By about the mid-1830s, certain assumptions about the inner experience of the drunkard had become central to temperance thought. The desire for alcohol was seen as "overpowering," and frequently labeled a disease. In 1833 Lewis Cass, Andrew Jackson's Secretary of War, discussed the alcohol addict's illness at a large temperance meeting in Washington, D.C.:

"As the habit of intoxication, when once permanently engrafted on the constitution, affects the mind and body, both become equally debilitated.... The pathology of the disease is sufficiently obvious. The difficulty consists in the entire mastery it attains, and in that morbid craving for the habitual excitement, which is said to be one of the most overpowering feelings that human nature is destined to encounter. This feeling is at once relieved by the accustomed stimulant, and when the result is not pleasure merely, but the immediate removal of an incubus, preying and pressing upon the heart and intellect, we cease to wonder, that men yield to the palliative within their reach." (41, p.124)

In 1838, Samuel B. Woodward, the Superintendent of the famed mental asylum at Worcester, Massachusetts, and probably the leading American physician concerned with mental health at that time, published a series of articles describing alcohol addiction as a "physical disease":

"The appetite is wholly physical, depending on a condition of the stomach and nervous system, which transcends all ordinary motives of abstinence. The suffering is immense, and the desire of immediate relief so entirely uncontrollable, that it is quite questionable whether the moral power of many of its victims is sufficient to withstand its imperative demands." (42, p.2)

Woodward argued that "The grand secret of the cure of intemperance is total abstinence from alcohol in all its forms" (42, p.8). And he claimed it had been learned only relatively recently that abstinence was the cure for intemperance. Similarly, Walter Channing, in an address before the Massachusetts Temperance Society in 1836, observed how little had been known about intemperance when the society had first been founded 24 years earlier:

"The direct connection between moderate drinking, and intemperance, or the extreme liability of the production of the last by the first, --were but vaguely understood,--the giant power of habit, beneath which the strongest will almost surely be made to bow, --and the total inefficacy of partial abstinence, to weaken this power, --the absolute certainty of fatal relapse where the smallest after indulgence is permitted, --upon all this, and much connected with it, the bright light of our day had not yet beamed." (43, p.9)

Many observations made by temperance advocates did not differ significantly from those made by contemporary students of alcoholism and by Alcoholics Anonymous. One temperance writer, for example, described a case of loss of control after one drink:

"All have seen cases of this kind, where a longer or shorter interval of entire abstinence is followed by a paroxysm of deadly indulgence.... In their sober intervals they reason justly, of their own situation and its danger; they know that for them, there can be no temperate drinking: They resolve to abstain altogether, and thus avoid temptation they are too weak to resist. By degrees they grow confident, and secure in their own strength, and ... they taste a little wine. From that moment the nicely adjusted balance of self control is deranged, the demon returns in power, reason is cast out, and the man is destroyed." (44, p.145)

The disease theme was often woven into temperance literature and speeches. In 1829 Nathan Beman (45, pp.6-7) declared that "drunkenness is itself a disease.... When the taste is formed, and the habit established, no man is his own master." John Marsh (46, pp.14-15) raised the rhetorical question "of whether there can be any prudent use of a poison, a single portion of which produces the same disease of which the drunkard dies, and a disease which brings along with it a resistless desire for a repetition of the draught."

In 1881, one authority was quoted as saying that most moderate drinkers eventually experience a diseased "craving for drink" and that "it is the nature of intoxicating liquors to produce the disease" (47, p. 67). Famous temperance lecturer John B. Gough said that he considered "drunkenness a sin, but I consider it also a disease. It is a physical as well as moral evil" (48, p. 443).

