Nonetheless, the aim of "demoralizing" addiction retains a strong appeal for liberal observers and for social and behavioral scientists. In fact, social researchers frequently bemoan the strong tendencies for both general populations and treatment personnel to continue to see addiction in moral terms even as most people ostensibly endorse the fashionable model view of addiction as a disease (Orcutt et al., 1980; Tournier, 1985). In other words, as scientists, they wish to stamp out entirely people's continuing tendency to regard addiction as a reflection of the addict's moral qualities and to hold people responsible for addictive behavior. The view of the present paper, on the other hand, is that appetitive behavior of all types is crucially influenced by people's pre-existing values, and that the best way to combat addiction both for the individual and the society is to inculcate values that are incompatible with addiction and with drug- and alcohol-induced misbehavior.

I sat with an older woman watching a program in which a woman who directed a prominent treatment program described how, as an alcoholic in denial, she drank alcoholically throughout her years as a parent, thus raising six children who all either became substance abusers or required therapy as children of an alcoholic. The woman's argument was that she had inadvertently inherited her alcoholism from her two alcoholic grandfathers (a model of genetic transmission of alcoholism, incidentally, which no one has actually proposed). The woman I was sitting with clucked about how insidious the disease was that it could make a mother treat her children this way. I turned to her and asked: "Do you really think you could ever have gotten drunk and ignored your children, no matter how delightful you found drinking or how it relieved your tension or however you reacted to alcohol genetically?" Neither she nor I could imagine it, given her values as a parent.

Scientists have ignored successful, value-based personal and social strategies against addiction because of their uneasiness about making distinctions among value systems. Their reluctance is counterproductive and, put simply, wrong on the evidence. The evidence that a person's or group's values are essential elements in combating addiction include the following areas of research: (1) the large group differences in the successful socialization of moderate consumption of every kind of substance; (2) the strong intentional aspects of addictive behavior; (3) the tendency for some people to abuse a range of unrelated substances and to display other antisocial and self-destructive behaviors; (4) developmental studies that repeatedly discover value orientations to play a large role in styles of drug use in adolescence and beyond; (5) the relationship of therapeutic and natural remission to personal value resolutions by addicts and to life changes they make that evoke values which compete with addiction.

How Do Some Groups Encourage Almost Universal Moderation and Self-Control?

The power of the group to inspire moderation of consumption is perhaps the most consistent finding in the study of addictive behavior. Even the most ardent supporters of the disease theory of alcoholism, including Jellinek himself, clearly indicated that cultural patterns are the major determinants of drinking behavior. Vaillant (1983), while defending the disease theory, claimed alcoholism had both a cultural and a genetic source. He noted that Irish-Americans in his core-city sample were seven times as likely to be alcoholic as were those of Mediterranean descent (Italians and Greeks, with some Jews). Clinical outcomes in this study, such as return to moderate drinking, were more closely tied to ethnic group than they were to numbers of alcoholic relatives, which Vaillant used as a measure of genetic determination of drinking.

Vaillant, like Jellinek, explained these data in terms of cultural differences in visions of alcohol's power and in the socialization of drinking practices. Yet this kind of explanation of group differences does not fit well with Vaillant's professed belief in inbred sources of individual drinking problems. Vaillant's ambivalence is indicated by his explanation for the large social-class differences in alcoholism he found: this core-city group had an alcoholism rate more than three times as great as that for his Harvard-educated sample. Vaillant suggested this discrepancy was due to the tendency for alcoholics to slide down the social ladder, in which case inherited alcoholism would be more prevalent in lower social classes. Among other problems with his explanation is its failure to take into account the ethnic differences in the composition of his two samples (almost entirely recent ethnic immigrants in the core-city group, predominantly upper-middle-class WASPs in the pre-World War II Harvard sample).

Vaillant's uneasiness about group differences in alcoholism rates is common among clinicians and other representatives of the dominant alcoholism movement in the United States, although it is certainly not limited to these groups. For example, a number of years ago the NIAAA published a popular poster entitled "The typical alcoholic American" that depicted a range of people from different ethnic, racial, and social groups, of different ages, and of both sexes. The point of the poster, obviously, was that anyone from any background could be alcoholic, a point often made in contemporary media presentations about alcoholism. Strictly speaking, this is true; at the same time, the poster ignores fundamental and major differences in alcoholism rates that appear with regard to almost every demographic category it depicted. Without an awareness of those differences, it is hard to imagine how a researcher or clinician could understand or deal with alcoholism.

One mark of the disbelief in social differences in alcoholism has been the tendency to hunt for hidden alcoholics in groups that ostensibly display few drinking problems. We are told regularly, for instance, that so many more men than women are in alcoholism treatment because the stigma attached to women's drinking problems prevents women from seeking treatment. In fact, indications are that women with drinking problems are more likely than men to seek therapy for alcoholism, as they are for all kinds of psychological and medical problems (Woodruff et al., 1973). Epidemiological investigations find that women have far fewer drinking problems than men by every kind of measure (Ferrence, 1980). Even researchers with biological and disease orientations find powerful sex differences in alcoholism. Goodwin et al. (1977), for example, found 4% of women with alcoholic biologic parents were alcoholic or had a serious drinking problem; the authors suggested that since from .1 to 1% of women in Denmark (where the study was conducted) were alcoholic, the findings hinted at a genetic component to female alcoholism, although the small number of female alcoholics discovered in the study forbade definitive conclusions.

Another group popularly singled out for denying their alcohol problems is the Jews. All surveys find Jews underrepresented among problem drinkers and alcoholics (Cahalan and Room, 1974; Greeley et al., 1980). Glassner and Berg (1980) conducted a survey of a Jewish community in an upstate New York city with the hypothesis "that low alcohol abuse rates among Jews resulted more from the ability to hide excessive drinking [and research methodology flaws] ... than from actual drinking patterns of Jews" (p. 651). Among 88 respondents, including both observant and nonpracticing Jews, Glassner and Berg discovered no problem drinkers. Even by accepting at face value all reports of Jewish alcoholics by zealous community alcoholism representatives, the researchers calculated an alcoholism rate far below that for Americans at large (less than 1%, probably closer to 1 in 1,000). Such research in no way discourages frequent claims that Jewish alcoholism is on the increase and may be rampant, and that Jews have an urgent need to deal with the denial brought on by the stigma they attach to alcoholism.