Pamphlet prepared for The Wine Institute, San Francisco: CA, July, 1996
How Culture Influences the Way People Drink
Stanton Peele, Morristown, NJ
Archie Brodsky, Boston, MA
Introduction:
Sociologists, anthropologists, historians, and psychologists, in their study of different cultures and historical eras, have noted how malleable people's drinking habits are.
"When one sees a film like Moonstruck, the benign and universal nature of drinking in New York Italian culture is palpable on the screen. If one can't detect the difference between drinking in this setting, or at Jewish or Chinese weddings, or in Greek taverns, and that in Irish working-class bars, or in Portuguese bars in the worn-out industrial towns of New England, or in run-down shacks where Indians and Eskimos gather to get drunk, or in Southern bars where men down shots and beers--and furthermore, if one can't connect these different drinking settings, styles, and cultures with the repeatedly measured differences in alcoholism rates among these same groups, then I can only think one is blind to the realities of alcoholism."
Peele, S., Diseasing of America, Lexington Books, Lexington, MA, 1989, pp. 72-73.
"Sociocultural variants are at least as important as physiological and psychological variants when we are trying to understand the interrelations of alcohol and human behavior. Ways of drinking and of thinking about drinking are learned by individuals within the context in which they learn ways of doing other things and of thinking about them--that is, whatever else drinking may be, it is an aspect of culture about which patterns of belief and behavior are modeled by a combination of example, exhortation, rewards, punishments, and the many other means, both formal and informal, that societies use for communicating norms, attitudes, and values."
Heath, D.B., "Sociocultural Variants in Alcoholism," pp. 426-440 in Pattison, E.M., and Kaufman, E., eds., Encyclopedic Handbook of Alcoholism, Gardner Press, New York, 1982, p. 438.
"Individual drinkers tend to model and modify each others' drinking and, hence,...there is a strong interdependence between the drinking habits of individuals who interact.... Potentially, each individual is linked, directly or indirectly, to all members of his or her culture...."
Skøg, O., "Implications of the Distribution Theory for Drinking and Alcoholism," pp. 576-597 in Pittman, D.J., and White, H.R., eds., Society, Culture, and Drinking Patterns Reexamined, Rutgers Center of Alcohol Studies, New Brunswick, NJ, 1991, p. 577
"Over the course of socialization, people learn about drunkenness what their society `knows' about drunkenness; and, accepting and acting upon the understandings thus imparted to them, they become the living confirmation of their society's teachings."
MacAndrew, C., and Edgerton, R.B., Drunken Comportment: A Social Explanation, Aldine, Chicago, 1969, p. 88.
Thus, how we learn to drink and continue to drink is determined most by the drinking we observe, the attitudes about drinking we pick up, and the people we drink with. In this booklet we will explore the relationship between cultural assumptions and educational messages about alcohol and the likelihood that people will drink in ways that are harmful to themselves or others.
I Alcohol problems are not simply a result of how much people drink.
One popular approach to reducing drinking problems is to reduce the overall amount of alcohol a society consumes. However, it is remarkable how little correspondence there is between the amount of alcohol consumed (per person) in different societies and the problems this alcohol consumption generates.
"Such efforts at increasing controls [on the availability of alcohol] are explicitly rationalized and recommended on the premise that alcohol-related problems occur in proportion to per capita consumption, a theory that we have disproved at least in France, Italy, Spain, Iceland, and Sweden, as well as in several ethnographic studies elsewhere."
Heath, D.B., "An Anthropological View of Alcohol and Culture in International Perspective," pp. 328-347 in Heath, D.B., ed., International Handbook on Alcohol and Culture, Greenwood Press, Westport, CT, 1995, pp. 341-342.
In a comprehensive study of alcohol consumption patterns and outcomes in European and English-speaking countries, none of the 10 countries with a history of Temperance movements (showing a concern with the destructive consequences of drinking) had as high a per capita alcohol consumption as any of the countries without Temperance movements.
Peele, S. "Utilizing Culture and Behaviour in Epidemiological Models of Alcohol Consumption and Consequences for Western Nations ," Alcohol & Alcoholism, 1997, Vol. 32, 51-64 (Table 1).
II Enormous differences can be observed as to how different ethnic and cultural groups handle alcohol.
