The Points Interview — Eoin Cannon

Note: Points’ managing editor, Eoin Cannon, favors us, today, with an interview on his just-out, new book, The Saloon and the Mission: Addiction, Conversion, and the Politics of Redemption in American Culture  (University of Massachusetts Press, 2013). BTW, Big Congratulations, Eoin!

Cannon-coverDescribe your book in terms your bartender could understand.

Sorry, barkeep, but this book is about people who ceased to need your services and then made a realllly big deal about it.  It’s about how and why people have told stories of recovery from alcoholism publicly since the late 19th century.

I focus especially on the legacies of the “drunkard’s conversion” testimonies given in urban evangelical missions and circulated widely in print from the 1880s to the 1910s. Despite their roots in old-time religion, these stories’ urban class dynamics made them compelling to those who saw the knot of poverty, ethnic difference, and vice as a modern social crisis. In personal voices and realistic slum settings, the drunkards’ conversion stories defied the irreversible fates associated with these categories. The practical understanding of salvation they offered also made such tales susceptible to a wide range of interpretations. So instead of seeing conversion stories as individualistically oriented distractions from structural injustices — as skeptical readers today might — many reformers, artists, and intellectuals in this period retold them as stories that modeled a wider social healing by the lights of a variety of social theories, from radical to reactionary. In the context of this contested discourse around the meaning of the drinker’s redemption, literary writers through the modern period told stories of alcoholism with high stakes. The drinker’s descent was a character-based crisis, but one that plumbed modern society’s perceived maladjustment and, possibly, harbored clues to its regeneration.

This programmatic approach to redemption shaped the storytelling conventions available to the budding recovery movement in the 1930s and beyond. A.A.’s pioneers subsumed the contested aspects of the form into a recognizably Depression-era revision of the self, one that understood the limitations of individualism in social as well as in spiritual terms. In mutual-aid circles, these stories could remain highly pragmatic, devoted to A.A.’s “primary purpose.” But public recovery stories since the rise of A.A. have taken the social ethic of mutual aid beyond twelve-step culture and out into the wider society. These stories often depict recovery as the solution to a social problem or even as the model of an ideal society. As such, they have tracked the progress of liberalism since the New Deal era and, I argue, helped to shape its redemptive ethos in the realm of culture. Cannon

So while we may not openly contest the meaning of the modern recovery story, preferring to accept that it simply describes how a sick person got well, the story form is so constructed as to embody foundational claims about the self and its relation to others. If we as a society don’t agree on those claims, neither will we agree on the meaning of recovery — arguably a dissensus increasingly in evidence since the 1960s.

What do you think a bunch of drug and alcohol historians might find particularly interesting about your book?

Most interesting might be the things they are most likely to question. First, I started my pre-history of recovery narrative in the postbellum rescue missions, rather than in the Washingtonian Movement of the 1840s. I placed a lot of weight on the secular implications of prevailing interpretations of mission testimonies, despite the fact that they had been preceded by an already secular movement a generation earlier. I did so because I found that the rescue mission stories were influential in mediating institutions — church homiletics, progressive reform, academic psychology, realist literature — which in turn informed the redemptive ideals and the storytelling styles more broadly associated with recovery in the 20th century. In other words, the rescue missions provided a master narrative of modern addiction storytelling.  Continue reading

Complete Quarterly Journal of Inebriety (1876-1914) Now Available Online

Editor’s note: This is an exciting development for researchers in addiction history and a welcome contribution from Weiner and White.

After more than a decade of persistent searching and meticulous collecting, a team led by historian William L. White and Hazelden Library Manager Barbara Weiner has acquired and digitized all 141 issues of the Quarterly Journal of Inebriety, which, from 1876 to 1914, documented the earliest stages of addiction medicine in the United States.

