higher learning, the criminal justice system, and religious institutions. For clarification, a revised definition of alcoholism was established in 1992 by a 23-member multidisciplinary committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine. The committee agreed to define alcoholism as follows: [It is] a primary, chronic, disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired comtro l over drinking, preoccupation with the drug alcoholale , use of" alcohol despite adverse consequences, and distortions in thinking, inost notably denial. Each of these symptoms may be continuous or periodic. (Morse & Flavin, 1992, p. 1012) The Diagnostic Criteria From DSM-IV of the American Psychiatric Association (1994) defined alcohol dependence under Substance Abuse Dependence as having three or moir e of the following symptoms: 1. Tolerance is either increased or decreased. 2. There are withdrawal symptoms. 3. The substance is taken in larger amounts over a longer period than was intended. 4. There is a persistent desire or unsuccessful efforts to cut down or control use. 5. A great deal of time is spe{it in activities to obtain the substance. 6. Important social, occupational, or recreational activities are given up or reduced because of substance use. 7. The use of the substance continues despite persistent or recurrent physical and/or psychological problems (pp. 108-109). Although the disease is chronic in nature, it is recognized