"...In those cultures where drinking is integrated into religious rites and social customs, where the place and manner of consumption are regulated by tradition and where, moreover, self-control, sociability, and `knowing how to hold one's liquor' are matters of manly pride, alcoholism problems are at a minimum, provided no other variables are overriding. On the other hand, in those cultures where alcohol has been but recently introduced and has not become a part of pre-existing institutions, where no prescribed patterns of behavior exist when `under the influence,' where alcohol has been used by a dominant group the better to exploit a subject group, and where controls are new, legal, and prohibitionist, superseding traditional social regulation of an activity which previously has been accepted practice, one finds deviant, unacceptable and asocial behavior, as well as chronic disabling alcoholism. In cultures where ambivalent attitudes toward drinking prevail, the incidence of alcoholism is also high."
Blum, R.H., and Blum, E.M., "A Cultural Case Study," pp. 188-227 in Blum, R.H., et al., Drugs I: Society and Drugs, Jossey-Bass, San Francisco, 1969, pp. 226-227.
"Different societies not only have different sets of beliefs and rules about drinking, but they also show very different outcomes when people do drink.... A population that drinks daily may have a high rate of cirrhosis and other medical problems but few accidents, fights, homicides, or other violent alcohol-associated traumas; a population with predominantly binge drinking usually shows the opposite complex of drinking problems.... A group that views drinking as a ritually significant act is not likely to develop many alcohol-related problems of any sort, whereas another group, which sees it primarily as a way to escape from stress or to demonstrate one's strength, is at high risk of developing problems with drinking."
Heath, D.B., "Sociocultural Variants in Alcoholism," pp. 426-440 in Pattison, E.M., and Kaufman, E., eds., Encyclopedic Handbook of Alcoholism, Gardner Press, New York, 1982, pp. 429-430.
"One striking feature of drinking...is that it is essentially a social act. The solitary drinker, so dominant an image in relation to alcohol in the United States, is virtually unknown in other countries. The same is true among tribal and peasant societies everywhere."
Heath, D.B., "An Anthropological View of Alcohol and Culture in International Perspective," pp. 328-347 in Heath, D.B., ed., International Handbook on Alcohol and Culture, Greenwood Press, Westport, CT, 1995, p. 334.
The Duke of Wellington felt that Napoleon's French army had an advantage over his British troops. Whereas the French soldiers could be allowed to forage freely, the British soldiers, when they encountered alcohol, could be expected to drink to unconsciousness. "Wellington's opinion of his soldiers: `The English soldiers are fellows who have all enlisted for drink.... I remember once at Badajoz,' Wellington recalled at the end of that terrible siege, `entering a cellar and seeing some soldiers so dead drunk that the wine was actually flowing from their mouths! Yet others were coming in not at all disgusted...and going to do the same. Our soldiers could not resist wine.'"
Keegan, J., The Mask of Command, Viking, New York, 1987, pp. 126-128.
Modern epidemiological and sociological research consistently documents these cultural differences.
- Using DSM-III, an international team led by John Helzer discovered the following remarkable differences in alcohol abuse rates among different cultures, including two native Asian groups:
"The highest lifetime prevalence rates [of alcohol abuse and/or dependence] were found in U.S. native Mexican Americans at 23 percent and in the Korean survey, where the total sample rate was about 22 percent. There is about a fiftyfold difference in lifetime prevalence between these two samples and Shanghai, where the lowest lifetime prevalence of 0.45 percent was found." Helzer, J.E., and Canino, G.J., Alcoholism in North America, Europe, and Asia, Oxford University Press, New York, 1992, p. 293.
- For as long as American epidemiologists have measured drinking problems, they have found clearcut, significant, and persistent group differences. It is notable that the groups with the lowest incidence of alcohol abuse, the Jews and Italians, have (a) the lowest abstinence rates among these groups, and (b) (especially the Italians) the highest consumption rates. Cahalan D., and Room, R., Problem Drinking among American Men, Rutgers Center of Alcohol Studies, New Brunswick, NJ, 1974; Greeley, A.M., et al., Ethnic Drinking Subcultures, Praeger, New York, 1980.
- Two sociologists searched for Jewish alcohol abusers in an upstate NY city in the belief that alcoholism rates among American Jews had risen. Instead, they found an astoundingly low rate of 0.1% alcohol abusers in this population. Glassner, B., and Berg, B., "How Jews Avoid Alcohol Problems," American Sociological Review, 1980, Vol. 45, 647-664.
