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A Brief History of Addictions Research and Treatment

A Brief History of Addictions Research and Treatment

In the early 1950s, addiction was widely considered only a medical condition, and the “disease concept” – that is, the concept that alcoholism was a physiological illness that could not be controlled by a matter of personal choice – prevailed. It was in that context that the psychological and spiritual work of Alcoholics Anonymous (AA) began in 1935. The forming of AA represents the first time in history that a group of individuals worked together to create a widely successful program for understanding and overcoming the intrapsychic,  interpersonal, and social forces of the addictive process on a large scale. The question of whether addiction is a “disease” or a “choice” remains a topic of considerable debate.

The 1960s represented a further developmental step in the psychological understanding of the puzzle of addiction. Many veterans came back from the Vietnam War having used a great deal of opium and heroin. The interesting phenomenon was that, although these individuals had used these addictive drugs,  some of them were “hooked” when they came home and others were not. Instead, large numbers of people seemed to have an entirely casual relationship with one or both of the highly addictive drugs. When these individuals ceased drug use, some simply went through withdrawal with no further consequences, while others were crushed by the weight of emotional issues. In the course of treating these individuals, it quickly became apparent to drug and alcohol counselors in Veterans Administration clinics that addiction was more than simply a physiological response to a chemical drug.

Simultaneously,  people entered crisis and rehabilitation centers whose lives were in total disarray even though they were not using highly addictive drugs like heroin and valium. Rather, they were experiencing addictive relationships with non-addictive substances like food and with activities such as spending, gambling, and sex. Thus, by the 1960s, the term “psychological dependence” had developed and become popular in regard to any number of activities.

In the 1970s and 1980s, an explosion of people suffering from addictions of all kinds and using the basic principles of recovery taught by Alcoholics Anonymous seemed to occur. Although these recovery principles will be considered in depth in a later module, suffice it to say at this point that they were based on the notion that people can be addicted not only to substances (Narcotics Anonymous,  Smokers Anonymous), but also to certain behaviors (Codependents Anonymous,  Spender’s Anonymous, Child Abusers Anonymous), activities (Gambler’s Anonymous,  Debtors Anonymous, Workaholics Anonymous), and even attitudes and emotions (Rageaholics Anonymous, Emotions Anonymous). Each group was and is based on the twelve principles of recovery.

Also,  in the early 1970s, as clinics and rehabilitation centers became aware that people can become addicted to behaviors and activities as well as to substances,  the research community became more aware of the neurochemical dimension of addictions.  More emphasis was placed on the opiate-like chemicals similar to morphine called endorphins and enkephalins that exist in the brain, and the argument was made that these chemicals could well represent the biological basis for addiction. The discovery actually supported the view of process addictions insofar as it was the body’s own biochemical system that was responsible for the addiction rather than the substance itself. Thus, in a substance addiction,  it was believed that the mood-altering substance entered the body from the outside and interacted with its biochemistry, while in a process addiction, the chemical reinforcers were released entirely from within the body. The belief that people could learn through repetitive behaviors to affect their own biochemical system and experience positive effects represented a step forward in understanding why almost any behavior or activity could become addictive.

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