Human And Social Sciences at the Common Conference

November, 18. - 22. 2013

A Brief History of Drug Abuse, Addiction Concepts

and Community Treatment
Miroslav Horak
Department of Languages and Cultural Studies
Faculty of Regional Development and International Studies
Mendel University in Brno
Zemedelská 1/1665, 613 00 Brno, Czech Republic
miroslav.horak.ujks@mendelu.cz

Abstract— In this article the definition of addiction is explored. primarily to the fact that only limited range of pharmaceuticals
A brief background of the historical literature in the area is was available to the physicians.
included. The basic concepts of substance abuse are also
discussed in the paper based on literature search of peer- At the same time also recreational opium use found its way
reviewed articles (n=91) provided by PubMed, Ovid MEDLINE, to the society thanks to the large number of Chinese workers
ScienceDirect etc. There is also alternative spiritual model of immigrating to America. It is estimated that almost 25% of
addiction explained on the case of two therapeutic community them smoked it. [12] Opium known for several thousand years
programs where field research was carried out from 2007 to as a folk medicine thus came into widespread use and it was
2010. often mixed with another New World import, tobacco.

Keywords - drug abuse, addiction, treatment In I803 morphine the active ingredient of opium was first
isolated. Fifty years after the invention of the hypodermic
I. INTRODUCTION syringe allowed administration of the drug in far more
The premise of this article is based on assumption that drug concentrated form, thus having a profound influence on the
addiction is a typical product of modern life style. Traditional opiate problem. Although morphine can be smoked or eaten,
cultures commonly used mind altering drugs in religious and injection is the preferred means till nowadays. [13]
medicinal context. As far as we know, the drug abuse was In 1898 heroin was produced from morphine. Originally it
unfamiliar to them, because they have always been able to deal was believed to have all the therapeutic qualities of morphine
with so called psychosocial problems through maintenance and without the most serious side effect. However, it was quickly
practice of their traditions. showed the opposite.
In various cultures, e.g. in Aguaruna, whose members are The end of the nineteenth century also saw a dramatic
living in the jungle of Northern Peru, when young people increase in cocaine use, first introduced to Europe in the 16th
reached a certain age of puberty or adolescence, there were century. Leaves of coca (Erythroxylum coca) had been chewed
ceremonies conducted by family members or elders for them. by the Aymara Indians of Peru for more than 1000 years
In these ceremonies or rites of passage certain psychoactive without any evidence showing the coca plant's potential for
plants were ingested, so the initiated could solve his concerns addiction. Also heart attacks and strokes were, and still are,
in personal and community life. Both physical and spiritual uncommon in this group of drug-takers, because the physical
illness could be also cured this way. However, these rites are constraints of leaf chewing restrict the amount of cocaine that
almost no longer performed. [30] can be introduced into the bloodstream. [10]
Drug use in European American society was first The benign phase of cocaine consumption abruptly came to
acknowledged to be a “problem” in the mid-nineteenth century. an end in 1884, when Freud published his famous paper
By the 19th century, the medical profession was under pressure praising cocaine as a miracle drug and recommended it same as
from unorthodox practitioners offering homeopathy, a number of American physicians in the treatment of
mesmerism, and other new “scientific” interventions that alcoholism and morphine addiction. [14] Cocaine also quickly
eschewed unpleasant standard treatments like blistering and found wide acceptance as an effective local anesthetic agent,
bleeding. To retain their wealthy patients, physicians shifted especially in ophthalmic surgery, in treatment of “wasting
towards managing symptoms rather than attempting dramatic diseases”, e.g. dyspepsia, typhoid fever, kidney disease, hay
but painful cures, and doctors increasingly prescribed opium. fever, colds, and sinus conditions. Later the problem of cocaine
[18] abuse rose, because of its inappropriate medical application as
Opium used by William Cullen from the Edinburgh School a stimulant. [33] In addition, the use of ether, chloroform, and
of Medicine to demonstrate the centrality of the nervous system chloral hydrate were all considered fashionable in this period.
through animal experiments [3], was applied in treatment of [12, 15]
wide variety of conditions, e.g. chronic respiratory disorders,
malaria, syphilis, rheumatism, insomnia, anxiety, fatigue and
alcoholism. Increased use of narcotics could be attributed

