The Roots of Substance Abuse Treatment
In America, alcohol consumption existed among precolonial Native Americans but primarily for ceremonial purposes; the beers and wine produced by respective tribes had an alcohol content too low to induce intoxication. However, contact with European colonists brought much stronger strains of alcohol, introducing the practice of recreational and excessive drinking with it. Colonists plied the natives with alcohol, making them weaker at the negotiating table and on the battlefield.
After much ground had been lost, and much damage done to tribes reeling from what we would now recognize as alcoholism, senior tribesmen encouraged their younger tribe members to focus on their spiritual beliefs and ancestral traditions to vanquish their antisocial behavior. The tribe would sit around in a circle, as the shape was believed to help ward off the evil spirits that were working against them. The elders called on their afflicted brethren to call on their beliefs in a concept larger than themselves and to use their beliefs to overcome the temptation to drink.
Centuries later, Alcoholics Anonymous would borrow the methods of the Native Americans: the sobriety circle, the belief in a higher power, and the idea of finding solidarity and strength in the members of the tribe (or the group in general) to battle alcoholism.
After America had been settled by colonists, the young country enjoyed a period of “unprecedented production and consumption of distilled alcoholic beverages,” according to the American Journal of Public Health. This made Benjamin Rush take notice. Rush, one of the nation’s Founding Fathers and signers of the Declaration of Independence, a leader of the American Enlightenment movement, a notable physician, and one of the first researchers in the field of mental health (so much so that he is known as “the father of American Psychiatry”), took objection to the prevalent system of dealing with drinkers: to condemn them as moral failures of weak well and to “treat” them by imprisoning them or sending them to a mental asylum. , 
Rush felt strongly otherwise. He wrote that alcoholism was not the problem of choice and moral character of the drinker but in the properties of the alcohol itself. His Inquiry Into the Effects of Ardent Spirits Upon The Human Body and Mind, published in 1785, was the first notable rejection of the general consensus of the era: that alcohol itself was harmless, and the trouble lay with drinkers of weak wills and questionable character. Rush was one of the first authorities on the subject to put forward the idea of alcoholism being a disease, a medical condition; as such, treating this disease called for drinkers to be slowly separated from their poison, and not subjected to methods that, today, would be taken for granted as being inherently harmful, like imprisonment or forced psychiatric commitment.
Rush’s positions were revolutionary, but his unimpeachable stature gave them unparalleled credibility. To a large degree, his writings swung the pendulum of public perception away from the general enjoyment of alcohol and empowered the temperance movement to become bolder and more vocal in its condemnation of the alcohol industry and the consumption of alcohol in general. Rush’s calls for alcoholics to be treated with more medical care also laid the foundations for the first “sober houses,” hospitals that specialized in helping heavy drinkers fight their battles. Rush believed that drinkers could be kept in these houses, safe from further temptation, until they were ready to walk out on their own again.
Benjamin Rush introduced a sea change in how the American public perceived substance abuse, and the treatment thereof, but many lessons were yet to be learned about the best way to help alcoholics. Rush himself espoused some theories that have fallen by the wayside, such as using mercury to treat everything from addiction to Yellow Fever. Proceedings journal, out of Baylor University Medical Center, asked if Rush was “early America’s most famous doctor” (in the words of the Historical Society of Pennsylvania) or an assassin., 
The Fix listed Dr. Keeley’s “gold cure” as one of “history’s scariest addiction treatments,” but the public was so taken by his promises that he had hundreds of centers offering his cure across the country and throughout the European continent, the last of which closed as recently as 1965. Modern doctors don’t put any faith in the mixtures Keeley and his staff injected into patients. What Keeley did right, however, was requiring his patients to stay in his centers for a month, partaking in exercise and eating healthy food, and directing his people to give each client personal care and encouragement. At the time, such measures might have been considered a novel way to work with alcoholics. Today, they are the standard for substance abuse treatment and rehabilitation.
The public opinion of how to treat addicts came a long way with the arguments made by Benjamin Rush and Leslie Keeley, but alcohol runs very deeply in the veins of American culture, and any evolution of substance abuse treatment (and its impressions) has to make room for the ubiquitousness and popularity of alcohol itself.
