There has never been a time in history when addiction has not impacted society. For instance, even in ancient Greece, Hippocrates wrote about the dangers of excessive opium use and alcohol consumption. While formal substance abuse counseling has only been around for the last century or so, if you are considering this profession, it can be interesting to look back at the history of the world’s response to substance use and addiction.
Ancient Civilizations to the Middle Ages
Many early physicians and philosophers, from Greece to China to Mesopotamia, warned about the possible social and physical consequences of excessive drinking. By the Middle Ages, religious institutions often addressed the issue of excessive drinking, linking it to a moral failing, rather than a disease.
Changes in the 1700s
In his 1784 publication, An Inquiry into the Effects of Ardent Spirits upon the Human Body and Mind, Dr. Benjamin Rush was one of the first physicians to state that the excessive use of alcohol may be more than simply a moral failing. He argued that habitual drinkers suffered from a progressive condition that impacted both the mind and the body.
Rush, often noted as the founder of American psychiatry, was one of the first doctors to recognize that a person could become physically dependent on alcohol and that, at some point, a person could lose control over their alcohol consumption. He also stated that treatment and abstinence were crucial for recovery.
He also advocated for the creation of specialized treatment facilities as well as sober living environments, as well as advocating that family members and community members provide support for people struggling with habitual drunkenness. While he did still view alcoholism as a moral failure to some extent, he was one of the first to argue that treatment rather than punishment was perhaps a better option.
The 1800s: Temperance Gains Steam
During this century, more and more people became concerned with the effects of excessive drinking on families and society. In 1840, the Washingtonian Movement was founded by six recovering alcoholics, and this group was groundbreaking in that they emphasized meeting with others struggling with alcohol to share stories and support and help each other maintain sobriety.
Additionally, in the late 1800s, physicians began challenging the idea that chronic drinking was a moral failing. In 1870, the American Association for the Cure of Inebriety was founded. This group’s founders believed that alcoholism as well as drug addiction were diseases and should be treated as medical conditions.
The 1900s: Prohibition & Radical Changes in Treatment
Until the 1900s, the job of a professional addiction counselor really did not exist. There were hospitals for those struggling with sobriety, and doctors and clergy members sometimes provided counseling or treatment, but there was no specialized training for addiction counseling.
From the 1920s to 1933, of course, the sale and consumption of alcohol was banned in the United States. Supporters of Prohibition hoped this change would eliminate alcohol-related problems. While drinking declined, the problem of addiction remained, and very little advancement in the actual treatment of addiction occurred during this period.
In 1935, however, Bill Wilson and Dr. Bob Smith founded Alcoholics Anonymous. Both men had struggled with alcoholism and discovered that sharing their experiences with support groups filled with those who understood this struggle helped them maintain sobriety.
Within a few years, AA introduced the Twelve-Step model, which has become one of the most widely recognized recovery frameworks in the world. The Twelve Steps encourage individuals to:
- Acknowledge their struggle with alcohol
- Examine their behavior honestly
- Make amends for past harms
- Seek personal growth and accountability
- Help others achieve recovery
AA fueled a huge shift in the way people viewed addiction. Rather than focus on addiction as a lack of willpower or moral failing, AA promoted the idea that this was a condition that required ongoing support and management, and, perhaps most importantly, AA reinforced the belief that people needed support rather than shame to achieve successful recovery.
In 1956, the American Medical Association formally recognized alcoholism as an illness, and more treatment programs became available for those struggling with drug or alcohol addiction. Many of these programs focused on the Twelve Step approach, popularized by Alcoholics Anonymous.
In 1970, the United States government passed the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act. This law established the National Institute on Alcohol Abuse and Alcoholism, which became a leading source of research, education, and funding related to alcohol use disorders. Federal support helped:
- Expand treatment facilities throughout the country
- Improve access to care
- Support scientific research into addiction
- Develop prevention and public education programs
- Train professionals who specialize in substance use treatment
For many healthcare providers, addiction treatment became increasingly integrated into hospitals, mental health programs, and community health services rather than existing on the margins of the healthcare system.
