History and Etiological Models of Addiction
The History and Etiological Models of Addiction
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history of addictions counseling, a specialization within the profession of counseling, follows a pattern of evolution similar to that witnessed in many of the helping professions (social work, psychology, nursing, medicine). Early practitioners had more limited education and supervision, were not licensed by regulatory boards, did not have well-defined codes of ethics upon which to base professional judgments, may not have been aware of the values and needs of diverse populations, and did not have access to a body of research that helped define best practices and treatment plans (Hogan, Gabrielsen, Luna, & Grothaus, 2003).
It is interesting to watch the evolution of a profession and specializations within a profession. For example, in the late 1950s, the profession of counseling was energized by the availability of federal funds to prepare counselors. The impetus for the U.S. Government to provide funds for both graduate students and university departments was Russia’s launching of Sputnik. School counselors were needed to help prepare students for academic success especially in math and science so the U.S. could “catch up” with its “competitors.”
As noted by Fisher and Harrison (2000), in earlier times, barbers who also did “bloodletting” practiced medicine, individuals who were skilled at listening to others and making suggestions for problem resolution became known as healers, and those who could read and write and were skilled at helping others do so became teachers with very little formal education or preparation to work with others in such a capacity. Fifty years ago nursing degrees were conferred without completing a baccalaureate (today a baccalaureate is minimal and a masters degree is rapidly becoming the standard), a teacher could become a school counselor with 12 to 18 credits of coursework (today a two-year masters is the norm), and twenty years ago an addictions counselor was an alcoholic or addict in recovery who used their prior experience with drugs as the basis for the addictions counseling done with clients.
Until the mid-1970s licensure for counselors did not exist and those wishing to become counselors could often do so with less than a master’s degree. In 1976 Virginia became the first state to license counselors and outline a set of requirements that had to be met in order to obtain a license as a counselor. It took 33 years for all 50 states to pass licensure laws for counselors; this achievement took place in 2009 when the state of California passed its licensure law for counselors.
The purpose of this chapter is threefold: first, to provide an overview of the history of substance abuse prevention in the United States; second, to describe the most common models for explaining the etiology of addiction; and third, to provide an overview and relate the discussion of the history of prevention and the models for understanding the etiology of addiction to the content of the text.
Approaches to the Prevention of Addiction in the United States
Alcoholic beverages have been a part of this nation’s past since the landing of the Pilgrims. Early colonists had a high regard for alcohol because it was regarded as a healthy substance with preventive and curative capabilities, rather than an intoxicant. Alcohol played a central role in promoting a sense of conviviality and community until, as time passed, the production and consumption of alcohol caused enough concern to precipitate several versions of the “temperance” movement (Center for Substance Abuse Prevention, 1993). The first of these began in the early 1800s, when clergymen took the position that alcohol could corrupt both mind and body and asked people to take a pledge to refrain from the use of distilled spirits.
In 1784 Dr. Benjamin Rush argued that alcoholism was a disease and his writings marked the initial development of the temperance movement. By 1810, Dr. Rush called for the creation of a “sober house” for the care of what he called the “confirmed drunkard.”
The temperance movement’s initial goal was the replacement of excessive drinking with more moderate and socially approved levels of drinking. Between 1825 and 1850, thinking about the use of alcohol began to change from temperance-as-moderation to temperance-as-abstinence (White, 1998). Six artisans and workingmen started the “Washingtonian Total Abstinence Society” in a Baltimore tavern on April 2, 1840. Members went to taverns to recruit members and, in just a few years, precipitated a movement that inducted several hundred thousand members. The Washingtonians were key in shaping future self-help groups because they introduced the concept of sharing experiences in closed, alcoholics-only meetings. Another version of the temperance movement occurred later in the 1800s with the emergence of the Women’s Christian Temperance Movement and the mobilization of efforts to close down saloons. Societies such as the Daughters of Rechab, the Daughters of Temperance, and the Sisters of Sumaria are examples of such groups. (Readers are referred to White’s discussion of religious conversion as a remedy for alcoholism for more details about the influence of religion in America on the temperance movement.) These movements contributed to the growing momentum to curtail alcohol consumption, leading to the passage of the Volstead Act and prohibition in 1920. Even though Prohibition was successful in reducing per capita consumption of alcohol, the law created such social turmoil and defiance that it was repealed in 1933.
Shortly after the passage of the Volstead Act in 1920, “speakeasies” sprang up all over the country in defiance of prohibition. The locations of these establishments were spread by word of mouth and people were admitted to “imbibe and party” only if they knew the password. Local police departments were kept busy identifying the locations of speakeasies and made raids and arrests whenever possible. Often the police were paid off so that raids did not take place and patrons would feel more comfortable in such establishments.