The notion that habitual drunkenness was hereditary was also quite common. One speaker told the Young Men's Temperance Society of New Haven that "Drunkenness, itself is a disease, and sometimes a hereditary disease" (49, p. 15). A National Circular sent out in the 1830s made the argument which was repeated throughout the century:

"Unlike the appetite which God gave for water, for bread, and for nourishing food and drinks ... [which] will not increase their demands, this cries continually 'Give, give.' And no man can form it without being in danger himself of dying a drunkard. Not that every man who forms it dies a drunkard. Some may withstand it; but the appetite which a father may withstand, may kill his children, and the children's children, to the third and fourth generation." (50, p. 3)

Nineteenth-century Americans believed in a particular version of the heritability of acquired characteristics. The disease of the parents would be passed on to later generations, but it was thought the traits could be unacquired as well, over several more generations (51). Thus liquor could be viewed as the cause of habitual drunkenness because any individual may have been weakened by his or her ancestors drinking habits. Mother Stewart, one of the early leaders of the Woman's Christian Temperance Union, told in her memoirs of addressing boys and girls during the Woman's Crusade which swept Ohio in 1873:

"Here, as everywhere, the children were greatly excited and interested in the crusade. Ah, many of them knew what it meant to be a drunkard's child. Many had the inherited taint coursing through their veins, and if they did not surrender to the inborn craving they would only escape through a lifelong battle." (52, p.275)

The efforts to develop inebriate asylums were supported by important temperance organizations and leaders. Benjamin Rush (33, 34) had been the first to recommend a "sober house" where drunkards could get special treatment. Samuel Woodward (42) also argued strongly for the idea. In 1865 and again in 1867 the Massachusetts Temperance Alliance (53, 54) issued strong statements of support for the work being done by the Washingtonian home, one of the first functioning inebriate asylums.

In 1873 the National Temperance Society, the major umbrella temperance organization, responded to the formation of an association for the promotion of asylums, and the study of inebriety, by writing in its annual report: "The Temperance press has always regarded drunkenness as a sin and a disease -- a sin first, then a disease; we rejoice that the Inebriate Association are now substantially on the same platform' (55, p. 26). In addition, the National Temperance Society published several pamphlets arguing that asylums were needed because of the very nature of the disease of inebriety (56-58).

"The inebriate is the victim of a positive disease, induced by the action of an alluring and deceptive physical agent, alcohol," said one writer, and he urged that the law "provide well-appointed asylums, in which the victims of alcoholic disease can be legally placed, until ... the disease and morbid appetite are effectually removed" (58, pp.7-8) .

In The Disease Concept of Alcoholism (8, p.6) Jellinek argued that temperance supporters felt "the idea of inebriety as a disease weakened the basis of the temperance ideology." In this paper I am suggesting precisely the opposite. While not every temperance writer called intemperance a disease, many did. And, more important, the core of the disease concept -- the idea that habitual drunkards are alcohol addicts, persons who have lost control over their drinking and who must abstain entirely from alcohol -- was also, from Rush on, at the heart of temperance ideology during the 19th century.

Jellinek cited an 1882 pamphlet by a Reverend John E. Todd as evidence of an anti-disease view of inebriety. What Jellinek failed to mention was that Todd was not a temperance supporter. Indeed, Todd's position was one temperance reformers had been fighting since the beginning of the century. The 17th- and 18th century view had not died out; rather, the belief that habitual drunkards simply loved to drink and get drunk, and that they could stop at any time, continued to exist alongside the addiction -- that is, the temperance -- model. Echoing Jonathan Edwards, Todd wrote:

"I consider it certain that the great multitude of drunkards could stop drinking today and for ever, if they would; but they don't want to.... I observe then there is no apparent difference between drunkenness in its first and drunkenness in its last stages. In both cases there is an appetite, and a will to gratify it. The man drinks simply because he likes to drink, or likes to be drunk." (59, pp.7-9)

Todd's pamphlet was reviewed and critiqued a year later by an anonymous Connecticut minister (60). "The whole question pivots, thus," wrote the pastor, "on the power or powerlessness of the will in the confirmed drunkard to resist his propensity to drink" (p. 3). Defending the temperance position, the minister argued that drunkards are unable to control their drinking. He cited the testimony of eminent physicians and temperance supporters, and he also referred to the experience of drunkards as evidence: "Many of these declare that they wish to refrain from liquor, that they choose to, and that they try to, that they put all the strength of their wills into the endeavor to, but that their craving for liquor is stronger than their wills, and overpowers them" (60, p. 15). Finally, like many other temperance supporters, the pastor believed that the drunkard's condition should be called a disease. He observed that "the essence of disease is involuntariness" and suggested that inebriety was therefore a disease because drunkards are "physically helpless to refrain from drink" (p.22).

