SAGE Books

The Spectrum of Addiction: Evidence-Based

Assessment, Prevention, and Treatment
Across the Lifespan
Historical Foundations of Addiction Counseling

By: Laura J. Veach & Regina R. Moro

Book Title: The Spectrum of Addiction: Evidence-Based Assessment, Prevention, and Treatment Across
the Lifespan
Chapter Title: "Historical Foundations of Addiction Counseling"
Pub. Date: 2018
Access Date: July 4, 2022
Publishing Company: SAGE Publications, Inc
City: Thousand Oaks
Print ISBN: 9781483364834
Online ISBN: 9781071800478
DOI: https://dx.doi.org/10.4135/9781071800478.n1
Print pages: 1-23
© 2018 SAGE Publications, Inc All Rights Reserved.
This PDF has been generated from SAGE Knowledge. Please note that the pagination of the online
version will vary from the pagination of the print book.
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Historical Foundations of Addiction Counseling

Historical Foundations of Addiction Counseling

Learning Objectives
Upon completion of reading this chapter and participating in the guided exercises, the learner will be able to

• understand and distinguish between the numerous professional organizations representing the
addictions counseling field;
• identify significant historical events related to the field of addictions counseling; and
• discuss and explain the professionalization of the addictions counseling field.

Examining the history of addiction within the United States is a multifaceted endeavor. A variety of different
issues of focus come into awareness that one may never had considered before, such as looking at
substance use trends, examining the person who has provided services to those struggling with addiction,
and attending to legal issues of relevance. This history is extensive and long. To fully examine the history
of addictions counseling, we will be covering five general historical foci: (1) the use of substances/addictions
over time, (2) the treatment of addiction over time, (3) the legislative history of substance/behavior regulation,
(4) the professionalization of addictions counselors, and (5) an introduction to the research foundations of the
profession. The research foundations will be further elaborated upon in Chapter 2.

In addition, the chapter will conclude with a comprehensive timeline highlighting

• dates in history and trends related to substance use and addiction;

• the evolution of the treatment of addiction;
• legal regulations of substances/behaviors;
• the professional regulation of the addictions counseling profession; and
• the establishment of a research base in addictions treatment.

Historical Use of Chemical Substances

Historically, the use of substances has evolved over time. Alcohol, being the “oldest child” per se has
dominated the landscape over time; however, there have been times in history that the use of other drugs
has claimed prime popularity status. The following section will examine the trends of substance use, primarily
focusing within the United States.

The use of mood-altering substances is not a new phenomenon, with findings going as far back as the Old
Stone Age, as anthropological discoveries include stone pots that contained mild beer or wine (Kinney &
Leaton, 1983). Other archaeological evidence of alcohol use dates back to 7000 BC in Japan and 3500 BC in
Iran (Inaba & Cohen, 2007). It was during the 10th century that Rhazes, an Arabian physician, first discovered
the distillation process, primarily to be used as medicine (Kinney & Leaton, 1983). During the early years of
alcohol use it was mainly for these medicinal properties that Rhazes found, as well as nutritional purposes
(Doweiko, 2012), as the alcohol was deemed safer than water.

In the 1500s, distilled spirits (e.g., vodka, whiskey) became popular as a beverage of choice (Kinney &
Leaton, 1983). According to Inaba and Cohen (2007), the mood-altering benefits of the substance helped
bolster its popularity. In 1640, the Dutch opened the first distillery in the United States, on Staten Island
(Kinney & Leaton, 1983). The use of alcohol was so widespread that by 1790 all rations for soldiers of the
United States included liquor (i.e., brandy, rum, or whiskey) at the rate of a ¼ pint (Kinney & Leaton, 1983).
As America was forming as a country, the history of substance use, primarily alcohol, was firmly rooted in the
soil.

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In 1806, morphine was discovered and used heavily in the decades following (Field, 2002). During the
American Civil War (1861–1865) addiction to morphine was referred to as the Army disease (Field, 2002);
considering the devastation, and physical and emotional pain associated with war, it is not surprising that such
rates were found during this time. It was also during this time, the 19th century, that alcohol and other drugs
were used as medicines (Briggs & Pepperell, 2009). These drugs went by the names of Godfrey’s Cordial (to
treat colic), Laudanum (for women’s menstruation), and Coca-Cola, and included cannabis (for headaches
and women’s menstruation).

The 20th century saw a rise and fall of numerous drugs of popularity. Many of you reading this can probably
name a few, as drug trends are often deeply rooted within decades. If someone was to ask you about
the 1960s and corresponding “Hippie Years” you may immediately think of marijuana and psychedelic use.
If questioned about the 1990s and “Punk Rock/Grunge” days, you may think Kurt Cobain and of heroin.
When someone imagines an addiction treatment center, they may even envision clients engaged in tobacco
smoking via cigarettes, also an addictive substance. These connections are not random, as our history is
constructed by stories, which are transmitted through a variety of media. Drug trends are no different from
other movements (e.g., women’s rights, civil rights) and have become woven into the historical fabric of our
country.

Synthetic Drugs
In recent times a particularly dangerous trend has been the rise in drugs of abuse that are classified as
synthetic. Synthetic implies the creation of the drug via a chemical process (i.e., in a laboratory) as opposed
to other substances (e.g., cannabis, cocaine, opiates) that are derived from plants. This process is not new; in
1887 amphetamines were first synthesized, and in the following decades they were used to keep pilots awake
during long hours of war (Inaba & Cohen, 2007). What is new is the creation of substances in man-made
laboratories. Commonly referred to as “meth labs,” these sites have become commonplace, with over 9,240
being found in 2014 (U.S. Department of Justice, Drug Enforcement Administration [DEA], 2015). In addition
to methamphetamine, individuals are also creating substances such as “bath salts.” These substances are not
the bath salts used to aid relaxation during a bath, but are substances synthetically created, and sold legally
(i.e., until regulations were passed) under the name “bath salts” (i.e., not for human consumption) to avoid
FDA regulation. Word on the street spread fast that Ivory Wave, Bloom, and Vanilla Sky (National Institute on
Drug Abuse, 2012) were not the traditional relaxation bath salts but instead were mood-altering substances
you could purchase at your local corner shop or gas station. The latest drug of abuse synthetically made is
known as “Flakka” and is becoming increasingly identified as a danger to the public, particularly due to the
low cost of the substance.

