Slaying The Dragon

Reviewed by bob k

Those among us having a fondness for history are accustomed to being transported to the past, and Mr. White does this deliciously in the second edition of Slaying the Dragon: The History of Addiction Treatment and Recovery in America, beginning with a sojourn to Colonial America to meet Dr. Benjamin Rush, “unquestionably the first American authority on alcohol and alcoholism… Rush’s father was an alcoholic whose drinking led to his parents’ divorce… Rush’s writings stand as the first articulation of a disease concept of alcoholism by an American physician.” (Dragon, p. 2-3)

Of course, Rush’s ideas ran counter to the prevailing attitudes of the era, in which drunkenness was seen as sin, chronic inebriety as “moral failing.” There is much in this book about the various temperance movements, including ones led by natives, and African Americans such as Frederick Douglass.

The rise and fall of the Washingtonians is brilliantly described, as are other fraternal temperance societies and “Reform Clubs,” early predecessors of the twentieth century “mutual-aid societies” such as Alcoholics Anonymous. There were also fore-runners to “Moderation Management” in societies with a choice of pledges including “total abstinence from all intoxicants except wine and beer” and “no alcohol consumption before 5 P.M.” (Dragon, p. 28)

“In 1984, Daniel Dorchester reported that these societies ‘organized on the imperfect basis of moderation, all died of drunkenness, and more radical methods were  found necessary.’” (Dragon, p. 29)

Half measures availed us nothing. One club had members pledge a strict daily limit of 14 glasses of wine per day.

There is much on inebriate homes and asylums, mostly a sad tale, but within this climate, addiction treatment in America was born. “These institutions marked the first broad-scale professional movement to medicalize excessive drinking and drug use in America.” (Dragon, p. 43)

The “Keeley Cure” led to an age in which “…physician-entrepreneurs… made incredible claims regarding the success of their addiction cures… Keeley Institutes boasted a 95% cure rate, although Dr. Leslie Keeley suggested in various publications that the rate was actually higher.” (Dragon, p. 79)

“A cure in every instance, provided he (the alcoholic) takes the remedy implicitly according to instructions.” (Dragon, p. 79) For some of us, this may be eerily evocative of the folks who (incorrectly) proclaim that Bill W. regretted using “rarely” rather than “never” in the opening line of the Big Book’s Chapter 5.

Keeley opened the door to a bizarre array of “snake oil” cures.

Rescue missions arrived on the scene with an earnest lack of profit motive. The “prophet motives” of the religious conversionists were refreshingly sincere. Jerry MacAuley was a captivating, drunken minor level criminal who found sobriety through religious transformation, and founded New York’s Water Street Mission,  in 1872. He and others maintained their own sobriety by helping others, down-and-outers, who were surprised to be treated with dignity and respect.

”Everybody welcome, especially drunkards.”

We pass through the Salvation Army, the ideas of William James, “Alcoholism and City Hospitals,” the story of Willie Seabrook, and on to Charles Towns, founder of the New York hospital that was the site of four Bill Wilson detoxes.

Slaying The Dragon is a monumental achievement of academic research, but at the same time, a wonderful compendium of colorful tales. From the flap jacket of Ernie Kurtz (and Katherine Ketcham’s) new offering, “A great master once said ‘The shortest distance between a human being and the truth is a story.’” (Experiencing Spirituality)

The Twentieth Century finds lay therapists such as Courtenay Baylor and Richard Peabody. These reformed drinkers had considerable success with what appears to have been a human power approach, and Peabody’s book “The Common Sense of Drinking” exercised an enormous influence on the thinking of AA founder, Bill Wilson. Peabody’s “relaxation” techniques are much akin to the AA concept of “letting go.”

“Halfway measures are of no avail” may have a familiar ring to AA folks.

The “Jacoby Club” in Boston had as a motto, “A club for men to help themselves by helping others.” Various therapies were employed, of which fellowship and mentoring played a huge role. Enormous success was achieved locally. Sadly, they has no visionary such as Bill Wilson to push expansion to a broad audience.

The largest share of Mr. White’s “meaty” tome is devoted to an account of the history and techniques of Alcoholics Anonymous, and its widespread impact on addiction treatment.

No recovery mutual-aid movement before or after AA has reached more alcoholics, achieved greater geographical dispersion, been more widely adapted to address other problems, sustained itself so long, nor more profoundly influenced the evolution of addiction treatment. (Dragon, p. 169)

The AA history section delivers accounts of the Oxford Group and its procedures, biographies of the AA founders as well as medical friends, Drs. Silkworth and Tiebout, and the very Roman Catholic Sister Ignatia.

Heroin and Heroines

Large sections of Mr. White’s book have been skipped over entirely in this review. Constraints of space dictate that it must be so. There is much about drugs , and there is much about the many women who have held prominent roles in the recovery field. Marty Mann, LeClair Bissell, Betty Ford, Dr. Ruth Fox, Lois Wilson, Mercedes McCambridge, Melody Beattie, Nora Volkow, and others.

