A History of Addiction and Recovery in the United States

More details at...

Book Review:

A History of Addiction and Recovery in the United States by Michael Lemanski (Tucson, AZ: See Sharp Press, 2001)

By Jerry Dorsman

What helps individuals break their addiction to alcohol? What programs have been tried in the United States—and what works?

For answers, read this book. In it, Michael Lemanski, a keen researcher in the addictions treatment field and author of numerous published articles on the topic, traces the history of addiction treatment in America. He proceeds by peeling back layer after layer and explaining why things are the way they are.

He shows, for instance, that the recovery movement over the past 250 years has been more of a religious than a scientific enterprise. He charts the path of the early temperance movement that began in the late-1700s, to the mid-1800s group “The Washingtonians,” to the Woman’s Christian Temperance Union (WCTU) that started in 1874. All of these offered recovery programs that required acceptance of religious dogma.

In the early 20^th century, not much changed. The ongoing movement to help people who were struggling with alcohol addiction remained firmly religious. The Salvation Army, a Christian organization offered food and shelter along with “9 Steps” to help problem drinkers find a new life. (As you read these 9 Steps, take a moment to compare them to AA’s 12.) Then there was another Christian based program, the Emmanuel Movement that interestingly included some Freudian psychoanalysis in its otherwise spiritual approach. In addition, there were the religious and moral activists who pushed for, and helped to bring about, “Prohibition,” the U.S. ban on the sale of alcoholic beverages that lasted from 1920 to 1933.

But the immediate predecessor to AA was the Oxford Group Movement/Moral Re-Armament, a Christian based program—complete with regular meetings—designed to help people turn their lives around by finding God and becoming moral. Both Bill Wilson and Dr. Bob Smith were members of Oxford Groups when they founded what was to become AA.

Lemanski describes these early recovery programs and does so with great precision. He then covers the entire history of AA, from its origin in 1935, through its heyday in the 1970s and 1980s, to its leveling off in the mid- to late-1990s and the beginning of its decline in the present day.

He also covers the birth, and growth, of the disease concept of addiction. The growth of this concept parallels the growth of AA and, in fact, the two become wedded. Lemanski analyzes the reasons for the broad-based acceptance of the disease model and also the many inconsistencies in its application.

For instance, if alcoholism as well as drug addiction is a disease with obvious physical origins, then why would we recommend, as treatment, a religious or spiritual program which encourages us to make a connection with God and revamp our moral lives? Lemanski describes this obvious mismatch and shows how addiction treatment in America evolved, in spite of this, into an AA-dominated industry.

He also includes an analysis of AA’s efficacy as a treatment program. This analysis alone should be required reading for every treatment professional working in the field today. It would help therapists, counselors, and program managers to realize, first, that AA doesn’t work for everybody (indeed it works for a surprisingly small percentage) and, second, that we can help more clients achieve lasting recovery by offering a broader array of treatment modalities and matching each client to the modalities that work best for him or her.

This latter approach, called client-treatment matching, will soon become the gold standard of addiction treatment. As scientific research proves the efficacy of more and more therapies and treatment modalities in treating addictions, an increasing number of treatment professionals will begin offering these as part of the standard fare.

What are some of these alternative treatments? Lemanski answers this too. He gives snapshot reviews of various treatment modalities, types of therapies, and self-help groups, all of which have been proven successful with some significant percentage of clients.

Today, every treatment professional needs to know these alternative treatments and be prepared to offer them directly to clients or to make referrals so that clients can access these treatments elsewhere. Sadly, few professionals do this currently. But when they become more savvy, then the addiction treatment field will compare favorably with its sister field of psychology. Within the past hundred years, psychology grew from one primary psychotherapeutic intervention, Freudian psychoanalysis, to the dozens upon dozens of successful interventions that are used today.

With this book, Lemanski offers not only a remarkably exciting read but an immensely important work on this topic. I feel everyone associated with the addictions treatment industry can benefit by reading it. As Goethe said, “Those who do not understand the past are doomed to re-live it.” We need not re-live the nightmares of addiction treatment past. We can move ahead. The path is clear.