Because the source of addiction was thought to reside in alcohol, and because liquor was a readily available and still somewhat socially acceptable substance, the possibilities of someone yielding to the temptation to drink, and becoming addicted, seemed quite real. Thus, in temperance speeches and literature the habitual drunkard was routinely viewed as a victim, and until the end of the 19th century the temperance movement held an essentially sympathetic view of the drunkard's plight. Indeed, it is probably fair to say that as a group temperance advocates were the Americans most openly and actively sympathetic to and supportive of habitual drunkards.

Moderate drinkers, not drunkards, came in for the most scorn in temperance literature. "And if there be any difference in the degrees of guilt between moderate drinkers and drunkards," asserted a Good Templar tract (61), "the moderate drinker is worse than the drunkard." Antitemperance writers of the time also complained of the movement's sympathetic attitude.

As Dr. Howard Crosby, one of the most famous of such writers, explained in 1881: "You will find the principal shafts of the total-abstinence literature are directed not at the drunkard, but at the moderate drinker. The drunkard is pitied and coddled, while the moderate drinker is scourged" (62, p.17).

This sympathetic attitude, of course, carried over into temperance activities. Contrary to much writing on the temperance movement (e.g., 63-65), I want to suggest that, in the 19th century, temperance was not only an attempt by one class or status group to change the behavior of another. It was also quite self-interested activity.

Because they regarded liquor as such a powerful and destructive substance, temperance supporters believed it could, and often did, destroy the lives of even the finest citizens. Members of temperance organizations were deeply concerned with the pernicious effects of alcohol on their own group -- primarily the Protestant middle class; they worried about themselves, their relatives, friends and neighbors. Thus support work for habitual drunkards comprised an important part of temperance activity, not only during the Washingtonian period of the 1840s, but for the rest of the century as well.

From the end of the Civil War to the turn of the century, the majority of people in temperance organizations belonged to fraternal groups -- highly organized secret societies requiring total abstinence, and aimed primarily at helping members stay sober, improving their character and helping other drunkards reform. As the Most Worthy Scribe of the Sons of Temperance explained, the Sons "sprang from the lap of the Washingtonians," and were dedicated to carrying on the reformation work by providing greater organizational structure and support. It was concerned with helping "reformed inebriates"; its first purpose was "to shield its members from the evils of intemperance" (66, pp.491-492).

Similarly, the Independent Order of Good Templars, the largest temperance membership organization in American history, was so involved in reform work that it worried about being branded solely as an association of ex-drunkards (67). While lifelong abstainers were important to the organization, a central focus of the Good Templars was helping inebriates to become and stay abstinent.

Good Templars were urged to "run and speak to that young man who is contracting vicious habits -- gain his consent that you shall propose his name for membership in the lodge" (68, p.8). In the initiation ritual of the Good Templars, those members "free from the undying curse of appetite" were encouraged to "fully sympathize with the confirmed inebriate" (69, p.57).

Those being initiated into the Charity Order were urged to "study well the nature of this appetite"; they were told that reformed individuals sometimes relapsed, and reminded that their task was to go to "thy reclaimed brother" in his "awful hour." And they took pride in pointing out "the many official positions now filled by worthy men who have been reclaimed and reformed, given back to their families and community ... by the labors of the Good Templars" (68, p.6).

In the latter half of the 19th century the Sons of Temperance, the Good Templars, and a host of smaller fraternal groups, functioned in much the same manner that A.A. does today. They provided addicts who joined their organizations with encouragement, friendship and a social life free from alcohol. They went to inebriates in times of need, and in some cases offered financial support as well.

