It’s always tempting to say that someone who wrote an influential book on an issue wrote the definitive book. Hardly ever the case. But in this instance totally the case. In 1998, William L. White wrote Slaying the Dragon: The History of Addiction Treatment and Recovery in America, and in 390 pages it takes you through the mutual aid societies, the therapies, Prohibition, the advent of the twelve-step process, all of it. You don’t have to read anything else. It’s fascinating. We spoke recently with the legendary White, who today is Emeritus Senior Research Consultant at Chestnut Health Systems/Lighthouse Institute, and he was most generous with his insights about life, mental health, and recovery.
TP: You were one of the original street outreach workers before becoming a counselor. What was it like out there in the late 1960s?
WW: People were open to help but there were so few resources available. Most communities did not have local or even regional resources for detoxification or treatment, and most had very few recovery mutual aid resources for individuals and families. And I saw just despicable conditions—addicts languishing in jails or in the back wards of aging state psychiatric hospitals where they were subjected to psychosurgery, mandatory sterilization and every manner of drug insult. These were places of deep despair and I decided, along with many of my early peers, to destroy such places and replace them with sanctuaries of hope and recovery support.
TP: You write that the understanding of addiction disease goes back to Benjamin Rush in the 1790s as he was the first person to state that chronic drunkenness was a medical disorder and not a moral disorder. One can’t underestimate Rush’s historical impact, no?
WW: No question. In many ways you can trace the current breakthroughs in understanding addiction as a brain disease and the roots of modern addiction medicine back to him. Many of the 19th century recovery mutual aid groups and the entire network of 19th century inebriate homes, inebriate asylums and private addiction cure institutes were built upon his influence, and his theory that addiction is a medical disorder warranting medical rather than penal treatment stands today.
TP: I was intrigued with our country’s evolution not only to alcoholism but to what kinds of alcohol were deemed the gravest threats. You see this in the temperance movement.
WW: The early temperance movement’s primary focus was on the destructiveness of distilled alcohol. Little attention was given to fermented alcohol until it became evident that the prohibition of distilled alcohol and signing temperance pledges to not drink spirituous alcohol was inevitably followed by growing problems of drunkenness on hard cider, wines, beer and ale. It was something of a cultural epiphany that the problem was alcohol, not the type of alcohol. Of course many people today experiencing alcohol dependence have tried similar patterns of substitution and experienced similar epiphanies.
TP: I didn’t know anything about Leslie Keeley before reading your book. You explain how he became interested in soldier alcoholism after the Civil War, and devised a medication concoction of mostly stimulants for addicts to take, called the Keeley Cure, which was later debunked. He also organized a community of support that was a predecessor of AA and other mutual aid societies, the Keeley Institutes, which was ahead of its time. How do you think he should be remembered?
WW: Well, the Keeley Cure holds an important lesson in that there will always be anecdotes attesting the success of any method of addiction recovery—including those that are scientifically unsupported, clinically contraindicated and financially exploitative—that’s the case with the Keeley Cure. Science by anecdote is very bad science and produces equally bad medicine. But I believe Keeley deserves credit for the climate of mutual recovery support he fostered with the Keeley Institutes.
TP: What do you think the most important contribution of AA has been?
WW: AA, more than any of its predecessors, recognized that the resolution of alcoholism involved not a point-in-time decision but a lifelong process of active recovery and mental health, and it extracted principles and rituals that could begin and sustain that process. It transformed the challenge away from stopping drinking to not starting drinking. It also founded through its Traditions unique strategies to address the problems of structure and leadership.
TP: Jumping to Prohibition, early on in its implementation it did reduce consumption and alcohol-related crimes. But an unintended consequence was that organized crime developed new distribution channels and consumption and crime rose again. And what happened, you write, was that in 1935 the country was caught off guard as we had all these addicts but no treatment programs, and the federal government was overwhelmed by the number of people flowing into its prisons. As a result, the first prison for drug addicts was created, out of necessity, in Lexington, Kentucky, and it was an advancement at least on the penal side. Today, as a legacy of Lexington, and knowing the volume of drug offenders has risen dramatically due to three-strikes laws, do we have enough programs in penal institutions catered to addicts?
WW: No. Lexington has many legacies but among them is the challenge of transferring institutional learning to natural environments—a challenge that still exists today. Recovery must be nested within and supported within the natural environment of each person being treated, which means that the environment must be a target of treatment as well as the patient. We still have not learned that lesson in addiction treatment.
TP: So where do we go in helping addicts? More investment in treatment, outreach, both?
WW: In most communities we are spending enough, perhaps more than enough, on acute biospsychosocial stabilization. We do this in the U.S. more safely and effectively than has ever been done in history. Where we are completely underinvested is in assertive outreach and early intervention programs and in supports for the transition to recovery maintenance and enhanced quality of personal and family life in long-term recovery. Available resources need to be allocated proportionally across the long-term stages of recovery. At present, almost all of our dollars are in recovery initiation for people in late stages of addiction. Our allocation schemes at present have little chance of shortening addiction careers prior to treatment entry, and the absence of post-treatment supports means that we have a substantial portion of our treatment population constantly recycling through treatment without achieving stable, long-term recovery. We are placing people with high problem severity and complexity and chronicity and low recovery capital into interventions of such low intensity and duration that there is little potential for success, and then blaming them when they inevitably resume alcohol and drug use. These are not personal failures; it is a system failure. It’s analogous to treating bacterial infections with inadequate dosages and durations of antibiotics.
TP: Taking it down to the micro, what’s the number one thing you want individuals to know who are just starting out on a path of sobriety?
WW: That recovery is contagious. Get close to it. Stay close to it. Catch it. Keep catching it. And pass it on. Recovery by any means necessary. People do it, and they do it together. It works.
— This interview has been edited and condensed for publication.
Adam Wahlberg
Founder of Think Piece Publishing
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