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Page 1 of 6 American Journal of Public Health, 83:803-810, 1993.
Morristown, NJ
Abstract
Objectives. The prevailing view today is that alcohol consumption is unambiguously a social and public health problem. This paper presents evidence to balance this view.
Methods. Evidence of beneficial effects of alcohol against coronary artery disease is examined, together with cultural reasons for resistance in the United States to the implications of this evidence.
Results. Alcohol use reduces the risk of coronary artery disease — the major cause of heart disease, America's leading killer — even for those at risk for such disease. Moreover, recent research indicates that alcohol continues to reduce risk at the higher levels of drinking measured in general populations. However, with consumption of more than two drinks daily, these gains are increasingly offset by greater mortality from other causes.
Conclusions. Educators, public health commentators, and medical investigators are uneasy about findings of healthful effects of drinking. A cultural preoccupation with alcoholism and the negative effects of drinking works against frank scientific discussions in the United States of the advantages for the cardiovascular system of alcohol consumption. This set has deep roots in American history but is inconsistent with public health goals.
Epigram
Clashing Drinking Cultures (not published with article)
Nilgul and James F. Taylor lost the restaurant they ran for 14 years after a sizable segment of their clientele, mostly fundamentalist Christians, stopped coming when the Taylors added wine to the menu. "I'm not believing this," said Mrs. Taylor [who came to the United States from Turkey in 1967].... "I wish someone had told us that serving wine would ruin our lives"....
Few subjects are as likely to stir the emotions of people in this region as alcohol, as seen in the array of letters to the editors of local newspapers.... Several of them discussed whether the wine Jesus drank was fermented.... Like half of the 100 counties in North Carolina, Transylvania County never repealed the 18th Amendment, which prohibited the manufacture, sale or transportation of liquor....
"As wine is served, business sours." The New York Times; p. A.14, January 7, 1993.
[Sections of the article that follows were not italicized in published version.]
Introduction
Today there is a public health debate in America over how to deal with beverage alcohol. The dominant approach, the disease model of alcoholism, emphasizes the biological — probably inherited — nature of problem drinking.1 This model is challenged by the public health model, which strives to limit alcohol consumption for everyone in order to reduce individual and social problems.2 The first approach is medical and treatment-oriented and the second is epidemiologic and policy-oriented; however, both present alcohol in fundamentally negative terms.
We hear little from those who hold the view that alcohol consumption satisfies an ordinary human appetite and that alcohol has important social and nutritional benefits. Yet at one time, the official position of the National Institute on Alcohol Abuse and Alcoholism under its founding director Morris Chafetz was that moderation in drinking should be encouraged and that young people should be taught how to consume alcohol moderately. This attitude has been completely expunged from the American scene. National and local antidrug campaigns produce banners to be displayed at schools throughout the United States declaring "ALCOHOL IS A LIQUID DRUG." Educational curricula are completely negative towards alcohol. Indeed, one of their thrusts is to attack the concept of moderate drinking as indefinable and dangerous. The logically inconsistent ideas that youthful drinking creates lifetime problem drinking and that alcoholism is inherited are merged into implausible, alarmist messages, such as this one in a school newsletter sent to one high school's entering freshman:
- Alcoholism is a primary chronic disease.
- A person who begins to drink at 13 years of age has an 80% risk of alcoholism and an extremely high risk of using other drugs.
- The average age at which kids begin to drink is 11.7 for boys and 12.2 for girls.3
Selden Bacon, a founder and long-time director of the Rutgers (formerly Yale) Center for Alcohol Studies, criticized this set of attitudes. Bacon's position is intriguing, because the Yale Center played an integral role in the National Council on Alcoholism's successful campaign to convince Americans that alcoholism was a rampant and unrecognized American epidemic. Bacon ruefully commented on what this effort had wrought:
Current organized knowledge about alcohol use can be likened to...knowledge about automobiles and their use if the latter were limited to facts and theories about accidents and crashes.... [What is missing are] the positive functions and positive attitudes about alcohol uses in our as well as in other societies.... If educating youth about drinking starts from the assumed basis that such drinking is bad...full of risk for life and property, at best considered as an escape, clearly useless per se, and/or frequently the precursor of disease, and the subject matter is taught by nondrinkers and antidrinkers, this is a particular indoctrination. Further, if 75-80% of the surrounding peers and elders are or are going to become drinkers, there [is] ... an inconsistency between the message and the reality.4
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