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The Evolution of Drug Treatment Programs

Table of Contents

Spiral stairs from top view - illustration for drug treatment programs evolution

Today’s drug treatment programs help an untold number of people overcome addiction and drug abuse.

Early Drug Treatment Programs

Modern drug treatment programs have evolved from earlier drug and alcohol treatment approaches. Various Native American tribes created the first alcoholic mutual aid societies, known as sobriety circles, in the 1750s to early 1800s. Some sobriety circles became part of or evolved into abstinence movements and temperance organizations.
In 1810, after decades of research into the effects of alcohol consumption, Dr. Benjamin Rush suggested the creation of a “Sober House” that would take care of confirmed alcoholics. Over the next several decades, these treatment centers evolved. A growing number of sobriety asylums began offering care for addiction to other substances, including opium, morphine, and cocaine. At that time in history, Americans also needed treatment for addiction to substances not commonly abused today, such as chloral, ether, and chloroform.
Scientists, doctors, politicians, patients and everyday people struggled with the ethics of drug and alcohol use and treatments in the early part of the 20th century. Beginning in 1907, states began passing laws calling for the mandatory sterilization of people deemed “defective,” including the mentally ill, the disabled, and those addicted to drugs or alcohol.
During these years, lawmakers passed legislation that put opiates and cocaine under federal law and places doctors as the gatekeepers to these substances. In addition to prescribing opiates to treat pain, physicians began prescribing them as a type of maintenance drug to addicted patients. These early maintenance programs helped patients to continue working and taking care of their families.
Lawmakers then made it illegal for a doctor to continue prescribing drugs to someone with an addiction. Forty-four communities broke federal law to create morphine maintenance clinics; all 44 clinics eventually close under threat of federal indictment. This effectively halted all drug treatment for everyone except the most affluent. The system of “inebriate homes” and other substance abuse programs collapses.
Shadel Sanatorium, an institutional alcohol treatment center, opened in 1935. Next, the U.S. Public Health Prison Hospital opened in Lexington, KY, as the first federal “narcotics farm.” The narcotics farms detoxified patients who entered voluntarily and they treated inmates with addictions. Another federal narcotics farm opened in Fort Worth, TX, in 1938. In addition to detoxification, these institutions offered medical, psychological, social and psychiatric services to patients.
While these institutions had a poor success rate, with some studies of these institutions showing 93 to 97 percent relapse rates, they did provide a solid foundation for today’s drug treatment programs.

Modern Drug Treatment Programs

Without available treatment, addiction rates began to rise. Addiction to heroin in New York rose after World War II, leading health officials to open Riverside Hospital in 1952. The program, designed to treat adolescents with addiction disorders, also failed in 1961.
Heroin overdose deaths in New York increased from 7.2 to 35.8 per 10,000 deaths between 1950 and 1961. By the late 1960s, deaths from illegal opiates became the leading cause of death for young adults in New York City between the ages of 15 and 35. Drug-related crime exploded.
In the 1960s, Dr. Vincent P. Dole and Dr. Marie E. Nyswander proposed the use of methadone rather than morphine for use in an opiate maintenance program. Scientists quickly developed other drugs to use in opiate maintenance programs, including levo-alpha acetyl methadol (LAAM) and buprenorphine.
Methadone treatments effectively stopped the New York heroin epidemic. In response, the U.S. government began to support drug treatment programs. For example, the Drug Abuse Treatment Act of 1972 laid the groundwork for the National Institute of Drug Abuse. The act also created TASC (Treatment Alternatives to Street Crime) to screen addicts in the criminal justice system then link those individuals to treatment programs. Vernon Johnson’s book, I’ll Quit Tomorrow, introduced the revolutionary idea that treatment was possible before a person hits “rock bottom.” The medical community began developing certification programs to credential counselors working in drug and alcohol rehabilitation services.
Attitudes towards drug treatment changed dramatically in the 1980s when zero tolerance campaigns reduced federal support for treatment programs and stiffened legal penalties for drug abusers. Treatment hospitals and freestanding clinics closed in record numbers. Unable to pay for treatment and afraid of incarceration, many people resorted to home-based treatment for their addictions.

The Final Shift towards Opiate Drug Treatment Programs

In the 1990s, online support groups created a virtual recovery community where a new generation could discuss addiction and treatment without great expense or fear of incarceration. The medical community, and eventually the government and public, renewed efforts to establish treatment centers and develop effective treatment protocols.
The American Society of Addiction Medicine (ASAM) published the ASAM Patient Placement Criteria for the Treatment of Psychoactive Substance Use Disorders, which suggested treatment specialists use a “levels of care” system to treat each patient as an individual rather than using a one-size-fits-all approach. The Center for Substance Abuse Treatment, created in 1992, worked to expand the availability and quality of drug addiction treatment.
Most recently, doctors have developed medical detoxification, which is a controlled and medically supervised withdrawal from addicting drugs. Rather than endure uncomfortable withdrawal symptoms for days or weeks at home, patients go to a hospital where nurses administer medications to ease nausea, aches, and pains, sweating and shaking associated with opiate detoxification.
Anesthesia Assisted Opiate Detoxification or Rapid Opiate Detoxification emerged about 40 years ago and have been researched and advanced by many doctors worldwide.  In the mid-1970’s, the use of opiate receptor antagonists was first described. (Blackley 1975, Resnick 1977) . A number of different protocols of “Rapid” or “Ultra Rapid” opiate detoxification (ROD or UROD) have been developed since 1988 when Loimer reported his “Ultra Rapid” technique of detoxification under anesthesia to rapidly induce detoxification while blocking the severe symptoms of opiate withdrawal.  These accelerated opiate detoxification methods usually called rapid detox, doctors administer medication including antagonists in order to shorten the acute withdrawal period while patients remain under sedation. When the patient awakens from sedation, opiate rapid detoxification is complete, withdrawal is kept to a minimal, and craving is very limited.
Throughout rapid detox history, several different methods of rapid opiate detoxification under anesthesia have been described and reported.  (Cook 1998, De Giacomo 1999,  Greenberg 2000, Loimer 1990, Legarda 1994, Pfab 1996, Scherbaum 1998, Cucchia 1998, Gold 1999, Bell 1999, Umbricht 1999, Kienbaum 2000, Hensel 2000, Elman 2001, Chutuape 2001, Collins 2005)  There is to date no uniformly accepted and practiced method, and several reports of complications occurring in centers in which appropriate monitoring was not provided, or where patients with underlying risk factors were included, have led to a great deal of controversy surrounding the practice of the procedure at all.
The Waismann Method® Group in its exclusive location in California has built what is widely considered the best rapid opiate detox based upon the treatment foundation laid by these medical professionals of the past. We combine the best of what medical science presently has to offer, with an individualized assessment to ensure superior medical care for each patient-specific individual needs.
After more than a decade of care and thousands effectively treated, we understand that comprehensive care is not a one-size-fits-all treatment. With this in mind, we at Waismann Method® Group treat more than just symptoms of addiction – we provide care for the whole person.
 

Source

http://www.williamwhitepapers.com/pr/AddictionTreatment%26RecoveryInAmerica.pdf
http://www.ncbi.nlm.nih.gov/books/NBK64157/

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