Before “alcoholism” had a name

For centuries, heavy drinking was framed as a moral failing, to be tackled by sermons or punished by law. In the early 1800s, the naval physician Thomas Trotter argued that habitual drunkenness behaved like a disease of the mind and body—an idea far ahead of its time. His Essay…on Drunkenness (1804) helped nudge medicine toward treatment rather than purely condemnation.

A few decades later, the Swedish physician Magnus Huss coined the term “alcoholism” (1849) to describe the chronic, physical consequences of long-term alcohol use. Naming the condition as a medical problem marked a turning point: if it had a name, perhaps it could have a treatment.

Meanwhile, popular movements pushed in different directions. The Washingtonian societies (1840s) championed peer support and personal pledges; the wider temperance movement pushed for abstinence and later prohibition. These currents shaped early “homes” for the inebriate across Britain and North America.

The inebriate asylums and reformatories (late 19th–early 20th century)

By the late 1800s, Britain experimented with dedicated facilities. The Inebriates Act 1898 allowed magistrates to send “habitual drunkards” to certified reformatories—including specific provisions for Scotland, authorising detention in certified inebriate reformatories north of the border. These were part hospital, part prison, blending moral discipline with medical care.

Women’s “homes” were a prominent strand. Some, like St James’s Home for Inebriate Women in England, mixed Victorian rescue-mission attitudes with the new medical language of inebriety—offering routine, work, religious observance and periods of abstinence. Scotland had parallel charitable and municipal efforts, often linked with poor-law and asylum systems. Results varied, and the approach could feel coercive, but a seed had been planted: structured environments could sometimes stabilize people whose drinking had overwhelmed ordinary life.

The era of “secret cures” and commercial sanatoriums

Alongside reformatories, a wave of private “cures” appeared. The most famous was Dr. Leslie Keeley’s “Gold Cure” (from 1879), which franchised clinics across the US and into London. The mixture (touted as bichloride of gold) was secretive and controversial; it drew crowds, testimonials—and scorn from mainstream medicine. Whatever its pharmacology, Keeley tapped a market: people wanted treatment settings away from courts and workhouses.

Mutual aid rewrites the script (1930s onward)

In 1935, Alcoholics Anonymous (AA) began in Akron, Ohio, emphasising peer support, honesty, and daily practice rather than institutional confinement. It spread to the UK after the war and remains widely available across Scotland today. Even if families choose other routes, AA proved that community could be treatment, not just moral policing.

Medicine catches up: the first modern drugs

After World War II, treatment moved further into clinics and hospitals. In 1947–49, Danish researchers Hald and Jacobsen observed that disulfiram (later Antabuse) made people violently unwell if they drank—ushering in the first widely used “pharmacotherapy” for alcohol dependence. Early use could be punitive; later practice framed disulfiram as a voluntary support for highly motivated people.

The next big step was acamprosate (approved in Europe by 1989), which helps the brain settle after long exposure to alcohol and supports abstinence, and naltrexone (approved for alcohol dependence in the 1990s), which reduces reward and craving. Together with psychological therapies, these began to replace custodial models with evidence-based outpatient care. Scotland and the wider UK also evaluated nalmefene for people aiming to cut down rather than stop entirely.

Beyond the 12 steps: cognitive-behavioural and secular options

In the 1990s, SMART Recovery emerged as a cognitive-behavioural, skills-based alternative to 12-step groups. Notably, its first UK meetings were piloted in Scotland’s Inverness Prison in 1998 before expanding, showing Scotland’s role in diversifying recovery culture. Today many people use both AA and SMART, choosing what fits.

Twenty-first-century services: harm reduction and trauma-informed care

Modern Scotland offers a spectrum—Community Addiction Teams, third-sector partners, mutual aid, and (when needed) residential rehab. Crucially, services recognise that suddenly stopping can be medically dangerous for dependent drinkers and that trauma, homelessness, and mental health often intersect with alcohol.

For people who can’t or won’t stop—especially those experiencing homelessness—Scotland has tested Managed Alcohol Programmes (MAPs), which provide measured doses in a supervised, housing-first environment. These programmes aim to reduce deaths, injuries, and street drinking, and Scotland launched its first MAP in 2021. The research base is growing, and early evaluations suggest MAPs can improve safety and stability for a very high-risk group.

What vanished—and what remains

The old “inebriate homes” faded as coercive models lost legitimacy and public health matured. Yet two legacies remain:

1. Structure helps. Whether it was a Victorian timetable or today’s care plans, predictable routines and safe shelter support change—especially after detox.
2. Community matters. The Washingtonians, AA, and modern peer support all show that relationships beat isolation. Families, too, are part of the “treatment system,” whether or not they want that job.

How treatment looks now—for families deciding what to do

• Start with safety. If someone drinks heavily every day, don’t encourage an abrupt stop without medical advice—withdrawal can be dangerous. GPs and Community Addiction Teams can organise thiamine, bloods, and medically assisted withdrawal where appropriate.
• Pick a pathway that fits. Abstinence via rehab or AA; reduction with nalmefene; relapse-prevention with acamprosate or naltrexone; skills-based groups like SMART; or a MAP when life is chaotic. There’s no single right door.
• Expect joined-up support. The best programmes today are trauma-informed, involve families (with consent), and combine psychological therapy with medical care and housing or employment help where needed.

Why this history matters

Knowing the path from reformatories to recovery communities, and from secret “gold cures” to rigorous, peer-reviewed medicine, can help families judge offers they see online, avoid false promises, and ask better questions. It also offers hope. We’ve moved from punishment to partnership, from shame to science, and from “one size fits all” to multiple doors into safer lives.