Promoting Positive Drinking: Alcohol, Necessary Evil or Positive Good?

Control Drinking

Temperance cultures (i.e., Scandinavian and English-speaking nations) foster the most active alcohol-control policies. Historically, these have taken the form of prohibition campaigns. In contemporary society, these nations enforce strict parameters for drinking, including regulation of the time and place of consumption, age restrictions for drinking, taxation policies, and so on. Nontemperance cultures show less concern in all these areas and yet report fewer behavioral drinking problems (Levine, 1992; Peele, 1997). For example, in Portugal, Spain, Belgium, and other countries, 16-year-olds (and those even younger) can drink alcohol freely in public establishments. These countries have almost no AA presence; Portugal, which had the highest per capita alcohol consumption in 1990, had 0.6 AA groups per million population compared with almost 800 AA groups per million population in Iceland, the country that consumed the least alcohol per capita in Europe. The idea of the need to control drinking externally or formally thus coincides with drinking problems in a paradoxically mutually reinforcing relationship.

At the same time, efforts to control or ameliorate drinking and drinking problems sometimes have untoward effects. In regard to treatment, Room (1988, p. 43) notes,

[We are in the midst] of a huge expansion in the treatment of alcohol-related problems in the United States [and industrialized nations worldwide]... In comparing Scotland and United States, on the one hand, with developing countries like Mexico and Zambia, on the other hand, in the World Health Organization Community Response Study, we were struck with how much more responsibility Mexicans and Zambians gave to family and friends in dealing with alcohol problems, and how ready Scots and Americans were to cede responsibility for these human problems to official agencies or to professionals. Studying the period since 1950 in seven industrialized nations.... [when] alcohol problem rates generally grew, we were struck by the concomitant growth of treatment provision in all of these countries. The provision of treatment, we felt, became a societal alibi for the dismantling of long-standing structures of control of drinking behavior, both formal and informal.

Room noted that, in the period from the 1950s through the 1970s, alcohol controls were relaxed and alcohol problems grew as consumption increased. This is the perceived relationship underlying the public policy approach of limiting consumption of alcohol. However, since the 1970s, alcohol controls in most countries (along with treatment) have increased and consumption has declined, but individual drinking problems have risen markedly (at least in the United States), particularly among men (Table 26.2). Around the point at which per capita consumption began to decline, between 1967 and 1984, NIAAA-funded national drinking surveys reported a doubling in self-reported alcohol-dependence symptoms without a concomitant increase in consumption among drinkers (Hilton & Clark, 1991).

Drink for Enjoyment

Most people drink in line with the standards of their social environments. The definition of enjoyable drinking varies according to the group of which the drinker is a part. Clearly, some societies have a different sense of the enjoyment of alcohol relative to its dangers. One definition of nontemperance cultures is that they conceive of alcohol as a positive pleasure, or as a substance whose use is valued in itself. Bales (1946), Jellinek (1960), and others have distinguished the very different conceptions of alcohol that characterize temperance and nontemperance cultures such as, respectively, the Irish and the Italian: In the former, alcohol connotes imminent doom and danger and at the same time freedom and license; in the latter alcohol is not conceived as creating social or personal problems. In Irish culture, alcohol is separated from the family and is used sporadically in special circumstances. In the Italian, drinking is conceived as a commonplace, but joyous, social opportunity.

Societies characterized by the permissive social style of drinking also might be seen to conceive of drinking in a predominantly enjoyable light. However, in this environment, excessive drinking, intoxication, and acting out are tolerated and are in fact seen as a part of the enjoyment of alcohol. This is different from the prescriptive society, which values and appreciates drinking but which limits the amount and style of consumption. The latter is consistent with nontemperance cultures (Heath, 1999). Just as some individuals shift from high consumption to abstinence and some groups have both high abstinence and high excessive-drinking rates, permissive cultures can become aware of the dangers of alcohol and shift as a society into ones that impose strict alcohol controls (Musto, 1996; Room, 1989).

Drink for Health

The idea that alcohol is healthy is also ancient. Drinking throughout the ages has been thought to enhance appetite and digestion, assist in lactation, reduce pain, create relaxation and bring rest, and actually attack some diseases. Even in temperance societies, people may regard a drink of alcohol as healthful. The health benefits of moderate alcohol consumption (as opposed to both abstinence and heavy drinking) were first presented in a modern medical light in 1926 by Raymond Pearl (Klatsky, 1999). Since the 1980s, and with greater certainty in the 1990s, prospective epidemiologic studies have found that moderate drinkers have a lower incidence of heart disease and live longer than abstainers (see Camargo, 1999; Klatsky, 1999).