Slaying the Dragon: The History of Addiction Treatment and Recovery in America (review)

William L. White. Slaying the Dragon: The History of Addiction Treatment and Recovery in America. Bloomington, Ill.: Chestnut Health Systems, 1998. xvi + 390 pp. Ill. $19.95 (paperbound, 0-938475-07-X).

Slaying the Dragon tells the story of addiction treatment in the United States from the post-Revolution "alcoholic Republic" to the present day.

Writ broadly, the narrative recounts the intertwined history of two therapeutic traditions: "mutual aid" or self-help groups inaugurated by the alcoholic-led Washingtonian Total Abstinence Society in the 1840s, and the professional medical specialty with roots in the postbellum "inebriate" asylums. Both were temporarily stymied by the harshly punitive climate of the 1920s, when legal and medical authorities began to define addiction as a criminal vice instead of a treatable disease. The mid-century rise of Alcoholics Anonymous—which serves as a protagonist of sorts in the story—heralded an end to this dark era for addiction treatment. The famous self-help society played a prominent role in rescuing the reputation of alcoholics by helping to revive the notion of addiction as a disease. It also powerfully influenced the development of the reemerging medical specialty by codifying and proselytizing the notion of "recovery" as an ongoing spiritual project rather than a one-time fix. By the early 1980s, backed by favorable legislation and generous funding, addiction treatment had become an established specialty (Board certification for physicians became available in 1983) and a surprisingly strong cultural influence.

The basic contours of Slaying the Dragon will be familiar to students of U.S. drug and alcohol history. William White's narrative echoes David Musto's The American Disease: The Origins of Narcotics Control (1973), which still offers the authoritative account of the criminalization of addiction in the 1910s and 1920s and the rebirth of therapeutic approaches in the 1960s. White also builds on the work of addiction historians such as H. Wayne Morgan, David Courtwright, John Burnham, AA historian Ernest Kurtz, and pioneering sociologist Alfred Lindesmith. What Slaying the Dragon contributes to this small but fascinating body of scholarship is a tight focus on the development of addiction treatment. Treatment programs do appear in earlier works—Musto, in particular, pays close attention to Progressive Era "narcotic clinics"—but White is the first scholar to follow the history of this branch of therapeutics continuously from the musings of Benjamin Rush to modern times. No treatment approach, it seems, escapes his gaze, from nineteenth-century water cures to Synanon, from federal "narcotics farms" to methadone maintenance. Drawing from a remarkable range of published and archival sources and (for later chapters) personal interviews, he provides rich and detailed descriptions of the methods and philosophies of these programs and their leading personalities. Much of this is new and valuable historical territory, unavailable in other secondary literature.

White holds an M.A. in addiction studies, and during his thirty years as a practitioner, administrator, and consultant in the field he has written several books on treatment strategies and related issues. Slaying the Dragon, his first historical effort, belongs with those earlier works (it was published by his employer, Chestnut Health Systems): it is written for addiction treatment professionals, analyzing the triumphs and follies of past efforts in the service of producing more humble and enlightened approaches today. This admirable goal can, unfortunately, make the text a frustrating one for historians. White leaves readers awash in details about the operations and philosophies of programs, but rarely locates them in a broader medical or social context. We learn, for example, about the importance of religion as a recovery strategy, but never get a sense of why religious groups have been interested in drug and alcohol addicts in the first place, and how this has changed over time. Major cultural phenomena like Prohibition and the Women's Christian Temperance Union slip by almost unmentioned, despite their apparent relevance. Even...