History of substance abuse and addiction: evolution, global spread, and treatment implications

The history of drug abuse and addiction is the study of why humans started consuming addictive drugs, how drug abuse causes addiction, and how addiction has affected families, communities, and nations over time. 

Drug use and addiction have evolved over time in response to the changing socio-cultural milieu, technological advances, and the policy landscape as it relates to public health and the regulatory framework. The drug use and addiction landscape has been influenced by globalization, an increased recreational use of synthetic opioids, the legalization and decriminalization of cannabis, and a proliferation of illegal drug trafficking networks.

The number of individuals aged 15-64 years who use drugs worldwide has increased by 20% in 2022 compared to numbers a decade earlier.

Learning about the history of drug abuse and addiction is important to understand the varied nuances of these issues and their medical, psychological, social, and occupational implications for individuals and communities. This knowledge helps in the development of effective treatment strategies by identifying knowledge gaps, predicting future trends in drug use patterns, and influencing the direction of future research.

What is the history of drug abuse and addiction?

The history of drug abuse and addiction is the study of the beginnings of the consumption of addictive substances, why and how their patterns of use have changed over time, and the effects of the use of drugs at the individual and societal levels. It is an ongoing investigation into evidence from the past, followed by analysis and interpretation of the findings to expand existing knowledge and influence future research.

The history of drug abuse and addiction focuses on how human actions of the past have shaped the present and future. The goal of this branch of study is to enforce legislative regulations that seek to curb drug trafficking, distribution, and use; direct research endeavors that promote greater understanding and empathy by exploring and explaining the multifaceted etiology of addiction; and educate the masses about the harms of illicit drugs.

What is known about drug use in ancient history?

It is known that drug use in ancient history dates as far back as 10,000 years ago, when humans were consuming opium and magic mushrooms. Cave paintings and artefacts from the prehistoric era depict images of individuals engaging in shamanic practices while being in an altered state of consciousness. The oldest use of cannabis for its intoxicating properties is traced back to the people of Central Asia about 2500 years ago. Archaeological findings from a burial site in the Pamir Mountains in western China include skeletons, wooden plates and bowls, and wooden braziers to hold burning objects. Cannabis seeds have also been discovered from Scythian burial sites. Harmal, a plant with therapeutic and psychoactive properties, has been discovered in the hair of an adult male mummy, believed to be from 800 and 1200 AD, in Northern Chile. The mummy was found buried with pipes and trays that are likely to have been used to snuff the drug. There is also archaeological evidence to suggest that Harmal was used in Arabia nearly 2700 years ago for its psychoactive properties. Coca, the leaf from which cocaine is derived, has been used by the Andean people as a stimulant and for medicinal purposes for over 3000 years. Psilocybin, also known as magic mushrooms, has been used by the ancient people of the Sahara Desert and the indigenous tribes of Central and South America. North African murals dating back to 9000-7000 BCE record the use of magic mushrooms to induce hallucinations, which the ancient people believed allowed access to higher realms of intelligence. The ancient Egyptians used the blue lotus flower, now considered a threatened species, for its psychedelic properties as far back as 3000 years ago. Ancient Ethiopian priests consumed coffee beans to stay awake through the night to pray and meditate.

There is historical evidence to suggest that mead, an alcoholic beverage prepared from fermented honey, was used about 8000 BCE. The ancient Egyptians used alcohol in 3500 BCE. The ancient Chinese used cannabis about 3000 BCE. There are archaeological records to suggest that drug use was prevalent among early hominid species about 200 million years ago. Inhabitants of Timor are known to have used betel nut about 13,000 years ago. About 40,000 years before European colonialism, Australian indigenous tribes used nicotine. North African and Ethiopian tribes are known to have used khat before European colonialism. Cocaine was used by the Ecuadorian people about 5000 years ago and by the indigenous tribes of the western Andes about 7000 years ago.

Why have people used drugs throughout history?

