CHANGING PERCEPTIONS OF ADDICTION AND TREATMENT, 1935-1974
Based on substantial primary research, this paper investigates how the Federal Narcotic Farm in Lexington, Kentucky, served as a pioneer in the medicalization of addiction and treatment from its establishment in the Porter Act of 1929 to its demise in 1974. In the early twentieth century, the public perceived addiction as a vice, which could only be solved by the criminalization of addiction. By mid-century, the perception of addiction changed; the medical community, policymakers, and the public began to see it as a medical ailment, which could be treated with rehabilitation in a medical context. Using standard social historical methods, I examine this transition through the lenses of public perception, scientific communities’ ideas on addiction, and governmental legislation on narcotic control and treatment of addiction. This research concludes that the half-century experiment at the Narcotic Farm in Lexington, Kentucky played a central and crucial role in the process of the medicalization of addiction.
Dream Castle, Big Shot Drug Farm, Alpha Government Home, U.S. Greatest Gift to Lift Mankind Sanatorium, Beneficial Farm, and Courageous Hospital: these were some of the readers’ entries a local Lexington, Kentucky, newspaper received in response to its contest to name the new institution believed to be the solution to the nation’s drug addiction problem.1 The United States government instead chose a less colorful name for the institution. On May 25, 1935, officials welcomed attendees to the opening ceremony to the “United States Narcotic Farm,” commonly referred to as the Lexington Narcotic Farm. Eventually, the nickname “Narco” became locally accepted for the home of the over 50,000 drug addicts who passed through its doors during its tenure in Lexington. The wide variety of names for the institution that emerged during its forty years of existence, official and unofficial, often metaphorically represented the changing perception of drug addiction and the path to a cure. This thesis utilizes “Narco” to investigate the changing perception of narcotic addiction and treatment from the 1920s to the 1970s.
Despite its importance in the history of drug addiction, “Narco” has received relatively little attention. The recently completed documentary produced by J.P. Olsen and Luke Walden and its corresponding book, written by Dr. Nancy Campbell along with Olsen and Walden, together serve as the best comprehensive history of the Lexington Narcotics Farm.2 Together, they explore the institution from its initial authorization by Congress in 1929 until its closure as a hospital for narcotic addicts in 1975. Patients volunteered or were court-mandated to participate in “the cure” to treat their addiction. Within Lexington’s walls a collective compilation of jazz musicians, doctors, nurses, businessmen, lawyers, authors, dealers, ministers, and prostitutes resided.3 The institution and its sister hospital in Fort Worth, Texas, both works contend, became a central part of a subculture of drug addicts in America. The documentary and companion book also examine the significance of the Addiction Research Center (ARC) housed as part of the Narcotic Farm in Lexington. For more than four decades, scientists and physicians at the ARC worked to understand the fundamental causes of addiction, document the effects of narcotics on the human body, and demonstrate potential for addiction in newly developed pharmaceuticals.
There is a robust scholarly literature on the medicalization of drug addiction, particularly a number of comprehensive histories of addiction.4 These works illustrate that the perception of drug addiction directly influences attempts at treating drug addicts. From the beginning of its conception as a widespread societal problem, ideas about treatment formed from the perceptions of addiction’s fundamental causes. It was a widespread belief that addiction resulted from a person’s immoral character and a conscious “falling away from a respectable life”.5 Many governmental officials and politicians believed criminalization and punishment were the solutions to a drug addict’s weak character and the means to an end for the vice of narcotic addiction. Yet by the latter half of the twentieth century, a shift had taken place and most regarded drug addiction in a medical context. The therapeutic and medical treatment model of “Narco” both emerged from and shaped the underlying medical understanding of drug addiction.
This thesis explores the Lexington Narcotic Farm and its significance in the transition to the medicalization of drug addiction and treatment. The first section examines the perception of the problem of addiction prior to the opening of the Lexington Narcotic Farm by the public, scientific communities, and by the government. The thesis then traces the early period of the Lexington Narcotic Farm as it became a world leader in the area of drug addiction treatment. The Lexington Narcotic Farm’s abrupt downfall and closure in the early seventies marked the end of an era in the treatment of narcotic addiction. The United States Narcotic Farm at Lexington, Kentucky, served as a primary vehicle for the transformation of ideas about addiction from moral failure to a medical problem, yet the very success of a medical model led to a decentralization of addiction treatment that made the Lexington model extraneous, a relic of a previous era.