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Changes in the Paradigm

In the last decade or so of the 19th century, temperance ideology began to shift away from its broad reformist orientation, toward a single-minded concern with Prohibition. The older organizations, especially the fraternal ones, declined markedly. The leaders who had guided the movement since the end of the Civil War died, and were replaced by a new generation which prided itself on its practical and scientific attitudes.

In the early 20th century, under the leadership of the Anti-Saloon League, all activities became secondary to the drive for Prohibition (64, 71, 72). As Gusfield (63) has rightly pointed out, the temperance movement shifted from "assimilative reform' to coercion.

One aspect of this transformation was that addiction came to occupy a less central role in the ideology of the movement. Thus the Prohibition campaign of the early 20th century focused on other evil effects of alcohol: Liquor's role in industrial and train accidents; its effects on business and worker efficiency; its cost to workers and their families; the power and wealth of the "liquor trust"; and especially the role of the saloon as a breeding place for crime, immorality, labor unrest and corrupt politics.

In a sense, the 'demon rum" became less the enemy than the "liquor trust" and the saloon (64, 71, 72). One aspect of the shift away from a focus on the addicting qualities of alcohol was the weakening, and in many cases the loss, of the movement's longstanding sympathetic attitude toward the habitual drunkard. The drunkard came to be viewed less and less as a victim, and more and more as simply a pest and menace.

Of course, the concept of addiction did not disappear from American life. Increasingly during the 19th century, opium came to be regarded as inherently addicting. After the Harrison Act of 1914, federal drug agencies emphasized the addicting qualities of opium and its derivatives, and later of marihuana (4, 6).

However, by the early 20th century the original moral entrepreneurs of alcohol addiction, the temperance movement, had lost much of their interest in forwarding the idea. In Gusfield's terms (73) no one "owned" the addiction model of alcoholism. While there seemed to be a general acceptance at that time within psychiatric and social work circles for a disease conception of alcoholism, the details and specifics of it were not clearly worked out (31).

Further, in order for a disease conception to be acceptable to masses of people in the 20th century, the idea that alcohol was an inherently addicting substance had to be abandoned. There was, therefore, a vacuum which remained unfilled until the creation of A.A.

The "rediscovery" of alcoholism as an addiction and a disease in the 1930s and 1940s, by A.A. and the Yale Center of Alcohol Studies, was indeed a significant change within the addiction paradigm. Now alcohol could be understood as a socially acceptable, "domesticated" drug which was addicting only to some people for unknown reasons. Thus alcoholism became the only popularly and scientifically accepted person-specific drug addiction.

For the first time, the source of addiction lay in the individual body, and not in the drug per se. The result has been a somewhat "purer" medical model -- that is, there is less of a tendency to view addiction as self-inflicted disease.

This "new disease conception" (8) of alcoholism was both novel, and yet based on a 150-year-old common-sense understanding of habitual drunkenness. As I have suggested, the post-Prohibition view has more in common with 19th-century temperance thought than with either pre-temperance or anti-temperance formulations (e.g., Jonathan Edwards and Reverend Todd).

Besides the belief in the necessity of abstinence, the essential commonality between A.A. and temperance lies in the importance attributed to, as well as the way of interpreting, the inner experiences of the alcoholic. Ultimately, one is only certain that a heavy drinker has passed over the line to alcohol addiction if that person reports experiencing irresistible desires for the substance -- if there is, in Jellinek's (8) term, loss of control. From such a definition of the problem -- as behavior beyond the control of the will -- stems the tendency to view habitual drunkenness as disease, and the potential for a sympathetic attitude toward the alcoholic.

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The Social Context of Addiction

A thorough discussion of why the concept of addiction emerged as and when it did is bound to be somewhat speculative, and is not possible here. However, I want to suggest the outlines of a sociology of knowledge approach. In the last 200 years definitions of habitual drunkenness have been shaped by developments in thought about deviance in general, and about mental illness in particular.