The 1st Human And Social Sciences at the Common Conference SECTION
http://www.hassacc.com Social Science, Families, - 157 -
Work, Activism, Lifestyle Choices
 Human And Social Sciences at the Common Conference
November, 18. - 22. 2013

II. EMERGENCE OF THE ADDICTION CONCEPT concept of addiction based on a well confirmed, substantive
As Meyer (1996) notices in his most comprehensive article, theory covering all the phenomena has not been found anyway,
the concept of disease in drug and alcohol addiction evolved and further empirical and theoretical work to develop it is
over the past 200 years in the context of changing constructs in necessary. [27]
clinical medicine, public health, and psychiatry. The concept of addiction also differs from the view of
One of the first notions on addiction can be found in clients and experts. Clients tend to define addiction in terms of
Thomas Trotter seminal Essay, Medical, Philosophical and needs, urges, and diminished control whereas expert focus
Chemical on Drunkenness and its Effects on the Human Body. more on the compulsive aspects of the behavior, the presence
Considering alcohol addiction, Trotter expressed here his ideas of physical dependence, and diminished control. [32]
that “the habit of drunkenness was a disease”, and moreover, “a III. SPIRITUAL CONCEPT OF ADDICTION
disease of the mind”. [31] In the USA the origin of disease
concept has been credited to Benjamin Rush, who identified Conducting the nine-month long field research in Takiwasi,
alcoholism as an illness in which alcohol is the causal agent, Centre for the Rehabilitation of Drug Addicts and For Research
loss of control over drinking being the characteristic symptom, on Traditional Medicines (Tarapoto, Peru), we also explored
and total abstinence the only effective cure. spiritual concept of addiction. [11]
The approach to mental disorders was influenced by the The rehabilitation program of Takiwasi is based on the
idea that there is a hidden motivation on human behavior and assumption of drug use related to looking for „holiness“. The
certain personality aspects why people become addicted. way a patient used drugs before coming to the centre is
[6, 21] In the second half of the 19th century an awareness of considered pathological, because he did so idiosyncratically,
physicians that alcohol distorts the view of reality was also i.e. made decisions wilfully about the dosage as well as the
emerging. Up to present day otherwise persists the tension setting. [9]
between medical view of addiction as a disease and a moral For example, if it is confined to appropriate times and
intolerance of intoxicants, weakening their self-restraint, places, most people accept drinking as normal behaviour.
impairing moral faculty, and damaging their soul. [18] When an individual begins to drink on the job, at school, or in
The concept of addiction has changed over the years, the morning, that behaviour is evidence of a drinking problem.
because drug taking is a behavior influenced by many Even subcultures or communities that accept the use of illegal
psychological, social, and cultural variables. Among the most drugs might distinguish between acceptable and unacceptable
influential the animal behavioral, conditioning or genetic situations. [2]
models are considered. New findings on the neurobiological of This is also the case of Takiwasi where the controlled drug
addiction bring us to the present. For example alcoholism is use with the pursuit of self-transcendence is accepted, because
nowadays defined as a primary, chronic disease with genetic, total abstinence or substitution treatment is seen here as less
psychosocial, and environmental factors influencing its efficient. The Centre provides a framework in which some kind
development and manifestations. This maladaptive pattern of of spiritual experience, induced by controlled ritual use of
behavior is characterized by continuous or periodic impaired herbal medicines with psychoactive effects traditionally
control over drinking within a 12-month period, preoccupation administered by the healers of the Peruvian Amazon
with the alcohol, use of alcohol despite adverse consequences, (ayahuasca), can be reached. Such rituals are generally
and distortions in thinking, most notably denial. [1, 22] performed in a unique space, set aside as a place of healing.
Historically an addiction was defined as a dependence on a They often include song, dance, the burning of incense, the
psychoactive substance. This substance would alter the brain calling on of gods, the casting out of evil spirits, the laying on
chemistry, activate neuronal circuits that underline of hands etc. [34] Important aspect here represents the fact that
reinforcement, as well as circuits that produce powerful the rite, which is primarily designed to integrate drug
emotional memories, and subsequently cause dependence. experience, is not profaned and the patients experience is
[8, 14] However, the number of addiction definitions has further analysed with individual psychotherapist, in group
grown during the second half of the 20th century to include sessions and ergo therapy. [17]
also so-called behavioral, soft, process or non-substance related A preliminary observational study of ayahuasca-assisted
addictions like gambling, compulsive sexual behaviors etc. [24, treatment for problematic substance use and stress delivered in
26] a rural First Nations community in British Columbia, Canada,
Currently the addiction concept remains controversial, was also implemented. Statistically significant improvements
because there are explicit criteria for its definition missing. were observed in several factors related to problematic
Sussman & Sussman (2011) in their systematic review substance use among a rural aboriginal population. [28]
analyzed 52 studies grappling with views of addiction and Another 12-step spiritual concept which dates back to 1935
discovered that they include five common elements is developed by Alcoholics Anonymous. The religious aspects
representing necessary and sufficient conditions for a of this model is much less concrete in contrast with prevailing
psychological state or pattern of behavior to be an addiction: 1. Roman-catholic religious beliefs of Peruvian therapists and it
engagement in the behavior to achieve appetitive effects, 2. was derived form an number of sources, some of them
preoccupation with the behavior, 3. temporary satiation, 4. loss particular to recent trends in American culture over the last half
of control and 5. suffering negative consequences. The precise century. In AA the acceptance of an ecumenical religious