Narcotic addiction treatment, before the opening of the two federal narcotic farms, normally consisted of abrupt withdrawal from the drug. Other substances were occasionally used to promote abstinence in the withdrawal phase of treatment,including sodium bromide, cocaine, cannabis, and alcohol. Physicians often prescribed a daily dose of morphine, maintaining a level of drug dependence. After the prohibition of narcotics in 1914, exorbitant prices for narcotics on the black market drove many addicts to resort to theft, forgery, crimes against property, and even prostitution to get their next fix.6 From 1919 until 1923, controversial “treatment” clinics could be found in various cities of the United States that dispensed narcotics to addicts in an attempt to prevent them from turning to crime and drug trafficking to fund their next dose.7 The clinics’ dispersal of weekly supplies for self-administration to addicts proved politically unacceptable to city officials as well as the general public, and the clinics were quickly closed.8 Due to increased enforcement of the Harrison Act of 1914, narcotic law violators in the twenties increased to about one third of all federal prisoners. By 1928, the existing problem of overcrowding in many federal prisons, inflated by narcotic law violators, prompted the Superintendant of Prisons to recommend the establishment of federal institutions for narcotic treatment and rehabilitation. The result was the introduction of a bill by Pennsylvania Congressman Stephen G. Porter to establish two of these institutions.9
Popular opinion in the early twentieth century labeled narcotic addicts as “degenerates.”10 Considered an immoral sin of society, narcotic addiction, like alcohol and prostitution, rousted reformers to action during the Progressive Era. Progressives and social reformers believed a weak personality and poor morals led individuals straight into addiction, and this moralistic conception proved considerably durable. “It was thoroughly indoctrinated that addicts were the lowest form of creature…,” said Marie Nyswander, a surgical intern at the Lexington Narcotic Farm, “they had some kind of wild, maniacal pleasure…for which they should be punished.”11 In her autobiography, Janet Clark, a narcotic addict sentenced to time at “Narco,” wrote about protestors outside her trial for narcotic possession. “Throw them in jail!” they shouted. “Get rid of them, preying on society!”12Drug addiction during the twenties and thirties was probably more misunderstood, hated, and feared than any other social vice. Society regarded addicts as law breakers and, therefore, saw the penal model as the best way to address the problem. For many, even the severe punishments often meted out were not enough for the “degenerates” involved in drug addiction.13 Harsh punishments, it was believed, would remove addicts from the streets and serve as deterrence to others.
This perception of addicts as crazed menaces clouded the imaginations of many visitors to the Lexington Narcotic Farm well into the 1950s. One patient who led tours through the treatment center in the 1950s recalled one of the visitors asking if they were going to get to meet some patients at the close of the tour. After the tour guide revealed his true identity, the visitors were incredibly surprised that this well-dressed and well-mannered tour guide was actually a patient. They were certainly not expecting to see a person just like them. A female patient who frequently spoke with visitors about her experience as an addict told the presentation coordinator, “Just once, I wish you would let me go in wearing a straight-jacket, struggling and behaving wildly. They expect that.”14
Medical and government officials overwhelmingly shared the perception of addicts as inferior beings. In 1918, health officials reported in a questionnaire that the majority of physicians regarded addiction as a debauchery within society as opposed to a disease.15 The American Medical Association’s Committee on Narcotic Drugs released a report in 1921, referring to drug addicts as “miserable wretches” who were involved in the “vice of drug addiction.”16 Government officials shared this belief in the inherent inferiority of addicts. The House committee debating the original legislation that established Public Health Service treatment of narcotic addicts stated that, “victims of narcotics are a social menace.”17 Even the legislation that authorized the two Narcotic Farms defined an addict as someone who endangered public morals.18 The Lexington Narcotic Farm opened in a time when the widespread perception of addiction was the immorality of society and the solution to addiction in society was incarceration.
The legislature established the Lexington Narcotic Farm, which served as a pioneer in the medicalization of addiction treatment, on January 19, 1929. The Second Session of the Seventieth Congress passed the Porter Act to authorize the terms, funding, and purpose of two institutions for the “confinement and treatment” of “any person who habitually uses any habit-forming narcotic drug.”19 Officials chose Lexington, Kentucky, and Fort Worth, Texas, for their tranquil countrysides and the availability of arable agricultural land, an important factor in the proposed treatment regimen.20 “A United States narcotic farm shall be designed to rehabilitate them, restore them to health, and where necessary to train them to be self-supporting and self-reliant.”21
Congress established the Lexington Narcotic Farm using a medical framework to address addiction to narcotics. With this shift, Congress initiated a significant first step in the medicalization of narcotic addiction and treatment. Construction began in the spring of 1932 along Lexington Pike between Lexington and Frankfort, about a half a mile from the highway (see Figure 1). The grounds included four large dairy barns, a greenhouse, a utility barn, railroad sidings, chicken hatcheries, and slaughter houses. Designed as a self-sustaining institution, it even included a sewage disposal and treatment plant.22 The total cost for constructing the Lexington Narcotic Farm came to about $4,000,000 in 1935. The planned yearly operating cost came to around $750,000 including employee salaries. 23 The main building accommodated 1,000 patients, and the grounds had quarters for about 250 more employees required to keep the institution operating.24
The design of the Lexington Narcotic Farm, with both hospital and prison-like features, facilitated the new approach to treatment of addiction. According to Campbell, “It was a prison built to confine violators of federal drug laws, but its rural setting and architectural style reflected a rehabilitation philosophy.”25 A high chain link fence topped with coiled barbed wire surrounded the facility, exactly as any other prison would have. Locking doors and barred windows characteristically marked the corridors of the patient quarters. Even its vast size was reminiscent of other federal prisons. Likewise, institutional rules required all patients to wear the government issued muslin uniforms and tennis shoes.26
The Lexington Narcotic Farm had other features, however, that revealed its unique mission. The whole compound’s architecture featured a modern art deco style. The entrance, decorated with columns and vaulted ceilings, looked more like a hospital than a prison.27 The locking doors were thoughtfully concealed by the architecture surrounding them, and the recreational facilities differentiated it from other federal penal retention institutions. Such amenities earned the Lexington Narcotic Farm the reputation as being a “country-club prison.”28 The unique style of the institution surprised many; it inspired one incarcerated addict to write, “I’m struck by the freedom, the lack of restraint.”29 The overall design and location reflected its two-fold mission; first, to serve as a means to segregate the afflicted from society and ensure their containment in a guarded facility; second, to rehabilitate and regain the health of addicts through its hospital-like atmosphere.
