The history of addiction rehab and why we need a different approach for opioids

Explore the evolution of addiction treatment & rehabilitation and understand how these developments have shaped modern approaches to overcoming substance abuse.

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Humanity has a long and complicated relationship with mind-altering substances. In fact, drugs have likely been in use since before written history in forms that include alcohol, tobacco, cannabis, coca leaves, caffeine, poppy seeds, and mushrooms, among others. Interestingly, addiction also dates back to before you might expect. Mentions of alcohol misuse can be found in European writings from the 1600s, with discussions of treatment showing up in the mid-1700s.

As the opioid crisis continues to affect millions across the U.S., it’s helpful to understand where and how “rehab” originated, and look closely at the efficacy of the predominant treatment model in America today.    

Historic timeline of addiction treatment and rehabilitation
Timeline of the evolution of addiction treatment and rehabilitation.

4 things you might not know about the history of addiction treatment and rehabilitation

1. The 12-step format was heavily influenced by Christianity

In the United States, alcohol was the first drug to present major public health concerns. The first substance abuse treatment programs were designed to address alcohol use, and these strategies have influenced addiction treatment philosophies across the board.

The most well-known treatment program is the 12-step approach famously employed by Alcoholics Anonymous (AA). Two of the founders of this group, Bill Wilson and Dr. Robert Holbrook Smith, were members of a Christian revival group during the 1930s known as The Oxford Group. The Oxford Group had six core tenets, which influenced the development of the 12 steps used by AA and its successors. 

From the start, AA viewed alcoholism as a spiritual, physical, and mental affliction. So the solution is also rooted in spirituality. This 12-step model is still used in programs today that seek to treat everything from eating disorders to opioid use disorder (OUD) and gambling problems.

Because AA and the “off-shoot” programs like NA (Narcotics Anonymous) are rooted in a fellowship, you’ll see that group therapy is a big part of a lot of rehab centers today. For instance, patients in rehab may have to meet weekly or more and go around the room recounting their positive or negative actions or who they might need to apologize to. In other words, the emphasis is on psychosocial interventions, not medical ones.

Thoughts and prayers won't stop opioid addiction, medication as treatment will.
While religious beliefs have influenced the history of addiction treatment, thoughts and prayers won't stop opioid addiction.

2. The debate between abstinence- and medication-based treatment is not new

Many rehab programs today focus on recovery through abstinence, and this approach has been used for nearly 200 years in various forms. However, people have been looking for medical treatments that curb and cure addiction along the way. As early as the 1870s, commercial medical facilities (Keeley Institutes, most notably) throughout the United States were offering medicinal cures and home remedies for alcoholism. In the 1880s, Sigmund Freud recommended cocaine as a treatment for both alcohol and morphine addiction. This is one of the earliest known treatment proposals for opioids specifically.

Today, there are still many parties advocating for abstinence-based opioid treatment despite the surge in research showing that medication-assisted treatment saves lives and reduces rates of relapse. Despite this evidence, there’s a persistent belief that using a drug to treat drug addiction isn’t a treatment at all; that it simply “replaces” one addiction with another.

3. Naloxone was FDA-approved in 1971

In the wake of the World Wars and subsequent global conflict, morphine saw increased use as a painkiller among the military, and it eventually became a mainstream medical treatment for pain. This contributed to growing rates of addiction among exposed servicemen. In 1971, naloxone (commonly sold as Narcan®) was approved by the FDA for its ability to reverse or override an ongoing opioid overdose. Naloxone has an incredible affinity for bonding with the brain’s opioid receptors and can stop opioids in a person’s system from taking effect. This drug has been increasingly used in community-based settings to save countless lives over the past decade.

4. Abstinence-based treatment outcomes are basically a coin toss

Today, Suboxone® is one of the most common medications for opioid use disorder. It’s a combination of naloxone and buprenorphine; these two drugs significantly reduce cravings, protect against overdose, and keep patients stable for longer. In study after study, patients are shown to have better rates of survival and better outcomes when undergoing medication-assisted treatment (MAT) than in abstinence-based programs. 

However, many contemporary treatment programs are still hesitant to include medication as a part of treatment, and people often feel stigmatized for taking medication. In alcohol addiction treatment programs, abstinence-only methods have higher rates of success, but when it comes to opioids, abstinence simply isn’t effective for most people. Abstinence-only treatment and rehab programs for opioid use often see over 50-90% of their patients relapse within a year. 

Because the history of addiction treatment has been so heavily influenced by alcohol treatment methods, many programs have been slow to see the benefits of MAT. Some treatment centers across the nation are beginning to include MAT in their regimen. This transition is saving lives and helping those with OUD find stability and support in a challenging environment. But we need widespread change in order to really make a difference.

An evidence-based alternative to rehab

Given what we know about medication as a treatment for substance use disorders, it’s time to rethink the entire process. Ophelia uses telehealth to provide care and support in the comfort and privacy of home. After intake, you’ll meet with a clinical care team to get your naloxone-buprenorphine protocol off on the right foot and receive ongoing support on your schedule. No more barriers, no more stigma, just reliable, personalized treatment.


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