There are comprehensive histories of Narcotics Anonymous, Synanon, and the Minnesota Model.

This is truly an encyclopedia of addiction treatment information.

Moving Forward Towards the Past

Chapter 30, “The Recovery Revolution” is new to the Second Edition.

In this chapter, we will explore the new recovery advocacy movement in the United States, the historically unprecedented scope of recovery community building activities and the emerging shift in the design of addiction treatment from a model of acute biopsychosocial stabilization to a model of sustained recovery management…

A new presidential administration brought a challenging set of ideas about drug control policy – captured in the slogans, “zero tolerance” and “just say no.” This set the stage for the restigmatization, demedicalization, and intensified criminalization of alcohol and other drug problems… As the “war on drugs” turned quickly into a war against drug users (particularly poor drug users of color), cultural ownership of alcohol and other drug problems shifted from institutions of compassion and care to institutions of control and punishment…

By the mid-1990’s, it appeared that America was once again attempting to incarcerate its way out of its drug problems… Pessimism about recovery was fed by frenzied media coverage of celebrities repeatedly recycling through “rehab” following their latest falls from grace. (Dragon, p. 474-475)

AA – Not the Only Game in Town

AA also is experiencing some unwelcomed change. Early on, AA language permeated many treatment milieus.

In the 1980s there was a reversal of this process. Treatment language began to filter into AA… AA traditionalists began to refer to the burgeoning mountains of commercialized recovery literature, tapes, and paraphernalia as “recovery porn.” …Another trend was the growing number of other mutual-aid societies that defined themselves… as alternatives to AA. …from 1935 to 1975, AA existed almost unchallenged as THE mutual-aid society for recovered alcoholics.” (Dragon, p. 476)

More than ever before, there exists a multiplicity of fellowship choices spanning all the way from the more religious such as the rapidly growing Celebrate Recovery to the fully secular organizations such as Rational Recovery, SOS, Smart, LifeRing, and Women for Sobriety.

New paths are being forged in support institutions such as community centers and residences. Recovery industries are providing employment opportunities specifically for people in recovery. Students in recovery are also being assisted, and religious groups continue their outreach efforts in a variety of ways.

Family recovery groups are forming, and advocating. Community Recovery addresses the notion that “whole communities and whole cultures (might) be so wounded by prolonged alcohol and other drug problems that they are themselves in need of a sustained recovery process.” (Dragon, p. 504) Don Coyhis, leader of the native American Wellbriety movement, used the metaphor of a healing forest.

The medical field continues its work. “An overwhelming body of scientific evidence has accumulated on the value of medications as a potential aid in addiction recovery.” (Dragon, p. 500)

The Lessons of History

In Mr. White’s own words:

For people in recovery, it will require acknowledging and celebrating the existence of pathways and styles of recovery far different than one’s own. (p. 510)

What is most striking in this American history of addiction recovery is the incredible diversity of pathways and styles… (p. 510)

The real and Imagined advances of science have a potentially malevolent side. (p. 511)

Science is unlikely to destroy the disease concept, but a better metaphor could. (P. 512)

Harold Hughes, the political Godfather of modern alcoholism treatment, often noted that alcoholism was the only disorder in which the patient was blamed when treatment failed. (p. 513)

The history of the relationship between professional helpers and people who are addicted is… a story of countertransference gone awry. (p. 515)

The effective treatment of addiction begins with the transcendence of contempt. (p. 515)

There has always been a propensity to oversell what a single episode of addiction treatment could achieve, both personally and socially. (p. 521)

The failure to define and enforce clear ethical standards governing our business practices has long rendered the addiction treatment field a predator’s paradise. The price the field could pay for that failure might be the loss of its own future. (p. 525)

I have immersed myself in this history for more than four decades, and the most profound message that I have drawn from this work is the power of one individual and a single institution to change the future, often in the face of insurmountable odds. (p. 531)

Slaying the dragon… begins with waging war against our own flawed selves and ends with the capacity to move forward through the acceptance and transcendence of our own imperfection. In this transition exists recovery, service, and life for each of us. (p. 531)

A Most Inadequate Appreciation

‘Chasing the Dragon’ is a phrase that has long been part of the argot of America’s illicit drug culture…This is a book filled with the stories of people chasing dragons, being devoured by dragons, and taming or slaying dragons.” (Dragon, p. xv)

Although this book is primarily directed toward the members of the professional community who encounter addiction in the performance of their service roles, this volume is far too interesting not to be in the possession of EVERY moderately erudite alcoholic and addict. The historical portions are spell-binding. How does ones adequately thank someone for such a masterwork, the product of four decades of dedication? As it is beyond me to do so, I thank you inadequately, but with brimming admiration, and a song.

But how do you thank someone
Who has taken you from crayons to perfume?
It isn’t easy, but I’ll try.

Thank you, Sir.

bob k

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