Talking Points: Ken Anderson

Points is proud to introduce our readers to the historical magnum opus of harm reduction pioneer and writer Kenneth Anderson. Anderson's multi-volume series The Untold History of Addiction Treatment in the United States is available for purchase here. The most recent volume in this ongoing research project is Alcoholism Treatment Rebirth. Anderson joins us to discuss the book and the progression of the series to date.

Author Ken Anderson

Please tell readers a little bit about yourself

I am the founder and CEO of HAMS, the world's only harm reduction-based support group for people who drink alcohol. HAMS is lay led and free of charge. I hold a master's degree in linguistics from the University of Minnesota, a master's degree in addiction psychology from the New School for Social Research, and I am currently pursuing a PhD in addiction psychology at Capella University. My dissertation will be a quantitative study of whether members of AA and members of SMART Recovery differ on the dimensions of dogmatism, authoritarianism, and anti-intellectualism. I learned harm reduction by working in needle exchange. I regularly publish articles on harm reduction, drug policy, the neuroscience of drugs and alcohol, and the history of drug and alcohol treatment in Filter, the Practical Recovery Blog, and elsewhere. In addition to my book series on the history of drug and alcohol treatment, I am also the author of How to Change Your Drinking: A Harm Reduction Guide to Alcohol, which serves as the handbook for the HAMS program.

What got you interested in the history of alcohol, drugs, and pharmacy?

My interest in drug and alcohol treatment began in the mid-1990s when I decided that I was drinking too much and checked myself into a residential treatment program. While I was there, I was introduced to some of the most bizarre ideas I had ever heard in my life, such as the idea that the only cure for addiction was belief in an omnipotent deity. Which could be a doorknob. And that anyone who failed to believe would die a horrible death of alcoholism. In other words, I was introduced to the 12-step program. Since I had grown up in a religious cult which I escaped as a teenager, such ideas did not sit well with me. Moreover, they contradicted my personal experience since the people I knew who had quit drinking had done so without God or the 12-steps.

So, the first thing I did after leaving treatment was go to the public library to see if there was any evidence for the efficacy of 12-step programs. Although there were a lot of books which hyped the 12 steps as the greatest thing since sliced bread, these books cited no scientific studies. The only books which cited scientific studies said there was no proof of the efficacy of 12-step programs. As the years went by, I continued to study the drug and alcohol field and began writing about it. Another thing which I soon learned was that almost everything drug and alcohol counselors were taught in school and passed on to their clients was contradicted by science. This led me to two questions: How was it that a treatment modality with no scientific evidence behind it had been adopted by US hospitals as the standard treatment for addictions? And what led to the split between addiction treatment and addiction science?

What motivated you to write this book specifically?

I read some excellent books and studies such as Bill White's Slaying the Dragon while I was pursuing these questions; however, I eventually found that Bill White had barely scratched the surface of the history of addiction treatment. So, I decided in 2016 to write a book to fill in the gaps. At that point I envisioned just a regular sized book. In fact, I have so far published about 2,500 pages of this history in four volumes and have only gotten up to facilities established before 1957. There is very little overlap between my book series and Slaying the Dragon. Slaying the Dragon is a history of recovery and covers support groups as well as treatment facilities and much else. My focus was much narrower; I only cover treatment facilities. In the cases where Bill and I have written about the same topic, such as Hazelden or Alina Lodge for example, I have either added new information or addressed these from a very different viewpoint.

Explain your book in a way your bartender won't find boring.

This book series offers encyclopedic coverage of all types of addiction treatment facilities which have existed in the United States from the 1840s to the present day. This includes the inebriate asylums and inebriate homes of the 19th century as well as the secret cure institutes such as the Keeley and Neal institutes of the 19th and early 20th centuries. I also discuss aversion treatment hospitals, facilities based on the Yale Plan, and the 12-step treatment facilities based on the Minnesota Model which appeared after Repeal of Prohibition. I have found the answers to the two questions which led me to write this book in the first place.

The first question is how did addiction treatment become divorced from addiction science?

This question is answered in Volume Four. Prior to the 1960s, addiction treatment and addiction science went hand in hand. Addiction treatment facilities based on the Yale Plan Clinic were established coast to coast. Yale was also home to the Quarterly Journal of Studies on Alcohol and the center of addiction research. Facilities based on the Yale Plan Clinic were eclectic and offered the 12 steps as one of several options. The treatment at Yale Plan Clinic was designed by the researchers at Yale who published in and edited the Quarterly Journal of Studies on Alcohol, which is why the research and the treatment were consonant with each other. This changed with the advent of the Minnesota Model.

