Kenneth Anderson founded HAMS (Harm Reduction, Abstinence and Moderation Support) in 2007 as a free online support group for people trying to change their drinking through harm reduction. He was frustrated that other organizations failed to support all of people’s goals. HAMS quickly grew, and now has a worldwide membership of 10,000.
I came to know Anderson through HAMS, which I joined in 2016. He absorbed the harm reduction principles on which it’s based after working at syringe programs in Minneapolis and New York City. His own prior journey took him from county detoxes and a “drunk house” in Minnesota to the New School of Social Research, where he earned an MA in psychology.
Anderson’s prolific writing includes dozens of articles setting the record straight about the science of addiction treatment and its failures. His past books include How to Change Your Drinking (2010), a practical guide that’s still widely read today, and Better Is Better: Stories of Alcohol Harm Reduction (2020, which I coauthored), chronicling HAMS members’ success stories.
The march toward locking up and abusing people with addiction was well underway.
But his current focus is the startling and often-troubling history of addiction treatment in the United States—a history with lessons for today. In 2021 I interviewed him for Filter about Strychnine & Gold, the first part of his grand project: The Untold History of Addiction Treatment in the United States. Strychnine & Gold introduced us to proprietary cures, some of which actually worked well and encouraged patients to return to their communities and go on with life.
Anderson’s new volume—From Inebriate Asylums to Narcotics Farms—paints a much less appealing picture. From asylums meant to confine “incurable drunks” for life, to federally funded “narcotics farms” where some residents were tortured, the book sheds light on the deep roots of cruel and dehumanizing treatments.
While some places, such as “inebriate homes,” pioneered a “curing with kindness” model that prefigured modern harm reduction, the march toward locking up and abusing people with addiction was well underway. I asked Anderson to tell me more.
April Wilson Smith: How would you summarize the context and purpose of From Inebriate Asylums to Narcotic Farms?
Kenneth Anderson: As in my first book in this series, we see that the history of American addiction treatment foreshadows the present-day treatment industry. Some of the dominant themes behind today’s rehabs, such as the idea that people who drink in a manner that is socially unacceptable should be locked up, existed long before the Minnesota Model. Tension between the interests of people who suffered from alcohol problems and those who proposed to treat them is nothing new. Despite the lack of evidence for medical necessity or efficacy of confinement for people who use alcohol or “narcotics,” the move toward medicalized imprisonment has continued from 1810 to today.
Where did the idea of “inebriate asylums” come from?
The first mention we see is from Benjamin Rush, who was the surgeon general of the colonial army during the Revolutionary War. In 1810, Rush made a note in his notebooks about something he called “sober house.” He expanded on this in 1812 in his book, Medical Inquiries and Observations Upon the Diseases of the Mind.
Rush recognized moderate drinking as being different from inebriety. He only condemned drunkenness; he did not condemn moderate drinking. But he felt “drunkards” were even more dangerous to the community than “the insane,” and that they should similarly be locked up in asylums. He implies in his articles that the confinement would be indefinite, possibly lifelong.
Later, in the 1830s, Samuel Woodward, the founder of what later became known as the American Psychiatric Association, wrote a series of articles about inebriate asylums. Woodward did not recognize moderate drinking and thought all drinking was equally bad. He also thought there should be lifetime confinement for incurable drunkards (I use this term, and others, anachronistically here, to reflect the terminology of the times). So far, all the discussion of inebriate asylums was theoretical—no steps had been taken to create them.
So when did they become reality?
The first “inebriate homes” appeared in the 1840s. Inebriate homes were very different from asylums. They came out of the Washingtonian Temperance Movement. Unlike the earlier temperance movements, which tried to impose abstinence from above, the Washingtonians were former drinkers who had quit, and wanted to help others do so. They were also working class, unlike other groups, whose members owned the means of production.
Their movement only lasted a few years, although there was a branch in Massachusetts until the 1860s. But its ideas were extremely influential for decades to come. At the early inebriate homes in various US cities, drunkards could come in, get sobered up and get fit to find employment. There was no confinement at the homes—staying there was entirely voluntary.
Most of the inebriate homes established in the 1840s and 1850s lasted only about a year. The exception was the Home for the Fallen, established in 1856 in Boston. It later became the Boston Washingtonian Hospital, and was in operation until 1980.
When did inebriate asylums appear?
The first was the one in Binghamton, New York. Incorporated in 1854 and opened by the state in 1864, it was the brainchild of Joseph Edward Turner, MD. It had a capacity of 440 people, but it was always nearly empty. Nobody wanted to go there. People were confined behind bars, so the asylum didn’t get many voluntary patients.
Judges were not committing people to inebriate asylums because they did not want to pack people away for months on end; they basically thought the idea was crazy. They might send people to jail for a few days for drunk and disorderly conduct, but not to asylums for long periods of confinement.
