This document provides a historical overview of addiction treatment in the United States from the 1700s to present day. It discusses how treatment began in non-medical facilities like jails and asylums before pioneers like Dr. Benjamin Rush argued it was a disease treatable by physicians. The first inebriate asylums opened in the 1800s using physical treatments. Religious missions and recovery homes then utilized moral and spiritual approaches. Today, treatment includes detoxification, counseling, medications, and support groups with a focus on individualized long or short-term residential, outpatient, or medication-assisted options.

1. A Long Journey from Inebriate Asylums
Gina de Peralta Thorne, MS
Director of Business Development

2. Objectives:
• Provide a historical overview of the
treatment of alcohol.
• Discuss events that prompted changes to
alcohol/addiction treatment.
• Discuss current levels of care available for
addiction treatment services.

3. Early Addiction Medicine
Non-specialty institutions
that could do little for their
conditions:
• Jails
• County farms
• Almshouses
• Water cure institutions
• Insane asylums

4. Pioneers in Addiction Medicine
• 1774, Anthony Benezet’s - Mighty Destroyer
Displayed is published. It is the earliest
American essay on alcoholism.
• 1784, Dr. Benjamin Rush’s - Inquiry into the
Effects of Ardent Spirits on the Human Mind and
Body, argued that the condition was a disease
that should be treated by physicians.
– Rush’s writing marked beginning of American
temperance movement.

5. 1800’s
• 1810 -Dr. Benjamin Rush called for creation
of a ―Sober House‖ for the care of the
―confirmed drunkard‖.
• 1825, Rev. Lyman Beecher’s Six Sermons on
Intemperance described the presence of an
―insatiable desire to drink,‖ and described
warning signs of addiction to distilled
spirits.

6. Medically Oriented Inebriate
Asylums
• Inebriety (alcoholism
wasn’t coined until
1849), could and should
be cured within special
institutions.
• Medically-oriented
inebriate asylums -New
York State Inebriate
Asylum in 1864

7. Methods of Treatment
Utilized physical methods of
treatment:
– Drug therapies
– Aversion therapy
– Hydrotherapy
– Electrical stimulation.
Inebriates could be legally committed to such
institutions for periods ranging from one year to
―until the patient is cured.‖

8. Temperance Influenced Inebriate
Homes
• Recovering Alcoholics founded mutual aid
societies
– Native American Temperance Societies
– Washingtonians
– Reform Clubs
– Leaders from these groups formed inebriate
homes

9. Inebriate Homes
• Short voluntary stays and non-physical
methods of treatment.
• Alcoholism recovery in most of these homes
was viewed as a process of moral
reformation.

10. Religiously Sponsored Missions &
Recovery Homes
• Jerry McAuley opened the Water Street Mission in
1872
• Redeemed alcoholics
• Weekly Advertisements stating: ―Everyone welcome,
especially drunkards.‖
• New York Christian Home for Intemperate Men –
religiously oriented.
• viewed recovery from addiction as a process of
religious conversion--a process of spiritual rebirth.

11. Addiction Treatment Franchises
• Private for-profit sanataria and addiction
treatment institutes
• Home cures
– Promoted alcohol, opium and cocaine-laced
products.
• Hangover cures and alcoholism cures

12. Collapse of Early Addiction
Treatment
• Internal Threats
• Ethical Breaches
• Economic Threats
• Political Threats -
Prohibition

13. 20th Century Addiction Treatment
• 1906 - Courtenay Baylor – 1st lay therapist
• 1940 – AA Bill Wilson & Dr. Bob
• Minnesota Model – distinguished between 12
step and Professional counseling.

14. What is Treatment?
American Society of Addiction Medicine
Treatment is the use of any planned, intentional
intervention in the health, behavior, personal and/or family
life of an individual suffering from alcoholism or from
another drug dependency designed to enable the affected
individual to achieve and maintain sobriety, physical and
mental health, and a maximum functional ability.

15. Types of Treatment
• Physical and Psychiatric evaluations
• Detoxification
• Counseling
• Self-help support (12 – step)
• Treatment for co-morbid physical or
behavioral complications
• Medication assisted therapy

16. Principles of Effective Treatment
• Addiction is a complex but treatable disease that affects brain function and
behavior.
• No single treatment is appropriate for everyone.
• Treatment needs to be readily available.
• Effective treatment attends to multiple needs of the individual, not just his
or her drug abuse.
• Remaining in treatment for an adequate period of time is critical.
• Counseling—individual and/or group—and other behavioral therapies are
the most commonly used forms of drug abuse treatment.