Benjamin Rush, for example, is best known today for his work on mental illness -- for his reconstruction of madness as disease. Recently a number of writers, notably Foucault (74) and Rothman (22), have suggested that the medical model of madness, first established at the end of the 18th and beginning of the 19th centuries in Europe and the United States, was in fact a medical model of deviance in general, and part of the new world view of the middle class.

French physician Philippe Pinel, British merchant William Tuke, as well as Dr. Benjamin Rush, are usually credited with the simultaneous and mostly independent discovery that within the asylum the mad could be freed from their chains and taught to constrain themselves. The therapy was called "moral treatment" and it replaced the traditional mechanisms of social control, chains, with fear and guilt. The mad were now expected to control themselves (22, 74, 75).

Foucault (74) argues that the establishment of the new view of madness was made possible by the achievement of economic and political power by the bourgeoisie. Grounded in the optimistic Weltanschauung of the Enlightenment, the middle class assumed that evil need not exist -- social problems were solvable or curable.

However, the conditions of a "free society," meaning individual freedom to pursue one's own interests, required shifting social control to the individual level. Social order depended upon self-control. "The madman as a human being originally endowed with reason, is no longer guilty of being mad," Foucault has written, "but the madman, as madman, and in the interior of the disease of which he is no longer guilty, must feel morally responsible for everything within him that may disrupt morality and society" (74, pp.245-246).

Madness had become a curable disease, the chief symptom of which was loss of self-control. The asylum was constructed as a place to restore the power of self-discipline to those who had somehow lost it.

In America the importance attributed to individual responsibility has usually been identified with the Protestant and Puritan heritage. However, by the beginning of the 19th century the value of inner discipline had become increasingly divorced from its religious scaffolding. In the colonial period it was thought even among Puritans that social control had to be maintained by a complex and hierarchical web of community relations (22, 76).

In the 19th century, however, the ideological and structural features of life shifted the locus of social control to the individual. Max Weber (77) cited Benjamin Franklin as the archetypal example of the capitalist spirit -- the disciplined and rational pursuit of money. Weber (77, p. 72) argued that the conditions of life in capitalist society required that individuals methodically regulate their activities in order to survive and succeed. The conditions and experiences of daily life meant that everyone in the middle class had to try to become like Franklin.

Because the United States was an especially or uniquely middle-class nation (78, 79, 80), the redefinition of evil or deviance as a disease of the will was carried even further here. That is, because self-control ("self-reliance" as Ralph Waldo Emerson proclaimed) had become so important to the middle class, its negation had to be more clearly defined and combated.

Boorstin (81) has observed that "when the Jeffersonian came upon the concept of evil in theology or moral philosophy, he naturalized it into another bodily disease; a disease indeed of the moral sense, but essentially no different from others" (p. 137).

In the Jacksonian era, the 1830s, Americans troubled by the disorder they perceived in their society built almshouses, penitentiaries, orphan asylums and reformatories to administer "moral treatment" to the dependent and deviant. The idea, in all cases, was to build up the dormant or decayed powers of self-control through discipline, routine and hard work (22).

The asylum managers explained that their purpose was to provide inmates with a "healthy moral constitution capable of resisting the assaults of temptations," and to "aid them in forming virtuous habits, that they may finally go forth clothed as in invincible armor.' The technique developed for treating the mentally ill was extended to all who had failed to regulate themselves properly.

Like asylum advocates, temperance supporters were interested in helping people develop and maintain control over their behavior and actions. Temperance supporters, however, believed they had located, in liquor, the source of most social problems. The temperance movement, it should be remembered, was the largest enduring mass movement in 19th-century America.

And it was an eminently mainstream middle-class affair. The temperance movement appealed to so many people, in part, because it had become a "fact of life" that one could lose control of one's behavior. Even the use of the word "temperance" for a total abstinence movement is understandable when we realize that the chief concern of tem perance advocates, and of the middle class in general, was self-restraint.

