Neither laboratory nor epidemiological experimentation provides support for the idea that alcoholics lose control of their drinking whenever they consume alcohol. That is, drinking alcohol does not inevitably, or even typically, lead to excessive drinking by the alcoholic. Moreover, experiments with alcoholics demonstrate that they drink to achieve a specific state of intoxication or blood alcohol level: that they are often self-conscious about this state, what it does for them, and why they desire it; and that even when they become intoxicated, they respond to important dimensions of their environments which cause them to drink less or more. In other words, although alcoholics often regret the effects of their drinking, they do regulate their drinking in line with a variety of goals to which they attach more or less value (cf Peele, 1986).

The failure of loss of control to provide an explanation for chronic overdrinking is now so well established that genetic theorists posit instead that alcoholics inherit special temperaments for which alcohol provides welcome amelioration (Tarter and Edwards, this issue). In this and related views, alcoholics are extremely anxious, overactive, or depressed, and they drink to relieve these states. Here the difference between genetic and social- learning viewpoints is solely in whether a mood state is seen to be inbred or environmentally induced, and to what extent the theorist believes drinking is reinforcing because learning plays a part in interpreting the pharmacological effects of alcohol. But either perspective leaves a great deal of room for the intervention of personal choices, values, and, intentions. Just because someone finds drinking relieves tension - even if this person is very tense - does not mean he or she will become an alcoholic.

The life study of alcoholism provides good support for the idea of alcoholism as an accumulation of choices. That is, problem drinkers do not become alcoholics instantaneously but instead drink with increasing problems over periods of years and decades (Vaillant. 1983). The development of clinical alcoholism is especially noteworthy because most problem drinkers reverse their drinking problems before reaching this point (Cahalan and Room, 1974). Why do some drinkers fail to reorient their behavior as over the years it eventually culminates in alcoholism? As Mulford (1984:38) noted from his natural processes perspective, "early acquired definitions of self as one who meets his responsibilities, who does not land in jail, and other self definitions that are incompatible with heavy drinking will tend to retard progress in the alcoholic process and accelerate the rehabilitation process." Mulford indicated here by "self definition" the values by which one defines oneself.

Why Do the Same People Do So Many Things Wrong?

Modern models of addiction have consistently overestimated the amount of variance in addiction accounted for by the chemical properties of specific substances (Peele, 1985). Although popular prejudice continues to uphold this view, no data of any sort support the idea that addiction is a characteristic of some mood-altering substances and not of others. For example, among the many fundamental re-evaluations caused by examining narcotics use among Vietnam veterans was the finding that heroin "did not lead rapidly to daily or compulsive use, no more so than did use of amphetamines or marijuana" (Robins et al., 1980:217-218). A related finding was:

Heroin does not seem to supplant the use of other drugs. Instead, the typical pattern of the heroin user seems to be to use a wide variety of drugs plus alcohol. The stereotype of the heroin addict as someone with a monomaniacal craving for a single drug seems hardly to exist in this sample. Heroin addicts use many other drugs, and not only casually or in desperation. Drug researchers have for a number of years divided drug users into heroin addicts versus polydrug users. Our data suggest that such a distinction is meaningless. (Robins et al., 1980:219-220)

Cocaine use is now described as presenting the same kind of lurid monomania that pharmacologists once claimed only heroin could produce; again, the explanation presented is in the "powerful reinforcing properties of cocaine" which "demand constant replenishment of supplies" (Cohen, 1985:151). Indeed, "if we were to design deliberately a chemical that would lock people into perpetual usage, it would probably resemble the neurophysiological properties of cocaine" (Cohen, 1985:153). These properties demand that those who become dependent on the drug "continue using [it] until they are exhausted or the cocaine is depleted. They will exhibit behaviors markedly different from their precocaine lifestyle. Cocaine-driven humans will relegate all other drives and pleasures to a minor role in their lives" (Cohen, 1985:152).

Seventeen percent of 1985 college students used cocaine in the previous year, 0.1% of 1985 students used it daily in the previous month (Johnston et al., 1986). Former college students who used the drug for a decade typically remained controlled users, and even those who abused the drug showed intermittent excesses rather than the kind of insanity Cohen described (Siegel, 1984). Perhaps the key to these subjects' ability to control cocaine use is provided by research by Johanson and Uhlenhuth (1981), who found that members of a college community who enjoyed and welcomed the effects of amphetamines decreased their usage as it began to interfere with other activities in their lives. Clayton (1985) pointed out the best predictors of degree of cocaine use among high school students were marijuana use, truancy, and smoking, and that even the very few people in treatment reporting cocaine as their primary drug of choice (3.7%) regularly used other drugs and alcohol as well.

These data indicate that we need to explore the user - particularly the compulsive user - for the key to addiction. Robins et al. (1980) constructed a Youthful Liability Scale for abuse from demographic factors (race, living in the inner city, youth at induction) and problem behaviors (truancy, school dropout or expulsion, fighting, arrests, early drunkenness, and use of many types of illicit drugs) that preceded drug users' military service, and that predicted use of all types of street drugs. Genetic-susceptibility models based on individual reactions to given drugs are unable to account for simultaneous misuse by the same individuals of substances as pharmacologically diverse as narcotics, amphetamines, barbiturates, and marijuana in the Robins et al. (1980) study or cocaine, marijuana, cigarettes, and alcohol in the Clayton (1985) analysis. Istvan and Matarazzo (1984) summarized the generally positive correlations among use of the legal substances caffeine, tobacco, and alcohol. These relationships are particularly strong at the highest levels of usage: for example, five out of six studies Istvan and Matarazzo cited have found 90% or more of alcoholics to smoke.