Source: guvo59/Pixabay The Colonial Period
It seems strange to Americans today that the disease theory of addiction was developed not in connection with opioids—which had been known and used since Greek antiquity, at least—but with alcohol. The disease theory of addiction was first promulgated by Colonial physician (and signatory of the Declaration of Independence) Benjamin Rush. Rush proposed that alcohol caused drinkers to lose control of their critical decision-making faculty—the essential element in American addiction theory for 200 years, since Rush proposed it in 1812 in Diseases of the Mind, through to Nora Volkow’s 2015 Addiction is a Disease of Free Will.
19th-Century: Temperance
Colonial Americans drank alcohol everywhere—in family taverns, at state legislative meetings, during the writing of the Constitution—indeed in churches and schools (even Protestants drank sacramental wine). This use was socially integrated, accepted and regulated. That changed around 1830 with the rise of Temperance—which dominated American society in the 19th century. (The history of this development is detailed in William Rorabaugh’s The Alcoholic Republic.) Drinking plummeted throughout this period, culminating belatedly in National Prohibition from 1920 to 1933.
19th-Century: "Dark Paradise"
Again, anomalously by contemporary thinking, while alcohol was vilified in 19th-century America, opioids were commonplace and accepted, sold on street corners and in apothecaries throughout the country in the tinctured form of laudanum, given to teething babies and lactating mothers. This has led to two alternative images of the 19th century: David Courtwright’s 1982 Dark Paradise, which backfills a vision of a country suffused with rampant, unacknowledged addiction, and Virginia Berridge’s 1981 Opium and the People, which instead depicts a nation (Britain) in which pervasive opioid use was benign and socially regulated.
The 20th Century: The Invention of Addiction
Americans today cannot conceive that addiction had to be invented as a medical concept and applied specifically to opiates, culminating in the 1914 Harrison Tax Act, which essentially made street drugs illegal. This led to the relegation of heroin, marijuana, and cocaine to racial minorities and social “misfits”—and our current unfortunate prevailing images of opioid use and drug users.
Let it be noted, as David Musto did in his 1973 The American Disease, that this history is peculiarly American (although we have spread it worldwide), with the concomitant result that we have always been world leaders in opiate addiction.
The 20th Century: The Neuro Revolution
Beginning with the identification of endorphins in the early 1970s by Solomon Snyder and culminating in the 2000 Nobel Prize awarded to Eric Kandel, neurochemistry became the sine qua non of mental illness and addiction theory. Although he himself was not a neurochemistry researcher, but a practicing neurologist, Richard Restak, beginning in the 1970s, marked by his 1986/1988 bestsellers The Brain/The Mind (both of which formed the bases for popular PBS specials), typified how neuroscience was seen as being on the verge of revolutionizing American mental illness and addiction theory and practice.
In Restak’s words in 1979, endorphins (and later dopamine) comprised “a veritable philosopher's stone—a group of substances that hold out the promise of alleviating, or even eliminating, such age-old medical bugaboos as pain, drug addiction, and, among other mental illnesses, schizophrenia.”
The 21st Century: The Chronic Brain Disease
Alan Leshner acceded to the directorship of the National Institute on Drug Abuse (NIDA) in 1996, to be succeeded by Nora Volkow in 2003. Together, they developed and promulgated worldwide the concept of addiction as a chronic relapsing brain disease, a conception that typifies and determines vast amounts of American research, medical school, and now even secondary school teaching on addiction, and the dominating image of the nature of and cure for addiction in the 21st Century. However, this revolution has not produced a single diagnostic tool or treatment method.
THE BASICSThe Dissenters: Zinberg, Peele, Alexander, Hart
The promised fruits of the neurorevolution have not been realized. Mental illness has grown steadily since the late 1970s, culminating in our current “epidemic of mental illness,” as noted in 2011 by Marcia Angel, with reference to Robert Whitaker’s 2010 Anatomy of an Epidemic. Exactly parallel to the explosion in mental illness has been the astronomical jump in drug deaths, an increase of about 600 percent since the 1990s, with a special leap of 350 percent from 2013 to 2017. (The latter occurring despite steep drops in opioid prescriptions.)
It should be noted that, from the 1980s, dissensions from the prevailing idea that opiates were special causes of addiction have appeared, most notably Norman Zinburg’s 1984 Drug, Set and Setting, and Stanton Peele’s 1985 The Meaning of Addiction. Supplementing these foundation works have been Bruce Alexander’s Rat Park studies (detailed in Meaning) and Carl Hart’s assertion that “drugs are not the problem,” beginning with his 2013 book High Price.
Addiction Essential Reads
A Vaccine Against Fentanyl! 
Substance Use Prevention in Teens With ADHD Where Do We Go in 2020?
Although there remains a vague, general cultural sense that we have achieved a new understanding of addiction and mental illness through brain science, there is a concurrent realization that we are not doing well in curbing these maladies, but rather that the reverse is occurring. Gone are the over-promised cures a la Restak’s 1980s PBS specials, Leshner’s 1990s Brain Disease broadsides, and Kandel’s 2000 Nobel Prize—indeed, even modest promises that we can get a handle on addiction and mental illness have seemingly been abandoned in the 21st century. Not deterred by its obvious lack of success, nonetheless major media series (like Volkow-NIDA’s 2007 HBO Addiction Project and PBS’s 2018 Nova special) repeatedly double down on the brain disease model in programs readily transferred to school curricula.
We are thus heading in three contradictory directions. Psychologists and theorists, like Peele and Zach Rhoads in their 2019 Outgrowing Addiction and Hart in his current lectures and a forthcoming book, point to a normalization of drug use within the ordinary parameters of social and individual behavioral controls. Brain disease advocates, a la Volkow and most medical science, nonetheless still prevail.
Meanwhile, drug policy reformers have proposed decriminalizing all personal drug use and administering opioids in controlled settings (called drug/safe consumption sites)—even as they join public health officials in scurrying to reduce painkiller prescriptions and prescribe narcotic blockers for current illicit opioid users. The latter themselves comprise disease theory responses.
The Ideal: Marianne Williamson
Marianne Williamson, the brilliant life philosopher and presidential candidate, proposes one essential answer to mental health, addiction, and indeed all of our social crises—that we enable everyone (or as many people as we can) to thrive. Then, and only then, will we have less addictive use of drugs (Williamson herself likes wine), self-immolating behavior, and social dysfunction—from social inequality to even global warming. Unfortunately, currently, the prospects for this revolution aren’t good.