History of substance abuse

3,400 BCE The opium poppy is cultivated in lower Mesopotamia. Sumerians refer to it as Hul Gil, the “joy plant.” The Sumerians would soon pass along the plant and its euphoric effects to the Assyrians. The art of poppy-culling would continue from the Assyrians to the Babylonians, who in turn would pass their knowledge on to the Egyptians.

12th century BCE: Early references to “drink madness” from ancient Egypt and Greece. 9th century BCE: In Homer’s Odyssey, Helen is described as giving soldiers and veterans of the Trojan War drugged wine according to a recipe discovered in Egypt—a magical potion called Nepenthes pharmakon, or the anti-sorrow drug.

5th Century BCE: Herodotus makes references to drunkenness as a sickness of body and soul. 4th Century BCE: Aristotle (384–322), in comparing licentiousness to drunkenness, noted that the former was a functional disorder while the latter resulted from an organic disorder. He viewed licentiousness as permanent, but drunkenness as curable. When Alexander the Great (Aristotle’s most famous pupil) died in 323 BCE, his death was ascribed partly to years of immoderate drinking.

1st Century BCE: The Yellow Emperor’s Classic of Internal Medicine, an organized and systematic explanation of acupuncture recognizable to practitioners today, is published in China. “These days, people have changed their way of life,” says the Yellow Emperor Huang Di in the opening chapter. “They drink wine as though it were water, indulge excessively in destructive activities, drain their jing (the body’s essence that is stored in the kidneys) and deplete their qi [life force].” The text treats alcoholism (and other diseases or ailments) as a behavioral problem, and recommends adjusting one’s behavior to compensate.

98 AD: Tacitus writes in Germania, that German tribes “do not show the same self-control in slaking their thirst. If you indulge their intemperance by plying them with as much drink as they desire, they will be as easily conquered by this besetting weakness as by force of arms.”

1st Century AD: The Roman philosopher Seneca (4 BCE–65 AD) defines drunkenness as a type of insanity. “The word drunken is used in two ways—in the one case of a man who is loaded with wine and has no control over himself; in the other, of a man who is accustomed to get drunk, and is a slave to the habit … there is a great difference between a man who is drunk and a drunkard.”

4th Century AD: St. John Chrysostom compares inebriation to other known diseases. He is, however, in favor of using wine because of its sacramental role in the Eucharist and its centrality in one of Jesus’ best-known miracles. 5th century AD: St. Benedict writes the Rule of Saint Benedict, in which alcohol is not prohibited. He notes that monks who abstain from alcohol tend to be more virtuous. 6th century AD: Germanic tribesmen prone to abusing alcohol or drugs are encouraged to binge before battle. Wearing wolf or bear skins, given plenty of space by their allies, these men were deployed as berserkers (from the Norse word for bear shirt) and feared by their enemies. Three of these tribes, the Angles, Saxons, and Jutes claim Britain between 450 and 550 AD.

7th century AD: Islam founded. Islam’s attitude toward alcohol differs from that of Christianity. Lacking the New Testament descriptions of Christ’s use and blessing of wine, Islam is free to prohibit alcohol completely, a prohibition that stands to this day. Although the prohibition broadly concerns “intoxicants,” thus providing a religious rationale for banning narcotics as well, early Islam seems to have been less strict in its attitude toward the consumption of nonalcoholic substances, including coffee.

The Middle Ages (5th–13th century AD): attitudes toward drunkenness varied. Some religious sects prohibited the use of substances (the Ismaili Naziri or “Assassins”), while others permitted or encouraged it (Benedictine and Franciscan monks); use varied by culture and religious context. Overall, addiction was regarded as vice, and treatment was either nonexistent or focused on spiritual redemption. 11th–12th century AD: Medical students from Salerno, Italy, build the first stills, enabling the distillation of spirits. This greatly increased the potency of beverage alcohol and spurred a worldwide surge in alcoholism. 12th–13th century: Zhang Sanfeng, whose exercises allowed him to (allegedly) live 152 years, establishes the basis for Tai Chi, which does not recognize a division between the physical body and the spirit. In addition to exercises, Sanfeng’s teaching recommends abstaining from alcohol, meat, beans, and grains.

