Historical Perspectives of Addiction

Histories of Addiction

In the past quarter century, historians of addiction have focused on contextualizing the political, social, and cultural meanings of addiction. Building on Harry Gene Levine’s classic 1978 article, “The Discovery of Addiction,” historians have suggested that the classification of certain substances as illicit or licit tells us more about social norms and power relationships than about the psychopharmacological properties of the substances themselves. Historians have contextualized the definitions of addiction, alerting us to the extent to which alcohol prohibition and the criminalization of narcotics and stimulants reflected dominant cultural values rather than robust scientific findings. These studies pose an intellectual challenge to the treatment and control of addiction. So far, however, they have made a less significant impact on addiction policy and treatment. In a recent article, I argued that historians of addiction should take biology seriously. Here I hope to persuade addiction scientists and practitioners of the value of these recent histories for their research and practice.

Doing so requires an appreciation of historical methods. Academic historians are not simply engaged in telling a chronological story; nor, since the late 19th century have they assumed that they can uncover “facts” that recreate the past as it was. Rather, academic historians insist that historical sources do not speak for themselves, but are subjects of contested interpretations framed by current and past cultural and political contexts. From this perspective, there can never be one final “factual” reading of the past; today’s landmark interpretation is regularly subjected to tomorrow’s reinterpretation because, odd as it may sound to the nonacademic historian, the past is always subject to change as historians redefine the contexts in which events occur. The current scientific paradigm that addiction is a brain disease is placed in social and cultural contexts. The implicit message is that, whatever the biological substrates of addiction, by acknowledging social, cultural, and political forces, addiction scientists, policymakers, and practitioners can develop more effective policies and interventions.

Brain Disease Redux

Often, writes historian Nancy Campbell, what has been learned in addiction science has been ignored in succeeding paradigms. More than a half century ago, Campbell found that addiction researchers Maurice S. Seever and Abraham Wikler had independently concluded that addiction was a chronic relapsing/remitting condition, a view presented in 2000 by then National Institute on Drug Abuse (NIDA) director, Alan Leshner, as novel. Campbell also points to a rhetorical resilience of a traditional “moral lexicon” of addiction. Citing the work of current NIDA director, Nora Volkow, and her colleagues as exemplars, Campbell finds that their notion of “disrupted volition” parallels 19th century constructs of addiction “as a ‘disease of the will’ subject to voluntary control.” Thus, writes Campbell, with “amnesiac gesture toward its own repressed past, the addiction enterprise comes full circle into the present.”

As Campbell suggests, the claims that addiction is a brain disease would sound familiar to 19th century neurologists. In many respects, current views resemble degeneration theory as expounded by the French physician Théodule Ribot in his 1883 study Les Maladies de la Volonté (which was reissued in 32 subsequent editions in French and English). Degeneration theory offered a hereditarian explanation for a variety of disorders including retardation, depression, depravity, and sterility. Behaviors that today would include addictions such as alcoholism, diet, and sexual addictions were alleged to have a cumulative destructive impact on the nervous system that was inherited by succeeding generations. Practitioners took extensive family histories and prepared elaborate pedigrees that sought to explain a current disorder by uncovering patterns of disease and behavior in a patient’s family. Adherents sought to portray degeneration as organic, but much like addiction practices today, treatment revolved around an array of psychological and moral interventions under the rationale that alterations in habits had a direct physiological influence on the nervous system.

Degeneration theory meshed with the views of the influential neurologist James Hughlings Jackson, whose “dissolution theory” was based on his claim that lesions in the neocortex reversed the evolutionary process in which the “higher” cortical structures restrained the “lower” emotive, limbic functions. Jackson’s hydraulic theory reinforced the assumptions that addictions reflected a hijacking by these more primitive structures, often referred to as the “reptilian brain.” Thus addiction was a brain disease because the behaviors were enabled by damage to cortical censors. Because these behaviors appeared to run in families, it was a small step to connect Jackson’s dissolution with degeneration.

Both degeneration and dissolution were translated into early 20th century popular scientific explanations of the physical effects of alcohol and other drugs. For instance, historian Susan Speaker writes of Richmond P. Hobson, a retired naval officer and three-term congressman from Alabama, who published Alcohol and the Human Race in 1919 and portrayed it as based on the best “evolutionary science” of the time. Hobson, who founded the American Alcohol Education Association in 1921, wrote that alcohol was a toxin that paralyzed white blood cells, making them unable to “catch the disease germ” that was “devouring” the drinker. This led to the destruction of the “centers of the brain upon whose activities rest the moral sense,” resulting in what Hobson labeled “retrograde evolution.” For Hobson, “alcoholic beverages, even in moderation reverse the process of nature.” Ninety-five percent of “all the acts of crime and violence committed in civilized communities,” Hobson claimed, “are the direct result of men being put down by alcohol to the plane of savagery.”

Hobson’s “science” both influenced and was influenced by early 20th century prohibitionist sentiments. With the end of Prohibition, a new science of alcoholism emerged. Americans, according to Speaker, ceased “demonizing alcohol after Prohibition, and chose to deal with its risks largely through regulation, education, and harm-reduction strategies.” However, she writes, “they have resisted” treating users of most other psychoactive drugs in a similar manner. What emerged were distinct attitudes, policies, and sciences that separated alcohol from other addictive substances. However, Speaker implies, these distinctions were based less on objective evidence than on the cultural, social, and economic attitudes toward alcohol and other mind-altering substances. I begin with historians’ interpretations of the science of alcohol addiction and then move on to other substances.