History Of Substance Use

Evolution of Substance Use

The history of substance use is a compelling tale full of intrigue, discovery, and evolving societal norms. From the earliest documented uses of psychoactive substances to the emergence of the modern concept of addiction, this journey offers fascinating insights into our collective past.

Historical Use of Psychoactive Substances

The human penchant for addictive psychoactive substances is documented in some of the earliest human records. Historically, these substances have seen usage across various spectrums of society. Priests employed them in religious ceremonies (e.g., amanita muscaria), healers utilized them for medicinal purposes (e.g., opium), and the general population partook in a socially approved manner (e.g., alcohol, nicotine, and caffeine) [1].

It's noteworthy that these substances and their consumption were often integrated into societal norms and customs. This historical use of psychoactive substances sheds light on the roots of substance use and sets the stage for understanding the development of addiction.

Emergence of Addiction Concept

The concept of addiction as we understand it today can be traced back as far as the 17th century. The issue of loss of control over substance use, which heralds the modern understanding of addiction, was already a topic of discussion during this period [1].

The term "addiction," in its current medical sense, first emerged in English-speaking countries and was later adopted by other languages that had previously used different terms. This evolution of addiction terminology reflects the growing understanding of this complex issue and its impact on individuals and societies.

The historical roots of addiction medicine can be traced back to Calvinist theologians in the 17th century. They offered explanations for the phenomenon of compulsive drinking, which were later accepted by physicians. This highlights the interplay between societal beliefs, religious doctrine, and medical understanding in shaping the concept of addiction [1].

The exploration of the history of substance use and the emergence of the addiction concept provides a crucial context for understanding the complexities of this issue. By delving into the past, we can better comprehend the present state of substance use and work towards effective strategies for addressing the challenges of addiction.

Addiction Medicine Development

The development of addiction medicine is a captivating aspect of the history of substance use. This evolution can be traced back centuries, and it has been influenced by various factors, including religious beliefs and the changes in societal attitudes towards substance use.

Calvinist Theologians' Influence

The roots of addiction medicine can be traced back to the Calvinist theologians' work in the 17th century. These theologians provided some of the earliest explanations for compulsive drinking, a phenomenon that was later accepted by physicians as a form of addiction. This marked a significant shift in the understanding of substance misuse, laying the groundwork for modern addiction medicine.

This early interpretation of addictive behavior was primarily moralistic, characterizing it as a sin or moral failing. However, this perspective has evolved over time, with the modern addiction medicine field viewing addiction as a complex disorder influenced by a variety of biological, psychological, and social factors.

Evolution of Addiction Terminology

The terminology used to describe addiction has also undergone significant changes throughout the history of substance use. The term "addiction" in its current medical meaning was initially used in English-speaking countries and then adopted by other languages that had previously used different terms [1].

Historically, the archetypal model of addiction was opiates, such as opium and heroin, which induce clear tolerance, severe physical withdrawal symptoms, and have serious consequences for the social, professional, and familial functioning of users. This model has paved the way for the current understanding of addiction, which now encompasses a broader range of substances and behaviors.

The complex etiology of addiction is reflected in the frequent pendulum swings between opposing attitudes on issues still currently being debated, such as whether addiction is a sin or a disease, whether treatment should be moral or medical, and whether addiction is caused by the substance, the individual's vulnerability and psychology, or social factors.

These debates highlight the complexity of addiction and the challenges inherent in developing effective treatments and prevention strategies. As our understanding of addiction continues to evolve, it is crucial to remain open to new perspectives and approaches that can enhance our ability to address this pervasive and often devastating issue.

Milestones in Substance Discovery

The history of substance use is marked by several significant milestones, particularly in the discovery and isolation of various psychoactive substances. This section will focus on the isolation of morphine and the introduction of cocaine and codeine.

Isolation of Morphine

The first addictive ingredient isolated from a natural product was morphine. This milestone was achieved by F.W.A. Serturner, a German pharmacist, in 1806. Extracted from crude opium, the increasingly widespread use of morphine revolutionized pain control [2]. Morphine constitutes roughly 10 percent of crude opium.

One of the first careful studies of morphine addiction was conducted in 1875 by Levinstein. He identified key elements in opiate addiction that still intrigue researchers today. These include the fixation on the drug that made it the highest priority even when the user's life situation was deteriorating, and the curious phenomenon of withdrawal that could be quickly reversed by administering more of the opiate.

Introduction of Cocaine and Codeine

The history of substance use also saw the introduction of cocaine and codeine. While cocaine was considered for medical use, it was eventually dropped due to declining abuse problems. Codeine, on the other hand, appeared to be less addictive, thus posing less danger. As a result, morphine remained the primary target of substance use research [2].

These milestones in substance discovery significantly impacted the understanding and management of substance use. They provided valuable insights into the physiological and psychological aspects of addiction, paving the way for advancements in addiction medicine. As the history of substance use continues to unfold, these discoveries remain at the core of ongoing efforts to address and mitigate the impacts of substance misuse.

Understanding Addiction

To fully comprehend the history of substance use, it's essential to understand the key concepts related to this issue, such as addiction versus dependence and the role of social and psychological factors.

Dependence vs. Addiction

The distinction between dependence and addiction has been a topic of debate for a long time. Traditionally, addiction was symbolized by opiates like opium and heroin, which lead to clear tolerance, severe physical withdrawal symptoms, and serious repercussions on the social, professional, and familial functioning of users.

Dependence, on the other hand, generally pertains to the physical reliance on a substance, where discontinuation results in withdrawal symptoms. A person can be dependent on a substance without being addicted, for example, in the case of certain prescription medications.