14th century: Italian scholar Petrarch’s rediscovery of humanist, pagan texts from classical thinkers lays the groundwork for the Renaissance and the Enlightenment. Humanist scholarship also plays a major role in the Protestant Reformation. While some Protestant churches (Lutheran, Anglican) continue to permit the use of alcohol, others adopt strict prohibitions against its use, including some of the smaller groups that help establish the English colonies of North America.

1517: Sigismond de Dietrichstein organizes the Order of Temperance in Germany. The order calls for an end to the custom of “pledging healths” (toasts)—a practice thought to promote intemperance.

1560s–90s: An early description of narcotic withdrawal, cravings, and compulsions: European explorers and scientists, in describing the opium traffic among the Turks, Chinese, Moors, and Persians, note of opium consumers: “If they leave off somewhat taking it, then they feel physically ill.” 1600: Dietrichstein’s Order of Temperance allowed members no more than seven alcoholic drinks per meal, and only two meals per day. Well, as the saying goes: “you have to start somewhere.”

1606: Shakespeare’s Macbeth offers a guarded evaluation of the ills of drink—Lady Macbeth drinks for courage to assassinate (“That which hath made them drunk hath made me bold; what hath quenched them hath given me fire”) while King Duncan and his guards have become vulnerable through drink. The play may reflect evolving Elizabethan attitudes toward drunkenness. Alcohol was not viewed as the problem, but rather human dependence on it for comfort. Drunkenness was therefore a sign of moral weakness rather than disease.

1620: Separatists, members of a Puritan sect, settle New England, and bring judgmental attitudes toward the use of substances with them. 1747: The French philosopher Condillac refers to inebriety as a disease and calls for state-sponsored treatment.

1772: Physician and social reformer Benjamin Rush calls for the abandonment of distilled spirits and the substitution of cider beer, wine, and non-alcoholic drinks in his sermons to Gentlemen Upon Temperance and Exercise. Later, he calls for the creation of special hospitals for “inebriates,” following the notion that drink (and not the drinker) was to blame for alcoholism. 1787–1813: Delirium tremens (acute alcohol withdrawal syndrome) recognized and medically described by Lettsom, Armstrong and Pearson, and then named by Thomas Sutton.

1789: First American temperance society organized in Litchfield, Connecticut.

1799: China’s emperor, Kia King, bans opium, making trade and poppy cultivation illegal.

Early 1800s: In Boston, temperance advocates found a brewery to provide beer to those who pledged to forsake “ardent spirits”—what we call hard liquor.

1811: A temperance society in Fairfield, Connecticut calls for total abstinence, acknowledging that this is a harsh remedy, “but the nature of the disease absolutely requires it.”

1819: Christopher Wilhelm Hufeland coins the term dipsomania to describe the uncontrollable craving for spirits that triggers “drink storms.” 1826: American Temperance Society formed—first national temperance organization.

1825–1850: Temperance movement abandons temperance (moderation) and embraces total abstinence as a goal and legal prohibition of alcohol as a means of collectively achieving that goal. 1830: The Connecticut State Medical Society calls for creation of inebriate asylums.

1833: Dr. Samuel Woodward, superintendent of the Worcester Insane Hospital and Women’s Lunatic Asylum in Massachusetts, writes a series of essays that are published in 1836 and again in 1838. “A large proportion of the intemperate in a well-conducted institution would be radically cured, and would again go into society with health reestablished, diseased appetites removed, with principles of temperance well grounded and thoroughly understood, so that they would be afterwards safe and sober men.”

1839: Lin Tse-Hsu, imperial Chinese commissioner in charge of suppressing opium traffic, orders all foreign traders to surrender their opium. To protect its opium trade, the British send expeditionary warships to the coast of China, beginning the first Opium War. By 1841, the Chinese have lost the war, and cede Hong Kong to the United Kingdom.

1840–1890: More than 200 American water cure institutions include alcoholics and addicts among their devoted clientele and solicit their patronage through such media as The Water Cure Journal.

1849: The Swedish physician Magnus Huss introduces the term “alcoholism” in his text, Chronic Alcoholism; it does not appear in the United States until after the Civil War.

1853: The hypodermic syringe is developed as a refinement of the use of cannulae to introduce drugs beneath the skin. Morphine is one of the first drugs for which the syringe is commonly used to treat such conditions as facial neuralgia.

1856: The British and French renew hostilities against China during the Second Opium War. The import of opium is legalized in China again.

