As NAADAC, The Association for Addiction Professionals celebrates its 35th anniversary as an organization, it is a fitting time to look back over the history of addiction counseling. There is a growing body of literature on the history of addiction treatment, but the history of NAADAC and a definitive history of addiction counseling as a profession have yet to be written. This article will offer a few snippets related to the origin of addiction counseling and will discuss the state of the field at the time NAADAC came into being.
This article offers a way to honor generations of men and women who spent their lives laying the foundation for what would become the profession of addiction counseling. We can still draw upon these individuals' lives and their stories for wisdom and inspiration.
Before there were counselors
No formal role of addiction counselor existed in the 18th and 19th centuries, but there were those who reached out to people with alcohol and other drug problems through activities that later would be integrated into this role. Those activities could be found in two settings: the earliest addiction recovery mutual aid societies, and within America's first inebriate homes, inebriate asylums, private addiction cure institutes, and faith-based recovery ministries.
Early addiction recovery support groups included Native American recovery circles, the Washingtonians, recovery-based fraternal temperance societies, the Ribbon Reform Clubs, the Drunkard's Club, and the United Order of Ex-Boozers.1,2,3 The reformed drunkard turned temperance missionary became a prominent figure in the American temperance movement. Individuals such as John Gough and John Hawkins used charismatic speeches detailing their fall and redemption to call others into recovery.4,5 They also provided personal consultations with alcoholics and their families, helped organize local recovery support groups, and maintained a prolific correspondence with individuals and families in recovery.
The therapeutic branch of the American temperance movement became involved in “rescue work” with confirmed drunkards, and these efforts spawned calls for specialized treatment institutions. What followed in the mid-19th century was an ever-expanding network of inebriate homes, medically directed inebriate asylums, private for-profit addiction cure institutes, and urban rescue missions catering to late-stage alcoholics. As “reformed men” sought service roles in these institutions, controversies raged about who was best equipped to do this work. The relapse of some prominent recovering temperance lecturers added to this debate.6,7
T.D. Crothers, MD, a prominent leader in the American Association for the Study and Cure of Inebriety—the first professional association of addiction treatment providers—adamantly opposed the hiring of persons in recovery. He wrote, “Physicians and others who, after being cured, enter upon the work of curing others in asylums and homes, are found to be incompetent by reason of organic deficits of the higher mentality. … The strain of treating persons who are afflicted with the same malady from which they formerly suffered is invariably followed by relapse, if they continue in the work any length of time.”8
This debate died in the larger collapse of addiction treatment in the opening decades of the 20th century—a collapse resulting from a perfect storm of intrafield factors (e.g., ideological schisms within the field, ethical abuses, aging leadership) and contextual factors (economic depressions, lost cultural faith in the prospects of long-term addiction recovery, and the advent of national alcohol and drug prohibition laws). In spite of the collapse of addiction treatment as a field, key functions performed by those in recovery carried into the 20th century: self-disclosing, educating (including providing lectures during residential treatment), advising, encouraging, modeling, and linking individuals to sources of long-term sober fellowship. These functions mark a thread of historical continuity that influenced the later rise of addiction counseling.
The lay therapy movement
Between 1900 and 1920, local efforts to treat alcoholism continued in spite of the larger national collapse of addiction treatment as a field. In 1906, the Emmanuel Church of Boston established a clinic that integrated religion, psychology, and medicine in the treatment of alcoholism. The clinic provided medical evaluation, educational classes, individual and group counseling, mutual support (the Jacoby Club), and personal support of “friendly visitors” (recovered alcoholics). Within a few years, the latter evolved into a formal system of lay therapy. Selected patients who had been successfully treated at the Emmanuel Clinic were trained to provide the same type of counseling they had received.9