Defending the 12 Steps
Even the criticism of AA being too religiously oriented has been addressed by the emergence of secular and agnostic groups that replace the explicit mentions of “God” in their respective 12 Steps with more ambiguous concepts of a “higher power” or even the group members’ senses of individual “self.” The evolution and adaptation of AA, and the 12-Step philosophy, to changing cultures and times (the rise of secular AA groups trends with the American public gradually becoming less religious) suggests that, notwithstanding the scientific concerns about how AA works, the method itself remains unshakably popular and positively perceived.
If Benjamin Rush changed how early America thought about alcoholics and other addicts, then Bill W. had an arguably similar effect on the United States of the 20th century. One of his converts was Marty Mann, one of the first women to complete all the 12 Steps of her AA program. Mann was so galvanized by her newfound sobriety that she took on the mantle of fighting a strain of thought that persists to this day: that alcoholism is not a medical condition, but a failure of morality and character. It was from reading a copy of AA’s Big Book that Mann understood she was “suffering from an actual disease,” one that had a name and symptoms, offering the same kind of respectability and compassion a sufferer of diabetes or cancer would receive, which alcoholism didn’t engender at the time.
The First Lady of Alcoholics Anonymous
Since its inception, NCEA (which has changed its name to the National Council on Alcoholism and Drug Dependence) has increased education outreaches on topics of substance abuse and rehabilitation, “engaged the medical profession” in how to treat addiction as a topic of health and medicine, and been a point of contact for the national press and general public for information about alcoholism and drug abuse. Materials and resources from NCADD have been used in schools and colleges. The organization also created Alcohol Information Week (which is now the National Drug and Alcohol Facts Week), recognized by multiple sitting presidents. April is Alcoholism Awareness Month in America, a drive launched by NCADD.
Losing the War on Drugs
Public perception on the state of substance abuse treatment may have come a long way since the days of addiction being seen as a moral failing, but other battles are still being fought. In 1971, President Richard Nixon declared a War on Drugs, saying that the manufacturing and trade of illegal chemical substances to the United States was America’s public enemy number one. Nixon increased the size and scope of America’s anti-drug campaign, empowering American agencies (both domestic and international) to intervene as they saw fit in order to enforce the “zero-tolerance” policy that Nixon wanted.
The War on Drugs was announced to great fanfare and acclaim, but a generation later, it lies in ruins, disavowed by politicians and the public alike. It achieved none of its goals, wrote NBC News in 2010 and created a worldwide black market for the distribution of the drugs it was supposed to destroy. With that black market came gang violence and warfare that have crippled American cities and entire South American countries.
The Post listed the impact on race as the first of “10 disastrous consequences” of the War on Drugs.
From the War on Drugs to Legal Marijuana
As the shortcomings of the War on Drugs have become starker and graver, the public’s opinion of drugs themselves have changed, and the direction of the change has condemned Nixon’s efforts in the court of public opinion. A Gallup poll conducted in 1969, two years before Nixon’s announcement, revealed that just 12 percent of Americans supported the idea of legalizing marijuana. In 2016, however, more than half the country – 60 percent – supported legalization policies. The figure is the highest amount of support in the 47 years that Gallup has been asking the question, and “almost all age groups” now favor legalization.
Utter Change and the Failed War
Oklahoma’s surprising move is held up by the Seattle Times as an example of the current trend of how the public responds to substance abuse treatment: “decriminalize drug use, seek public health options.” The shift in perception comes as communities and cities across the country reel from an epidemic of heroin abuse brought on by overprescription of opioid-based painkillers. The wave has not only changed the demographic of substance abuse (“the face of heroin has changed utterly,” writes The Economist) but also how people respond to ideas and programs meant to treat substance abusers.
Decriminalizing drug use is seen by many as a drastic step to solve a drastic problem, but it signals how far the country has moved away from Nixon’s War on Drugs. Such has been the extent of the effort’s failure that Al Jazeera theorized that Americans not only support more lenient laws for marijuana “but also for hard drugs like cocaine and heroin,” to go along with the idea of offering more compassionate and progressive treatment for addictions (as opposed to threats of punishment and incarceration).
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