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Conclusion By 1940, all the elements were in place for a configuration of ideas about opiate addiction that remained essentially stable until the enormous demographic changes in drug use that characterized the 1960s. For psychiatrists and pharmacologists, social concerns about opiate addiction in the 1920s and 1930s had created opportunities for disciplinary growth and creation of new knowledge consistent with prevailing theoretical currents in each discipline. In psychiatry, through the work of Lawrence Kolb, a view of addiction consistent with the creation of the new public health psychiatry of adjustment had displaced competing medical views. In pharmacology , formulating a research strategy that linked solving the addiction problem to the development of better medicines had brought resources for creating a research infrastructure to balance the new teaching opportunities resulting from the reform of medical education. Disciplinary leaders and addiction experts in each discipline saw no inconsistency between their intradisciplinary concerns and the objectives of policy makers in the Public Health Service and the Bureau of Narcotics . Similarly, the addiction research interests of the psychiatrists and pharmacologists in the 1920s and 1930s served the aims of reforming physicians in the American Medical Association leadership. A cluster of related ideas provided a conceptual framework that seemed to confer coherence on the separate efforts of Public Health Service researchers like Lawrence Kolb, pharmacologists seeking improved opiate analgesics, Bureau of Narcotics officials enforcing laws against drug trafficking and possession, and physicians aiming to raise the status of their profession. For all of these groups, addiction in its current problematic form was associated with the emergence of a complex, modern society. Psychiatrists noted that the increasing complexity of an industrial civilization exacerbated the problems of adjustment. The growing association of opiate addiction with marginal urban neighborhoods, the demimonde of new entertainment and crime venues, seemed to reflect a disparity between social demands and individual capabilities. For pharmacologists, and for policy ⡢⡡⡢ ⡠⡣⡠ makers like Lawrence Dunham at the Bureau of Social Hygiene, the development of newer, stronger drugs and the invention of improved drug delivery tools like the hypodermic syringe meant that addiction was a specific hazard unfortunately associated with desirable medical progress. The AMA’s long campaign, dating from the 1870s, to gain increased control over the distribution of medications to the public had addressed opiate addiction as a particularly important area of concern. From the late nineteenth century to about 1920, both medical and public opinion agreed that physicians’ prescribing practices were chiefly responsible for widespread addiction. By the 1930s, the AMA was able to cite Kolb’s theory that the etiology of addiction lay in personality defects, as well as its own activities in restricting the medical uses of opiates, in denying physicians’ responsibility for the prevalence of addiction.1 A commitment to reducing addiction through controlling the world supply of opiates also linked these interests. The original impetus for passage of the Harrison Narcotic Act had been part of an effort to limit worldwide supplies of opiates to the amounts needed in medical practice. The medical profession approved of keeping opiates out of the hands of the public by means of prescribing laws that gave physicians virtually complete authority to determine who could legally consume opiates. Defining these and other drugs as substances so powerful that only expert medical knowledge could deploy them safely and effectively was entirely consistent with the larger current of medical reform from about 1900 to 1940. The work of the Bureau of Social Hygiene’s Committee on Drug Addictions , always consistent with the aim of setting import quotas for opiates, became focused more closely on this activity following Lawrence Dunham ’s assumption of the committee’s directorship. No unitary explanation of addiction emerged in the period under consideration , and certainly effective control of addiction was not achieved in the form of either definitive cure or foolproof policy. However, Kolb’s psychiatric explanation of the addict’s personality and the focus of the NRC’s Committee on Drug Addiction’s pharmacologists on the physiological aspects of tolerance and withdrawal formed a set of ideas that dominated medical and scientific thinking about addiction for several decades. Besides publishing his landmark articles on the psychiatric etiology of addiction in 1925, Kolb worked to disprove physiological theories of addiction that would have challenged his own views. If, for example, Ernest Bishop’s and George Pettey’s autoimmune theory of addiction were correct, then the process would work identically in all individuals, and Kolb’s...

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