Harm reduction is implemented in the case of drugs not simply for reasons of humanity; rather, the approach is justified as offering cost-effective ways to prevent morbidity and mortality. Likewise, the case for accepting and working with drunkards or individuals who occasionally get drunk might be that to do so is to recognize and deal more effectively with an ineradicable reality. In contrast, the predominantly zero-tolerance approach taken to fight binge drinking on college campuses has been a bust — "Efforts to curb excessive drinking on college campuses fall short," newspaper headlines announced when the latest collegiate binge-drinking study was published. Researcher Wechsler's reaction: "My disappointment is, given all the action on college campuses to deal with this problem. . ., the fact that it has stayed so remarkably stable shows what a difficult problem it is."

The Social Custom of Drunkenness

Students of human culture have noted that drunkenness is often built into social custom. That is, even in societies or groups where alcohol is typically consumed moderately — or rarely — room is allowed for feasts or revels in which general drunkenness occurs. The classic description of this phenomenon is the book "Drunken Comportment: A Social Interpretation," by MacAndrew and Edgerton. These researchers examined drunken episodes cross-culturally and determined that these typically occurred within tightly regulated social boundaries. How people acted when drunk was consistent within a given society, but varied tremendously from culture to culture — suggesting that drunken behavior was socially constructed.

In this model, drunkenness often serves as a social release — as an agreed-upon "time out" from ordinary social constraints. Nonetheless, when drunk, people were not forgiven all social obligations. Certain behaviors were still forbidden — for example, incest taboos were observed in native tribes during drunken orgies, even when relationships were defined in such complicated ways that Westerners were not able to comprehend them. Anthropologist Dwight Heath described drinking among the Bolivian Camba, who once a month or so gathered as a village to drink themselves into a stupor — while never acting out against one another.

Indeed, drunkenness seems to have been a well-accepted part of drinking in American society, especially before the industrial revolution. In the Colonial period, Americans drank about three times as much per capita as they drink today. This drinking generally took place in tightly regulated social environments, and antisocial acting out was not tolerated — rather, it was strongly disapproved. According to historian Harry Gene Levine, "The 'liquor problem' was not a public issue or fact of consciousness in colonial America. In the 17th and 18th centuries. . . , . . . [a]ll liquor was regarded as good and healthy.... It was drunk at all hours of the day and night, by men and women of all social classes, and it was routinely given to children." Drunkenness often resulted — but it nonetheless did not fall outside the social constraints on drinking behavior.

More recently, in America and other societies, ritualized drunkenness occurs during certain celebrations, or get-togethers, or commemorations of shared experiences. School alumni, or work colleagues, or people who have collaborated to reach a goal or achieve an award drink together, sometimes or often to excess, in order to forge a common identity. The need to transcend individual boundaries, to feel part of a larger group or experience, is one often associated with drinking and heavy drinking. People often speak of these episodes as key experiences in their lives, even years and decades after they took place.

Even groups historically noted for their moderate drinking — such as the Jews — apparently have a place for drunkenness. Wine has been a part of sacrament and prayer in Judaism since biblical times. According to the "Virtual Jerusalem" website, in Judaism, "alcohol is a sober pleasure. We appreciate the fact that it gladdens the heart, and include it in all our festive occasions. What would Pesach (Passover) be without the four cups? Or Shabbat (sabbath celebration) without kiddush (a glass of wine)? Every holiday, and personal occasions like weddings and Britot (circumcisions) include a kiddush (as, of course, do many other religions)."

The site notes, however, that "to get drunk is 'not Jewish' at all, and is condemned strongly by the sages." Yet, although Jewish temperance (meaning moderation) has been noted since biblical times, this too has exceptions. The site describes Purim as the holiday in which "Everyone gets drunk, eats a bunch of food and walks around in crazy costumes while making a lot of noise and beating an effigy." According to virtual Jerusalem, "The Talmud (the guiding Jewish holy work) — which normally presents a particularly severe view of intemperance — features a strange statement about Purim (another Jewish holiday) — 'You should drink until you don't know the difference between "Cursed is Haman (an archetypal enemy of the Jews), Blessed is Mordechai".' "

Conclusion

There seems to be a drive toward drunkenness (as identified in Ronald Siegel's book, "Intoxication") as a way of transcending ordinary experience, of fusing one's identity with a larger social unit, or as just plain fun. Whether the urge for intoxication is inherent or irresistible or not, drunkenness nonetheless seems to be a commonplace human experience. There is a long history of such behavior, it is almost universal across societies, and it persists despite efforts in our society to extirpate it (especially among the young). As Andrew Weil points out in "The Natural Mind," even quite young children twirl around until they achieve an altered state of dizziness. Yet, in contemporary America, we are having trouble accepting and managing this experience. For individuals whose drunkenness is habitual and obviously harmful, some have recognized a need to quarantine and protect the drunkard. That this is not likely to be made a part of public policy (certainly in the United States) expresses a particular attitude towards drinking at this time and place. Whether it is a realistic, or optimal, attitude can be questioned.

next: The Nature of Addiction

References

Heath, D.B. (1991). Continuity and change in drinking patterns of the Bolivian Camba. In Pittman, D.J., and White, H.R. (eds.), Society, Culture, and Drinking Patterns Reexamined. New Brunswick, NJ: Rutgers Center of Alcohol Studies, pp. 78-86.

Levine, H.G. (1984). The alcohol problem in America: From temperance to alcoholism. British Journal of Addiction, 79: 109-119.

MacAndrew, C. and Edgerton, R.B. (1969). Drunken Comportment: A Social Explanation. Chicago: Aldine Publishing Company.

Room, R. (1981). Reducing environmental risks. In Moore, H., and Gerstein, D.R. (eds.), Alcohol and Public Policy: Beyond the Shadow of Prohibition. Washington, DC: National Academy Press, pp. 100-111.

Siegel, R.K. (1989). Intoxication: Life in Pursuit of Artificial Paradise. New York: Dutton.

Virtual Jerusalem. Drinking on Purim. Located at http://www.virtualjerusalem.com/jewish_holidays/purim/drinking.htm.

Wechsler, H., Davenport, A., Dowdall, G., Moeykens, B, and Castillo, S. (1994). Health and behavioral consequences of binge drinking in college: A national study of students at 140 campuses. JAMA, 272(21): 1672-1677.

Wechsler, H., Molnar, B., Davenport, A., and Baer, J. (1999) College alcohol use: A full or empty glass? Journal of American College Health, 47(6): 247-252.

Wechsler, H., Lee, J.E., Kuo, M., and Lee, H. (2000). College binge drinking in the 1990s: A continuing problem. Journal of American College Health, 48(10): 199-210.

Weil, A. (1986). The Natural Mind: An Investigation of Drugs and the Higher Consciousness. Boston: Houghton Mifflin.