By the late 1870s, there were just 24 residents at the Binghamton inebriate asylum, all of whom were rich drunkards who had reserved rooms to come in to recover from what was then called a “spree.”
There was also a huge amount of political corruption in the system, with politicians using asylums as a cash cow. They would sell products from companies they owned to the asylums, and to the Kings County Inebriates’ Home in Brooklyn, at exorbitant prices.
It failed. No one liked the idea, and New York government would not pass laws mandating confinement.
By 1879, the state government had lost patience with the Binghamton inebriate asylum. The state insane asylums were severely overcrowded, and here was this gigantic building with 24 people in it. The government decided to turn it into an insane asylum instead.
Other asylums were created, such as Walnut Hill Inebriate Asylum in Connecticut, which lasted two years before it was closed down. The superintendent, Thomas Davidson Crothers, became the de facto leader of the inebriate asylum movement in the United States, and he continued for the rest of his life to try to establish a nationwide chain, which would confine people for life or until they were cured.
It failed. No one liked the idea, and New York government would not pass laws mandating confinement after they saw the abysmal failure in Binghamton. No state ever passed a law to confine incurable inebriates for life. When new inebriate asylums opened, they went out of business in a few years.
Aside from involuntary confinement itself, were there abuses at the inebriate asylums or homes?
The Dashaway Home in California was probably the scene of the worst patient abuses. It was founded in 1859 by the Dashaway Temperance Society, whose members pledged to “dash the cup which inebriates away from their lips.” It was in operation until 1898.
The Dashaway Home started out as an inebriate home and did quite well until it started getting government-committed patients near the end of its lifetime. In the 1890s, Dr. Samuel Potter was in charge and it got the nickname “Dr. Potter’s Prison.” As well as an inebriate home, it became a temporary holding facility for people being evaluated for their sanity.
Potter took charge in 1893, and the cases that made the papers were people awaiting their insanity evaluations. The newspapers ran exposés on this “chamber of horrors.”
“She died shortly thereafter from injuries she had received at the home.”
Horrifying quotes include: “Mrs. Bernard Riley had been strapped to a bed for two weeks. When she was finally rescued from the home by her husband, her back was a mass of festering sores, her wrists were raw from the restraints, and her clothing was infested with vermin.”
And: “Mrs. Mary B. Brown was sent to the home because she had been drinking. Her sister stated that ‘She went there a strong woman in good physical condition. She came out in one week a bleeding broken mass of disfigured flesh. She is so horribly hurt and bruised that I could have looked at her for hours without knowing her. Her teeth are knocked out, her hands have been frightfully burned, her ears are torn, and her whole body is one mass of revolting hurts and bruises.’ She died shortly thereafter from injuries she had received at the home.”
The Dashaway staff also stole the money patients brought in with them. Another patient reported, “Dr. Potter came at me with an oath, saying ‘I’ll fix you,’ and with that he grabbed a coarse crash towel and choking me with one hand to make me open my mouth, stuffed the towel with the other hand between my jaws. When I grew black in the face and felt that I was choking to death, Potter released my throat and jerked the towel out of my mouth, pulling out two of my front teeth. Then he struck me with his open hand across the face and on the side of the head cursing me in the profanest language.”
Then there was the gag—a horrible instrument of torture that the Dashaway Home utilized. It consisted of a piece of iron covered with leather, which fitted the mouth up to the palette.
How did we go from inebriate asylums to narcotic farms?
Despite the failure of inebriate asylums, the Temperance movement continued to gather the steam that would eventually lead to alcohol Prohibition. And sadly, the idea that people who used substances needed to be confined did not die out.
Eventually the federal government created narcotic farms in Lexington, Kentucky and Fort Worth, Texas. These came into existence because, in the decades following the passage of the Harrison Narcotics Act of 1914, federal prisons became overcrowded with people whose only “crime” was using drugs. In the Kentucky and Texas narcotic farms, people were confined away from other prisoners.
They were almost the only places people could be treated for opiate addiction with medications, because doctors were being arrested for doing this in other settings.
How were narcotic farms supposed to work?
The plan was similar to the earlier inebriate asylums: Take people with drug addiction, confine them for six months and have them work on a farm, instilling in them the ethic of hard work. Detainees who used opiates were tapered off with morphine, or later methadone, in two weeks or less.
The narcotic farms were in existence from 1934 until 1974. Like the inebriate asylums, they were a dismal failure. But they were almost the only places people were allowed to be treated for opiate addiction with medications, because doctors were being arrested for doing this in other settings.
Did any good come of the narcotic farms?
The Lexington facility conducted considerable and important clinical research. Much that we know about drugs today originates in research from the Lexington Narcotics Farm. They tested marijuana, for example, and found that unlike alcohol or opiates, it had no physical withdrawal syndrome. They also found few ill effects from marijuana use. The Farm was the scene of some of the first clinical trials of LSD in a controlled setting. It was there that they developed a methadone taper to take people off of opiates. They also ran the first trials of naloxone and naltrexone.