Admission to the treatment program came in two forms. First, any person federally convicted who fit the criteria of a drug addict was eligible for transfer or sentencing to one the two narcotic farms. Federal prisoners were given priority; however, if space permitted, a person who fit the criteria of an addict could voluntarily apply for admission.30 Officials consistently had to reject volunteer applications due to space limitations. The staff processed an average of 260 voluntary applications a month, but could accept only about a third of those.31 During the forty years of operation, only one-third of the patients at the Lexington Narcotic Farm came for voluntary treatment.32 The Lexington Narcotic Farm admitted patients east of the Mississippi River, while the Fort Worth Narcotic Farm received patients from the west.
Upon admission to the institution, the staff photographed voluntary as well as remanded patients, gave them an identification number, issued a uniform of grey cotton pants and shirt, and strip searched them for contraband-procedures similar to those of traditional prisons. Patients often tried to conceal narcotics and drug paraphernalia in an attempt to smuggle it inside the institution. Staff found narcotics and paraphernalia in the soles of shoes, in hollowed-out books, as well as hypodermic syringes disguised as fountain pens.33 Despite efforts by officials, patients still found ways to sneak drugs into the facilities. “I wasn’t in Population for two weeks before I made a connection for Dilaudid,” William S. Burroughs, Jr. wrote. “That’s synthetic morphine, very fine, and with all the money they are spending on the damn moon, you’d think they’d be able to keep junk out of Narco.”34 The problem of contraband remained endemic throughout the history of the Lexington facility.
After admission, a complete medical physical followed to evaluate the general health of the patient. Addicts often suffered from many secondary side effects of their addiction as well as other unrelated ailments. A large percentage of addicts who injected their drugs contracted hepatitis, tetanus, and various skin infections from improperly cleaned needles or sharing needles with those already infected. Doctors at the facility frequently treated patients with venereal diseases, a common hazard of the drug subculture.35 Other diseases that afflicted addicts included: tuberculosis, cancer, heart disease, high blood pressure and diabetes. Many of the patients had had little access to health care due to lack of funds to pay for a doctor, and most hospitals refused to treat addicts.
The initial medical examination was not the last for the patients. The Lexington Narcotic Farm maintained an extensive staff of professionals, including physicians, surgeons, psychiatrists, psychologists, nurses, social workers, pharmacologists, and dietitians, who constantly monitored patients’ progress throughout their stay.36 Several addicts resented this constant scrutiny, in particular the incarcerated patients. In 1967, Clarence Cooper, an addict sentenced to five years of federal incarceration for possession, sarcastically described these evaluations in his first few weeks at the Lexington Narcotic Farm: “Right down on the first floor, next to the hack’s office, there is a bulletin board whose every dopie’s duty it is to read each morning and noon and night because sometimes you’d be on call for tests on Branch-5, the Pysch level, or maybe they’d need to jack you off for some blood, or some unbelievable mad hatter of a social worker wanted to talk to you.”37 The constant formal and informal evaluations of a patient’s progress by Lexington staff served as a significant part of the treatment program.
The treatment regimen for patients at the Lexington Narcotic Farm, consisted of three phases. The first stage following admission and evaluation was the withdrawal stage. Lexington’s medical withdrawal program was unlike the prison system, which merely incarcerated drug addicts long enough to complete the process of withdrawal, forcing them into a cold-turkey method of withdrawal. Cold-turkey withdrawal, or the abrupt removal of the substance, was neither the safest nor most successful method.38 Depending on the type of addiction, going cold-turkey could cause dangerous convulsions or even death.39 One patient of the Lexington Narcotic Farm recounted her experience in a traditional prison going through withdrawal: “By the second day I was in very bad shape. They gave me nothing. I threw up all over myself, my hair, my clothes…”40 Even hospitals often neglected to give addicts adequate medical care and observation required during withdrawal. “They gave me some aspirin,” a young man recounted of his experience in a state hospital near Detroit, “and locked me up for two weeks.”41
The process of withdrawal with its unpleasant symptoms began as the body readjusted to the absence of a foreign chemical upon which it previously depended on.42 Medical officials at Lexington used morphine or methadone as withdrawal drug therapy. Other treatments for addicts going through withdrawal included “flow-baths” to help soothe patients’ nerves (see Figure 2).43 In the care of the doctors and nurses of the detoxification ward, patients were constantly subjected to medical observation, including bed checks every half hour, during the process of withdrawal.44 Medical professionals in the detoxification ward prevented patients from being dehydrated or malnourished during the process. The hospital environment also lowered the chances of addicts getting pneumonia or other illnesses due to weakened immune systems from the withdrawal process.45
The second treatment phase took the remainder of a patient’s time at the institution. Bed times, meal times, therapy, recreational activities all had a set time each day. Assigned jobs and activities created a rehabilitative environment where patients “lived by the rules approximating those of society” and learned to respect the rights of others while learning personal responsibility.46 Everyone within the institution held a particular job for twenty hours a week, considered “vocational training.” (see Figure 3).47 The most common job assignment for male patients was the farm, caring for the animals or working in agriculture. The farm was symbolic of the institution, evidenced by its original name, “U.S. Narcotic Farm.” The working farm continually found success among the local dairy and agricultural industry. Other work assignments at Lexington included making clothing or furniture to be used within the Lexington facilities or in other federal prisons. Still others worked for the direct maintenance of the institution, doing laundry, working in the water treatment plant, maintenance, cleaning, or cooking. The automotive mechanics shop, the woodworking shop, and the metal working shop provided technical skills potentially useful to patients following their rehabilitation.48
Beyond work assignments and training, the rehabilitation of addicts included extensive emotional therapy (see Figure 4). Psychologists and staff attempted to teach proper behavior through the routine of the program. Patients participated in group and individual therapy sessions. Initially, the high numbers of patients and shortage of staff limited the number of individual therapy sessions. At its peak in 1953, the institution treated 1,509 addicts with only about 250 staff members. 49 Therefore, most of the emphasis was placed on group psychotherapy led by a team of social workers and psychologists. However, patient therapy was integrated into every level of the administrative processes of the institution. All personnel, including vocational training staff, clerks, administrative assistants, technicians, and custodial staff, served as social and vocational training for the patients.50 Personnel were encouraged to develop friendly, mentoring relationships with patients to assist in their social therapy. Becky B., a volunteer patient who wrote to Dr. Sidney Louis, a mentor of hers, exemplified this vital component to a patient’s therapy: “You have meant more to me with the redirection and rehabilitation that I would have never [sic] thought possible. This is certainly the type therapy [sic] that has helped me more than any other to shock me into realization.” The formal therapy and professional relationships with patients aided in their treatment process.