1860: Alexander Peddie, a Scottish physician practicing in Edinburgh, calls for legal commitment of dipsomaniacs to inebriate asylums. He distinguished between common drunkards whose excessive drinking was a vice and the “insane drinker” whose vice had been transformed into a disease no longer under his volitional control. Peddie believed this disease could be inherited or acquired.

1861–65: Widespread use of morphine during America’s Civil War, along with the introduction of the hypodermic syringe, lead to an epidemic of opioid addiction among veterans of the conflict; so much so that opioid addiction temporarily becomes known as “soldier’s disease.”

1878: Britain passes the Opium Act with hopes of reducing opium consumption. The selling of opium is restricted to registered Chinese opium smokers and Indian opium eaters, while the Burmese are strictly prohibited from smoking opium.

1890: The U.S. Congress, in its earliest law-enforcement legislation on narcotics, imposes a tax on opium and morphine. Tabloids owned by William Randolph Hearst publish stories of white women being seduced by Chinese men and their opium to invoke fear of the yellow peril disguised as an anti-drug campaign.

1895: Heinrich Dreser, working for The Bayer Company of Elberfeld, Germany, finds that diluting morphine with acetyls produces a drug without the common side effects of morphine. Bayer begins production of diacetylmorphine and coins the trade name “Heroin.” Within a few years, the philanthropic Saint James Society in the United States has mounted a campaign to supply free samples of heroin through the mail to morphine addicts trying to break their habit. By 1902, physicians have begun to note in various medical journals the side effects of using heroin as a morphine step-down cure. Several physicians argued that their patients suffered from heroin withdrawal symptoms equal to morphine addiction.

1905: U.S. Congress bans opium.

1906: Several physicians experiment with treatments for heroin addiction. Alexander Lambert and Charles B. Towns tout their popular cure as the most “advanced, effective, and compassionate cure” for heroin addiction. The Towns-Lambert Cure consists of a seven-day regimen, which includes a five-day purge of heroin from the addict’s system with doses of belladonna (nightshade) that often produces delirium. The patient also receives other drugs thought to be beneficial.

1914: The Harrison Narcotics Act passes. It requires doctors, pharmacists, and others who prescribe narcotics to register and pay a tax.

1923: The U.S. Treasury Department’s Narcotics Division (the first federal drug agency) bans narcotics sales. As a result, substance users are forced to buy from illegal street dealers.

1939: The first edition of the basic text of Alcoholics Anonymous (AA), notes: “Then we have a certain type of hard drinker. He may have the habit badly enough to gradually impair him physically and mentally. It may cause him to die a few years before his time. If a sufficiently strong reason—ill health, falling in love, change of environment, or the warning of a doctor—becomes operative, this man can also stop or moderate, although he may find it difficult and troublesome and may even need medical attention.” 1944: Two “Yale Plan” clinics open in Connecticut, one in New Haven and one in Hartford. The Clinics hope to develop a plan for cost-effective assessment and treatment of people suffering from alcoholism.

1960s: Expansion of drug use into white middle class youth transforms attitudes and approaches toward treatment. Shifting patterns of substance use addiction during the Vietnam War and Civil Rights era lead to a massive cultural divide in the U.S., leading to a fundamental split between conservative and progressive lawmakers in their approach to treating drug and alcohol dependence.

1965-75: Involvement in Vietnam is blamed for the surge in illegal heroin being smuggled into the United States.

1970: The Controlled Substances Act of 1970 classifies marijuana along with heroin and LSD as a Schedule I drug—high abuse potential, with no accepted medical use.

1973: President Richard Nixon creates the DEA (Drug Enforcement Administration) under the Justice Department to consolidate federal powers of drug enforcement in a single agency.

1985–93: New research extols the positive effects of moderate drinking; the first “how-to” books on controlled drinking are published, contributing to “Moderation Management,” a moderation-based support group alternative to AA.

1994: The Clinton Administration orders a shift in policy away from the anti-drug campaigns of previous administrations. Instead focus includes “institution building”—included harsh sentences for repeat offenders (also known as the “Three Strikes” law).

2000: The Drug Addiction Treatment Act facilitates the treatment of chronic opioid users by qualified doctors in a clinical setting using approved Schedule III, IV, and V narcotics. 2002: Buprenorphine is approved as a Schedule III drug, and becomes the first approved as safe to use as treatment in a doctor’s office.