A long journey from inebriate asylums

Gina de Peralta Thorne, MSDirector of Business

Development

A Long Journey from Inebriate Asylums

Objectives:

• Provide a historical overview of the treatment of alcohol.

• Discuss events that prompted changes to alcohol/addiction treatment.

• Discuss current levels of care available for addiction treatment services.

Early Addiction Medicine

Non-specialty institutions

that could do little for their

conditions:• Jails• County farms• Almshouses• Water cure institutions • Insane asylums

Pioneers in Addiction Medicine

• 1774, Anthony Benezet’s - Mighty Destroyer Displayed is published. It is the earliest American essay on alcoholism.

• 1784, Dr. Benjamin Rush’s - Inquiry into the Effects of Ardent Spirits on the Human Mind and Body, argued that the condition was a disease that should be treated by physicians.– Rush’s writing marked beginning of

American temperance movement.

1800’s

• 1810 -Dr. Benjamin Rush called for creation of a “Sober House” for the care of the “confirmed drunkard”.

• 1825, Rev. Lyman Beecher’s Six Sermons on Intemperance described the presence of an “insatiable desire to drink,” and described warning signs of addiction to distilled spirits.

Medically Oriented Inebriate Asylums

• Inebriety (alcoholism wasn’t coined until 1849), could and should be cured within special institutions.

• Medically-oriented inebriate asylums -New York State Inebriate Asylum in 1864

Methods of Treatment

Utilized physical methods of treatment:

– Drug therapies– Aversion therapy– Hydrotherapy– Electrical stimulation.

Inebriates could be legally committed to such institutions for periods ranging from one year to “until the patient is cured.”

Temperance Influenced Inebriate Homes

• Recovering Alcoholics founded mutual aid societies– Native American Temperance Societies– Washingtonians– Reform Clubs– Leaders from these groups formed

inebriate homes

Inebriate Homes

• Short voluntary stays and non-physical methods of treatment.

• Alcoholism recovery in most of these homes was viewed as a process of moral reformation.

Religiously Sponsored Missions & Recovery Homes

• Jerry McAuley opened the Water Street Mission in 1872

• Redeemed alcoholics• Weekly Advertisements stating: “Everyone

welcome, especially drunkards.” • New York Christian Home for Intemperate Men

– religiously oriented.• viewed recovery from addiction as a process of

religious conversion--a process of spiritual rebirth.

Addiction Treatment Franchises

• Private for-profit sanataria and addiction treatment institutes

• Home cures – Promoted alcohol, opium and cocaine-

laced products.• Hangover cures and alcoholism cures

Collapse of Early Addiction Treatment

• Internal Threats • Ethical

Breaches • Economic

Threats• Political Threats

- Prohibition

20th Century Addiction Treatment

• 1906 - Courtenay Baylor – 1st lay therapist

• 1940 – AA Bill Wilson & Dr. Bob• Minnesota Model – distinguished

between 12 step and Professional counseling.

What is Treatment?

American Society of Addiction Medicine

Treatment is the use of any planned, intentional intervention in the health, behavior, personal and/or family life of an individual suffering from alcoholism

or from another drug dependency designed to enable the affected individual to achieve and

maintain sobriety, physical and mental health, and a maximum functional ability.

Types of Treatment

• Physical and Psychiatric evaluations• Detoxification• Counseling• Self-help support (12 – step)• Treatment for co-morbid physical or

behavioral complications• Medication assisted therapy

Principles of Effective Treatment

• Addiction is a complex but treatable disease that affects brain function and behavior.

• No single treatment is appropriate for everyone.

• Treatment needs to be readily available.

• Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.

• Remaining in treatment for an adequate period of time is critical.

• Counseling—individual and/or group—and other behavioral therapies are the most commonly used forms of drug abuse treatment.

Principles of Effective Treatment

• Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.

• • An individual's treatment and services plan must be assessed continually

and modified as necessary to ensure that it meets his or her changing needs.

• Many drug-addicted individuals also have other mental disorders.

• Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.