The Minnesota Model had its roots in the treatment program developed at Wilmar State Hospital in Wilmar, Minnesota between 1950 and 1960. At this point in time the Minnesota Model was still working with science. The three key figures involved in developing the Wilmar Program were Nelson Bradley, Dan Anderson, and Jean Rossi. Rossi was a statistician and Bradley was a psychiatrist, and together they published their research in the Quarterly Journal of Studies on Alcohol.

Anderson preferred religion to science and opted to get his PhD in psychology at the University of Ottawa, because they based their psychology program on the teachings of St. Thomas Aquinas instead of the teachings of Sigmund Freud and other secular sources. In 1961, Anderson became executive director of Hazelden, a treatment center located in Center City, Minnesota. Anderson discovered that Hazelden had its own press and that he could publish whatever he wanted without worrying about peer review. In 1966, Episcopal priest Vernon Johnson, a graduate of the Hazelden treatment program, established the Johnson Institute. The Johnson Institute trained addiction counselors in Hazelden's treatment methodology, established treatment units based on the Hazelden Model in a number of hospitals, and invented the Johnson Intervention, now made famous by the television show Intervention. Johnson was also indirectly involved in Betty Ford's intervention. Between them, the Johnson Institute and Hazelden established a near monopoly on the training of addiction counselors and the publication of addiction treatment materials, and the divorce between addiction treatment and addiction science was complete.

The one-size-fits-all 12-step model gained a stranglehold on the industry. Hospitals came to adopt the 12-step model despite an absence of scientific evidence largely thanks to CompCare. B. Lee Karns, the CEO of CompCare, had previously been a financial analyst for Caterpillar Tractors in Peoria, Illinois. Karns was hired as CEO of CompCare in 1972 when the company was teetering on the edge of bankruptcy and he saw a potential business opportunity. Because of severe hospital overbuilding in the 1960s, there were many hospitals which were losing money because they had too many empty beds. Although insurance companies of the era were offering to pay for alcoholism treatment if it were offered in a hospital, almost no hospitals were offering alcoholism treatment. Karns got the idea that if CompCare could supply the alcoholism treatment personnel, hospitals could supply the beds, and they could split the profits.

Karns called his alcoholism treatment units CareUnits. Karns established his first CareUnit in South Coast Hospital in South Laguna, California, in May 1973. It was a financial success. By 1986, CompCare was operating 123 CareUnits in hospitals coast to coast, as well as operating 16 freestanding alcoholism facilities and numerous other facilities offering psychiatric treatment and eating disorder treatment. Karns did not need to prove to scientists that 12-step treatment was effective in order introduce it into hospitals: all he had to do was prove to hospital administrators that it was profitable. Thus, in a triumph of capitalism over science, 12-step treatment became the standard in hospitals throughout the United States. The story of CompCare will be told in a future volume.

Did you uncover anything particularly interesting or surprising during your work on this project?

I find it fascinating that throughout the 19th century, orthodox medicine opposed effective treatments which used drugs in favor of ineffective treatments based on incarceration. Thomas Davison Crothers was the de facto thought leader of orthodox medicine's addiction treatment throughout the 19th century. Crothers was the secretary of the American Association for the Cure of Inebriates from 1875 until his death in 1918. Crothers was also editor of the Quarterly Journal of Inebriety from its first issue in 1876 until its demise in 1914. Crothers was adamantly opposed to the use of any drugs for the treatment of inebriety and thought that inebriates should be incarcerated in inebriate asylums until they were cured, even if it took a lifetime. Yet inebriate asylums proved an abject failure, and of the few that were opened, nearly all shut down quickly due to a lack of patients. Very few potential patients volunteered themselves to be incarcerated for long periods, and few judges were willing to sentence offenders to six months or a year in an inebriate asylum.

The effective treatments which I referred to above were aversion therapies, of which there were two variants: One type involved giving the patient strychnine injections three to four times per day and allowing the patient all the whiskey he wished to drink. After two to three days the patient developed a severe aversion to alcohol. The other type of aversion therapy relied on pairing whiskey with an emetic such as ipecac to cause immediate vomiting, thus creating a conditioned taste aversion. Conditioned taste aversion is a type of built-in survival mechanism found in many animals, including humans. If an animal eats or drinks something which makes it vomit, it will develop an aversion to that food or beverage after even a single exposure.

