Addiction treatment was in its infancy in the nineteenth century and, almost predictably, the absence of any regulation or real knowledge about this discipline created an environment where physicians could prescribe virtually anything to treat it. Unsurprisingly, this lack of oversight paved the way for a variety of “business opportunities” that sprang up as the country pushed towards prohibition of drugs and alcohol. A growing societal interest in methods that promoted sobriety would lead to the development of various questionable medical treatments for addiction. The irresistible opportunity to make people pay money for their sobriety inspired a spate of treatments and addiction “cures.”
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The term “withdrawal” (as it related to opium addiction) came into use during the nineteenth century and there were three basic treatments. The first was “cold turkey,” which is a reference to the goose bumps that often accompany withdrawal. The second method favored a reduction of drugs over the period of a week or so, and the third was a prolonged tapering over weeks or months. The latter typically included the use of tonics, replacement drugs (stimulants or sedatives) and alcohol or coffee.
One of the more popular addiction treatments of the late nineteenth century was developed by Dr. Leslie Keeley. After serving as a Civil War surgeon, Keeley settled in Dwight, Illinois, where he pursued an interest that he had developed during his military service – addiction and its treatment. Keeley and an associate named Frederick Hargreaves (a former minister and temperance lecturer) experimented on the town’s resident addicts and eventually declared that they had found a cure for addiction.
The cornerstone of their treatment was a secret formula called, “Double Chloride of Gold.” After some fits and starts, the Keeley Institute became wildly successful and was franchised nationwide. A period of explosive growth followed between 1890-1893. Boasting a ninety-five percent success rate, the treatment consisted of a regimen of several daily shots and tonics. Touted as miracle treatment by its patients and decried as a fraud by its critics, the Keeley method was nonetheless an extremely popular option for addicts of the day. By the time Dr. Keeley died in 1900, over four hundred thousand people had been treated in locations all over the country. The business went into decline at the beginning of the twentieth century, but the Keely Institute continued to operate in one form or another until 1966. To this day, the exact formulation of the Double Chloride of Gold treatment is unknown.
As the twentieth century dawned, psychoanalytic thinking played a large role in treating (or at least coming up with opinions about) addiction. The leading theory was that addiction was a failed attempt at self-curing a deeper, more serious psychiatric issue. Many leading thinkers of the day believed that these were largely sexual in nature. Dr. William Stekel (an associate of Freud) posited that “narcotomania” was almost always the result of “a serious mental conflict…Morbid sexual life plays the chief role.” Freud himself believed that all addictions were the substitute for masturbation, which he called the “primary addiction.” Lots of psychotherapy was done with the intention of uncovering the unconscious motivation for the aberrant behavior. As it turned out, the psychoanalytic community offered lots of explanations for addiction, but not much in the way of treating it.
Perhaps one of the more shocking ways the United States dealt with any number of “undesirables,” (including addicts) was through forced sterilization. The practice of eugenics emerged during the late nineteenth century and espoused the virtues of improving the quality of the human genetic system by directing its evolution. As such, the medical community, lawmakers and social reformers of the Progressive Era conspired to pass laws that would render certain people sterile. The goal was to eliminate the transmission of genetic defects (like addiction) from passing down to subsequent generations, or as it states in the law (to prohibit offspring from someone who) “fails chronically, in comparison with normal persons, to maintain himself or herself as a useful member of the organized social life of the state.” The practice resulted in over sixty thousand procedures up through the 1970s. Many of those who were sterilized weren’t even aware that it was being done.
Despite the fact that most of the inebriate homes, asylums and private addiction cure institutes closed down between 1910 and 1925, addiction was still a persistent problem that necessitated treatment. Around 1920, Dr. Lawrence Kolb (an addiction treatment pioneer) estimated that there were between 110,000 and 150,000 addicts in the United States. By now most states were involuntarily committing addicts – many of them in prisons. Unfortunately, most of these people were not treated for addiction.
The state of California made one of the first real attempts at institutional treatment of addicts at the California State Narcotics Hospital at Spadra. This facility was the brainchild of Senator Sanborn Young, who got the bill passed to create it in 1927. Doors opened in 1928, and an experienced doctor who knew how to handle addicts supervised those who were admitted. The treatment was meant to last from eight to twenty-four months and the establishment was intended to serve as an alternative to jails and state hospitals. It operated until 1941.
The Porter Act of 1929 allocated funds for two narcotics farms to house and rehabilitate addicts and offenders who had violated federal drug laws. The first one opened in Lexington, Kentucky in 1935 and the second in Fort Worth, Texas in 1938. The former was headed by the aforementioned Dr. Lawrence Kolb, who considered addiction a psychiatric problem. Residents were committed both legally and voluntarily (though these cases were usually achieved by use of legal duress). The treatment method involved a four to seven day withdrawal period followed by participation in vocational and recreational activities. Unfortunately, the recidivism rate was between ninety and ninety-six percent because there wasn’t a good follow-up system; when residents returned to the urban lifestyle they also returned to old habits.
Other cures and treatments came and went including, “A Comfortable and Spontaneous Cure of the Opium Habit by Lecithin.” In a 1935 League of Nations document, W.C. Ma describes how oral lecithin “reduces lipoid in body cells of addicts,” which results in less craving for the drug. Dr. Manfred Joshua Sakel developed insulin shock therapy in Vienna in 1927. After treating patients, he reported that insulin comas had a dramatic effect on drug addiction, believing (incorrectly) that lowering blood sugar combatted withdrawal illness. Modino introduced Serum Therapy 1938. The process consisted of raising blisters on an addict’s abdomen, withdrawing the fluid within and re-injecting it into the arm. He theorized that the fluid contained antibodies that had a therapeutic value against withdrawal symptoms. These are just a few of the many treatments to follow that focused solely on withdrawal, which of course, is only a small part of the challenge of treating opioid addiction – an inaccurate distortion that stubbornly persists to this day. At this point in history, the treatments for addicts are all over the map, but there is still no reliable “cure.”
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Next week: The advent of Methadone ushers in a new era of treatment for dependency.
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