A Look at Addiction Treatment: Past and Future

Addiction treatment in the United States has come a very long way in the past 70 years. This Maryland Addiction Recovery Center article summarizes some of the major milestones in the evolution of addiction treatment and considers its future. 

The Humble Beginnings of Addiction Treatment (1930s-40s)

For most of human history, addiction to drugs or alcohol has been treated as more of a moral failing or a nuisance than an illness. No one was quite sure what to do with the chronically addicted or the seemingly hopeless “alcoholic”. More often than not, if these people were unable to get sober and stay that way, they were destined to live in sanitariums if they could afford them, or poorhouses if they couldn’t. 

That first began to change in the 1930s when a New York physician by the name of Dr. William Silkworth crossed paths with a former stockbroker named Bill Wilson and his partner Dr. Bob Smith. Dr. Silkworth operated what was then called a “drying out place” in NYC’s Towns Hospital. He found himself continually frustrated by the lack of long-term success in treating alcohol addiction. The proportion of his patients who returned to drinking was depressingly high.

Wilson and Smith, however, were having much greater success in helping people addicted to alcohol stay sober for significant lengths of time, including themselves. Dr. Silkworth was responsible for positing the “disease model of alcoholism” based on his work and what he witnessed with these men and those they helped. He would go on to write the foreword of the Alcoholics Anonymous textbook titled The Doctor’s Opinion.

A New Dawn of Understanding Addiction As A Disease (1940s-50s)

Alcoholics Anonymous quickly spread from its two hubs of New York City and Akron, Ohio. There was no shortage of people living with alcohol addiction in America and people were desperate for solutions. Following Jack Alexander’s 1941 feature article about AA in The Saturday Evening Post, the organization swept the country and eventually the globe. 

In 1956, the American Medical Association formally recognized alcoholism as a disease. This endorsement may have done for the medical community, what AA did for the sufferers of alcohol addiction. It helped transform addiction treatment because people living with addiction began to be seen as patients rather than victims of their own excess and overindulgence. More effective addiction treatment really began to evolve through the 1940s and 50s and beyond. This is when we saw the first dedicated addiction treatment centers established.

AA and the disease model of alcoholism offered several important advancements:

• Alcohol addiction was seen as an illness for the first time, not the fault of the sufferer.
• AA introduced the idea of peer support and spiritual development as a solution.
• Hope for addiction to alcohol, severe alcoholism no longer seen as a “death sentence”. 

The Addiction Treatment Tent Grows Wider (1950s-60s)

For all the good that AA was doing, along with the AMA’s recognition of alcohol addiction as a disease, there was still a large population of people who weren’t reaping the benefits. People with addictions to other substances. By and large, people addicted to heroin, morphine, cocaine, barbituates, or amphetamines didn’t get the same empathy as “alcoholics” did. Many of these people realized AA was onto something and tried to attend the meetings, but found trouble fitting in. 

In 1953 a man named Jimmy Kinnon decided to adopt the AA 12-step model and begin a separate fellowship called Narcotics Anonymous. As Alcoholics Anonymous was a not-for-profit and didn’t copyright or patent its form of “open source spirituality”, this left the door open for NA and the other 12-step organizations that would follow it. 

The openness of AA and the advent of NA made the peer support and spiritual development solution pioneered by AA available to millions more people. Through the 1960s, drug addiction gained the same recognition as a disease. The Narcotic Addict Rehabilitation Act of 1966 was a major milestone that allowed for treatment and rehabilitation instead of imprisonment for people addicted to drugs. 

Addiction treatment in the 1950s and 60s was marked by:

• A growth in understanding that drug addiction was as much a disease as alcoholism,
• More inclusive attitudes toward helping those addicted to substances other than alcohol. 
• Increasing availability of addiction treatment to Americans in different socioeconomic strata. 

Mental Health and Medication-Assisted Treatment (1970s-80s)

The 1970s saw the freedom of the 1960s turn into a bit of a drug-fueled nightmare. America was being pulled apart socially by the Vietnam War and racial tensions. Drug use was at an all-time high. The federal government recognized addiction as a serious public health problem, not just a matter for law enforcement. 