• Treatment does not need to be voluntary to be effective.

• Drug use during treatment must be monitored continuously, as lapses during treatment do occur.

Interventions

Detoxification

Detoxification is the process by which the

body clears itself of drugs and is oftenaccompanied by unpleasant and

sometimeseven fatal side effects caused by

withdrawal.

Medically Assisted Treatments

Medically assisted treatment (MAT) is a type of pharmacotherapy that describes any type of treatment that's used for substance use disorders that includes a pharmacologic intervention as a part of their treatment plan. • The goal is for the patient to recover and to be able to fully function in society.

• Methadone (Opiate/Heroin)• Buprenorphine (Opiate/Heroin) • Disulfiram (Antabuse)• Naltraxone (Vivitrol) - alcohol• Acamporsate (reduces WD symptoms)

Long-Term Residential Treatment

• Long-term residential treatment – 24 hours a day, – Non-hospital settings– Therapeutic community (TC)– lengths of stay between 6 and 12 months. – Treatment is highly structured- confrontational

at times

Short-Term Residential Treatment

• Short-term residential programs– Intensive but relatively brief treatment

based on a modified 12-step approach.– 28-32 day model

Outpatient Treatment Programs

• Treatment costs less than residential or inpatient treatment

• More suitable for people with jobs or extensive social supports

• Intensive Outpatient Treatment (IOP)– Group counseling can be a major

component

Individualized Drug Counseling

Individualized drug counseling • Focuses on reducing or stopping illicit

drug or alcohol use• Addresses related areas of impaired

functioning such as employment status, illegal activity, and family/social relations

• Content and structure of the patient's recovery program.

Group Counseling

Recovery Coaching

Recovery coaching is a form of strengths-based support for persons with addictions or in recovery from alcohol, other drugs, codependency, or other addictive behaviors. Recovery coaches work with persons with active addictions as well as persons already in recovery.Recovery coaches do not:• Offer primary treatment for addiction• Diagnose• Associate with any particular method or means of

recovery

Farley Center at Williamsburg Place

What is the Farley Center at Williamsburg Place?

• Partial Day Hospitalization Program. (Varying length of stay with a treatment experience averaging as short as a few days to 12 weeks)

• Treat Adult Alcohol and Drug Addiction and/or Dual Diagnosis patients. (18 yrs and up)

• 72 bed capacity• FC/WP is accredited by the Joint Commission on Accreditation of Healthcare

Organizations

Where is the Farley Center at Williamsburg Place?• Located on 10 acres outside of Historic Colonial Williamsburg, VA.

(Mooretown Road)• 40 minutes from Richmond Airport (International)

We Treat FamiliesNot Just the Addict/Alcoholic

Goals of WP Treatment

• Safe medical withdrawal “Detox”• Development of abstinence-based lifestyle• Nurture identity apart from professional lifestyle.• Exposure to and assimilation into 12-step

programs• Developing and practicing recovery skill set under

stressful and unpredictable circumstances• Identify and address relapse warning signs• Internalize need for surrogate decision making

across Psychosocial domains

Programs Offered

• Addiction Treatment/Dual Diagnosis

• Addiction Treatment/Chronic Pain

• In-Resident and Outpatient Evaluations

• Family Program

• Addicted Professionals• Physicians• Dentists• Attorneys• Pharmacists• Business Executives

References

White, W. L. (1999). A lost world of addiction treatment. Counselor, 17(2), 8-11.

Kleber, H.D. Outpatient detoxification from opiates. Primary Psychiatry 1:42-52, 1996.

Lewis, B.F.; McCusker, J.; Hindin, R.; Frost, R.; and Garfield, F. Four residential drug treatment programs: Project IMPACT. In: J.A. Inciardi, F.M. Tims, and B.W. Fletcher (eds.), Innovative Approaches in the Treatment of Drug Abuse, Westport, CT: Greenwood Press, pp. 45-60, 1993.

http://www.asam.org/

Questions?

Gina de Peralta Thorne, [email protected]

757-565-0106