Patients also had opportunities to participate in recreational activities as a part of the rehabilitative program. Officials encouraged recreational activities during patients’ free time because they helped to build healthy interpersonal relationships.52 The handbook given to patients during their initial orientation to the Lexington Narcotic Farm stated that patients should make use of the recreational activities and opportunities to “make your hospital stay more pleasant.”53 The auditorium was used for music, dance, and theatre, all of which were regularly produced and performed by the patients (see Figure 5).54 An orchestra group, called the Ambassadors, even played for benefit drives and for other local institutions.55 Patients also filled their time using the athletic field, mini-golf course, tennis courts, gymnasium, basketball court, bowling alley, and pool tables.
The third and final stage of treatment prepared patients for departure from the institution. Extraordinarily high addiction relapse rates made this final step the most important. Staff evaluated the patients in an effort to determine if they were committed to remaining sober once they were released and assisted departing patients in securing employment and a suitable place of residence.56 Since environment was believed to play a significant role in a former addict’s probability of relapse, the staff did all they could to help patients return to the ideal setting, a good job and a welcoming family.
While rehabilitation of addicts remained an important goal, Lexington also served as a center for research on addiction. From its founding, the Lexington Narcotic Farm served as the home to the Addiction Research Center (ARC), a facility that established the foundation for the current scientific understanding of addiction and drug abuse (see Figures 6 and 7). With the development of a greater understanding of addiction and its causes, officials believed drug addiction could be “cured.”57 The field of addiction research and knowledge about narcotic addiction was in its infancy at the time of the ARC’s opening. In 1934, the U.S. Penitentiary at Fort Leavenworth, Kansas, began clinical investigations of the addicting properties of drugs. When the Lexington Narcotic Farm opened in spring of 1935, these operations were promptly transferred to the state-of-the-art Addiction Research Center.58
Over four decades, the ARC worked to understand the fundamental causes of addiction, research the biological basis of intoxication, and examine the effects of many drugs in a controlled setting. Researchers sought to discover new treatments and methods of prevention as well as to refine addiction diagnosis strategies.59 The staff of the ARC pioneered a multidisciplinary approach to addiction, which included biologists, chemists, biophysicists, psychiatrists, pharmacologists, and psychologists.60 Work in the research lab ranged from basic chemistry to animal and human research.61Drugs tested on patients included heroin, morphine, cocaine, marijuana, LSD, tranquilizers, sleeping pills, and many more.
After WWII, many pharmaceutical companies developed and marketed a substantial number of potentially addictive drugs in the form of painkillers, tranquilizers, amphetamines, and barbiturates. The World Health Organization, the United Nations, U.S. and foreign governments turned to the ARC to test these new synthetic “wonder drugs.” The ARC conducted research on over one hundred newly developed synthetic narcotic analygesics and antagonists. The studies and pharmaceutical research conducted in the ARC helped develop drugs with lower abuse potential such as propoxyphene, pentazocine, nalorphine, and naloxone.62 Greater international drug controls, warning labels about operation of vehicles or heavy machinery, and more caution in writing prescriptions for addictive medications resulted from this valuable research and experimentation conducted by the ARC.63 The ARC pioneered medical addiction research and promoted the medicalization of addiction and treatment.
ARC’s privileged status in drug research relied on its relationship to the incarcerated population at Lexington. Incarcerated men with a considerable drug experience could volunteer for experiments conducted by the ARC. To reduce statistical error, the ARC used only men, and for follow-up study reasons, only those who had more than a year left of time to serve at the Narcotic Farm could apply.64 Although ARC research relied on volunteers, there were significant incentives for patients to participate. “Little Joe,” as he was called by fellow patients, explained one of these incentives for participation in ARC experiments in Clarence Cooper’s autobiography, The Farm: “And they give me two days’ good time for every test, and you see how this cut the 10 year bit down? Already I earned 288 days outsida my statutory goodtime, just from goin on experiments.”65 Some addicts participated just to experience one more high; a desire that never drifted far from many former addicts’ minds. ARC was the world’s premiere laboratory in narcotic research precisely because it “had access to a captive population of highly experienced and knowledgeable drug addicts.”66 However, many of the ARC’s practices were, by contemporary standards, highly unethical. Officials used former addicts’ intense desire for a high to their advantage. Test subjects were often subjected to study procedures that adversely affected their health. For the studies that tested the effects of various narcotics on the body and the process of withdrawing from those substances, researchers purposefully re-addicted participants to narcotics, observed their intoxicated state, and documented the subsequent withdrawal. The ARC’s usage of prisoner subjects in studies, although morally suspect, led to several breakthroughs and discoveries in the field of addiction.