The 1st Human And Social Sciences at the Common Conference SECTION
http://www.hassacc.com Social Science, Families, - 158 -
Work, Activism, Lifestyle Choices
 Human And Social Sciences at the Common Conference
November, 18. - 22. 2013

orientation has led to an appreciation that the formalities of retention are cited. [5, 20] To firmly substantiate the specific
ritual practice may be less important than the values that many contribution of the therapeutic community to long-term
religious denominations hold in common. [7] recoveries the link between treatment elements, experiences
and outcomes must be established, because the knowledge
However, in both cases an acceptance of practices like gained exclusively from the experience of personal recovery
meditation and yoga with their relationship to Asian and program rituals tends to remain static, unresponsive to
philosophies, and complementary medicine, has added another individual differences or circumstantial change.
dimension to the treatment. The emergence of spiritual
recovery programs itself is a potent vehicle for personal V. CONCLUSIONS
transformation, but firstly the validation of spirituality in the
rehabilitation process must be done and it lies in defining it in Addiction is a multifaceted behavior. There is no one
empirical terms, e.g. as something “that which gives people definition that encompasses all its aspects. Although science
meaning and purpose in life.” (Puchalski, Dorff, & Hendi, lags, there has been some good research to demonstrate that
2004) addiction has some biological roots. The social and
environmental issues that exist are also important in nurturing
The model of AA found its application in the Nicaraguan addictive behavior. The extent to which non-biological factors
therapeutic community CEA (Centro de Especialidades en play an important role in developing addictive behavior is not
Adicciones), where also the Matrix model, an evidence-based well defined and the role of spirituality in the drug addiction
intensive outpatient treatment program for alcohol and drugs, is treatment must be further analyzed. Spirituality in the context
used. Originally developed to meet the needs of cocaine and of recovery programs plays an important role which still waits
crack users, today it is delivered to a broad spectrum of people to be clarified.
with no race/ethnicity, gender of drug limitations. [35]
ACKNOWLEDGMENT
IV. EVOLUTION OF THERAPEUTIC COMMUNITIES This article is dedicated to prof. Peter Jackson, Director of
Therapeutic community represents a self-approach, evolved History of Religions, Deputy Head of Department of
primarily outside of mainstream psychiatry, psychology and Ethnology, History of Religions and Gender Studies,
medicine. Originally so-called Homes for inebriates were Stockholm University, Sweden, for his instant support, fruitful
established in the 19th century England and the USA, discussions and access to cited reference in the university
undertaking usually mild cases of alcoholism in the early stage library.
only, because they are more amenable to treatment by
compelling total abstinence, and opium addicts. [23] The first REFERENCES
therapeutic community was founded at Belmont (Henderson) [1] APA. Diagnostic and Statistical Manual of Mental Disorders, Fourth
Hospital in London in 1947. [29] Edition: DSM-IV-TR®. American Psychiatric Association, 2000.
[2] Belin, D. Addictions – From Pathophysiology to Treatment. InTech,
