The Addiction Cure Institutes: New Historical Research (Bill White and Ken Anderson)
One of the most fascinating chapters in the history of addiction treatment and recovery in the United States is that of the private addiction cure institutes that flourished in the late nineteenth and early twentieth centuries. Ken Anderson, the founder of the international organization Harm Reduction, Abstinence, and Moderation Support (HAMS), has just published a two-volume book, Strychnine & Gold—the most comprehensive account yet of this historically obscure era of addiction treatment. This meticulously researched and well-written text will find many appreciative readers. Anyone interested in the history of addiction treatment and recovery will want to possess this invaluable reference text.
I recently had the opportunity to interview Ken Anderson about how this book came to be and what he had learned through his researches.
Bill White: Ken, how did your research for Strychnine & Gold and the larger project of which it is a part begin?
Ken Anderson: Not surprisingly, it started from a paper I was writing for a course in graduate school. The paper was attempting to look at how various economic forces shaped the addiction treatment industry we have in the United States today. I found a lot of gaps in the literature: almost nothing had been written about many major players in the addiction treatment industry, such as CompCare Corporation, National Medical Enterprises, the Koala Centers, Raleigh Hills, etc. I also found that a number of addiction treatment facilities founded in the 19th century had continued in operation throughout the prohibition era and were still in operation in the second half of the 20th century. The parent Keeley Institute in Dwight, Illinois remained in operation until 1966. The Murray Cure Institute in Minneapolis, Minnesota remained in operation until 1955, and there was a Gatlin Institute in operation until 1944 and a Neal Institute in operation until 1957. Initially, I thought I might write a short chapter of about 20 pages devoted to these early proprietary addiction treatment institutes. But the deeper I dug, the more fascinating the topic became, and eventually I wound up with a 900-page book about these proprietary cure institutes. The book was so big that I had to publish it in two pieces: volume one part one and volume one part two. Now that I have finished writing about these proprietary cure institutes, I am working on volume two, which will cover the orthodox addiction treatment facilities which existed prior to prohibition, i.e., inebriate asylums, homes, hospitals, and sanitariums.
Bill White: Who were the audiences you wanted to reach with this early story within the history of addiction treatment?
Ken Anderson: First of all, I hope that people who write about the history of medicine and the history of addiction treatment will find that this book is a useful source of raw data. I hope that future writers will take this data and put it in a larger historical context. Although the book was written with specialists in mind, I strove to keep the language simple and straightforward so that the book would be accessible to the general readership. I think the story is fascinating to anyone with an interest in addiction treatment, the history of medicine, the history of American capitalism, and to general readers as well.
Bill White: What were the biggest surprises you uncovered in your research?
Ken Anderson: I had been under the impression that all the early addiction treatment facilities had shut down after the passage of the 18th amendment (alcohol prohibition) and that there were no resources available for people addicted to alcohol or other substances until Alcoholics Anonymous was founded in 1935 and until Hazelden began offering residential 12-step treatment in the 1940s. These impressions turned out to be quite false. Although the majority of these early alcohol treatment facilities shut down, this happened in the second half of the 1910s, prior to the enactment of federal alcohol prohibition. Moreover, a small number of these treatment facilities remained in operation throughout prohibition and into the second half of the 20th century. Additionally, the repeal of prohibition gave birth to numerous new treatment franchises such as the Samaritan Institutions and the HALCO Institutes which were not based on the 12 steps.
Another surprising thing to see was the utter lack of scientific thinking and the reliance on logical fallacy found in 19th century orthodox medicine (allopathy) when protecting their medical dogmas from new ideas. The infighting between allopathy and other medical sects such as homeopathy and eclecticism was quite vicious, and all the various schools of medical thought relied heavily on the straw man fallacy and cherry picking in their arguments. These same fallacies were used in attacking proprietary addiction treatment franchises such as the Keeley Institutes, the Neal Institutes, etc.; however, these proprietary institutes simply ignored the attacks in the medical journals and continued business as usual.