Because the Lexington Narcotics Farm and the Addiction Research Center were the world leaders in the field of addiction research and treatment, the institution hosted hundreds of professional visitors looking to learn from the facility, including many from foreign countries around the world. For example, in 1959, the Lexington Narcotic Farm welcomed professionals from Brazil, Belgium, Iran, Japan, New Zealand, Puerto Rico, Scotland, and Thailand.67 In 1965, The Lexington Herald reported on visitors from Japan’s National Institute of Mental Health, the University of Tokyo, Canada’s Department of Health, and a Swiss doctor from the World Health Organization.68 Staff received and filled hundreds of requests for information each year about the institution’s methods of treatment, program design, and general information on narcotic addiction.69 Requests for information and visitors from all around the world were “indicative of the continued recognition of this hospital as the source of expert information about drug addiction.”70
In addition to international visitors, guests came from every state to learn from the Lexington model. The institution received visitors from all walks of life: health professionals, students from many backgrounds, law enforcement officers, local and state officials, concerned laity, religious counselors, and military representatives.71 The Lexington Narcotic Farm provided an excellent place for visitors to learn about addiction because one could see an actual treatment center, talk with professionals providing care, and observe and meet with patients. The institution was a “living laboratory” that provided the opportunity to study and observe real treatment.72 The education efforts of the facility ultimately led to a fundamental change in the general perception of addiction and treatment in the United States.
By the 1960s, the perception of addiction and treatment among medical and government officials had transformed into the medical context that the institution had advocated for forty years. Dr. Howard Rusk, in 1951, concluded that the “prognosis for a cure is good” for young teen-aged addicts who were hospitalized and under treatment for their addiction.73 That same year the Senate Crime Investigating Committee called narcotic addiction a contagious disease, following the lead of Dr. Lawrence Kolb during Lexington’s opening ceremony decades earlier.74 A joint statement released by the American Medical Association and the National Research Council in 1959, concluded that “[s]uccessful treatment of narcotic addicts in the United States requires extensive post-withdrawal rehabilitation and other therapeutic services.”75 By 1965, Senator Jacob K. Jarvits remarked there was a “growing acceptance of the premise that narcotics addiction is a disease rather than a crime.”76 In testimony Senator Robert F. Kennedy before the House Judiciary Committee, expressed sympathy for addicts and their families for the emotional chaos and economic hardships the affliction inevitably brings.77 By the seventies, even law professionals agreed with the sentiment that drug addiction was a highly communicable disease that spread rapidly, as opposed to just an illegal act requiring incarceration.78 The assumption that addicts were genetically different and weak-minded inferior humans was generally discredited by government officials and professionals in the fields of medicine and law.
Similar to medical and governmental professional perception, the general public began to accept that addiction was first and foremost a medical problem. Society generally accepted addiction as a medical ailment and that the best treatment occurred in a medical context. An East Harlem Protestant parish wanted “narcotics addiction to be treated as a medical problem, not a criminal one.”79 Its reverend, Norman C. Eddy, travelled to the state capitol to push for legislation to change hospitals’ current policy of rejection of addicted individuals seeking treatment.80 The following year, the General Federation of Women’s Clubs at International Convention adopted a resolution that, “strongly urges compulsory hospitalization for addicts…to cure, rehabilitate, and prevent further addiction.”81 At a hearing in New York City to discuss combating narcotic addiction, witnesses appealed to city officials for greater research and more hospital beds for those going through narcotics withdrawal.82 In 1971, in a New York Times article titled, “Addiction: Chemistry is the New Hope,” the reporter claimed that methadone treatment in addiction programs in New York (first experimented with and used on patients by the ARC) produced positive results for heroin users to stop abusing it regularly.83
Despite the early optimism, Narco’s days were numbered. The eventual closure of the facility occurred for three reasons: continued recidivism, financial exigency, and political pressure. All resulted in the decision by political officials to close the Lexington Narcotic Farm.