This historical review of substance use is limited, and we suggest anyone who has a desire to work in the
field of addictions counseling acquire a comprehensive knowledge of substances and associated histories.
There are great resources available, such as Inaba and Cohen’s (2007) Uppers, Downers, All Arounders, and
also William White’s (1998) Slaying the Dragon. The purpose of our review here was to lay the foundation
of substance use/abuse in our history. Humans have been using mood-altering substances for an unknown
period of time. What is known, as highlighted in the historical review, is that humans have and will continually
use substances, and create new ones to advance the mood-altering effects. It is for this reason that treatment
has continually evolved over time. We will review this history in the following section.

History of the Treatment and Recovery Movement

The following section will discuss the history of recovery in the United States. One caveat is needed when
discussing the concepts of recovery, as there are multiple avenues for an individual. The following section
will include information about mutual aid societies, as well as formalized treatment modalities. Mutual aid
societies are not a primary treatment mechanism, but they are an adjunct for support and are typically thought
of as groups. Treatment is designated as formalized and professional endeavors at helping individuals enter
into a recovery program. Each individual’s pathway to recovery is as unique as the individual.

The official beginning date for the treatment of addiction issues is unknown, however one may speculate
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that the initial attempts involved familial efforts to restrict an individual’s substance use. There is formal
documentation of Native American recovery circles in the 1700s (White, 2000a). These recovery circles
were initiated by tribal leaders who themselves had overcome an addiction, and began these abstinence-
based programs firmly rooted in native tribal traditions (Coyhis & White, 2002). While the recovery circle
represented the beginnings of mutual aid support groups, they were also the beginnings of formalized
treatment. Formalized treatment options during the late 1700s to early 1800s included religiously oriented
inebriate homes, medically oriented inebriate asylums, for-profit private addiction cure institutes, and bottled
home cures for the use of alcohol, drugs, and tobacco (White, 2000a). These options represent a wide variety
of attempts at curbing the issue of addiction and were due, in part, to a lack of understanding of addiction.

In 1784, Dr. Benjamin Rush outlined the effects of alcohol on the body and mind in his landmark manuscript
(Thombs, 2006). This writing also included a list of “remedies for the evils which are brought on by the
excessive use of distilled spirits” (Rush, 1823, p. 28). Dr. Rush’s work has been acknowledged as the first
recognition of alcoholism as a disease (Inaba & Cohen, 2007; Thombs, 2006). In 1823, Dr. Rush published
An Inquiry Into the Effects of Ardent Spirits Upon the Human Body and Mind (Kinney & Leaton, 1983). This
book included information about the current attitudes toward alcohol at the time, as well as information related
to scholarly treatment of the time. For example, Dr. Rush referred to the importance of religion on fostering
sobriety along with the powerful feelings of guilt and shame. He further identifies that for some it is the
recognition of medical problems that are a result of alcohol use, and even making a commitment as productive
treatment mechanisms that helps one achieve sobriety, and he further comments on the power of a vegetable-
based diet. Many of Dr. Rush’s recommendations related to treatment were based upon anecdotal evidence
from one or two patients. The recommendations by Dr. Rush represent a common theme of the time: go see
a physician and try whatever works.

In addition to formal treatment modalities and support systems, societal concern over addiction was
increasing, which led to the founding of organizations focused on abstinence messages. First, in 1840, the
Washingtonian Total Abstinence Society was formed (White, 1998). As the name of the organization implies,
the organization focused on the exclusive use of abstinence to eliminate the societal problems attributed to
alcohol. Throughout the rest of the decade (1842–1850) fraternal order of temperance societies emerged
across the country (White, 1998). These all had different names (e.g., The Sons of Temperance, Good
Templars, and Good Samaritans), however they all had a similar mission, which also corresponded to the
Washingtonians’: to eliminate the destruction from alcohol through an abstinence movement.

The 1870s saw the beginnings of mail-order treatment. One business owner, Sam Collins, sold a bottled
“cure” via the postal service to users looking to cure their addiction (Morgan, 1981). These bottle home
cures were often used to cure alcohol, tobacco, and other drug use, yet were found to have high levels
of substances (e.g., cocaine, marijuana, alcohol) early in the 20th century (White, 2004). The very thing
individuals were hoping to be free from was exactly what they were ingesting.

If there is any single decade that is crucially important in the history of the recovery movement, it is the
1930s, specifically the year 1935. The Porter Narcotic Farm Act (Field, 2002) was a piece of legislation that
provided the first federal funding for addiction treatment. As a result, two treatment centers opened, one in
Lexington, Kentucky, and the other in Fort Worth, Texas. The 1930s was also when Dr. Richard Peabody
reportedly applied the first psychological methods to the treatment of individuals struggling with addiction to
alcohol (Kinney & Leaton, 1983). For current recovery issues, 1935 represented a significantly important year,
as the popular organization Alcoholics Anonymous (AA) was formed by Bill Wilson (“Bill W”) and Dr. Robert
Smith (“Dr. Bob”) (White, 1998). AA has become synonymous with the recovery movement through the years,
relying not on professional treatment but on the power of individuals struggling with their addiction to alcohol
coming together in fellowship to support one another. Today, AA has over 2 million members worldwide
(Alcoholics Anonymous, 2014), and has contributed to the founding of other like-minded organizations. The
well-known Narcotics Anonymous (NA), a group for those struggling with other drug addictions, was founded
in California in 1953 (White, 1998). Although there was an emergence of multiple organizations for the
narcotic addict, the California-based organization formed the roots of the organization as it is known today.

