Our country’s history of treating those with substance use disorders is a long, fascinating and often disturbing one — a saga brought to vivid life by author, historian and addiction expert William “Bill” L. White in Slaying the Dragon: The History of Addiction Treatment and Recovery in America.
The award-winning book, first published in 1998, tells the story of reform clubs, “Gold” cures, forced sterilization, missions, asylums, AA and of a populace seemingly unable to decide from one moment to the next whether addiction should be considered sin or sickness — a conversation that continues today. Not only a historian and prolific writer, White has been a street worker, counselor, clinical director, trainer and researcher. His contributions to the treatment field have been acknowledged by numerous awards from groups such as the National Association of Addiction Treatment Providers and the National Council on Alcoholism and Drug Dependence, to name just a couple. He now speaks out against stigma as a volunteer consultant to Faces & Voices of Recovery and is Emeritus Senior Research Consultant at Chestnut Health Systems. His collected papers can be found at williamwhitepapers.com.
White released a second edition of Slaying the Dragon in summer 2014. He talked to Addiction.com about the changes those 16 years have brought and the back story of the book, as well as his thoughts about how far we have and haven’t come in helping those dealing with addiction:
Addiction.com: What inspired you to write Slaying the Dragon: The History of Addiction Treatment and Recovery in America?
Bill White: I began work in the addictions field in the 1960s and was shocked some years later to discover that there were addiction treatment institutions that had existed in the United States more than a century earlier. That discovery and my disappointment that such knowledge had not been included in my early orientation and training in the field sparked my interest in reconstructing the history of addiction treatment and recovery in the U.S.
What started as a hobby in the mid-1970s grew into more serious and scholarly research under the mentorship of such historians as Dr. Ernest Kurtz and Dr. David Musto. The research took years because I kept stumbling onto fascinating episodes within this history that had been lost. My wife became convinced that Slaying the Dragon was a book that would never be completed.
Addiction.com: What most surprised, discouraged and encouraged you during the research and writing of Slaying the Dragon?
BW: The biggest surprises were how early recovery mutual aid groups and addiction treatment organizations appeared within American history and the pervasive presence of “harm in the name of help” within the history of addiction treatment. The history of treatment is filled with bizarre and harmful treatments and the financial exploitation of individuals and families affected by addiction. And in spite of such insults, individuals and families have found ways to rise above these problems for more than 250 years.
What was most encouraging to me was that any time within this history that systems of care or mutual support collapsed, recovering people, their families and visionary professionals would rise from the ashes of that collapse to organize new recovery support systems. I am confident that if our current addiction treatment and recovery mutual aid organizations collapsed today, new systems of recovery support would arise tomorrow. Momentum for recovery is unchecked within American history, even as organizations within the field have struggled to forge a core set of values and strategies that could assure their long-term resilience and effectiveness. That enduring spirit of recovery across the generations was a great source of inspiration within this larger story I was trying to tell.
Addiction.com: The cover of Slaying the Dragon includes a photo from the late 1800s of a group of men beneath a sign proclaiming “Medical Not Penal Treatment Reforms the Drunkard.” It seems a progressive message for the era. Do you feel we are still trying to learn this lesson?
BW: We are still trying to learn that lesson. We continue to experience moral panics at a cultural level that are ignited and exploited by politicians, numerous industries and the media for the profits reaped from such social hysteria. The outcome is that we again try to incarcerate our way out of what is more effectively understood as a personal health issue and a public health problem.
Such reactionary measures, while feeding these industrial economies, reap more personal and social harm than the problems they promise to solve. The mass incarceration experiment since the 1980s targeting poor communities of color has reaped horrific consequences on these families and communities that will reverberate for generations in the same way the traumatizing effects of the 19th- and 20th-century Indian Boarding Schools continue to reverberate through Indian communities today.
Addiction.com: The second edition of Slaying the Dragon was recently released. What has changed from the first edition?
BW: Since publication of the first edition, there had been seminal research by others on some of the earlier periods of history. There were also more than 16 years of new addiction and recovery research and, of course, the many significant developments within the field that transpired since publication of the first edition in 1998. That addiction treatment has gone through significant challenges and changes in these years is self-evident, but what the public may not fully appreciate are some of the momentous and unprecedented events that have occurred within the larger history of addiction recovery. Such events include the growth and diversification of recovery mutual aid societies, the cultural and political mobilization of people in recovery, the emergence of new grassroots recovery support institutions, the rise of recovery as a potentially new organizing paradigm for national drug policy, and key breakthroughs in recovery research. Pulling together the threads of these developments into new chapters within Slaying the Dragon was a work of love.
Addiction.com: Where do you think we’re headed as a nation in our treatment of those dealing with addictions? And where do you think we should be headed?
BW: We are in the process of radically redesigning addiction treatment in the United States from acute and palliative care models of intervention to models of assertive and sustained recovery management wrapped in larger recovery-oriented systems of care. These transformation processes are fundamentally changing clinical practices within addiction treatment across such dimensions as attraction, access, engagement and retention, screening and assessment, service planning, service relationships, locus of service delivery, composition of the care delivery team, the service menu and, in particular, the nature and duration of post-treatment monitoring and support.