First, the readmission rate due to patients’ inability to remain off drugs after their release from the CRC was alarming. Dr. Richard Stephens conducted a study in which addicts listed their reasons for reverting back to drugs after release from the Lexington Narcotic Farm. He found three general reasons for relapse: to alleviate interpersonal stress, craving or enjoyment of the euphoric effects, and the “magnetic” pull of the addict subculture. Researchers conducted several follow-up studies of former Lexington patients. One study in 1969 found a relapse rate of over 90% since their release from the Narcotic Farm.84 A study published in Public Health Reports in 1970 that examined patients from the Narcotic Farm’s opening to the end of 1966 and found that for the 43,000 addicts admitted, over 77,000 re-admissions occurred. This means that a great majority of the patients were admitted more than once.85 The revolving door of Lexington was not just a statistical fact; it pointed to the difficulties addicts faced after their return to their communities. Many addicts maintained that although their physical dependence was gone, their mental dependence was just as strong after their third year of sobriety as it was their first day of sobriety.86 Brenda, an addict who frequented Lexington both voluntarily and by court mandate, became a victim of relapse as well: “When you’re confined [at the Lexington Narcotic Farm] its [sic] very different from when you hit the street. You have no direction when you come out of the hospital. While you’re in the hospital, you have something to do. It’s planned.”87 Officials also knew from early on that enforced cures, like those mandated for the prisoners at Lexington were less effective than voluntary ones.88
Second, questions of cost-effectiveness surfaced prior to the CRC’s closure. Readmission to Lexington cost the federal government millions of dollars. Local treatment centers by the late 1960s became increasingly widely accessible and arguably more cost-effective. The Prettyman Commission, the advisory committee to the executive office on narcotic addiction, estimated that the net cost of treatment in a community clinic would amount to about three to four dollars a day per patient. Treatment at the Narcotic Farms cost taxpayers about twelve dollars a day per person treated.89
The third, and ultimately precipitating cause, was political pressure. Two events caused an uproar in Washington and led to rapid efforts to keep them from becoming media frenzies. The first scandal involved the ARC and its participation in CIA experiments with LSD.90 The CIA spent millions of dollars from the early 1950s through the late 1960s on Project MK-ULTRA, an attempt to find mind-control techniques by experimenting with substances like LSD. Many of the test subjects did not consent to participating in the experiments, some of which resulted in deaths, including Dr. Frank Olson and Harold Blauer. When information came out in the early 1970s about the CIA experiments, investigations ensued including the Congressional Church Committee and the Presidential Rockefeller Commission.91 Although the results of the investigations did not come out before the CRC closed, federal officials certainly knew that the ARC was deeply implicated in the program. The specific case of MK-ULTRA highlighted the government’s long term medical experimentation on unwitting subjects and the ARC was tarnished by its proximity to egregious cases.
From 1932 until 1972, the Public Health Service conducted the Tuskegee Syphilis Experiment, where over 300 African-Americans with syphilis participated in a clinical study researching the natural progression of the disease. When penicillin became available in the late 1940s as an effective cure for the disease, the researchers withheld information about the treatment and failed to treat patients with penicillin to cure their ailment. The experiment became infamous in the early 1970s, right around the same time the CIA experiments became known by government officials. Although the experiment took place in Alabama and did not have direct involvement with the ARC, it was another instance where the Public Health Service conducted unethical experimentation on patients.92
In a memorandum to the Director of the Clinical Research Center on January 18, 1974, the CRC received formal notification of the transfer of the facility to the Bureau of Prisons. The CRC began “reduction-in-force proceedings…in preparation for a February 17, 1974 transfer date.”93 Unfortunately, many of the records were destroyed or thrown out, amounting to the loss of invaluable research on addiction.94 With haste and secrecy, the transfer of facilities to the Bureau of Prisons ended four decades of a sanctuary for narcotic addicts to recover from their addiction.95
Although the haven for narcotic addicts in Lexington, Kentucky, closed in 1974, the legacy of the half century experiment remained. It served as a pioneer in the transformation of the perception of narcotic addiction and treatment from the view is addiction as a moral weakness to a medical problem. In the first half of the 20th century, the public believed narcotic addiction was a vice, perpetuated by biologically and morally inferior, weak-minded humans. From its initial establishment, the Lexington Narcotic Farm maintained the principle of addiction within a medical context. Eventually, the common perception followed suit, resulting in the overall acceptance of the medicalization of addiction by the general public, medical professionals, and government officials.
The institution initially served as one of the only places a person could turn to seek treatment from the lowest depths of their addiction. The Addiction Research Center provided the base of scientific knowledge of narcotic addiction as the premiere laboratory of its kind in the world. Researchers and the medical staff of the Lexington Narcotic Farm agreed that addiction was a chronic, relapsing disease, long before it became widely accepted as a mainstream belief.96
The decentralization of addiction treatment to community-based programs marked the end of an era for the Lexington Narcotic Farm. The shift to decentralized programs ultimately resulted from the successful efforts of the institution to educate the public that addiction was a medical ailment. Once the perception changed from the earlier belief of addicts as crazed criminals, the centralized, isolated facilities of the narcotic farms were no longer needed. The closure of the Lexington Narcotic Farm marked the success of the medical model but an end to institution that made the medicalization of addiction possible. Regardless of its name, “Narco,” “Lex,” or “U.S. Narcotic Hospital,” its patients and doctors knew exactly what the institution stood for: the medicalization of narcotic addiction and treatment.
1 Nancy D. Campbell, JP Olsen, and Luke Walden, The Narcotic Farm (New York: Abrams, 2008), 36-37.
2 On the history of the Lexington Narcotic Farm, see Campbell, Olsen, and Walden; Olsen and Walden, DVD, The Narcotic Farm (Hollywood, CA: PBS 2008); Caroline Jean Acker, Creating the American Junkie: Addiction Research in the Classic Era of Narcotic Control (Baltimore: Johns Hopkins University Press, 2002); Robert S. Weppner, The Untherapeutic Community: Organizational Behavior in a Failed Addiction Treatment Program (Lincoln: University of Nebraska Press, 1983).