QJI issue 2 masthead clean editedThe Quarterly Journal of Inebriety (QJI) was published by the American Association for the Study and Cure of Inebriety (AACI), a group of managers and doctors that formed in 1870 to normalize and improve practices at the residential treatment institutions that had been springing up since midcentury. Its sole editor for 38 years was T.D. Crothers, superintendent at the Walnut Hill Asylum in Hartford, Connecticut and a leading advocate of the medical treatment of inebriety until his death in 1918. The QJI‘s central principle was the disease concept of alcohol and opiate inebriety and although it announced the AACI’s position on various issues, its commitment was to medical knowledge over moral or legal polemic. It was received with some hostility by critics of the disease concept, as well as by temperance advocates and religious reformers refused publication by Crothers for their unscientific approaches. It folded, upon the collapse of the field it represented, when public and political attention to the issue shifted decisively from individual vulnerabilities to dangerous–soon to be illegal–substances (Weiner and White, 2007, see below).

“As the nation’s first scientific addiction journal, [QJI] remains an important resource for us today, in terms of setting contemporary issues in historical context,” said White, emeritus senior research consultant for Illinois-based treatment provider Chestnut Health Systems. “I’m proud that we’ve been able to make it readily and comprehensively available to the public.” White began collecting issues while doing the research for his monumental history of addiction treatment, Slaying the Dragon: The History of Addiction Treatment and Recovery in America (1998). Weiner and her team at Hazelden took up the project in 2000. Continue reading

Reflections on “Addicts Who Survived”: Amund Tallaksen

Editor’s note: Our commentary to accompany yesterday’s excerpt from Addicts Who Survived comes from Amund Tallaksen (NB: if you’ve missed any of the series, please check out the series introduction, the first excerpt, and Eric Schneider’s commentary).  Amund is a doctoral candidate in history at Carnegie Mellon University, presently working on a dissertation examining drugs and drug control on post-World War Two New Orleans.  He has graciously taken some time away from the archives in Louisiana to offer these reflections on Willis Butler’s oral history. 

Shreveport, Louisiana, is a city most Americans know very little about. Close to the Texas and Arkansas borders, Shreveport is the largest urban area in northern Louisiana, the majority-Protestant and more culturally “southern” part of the state (as opposed to the majority-Catholic, geographically southern half). Americans with an interest in drug history, however, have an almost intimate knowledge of what happened in Shreveport in the early 1920s. This is largely because of one man, Willis P. Butler, who ran the narcotic dispensary in the city from 1919 to 1923, providing legal access to morphine for addicts in need. The Shreveport clinic was the longest functioning of all the narcotic clinics in the country (most of which were located in the Northeast) and when Willis P. Butler was forced to shut his operation down in 1923 it unequivocally marked the end of the clinic era.

Willis Butler, at the age of remembering

Willis Butler, at the age of remembering

The clinics were largely forgotten by mid-century, yet when methadone became increasingly available to American opiate addicts in the late 1960s, it created a renewed interest in the clinic system of the 1920s. Willis P. Butler was essentially “rediscovered” in the fall of 1971. One academic managed to get in touch with Butler in early October 1971, and the word quickly spread – the late Yale historian David F. Musto, for example, was among the earliest to get in touch with Butler, only a few weeks later. When interviewed by David Courtwright in 1978, Butler was over ninety years old and among the very few alive to tell the story of the clinics from personal experience. Butler was born in 1888, and graduated from Vanderbilt Medical School in 1911. After finishing his degree, Butler moved to Shreveport and was elected to the role of parish (county) physician and coroner of Caddo parish, a role which included tending to the needs of addicts.

Shreveport, 1919

Shreveport, 1919

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Reflections on “Addicts Who Survived”: Willis Butler’s Narrative

Editor’s note: Not every interview conducted for Addicts Who Survived was of an addict.  The work includes some fascinating oral histories of individuals with notable roles in the modern history of addiction and the drug war.  Among these, Dr. Willis Butler, who operated one of the most notable narcotic maintenance clinics opened around the time of the Harrison Act and closed soon thereafter.  We’ll have commentary to Dr. Butler’s oral history tomorrow.