The Minnesota model of treatment for alcoholics followed closely behind the creation of AA (Spicer, 1993).
Addiction treatment following the Minnesota model embraces the disease concept and provides individuals

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with tools to assist as they embark on a journey of recovery. In addition to attending lectures about the 12
steps of AA (the guiding principles), participants in Minnesota model–type treatment receive medical care
and clinical counseling—creating a multidisciplinary and multimodal treatment approach. This model was
reminiscent of the treatment provided at the Emmanuel Clinic, founded in 1906 (White, 1998). This treatment
effort combined multiple disciplines (i.e., medicine, religion, and psychology) to offer well-rounded treatment,
very similar to the success of the Minnesota model. However, the Emmanuel Clinic was not able to sustain
following the death of one of their founders.

Box 1.1: The Florida Model

The Florida model grew on the success of the Minnesota model in terms of integrating multiple services.
According to Caron (2014), the model integrates treatment in both clinical and residential settings. The
programs typically offer residential facilities that have a home-life feel, much different from traditional
dormitories of inpatient facilities (Palm Beach Institute, 2013). In addition, treatment is often more
comprehensive, offering differing levels of care with transitional housing nearby. Although these services are
often recommended upon discharge from a treatment center, the Florida model differs by integrating that into
the entire treatment program. From medical detoxification to halfway houses, the Florida model represents a
comprehensive program of care.

In stark contrast to the legacy that Alcoholics Anonymous and the Minnesota model have forged, the
organization Synanon was founded in 1958 (White, 2000b). Synanon was formed by Charles Dederich and
early on was composed of a group of individuals struggling with alcohol addiction who attended AA meetings,
while the group also met three times per week at Dederich’s home (White, 1998). These early meetings
set the groundwork for the legacy of confrontational treatment that Synanon has been known for. Dederich,
with no formal training, was leading groups and experimenting with different techniques such as ridicule
and shaming (White, 1998). Synanon has gone through transitions as an organization, with the second shift
moving away from solely focusing on meetings to the rise of the therapeutic community model (Oshe, 1980),
which is recognized as the first such model for treatment. Within this model, communities were organized
with clients living on site, and oftentimes becoming workers (Oshe, 1980). This shift is also where the
confrontational style became more prominent and relied on the staff (who were themselves in recovery) to
enforce the rules of the communities (White, 2000b). Although the organization claimed significant rates
of rehabilitation, there was little documented evidence of these claims (Oshe, 1980). The founding and
resulting evolution of Synanon has contributed to the field of addiction treatment, particularly in regard to the
therapeutic community model, while at the same time has produced many cautionary tales for the field (White,
1998). For a more thorough review of the Synanon organization, including the final transformation into an
organized religion, please refer to the work of Richard Oshe (1980).

The later part of the 20th century involved two parallel movements: one of integration, one of diversification/
separation. It was during the 1980s that Dr. Ottenberg, of the Eagleville Hospital and Rehabilitation Center in
Pennsylvania, called to integrate alcoholism and drug treatment (White, 2000b). During this time, there was
also a recognized importance of attending to systemic issues of clients (i.e., family, support systems) and
family members began being integrated into treatment (White, 2000b). Another significant change included
the diversification of the background of treatment providers. Previously the professional membership included
those who were solely in recovery themselves, however during the 1980s there was a surge in family
members of addicts seeking training, as well as academically trained professionals (Hagedorn, Culbreth, &
Cashwell, 2012; White, 2000b).

There was an emergence of mutual aid groups offering alternatives to AA. Dr. Jean Kirkpatrick founded
Women for Sobriety in 1975, Secular Organization for Sobriety was formed in 1985, and Rational Recovery
was founded in 1986 (White, 2000b). These organizations separated themselves from AA for a variety of
reasons and are but a small representation of such alternatives.

In addition to attending to the treatment process, the later part of the century also saw attention shift to relapse
prevention. Relapse prevention is precisely as it sounds: helping clients learn to prevent the use of substance
or act of behavior after a period of abstinence. One of the most well-known authors and researchers on the
topic of relapse prevention is Gordon Marlatt, who developed a specific model for clinicians and centers to
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use (see Marlatt & George, 1984). Other relapse prevention models include the CENAPS model by Gorski
(1989) and the Recovery Training and Self Help model specifically for opiate addiction (McAuliffe & Ch’ien,
1986).

Managed Care, Placement, and Diagnosis

Managed care entities began during the 20th century, with the primary goal to offer alternative forms of
health care to those who may not be able to afford medical costs (Miller, 2015). The growth of inpatient
residential programs was stymied during this time (Spicer, 1993). In addition to the goal of providing care, the
managed care organizations (i.e., health maintenance organizations, preferred provider organizations) were
also seeking to reduce health care costs, and therefore became much less likely to pay for inpatient treatment
if there was an alternative outpatient care program available.

The American Society of Addiction Medicine (ASAM, 2015) published its first Patient Placement Criteria
manual in 1991. These criteria are used by managed care entities to determine the level of care a patient
requires (e.g., outpatient, inpatient, intensive outpatient). Since the first publication, the ASAM criteria have
been revised, most recently in 2013. The ASAM also furthered the mission of the organization in 2007 when
it created the American Board of Addiction Medicine. The ABAM offers specific addiction-related training to
physicians seeking to be board certified in addiction medicine (ABAM, 2015).