3 Campbell, Olsen, and Walden, 12, 88.
4 On the history of the medicalization of addiction and treatment, see Acker; Sarah W.Tracey and Caroline J. Acker, eds., Altering American Consciousness: The History of Alcohol and Drug Use in the United States, 1800-2000 (Amherst, Mass: University of Massachusetts Press, 2004); H. Wayne Morgan, Drugs in America: A Social History, 1800-1980 (Syracuse, NY: Syracuse University Press, 1981); Weppner; Nancy D. Campbell, Discovering Addiction (Ann Arbor, MI: University of Michigan Press, 2007); Jill Jonnes, Hep-cats, Narcs, and Pipe Dreams (Baltimore, Md: Johns Hopkins University Press, 1999); David F. Musto, The American Disease: Origins of Narcotic Control, 3rd ed (USA: Oxford University Press, 1999); David T. Courtwright, Dark Paradise: Opiate Addiction in America before 1940 (Cambridge, Mass: Harvard University Press, 1982).
5 Acker, 23.
6 The Prettyman Commission, “Report on a Study of the Narcotics Problem and the Public Health Service Narcotic Hospitals,” July 1965, 7. Records of the Lexington, KY, Clinical Research Center, 511.2.3, The National Archives Southeast Region (hereafter cited as CRC MSS); Courtwright, Dark Paradise, 135-137.
7 William R. Martin, M.D. and Harris Isbell, M.D., eds., Drug Addiction and the U.S. Public Health Service: Proceedings of Symposium Commemorating the 40th Anniversary of the Addiction Research Center (Rockville, MD: U.S. Department of Health, Education, and Welfare, 1978), 218-219.
8 The Prettyman Commission, 7.
9 Martin and Isbell, 218-219.
10 Campbell, Olsen and Walden, 164.
11 David T. Courtwright, Herman Joseph, and Don Des Jarlais, Addicts Who Survived; An Oral History of Narcotic Use in America (Knoxville: University of Tennessee Press, 1989), 310.
12 Helen MacGill Hughes, ed., The Fantastic Lodge: The Autobiography of a Girl Drug Addict (Boston: Houghton Mifflin, 1961), 205.
13 Sidney S. Louis, “The Drug Dependent- What They are Like,” (an essay prepared for presentations of the Education and Training Section, ca. 1960s). The Lexington Narcotics Farm Collection, 1930s-1970s, 1998PH04, Library and Special Collections and Archives, Kentucky Historical Society 9hereafter cited as Lexington MSS).
14 Louis, “The Evolvement of New Treatment Programs,” 3.
15 Martin and Isbell, 218.
16 US Treasury Department Bureau of Narcotics, Prevention and Control of Narcotic Addiction (Washington, D.C.: GPO, 1967), 17.
17 Earle V. Simrell, “Historical Background; Statutory and General,” Subcommitte- Drug Abuse II; Review of Programs, 1965, 2. CRC MSS.
18Porter Act of 1929, U.S. Statutes at Large70 (1929): 1085.
19Porter Act of 1929, 1085.
20 Campbell, Olsen, and Walden, 36.
21Porter Act of 1929, 1086.
22 “Huge Farm Ready for Drug Addicts; Federal Government Will Dedicate $4,000,000 Plant in Kentucky on Saturday,” New York Times, May 19, 1935. PHN; Weppner, 27-29.
23 “Huge Farm Ready for Drug Addicts.”
24 U.S. Public Health Service, “A Federal Hospital for Drug Addicts” American Journal of Public Health 25 (1935), 803.
25 Campbell, Olsen, and Walden, 36
26 Weppner, 27-29.
27 Campbell, Olsen, and Walden, 43.
28 Campbell, Olsen, and Walden, 15.
29 Clarence L. Cooper, Jr., The Farm (New York: Crown Publishers Inc, 1967), 15.
30 National Institute of Mental Health Division of Narcotic Addiction and Drug Abuse, Lexington; The Clinical Research Center, Addiction Research Center. (Washington, D.C.: GPO, 1971), 1.
31 National Institute of Mental Health Division of Narcotic Addiction and Drug Abuse, 43.
32 Campbell, Olsen, and Walden, 62.
33 Acker, 164.
34 William S. Burroughs, Jr., Kentucky Ham (Woodstock, NY: The Overlook Press, 1984), 85.
35 Sidney S. Louis, “Treating the Addicted” (an essay prepared for presentations of the Education and Training Section, ca. 1967), 5-6. Lexington MSS.
36 “The Center; In Historical Perspective,” 4
37 Cooper, 29.
38 Campbell, Olsen, and Walden, 74, 165.
39 Linedecker, “Escape.”
40 Courtwright, Joseph, and Des Jarlais, 305.
41 Bill Powell, “Winning the Drug-Abuse Battle; Young CRC Patients tell of Addicts Hell on Earth,” The Lexington Herald, October 14, 1970. CRC MSS.
42 Louis, “Treating the Addicted,” 1.
43 Campbell, Olsen, and Walden, 74, 82.
44 Jonathan D. Rosenthal, M.D., “The Management of Barbiturate-Sedative Drug Withdrawal,” 5. Lexington MSS.
45 Acker, 164.
46 “The Center: In Historical Perspective,” 9.
47 Weppner, 30-31.
48 Acker, 165.
49 Bromer, 30.
50 Annual Report United States Public Health Service Hospital. 1957 18.
51 Becky B. to Sidney S. Louis, 10 February 1973. Lexington MSS.
52 “The Center; In Historical Perspective,” 11
53 Public Health Service, “Handbook for Patients,” July 1964, 20.
54 Public Health Service, 20-22.
55 Report United States Public Health Service Hospital. 1957, 24.
56 Acker, 166.
57 “NARA.”(draft for a informational internal memorandum, ca. 1966), 7. Lexington MSS.