WILLIS BUTLER

Willis Pollard Butler was the most celebrated and controversial of all the early clinic doctors. Born in modest circumstances in Gibsland, Louisiana, in 1888, Butler moved with his family to Shreveport in 1899, where he took a summer job as a drugstore delivery boy. (Ironically, his chores included the delivery of dram bottles of morphine to the local addicts.) He eventually worked his way through Vanderbilt Medical School, graduating in 1911. Returning home, he applied his talents as chemist and bacteriologist for the Shreveport Board of Health, until he was elected parish physician and coroner in 1916. He served in that capacity for no fewer than forty-eight years. When interviewed in 1978, he was over ninety years old.1

            Butler was above all else a superb politician. He was handsome, charming, articulate, and on a first-name basis with everyone who counted in Shreveport. That, together with the efficient and discriminating manner in which his clinic was run, assured local support and temporarily frustrated the designs of interloping federal agents.

            Although Butler’s memory was phenomenal for a man of his years, it should be borne in mind that his is only one side of the story, that the agents who hounded him and the doctors who turned on him can make no rebuttal. As Butler himself observed, “I don’t know anybody connected with it—top, bottom, or middle—still living except me.For the sake of confidentiality, the names of addicts mentioned by Butler have been changed, as have the names of those who may have violated the law.

I was health officer, medical examiner for this district, and parish physician. One day—it was the third of May, 1919—Dr. Oscar Dowling, president of the state board of health, came to Shreveport. As usual, he called me, because I was representing the state board of health up in northern Louisiana. He asked me down to the hotel to make a culture of his throat—he had a sore throat. I went down there to see him and, as we walked out of the hotel, he said, “Butler, you having any problem up here with addicts?” I said, “Yes. I don’t know about particular problems, but we got a lot of them. I’m having trouble with them in jail, and there’s an awful lot of thievery and that sort of thing going on, and the police say that a lot of them are responsible.” He said, “Well, we have opened up a clinic down in New Orleans, under Dr. Marion Swords. I suggest that you come down there and see how it’s being done, because we have the approval of the government and the Treasury Department Narcotic Division. Maybe you could start the same thing up here.”

Well, I went to New Orleans. I knew Dr. Swords quite well; he was secretary-treasurer of the state board of health. He had this clinic right across from the courthouse on the corner of Conti Street; it looked like a little alley down in the French Quarter. What I saw was a bunch of derelicts coming in, and they were giving them a little vial—it looked like it might hold 15 or 20 cc. He said that they were putting morphine in there, a certain amount according to what they wanted them to start with. The next day, they would put in a little less, but the same amount of water. They were going to get them off of it by reduction. I said, “You don’t know much about addicts if you think that you can fool them as to whether they’re suffering or not.” I said I’d have nothing to do with that sort of thing at all, and I told Dr. Dowling that I did not want to assume any such responsibility. Continue reading

Setting the Record Straight, Part 5: A Disease They Didn’t Have

Editor’s note: Today marks the final installment of guest blogger Marcus Chatfield’s eye-opening exploration of the role that peer-reviewed research played in facilitating the survival of Straight Inc. into the 1990s, as well as its ongoing legacy in coercive youth drug abuse treatment.

In the 1989 Journal of Substance Abuse Treatment article “Outcome of a Unique Youth Drug Abuse Program: A Follow-up Study of Clients of Straight Inc.”, Alfred S. Friedman, Richard Schwartz, and Arlene Utada state that 99 percent of Straight’s clients were white and that 30 percent of clients attended church regularly prior to intake. It is relevant to consider the type of teens that were recruited for “treatment,” as well as how they were recruited for treatment and why their parents placed them in Straight. Notably, several authors have reported that many clients at Straight were treated for a disease they didn’t have. This was due in large part to Straight’s assertion that even the experimental use of alcohol or marijuana was the symptom of a disease. And because this disease was the cause of even initial drug use, treatment was required whether teens had experimented with drugs or not. Many clients in Straight were “dry druggies” who had never used an illegal substance but were displaying “druggie behavior.”