People have used drugs throughout history for medicinal, religious, spiritual, and recreational purposes. Opium has been used as a medicine for various ailments since ancient times, with the Ebers papyrus (1500 BCE) being the first written record of opium’s medicinal use. Opiates like morphine have been used since the early 1800s to manage chronic pain. Hallucinogenic substances like the Amanita muscaria mushroom were used in religious ceremonies in Central Asia for at least 4000 years, according to a 2007 article by Marc-Antoine Crocq published in the journal Dialogues in Clinical Neuroscience, titled “Historical and cultural aspects of man’s relationship with addictive drugs.”

Peyote, a hallucinogenic plant, was used by the indigenous people of pre-Columbian Mexico and the Navajo tribe in spiritual ceremonies. Hallucinogens were used to induce altered states of consciousness or trance that were believed to aid in spiritual experiences. Individuals who used drugs recreationally did so for reasons like inducing euphoria or pleasurable sensations, getting intoxicated, relieving mental anxiety and stress, and blocking out negative emotions.

When did humans first start using drugs?

Humans first started using drugs as far back as 200 million years ago, according to a 2005 article by Tammy Saah published in the Harm Reduction Journal, titled “The evolutionary origins and significance of drug addiction.” This was the period when the early hominid species existed on Earth. Archaeological records point to the presence of psychotropic plants and the use of drugs in ancient civilizations dating back to this era. However, it is believed that the early hominids did not manifest neural adaptations to the substances because of their limited availability.

Who invented drugs? 

A German physicist, F.W.A. Serturner, invented the first addictive drug, morphine, in 1806. Serturner is credited with the extraction of morphine from crude opium. In 1895, Heinrich Dreser invented heroin. However, distilled spirits were being made from much earlier times. Multiple civilizations in the world—the ancient Chinese, the Greeks, the Romans, and the Arabs—had been distilling alcoholic beverages from starchy grains, sugarcane, rice, honey, and grapes as far back as 100 CE. 

Why were drugs invented?

Drugs were invented as remedies for physical conditions like pain and injuries, for use during religious rituals, and as tools for spiritual healing. They were used to provide stimulation and ease pain, trauma, and injury. Opioid narcotics were invented to provide relief from chronic pain. Performance or “enlightenment” drugs were developed and experimented with to stimulate creativity and enhance performance on intellectual pursuits, according to a 2014 article by Ross D. Aikins published in the journal History of Education, titled “From recreational to functional drug use: the evolution of drugs in American higher education, 1960–2014.” Author Tammy Saah, in a 2005 article published in the Harm Reduction Journal, titled “The evolutionary origins and significance of drug addiction,” notes that psychotropic substances were used by ancient human beings as sources of nutritious food that provided them with vitamins, proteins, and minerals. They consumed these substances to improve their tolerance to extreme temperature fluctuations, decrease fatigue, and enhance stamina levels. It was believed that these substances enhanced their resilience by allowing them to hunt and forage for food for longer durations and sustained them when food was scarce.

During ancient times, drugs were primarily made from plant extracts to which animal products and minerals were added. These folk medicines were dispensed by religious leaders or sages. Although folk medicines developed independently across different cultures spread across wide geographical areas, there were similarities between the medicinal practices of different cultures. This was likely due to traders who roamed around the world and spread medicinal knowledge. Drug development started being informed by scientific knowledge in the late 1800s. From this time onwards, drugs were synthesized, tested, and produced in large quantities in specialized manufacturing facilities. The modern pharmaceutical industry, with its operations firmly based in rigorous scientific know-how, had its origins after World War I. However, in certain cultures, folk medicines are still in use. In other cultures, folk medicines are complemented by pharmaceutical medications.

How long have drugs been around?

Drugs have been around for thousands of years, with mead, an alcoholic beverage made from fermented honey, being consumed about 8000 BCE. Historical records suggest that beer and berry wines were consumed about 6000 BCE. Drugs have been used as medications for the majority of human existence. For instance, the earliest written records mention the medicinal use of opium. There is mention of an anxiolytic or antidepressant-like substance in Homer’s Odyssey, which dates back to the 9th century BC.

What is the oldest known drug used by humans?

