The Antidote to Alcohol Abuse: Sensible Drinking Messages

What is the result of this negative indoctrination? During the past few decades per capita alcohol consumption in the U.S. has declined, yet the number of problem drinkers (according to clinical and self-identification) continues to rise, especially in younger age groups (17,31). This frustrating trend contradicts the notion that reducing the overall consumption of alcohol—by restricting availability or raising prices—will result in fewer alcohol problems, even though this panacea is widely promoted in the public-health field (29). Doing something meaningful about alcohol abuse requires a more profound intervention than "sin taxes" and restricted hours of operation; it requires cultural and attitudinal changes.

We can do better than we are; after all, we once did do better. In eighteenth-century America, when drinking took place more in a communal context than it does now, per capita consumption was 2-3 times current levels, but drinking problems were rare and loss of control was absent from contemporary descriptions of drunkenness (22,23). Let's see if we can recover the poise, balance, and good sense our founding fathers and mothers showed in dealing with alcohol.

It is long past time to tell the American people the truth about alcohol, instead of a destructive fantasy that too often becomes a self-fulfilling prophecy. Revising the Dietary Guidelines for Americans is a necessary, but not sufficient condition for transforming a culture of abstinence warring with excess into a culture of moderate, responsible, healthy drinking.

next: Introduction to Alcohol and Pleasure: A Health Perspective

References

1. Armor DJ, Polich JM, Stambul HB. Alcoholism and Treatment. New York: Wiley; 1978.
2. Babor TF, Grant M, eds. Programme on Substance Abuse: Project on Identification and Management of Alcohol-Related Problems. Geneva: World Health Organization; 1992.
3. Bacon S. Alcohol issues and science. J Drug Issues 1984; 14:22-24.
4. Barnett ML. Alcoholism in the Cantonese of New York City: An anthropological study. In: Diethelm O, ed. Etiology of Chronic Alcoholism. Springfield, IL: Charles C Thomas; 1955;179-227 (quote pp. 186-187).
5. Bradley KA, Donovan DM, Larson EB. How much is too much?: Advising patients about safe levels of alcohol consumption. Arch Intern Med 1993; 153:2734-2740 (quote p. 2737).
6. Cahalan D, Room R. Problem Drinking Among American Men. New Brunswick, NJ: Rutgers Center of Alcohol Studies; 1974.
7. Clark WB, Hilton ME, eds. Alcohol in America: Drinking Practices and Problems. Albany: State University of New York; 1991.
8. Ennett ST, Tobler NS, Ringwalt CL, et al. How effective is Drug Abuse Resistance Education? Am J Public Health 1994; 84:1394-1401.
9. Friedman GD, Klatsky AL. Is alcohol good for your health? (Editorial) N Engl J Med 1993; 329:1882-1883.
10. Glassner B, Berg B. How Jews avoid alcohol problems. Am Sociol Rev 1980; 45:647-664.
11. Greeley AM, McCready WC, Theisen G. Ethnic Drinking Subcultures. New York: Praeger; 1980.
12. Harburg E, DiFranceisco W, Webster DW, et al. Familial transmission of alcohol use: II. Imitation of and aversion to parent drinking (1960) by adult offspring (1977); Tecumseh, Michigan. J Stud Alcohol 1990; 51:245-256.
13. Harburg E, Gleiberman L, DiFranceisco W, et al. Familial transmission of alcohol use: III. Impact of imitation/non-imitation of parent alcohol use (1960) on the sensible/problem drinking of their offspring (1977); Tecumseh, Michigan. Brit J Addiction 1990; 85:1141-1155.
14. Heath DB. Drinking and drunkenness in transcultural perspective. Transcultural Psychiat Rev 1986; 21:7-42; 103-126.
15. Heath DB. American Indians and alcohol: Epidemiological and sociocultural relevance. In: Spiegler DL, Tate DA, Aitken SS, Christian CM, eds. Alcohol Use Among U.S. Ethnic Minorities. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism; 1989:207-222.
16. Heather N. Brief intervention strategies. In: Hester RK, Miller WR, eds. Handbook of Alcoholism Treatment Approaches: Effective Alternatives. 2nd ed. Boston, MA: Allyn & Bacon; 1995:105-122.
17. Helzer JE, Burnham A, McEvoy LT. Alcohol abuse and dependence. In: Robins LN, Regier DA, eds. Psychiatric Disorders in America. New York: Free Press; 1991:81-115.
18. Holder HD. Prevention of alcohol-related accidents in the community. Addiction 1993; 88:1003-1012.
19. Institute of Medicine. Broadening the Base of Treatment for Alcohol Problems. Washington, DC: National Academy Press; 1990.
20. Klatsky AL, Friedman GD. Annotation: Alcohol and longevity. Am J Public Health 1995; 85:16-18 (quote p. 17).
21. LaPorte RE, Cresanta JL, Kuller LH. The relationship of alcohol consumption to atherosclerotic heart disease. Prev Med 1980; 9:22-40.
22. Lender ME, Martin JK. Drinking in America: A Social-Historical Explanation. Rev. ed. New York: Free Press; 1987;
23. Levine HG. The discovery of addiction: Changing conceptions of habitual drunkenness in America. J Stud Alcohol 1978; 39:143-174.
24. Levine HG. Temperance cultures: Alcohol as a problem in Nordic and English-speaking cultures. In: Lader M, Edwards G, Drummond C, eds. The Nature of Alcohol and Drug-Related Problems. New York: Oxford University Press; 1992:16-36.
25. Miller WR, Brown JM, Simpson TL, et al. What works?: A methodological analysis of the alcohol treatment outcome literature. In: Hester RK, Miller WR, eds. Handbook of Alcoholism Treatment Approaches: Effective Alternatives. 2nd ed. Boston, MA: Allyn & Bacon; 1995:12-44.
26. Parents Advisory Council. Summer 1992. Morristown, NJ: Morristown High School Booster Club; June 1992.
27. Pearson TA, Terry P. What to advise patients about drinking alcohol: The clinician's conundrum (Editorial). JAMA 1994; 272:967-968.
28. Peele S. The cultural context of psychological approaches to alcoholism: Can we control the effects of alcohol? Am Psychol 1984; 39:1337-1351 (quotes pp. 1347, 1348).
29. Peele S. The limitations of control-of-supply models for explaining and preventing alcoholism and drug addiction. J Stud Alcohol 1987; 48:61-77.
30. Peele S. The conflict between public health goals and the temperance mentality. Am J Public Health 1993; 83:805-810 (quote p. 807).
31. Room R, Greenfield T. Alcoholics Anonymous, other 12-step movements and psychotherapy in the U.S. population, 1990. Addiction 1993; 88:555-562.
32. US Dept of Agriculture and US Dept of Health and Human Services. Dietary Guidelines for Americans (4th ed). Washington, DC: US Government Printing Office.
33. Vaillant GE. The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery. Cambridge, MA: Harvard University Press; 1983 (quote p. 226).
34. Wechsler H, Davenport A, Dowdall G, et al. Health and behavioral consequences of binge drinking in college: A national survey of students at 140 campuses. JAMA 1994; 272:1672-1677.