History of Alcohol Rehabilitation and Treatment in America
Most historians point to the meeting in Akron, Ohio in 1935 as the beginning of alcohol treatment in America. The meeting being referred to is the joining of ideas and philosophies by the co-founders of Alcoholics Anonymous or AA. These two men, Bill Wilson and Dr. Bob Smith (known among the AA membership as Bill W. and Doctor Bob) combined their ideas into "The Big Book", which delineates AA's Twelve Step program of spiritual and character development. Eleven years later, the Twelve Traditions were introduced to AA to address their growth and unity problems. These traditions recommended that AA members acting on behalf of the fellowship steer clear of dogma, governing hierarchies and involvement in public issues.
The AA movement gathered support because its success rate of approximately 10% was better than any other organized approach at addressing alcoholism. Alcoholics Anonymous is a self-help organization that now claims to have over two million members worldwide.
It should be noted that these founders of AA created a movement whose "primary purpose is to stay sober and help other alcoholics achieve sobriety." This organization never stated that this was a form of alcohol treatment, in fact, they stated that the principals of AA should never be institutionalized into a treatment setting because its strength comes from an understanding of mutual sharing and support and not the traditional treatment with lessons being taught by a therapist who has learned a type of therapy to apply to his patients.
Alcoholics Anonymous wasn't the first social movement of bringing individuals together to share their negative experiences with alcohol, since there is evidence that Native Americans were doing something of the same as early as 1772.
A United States Congressional Study entitled: "Broadening the Base of Treatment for Alcohol Problems", gives credit to Dr. Benjamin Rush, who was a surgeon general in the Continental Army and a signer of the Declaration of Independence, as being the founder of the concept of treatment for alcoholism in America in 1785, when Dr. Rush published a work that suggested that alcoholism was a disorder that should be treated. Colonial America wasn't ready for the idea that addiction was a disease that should ethically be treated, but wanted to hold on to their superstitious ideas of devil possession and other such origins of these problems of the soul, so Dr. Rush's ideas were pretty much ignored until nearly a century later when the Washingtonian Movement began.
America's reaction to the widespread problems of alcoholism fueled the establishment of the Washingtonian movement, also called Washingtonians, Washingtonian Temperance Society or the Washingtonian Total Abstinence Society. Six alcoholics who came together at Chase's Tavern on Liberty Street in Baltimore, Maryland founded this organization in 1840. The idea of their group was very similar to that of AA; relying on each other, sharing their alcoholic experiences and seeking divine help could help remove them from their addiction to alcohol. The Washingtonians differed from the temperance movement of the same time, in that their focus was on the individual alcoholic rather than on society's greater problems with liquor.
Americans were vexed between the ideas that alcoholism was a problem coming from the sale of liquor or an individual problem that needed treating. This ambivalence was seen in America's approach to treatment in the mid-1800s with the establishment of inebriate asylums or reformatory homes for alcoholics, which included the New York State Inebriate Asylum, The Inebriate Home of Long Island and the Home for the Incurables in San Francisco. Some of the membership rush into the Washingtonians came from these punitive ideas of alcoholics. At its peak, Washingtonians claimed to have as many as 600,000 members.
The ideal that addiction was a disease was first promoted in the 1870s by a group of physician who called themselves the "American Association for the Cure of Inebriates", who published a decree stating that "Intemperance is a disease."
The Alcoholics Anonymous community supports that idea of alcohol addiction being a disease, and was the main force that drove the AMA (the American Medical Association) to claiming it as a disease in the 1950s. This idea of alcoholism being a disease led to addiction as a whole being classified as a disease, which has led many treatment professionals to believe in the statement: "Once an alcoholic, always an alcoholic". This concept didn't come merely from the idea that addiction, and specifically alcoholism, was a disease, but that this disease falls under the categories of a chronic disease, meaning that it lasts continually and is a progressive disease, meaning that alcoholism gets worse as time passes, whether an alcoholic is abstinent or not.
One can easily see that an idea of a problem being an incurable disease can arise from failed attempts at treating this problem. It is true that untreated alcoholism and other addiction will progress as the body is no longer able to withstand the onslaught of poisons that require metabolizing as well as the alcoholic's demoralization that comes from repeated failures at addressing his resolve to take control of his life.
Whether alcoholism is a chronic and progressive disease isn't as important as what the professionals in the addiction field have done to address this problem. If you follow the most recent history of alcohol treatment, since the 1970s, you will see that billions of dollars have been made by treatment programs that use the philosophy of AA and some group therapy to establish and codify what has been characterized as the Minnesota model of treatment. This model of treatment violates the tenants of AA founders by bringing the AA philosophy into a treatment setting, and the poor treatment outcomes have further defined this problems as a disease of relapse and other characterizations that translate into the idea that if you are an alcoholic, you may never free yourself from this addiction.
However, some treatment modalities that have a record of success at ending the compulsion to alcoholism refrain from categorizing this problem as a disease or as a combination of problems that need to be addressed and resolved. Narconon, one of the largest alcoholism and drug treatment programs in America, approaches alcoholism from a viewpoint that there are physical, behavioral and spiritual problems that need correcting before a person can take control of his life. These programs build the physical and intellectual strength of the person so that a high percentage of their graduates don't revert to alcohol consumption, but build on their successes to be productive citizens.