The oldest known drug used by humans is opium, with archaeological evidence suggesting that the opium poppy plant was grown by the Neolithic tribes (10,000-4000 BCE) in Europe. The earliest evidence of opium being used as medicine dates back to the Sumerians in Mesopotamia in 3000 BCE. The discovery of an 8000-year-old Sumerian clay tablet prescribing opium is testimony to the practice of using opium as medicine in ancient times. The Sumerians called the poppy plant Hul Gil, or the “joy plant,” a reference to the euphoria-inducing properties of opium. The Sumerians passed on the know-how of poppy cultivation to the Assyrians, Babylonians, Greeks, Egyptians, Romans, and Persians. The Ebers papyrus, dating back to 1500 BCE and one of the oldest medical texts of mankind, refers to the use of opium to treat various ailments in children.

How has drug use and addiction evolved over time?

Drug use and addiction have evolved over time in response to dynamic cultural and social norms and rapid technological advances. The changes in consumption patterns–from traditional plant-based substances to pharmaceutical drugs–are linked to man’s propensity to continuously experiment with substances in an attempt to expand their scope of use. Drug use over the ages has also changed with respect to usage scenarios. Substances have been used as part of religious ceremonies, cures for medical and/or psychiatric disorders, a medium for pleasure and recreation, and tools for social bonding. 

These changes are reflected in the increase in the hazardous and non-medical use of synthetic opioids that has resulted in the current opioid crisis, the emergence of novel psychoactive substances, the legalization and decriminalization of cannabis, and the rise of cannabis vaping among adolescents. Globalization has seen the spread of drugs across borders, a development that has resulted in diverse kinds of drugs becoming available easily, an increase in the consumption of substances, and a proliferation of illicit drug trafficking channels. For instance, the number of drug users worldwide among individuals aged 15-64 years has increased by 20% in 2022 compared to what it was a decade earlier, according to the statistics quoted in the Key Findings and Conclusions: Drug Use Harms and Impacts booklet of the World Drug Report 2024, published by the United Nations Office on Drugs and Crime (UNODC). The emergence of a class of novel and extremely powerful synthetic opioids has contributed to a global opioid crisis marked by an increase in the number of fatal opioid overdose incidents, according to a publication by the European Union Drug Agency titled “Spotlight on… Fentanils and other new opioids” last updated on 4 October 2023. Increased use and misuse of both prescription and non-prescription opioids, coupled with the practice of mixing drugs, have fueled this opioid epidemic. The opioid epidemic has also involved overdose deaths linked to polysubstance use. It is estimated that 80% of fatal overdoses involving synthetic opioids involve another opioid such as prescription opioids, heroin, non-opioid prescription drugs like benzodiazepines, stimulants like cocaine, or alcohol, according to a 2022 article by Park et al., published in the Journal of Addiction Medicine, titled “Polysubstance Overdose Deaths in the Fentanyl Era: A Latent Class Analysis.” Statistics gathered from studies show that the prevalence of cannabis vaping among adolescents across all school grades has increased in the US and Canada, according to a 2021 article by Lim et al., published in the journal JAMA Pediatrics, titled “Prevalence of Adolescent Cannabis Vaping: A Systematic Review and Meta-analysis of US and Canadian Studies.” The World Drug Report 2024 by the UNODC also points to an increase in the abuse of psychostimulants like cocaine and ecstasy and the non-medical use of ketamine in recent times.

Changes in drug use and abuse patterns have influenced drug policies that address substance use disorders and their harms, as part of an ongoing effort to promote public health and uphold human rights. For instance, legal prohibitions, licensing requirements, and taxation measures, as well as religious and cultural sanctions, have been imposed to curb drug use. These regulatory measures have, in turn, influenced drug use patterns. The United Nations Human Rights Office of the High Commissioner, in a release titled “An effective and humane approach to drug policies,” published on 4 April 2025, notes that drug policy reforms that focus on punitive measures like criminalizing and punishing the personal possession and usage of drugs produce disastrous results like increase in drug-related fatalities and crimes, illicit manufacturing of drugs, and stigmatization of not only the drug-using individual but also whole communities. Over the years, it has been witnessed that drug usage and instances of fatal overdoses decreased when drug decriminalization measures were adopted alongside harm-reduction approaches, as had happened in Portugal in the early 2000s, according to The Lancet editorial of November 2023 titled “Drug decriminalisation: grounding policy in evidence.”