The model of peer community emerged from trial and error 2012.
experience of its first participants creating and managing their [3] Cullen, W., Thomson, J. The works of William Cullen: containing his
own self-help communities. Initially it was developed to physiology, nosology, and First lines of the practice of physic: with
address substance abuse, but nowadays it contains also variety numerous extracts from his manuscript papers, and from his treatise of
of additional services, e.g. family counselling, education and the materia medica. Blackwood, 1827.
vocational training, and medical and mental health. Among the [4] De Leon, G. The Therapeutic Community: Theory, Model, and Method.
Springer Publishing Company, 2000.
staff can be found degreed professional counsellors together
with ex-addicts and non-ex-addicts paraprofessionals, differing [5] Edelen, M. O., Tucker, J. S., Wenzel, S. L., Paddock, S. M., Ebener, P.,
Dahl, J., and Mandell, W. Treatment process in the therapeutic
of course in their attitudes and expectations for their clients. community: Associations with retention and outcomes among adolescent
[19] residential clients. Journal of substance abuse treatment. Pergamon
Press, June 1, 2007.
The stay in therapeutic community traditionally took from 2
[6] Foddy, B., and Savulescu, J. Relating Addiction to Disease, Disability,
to 3 years of planned duration. Therapeutic communities with Autonomy, and the Good Life. Philosophy, Psychiatry, and Psychology,
shorter duration of stay (3, 6, 12 months), as well as day 17(1), 2010.
treatment models developed because of recent changes in client [7] Galanter, M. Spirituality And The Healthy Mind: Science, Therapy, And
population, clinical realities, and funding requirements. [4] The Need For Personal Meaning. Oxford University Press, 2005.
[8] Goodman, A. Neurobiology of addiction: An integrative review.
Treatment is usually voluntary. In secure therapeutic Biochemical Pharmacology, 75(1), 2008, pp. 266–322.
communities inmates are generally selected by staff. In other [9] Hirschman, E. C. The Consciousness of Addiction: Toward a General
therapeutic communities selection is by the community, or by Theory of Compulsive Consumption. Journal of Consumer Research,
staff-patient assessment group. Inmates can leave if they 19(2), 1992, pp. 155–179.
choose to do so, or be expelled from the community for their [10] Holmstedt, B., Lindgren, J.-E., Rivier, L., and Plowman, T. Cocaine in
behaviour. [16] blood of coca chewers. Journal of Ethnopharmacology, 1(1), 1979, pp.
69–78.
Wide diversity of programs makes it difficult to evaluate [11] Horak, M. The House of Song. The Rehabilitation of Drug Addicts by
the general effectiveness of the therapeutic community the Traditional Indigenous Medicine of the Peruvian Amazon. Brno:
modality and underscores the need for defining the essential Mendel University in Brno: Faculty of Regional Development and
elements of the model and the method. Between the most used International Studies, 2013. In press.
indicators of programs usually treatment completion and [12] Kandall, S. R. Women and drug addiction: a historical perspective.
Journal of addictive diseases, 29(2), 2010, 117–126.

The 1st Human And Social Sciences at the Common Conference SECTION
http://www.hassacc.com Social Science, Families, - 159 -
Work, Activism, Lifestyle Choices
 Human And Social Sciences at the Common Conference
November, 18. - 22. 2013