In May 2013, The Diagnostic and Statistical Manual, 5th edition, was released by the American Psychiatric
Association (APA, 2014). The release of this edition was not without controversy. The fifth edition of the
manual had significant changes for the sections pertaining to substance use and addictions counseling. The
diagnostic categories of “Abuse” and “Dependence” were removed, and instead the language of a severity
spectrum was implemented to diagnose “Substance Use Disorders.” Some critics suggested that the new
diagnostic possibilities would increase the amount of substance use disorder diagnoses via false positives.
An alternative viewpoint is that more individuals in need of treatment would be able to seek such without
being labeled as an abuser or dependent. A recognized strength of this edition was the integration of ICD-9
and ICD-10 coding systems into the manual. These codes are used worldwide for health conditions, where
the DSM is solely focused for use in the United States. This shift helps create a uniform language for
professionals to utilize; more about this will be explored in Chapter 7 when we discuss diagnosis in detail.

Treatment Today
In reviewing the history of the recovery initiatives, it is obvious that the focus of attention has been directed
to one of two issues. The first is direct attention to the prevention of addiction by emphasizing abstinence.
This was commented on above with the creation of abstinence societies (e.g., Washingtonian Temperance
Society). The second focus of attention has been on the individual who is struggling with the more debilitating
disease of addiction. When considering these two foci, it is obvious there is a large gap between when an
individual is abstinent, to when they are struggling with the disease. This gap is the target of this text, as we
will be examining many more points to intervene with clients than has previously been examined.

In addition to the greater emphasis on the gap between prevention and intensive treatment that has been
occurring in recent years, there has also been a surge of initiatives to integrate recovery into educational
settings, both at the secondary and collegiate level. The Association of Recovery Schools (2016) has
identified 38 recovery high schools in existence in the United States, with five more in planning stages. In
addition to high school initiatives, there are many college campuses embracing the recovery movement. At
the time of this writing, the Association of Recovery in Higher Education (2016) estimates there are 72 college
campuses across the United States with collegiate recovery programs, each unique to the campus culture
and population. This number is ever changing as more programs are identified by the association, and as
more programs are created. These recovery education programs symbolize a shift away from the tradition of
isolation among individuals in treatment and recovery to integrating the many parts of our clients’ lives.

Many of the workers working on the front lines of addiction treatment, whether in inpatient settings or
manning prevention efforts, will report on the increased importance of evidence-based practices for the work
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that is being conducted. Evidence-based practices are treatments that are rooted in scientific evidence.
The rationale for using these practices is logical; the more evidence a treatment has the more likelihood
it would work for an individual. This has become increasingly important for a variety of reasons, including
the recognized impact of dual-diagnosed clients (e.g., mental disorder and substance use disorder) and the
complexities associated with treatment. We will explore these treatments in depth in Chapter 2 and throughout
the text.

The above history of recovery in the United States is certainly not fully comprehensive. The purpose was to
familiarize readers with the process individuals seeking recovery may take, via the many different mediums
(e.g., mutual aid support groups, professional treatment). For a full history of addiction treatment we would
like to refer readers to Slaying the Dragon and The History of Addiction Counseling in the United States, both
authored by William L. White, and Learning the Language of Addiction Counseling (4th edition), authored by
Geri Miller.

History of Addiction-Related Research

There are multiple accounts for who is recognized as the founding researcher concerning the concepts
of addiction. As mentioned previously, Dr. Benjamin Rush has received credit for being the first to give
recognition to alcoholism being a disease. However, Dr. Thomas Trotter has also received credit as being the
first to fully describe the concept of alcoholism, in 1804, and is considered by Kinney and Leaton (1983) to
have offered the first published scientific formulation of drunkenness. As we do not have an available time
machine to fully examine the historical timeline, we will regard both Dr. Rush and Dr. Trotter as the pioneers
of the scientific evaluation of the concept of addiction.

The Congressional Research Service (CRS) was formed in 1914. Among many other issues and topics, the
CRS conducts research on drug trends, treatment needs, and uses the findings to inform U.S. Congress
members with information relevant to legislation. This is crucially important research in terms of addiction
when considering legalization of drugs of abuse and professional regulation.

The Yale Center of Alcohol Studies, the first academic center to do research on alcoholism, was founded
in the 1930s at Yale University (Spicer, 1993). This center became a hub of research activity related to
alcoholism. In 1940, the first academic journal was published, the Quarterly Journal of Studies on Alcohol,
now known as the Journal of Studies on Alcohol and Drugs (Kinney & Leaton, 1983). Dr. E. Morton Jellinek
was a researcher at the Yale Center and published the book The Disease Concept of Alcoholism in 1952.
Within this publication was the Jellinek curve, a proposed model to understand alcohol addiction, represented
by a downward curve. The model was expanded in the 1960s by including an upward part of the curve,
symbolizing the recovery process (Hazelden Betty Ford, 2016). Although the model has remained popular
for explanatory purposes, questions concerning the research methodology and supporting evidence have
emerged over the years (Ward, Bejarano, Babor, & Allred, 2016). The Summer School of Alcohol Studies
was founded in 1943, which provided a professional platform for dissemination of addiction-related research
(Center of Alcohol Studies, 2014). The activities of the Yale Center are still alive and active today, however
they have been relocated to Rutgers University, located in New Brunswick, New Jersey.

The disease concept of addiction was formally recognized by the American Medical Association via a
publication in the Journal of the American Medical Association in 1956 (Merta, 2001). Not only did this
scholarly publication have implications for future research, but it also had implications for treatment. This
theory of addiction differed to the popular moral model theory of addiction, which viewed addictive behavior
as a choice, and the user, a sinner. This new theory removed the judgment from the person and allowed the
use to be conceptualized as a symptom of the greater disease. From this viewpoint, individuals that live with
addiction are told they are not responsible for the disease, but they are responsible to the disease.

The National Institute on Drug Abuse (NIDA), a branch of the U.S. National Institutes of Health (NIH),
initiated the Monitoring the Future survey in 1975 (NIDA, 2015). This annual survey examines national use
and longitudinal trends concerning substance use among youth and activity in other risky behaviors. The
following year, an infamous report titled “Alcoholism and Treatment” but better known as the “Rand Report
was published (Armor, Polich, & Stambul, 1976). This report was conducted by the Rand Corporation and
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upon its release was highly controversial. All nationally funded treatment programs were required to collect
intake and follow-up (6 months) data from patients. Among other findings, the study reported that some of the
participants reported controlled drinking (in contrast to abstinence only) at follow-up. The study also found no
difference in treatment in the form of halfway houses, hospitals, or group counseling.