Spot the druggies.

Spot the druggies.

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Setting the Record Straight, Part 4

Editor’s note: Marcus Chatfield continues his series on Straight, Inc., the coercive treatment program for children and teens suspected of drug use that flourished with White House and NIDA support in the 1980s. In today’s entry, Marcus breaks down the flaws in the peer-reviewed research that helped cement this official legitimacy.

In “Outcome of a Unique Youth Drug Abuse Program: A Follow-up Study of Clients of Straight Inc.” (1989), Alfred S. Friedman, Richard Schwartz, and Arlene Utada claim that their report will include: “(1) the description of the study sample, (2) the outcome of the improvement that occurred between intake and follow-up, (3) the comparison of the outcome between graduates and ‘dropouts,’ and (4) the relationship of the amount of time in treatment to treatment outcome.”

"This report is in fulfillment of NIDA Professional Services Contract #64986."

In their sights.

However, in each of these areas the study is flawed: (a) their description of the study sample reveals major problems, such as selective sampling; (b) the intake-to-follow-up comparisons show limited correlation and also, the authors state that they are meant to measure outcome of improvement rather than actual outcome; (c) they completely fail to discuss their promised comparisons between graduates and dropouts (they also claim to discuss a comparison between “respondents” and “nonrespondents” and then omit this comparison as well); and (d) perhaps most importantly, but left unexplained, they found that “time in treatment” had no effect on drug use reductions. Continue reading

Setting the Record Straight, Part 3

Editor’s note: Today Marcus Chatfield continues his series on Straight Inc., the involuntary treatment program for adolescents suspected of drug use that operated in several states between the 1970s and 1990s. Parts 1 and 2 of the series can be found here and here.

In Help at Any Cost (2006), Maia Szalavitz reveals some of the troubling history of coercive programs. The sub-title of her book is, “How the Troubled Teen Industry Cons Parents and Hurts Kids,” and this is one of the hardest things for a survivor to describe – the deceit that protects abusive programs. Dr. Charles Huffine writes, “I cannot tell you how many youth I’ve been in contact with that do not tell their family about the painful aspects of their experiences for fear of making their family feel bad — though I can say they number in the majority. All too frequently, simply, they did not know they were abused, or worse, that the abuse was justified and necessary for them to ‘get better.’”

Straight-inspired TV movie Not My Kid (1985). Spoiler alert: they got their kid back.

Straight-inspired TV movie Not My Kid (1985). Spoiler alert: they got their kid back.

Tough-love programs often ritualize emotional testimonies and require testimony about conversion experiences as a prerequisite for release from treatment. Because there is no scientific evidence to validate the safety and efficacy of coercive methods, these anecdotes are the “hook” that this multi-billion dollar industry is built upon. Many victims of thought-reform treatments, like victims of domestic violence, will defend their captors as a self-protective survival response. Similar to abusive dynamics in families, when people are beaten down long enough they may believe it’s normal, deserved, and even good for them. As one former staff member of the program said to me recently, “at the time I graduated I was so duped into believing that I’d been helped, I couldn’t even begin to see the damage caused to me.”

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Pharma Gamesmanship in the Booming Business of Addiction Therapeutics: the Case of Suboxone

Editor’s Note: Points welcomes another new guest blogger to the ranks today. Kimberly Sue is an M.D.-Ph.D. candidate in medical anthropology at Harvard, doing ethnographic fieldwork with opiate-addicted women. Below, Kim details some very recent developments in the ways pharma companies invoke societal values around drugs in order to manage their market share, and discusses how the outcomes are likely to affect people in treatment.

