Drug Treatment

History of Drug Treatment

Opiate use emerged as a significant social problem in the United States during the first half of the nineteenth century. The response by social activists and local and state policymakers included both prohibition and treatment. Early efforts to treat morphine and opium addiction frequently used medical interventions, including both heroin (developed in 1898) and purgative compounds, such as the Towns-Lambert Cure, which was developed in 1908. Such “cures” occasionally proved fatal. The alternative was to punish the addict and, through incarceration, deprive him or her of the drug.

Select states and localities had enacted laws regulating the production, distribution, and use of opiates since the mid-1880s. However, the nation as a whole did not do so until the passage of the Harrison Act in 1914, which effectively criminalized drug possession. That act was the culmination of decades of concern about drug use. While the legislation included efforts to treat addiction, the principal effect of the Harrison Act was to increase the number of drug users incarcerated in federal prisons. Consequently, concern arose that prisons were inappropriate and ineffective in curing addicts, and in 1929, Congress passed legislation creating the first federally funded treatment programs, which were called “narcotic farms.” These mandatory residential treatment facilities, the first of which opened in 1935, used a regime of detoxification and mental and physical development.

Drug treatment efforts made a significant advance between 1941 and 1945, when pharmaceutical researchers tested methadone, a synthetic narcotic developed by German researchers during World War II. Methadone prevents the euphoria of opiate use, which makes morphine and heroin less desirable. It also prevents the painful physical effects of withdrawal from those drugs. Methadone has been used since its discovery to maintain abstinence from drug use. Beginning in the 1950s, health professionals recognized the need for services and treatment beyond abstinence, however, funding to provide those services was limited.

Dramatic increases in drug use in the 1960s led to state and federal legislation mandating civil commitment for treatment purposes (Narcotic Addict Rehabilitation Act of 1966). These efforts largely failed. Continued heroin use both in cities and among U.S. soldiers in Vietnam led to renewed efforts to reduce drug use, which were introduced as the War on Drugs by the Nixon administration in 1971. Within eight years, with the help of federal funding (along with funds from state and local governments and private sources), community drug treatment centers increased from six facilities in 1969 to over 3,000 in 1977. Since the late 1970s, the War on Drugs has spent approximately 80 percent of its resources on interdiction (law enforcement); however, funding for treatment has also continued. Despite the fact that drug use remained high in the 1980s and 1990s, and continues to be an issue in the twenty-first century, public funding for treatment and private insurance coverage are limited and insufficient.

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