addiction--and to the emerging “crack epidemic”
in the late 1980s, substance use and addiction
increasingly were criminalized.^126 This trend
toward criminalization was reflected in federal
and state laws such as New York’s Rockefeller
Drug Laws which created mandatory minimum
sentences of 15 years to life for possession of
four ounces of narcotics (about the same as a
sentence for second-degree murder).^127 Later,
prescription opioid medications were heavily
marketed for pain which led to increased
negative consequences associated with their use
and renewed calls for increased legal
restrictions.^128 (See Text Box on page 28.)
The latter half of the 20th century has seen more
systematic and consistent progress in how
addiction is perceived in the medical field. In
1956, the American Medical Association
(AMA) declared that alcoholism is an illness and
that it can and should be treated within the
medical profession;^130 in 1967, the AMA
elaborated on this position in a manual for
physicians declaring that alcoholism is
characterized by a distinct pattern of symptoms,
chronicity, progression, and by a tendency
toward relapse and that it should be treated by
physicians.^131 The U.S. Comprehensive Alcohol
Abuse and Alcoholism Prevention, Treatment,
and Rehabilitation Act of 1970 recognized
alcoholism as “an illness requiring treatment and
rehabilitation.”^132
In 1979, the AMA Council on Scientific Affairs
published Guidelines for Physician Involvement
in the Care of Substance-Abusing Patients
which put the weight of policy behind the
declaration that physicians are responsible for
addressing alcohol and other drug use in their
patients by engaging in diagnosis and referral (at
a minimum) and preferably interventions that
would ready the patient for treatment or actually
providing treatment and follow-up care; the
guidelines also specify the actions and
knowledge required for each level of physician
involvement.^134 In 1989, a third of a century
after declaring that alcoholism is a disease, the
AMA adopted a policy declaring addiction
involving other drugs--including nicotine--to be
a disease.^135Addiction involving alcohol and other drugs first
was viewed by the field of psychiatry* as a
symptom of an underlying personality disorder
in 1952;^136 in 1980, addiction involving nicotine,
alcohol and other drugs was described by the
American Psychiatric Association (APA)† as an
independent disorder--a substance use disorder
for which the clinician was instructed to specify
the substance involved in the addiction.^137From the mid-1990s through the present day
there has been a growing backlash against a
punitive approach to individuals with
addiction,^138 concomitant with the growth in
scientific understanding of the brain processes
underlying addiction and the development of
evidence-based pharmaceutical and psychosocial
therapies to treat it.^139 Yet it was not until the
late 1990s that addiction began to gain broader
recognition as a brain disease.^140* By the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorder
(DSM), first edition. (See page 31 for a description
of the DSM.)
† In the DSM-III.The history of addiction as a brain disease looks
a lot like the history of atoms or germs, insofar
as these were all older and controversial ideas
for which scientific confirmation later became
available.^129--David T. Courtwright, PhD
Professor, Department of History
University of North FloridaAlcoholism must be regarded as within the
purview of medical practice. The Council on
Mental Health, its Committee on Alcoholism, and
the profession in general recognizes this syndrome
of alcoholism as illness which justifiably should
have the attention of physicians.^133--American Medical Association
Reports of Officers
Report of the Board of Trustees, 1956