- George Vaillant, studying inner-city ethnic men in Boston over a 40-year period, found that Irish-Americans were 7 times as likely to develop alcohol dependence as Italian-Americans--this despite the Irish-Americans having a substantially higher abstinence rate. Vaillant, G.E., The Natural History of Alcoholism, Harvard University Press, Cambridge, MA, 1983.
- A sociologist who reviewed 17,500 arrest records in New York's Chinatown from 1933 to 1949 found that not one arrest noted public drunkenness. Barnett, M.L., "Alcoholism in the Cantonese of New York City: An anthropological study," pp. 179-227 in Diethelm, O., ed., Etiology of Chronic Alcoholism, Charles C Thomas, Springfield, IL, 1955.
- There are also clear and distinct differences in alcohol abuse rates by socioeconomic status. Higher-SES Americans are more likely to drink, but also more likely to drink without problems, than lower-SES Americans. Again, this suggests that lower abstinence rates and higher consumption levels are not themselves the source of drinking problems. Hilton, M.E., "Demographic Characteristics and the Frequency of Heavy Drinking as Predictors of Self-reported Drinking Problems," British Journal of Addiction, 1987, Vol. 82, 913-925.
- Drinking patterns in the U.S. also differ markedly by region (reflecting religious and cultural differences). The Southern and Mountain regions of the country, with their "dry" traditions, have high levels of both abstinence and individual excess.
"The higher per-drinker apparent consumption levels in the historically drier regions are accompanied by higher levels of problems in the categories of belligerence, accidents, and trouble-with-the-police. These differences in problem rates, however, are apparent only among men.... It has recently been argued that drinking practices and problems in the United States are heading toward a regional convergence.... The evidence given here, however, contradicts the convergence thesis. According to the latest national survey data, the wetter and drier sections of the country continue to have markedly different rates of abstention and per-drinker consumption." Hilton, M.E., "Regional Diversity in United States Drinking Practices," British Journal of Addiction, 1988, Vol. 83, 519-532 (quotes pp. 519, 528-529).
- Alcoholics Anonymous World Headquarters has compiled AA group membership data in countries around the world. In 1991 (the last year for which data were kept), the western country with the fewest AA groups per capita was Portugal, with 0.6 groups per million population. The highest was Iceland, with almost 800 groups per million. This is a strong indicator of greater perceived alcohol problems in Iceland--even though Portugal consumes 2 1/2 times as much alcohol per capita as Iceland! (Peele, S. "Utilizing Culture and Behaviour in Epidemiological Models of Alcohol Consumption and Consequences for Western Nations ," Alcohol & Alcoholism, 1997, Vol. 32, 51-64 (Table 1).)
III Alcohol use does not lead directly to aggressive behavior.
Drunken aggression is commonly observed in some cultures and settings in the United States. Worldwide, however, such behavior is typically quite rare, even among people who drink a great deal. Numerous anthropological studies demonstrate that alcohol-related violence is a learned behavior, not an inevitable result of alcohol consumption.
"The way people comport themselves when they are drunk is determined not by alcohol's toxic assault upon the seat of moral judgment, conscience, or the like, but by what their society makes of and imparts to them concerning the state of drunkenness."
MacAndrew, C., and Edgerton, R.B., Drunken Comportment, Aldine, Chicago, 1969, p. 165.
"Beverage alcohol cannot be viewed as the cause of specific drunken behaviors.... Alcohol as a drug can be viewed as an enabler or a facilitator of certain culturally given inebriate states, but it cannot be seen as producing a specific response pattern among all human beings who ingest it."
Marshall, M., "`Four Hundred Rabbits': An Anthropological View of Ethanol as a Disinhibitor," pp. 186-204 in Room R., and Collins, G., eds., Alcohol and Disinhibition: Nature and Meaning of the Link (Research Monograph No. 12), U.S. Dept. of Health and Human Services, Rockville, MD, 1983, p. 200.
"In Truk, the life cycle of drinking finds the same men behaving in strikingly different ways when drinking, according to their age and to social expectations about what their appropriate behavior at that age ought to be. Young men, out to build public reputations for `bravery' and `strong thought,' engage in brawls and other displays of bravado; by their midthirties, as they leave the `young man' category, they give up this arresting style of drunken comportment even though they continue to drink as much as before. As they move into the `mature man' age category, they are expected to demonstrate more responsibility and are publicly ridiculed if they continue to behave as `young men' when drinking."
Marshall, "`Four Hundred Rabbits,'" pp. 192-193.