Pharmaceutical companies and opiates have a complicated, intertwined history. Analgesia was and continues to be a big business as well as an ongoing medical conundrum. Opiates, as we know, are wildly popular analgesics. Yet when did opiates specifically indicated for treating addiction become such a big business, a lucrative niche market inciting pharmaceutical companies to aggressive industry maneuvers? As Penn professors John Kimberly and Thomas McLellan wrote in a 2006 article on the substance abuse treatment industry, “Pharmaceutical companies that, not long ago, refused to allow the use of even their discarded medications for clinical research in addiction now invest hundreds of millions of dollars in the marketing and sales of approved addiction medications.”

Mum, mustard, and maintenance. ( Reckitt Benckiser annual report, 2011).

Mum, mustard, and maintenance. (Reckitt Benckiser annual report, 2011)

Does this say something about the changing cultural attitudes towards addiction—that pharmaceutical companies are no longer afraid of being branded as making drugs for drug addicts—or does it simply speak to the enormous profits to be had?

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Setting the Record Straight, Part 2

Editor’s note: Today guest blogger Marcus Chatfield continues his series on Straight, Inc. and the research it used to burnish its reputation in the 1980s.

As part of my research I sent a questionnaire to 12 former clients of Straight, some of whom I was in treatment with. My purpose was to collect testimony that would help explain the findings of Friedman et al., and to help raise awareness about the abuses that went on in Straight. I asked participants to reflect on their experiences in Straight and compare their current perspective with their perspective immediately following treatment. Their reports also included descriptions of broken relationships with parents, intensified drug use in the first few years after graduation, and long-term trauma resulting from coerced participation in the program. All of the participants reported being “extremely dissatisfied” now but most reported high levels of satisfaction with their treatment during the time soon after their release. As one former staff member responded, “my answers to these questions are completely different than they would have been immediately after completing aftercare because I was still brainwashed by Straight’s doctrine well beyond my involvement with Straight.”

Large group therapy

“Large group therapy process” (Straight brochure)

The only peer-reviewed research specific to clients of Straight was conducted by Straight’s own Medical Director, Richard Schwartz. Looking at the history of the program, it appears that this research began during a financially critical time. Continue reading

Setting the Record Straight: Part 1

Editor’s Note: Points is pleased to introduce a new guest blogger today. Marcus Chatfield is currently writing a book about coercive therapy in the “troubled-teen industry,” based on research he has conducted as a student at Goddard College. A client of Straight, Incorporated from 1985-1987, he is associate producer of the upcoming documentary film, Surviving Straight Inc. Marcus’s five-part weekly series for Points focuses on the research that enabled this program to win the trust of families, media, and high-ranking officials during its operations in nine states between 1976 and 1993.

“The problem, of course is that Straight really does not know what happens to a good many of its graduates. And it will be criticized for this in the future.” Andrew I. and Barbara E. Malcolm, report to the White House drug czar, 1981.

Straight building 1

The building that housed the Straight Inc. program in Springfield, Virginia.

Straight Incorporated is one of the most infamous adolescent treatment programs in the history of America’s War on Drugs. Straight was an intervention and prevention program, established in 1976 with a federal grant from the Law Enforcement Assistance Agency (LEAA). The LEAA funded hundreds of behavior-modification programs in America and many of them were found to be dramatically unethical. The coercive methods that were used at Straight were not only ineffective, but quite harmful for a large percentage of clients. This essay is a critical examination of an article published in 1989 by the Journal of Substance Abuse Treatment (JSAT), entitled “Outcome of a Unique Youth Drug Abuse Program: A Follow-up Study of Clients of Straight Inc.” Authors Alfred S. Friedman, Richard Schwartz, and Arlene Utada claimed that Straight was highly effective at reducing drug use and that 70% of the former clients from the Springfield, Virginia facility were “satisfied” with their treatment. Program executives presented this statistic to parents and the media as scientific proof that Straight worked.

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