A Moral Vision of Addiction - Cultural Difference in Alcoholism Rates

Written by Stanton Peele

One particularly interesting cultural difference in alcoholism rates concerns Asian and Native American populations. That is, the large-scale alcohol problems often described among Indian and Eskimo groups have been attributed to the way these racial groups metabolize alcohol. Native Americans often show a quick onset of intoxication and a visible reddening from ingesting small amounts of alcohol. Unfortunately, while reliable racial differences in processing alcohol have been measured, these do not correlate with alcohol abuse (Peele, 1986). In particular, Chinese and Japanese Americans, who have the same reactions to alcohol as do Native Americans, display according to some measures (such as alcohol-related crime and violence) the very least alcohol abuse among American ethnic and racial groups, measures by which Indians show the highest such rates.

What Accounts for Cultural Differences in Alcoholism?

The effort to explain Native American alcoholism by way of racial differences is, of course, another version of the denial of the importance of social learning in addiction. A related suggestion is that natural selection has weeded out those susceptible to alcoholism in groups that have a long history of drinking, and that this elimination of alcoholics in some races accounts for their lower alcoholism rates. Besides displaying a Lysenko-like optimism about the speed of genetic adaptation, this hypothesis neglects important elements in the history of drinking. Aboriginal Indian groups did drink beverage alcohol and therefore were available for a similar racial elimination of alcoholism; moreover, different Indian groups in Latin and North America have had very different experiences with problem intoxication, depending usually upon their relation to Caucasians (MacAndrew and Edgerton, 1969).

Jews, on the other hand, have been known as moderate drinkers since Biblical times - that is, from their first identification as a group distinct from the racially related Semitic populations that surrounded them (Keller, 1970). This analysis strongly suggests that their belief system from the beginning distinguished the Jews from their neighbors. Some theorists have speculated that Jewish moderation stems from the group's perpetual minority status and the premium this has placed on self-control and intellectual awareness (Glazer, 1952). Similar kinds of cultural explanations have been used to account for the notable drinking patterns of other groups. For example, Bales (1946) analyzed frequent problem drinking among the Irish as a reflection of a world view that is at once flamboyant and tragic. Room (1985) points out that Indian groups lack a value for self-control that would inhibit excessive drinking or drunken misbehavior.

Maloff et al. (1979) summarized the results of decades of social-scientific observations of cultural drinking styles and other consumption practices in detailing cultural recipes for moderation. One rather remarkable element in cultural recipes for moderate consumption is illustrated by the cases of Jewish and Chinese-American drinking. As described by Glassner and Berg (1984:16), "Reform and nonpracticing Jews define alcoholism in terms of psychological dependency and view suspected alcoholics with condemnation and blame." In other words, Jews guarantee almost universal moderation by explicitly rejecting the major contentions of the disease theory of alcoholism, including a belief in biological causation and the need for a nonpunitive attitude toward habitual drunkenness. Jews instead strongly disapprove of drunken misbehavior and ostracize those who do not conform to this standard of conduct.

The Cantonese Chinese in New York City, as described by Barnett (1955), employed a similar approach in disapproving of and applying powerful group sanctions to those who do not control their drinking. These people simply refused to tolerate loss-of-control drinking. As a part of his study, Barnett examined police blotters in the Chinatown district of New York. He found that, among 17,515 arrests recorded between 1933 and 1949, not one reported drunkenness in the charge. Are these Chinese suppressing alcoholism or simply its overt manifestations? Actually, since drunken arrest is a criterion for alcohol dependence in DSM III, its elimination automatically eliminates a central element of alcoholism. All this is academic, however. Even if all these Chinese accomplished was to eradicate drunken misbehavior and violence in a crowded urban area for 17 years, their model is one America as a whole could emulate with great benefit. ¹

This Chinese case study stands in stark contrast to that of an Ojibwa Indian community in northwest Ontario studied by Shkilnyk (1984). In this community, violent assault and suicide are so prevalent that only one in four die of natural causes or by accident. In one year one-third of the children between five and fourteen were taken from their parents because the parents were unable to care for the children when almost continuously drunk. This village was marked by a "cycle of forced migration, economic dependence, loss of cultural identity, and breakdown in social networks" (Chance, 1985, p. 65) that underlay its self-destruction through alcohol. At the same time, the people of this tribe had an absolute belief that alcoholism was a disease they could not control. The title of this work, "A poison stronger than love," comes from a village resident who declared "The only thing I know is that alcohol is a stronger power than the love of children."

Can somebody seriously recommend converting Chinese or Jewish populations to the conception of alcoholism as an uncontrollable disease - one that is not indigenous to their cultures? What might we expect from such a conversion? MacAndrew and Edgerton (1969) surveyed cultural differences in attitudes toward alcohol in relation to drinking patterns. Their primary finding was that drunken comportment took a specific form in each society, a form that often varied dramatically from one cultural setting to another. Societies accepted that drunkenness led to certain behaviors and, not surprisingly, had a high incidence of such behaviors - including violence and alcoholic crime. In other words, societies have varying notions of both the degree and the results of loss of control caused by drinking, differences with major consequences for behavior. Similar differences in the belief that alcohol causes misbehavior have also been found to hold for individuals within American culture (Critchlow, 1983).

The Causes and Consequences of the Denial of Social Forces in Addiction

The measurement of social variation in the addictive and appetitive behaviors often achieves an order of magnitude comparable to that Vaillant found between Irish- and Italian-American drinking styles. For example, in the case of obesity, Stunkard et al. (1972) found low-socioeconomic-status (SES) girls were nine times as likely to be fat by age 6 as high-SES girls. Is there a cultural bias against such social-scientific findings compared with results that are seen to indicate genetic or biological causality? If some biological indicator were found to distinguish two populations as well as ethnicity does in the case of alcoholism or SES does in the case of childhood obesity for women, the discovery would surely merit a Nobel Prize. Instead, in our society, we ignore, minimize, and deny socially based findings.