Addiction, however, encompasses not only physical dependence but also psychological aspects. It is characterized by the uncontrollable use of a substance despite harmful consequences, which was a concept already being discussed back in the 17th century [1].

Social and Psychological Factors

The complicated origins of addiction are mirrored in the frequent shifts in attitudes towards issues that remain under debate to this day. Questions such as whether addiction is a sin or a disease, whether treatment should be moral or medical, and whether addiction is caused by the substance, individual vulnerability and psychology, or social factors, are still being explored.

Historically, the association of certain substances with specific demographics played a role in the perception and legislation of these substances. For instance, the association of opium with Chinese immigrants, cocaine with African Americans, and morphine addiction with careless physicians led to more restrictive legislation and opposition to easy access to these drugs.

Understanding these aspects is crucial in the context of the history of substance use. As the field continues to evolve, it's important to consider these factors when discussing substance use, dependence, and addiction. This awareness can contribute to more effective treatment approaches and better outcomes for individuals struggling with substance use disorders.

Substance Use Throughout History

Understanding the history of substance use in various parts of the world can provide valuable insights into the current state of drug policy, addiction treatment, and societal attitudes towards drugs. In this section, we will focus on the evolution of drug use in two countries with significant historical impacts: Canada and the United States.

Drug Use in Canada

The history of substance use in Canada is marked by a series of legal measures aimed at restricting and regulating the use, importation, and sale of various substances.

In 1908, the Opium Act was passed, criminalizing the importation, manufacture, and sale of opium for non-medical purposes. This legislation primarily targeted Chinese Canadian men and was grounded in anti-Chinese racism.

Three years later, the Opium and Drug Act was passed, which added other drugs to the list of prohibited substances, including cocaine and morphine. This act also expanded police powers of enforcement and intensified targeting of Chinese men, leading to a rise in drug-related convictions.

By the 1920s, cannabis was added to the list of prohibited drugs in Canada. The push towards prohibition spread across the country, with anti-drug campaigns launched by organizations such as the Montreal Children’s Aid Society and the media playing a role in demonizing substance use [3].

In the 1960s and 1970s, Canada saw a shift towards a counter-culture movement and increased illegal drug use, particularly cannabis. The Narcotic Control Act came into force in 1961, strengthening criminal penalties against people who used drugs. The media perpetuated stereotypes and myths about drug use, and arrests for cannabis possession dramatically increased.

Drug Use Evolution in the U.S.

In the United States, the history of substance use dates back to the 1500s with the introduction of tobacco and alcohol. Marijuana was introduced as early as the 1600s, and opium was brought by Chinese immigrants in the 1800s. It was during this century that European chemists separated morphine from opium.

The 1900s saw the use of barbiturates as tranquilizers and sedatives, while amphetamines were found to raise blood pressure and stimulate the nervous system. The 1960s brought LSD to American culture, leading to tighter regulations and a subsequent turn to heroin, worsened by the drug problems of soldiers returning from the Vietnam War.

A century ago, addicts were considered morally degenerate, with no formal treatment available. In the 1950s, drug abuse was seen as a problem in lower socioeconomic groups, and by the 1970s, lawmakers were recommending treatment instead of criminal prosecution.

The last three decades have seen a shift in understanding addiction as a complex brain disease, leading to a shift to client-centered care and more therapies to aid in recovery.

By tracing the history of substance use in these two countries, we can gain a better understanding of the complex interplay between societal attitudes, legal measures, and the realities of addiction. These insights can inform policies and interventions aimed at addressing the challenges associated with substance use today.

Impact of Substance Use

Substance use has a significant impact on society at large and individuals, particularly when it transitions into misuse or addiction. In this section, we will explore the costs and consequences of substance use and the health implications of substance misuse.

Costs and Consequences

Substance misuse and substance use disorders, including addiction, result in total costs of more than $420 billion annually, with over $120 billion in healthcare costs in the United States alone. Such problems deteriorate the quality of health, educational, and social systems and can lead to debilitating conditions or even death. This is particularly true among young people through alcohol-related car crashes, drug-related violence, and medication overdoses.

‍

Impact	Annual Cost
Total cost of substance misuse and disorders	$420 billion
Healthcare costs due to substance misuse and disorders	$120 billion

The societal costs of substance misuse reach far beyond financial implications, impacting the quality of life for individuals and communities. The consequences of substance use can be devastating, affecting education, employment, relationships, and overall well-being.

Health Implications of Substance Misuse

The health implications of substance misuse are profound. The presence of an early substance use disorder often doubles the odds for the subsequent development of chronic and expensive medical illnesses such as arthritis, chronic pain, heart disease, stroke, hypertension, diabetes, and asthma. Failure to detect and address substance use has been associated with misdiagnoses, poor adherence to prescribed care, high use of hospital and emergency services, and deaths.

Approximately 17% (44 million people) of the US population aged 12 years and older reported using an illegal drug, non-medical use of a prescribed drug, or heavy alcohol use during the prior year. Close to 3% (7.8 million) initiated substance use in the prior year, and 8% (21.4 million) met diagnostic criteria for a substance use disorder [5].

More than 34 million people reported heavy drinking in the past year. Marijuana was the most frequently used drug, with use significantly increasing over the past five years, likely as a result of the legalization of medical and recreational marijuana in certain states. Non-medical use of prescription drugs was reported by almost 15 million individuals (5.5% of the population) in the national survey. Brand-name opioid pain relievers accounted for 69% of the prevalence, followed by sedatives/tranquilizers or stimulants, each reported by 4 million people.

The history of substance use underscores the importance of understanding the costs and health implications associated with substance misuse. By acknowledging the impacts and addressing the issues at hand, society can work towards strategies and solutions that reduce harm and improve overall health.