In 1992, the U.S. Congress passed legislation creating the Substance Abuse and Mental Health Services
Administration (SAMHSA, n.d.). The mission of this organization is to “reduce the impact of substance abuse
and mental illness on America’s communities” (SAMHSA, n.d., p. 1). In addition, the organization aims to
make information, services, and research related to substance use more available to the public.

Toward the end of the century, the main findings of Project MATCH were released (National Institute on
Alcohol Abuse and Alcoholism [NIAAA], 1996). Project MATCH is a landmark study examining a variety of
variables related to treatment of alcohol-specific addiction. The project’s main aim was to identify if matching
patients to treatment based upon patient characteristics would increase treatment outcomes. At the 1-year
follow-up, the hypothesis of patient placement was not supported. This was important as it identified cognitive
behavioral therapy, motivational enhancement therapy, and Twelve-Step Facilitation to all be just as effective
in reducing alcohol consumption. Lastly, in 1997, SAMHSA launched the National Registry of Evidence-based
Programs and Practices (NREPP, 2012), a clearinghouse of treatments. Chapter 2 will include more attention
to this national registry, and the history of research within addiction counseling will be rounded out via the
examination of evidence-based treatments throughout the remaining chapters.

Historical Legislation Efforts Impacting the Field

Although discussing politics is not always the best way to make friends, we are hopeful we will not alienate
you all through this discussion. Legislation related to drug use/addiction has had a profound impact on our
profession. We will examine some of the most critical legislative activities in our history as related to addictions
counseling.

Regulation primarily began in the beginning of the 20th century. The Pure Food and Drug Act was passed in
1906 (Morgan, 1981), which created the Food and Drug Administration. The significance of this act is that it
limited the mail-order bottle cure industry. (Remember our previous discussion of Mr. Collins?) The Harrison
Act was passed in 1914, which regulated narcotics distribution and prescriptions (Briggs & Pepperell, 2009).

The 18th Amendment may be the most well-known piece of legislation to be passed by Congress during
the 20th century. This amendment is commonly referred to as Prohibition, which made the production and
distribution of alcohol illegal (Kinney & Leaton, 1983). Prohibition lasted 13 years, from 1920–1933, when
it was repealed through the passing of the 21st Amendment. In 1929, Congress passed the first piece of
legislation to formalize treatment for Americans, specifically, those in prison. The Porter Narcotic Farm Act
authorized the Public Health Service to open federal hospitals specifically focusing on addiction treatment
(Field, 2002). The two facilities, one in Fort Worth, Texas, and one in Lexington, Kentucky, were opened in
1935. Although alcohol prohibition was over, in 1937 the Marijuana Tax Act was passed (WGBH Educational
Foundation, 2014). This law restricted possession of marijuana solely to individuals who paid a tax for
authorized uses (medical and industrial), which in effect criminalized marijuana in the United States.

The 1960s were not only filled with flower children and love-ins, but the decade also represents a period
of time in which there were significant legislative efforts to expand treatment for addiction issues. President
Lyndon Johnson made a statement in which he discussed the disease concept of alcoholism in 1965, which
marked the first presidential speech attending to addiction issues (White, 1998). In 1966, Congress passed
the Narcotic Addict Rehabilitation Act that created a federal compulsory treatment program (Field, 2002). The
1968 Amendments to the 1963 Community Mental Health Centers Act established treatment grants for local
areas specifically focusing on addiction (Field, 2002). It was clear that the U.S. government was not taking the
issue of drug use and addiction lightly. This was even more evident in 1968 with the creation of the Bureau of
Narcotics and Dangerous Drugs (formed via a merger of the Federal Bureau of Narcotics and the Bureau of
the Dangerous Drugs of the Food and Drug Administration).

The Controlled Substance Act was passed in 1970, which created a drug classification system (Moore, 2013).
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The schedule is still in use, and consists of five categories, each rated in intensity of abuse potential (taking
into account medical use considerations) (Inaba & Cohen, 2007). Schedule V is the least severe, consisting
of drugs that are very low in abuse potential, mainly because they contain low levels of narcotics, some of
which are sold over the counter. Schedule IV drugs also have a low abuse potential, however just slightly
more so than Schedule V drugs. Schedule III drugs have a moderate abuse potential, and are sometimes
drugs that are compounds containing Schedule II drugs. Schedule II drugs have a high potential for abuse,
however they also have acceptable medical uses (e.g., pain killers, ADHD stimulant medication). Schedule I
drugs are those deemed highly addictive and have no accepted medical use. Of relevance toward legislation
is that as of the writing of this textbook, marijuana is classified as a Schedule I substance.

Legislation in the early 1970s created the National Institute for Alcohol Abuse and Alcoholism (via the
Comprehensive Alcohol Abuse and Alcoholism Prevention and Treatment Act), and the National Institute on
Drug Abuse (via the Drug Abuse Treatment Act of 1972). The NIAAA and NIDA are two leading organizations
focusing on researching addiction and educating the public. The Drug Enforcement Agency (DEA) was also
created in the early 1970s due to a merger of the Bureau of Narcotics and Dangerous Drugs and the Office
of Drug Abuse Law Enforcement (WGBH Educational Foundation, 2014).

President Ronald Reagan may be known for his history as a famous actor, but he also played a significant role
in the history of our field. In 1984, he signed the National Minimum Drinking Age Act into law, raising the legal
age of alcohol consumption to 21 years of age (Hanson, 2015). He also signed the Anti-Drug Abuse Act into
law in 1986. This law created mandatory sentences for drug-related crimes (WGBH Educational Foundation,
2014). The hard-hitting ways of President Reagan were upheld by his successor, President George H. W.
Bush, who declared a new War on Drugs in a nationally televised speech (WGBH Educational Foundation,
2014).