This environment led to the development of the first Medication-Assisted Treatment (MAT) programs in the form of methadone clinics. While these clinics didn’t offer a “cure” for addiction, per se, they were seen as a way to potentially reduce the harm done by IV heroin use in cities in particular. 

It was during this time that psychology began to play a more important role in addiction treatment. The use of Cognitive Behavioral Therapy and other talk therapy approaches expanded throughout the substance abuse treatment field throughout the 1980s. Clinicians wanted to provide people suffering from addiction with better tools for transforming their thinking and behavior. The goal was lasting sobriety, rather than settling for “harm reduction” alone. 

Treatment for addiction in the 1970s-80s saw:

• An increasing emphasis on “harm reduction” and medication-assisted treatment.
• The incorporation of talk therapy (esp. Cognitive Behavioral Therapy) in treatment.
• The standardization of the “28-day rehab” inpatient treatment model. 

Clinical Research Into Addiction (1990s-2000s)

The 1990s and 2000s marked a period where science gained greater traction in the addiction treatment world. This period saw significant advancements in the understanding of the neurobiology of addiction, leading to the development of new pharmacological treatments. It also expanded the use of psychotherapy and clinical studies. The new emphasis on evidence-based treatment for addiction meant treatment methods had to deliver real, measurable results.

During the 2000s especially, dual-diagnosis addiction care (treatment for co-occurring disorders) came into focus. The clinical community recognized the prevalence of depression, anxiety, and other disorders among people with addiction. They also saw that treating these conditions led to more long-term sobriety and better outcomes. Interestingly, this new evidence-based approach has served to validate the effectiveness of 12-step fellowships such as AA in helping people establish and maintain sobriety. 

In the 1990s-2000s addiction treatment began to evolve in these ways:

• More emphasis on clinical research and evidence-based care.
• Innovations in treatment to include PHP, and IOP (i.e. the “Florida model”).
• Less institutionalization, more emphasis on mental health therapy and wellness. 

The Present and Future of Addiction Treatment (2010-2020s)

During the mid-late 2000s and beyond the addiction treatment community was under fire from the opioid epidemic. The first wave, fueled by OxyContin eventually gave way to heroin and fentanyl. The escalation in overdose deaths demanded answers. Medication-assisted treatment (MAT), now with Suboxone as the more popular agent, increased in popularity as one tool in the battle. With the human genome mapped and research into the inner workings of the brain, the science of addiction treatment has continued to evolve in its search for answers.

One of the most significant ways in which addiction treatment is evolving is the emphasis on long-term recovery and support. In the 1990s and before, treatment was typically seen as a 28-day stay at rehab, then you were on your own, told to “go to meetings”. While that path worked for millions of people, millions more found themselves at the mercy of their addictions time and time again.

Today the focus on treatment is much more on the lifestyle aspect. Not only stabilizing patients and educating them about addiction but also teaching them new ways to live and providing continuing support in their recovery lifestyle. The evidence-based approach is widespread and addiction treatment is expected to deliver lasting results. Innovation in treatment models continues, with patients receiving longer-term support through partial care,  intensive outpatient programs, and telemedicine. 

The current and future of addiction treatment is defined by:

• More individualized treatment programming and care plans.
• Breaking away from the old “28-day rehab” model into extended care.
• Providing long-term recovery lifestyle support for people with addiction.
• Continuing scientific research into how addiction works in the brain. 

A Better Future For You or the One You Love

MARCs Baltimore addiction treatment program features specialized care to help you or your loved one conquer addiction for good. The emphasis we place on individualized treatment programming is just one of many factors that make Maryland Addiction Recovery Center (MARC) unique. We believe treatment should be designed to fit each individual for the best results. 

Maryland Addiction Recovery Center (MARC) is proud to be a part of the solution to addiction in Baltimore. If you or someone you love is challenged by a substance use disorder, MARC can help. Please give us a call today at (866) 929-2159