Systems performance data across these dimensions are profoundly changing addiction treatment and will continue to do so in the coming decades. The potential fruits of these changes will include a dramatic shortening of addiction careers in the U.S., a major increase in recovery prevalence across diverse cultural contexts and the mobilization of people in recovery as a force for the prevention of addiction at the local community level.
Addiction.com: What do you think are the most important things we can do to end our nation’s epidemic of addiction?
BW: Dependence on illicit drugs is only the most culturally visible tip of that epidemic. We need to eschew the notion of “good drugs” and “bad drugs” and forge public health policies that address the personal and social harm from the whole spectrum of psychoactive drug use and dependence. We cannot continue a war on some drugs (and their users) while subsidizing and politically catering to legal drug industries whose interests are served by enhancing the pharmacological potency of their products, expanding who uses their products and altering social mores about when, where and how such substances can be used in ways that undermine personal and public health. We need, but will unlikely get, a comprehensive public health approach to cultural management of psychoactive drug use. Too many people and too many organizations currently profit from the absence of such an approach.
Addiction.com: You talk of the “problem of language” surrounding addiction. Why do the words we use matter?
BW: Words have immense power to wound or heal. The wrong words shame people with alcohol and other drug problems and drive them into the shadows of subterranean cultures. The wrong words, by conveying that people are not worthy of recovery and not capable of recovery, fuel self-destruction and prevent or postpone help-seeking.
The right words serve as catalysts of personal transformation and offer invitations to citizenship and community service. The right words awaken processes of personal healing, family renewal, and community and cultural revitalization. The wrong words stigmatize and disempower individuals, families and communities. Words determine the social institutions that will lay claim to AOD [alcohol and other drug] problems and whether people with such problems will find themselves in systems of compassion and care or systems of control and punishment.
We must forge a new vocabulary that humanizes AOD problems and widens the doorways of entry into recovery. It is time we embraced a new language that helps us talk about how we heal ourselves, our families and our communities. It is time we abandoned a rhetoric that declares war on our own people.
Addiction.com: You are active in the Recovery Movement. Why did you get involved and why do you think the movement is an important one?
BW: I got involved in the late 1990s in helping birth new grassroots recovery community organizations (RCOs) in the United States. In many ways, this movement was an effort to counter the restigmatization, demedicalization and recriminalition of addiction that had prevailed in the U.S. in the 1980s and 1990s. In 2001, leaders of RCOs came together in St. Paul, Minnesota, to found Faces & Voices of Recovery and to officially launch a national recovery advocacy movement. Following the St. Paul Recovery Summit, I served as a mix of cheerleader and historian of this movement.
That movement has come a long way in the past 15 years. Historically, the consequences of addiction have been very visible in the U.S., but recovery, because of the attached social stigma, has been quite invisible. The new recovery advocacy movement is changing that by putting hundreds of thousands of faces and voices on the experience of addiction recovery. I have walked in public recovery rallies in U.S. cities where people in recovery and their families were marching as far as my eyes could see. That is something I never thought I would witness in my lifetime.
Addiction.com: Can you point to moments where we have gone astray in our history of addiction treatment in the U.S.? Do you feel we are on the right track now? If not, how can we get on track?
BW: When social stigma attached to excessive alcohol and other drug use was at its greatest, the resulting contempt toward people experiencing these problems created a climate in which the most harmful treatments emerged — from prolonged and involuntary sequestration from the community, mandatory sterilization laws, the indiscriminate application of electro- and chemo-convulsive therapies, potentially lethal medication protocol, humiliating confrontation tactics — all in the name of help.
It is easier to look back in historical hindsight and wonder, “What the hell were they thinking back then?” But what I have learned is that it is sometimes very hard to see the “harm in the name of help” perpetrated within the present. History is a great teacher of the value of humility and rigorous self-examination. What we are now seeing is rigorous scientific evaluation of addiction treatment as a system of care and the use of scientific data to guide the reconceptualization and execution of addiction treatment. That is a very positive trend if we can speed the application of this growing base of knowledge, but we also need the voices of people affected by this problem to be heard at all levels. That is what the new recovery advocacy movement is contributing.
Addiction.com: Your career in the addiction treatment field and as a historian is a remarkable one. What is your proudest achievement?
BW: Nothing pleases me more at a personal level than the individuals and families I have helped guide into recovery over the past decades, but, as a historian and writer, I experience great satisfaction in knowing that Slaying the Dragon has given addiction professionals and other recovery support specialists a sense of their history and that some of my advocacy writings have helped inspire grassroots recovery advocacy organizations in the U.S. and in other countries.
I also hope I will be known as someone who worked to reconnect addiction treatment to the larger and more enduring process of addiction recovery and to reconnect addiction treatment organizations to the grassroots communities out of which the modern field was birthed in the mid-20th century.