[13] Kaplan, J. A Primer on Heroin. Stanford Law Review, 27(3), 1975, pp. [25] Puchalski, C. M., Dorff, R. E., and Hendi, I. Y. (2004). Spirituality,
801–826. religion, and healing in palliative care. Clinics in geriatric medicine,
[14] Karch, S. B. Cocaine: history, use, abuse. Journal of the Royal Society 20(4), 689–714, vi–vii. doi:10.1016/j.cger.2004.07.004
of Medicine, 92(8), 1999, pp. 393–7. [26] Schneider, J. P., Irons, R. R. Assessment and Treatment of Addictive
[15] Knapp, H. J. Cocaine and its use in ophthalmic and general surgery. Sexual Disorders: Relevance for Chemical Dependency Relapse.
Putnam, 1885. Substance Use & Misuse, 36(13), 2001, pp. 1795–1820.
[16] Lees, J., Manning, N., Rawlings, B., Lees, J., Manning, N., and [27] Sussman, S., Sussman, A. N. Considering the definition of addiction.
Rawlings, B. Therapeutic community effectiveness: a systematic International journal of environmental research and public health, 8(10),
international review of therapeutic community treatment for people with 2011, pp. 4025–38.
personality disorders and mentally disordered offenders. York: [28] Thomas, G., Lucas, P., Capler, N. R., Tupper, K. W., and Martin, G.
University of York, 1999. Ayahuasca-assisted therapy for addiction: results from a preliminary
[17] Lewis, S. E. Ayahuasca and Spiritual Crisis: Liminality as Space for observational study in Canada. Current drug abuse reviews, 6(1), 2013,
Personal Growth. Anthropology of Consciousness, 19(2), 2008, pp. 109– pp. 30–42.
133. [29] Thomstad, H. [A meeting with the Therapeutic Community and its
[18] London, M. History of Addiction: A UK Perspective. American Journal creators. A personal retrospect]. Tidsskrift for den Norske lægeforening:
on Addictions, 14(2), 2005, pp. 97–105. tidsskrift for praktisk medicin, ny række, 111(8), 1991, pp. 1019–22.
[19] LoSciuto, L., Aiken, L. S., Ausetts, M. A., and Brown, B. S. [30] Torres, J. Purgahuasca: aportaciones de la cultura Awajún en el
Paraprofessional versus professional drug abuse counselors: attitudes tratamiento de las adicciones. In D’Abbadie, R., Mikaelian, C., Díaz, P.,
and expectations of the counselors and their clients. The International and Mabit, J. (Eds.), Memorias del Congreso Internacional. Medicinas
journal of the addictions, 19(3), 1984, pp. 233–52. tradicionales, interculturalidad y salud mental. Sección 2. 7.-10. 6. 2009.
tarapoto, San Martín. (pp. pp. 125–130). Tarapoto, San Martín - Perú:
[20] Malivert, M., Fatséas, M., Denis, C., Langlois, E., and Auriacombe, M. Takiwasi.
Effectiveness of therapeutic communities: a systematic review.
European addiction research, 18(1), 1–11, 2012. [31] Trotter, T., Porter, R. An Essay, Medical, Philosophical, and Chemical,
on Drunkenness and Its Effects on the Human Body. Routledge, 1804.
[21] Meyer, R. The disease called addiction: emerging evidence in a 200-year
debate. The Lancet. Free Press, New York, January 20, 1996. [32] Walters, G. D., Gilbert, A. A. Defining Addiction: Contrasting Views of
Clients and Experts. Addiction Research & Theory, 8(3), 2000, pp. 211–
[22] Morse, R. M., Flavin, D. K. The definition of alcoholism. JAMA, 220.
268(8), 1992, pp. 1012–1014.
[33] Weil, A. T. The therapeutic value of coca in contemporary medicine.
[23] Parrish, J. Inebriety and homes for inebriates in England. The Case, Journal of Ethnopharmacology, 3(2–3), 1981, pp. 367–376.
Lockwood & Brainard company, 1886.
[34] Welch, J. Ritual in Western Medicine and Its Role in Placebo Healing.
[24] Pearson, M. M., Little, R. B. The addictive process in unusual Journal of Religion and Health, 42(1), 2003, pp. 21–33.
addictions: A further elaboration of etiology. The American Journal of
Psychiatry. US: American Psychiatric Assn, 1969. [35] Witkiewitz, K. A., Marlatt, G. A. Therapist’s Guide to Evidence-Based
Relapse Prevention. Elsevier Science, 2011.

The 1st Human And Social Sciences at the Common Conference SECTION
http://www.hassacc.com Social Science, Families, - 160 -
Work, Activism, Lifestyle Choices