These figures are especially interesting because earlier population surveys had revealed very few people (fewer than 1 percent) who had consumption and problem levels typical for those who at the time entered treatment clinics (Room, 1980). One argument had been that genuine alcoholics were hard to reach by such surveys. Thus, the growth in reported dependence-type symptoms occurred among other than the skid-row-type of alcoholic who at one time typified alcoholism. Nonetheless—despite reporting skipping meals, blackout drinking, an inability to stop, and binge drinking—these surveyed drinkers drank far less than the median 17 drinks daily in a treated population in the mid-1970s (Polich et al., 1981).

One possibility is that these self-reports of dependence symptoms do not correspond to clinical assessments of alcoholism—that is, while people report alcoholic symptoms, clinical tools would find that they are not alcoholic. (This would belie claims by those in the treatment industry that alcoholism is underreported because of the widespread denial of drinking problems by alcoholics.) However, community studies which employ objective clinical tests show the same sharp upturn in alcohol abuse/dependence. The Epidemiologic Catchment Area (ECA) survey (Helzer et al., 1991) found that 27 percent of men age 18-29 were classifiable as alcohol abusers/alcohol dependent over their lifetimes, along with 7 percent of women in this age group. While the youngest group of women had the highest lifetime prevalence rate, the 30-44 age group lifetime prevalence was slightly higher for men, although this figure dropped substantially for those over 45. Note that, since these were lifetime rates, the youngest cohort can only increase its alcoholism prevalence, making all but certain the discovery of a growing rate of clinically-defined alcohol abuse in the American population.

In summary, alcoholism treatment expanded dramatically among all social classes beginning in the 1970s and continuing to the 1990s. Yet both self- and clinically-diagnosed alcoholism simultaneously increased. Obviously, this increase represents a new labeling of drinkers whose lives are outwardly functional who would previously not have been seen as alcoholics. Since this labeling includes respondents' views of themselves, Americans seemingly feel less satisfied and in control of their own drinking. Apparently, widespread alcoholism treatment and knowledge of alcoholism serve primarily to make people feel out of control of their behavior. The parallel here is to the experience of participating in Alcoholics Anonymous. According to David Rudy (1986), in his book Becoming Alcoholic, people enter AA with a wide range of drinking symptoms. Those who remain in AA report symptoms that converge to meet AA's standard description of alcoholism—including loss of control, blackout, and the phenomenon of a single drink leading to full-scale relapse. In these cases, self-labelling seems likewise to be self-fulfilling.

The Nature of Treatment

American alcoholism treatment is nearly entirely 12-step based, even as it shifted from inpatient to outpatient treatment in the late 1980s. The National Treatment Center Study (Roman and Blum, 1997) found that 93% of U.S. treatment programs still use 12-step methods. In a not unrelated result, 99 percent of these centers advocated abstinence for all of their alcohol and/or drug dependent patients. This is despite the fact that treatment efficacy studies have consistently shown the typical treatment provided in these programs to be ineffective.

Miller and his colleagues (1995) ranked 43 treatments in terms of 217 published clinical research trials, although 13 therapies (including AA) had too few studies to be definitively rated. (Table 4) Of the treatments reliably rated, brief interventions had the highest score, followed by social skills training. These social skills include those required to avoid drinking situations, to cope with stressful settings, and to deal with bosses, spouses, children, and other relationships. At the bottom of the list of effectiveness were general alcoholism counseling and educational lectures and films about alcoholism. AA had the lowest score among treatments that had been inadequately tested.