In 1972, the National Association for Alcoholism and Drug Abuse Counselors (NAADAC) was founded, although it was then known as the National Association of Alcoholism Counselors and Trainers. This was one of the first major organizations created to support not only people struggling with substance use disorders but also substance abuse counselors and related professionals.
During the 1970s, substance abuse counseling emerged as a distinct profession, and states began developing licensing and certification standards for substance abuse counselor certification.
Unfortunately, during the 1980s “war on drugs,” there were some setbacks for addiction treatment, as policy focused more on punishment and imprisonment than treatment. During these years, prison and jail times for drug use and possession increased significantly. As we moved into the 1990s, however, growing evidence showed that treatment could reduce substance use and lower crime rates, which led to the development of drug courts, diversion programs, and even treatment programs within correctional facilities.
While there were some setbacks in the 1980s, this also was a period of expansion for addiction counseling. During this decade, the 12 Core Functions of Addiction Counseling were developed. These core functions, which are still used today, include everything from patient screening to treatment planning to counseling to case management and more.
2000s: Medication-Assisted Treatment Grows
During the 1970s, methadone became a treatment option for those suffering from opioid addiction, and during the early 2000s, there was a huge expansion of medication-assisted treatment. In addition to methadone, doctors could now prescribe buprenorphine to patients.
This was significant because patients could simply go to their doctor for medication rather than traditional methadone clinics, and this drug was found to be highly effective in supporting recovery and reducing the risk of overdoses.
Additionally, during the 2000s, addiction treatment became far more comprehensive and more widely available. Treatment plans shifted from focusing merely on abstinence and counseling to integrating these tools with education, mental health services, social services, and more comprehensive case management.
2010s: Significant Changes from the Medical Community
In 2013, the American Psychiatric Association (APA) published the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In this edition, the APA used the term substance use disorder as the preferred term to people struggling with addiction.
In the past, professionals used terms such as alcoholism, drug addiction, and substance dependence. Prior to publication of the DSM-5, counselors and doctors classified patients as either dealing with substance abuse (considered less severe) or substance dependence (more severe). The DSM-5 instead shifted the terminology to substance use disorder and set up a framework that recognized addiction as a spectrum, with patients experiencing cases that were mild, moderate, or severe.
While this framework was important, the change in terminology was crucial, as well. Many advocates and clinicians felt that terms such as “abuse” carried moral judgment and stigma. “Substance use disorder” was adopted in part to encourage more person-centered language and reinforce the idea that addiction is a medical condition rather than a character flaw.
Looking Toward the Future
Substance abuse counseling continues to evolve, and in the 2020s, we have seen more of a focus on treating the “whole person.” This ensures that we don’t simply focus on substance use disorders but on issues such as mental health, physical health, addressing trauma, and providing social support such as housing and employment to those in recovery.
Today’s addiction treatment landscape combines decades of medical research, counseling theory, peer support, and recovery science. While approaches continue to evolve, the field has moved significantly away from viewing addiction as a moral failing and toward understanding it as a treatable health condition that often requires long-term support and comprehensive care.
The demand for addiction counselor jobs is high, and the need for counselors is projected to grow significantly over the next decade. If you are interested in joining this profession and helping others heal, Sober College School of Addiction Studies can help. We provide quality education for those wishing to become a Certified Alcohol and Drug Counselor, or CADC.
Completing your educational units is the first step toward CADC certification, and our program is CCAPP-approved, NAADAC-approved, and IC&RC-approved, which means it can be used throughout the United States to fulfill your addiction studies curriculum requirements. The only exceptions include Alaska, Montana, and North Dakota.
Our program is 100% online, and we offer rolling admissions so you can get started at any time. Best of all, our program can be completed in just six months, allowing you to jumpstart your new career in substance abuse counseling. To enroll in our program, head to our homepage and click on the Get Started tab.
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