The Spectrum of Addiction

Evidence-Based Assessment, Prevention, and Treatment Across the Lifespan

Laura J. Veach, Regina R. Moro

• Publisher: SAGE Publications, Inc
• Year: 2017
• ISBN:
  9781483364827
• Edition: 1
• Topic: Psychologie
• Subtopic: Sucht in der Psychologie

Reflecting the latest content in the DSM–5, The Spectrum of Addiction presents a comprehensive overview of addictive behaviors and habits from early use through risky use, severe-risk use, and addiction. Authors Laura Veach and Regina Moro draw from their experience in both teaching and counseling to provide real-world knowledge and evidence-based practices for working with clients who fall within the spectrum of addiction ranging from experimentation to physical addiction and recovery. With a unique focus on neuroscience, integration of CACREP standards, and extensive coverage of addictions across the lifespan, the book serves as a practical resource for future addiction counselors.

The Spectrum of Addiction is part of SAGE's Counseling and Professional Identity Series. To learn more about each text in the series, please visit sagepub.com/cpiseries.

1 Historical Foundations of Addiction Counseling

Learning Objectives

Upon completion of reading this chapter and participating in the guided exercises, the learner will be able to

• understand and distinguish between the numerous professional organizations representing the addictions counseling field;
• identify significant historical events related to the field of addictions counseling; and
• discuss and explain the professionalization of the addictions counseling field.

Examining the history of addiction within the United States is a multifaceted endeavor. A variety of different issues of focus come into awareness that one may never had considered before, such as looking at substance use trends, examining the person who has provided services to those struggling with addiction, and attending to legal issues of relevance. This history is extensive and long. To fully examine the history of addictions counseling, we will be covering five general historical foci: (1) the use of substances/addictions over time, (2) the treatment of addiction over time, (3) the legislative history of substance/behavior regulation, (4) the professionalization of addictions counselors, and (5) an introduction to the research foundations of the profession. The research foundations will be further elaborated upon in Chapter 2.

In addition, the chapter will conclude with a comprehensive timeline highlighting

• dates in history and trends related to substance use and addiction;
• the evolution of the treatment of addiction;
• legal regulations of substances/behaviors;
• the professional regulation of the addictions counseling profession; and
• the establishment of a research base in addictions treatment.

Historical Use of Chemical Substances

Historically, the use of substances has evolved over time. Alcohol, being the “oldest child” per se has dominated the landscape over time; however, there have been times in history that the use of other drugs has claimed prime popularity status. The following section will examine the trends of substance use, primarily focusing within the United States.

The use of mood-altering substances is not a new phenomenon, with findings going as far back as the Old Stone Age, as anthropological discoveries include stone pots that contained mild beer or wine (Kinney & Leaton, 1983). Other archaeological evidence of alcohol use dates back to 7000 BC in Japan and 3500 BC in Iran (Inaba & Cohen, 2007). It was during the 10th century that Rhazes, an Arabian physician, first discovered the distillation process, primarily to be used as medicine (Kinney & Leaton, 1983). During the early years of alcohol use it was mainly for these medicinal properties that Rhazes found, as well as nutritional purposes (Doweiko, 2012), as the alcohol was deemed safer than water.

In the 1500s, distilled spirits (e.g., vodka, whiskey) became popular as a beverage of choice (Kinney & Leaton, 1983). According to Inaba and Cohen (2007), the mood-altering benefits of the substance helped bolster its popularity. In 1640, the Dutch opened the first distillery in the United States, on Staten Island (Kinney & Leaton, 1983). The use of alcohol was so widespread that by 1790 all rations for soldiers of the United States included liquor (i.e., brandy, rum, or whiskey) at the rate of a ¼ pint (Kinney & Leaton, 1983). As America was forming as a country, the history of substance use, primarily alcohol, was firmly rooted in the soil.

In 1806, morphine was discovered and used heavily in the decades following (Field, 2002). During the American Civil War (1861–1865) addiction to morphine was referred to as the Army disease (Field, 2002); considering the devastation, and physical and emotional pain associated with war, it is not surprising that such rates were found during this time. It was also during this time, the 19th century, that alcohol and other drugs were used as medicines (Briggs & Pepperell, 2009). These drugs went by the names of Godfrey’s Cordial (to treat colic), Laudanum (for women’s menstruation), and Coca-Cola, and included cannabis (for headaches and women’s menstruation).