17. Principles of Effective Treatment
• Medications are an important element of treatment for many patients, especially
when combined with counseling and other behavioral therapies.
•
• An individual's treatment and services plan must be assessed continually and
modified as necessary to ensure that it meets his or her changing needs.
• Many drug-addicted individuals also have other mental disorders.
• Medically assisted detoxification is only the first stage of addiction treatment and by
itself does little to change long-term drug abuse.
• Treatment does not need to be voluntary to be effective.
• Drug use during treatment must be monitored continuously, as lapses during
treatment do occur.

18. Interventions

19. Detoxification
Detoxification is the process by which the
body clears itself of drugs and is often
accompanied by unpleasant and sometimes
even fatal side effects caused by withdrawal.

20. Medically Assisted Treatments
Medically assisted treatment (MAT) is a type of pharmacotherapy that describes
any type of treatment that's used for substance use disorders that includes a
pharmacologic intervention as a part of their treatment plan.
• The goal is for the patient to recover and to be able to fully function in society.
• Methadone (Opiate/Heroin)
• Buprenorphine (Opiate/Heroin)
• Disulfiram (Antabuse)
• Naltraxone (Vivitrol) - alcohol
• Acamporsate (reduces WD symptoms)

21. Long-Term Residential Treatment
• Long-term residential treatment
– 24 hours a day,
– Non-hospital settings
– Therapeutic community (TC)
– lengths of stay between 6 and 12 months.
– Treatment is highly structured- confrontational at
times

22. Short-Term Residential Treatment
• Short-term residential programs
– Intensive but relatively brief treatment based
on a modified 12-step approach.
– 28-32 day model

23. Outpatient Treatment Programs
• Treatment costs less than residential or
inpatient treatment
• More suitable for people with jobs or
extensive social supports
• Intensive Outpatient Treatment (IOP)
– Group counseling can be a major component

24. Individualized Drug Counseling
Individualized drug counseling
• Focuses on reducing or stopping illicit drug
or alcohol use
• Addresses related areas of impaired
functioning such as employment status,
illegal activity, and family/social relations
• Content and structure of the patient's
recovery program.

25. Group Counseling

26. Recovery Coaching
Recovery coaching is a form of strengths-based support for persons
with addictions or in recovery from alcohol, other drugs, codependency,
or other addictive behaviors. Recovery coaches work with persons with
active addictions as well as persons already in recovery.
Recovery coaches do not:
• Offer primary treatment for addiction
• Diagnose
• Associate with any particular method or means of recovery

27. Farley Center at Williamsburg Place
What is the Farley Center at Williamsburg Place?
• Partial Day Hospitalization Program. (Varying length of stay with a treatment
experience averaging as short as a few days to 12 weeks)
• Treat Adult Alcohol and Drug Addiction and/or Dual Diagnosis patients. (18 yrs and
up)
• 72 bed capacity
• FC/WP is accredited by the Joint Commission on Accreditation of Healthcare
Organizations
Where is the Farley Center at Williamsburg Place?
• Located on 10 acres outside of Historic Colonial Williamsburg, VA. (Mooretown Road)
• 40 minutes from Richmond Airport (International)

28. We Treat Families
Not Just the Addict/Alcoholic

29. Goals of WP Treatment
• Safe medical withdrawal ―Detox‖
• Development of abstinence-based lifestyle
• Nurture identity apart from professional lifestyle.
• Exposure to and assimilation into 12-step programs
• Developing and practicing recovery skill set under
stressful and unpredictable circumstances
• Identify and address relapse warning signs
• Internalize need for surrogate decision making across
Psychosocial domains

30. Programs Offered
• Addiction Treatment/Dual Diagnosis
• Addiction Treatment/Chronic Pain
• In-Resident and Outpatient Evaluations
• Family Program
• Addicted Professionals
• Physicians
• Dentists
• Attorneys
• Pharmacists
• Business Executives

31. References
White, W. L. (1999). A lost world of addiction treatment. Counselor,
17(2), 8-11.
Kleber, H.D. Outpatient detoxification from opiates. Primary Psychiatry
1:42-52, 1996.
Lewis, B.F.; McCusker, J.; Hindin, R.; Frost, R.; and Garfield, F. Four
residential drug treatment programs: Project IMPACT. In: J.A.
Inciardi, F.M. Tims, and B.W. Fletcher (eds.), Innovative Approaches
in the Treatment of Drug Abuse, Westport, CT: Greenwood Press,
pp. 45-60, 1993.
http://www.asam.org/

32. Questions?
Gina de Peralta Thorne, MS
gthorne@farleycenter.com
757-565-0106