Although the voice from the presidential office was clear, along with the legislative efforts of Congress, the
people’s voice rang loud in 1996 when California became the first state to legalize medical marijuana by
passing Proposition 215 (WGBH Educational Foundation, 2014). Following the passage in California, 22
additional states, the District of Columbia, and Guam passed similar legislation. Although these states and
districts approved of the legal usage of medical marijuana, the federal prohibition is still in effect.

If you have had a cold and gone to a pharmacy in the last decade, you may have been surprised to be asked
for your driver’s license to purchase a particular type of cold medicine. As discussed in the above historical
use section, one recent trend has been the use of synthetic drugs, of which one is methamphetamine
(“meth”). Meth has drastically risen in popularity, primarily due to the ability to manufacture the substance at
home. In 2005, the Combat Methamphetamine Act was signed to regulate the sale of retail over-the-counter
medication used in the manufacture of methamphetamine (U.S. Department of Justice, Drug Enforcement
Administration, 2007). Over-the-counter medicines that contain pseudoephedrine are required to be kept
behind the pharmacy counter, require purchasers to show ID, and are entered into a database to limit the
quantities an individual is able to purchase.

Three pieces of legislation have had significant impacts on the treatment of addiction within the past decade.
In 2008, Congress passed the Mental Health Parity and Addiction Equity Act (U.S. Department of Labor,
2010). In sum, this act puts mental health and substance abuse treatment on par with medical/surgical
treatment. In 2010, President Barack Obama signed the Affordable Care Act into law. This law requires
all U.S. citizens to have medical insurance, and created a national medical insurance program to offer
low-cost insurance. Although controversial, this law has expanded medical insurance coverage, and as a
result has increased treatment availability. The latest piece of legislation having a significant impact on the
field of addictions counseling is the 21st Century Cures Act. According to NAADAC (National Association
for Alcoholism and Drug Abuse Counselors, 2016), this act provides over $1 billion to help states with
opiate prevention and treatment services. Also, the act provides funding to establish federal drug courts and
encouragement for integration of substance use disorders within primary care (NAADAC, 2016).

The most recent legislative efforts are in relation to substance use, specifically marijuana. Although it was
in 1996 that California passed the medical-marijuana law, it was in 2012 that two states, Washington and
Colorado, successfully became the first two states to legalize recreational use of marijuana (Moore, 2013).

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Although the federal ban is still in existence, and marijuana is still considered a Schedule I drug under the
1970 Controlled Substance Act, the U.S. Department of Justice issued a statement in 2013 that no federal
efforts would block the legalization process in states that seek to legalize marijuana (Moore, 2013). Although
not a piece of legislation, this was a significant statement made by a powerful organization.

The Evolving Addiction Treatment Professional

The professional identity of addictions counselors is multifaceted and has been referred to as a “patchwork
system” (Mitchell, 1981, cited in White, 2000b). There is not one pathway to become an addictions counselor,
which leads to confusion among students as they attempt to navigate the complexities related to education
requirements, practice standards, assessment requirements, state regulations, and even personal sobriety
requirements. The following will outline the historical evolution of the helping professions, particularly
attending to the emergence of addiction counseling as a particular field of practice.

The initial years of addiction treatment predominantly relied on services provided by individuals who were in
recovery themselves. The mid-20th century saw a rise in government-funded training initiatives through the
Office of Economic Opportunity, Department of Labor, the National Institute of Mental Health, NIAAA, and
NIDA (Hagedorn et al., 2012). Not only was the substance abuse field establishing a professional identity
through these training programs, but the counseling profession was also solidifying during this time (West,
Mustaine, & Wyrick, 1999). The Association for Counselor Education and Supervision presented the first
set of counselor preparation standards in 1973 (Hagedorn et al., 2012), and in 1981 the Council for the
Accreditation for Counseling and Related Educational Programs (CACREP) was founded (Hagedorn et al.,
2012). The National Commission for Credentialing Alcoholism Counselors, the first national body seeking to
implement uniform credentialing standards for addiction treatment providers, was founded in 1977 (West et
al., 1999).

In 1989, the National Certification Reciprocity Consortium/Alcohol and Other Drug Abuse (NCRC/AODA)
was formally named (West et al., 1999) although it was really a combination of early efforts of a wide
variety of organizations that began around 1977. Throughout the years, the organization has evolved and
is now formally known as the International Credentialing & Reciprocity Consortium (IC&RC). IC&RC is the
largest credentialing organization and represents the “gold standard for competency in the field” of addictions
counseling (IC&RC, n.d.a, para. 3). One major initiative the IC&RC undertook in the late 20th century was
clarification of the role of an addictions counselor. After examining more than 2,000 duties a counselor may
perform, the IC&RC identified 12 core functions (e.g., intake, assessment, counseling, crisis intervention)
an addictions counselor can be expected to perform (IC&RC, n.d.a.). The functions allow for consistency
between international credentialing and competency expectations.

The IC&RC has eight standardized credentials that allow reciprocity opportunities once earned (IC&RC,
n.d.b, para. 2). The eight credentials are (1) Alcohol & Drug Counselor (ADC); (2) Advanced Alcohol &
Drug Counselor (AADC); (3) Clinical Supervisor (CS); (4) Prevention Specialist (PS); (5) Certified Criminal
Justice Addictions Professional (CCJP); (6) Certified Co-Occurring Disorders Professional (CCDP); (7)
Certified Co-Occurring Disorders Professional Diplomate (CCDPD); and (8) Peer Recovery (PR). Although
there is consistency within the larger organization, each individual nation, state, and territory of member
organizations may use different professional titles (e.g., Licensed Clinical Addiction Specialist, Certified
Addiction Professional). The following table highlights the variety in credentialing language as demonstrated
by the two authors’ credentials.

