Jan. 15, 2022 – I found little help from my own field, which is divided into sometimes clashing schools of thought about how addiction works. As a result, I looked beyond medicine and science to history, philosophy and sociology; addiction is an idea with a long, messy and controversial history, dating back more than half a millennium. That history deepened my understanding of addiction and helped me make sense of my own experiences.

Around 500 years ago, when the word “addict” entered the English language, it meant something very different: more akin to a “strong devotion.” It was something you did, rather than something that happened to you. For example, an early writer counseled his readers to “addict all their doings towards the attainment of life everlasting.” My experiences and those of my patients seem more in line with how 16th- and 17th-century writers described addiction: a disordered choice, decisions gone awry.

Benjamin Rush, a founding father of the United States and one of the most influential physicians in America in the late 18th century, was particularly focused on mental illness. He was famous for describing habitual drunkenness as a chronic and relapsing disease. However, Rush argued medicine could help only in part; he recognized that social and economic policies were central to the problem. It was the later temperance movements of the 1820s and 1830s that emphasized a harder language of disease, insisting that people with drinking problems had been damaged by a sort of reductionist biology, that “demon rum” took you over, as in a possession.


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