58 Mary C. Gillis, “Research,” Subcommitte- Drug Abuse II; Review of Programs, 1965, 75. CRC MSS.
59 Simrell, 1.
60 Gillis, 75.
61 National Institute of Mental Health Division of Narcotic Addiction and Drug Abuse, i.
62 “NARA,” 8.
63 Campbell, Olsen, and Walden, 164.
64 Campbell, Olsen, and Walden, 164.
65 Cooper, 191-192.
66 Campbell, Olsen, and Walden, 164.
67 “Scientific Leadership.” Annual Report United States Public Health Service Hospital, 1959. CRC MSS.
68 “Foreign Medics Tour USPHS Hospital,” The Lexington Herald, February 20, 1965. CRC MSS.
69 Annual Report United States Public Health Service Hospital. 1959.
70 Annual Report United States Public Health Service Hospital. 1957, 18.
71 “NARA,” 10.; National Institute of Mental Health Division of Narcotic Addiction and Drug Abuse, 13.
72 “The Education and Training Section,” (draft for an educational brochure, ca. 1970), 1. Lexington MSS.
73 Howard A. Rusk, “Headway Seen for Control Of Teen-Aged Narcotic Users; Alarm over Widespread Addiction Aids Development of National Problem,” New York Times, May 20, 1951. PHN.
74 “Text of Conclusions and Recommendations of the Senate Crime Investigating Committee,” New York Times, September 1, 1951. PHN.
75 US Treasury Department Bureau of Narcotics, 15.
76 Congressional Record, 89th Cong., 1st sess., 1965, 111, pt.1:12575.
77 “Congressional Hearings on Civil Commitments,” (testimony released to parties involved, 1965). CRC MSS.
78 Judianne Densen-Gerber, “A Visit to Lexington.” New York Law Journal December 29, 1971. CRC MSS.
79 John Wicklein, “Parish is Seeking Care For Addicts; East Harlem Group Wants Heroin Users to be Treated Medically,” New York Times, February 23, 1959. PHN.
81 US Treasury Department Bureau of Narcotics, 12.
82 Peter Flint, “City Bids U.S. Help it Combat Addiction,” New York Times, May 17, 1960. PHN.
83 Richard Severo, “Addiction: Chemistry Is the New Hope,” New York Times, March 19, 1971. PHN.
84 John A. O’Donnell, Narcotic Addicts in Kentucky (Chevy Chase, MD: Department of Health, Education, and Welfare, 1969), 1-4.
85 John C. Ball, William O. Thompson, and David M. Allen, “Readmission Rates at Lexington Hospital for 43,215 Narcotic Drug Addicts” Public Health Reports 85, No. 7 (July 1970): 610-11.
86 Prescor, 5-6.
87 Courtwright, Joseph, and Des Jarlais, 301.
88 Prescor, 5.
89 The Prettyman Commission, 9.
90 Campbell, Olsen, and Walden, 165, 186.; Richard Ashley, “The Other Side of LSD,” New York Times, October 19, 1975. PHN; “Private Institutions Used in CIA Effort to Control Behavior,” New York Times, August 2, 1977. PHN.
91 “The Select Committee to Study Government Operations with Respect to Intelligence Activities, Foreign and Military Intelligence.” Church Committee Report, no. 94-755, 94th Cong., 2nd Sess., Washington, D.C.: United States Congress. 1976. P. 392. http://www.aarclibrary.org/publib/church/reports/book1/html/ChurchB10200b.htm.
92 James H. Jones, Bad Blood; The Tuskegee Syphilis Experiment (New York: The Free Press, 1993).
93 Elmore S. King to Chief, Clinical Research Center, January 18, 1974. CRC MSS.
94 Louis, “The Closing,” 3.
95 Nancy D. Campbell, Discovering Addiction (Ann Arbor, MI: University of Michigan Press, 2007), 135; Courtwright, Joseph, and Des Jarlais, 298.
96 Campbell, Olsen, and Walden, 166.
Kentucky Historical Society, Library of Special Collections and Archives, Lexington Narcotics Farm Collection, 1930s-1970s, 1998PH04.
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Bass, Elizabeth. “Voice of the People.” Chicago Daily Tribune, September 15, 1935. PHN.
Boland, Joe. “VCCC Drug Abuse Committee Will Attend Training Course.” The Terre Haute Star, 20 January 1971. [Lexington MSS].
Browning, Norma Lee. “The Tragedy of an ‘Accidental Addict.’” Chicago Tribune, October 29, 1950. [Lexington MSS].
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Linedecker, Cliff. “Help Continues After the Return Home.” The Philadelphia Inquirer, April 1, 1970. [Lexington MSS].
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ERIN M. WEISS
Erin Weiss, from Woodbridge, Virginia, graduated summa cum laude from Virginia Tech with a bachelor’s degree in History and interdisciplinary studies in May 2010. She is currently pursuing a master’s degree in Secondary Social Studies Education and in History at Virginia Tech. Her project “A New Deal for Junkies” began as a senior seminar history class with Dr. Robert Stephens. A large part of her success is owed to his thoughtful and challenging guidance, encouragement, and his confidence in her abilities. Named an ACC Scholar in spring of 2010, Erin received funding to conduct archival research in Lexington, Kentucky, and Atlanta, Georgia. Erin presented her work at the annual ACC Meeting of the Minds at Georgia Tech last April and at the Virginia Social Sciences Association Conference and the Virginia Tech Undergraduate Research Conference.