as a nervous disorder; no concept of addiction, it is claimed, existed in England or America before this period. Advances in medical science and psychology led to its definition in both countries. First, the British navy physician Thomas Trotter, who has been called “the first scientific investigator of drunkenness,” produced a 1788 Edinburgh doctoral thesis arguing that habitual drunkenness is itself a disease.8 His dissertation was published in 1804 as An Essay, Medical, Philosophical, and Chemical, on Drunkenness, and Its Effects on the Human Body, and in it Trotter notes, “In medical language, I consider drunkenness, strictly speaking, to be a disease.”9 This disease manifests in illnesses attendant on overdrinking, including “universal debility, emaciation, loss of intellect, palsy, dropsy, dyspepsia, hepatic diseases, and all others which flow from the indulgence of spirituous liquors.”10 Nearly simultaneously, Benjamin Rush in America (one of the original signatories of the Declaration of Independence and a man deemed the founder of American psychiatry) published An Inquiry into the Effects of Ardent Spirits upon the Human Body and Mind (1785), in which he also defines drunkenness as a disease: “Drunkenness resembles certain hereditary, family and contagious diseases.”11 Rush’s work theorizes the trajectory from choice to compulsion: “The use of strong drink is at first the effect of free agency. From habit it takes place from necessity. That this is the case, I can infer from persons who are inordinately devoted to the use of ardent spirits being irreclaimable, by all the considerations which domestic obligations, friendship, reputation, property, and sometimes even by those which religion and love of life, can suggest to them.”12 As with Trotter, he names the diseases stemming from drunkenness, including jaundice, dropsy, epilepsy, gout, and madness.
The work of Trotter and Rush ushered in a “new paradigm,” as the medical sociologist Harry G. Levine writes. This new paradigm “constituted a radical break with traditional ideas about the problems involved in drinking and alcohol.”13 Specifically, opinion shifted on habitual drunkenness (and in turn on opium use and other addictive behaviors) to a disease model, the key feature of modern definitions of addiction. As the historian of science Roy MacLeod notes: “It was too easy to view alcoholism simply as immoral excess, its cure, simple moral restraint, and its expense, a personal responsibility.”14 As a result, he writes, “the transformation of public attitudes from the conception of alcoholism as a moral sin to its recognition as a nervous disease required concerted effort.”15 In understanding the shift in viewpoint on excessive drinking, scholars not only stress the moralizing of earlier periods, as MacLeod does here, but they also point to earlier conceptions of drinking as a matter of choice. Levine, for example, discusses how “during the 17th century, and for the most part of the 18th, the assumption was that people drank and got drunk because they wanted to, and not because they ‘had’ to.”16 He elaborates: “In the modern definition of alcoholism, the problem is not that alcoholics love to get drunk, but that they cannot help it—they cannot control themselves.”17
This paradigm shift in the study of addiction is of a piece with other scientific discoveries of the period, Roy Porter argues: “Building to some degree on the work of precursors such as Erasmus Darwin, nineteenth century doctors set about investigating the pathology of excessive drinking, exploring its associations with conditions such as dropsy, heart disease, cirrhosis of the liver, … nervous disorders, paralyses.”18 MacLeod also recognizes this new nineteenth-century paradigm and charts the general impact of this breakthrough over the course of the century:
Not until the last half of the 19th century did the scientific appreciation of alcoholism become general. Only then, under the guidance of a few doctors and reformers, was the image of the drunkard as a disorderly, ill-disposed social unit gradually transformed into one of a neglected patient suffering from a mental disease with well-marked clinical features. Reformers, who sought to remove the moral stigma from alcoholism and to treat the alcoholic by medical means, led the advance guard of a movement to promote prevention and cure on a public basis.19
As part of these reform movements, the first temperance societies appeared in England in the 1830s, and Parliament passed the landmark Habitual Drunkards Act in 1879. That legislation is, in terms of this addiction narrative, the culmination of efforts by physicians and reformers who shifted the notion of inebriation from social condemnation to scientific understanding. In doing so, they redefined a habitual drunkard from a sinner to someone with a disease akin to lunacy.20
More-recent historians have put pressure on the pioneering nature of Trotter and Rush’s conclusions. The research of both Porter and Jessica Warner on the eighteenth-century gin craze exposes a notion of diseased drinking in the century before Trotter and Rush.21 The work of Phil Withington and others on intoxication tracks the “modern obsession” with substance abuse, even as it illuminates how contemporary concerns about intoxication have “enduring roots in the past.”22 Yet even though the dating of addiction might vary, and even as historians illuminate the long history of intoxication, a broad consensus remains that addiction constitutes a modern discovery, one connected intimately to familiar features of modernity: the rise of Enlightenment individualism, medicalization, global trade, nation states, and capitalism.23 Current advances in neurobiological research further reinforce the link of addiction to modernity by suggesting how addiction’s discovery is ongoing and dependent upon modern technologies: using newly available scanning devices, such as PETs and fMRIs, to trace precisely how the addicted brain operates, neuroscientists have exposed the long-lasting changes in brain function caused by addiction, including “the pathological usurpation” of the brain’s reward-circuit learning.24 As a result of such usurpation, the rewired, addicted brain releases dopamine in response to the anticipation of drug taking, rather than merely as a result of drug ingestion.25
Finally, literary histories have underscored addiction’s modernity by studying the emergence, in the late eighteenth century, of the inspired writer-addict. Samuel Taylor Coleridge and Thomas De Quincey stand as early examples of addict-writers, with Coleridge linking literary inspiration and drug consumption in his famous preface to “Kubla Khan.” From the Romantic’s tincture of opium through Eugene O’Neill’s and Tennessee Williams’s alcoholism to Jim Morrison’s acid trips and William Burroughs’s heroin addiction, writers offer autobiographical chronicles of how drug addiction might fuel or fell creativity. The addict-writer holds a clear place in the imaginative landscape of the twentieth century, articulating what seems to be a particularly modern, or postmodern, condition of stasis and excess.26 “Addiction,” as Janet Ferrell Brodie and Marc Redfield write, “belongs as a concept to the social and technical regimes of the modern era.”27 Their cultural history draws attention to the ideological ramifications of addiction, a concept that is “little more than a century old.”28 Chronicling drug abuse, Stacey Margolis calls addiction “a particularly modern form of desire.”29 Anna Alexander and Mark S. Roberts argue that “addiction emerges directly alongside modernity,” and Jacques Derrida speaks of our “narcotic modernity.”30 These accounts draw on the perception of the modern bodies as uniquely pathologized and incapacitated, precisely as Sedgwick illuminates. Specifically, the modern subject, imbricated in a global economy, finds addiction at once an expression of powerlessness and pleasure.
Yet even as modern medical and psychological research illuminates the workings of addiction in entirely new ways, and even as writers from Coleridge onward experience addiction more acutely than in the past, addiction is not a singular feature of modernity. As this introduction’s final section reveals, a model of addiction as compulsion and disease existed earlier than the nineteenth century. Overturning the notion that addiction was “discovered” only a century ago, or even two or three centuries ago, this project demonstrates an early modern awareness of alcohol addiction as a disease along the lines charted by medical pioneers and modern-day neurobiologists: addiction alters the brain and results in a familiar, and oft-repeated, set of related diseases. To imagine that the premodern period remains entirely distinct from modernity when it comes to addiction is to overlook the rich evidence from the sixteenth and seventeenth centuries that suggests the awareness