A third surprising thing was the large number of scientific trials which found that the strychnine cure, i.e., the Keeley Cure, was quite effective in getting people who were addicted to alcohol to spontaneously stop drinking. Although the cure was not always permanent, quite a number of people used the strychnine cure as a springboard to stop drinking for good.
A fourth surprising thing was the sheer magnitude of the pre-prohibition addiction treatment industry. There were an estimated 126 Keeley Institutes established worldwide and roughly half a million people took the Keeley Cure. About 80 Neal Institutes were established, etc.
Bill White: Are there other aspects of this history that you feel will be of particular interest to addiction treatment professionals and those working in other arenas of recovery support?
Ken Anderson: We often see the temperance movement as somehow tied to the moral model and represented as opposed to addiction treatment. This is not borne out at all by the historical data. Many of the doctors working in addiction treatment prior to prohibition were members of temperance organizations, as were many of the managers of these addiction treatment institutes. This was true both of the proprietary cure institutes and the orthodox inebriate asylums and hospitals. Temperance organizations such as the Good Templars or the Sons of Temperance functioned as support groups and helped people to maintain abstinence from alcohol. The Woman’s Christian Temperance Union strongly promoted all forms of addiction treatment, both in proprietary institutes and orthodox facilities. Prohibition was seen by temperance organizations as a public health law which would eliminate alcohol addiction by eliminating the sale of alcohol. This is why prohibition made the sale of alcohol illegal, but not the purchase or consumption of alcohol. Prohibition was intended to stop sales of alcohol, not to punish drinkers or people addicted to alcohol. The 18th amendment passed because it was overwhelmingly popular with the voters. Unfortunately, no one foresaw that prohibition would lead to perhaps the greatest era of crime and corruption in United States history. Any reductions in alcohol consumption failed to outweigh the rise of organized crime and the realities of open gang warfare in Chicago and elsewhere. By 1933, prohibition had become overwhelmingly unpopular, and the vast majority of voters favored repeal.
Bill White: Are there any lessons from this era of addiction treatment that you feel have important implications for the present status of addiction treatment?
Ken Anderson: History repeats itself. As the saying goes, “Those who do not learn from history are doomed to repeat it.” Despite all the evidence favoring the strychnine and belladonna cures, the addiction treatment orthodoxy of the 19th century, as represented by the American Association for the Study and Cure of Inebriety, shunned pharmaceutical treatments and pushed for asylum treatment instead. However, the inebriate asylum movement failed. Since nature abhors a vacuum, the strychnine and belladonna cures were adopted by entrepreneurs who franchised them as proprietary cures and had great success with them.
We see something similar happening in the United States today. In countries like Switzerland, methadone is free for anyone, and methadone dosing can be done in pharmacies or doctors’ offices. Moreover, methadone is not stigmatized in Switzerland. In Switzerland, overdose death rates have dropped 80%. However, in the United States, methadone maintenance has been under attack and stigmatized by orthodox addiction treatment programs since its introduction in the 1960s. And in the United States, patients entering methadone treatment must receive and consume their medication on a daily basis at a licensed clinic. For-profit methadone clinics often cost $400 to $500 a month, despite the fact that the methadone itself costs less than $30 a month. In many cases, this $400 to $500 monthly payment must be paid out of pocket by the methadone client him/herself. This is more money than many people pay for rent. And the nearest methadone clinic may be 100 miles away. If we would drop our misguided ideology, stop the profiteering by private methadone clinics, and instead adopt the Swiss model of free methadone and office- or pharmacy-based dosing, we, too, could reduce overdose deaths by 80%. The cost to the government for supplying the methadone would be minuscule, and the monetary savings alone would be huge, not to mention the number of lives saved.
Bill White: How can people obtain a copy of Strychnine & Gold?
Ken Anderson: The easiest way to get the book is to order it from Amazon. It is available both in paperback and on Kindle. This link will get you to the two-book series: https://www.amazon.com/gp/product/B09B78Z88R