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Table 1.1 IC&RC Credentials of Authors

In 2009, CACREP became the first graduate-level mental health training accreditation body (i.e., among
the counseling, social work, and psychology professions) to adopt the inclusion of addiction-related content
knowledge requirements for all students, regardless of their scope of practice (Hagedorn et al., 2012).
This inclusion indicated that in order to receive a master’s degree in counseling, all students in CACREP-
accredited programs now have to learn about the “theories and etiologies of addictions and addictive
behaviors, including strategies for prevention, intervention, and treatment” (CACREP, 2009, p. 11). National
requirements mostly require substance abuse counselors to have the equivalent of a high school degree,
whereas the majority (i.e., 97%) of states require mental health counselors are required to hold a master’s
degree (Kerwin, Walker-Smith, & Kirby, 2006). West et al. (1999) pondered the question of why the
professional standards of substance abuse counselors are so much less than that of professional counselors.

One other certification board that should be acknowledged is the National Certification Commission for
Addiction Professionals (NCCAP), a member organization of NAADAC, the Association for Addiction
Professionals. This organization has three main credentials, with a variety of other certificates it offers.
The credentials are The National Certified Addictions Counselor Level I and Level II, and the Master
Addiction Counselor (MAC) (NCCAP, 2013). The MAC credential was initiated in the 1980s by three different
organizations (i.e., the National Board for Certified Counselors [NBCC], NAADAC and the Commission on
Rehabilitation Counselor Certification [CRCC]). All three organizations have MAC credentials today, although
each requirement is specific to the organization (e.g., NBCC requires those seeking the MAC credential
through their organization to be certified as a National Certified Counselor).

The complexity associated with the title of addictions professional makes the process quite complex for those
seeking this professional pathway. As outlined, there are numerous organizations that provide credentials
for individuals to seek certification and/or licensure, as well as complexities in relation to educational
standards. Individuals are encouraged to peruse the certification and/or licensure requirements of their state
for additional guidance related to the necessary background to practice in the addiction field.

Conclusion
The historical evolution of addictions counseling is multifaceted and complex. As we highlighted in this
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chapter, not only is it important to consider trends of use in relation to substances, but also the evolution of
treatment modalities over time. In addition, legislative efforts have had a significant impact on the profession,
as well as the changing landscape of the addiction counselor over time. The historical research base of the
profession has been established and will be expanded upon in Chapter 2.

Box 1.2: Case Illustration of Malini’s Exploration of the Addiction Counseling

Profession
Hi, my name is Malini, and I am entering my senior year of college. I have been a pre-med major, doing
well academically, however I have decided that a career in medicine is not what I want to pursue. I originally
decided on medicine primarily because it is a typical career path for others in my family. I was born and raised
in the United States, and my parents immigrated here from New Delhi, India, to attend medical school. They
excelled and are both currently practicing—my mother an anesthesiologist and my father a neurosurgeon. It
has been expected that I will also follow in their footsteps, yet my passions are being ignited elsewhere. For
many years, my father has struggled with an addiction, although this was well hidden. He has a very stressful
job, and he has up until about 5 years ago, managed very well. Five years ago, things went south really fast.
My father has always been a drinker, but with my brother and I both being in college, my mom would call
and say how much more Dad was drinking in the evenings coming home from work. Then one night when
Dad was on call, he decided to have a few drinks. Although he was never called to go in for surgery, my
mother was extremely distressed by this. She was concerned that if he was called, he would have gone in
and performed surgery. It was then that my mom decided he needed an intervention. My whole family was
there and we went through the process; my dad entered a treatment program that was specifically tailored for
medical professionals, and my mom, brother, and I entered our own counseling. My dad has been sober for
the past 3 years, and I have been incredibly grateful for the support of our counselor as well as the support
group, Al-Anon, that I joined during that time. All of this has led to me wanting to give back in some way to
other families struggling with addiction. My dream is to now become an addictions counselor, yet I’m having
a hard time understanding how to live out my dream.

Questions for Reflection

• What advice do you have for Malini?
• What organizations would you recommend Malini look into?
• How would you describe the difference between certification and licensure to Malini?

Table 1.2 Comprehensive Timeline of Events Related to Addiction Counseling

Date Event

Stone Age Archaeological evidence of pots that contained a mild beer or wine

900s Rhazes, an Arabian physician, discovered distilled spirits

1500s Distilled spirits became a popular drink

1640 Dutch opened first distillery in Staten Island

1700s Native American recovery circles were in existence

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1790 All rations for U.S. soldiers included ¼ pint of brandy, rum, or whiskey

1800–1880 Recognized widespread drug patterns

1804 Dr. Thomas Trotter describes the “disease concept” of alcoholism

1806 Morphine was discovered

1861–1865 American Civil War; morphine addiction is known as the “Army Disease”

1823 Dr. Benjamin Rush authors a book on addiction as a disease

1840 Founding of the Washingtonian Total Abstinence Society

Founding of Fraternal Order of Temperance Societies (e.g., The Sons of Temperance, Good
1842–1850
Templars, and Good Samaritans)

1870s Clinical concepts of addiction solidified

1870s Emergence of the mail-order bottled cures

The New York Times published an article including reference to addiction as “a disease which
1877
[requires] proper medical aid and systematic treatment”

Use of alcohol and other drugs as medicines:

• Godfrey’s Cordial (“Mother’s Helper”) used to treat colic

1800s • Laudanum (women for pain)

• Coca-Cola (with cocaine) for energy

• Cannabis (feminine pain and headaches)

1800s Emergence of alcoholic mutual aid societies

1892 The American Psychological Association was founded

1906 Congress passed the Pure Food and Drug Act

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1914 Congress passed the Harrison Act