When did recreational drug use start becoming a problem?

Recreational drug use started becoming a problem in the US from the 1960s when marijuana and LSD (Lysergic acid diethylamide) consumption increased rapidly. It was observed that the prevalence of marijuana use among college students was as much as 33%, with the average being 20-25%, according to a 2014 article by Ross D. Aikins published in the journal History of Education, titled “From recreational to functional drug use: the evolution of drugs in American higher education, 1960–2014.” The prevalence estimates of LSD, an illegal street drug with powerful hallucinogenic properties, ranged between 2% and 11%. Its widespread recreational use led to the substance being banned in 1966. During the 1950s, amphetamines and barbiturates were commonly used for non-medical purposes. The recreational use of amphetamine increased throughout the 1960s. During the 1980s, ecstasy was widely used for recreational purposes, especially in clubs. Its escalating problematic use prompted a ban on the substance in 1985. The use of crack cocaine increased among working-class and poor individuals around 1985. In the first decade of the 21st century, methamphetamine was a popular recreational drug of choice. The increasing use of opioids for non-medical purposes from the start of the 2010s marks the beginning of the opioid crisis in the US and Canada, with addiction rates and overdose fatalities increasing rapidly.

When was addiction first recognized as a disease?

Addiction was first recognized as a disease in 1987 by the American Medical Association (AMA), according to a 2010 article by Kathy Bettinardi-Angres and Daniel H. Angres published in the Journal of Nursing Regulation, titled “Understanding the Disease of Addiction.” The AMA had declared alcoholism an illness in 1956. In 1997, Alan Leshner, the then Director of the US National Institute on Drug Abuse (NIDA), proposed that addiction is a chronic, relapsing brain disease, according to a 2015 article by Hall et al., published in journal The Lancet Psychiatry, titled “The brain disease model of addiction: is it supported by the evidence and has it delivered on its promises?” However, the term “addiction” was intentionally omitted from four consecutive versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association, namely DSM-III, DSM-III-R, DSM-IV, and DSM-IV-TR, according to a 2019 paper by Richard J. Rosenthal and Suzanne B. Faris published in the journal Addiction Research & Theory, titled “The etymology and early history of ‘addiction’.” The omission stemmed from the perception that the word is a layman’s term and is difficult to define. It was also believed that the term reflected prejudice and stigma. It has been introduced in the DSM-5, but only as part of the category “Substance-Related and Addictive Disorders.” Benjamin Rush, one of the Founding Fathers of America and a pioneer of addiction medicine, is credited with laying the groundwork for the concept of addiction as a disease. He was one of the first individuals to dispute the prevailing social belief that addiction is a moral failing. He suggested that alcoholism is caused by alcohol itself.

What was the first drug to be made illegal?

The first drug to be made illegal was opium. However, there was no outright ban initially. Rather, there were a series of regulatory moves to control the production and distribution of opium and other dangerous narcotic drugs. The Pure Food and Drug Act of 1906 made it compulsory that manufacturers disclose the ingredients in their products so that buyers and consumers are able to identify those that contain opium. In 1909, a congregation of 13 nations in Shanghai adopted recommendations that formed the basis for the first opium convention that took place in The Hague in 1912. These recommendations formed the basis for the Opium Exclusion Act of 1909, which banned the import of opium and its derivatives like morphine, heroin, and codeine for all purposes other than medicinal use. Subsequent meetings of the Hague Convention resulted in the curbing of opium trading overseas, but not in the US. The Opium Exclusion Act laid the groundwork for the Harrison Narcotic Act of 1914, which placed restrictions on the sale and use of opium across the nation. Although the US had established itself as the global leader in the movement to outlaw the production, trade, and use of opium, regulations in other countries were still flexible. For instance, the UK supported the supervised distribution of opium. Eventually, international pressure resulted in the codification, standardization, and strengthening of existing laws into a Single Convention on Narcotic Drugs in 1961. All nations that signed up to the 1961 Convention were expected to adhere to the global drug prohibition regulations with measures like establishing a schedule of control based on the estimated risk of various classes of drugs. For instance, the US established the Controlled Substances Act in 1970 and then the Drug Enforcement Agency in 1973 to curb access to opiates.

