Timeline: History of Addiction Treatment

Psychoactive substances have been used since the earliest human civilizations, with problematic use documented as early as the 17th century.¹

Over time, society’s response to addiction has evolved dramatically, from moral judgment and punishment to medical, psychological, and evidence-based care.

The timeline below outlines the major milestones in addiction treatment from the mid-18th century to the present day, highlighting key movements, institutions, and innovations that continue to shape treatment today.

1750–Early 1800s: Early Recognition and Mutual Aid

This era marked the first organized responses to alcoholism, emphasizing community support and early medical theories.

1750–Early 1800s: Alcoholic Mutual Aid Societies Emerge

Early sobriety circles formed among various Native American tribes, some of which evolved into abstinence-based revival movements.² Native healing practices were commonly used to address alcoholism within these communities.³

1784: Benjamin Rush Defines Alcoholism As a Disease

Excessive use of alcohol in the late 18th and early 19th centuries was a major public health problem. Physician Benjamin Rush argued that alcoholism should be treated as a medical condition rather than a moral failing.⁴ His work raised public awareness of alcohol-related harm and helped spark the early temperance movement.²

1800s: Institutional Care and Early Medicalization

The 19th century saw the rise of specialized institutions for addiction treatment, followed by their eventual decline.

1850s: Inebriate Homes Open

These homes provided short, voluntary stays that included non-medical detoxification, isolation from drinking culture, moral reframing, and immersion in newly formed sobriety fellowships.⁵ The first inebriate homes opened in Boston in the 1850s and were modeled after state-operated insane asylums.^2,5

1864: New York State Inebriate Asylum Opens

This facility opened in 1864 under the direction of Dr. Joseph Edward Turner. It was the first medically monitored addiction treatment center in the U.S. and is considered the first alcohol rehab center.⁶

1870s: Keeley Institutes Spread

Founded by Dr. Leslie Keeley, who opened more than 120 Keeley Institutes in North America and Europe, these consisted of addiction cure institutes and proprietary home cures, such as bottled “Double Chloride of Gold Cures for drunkenness.”⁵

1880s: Cocaine Promoted As a Treatment

Sigmund Freud began using cocaine himself, calling it the “magical drug.”⁷ Freud and other American physicians used cocaine to treat alcoholism and morphine addiction. However, in the last of Freud’s writings, he backed off his former defense of using cocaine to treat morphine addiction.^2,7

1890s: Inebriate Homes Close

Poorly evaluated clinical therapies, ethical abuse, economic depressions, stigma, de-medicalization, and criminalization of alcohol/drug problems led to the shuttering of inebriate homes and the first generation of addiction treatment.⁵ After inebriate homes and asylums closed, alcoholics were sent to city drunk tanks, public hospitals, and insane asylums.²

1900–1950: Foundations of Modern Treatment

This period laid the groundwork for modern addiction treatment through medical care, spiritual approaches, and self-help movements.

1901: Charles B. Towns Hospital Opens

Charles Towns, in collaboration with Dr. Alexander Lambert (Theodore Roosevelt’s personal physician), opened this New York City substance abuse hospital in 1901, which treated affluent alcoholics with its famous belladonna elixir.

Bill Wilson, founder of Alcoholics Anonymous, was a patient at Charles B. Towns Hospital four times. The cost of treatment was $350 a day, equivalent to $5,610 today.⁸

1906: Emmanuel Clinic introduces lay therapy

The Emmanuel movement was a church-based form of psychotherapy to heal addictions with a combination of spirituality and psychological interventions.⁹ The Emmanuel movement’s groundwork was instrumental to the establishment of Alcoholics Anonymous.¹⁰

1910s: Forced Sterilization Laws Enacted

Legislation granted the medical supervisors of asylums and prisons the authority to “asexualize” a patient or inmate if such action would improve his or her physical, mental, or moral condition. Among those affected were alcoholics and addicts, who were considered degenerate and feeble-minded.¹¹

1919–1924: Morphine Maintenance Clinics Operate

Communities established morphine maintenance clinics to treat people with morphine addiction. Most eventually close for legal reasons.²

1935: Federal Narcotics Farms Open

The first federal narcotics farm opened in Lexington, Kentucky in 1935.² Lexington was a center for drug treatment and federal research, and provided free treatment to addicts and alcoholics, including the “Lexington Cure.” The Narco farm was a prison where research on human subjects could be conducted.¹²

1935: Alcoholics Anonymous is Founded

The 4 founding members of Alcoholics Anonymous (AA), Bill Wilson, Ebby Thatcher, Rowland Hazard, and Dr. Bob Smith, were highly influenced by the pioneers of the Emmanuel Movement.¹⁰

Wilson and Dr. Bob were both alcoholics in the 1930s, unable to achieve sustained abstinence despite their Christian faith and membership in the Oxford Group, a Christian organization whose principles heavily influenced the creation of the 12 steps.¹³

The meeting between Bill W. and Dr. Bob in 1935 marked the formation of AA, and the Big Book, was published in 1939.² AA separated from the Oxford Group in the 1930s.¹³

1948–1950: Minnesota Model Developed

The Minnesota Model was a self-help model intertwined with the AA philosophy. Its primary treatment goals were abstinence and behavioral change.¹⁴

1948–1950: Disulfiram and Other Drugs Introduced

Disulfiram, otherwise known as Antabuse, was introduced in the U.S. as a supplemental treatment for alcoholism. Antabuse created feelings of nausea and unpleasant reactions to alcohol. Other drugs used to treat alcoholism during this time included barbiturates, amphetamines, and LSD.²

1950–2000: Expansion, Policy Change, and Medical Acceptance

This era brought widespread recognition of addiction as a disease and expanded access to treatment.