1914 Congressional Research Service formed

1919 Congress passed the 18th Amendment, aka Prohibition

1920–1933 Prohibition was in effect

1929 Congress passed the Porter Narcotic Farm Act

1930 The Federal Bureau of Narcotics was founded

1933 Congress passed the 21st Amendment, repealing Prohibition

1930s The Yale Center of Alcohol Studies was founded at Yale University

1935 Alcoholics Anonymous was formed

1935 A treatment facility opened in Lexington, Kentucky, under the Porter Narcotic Farm Act

1936 “Reefer Madness” released

1937 Marijuana Tax Act passed

1938 A second treatment facility opened in Fort Worth, Texas, under the Porter Narcotic Farm Act

Yandell Henderson, Howard Haggard, Leon Greenberg, and later E. M. Jellinek founded the
1940
Quarterly Journal of Studies on Alcohol

The Summer School of Alcohol Studies was founded at Yale University’s Center of Alcohol
1943
Studies

Disulfram (brand name Antabuse) first used in the United States to treat alcoholism by Dr. Ruth
1948
Fox

1949 Founding of the first group called “Narcotics Anonymous” in New York City, NY

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1951 Formalization of Al-Anon

New York City Medical Committee on Alcoholism formed (founding organization of the
1951
American Society of Addiction Medicine)

1952 The Council on Social Work Education was formed

1953 Narcotics Anonymous was founded in California

1958 Founding of Synanon

1964 Methadone maintenance began as a research initiative at Rockefeller University

1965 President Lyndon Johnson addressed the disease concept of alcoholism

1966 Congress passed the Narcotic Addict Rehabilitation Act (NARA)

Training initiatives were developed by the Office of Economic Opportunity, the Department of
1966–1972
Labor, and the National Institute on Mental Health

1967 American Medical Association’s disease concept was first published

Amendments are made to the 1963 Community Mental Health Centers Act in order to support
1968
specialized addiction treatment grants

1968 The Bureau of Narcotics and Dangerous Drugs was formed

1970 Controlled Substance Act is passed

Comprehensive Alcohol Abuse and Alcoholism Prevention and Treatment Act passed (created
1970
the NIAAA)

1970s NIAAA and NIDA created training programs

1972 Drug Abuse Treatment Act passed (created NIDA)

1972 National Association of Alcoholism Counselors and Trainers was formalized (now NAADAC)

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1973 The U.S. Drug Enforcement Agency was formed

1973 ACES introduced the first set of counselor preparation standards

1970s–1908s Call to integrate alcohol and drug abuse treatment by Dr. Donald Ottenberg

1975 Women for Sobriety Founded by Dr. Jean Kirkpatrick

1975 Monitoring the Future Survey initiated

1976 The Rand Report “Alcoholism and Treatment” was published

National Commission for Credentialing Alcoholism Counselors was formed, the first national
1977
body seeking to implement uniform credentialing standards

1981 CACREP was established (premier accrediting body for the training of professional counselors)

1980s Emergence of including family members in treatment

1980s Diversification of treatment provider backgrounds increased

1982 The National Board for Certified Counselors was established

1984 National Minimum Drinking Age Act of 1984 was signed into law by President Ronald Reagan

1985 Secular Organization for Sobriety was founded

1986 Rational Recovery was founded

1980s NBCC, NAADAC, and CRCC create the “Master Addictions Counselor” (MAC) credential

Anti-Drug Abuse Act signed into law by President Reagan; instituted mandatory sentences for
1986
drug-related crimes

The American Medical Association approves the American Society of Addiction Medicine as a
1988
national medical specialty

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The National Certification Reciprocity Consortium/Alcohol and Other Drug Abuse (NCRC/
1989
AODA) was formally named

1989 President George H. W. Bush declares a new War on Drugs during televised speech

Drug Abuse Treatment Outcome Studies initiated by NIDA 1990

1990 –Drug Abuse Reporting Program (data collection from 1969–1972)

–Treatment Outcome Perspective Study (data collection from 1979–1981)

1991 ASAM published the first Patient Placement Criteria

Congress passed legislation creating the Substance Abuse and Mental Health Services
1992
Administration (SAMHSA)

1994 Federal funds were allocated to explore the use of drug courts

1996 California becomes the first state to legalize medical marijuana

1996 Project MATCH main findings released

1997 National Registry of Evidence-based Programs and Practices launched

Combat Methamphetamine Act signed to regulate the sale of retail over-the-counter

2005
medication used in the production of methamphetamine

CACREP became the first graduate mental health training accreditation body to adopt the
2009
inclusion of addiction-related content knowledge requirements

2008 Congress passes the Mental Health Parity and Addiction Equity Act

2010 President Barack Obama signs the Affordable Care Act into law

2012 Congress passed the Synthetic Drug Abuse Prevention Act

Washington and Colorado become the first two U.S. states to legalize personal, recreational
2012
use of marijuana

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The Diagnostic and Statistical Manual, 5th edition, was released by the American Psychiatric
2013
Association

2016 The 21st Century Cures Act was signed into law by President Obama

Resources For Further Learning

Websites
Center of Alcohol Studies

http://alcoholstudies.rutgers.edu/history

International Credentialing & Reciprocity Consortium Credentials

http://internationalcredentialing.org/creds

National Board for Certified Counselors Master Addictions Counselor Credential

http://www.nbcc.org/Certification/MAC

National Certification Commission for Addiction Professionals Credentials

http://www.naadac.org/certification

Webinar
History of Recovery in the United States and the Addiction Profession

Presented by William L. White

Sponsored by NAADAC

http://www.naadac.org/thehistoryofrecoveryintheunitedstatesandtheaddictionprofession

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Briggs, C. A., & Pepperell, J. L. (2009). Women, girls, and addiction: Celebrating the feminine in counseling
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• addiction
• foundations
• counseling
• counselling
• recovery
• drugs
• treatment and addiction

http://dx.doi.org/10.4135/9781071800478.n1

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