Liquor was evil, a demon, because its short- and long-run effect was to prevent drinkers from living moderate, restrained, temperate lives. In A.A.'s terms, it made their lives "unmanageable."

In the 19th century, the concept of addiction was interpreted by people in light of their struggles with their own desires. The idea of addiction "made sense" not only to drunkards, who came to understand themselves as individuals with overwhelming desires they could not control, but also to great numbers of middle-class people who were struggling to keep their desires in check -- desires which at times seemed "irresistible."

Given the structural requirements of daily life for self-reliant, self-making entrepreneurs and their families, and the assumptions of the individualistic middle-class world view, it seemed a completely reasonable idea that liquor, a substance believed to weaken inhibitions when consumed (intoxication), could also deprive people of the ability to control their behavior over the long run (addiction).

Riesman et al. (80) have characterized the property-owning middle class as "inner directed," by which they meant both the particular way in which conformity was assured, and a concern with the integrity and inner experiences of the individual. Thus the distinctively middle-class literary form, the novel, made its domain the exploration of the nuances of daily life and inner experiences (82).

The novel, therefore, became one important place where the inner struggle of the drunkard was portrayed (38, 40). The rise of middle-class society was the precondition for a literature based on everyday life and experience, and also a precondition for the new way of seeing the drunkard.

The invention of the concept of addiction, or the discovery of the phenomenon of addiction, at the end of the 18th and beginning of the 19th century, can be best understood not as an independent medical or scientific discovery, but as part of a transformation in social thought grounded in fundamental changes in social life -- in the structure of society.

For those interested in criticizing and transcending the addiction model of drug use, it is important to understand that the medical model has much deeper roots than has previously been thought. A.A., and Jellinek's and Keller's formulations are only the most recent articulations of much older ideas. Further, the structural and ideological conditions which made addiction a "reasonable" way to interpret behavior in the l9th century have not disappeared in the 20th: Many people still face the problem of controlling their own "compulsive" behavior.

The proliferation of "Anonymous" groups, based on the A.A. format, is testimony to the continued effectiveness of such organizational methods of helping people control themselves. In all cases, the focus is on the interaction between the individual and the deviant activity (drinking, eating, smoking, gambling) and with helping the individual to stop being deviant.

On the other hand, there is the beginning of what I would call a "postaddiction" model of drug and alcohol problems emerging -- based in part on developing critiques of the medical model of deviance in general. A new formulation of drug and alcohol problems does not look primarily at the interaction between individual and drug, but at the relationship between individual and social environment.

Deviance, therefore, is not simply defined as an issue of individual control and responsibility, but can be seen as a social and structural process. Indeed, exactly who or what is deviant can now be problematic. In part, the rise of a new popular and scientific "gaze" is rooted, as the old one was, in changes in the organization of daily life.

The different conditions facing people in the 20th century, in particular the obviousness of giant organizations and of the degree of human interdependence, begin to make it possible to see the "social" nature of what had formerly been viewed as "individual" problems.

Take, for example, the issue of drunken drivers. An individualist perspective looks at those who have lost their ability to "manage" in the world because of drink; an alternative view focuses, instead, on the interaction between social life and transportation. If drinking is "normal" activity, then perhaps the phenomenon of drunken drivers is not a drinking problem, but a transportation problem.

Indeed, if one thinks about it, we live with a bizarre system of transportation: In order to get from one place to another people are required, at all hours of the day and night, to execute high-speed maneuvers, through a maze of obstacles, with a ton of machinery. There would, of course, be serious opposition to a redefinition of the problem of drunken drivers as a transportation problem -- from automobile companies, for example.

As was true at the beginning of the 19th century, developing a new model of alcohol problems would necessarily be part of a reformulation of social problems in general. Thus even if a new paradigm or model does emerge, it will have to compete and coexist with the addiction perspective for a long time -- just as, for the last 200 years, the addiction model has had to compete and coexist with the pre-addiction view.

 
 References & Appendix
 http://soc.qc.cuny.edu/Staff/levine/doa-refs.htm

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