Beyond confinement, were there further abuses at the farms?
After 1969, the Lexington Narcotics Farm instituted therapeutic communities based on Synanon. Some of the residents formed their own patient-led therapeutic community, called Matrix House, which got totally out of hand. In Matrix House you were awake 18 hours a day, they didn’t give people adequate sleep time, and the patient leadership kept people constantly doing the Synanon program and reading Synanon books.
Fill us in on what Synanon was.
Synanon originated therapeutic communities for addiction in the 1950s. They got shut down after their founder put a rattlesnake with its rattles cut off in the mailbox of a lawyer who was suing him. Their basic therapeutic tool was something they called “The Game,” where they would put a person in the center of a circle, and everyone would scream obscenities at them and tell them what a piece of shit they were. During the 1960s and ‘70s, many people doing drug treatment thought this was great and introduced it. In fact, it just gives people PTSD and doesn’t help them in any way.
So what happened at Matrix House?
A patient named Jon Staten Wildes took control of Matrix House and got absolute control over the lives of the other patients. He liked to subject people to sexual torture. He audiotaped interviews with patients regularly. In one of these interviews, his fellow patient said he was considering suicide. Once Wildes that had on tape, he said to the other patient, “Now I can hang you in the basement anytime and everyone will think it was suicide.”
Eventually the Synanon adherents got ordered off the property and a Grand Jury sent Wildes to prison. The Grand Jury wanted to indict the medical director of the program but were told that there was no law under which he could be charged.
What about hospitals? Were they also involved in treating people who used alcohol and other drugs?
My book also covers public facilities, either government- or city-run. Bellevue Hospital in New York City was the first in the United States to treat alcoholics, as they were termed, for delirium tremens. Bellevue opened in 1736 as a one-room infirmary located in the public workhouse. They were regularly treating DTs from at least the 1850s on. The typical treatment for delirium tremens during this era was potassium bromide, which was fairly effective, although it has been replaced by better sedatives such as barbiturates and benzodiazepines in today’s pharmacopeia.
The philosophy at Bellevue was “treat ‘em and street ‘em.” As soon as patients were over acute withdrawal, they were released.
We have good records from the 1850s, when the city reorganized the governing structure of Bellevue and began requiring annual reports, although Bellevue was no doubt treating people for DTs before then. The philosophy at Bellevue was “treat ‘em and street ‘em.” As soon as patients were over acute withdrawal, they were released.
Clinical research also took place at Bellevue. It was there that researchers discovered that deficiency of vitamin B1 (thiamine) caused Korsakoff’s syndrome, and that other alcohol-related neurological disorders were caused by a lack of B3 (niacin). Bellevue did a number of clinical trials on addiction treatments in the 1920s and 1930s. They found that Towns-Lambert Cure, also known as the Belladonna Cure, had a 5 percent success rate, with 95 percent either lost to follow-up or resumed drinking or drug use. The Belladonna Cure was used at the Towns Hospital, where AA founder Bill Wilson was treated.
And the Boston Washingtonian Hospital, which had grown out of the Home for the Fallen inebriate home, was the site of 1970s clinical trials of naltrexone (sponsored by NIDA) to treat heroin addiction. They found very few people wanted to take part, as naltrexone kills the high achieved from heroin.
What are some of the other treatments covered by your book?
It also discusses the ambulatory municipal morphine clinics. Most of these were in operation in 1919 and 1920; a few started before that and a few extended later, but this was their heyday. These were reduction clinics. You came in and you got your dose, but your dose got reduced every day until you were tapered off. They didn’t want to maintain people’s habits.
It seems fairly clear that we have failed to learn from the past and continue to repeat the same mistakes over and over again.
The Jacksonville, Florida clinic that opened in 1912 was actually a morphine maintenance clinic that gave people the dose they needed, and it kept them out of trouble. However, generally these clinics tried to do reduction, even though reduction didn’t work very well because people didn’t want their dose reduced. Most were closed down by the Federal Bureau of Narcotics in 1920, though some lasted until 1924.
What are some of the lessons we can learn from all this?
It seems fairly clear that we have failed to learn from the past and continue to repeat the same mistakes over and over again. We have effective addiction treatments, such as methadone maintenance, which can reduce overdose mortality rates by 50-75 percent. Yet we make methadone extremely difficult to access and prefer ineffective treatments which involve confining people in rehab facilities or halfway houses instead. Moreover, rehabs and halfway houses lack any proper oversight, and still frequently turn into “chambers of horrors” where residents suffer terrible abuses.
As the philosopher George Santayana said, “Those who cannot remember the past are condemned to repeat it.”
Image of woodcut illustration of the Binghamton Inebriate Asylum from the book State of New York (1882) via Wikimedia Commons/Public Domain