The first article which reported that strychnine injections could remove the desire to drink and create an aversion to alcohol appeared in early 1886, in the Russian medical journal Vrach (The Doctor; issue No. 10, 1886, p. 177). An English language summary of Popoff's article appeared in the May 1, 1886 issue of the British Medical Journal (pp. 835-836). Subsequently, English language summaries of the Popoff article appeared in numerous medical journals for years to come. Subsequent to the Popoff article, a number of other Russian articles on the strychnine cure for dipsomania appeared and were summarized in the October 16, 1886 issue of the Lancet (pp. 733- 734). Dozens of Russian articles on the strychnine cure appeared after this, all of which were translated into English and published in major medical journals.

However, the Quarterly Journal of Inebriety pointedly ignored all pharmaceutical treatments for inebriety and published not a single positive article about them throughout its entire run, from 1876 to 1914, although some derogatory articles were published. Crothers promoted inebriate asylums and nothing else. However, entrepreneurs like railroad physician Leslie Keeley picked up on the strychnine cure and made millions off it. Keely marketed the strychnine treatment as the Gold Cure and established a huge chain of Keeley Gold Cure Institutes. Keeley's biggest competitor was the Neal Institute chain, which used conditioned taste aversion, rather than strychnine injections. Prior to federal alcohol prohibition, millions of people were treated with aversion therapy by institutes such as the Keeley Institute, the Neal Institute, or one of their many imitators. It is likely that all the other inebriate asylums, inebriate homes, sanitariums, etc. treated less than 100,000 inebriates in this same time period. Nature abhors a vacuum, and if orthodox medicine fails to fill it, entrepreneurs will do so. Crothers made numerous vicious attacks on Keeley; however, Keeley simply ignored him and laughed all the way to the bank. Interestingly, Keeley's book shows him as a man who had great sympathy for the suffering of inebriates; Crothers works show him as a man who despised inebriates.

What do you think is the most important takeaway from your book?

I have tried throughout the series to stick to "just the facts," as I want this to be a useful source of data for future researchers. I have tried to avoid too much editorializing or promoting specific ideologies. Yet in the end, I have come to the conclusion that addiction treatment needs to be based in pragmatism, kindness, and science rather than in profiteering and ideology. From the very beginning of the addiction treatment “industry”—a telling term-- people with substance problems have been dealt with as raw materials from which to make a profit from rather than as human beings. Substance users have been despised by those who profit off their existence. Substance users have been denied a voice in their own treatment. We need to recognize that substance use is every bit as much a fundamental human right as is homosexuality--it is part of the right to bodily autonomy. Then we need to help people to change in ways which they choose for themselves or respect their right to choose to remain the same.

Has this research led to your next endeavor—what else are you working on?

Future volumes of this series will discuss the various gigantic corporate chains which took over the provision of addiction treatment starting in the 1970s, such as CompCare, National Medical Enterprises, and so on. I will also discuss addiction treatment in state mental hospitals. Both of these types of institutions were huge sources of addiction treatment which have almost no mention at all in existing histories of the field.

Based on your research and experience, what do you see as the future of the field (of alcohol, drugs, and pharmacy history)?

My hope is that we can learn from the past and not keep repeating the same mistakes. In the 1990s, a one-size-fits-all model dominated the treatment industry, and the 12 steps were forced on everyone, whether they were a good fit or not. In my personal experience, while I was attending AA, my drinking increased to the point that I nearly died of alcohol withdrawal. It was only after leaving AA some 25 years ago and adopting a strict harm reduction model that I recovered. When I look at the addiction treatment industry today, I see some progress, albeit very slow. There are more options available to people seeking addiction treatment now than there were in the 1990s. Narcan, which is a harm reduction tool introduced by Dan Bigg, has also been widely adopted for opiate use disorder. However, much of what addiction counselors must learn in order to get certified is false and outdated. For example, addiction counselors are taught that substances “hijack people's brains,” which is a distortion of addiction neuroscience, and that everyone with an addiction will die unless they get treatment.. Yet, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) tells us that nearly everyone with an addiction recovers on their own without treatment and without attending support groups such as AA. Self-recovery should be impossible for a "hijacked brain." Maybe it is time to start working with people's strengths, rather than forcing the dogma of powerlessness on them.