Early 1950s: AA Membership Surpasses 90,000

The reach of AA membership grew exponentially, and in 1951, AA won the Lasxfker Award from the American Public Health Association (considered to be America’s equivalent to the Nobel prize).¹⁵

AA’s success was due to several factors, including an increase in alcoholism-related films and a wider acceptance of those suffering from the illness.²

1952: AMA Defines Alcoholism

In 1952, the American Medical Association (AMA) first defined alcoholism.² Eventually, the committee agreed to define alcoholism as a primary, chronic disease with genetic, psychosocial, and environmental factors influencing the condition’s prognosis.¹⁶

1957: VA Establishes Alcoholism Treatment Units

The Veteran’s Health Administration began developing alcoholism treatment units within its national network of VA hospitals.²

1958: Halfway House Association Founded

The halfway house movement peaked in 1958 with the founding of the Association of Halfway House Alcoholism Programs of North America.² Halfway houses provided safe, recovery-focused housing for individuals who were suffering from substance abuse problems.

1960: E.M. Jellinek Promotes Disease Model

E.M. Jellinek, a 1960s alcoholism researcher, published TheDisease Concept of Alcoholism.²

1964–1975: Insurance Reimbursement Begins

When the medical community emphasized alcoholism as a chronic disease, policymakers responded, leading to a rise in inpatient rehabs and an upswing in medication for alcoholism/addiction.^2,17 In turn, the insurance industry began reimbursing alcoholism treatment in line with other illnesses.²

1964: Methadone Introduced

Vincent Dole, an endocrinologist, and Dr. Marie Nyswander, a psychiatrist, introduced methadone to treat narcotic addiction. The FDA approved it to treat heroin addiction in 1972.² Methadone is a slow-acting opioid agonist that prevents harsh opioid withdrawal symptoms.¹⁸

1970: Acupuncture Used in Addiction Treatment

Lincoln Recovery was initially an outpatient treatment center in the 1970s that used methadone. In 1973-74, a community-based demand for natural, non-pharmaceutical treatments for heroin and opioid addiction spurred the use of acupuncture in the clinic. The alternative treatment proved to be highly successful, and many of the founding staff went on to study acupuncture.¹⁹

1970: Controlled Substances Act passes

The Controlled Substances Act (CSA) placed all regulated substances into 5 schedules, or classifications, based on the substance’s medical use, potential for abuse, and dependence liability.²⁰

1971: Naloxone Approved

Naloxone, the main ingredient in today's brand name medication Narcan, could counter opioid overdose effects, usually within 2 minutes. It was first made available as an injectable solution, but is now available as a nasal spray.^21,29

1982: Betty Ford Center Founded

Former First Lady Betty Ford sought treatment for alcohol and prescription pill addiction at age 60. In 1982, Ford co-founded the first Betty Ford Center in Rancho Mirage, CA.²²

1982: Cocaine Anonymous Founded

Cocaine Anonymous (CA) adopted the 12-step philosophy embraced by Alcoholics Anonymous.²

1985–1986: Secular Recovery Programs Emerge

Former serious problem drinker James Christopher founded Secular Organizations for Sobriety (SOS) in the mid-80s. Around the same time, recovered alcoholic Jack Trimpey founded Rational Recovery. These programs emphasize rational decision-making, not spirituality.²

1987: AMA Recognizes All Drug Addictions as Diseases

The AMA passed legislation identifying alcoholism as a complex disease that merited the serious concern of all members of the health professions.²

1994: SMART Recovery Founded

SMART Recovery is a non-12-step program focused on self-empowerment. The program teaches skills for self-directed change and helps users cope with urges and manage thoughts, feelings, and behaviors that can drive addiction.²³

1994: Naltrexone Approved for Alcoholism

In late 1994, naltrexone became the second drug the FDA approved for alcoholism. Naltrexone is non-addictive and does not react with alcohol. It blocks opioid receptors in the brain, preventing the pleasurable effects.²⁴

1999: Drug Addiction Treatment Act passed

This bill was introduced in 1999 to amend the Controlled Substances Act with stricter registration requirements for practitioners who dispense narcotic drugs in Schedules III, IV, or V for maintenance and detoxification treatment.²⁵

2000–Present: Evidence-Based and Patient-Centered Care

Modern addiction treatment emphasizes accessibility, medication-assisted treatment, and parity with other medical care.

2002: Buprenorphine Approved

In 2002, the FDA approved buprenorphine, a medication-assisted treatment (MAT) for opioid addiction. Unlike methadone, which is dispensed within a structured clinic, specially qualified physicians can prescribe buprenorphine.²⁶

2008: Mental Health Parity and Addiction Equity Act Passes

This act required insurance companies and group health plans to provide similar benefits for mental health and/or substance use treatment and services as other types of medical care.²⁷

2010: Affordable Care Act Expands Coverage

The ACA expanded MHPAEA’s criteria by making sure insurance plans offered through state health insurance marketplaces included behavioral health services, including substance abuse treatment.²⁷

2016: AMA Reconsiders Pain As a Vital Sign

In response to the opioid crisis and national addiction epidemic, the AMA met in 2016 to discuss dropping vital sign number 5 (pain) as a professional standard of medical care, a statute first implemented in the early 1990s.²⁸

The history of addiction treatment reflects a long journey from punishment and stigma toward compassion, science, and patient-centered care. What began with early mutual aid societies and asylum-based treatment has evolved into modern approaches grounded in research, medication-assisted treatment, and evidence-based therapies. Each era has contributed insights that shape how care is delivered today.

Understanding this evolution helps us see how far the field has come—and how many effective, accessible treatment options now exist. Recovery is possible, and people today have more support, choice, and hope than ever before.

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