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Historical Treatment of Substance Use Disorders

Historically, substance misuse has been viewed as a crime rather than a chronic disease. The Congressional Research Service's (CRS) Drug Enforcement in the United States: History, Policy, and Trends describes the history of drug enforcement in the United States, beginning in the 19th century when the federal government did not regulate the distribution or use of drugs.

Federal regulation of drugs began in the early 20th century, when the Harrison Narcotics Act of 1914 required importers, manufacturers, and distributors of opium and cocaine — which were commonly used for recreational purposes — to register with the Department of the Treasury, pay a tax on substances, and maintain records of transactions. Healthcare providers were permitted to prescribe opiates and cocaine. However, the law was subject to interpretation; many physicians and drug users were prosecuted and imprisoned, and narcotic clinics closed. Physicians stopped prescribing drugs covered under the Harrison Act, leading users to illegally purchase these substances.

Congress continued to pass laws regulating substance use in the mid-20th century. Laws passed in the 1950s established prison sentences and increased penalties for drug offenses. By the 1960s, however, support for severe legal penalties for substance misuse had decreased. There was greater support for the rehabilitation of people with substance use disorders through treatment.

The “War on Drugs” period of drug control in the U.S. began in the 1970s, when the Controlled Substances Act was passed to create a framework for federal regulation of controlled substances. The Drug Enforcement Administration was established to coordinate all federal drug enforcement efforts. Drug misuse was addressed through the criminal justice system and federal convictions for drug offenses increased. Laws in the 1980s established criminal penalties for possession of a controlled substance, including penalties for specific federal drug trafficking offenses and drug violations committed by minors.

In the 21st century, the federal government gradually shifted to a drug control policy focused on prevention, treatment, and enforcement. Much of the drug control budget continues to be allocated to drug supply reduction and domestic law enforcement.

The historical classification of substance use as a crime has led to stigma surrounding substance misuse. Stigma is a barrier to recovery and affects whether individuals with substance disorders seek treatment and social support services.

Resources to Learn More

Drug Enforcement in the United States: History, Policy, and Trends
Describes the history of drug enforcement in the U.S., including information on efforts from the 1990s to the present to address methamphetamine, marijuana, heroin, and prescription drugs.
Organization: Congressional Research Service
Date: 10/2014