The 20th century saw a rise and fall of numerous drugs of popularity. Many of you reading this can probably name a few, as drug trends are often deeply rooted within decades. If someone was to ask you about the 1960s and corresponding “Hippie Years” you may immediately think of marijuana and psychedelic use. If questioned about the 1990s and “Punk Rock/Grunge” days, you may think Kurt Cobain and of heroin. When someone imagines an addiction treatment center, they may even envision clients engaged in tobacco smoking via cigarettes, also an addictive substance. These connections are not random, as our history is constructed by stories, which are transmitted through a variety of media. Drug trends are no different from other movements (e.g., women’s rights, civil rights) and have become woven into the historical fabric of our country.

Synthetic Drugs

In recent times a particularly dangerous trend has been the rise in drugs of abuse that are classified as synthetic. Synthetic implies the creation of the drug via a chemical process (i.e., in a laboratory) as opposed to other substances (e.g., cannabis, cocaine, opiates) that are derived from plants. This process is not new; in 1887 amphetamines were first synthesized, and in the following decades they were used to keep pilots awake during long hours of war (Inaba & Cohen, 2007). What is new is the creation of substances in man-made laboratories. Commonly referred to as “meth labs,” these sites have become commonplace, with over 9,240 being found in 2014 (U.S. Department of Justice, Drug Enforcement Administration [DEA], 2015). In addition to methamphetamine, individuals are also creating substances such as “bath salts.” These substances are not the bath salts used to aid relaxation during a bath, but are substances synthetically created, and sold legally (i.e., until regulations were passed) under the name “bath salts” (i.e., not for human consumption) to avoid FDA regulation. Word on the street spread fast that Ivory Wave, Bloom, and Vanilla Sky (National Institute on Drug Abuse, 2012) were not the traditional relaxation bath salts but instead were mood-altering substances you could purchase at your local corner shop or gas station. The latest drug of abuse synthetically made is known as “Flakka” and is becoming increasingly identified as a danger to the public, particularly due to the low cost of the substance.

This historical review of substance use is limited, and we suggest anyone who has a desire to work in the field of addictions counseling acquire a comprehensive knowledge of substances and associated histories. There are great resources available, such as Inaba and Cohen’s (2007) Uppers, Downers, All Arounders, and also William White’s (1998) Slaying the Dragon. The purpose of our review here was to lay the foundation of substance use/abuse in our history. Humans have been using mood-altering substances for an unknown period of time. What is known, as highlighted in the historical review, is that humans have and will continually use substances, and create new ones to advance the mood-altering effects. It is for this reason that treatment has continually evolved over time. We will review this history in the following section.

History of the Treatment and Recovery Movement

The following section will discuss the history of recovery in the United States. One caveat is needed when discussing the concepts of recovery, as there are multiple avenues for an individual. The following section will include information about mutual aid societies, as well as formalized treatment modalities. Mutual aid societies are not a primary treatment mechanism, but they are an adjunct for support and are typically thought of as groups. Treatment is designated as formalized and professional endeavors at helping individuals enter into a recovery program. Each individual’s pathway to recovery is as unique as the individual.

The official beginning date for the treatment of addiction issues is unknown, however one may speculate that the initial attempts involved familial efforts to restrict an individual’s substance use. There is formal documentation of Native American recovery circles in the 1700s (White, 2000a). These recovery circles were initiated by tribal leaders who themselves had overcome an addiction, and began these abstinence-based programs firmly rooted in native tribal traditions (Coyhis & White, 2002). While the recovery circle represented the beginnings of mutual aid support groups, they were also the beginnings of formalized treatment. Formalized treatment options during the late 1700s to early 1800s included religiously oriented inebriate homes, medically oriented inebriate asylums, for-profit private addiction cure institutes, and bottled home cures for the use of alcohol, drugs, and tobacco (White, 2000a). These options represent a wide variety of attempts at curbing the issue of addiction and were due, in part, to a lack of understanding of addiction.

In 1784, Dr. Benjamin Rush outlined the effects of alcohol on the body and mind in his landmark manuscript (Thombs, 2006). This writing also included a list of “remedies for the evils which are brought on by the excessive use of distilled spirits” (Rush, 1823, p. 28). Dr. Rush’s work has been acknowledged as the first recognition of alcoholism as a disease (Inaba & Cohen, 2007; Thombs, 2006). In 1823, Dr. Rush published An Inquiry Into the Effects of Ardent Spirits Upon the Human Body and Mind (Kinney & Leaton, 1983). This book included information about the current attitudes toward alcohol at the time, as well as information related to scholarly treatment of the time. For example, Dr. Rush referred to the importance of religion on fostering sobriety along with the p...