How was drug addiction treated in the past?

Drug addiction was treated in the past using plant-based remedies and religious and spiritual practices based on the limited scientific knowledge and the cultural traditions and beliefs prevalent during a specific period. The ancient Egyptians and Greeks were known to use herbs and other natural products to reduce cravings and ease withdrawal symptoms. In the 1750s, native American tribes formed “sobriety circles” to address the problem of alcohol addiction. These “circles” were led by tribe members who had won their battles with addiction and were thus regarded as “healers.” This tradition of “sobriety circles” is a form of communal therapy. In the early 1800s, Benjamin Rush, a pioneer of American addiction medicine, advocated for occupational therapy as a therapeutic intervention for substance abuse. This stand was influenced by his observation that mental health patients in hospitals who engaged in daily chores like chopping wood, digging in the garden, washing and ironing clothes, and scrubbing floors recovered in greater numbers compared to patients from the privileged sections of society who were exempted from such menial tasks. However, these were also times marked by ignorance, and fraudulent “home cures” for addiction were advertised aggressively and blindly followed by the masses.

The temperance and alcohol recovery mutual aid movements of the mid-1800s mark the beginning of endeavors to provide specialized and systematic addiction treatment. These movements were grounded in a more scientific understanding of addiction, accompanied by a greater degree of compassion and empathy. The temperance movement of the 19th and early 20th centuries advocated for the reduction or cessation of alcohol consumption. Individuals with alcohol addiction were placed in specialized treatment facilities, known as inebriate homes or asylums. These places provided a controlled, substance-free environment where recovering addicts were able to focus on healing. The birth of Alcoholics Anonymous (AA) in 1935 is a revolutionary approach in addiction treatment grounded in spirituality alongside peer support and counseling. The 12-Step methodology is the cornerstone of AA and emphasizes self-reflection, personal agency, and self-growth as tools to recover from addiction. It has since been adopted by other self-help groups like Narcotics Anonymous and Gamblers Anonymous. The success of the 12-Step model promoted optimistic attitudes toward addiction recovery. Buoyed by this positivity and compelled by the increasing rates of narcotics addiction among juveniles, addiction treatment was made available to a greater number of individuals via outpatient clinics, inpatient and residential programs, therapeutic communities, and methadone maintenance clinics. Modern addiction treatment strategies encompass medication-assisted treatments, the roots of which are traced back to the 1940s when drugs were introduced to treat symptoms of alcoholism.

Why is it important to learn about the history of drug abuse and addiction?

It is important to learn about the history of drug abuse and addiction to be able to understand the complexity and nuances inherent in these multifaceted problems. Specifically, studying how substance use and addiction treatment have evolved helps identify drug consumption patterns, predict future trends, spot biases in popular theories, and learn from what has not worked in the past to develop more effective treatment strategies. For instance, understanding how ancient psychotropic substance use has changed mammalian brains helps determine the causes and consequences of drug abuse in today’s context, as noted in a 2005 article by Tammy Saah published in the Harm Reduction Journal, titled “The evolutionary origins and significance of drug addiction.” Patterns of lifetime drug use and associated health and psychosocial problems tend to vary across populations.

Learning about the findings of studies carried out in multiple geographies and among diverse demographic categories over extended periods aids in the understanding of the process of drug use initiation, progression, the development of addiction, substance use cessation, and recovery. Drug abuse and addiction have a powerful social component.

Themes like inequality, dominance, and dependence that arise from interpersonal relationships tend to act as protective or risk factors that influence vulnerability to drug use and the development of addiction. Studying the history of drug abuse helps dispel the myth of addiction being a moral failing and encourages communities to come together to protect the most vulnerable individuals in society.