Can We Control the Effects of Alcohol?

Stanton Peele
Morristown, New Jersey

Abstract

The unique history of alcohol use in the United States has led to the ascendance of the disease theory as the dominant conception of alcoholism. Social-scientific research has consistently conflicted with the disease theory, but psychological and other nondisease conceptions of alcoholism are not well represented in the public consciousness, in treatment programs, or in policies for affecting nationwide drinking practices. Conflict in the field has intensified in the last decade, most notably surrounding the issue of controlled drinking in alcoholism treatment. Our current cultural attitude toward alcoholism, one strongly influenced by disease notions, has not led to an improvement in our society's drinking problems. There continues to be a need for psychologists to present alternative views of alcoholism.

The issue . . . is not whether we know enough; the real questions are whether we have the courage to say and use what we do know and whether anyone knows more.
—Alvin Gouldner, 1961, p. 205

Styles of drinking and attitudes toward alcohol vary tremendously across cultures. The United States has been a battleground of warring conceptions of drinking. Such diversity is not as apparent in contemporary American views of alcoholism, because alcohol problems are now widely considered to be primarily the result of an uncontrollable response to alcohol among those who are classified as alcoholic. This modern disease theory has deep historical roots and represents the experiences of particular groups of drinkers. The disease theory disagrees with social scientific research that finds responses to alcohol to be based on a range of cognitive and environmental factors and thus to be more variable than the disease theory describes. Conflict has been especially intense between the disease theory and behavioral approaches in which abstinence is not seen as essential for the treatment of alcoholism. Despite efforts to accommodate to the disease position—efforts that have significantly influenced psychological theorizing about alcoholism—controlled-drinking approaches are now endangered by dominant treatment attitudes in the field.

Disagreements also exist among social scientific conceptions of alcoholism. For example, there are differences between social-learning and control-of-supply views of the cultural variability in alcoholism rates. Important aspects of social-learning concepts of alcoholism include the extent to which drinkers doubt their own ability to control their drinking and believe that alcohol is a potent and efficacious mood modifier. All social-scientific viewpoints are overridden, however, by a larger cultural ethos that agrees with the disease viewpoint. Yet this ethos, including its emphasis on abstinence and on the potency of alcohol's effects, is one that is often found to coexist with high levels of drinking problems. There is a need for social-psychological examination of our culture's drinking dispositions at the same time that psychologists must maneuver within the reality of this cultural context in dealing with alcoholism.

The Experience of Drinking and Conceptions of Alcoholism in America

Social scientists have traditionally been concerned with cultural recipes that distinguish between socially disruptive and socially integrated drinking (cf. Bales, 1946; Blum & Blum, 1969; Maloff, Becker, Fonaroff, & Rodin, 1982). Moderate drinking is notable in ethnic and cultural groups such as the Chinese (Barnett, 1955), the Greeks (Blum & Blum, 1969), the Jews (Glassner & Berg, 1980), and the Italians (Lolli, Serianni, Golder, & Luzzatto-Fegiz, 1958), where such drinking is modeled for the young and maintained by social custom and peer groups. Children are gradually introduced to alcohol in the family setting; drinking is not presented as a rite of passage into adulthood and is not associated with masculinity and social power. Adult drinking is controlled by group attitudes both toward the proper amount of drinking and proper behavior when drinking. Strong disapproval is expressed when an individual violates these standards and acts in an antisocial manner.

The American experience with alcohol parallels the results of such cross-cultural findings. In colonial America, drunkenness was accepted as a natural consequence of drinking, and habitual drunkenness was not considered to be an uncontrollable disease. Despite higher per capita consumption, alcoholism was not a serious social problem, and problem drinking was less evident than it is today (Beauchamp, 1980; Lender & Martin, 1982; Levine, 1978; Zinberg & Fraser, 1979). Drinking was a universally accepted social activity that took place within a tightly knit social fabric; families drank and ate together in the neighborhood tavern. Between 1790 and 1830, due to expanding frontiers and other social changes, the male-oriented saloon became the typical setting for drinking. Here alcohol was consumed in isolation from the family (the only women likely to be present were prostitutes), and drinking came to symbolize masculine independence, high-spiritedness, and violence. Alcoholism rates rose dramatically.

The temperance movement arose in response to the explosion of alcohol problems in 19th century America. It propagated the view that habitual inebriates were unable to control their drinking, the early version of the disease theory that originated with physician Benjamin Rush (Levine, 1978). Large numbers of Americans came to view alcohol as "demon rum" and regarded drinking as frequently—or inevitably—leading to uncontrolled drunkenness. The solution they proposed was national abstinence. There were regional, social class, religious, sex, and ethnic variations in these views and in the composition of the wet and dry forces that battled throughout the century (Gusfield, 1963). In 1920—at a point when, paradoxically, drinking patterns had moderated substantially— national prohibition was enacted. When prohibition was repealed in 1933, the goal of universal abstinence died with it. The disease theory became transmuted at this time to the view that chronic drunkenness was not an inescapable property of alcohol but was rather a characteristic of a small group of people with an inbred susceptibility to alcoholism (Beauchamp, 1980).