"Schaefer (1973) examined ethnographic reports about drinking behavior for a probability sample of 60 small-scale and folk societies. He found that men get drunk either occasionally or often in 46 of these 60 societies. But, he found men involved in drunken brawls in only 24 of the societies. So, in a worldwide sense, it seems that alcohol-related aggressive behavior -- as measured by male involvement in drunken brawls -- is about as likely to be present as it is to be absent."
Levinson, D., "Alcohol Use and Aggression in American Subcultures," pp. 306-321 in Room R., and Collins, G., eds., Alcohol and Disinhibition: Nature and Meaning of the Link (Research Monograph No. 12), U.S. Dept. of Health and Human Services, Rockville, MD, 1983, p. 306.
"Cross-cultural evidence from diverse populations around the world shows that some have habitual drunkenness with little aggression, others show aggression only in specific drinking contexts or against selected categories of drinking companions, and so forth. Such widespread and diverse variation contradicts the view -- shared by both `common sense' and much scientific writing -- that characterizes alcohol as having a relatively direct pharmaconeurological effect in triggering aggression."
Heath, D.B., "Alcohol and Aggression," pp. 89-103 in Gottheil, E., et al. Alcohol, Drug Abuse and Aggression, Charles C Thomas, Springfield, IL, 1983, p. 89.
"Interestingly enough, even in our own society, aggression seems never to be an important component in the image of drunken comportment on the part of women."
Heath, "Alcohol and Aggression," p. 92.
"The Camba of Bolivia have gained considerable notoriety in the alcohol literature because more of them drink, they drink more often, and they drink more of the most potent alcoholic beverage in customary usage anywhere in the world, yet they have virtually no social, psychological, or economic problems in connection with drinking.... There is no verbal or sexual aggression, no destruction of property, no drunken homicide or suicide. On the contrary, drinking is a time for cordiality and easy social interaction that are rare in other times of their lives...."
Heath, "Alcohol and Aggression," p. 93.
"Consider the frequency with which beer drinking in taverns results in expressions of aggression. Then consider the frequency with which wine drinking at `singles bars' results in expressions of aggression.... Or, conceivably, the blood alcohol levels could even be in inverse relation to expressions of aggression if we compare beer in taverns to martinis at business luncheons or at cocktail parties."
Heath, "Alcohol and Aggression," p. 97.
"In our society wine is clearly considered the beverage of choice for integrative social occasions. Its use is associated with sociability and the enhancement of pleasure...and is almost always moderate in nature. Few, if indeed any, major alcohol-related problems are thought to arise from the consumption of wine. Wine is deemed most appropriate for consumption at home, usually during mealtime -- which, it should be noted, is yet another drinking occasion that has been related to moderate alcohol intake...."
Klein, H., "Cultural Determinants of Alcohol Use in the United States," pp. 114-134 in Pittman, D.J., and White, H.R., eds., Society, Culture, and Drinking Patterns Reexamined, Rutgers Center of Alcohol Studies, New Brunswick, NJ, 1991, p. 129.
"In the `Mom and Pop' community bar, the men were quiet and deferential in their dealings with older members of the Charlestown [Mass.] community. But, in Boston's downtown `combat zone' -- an area designated for `adult entertainment,' [the same men] exhibited their rowdiest behavior, getting involved in a loud argument, a fight involving a gun, and a run-in with the police."
Levinson, D., "Alcohol Use and Aggression in American Subcultures," pp. 306-321 in Room R., and Collins, G., eds., Alcohol and Disinhibition: Nature and Meaning of the Link (Research Monograph No. 12), U.S. Dept. of Health and Human Services, Rockville, MD, 1983, p. 314.
IV There have been major historical variations in drinking patterns in the U.S.
- In colonial America, alcohol was viewed as benign and even as a blessing. Drinking and occasional drunkenness were tolerated as part of everyday life--the workplace, elections, social gatherings. Antisocial drinking, on the other hand, was held in check by strong social sanctions.
"In the late seventeenth century the Rev. Increase Mather had taught that drink was `a good creature of God' and that a man should partake of God's gift without wasting or abusing it. His only admonition was that a man must not `drink a Cup of Wine more than is good for him'.... At that time inebriation was not associated with violence or crime; only rowdy, belligerent inebriation in public places was frowned upon.... Control was also exercised through informal channels. One Massachusetts minister insisted that a public house be located next to his own dwelling so he could monitor tavern traffic through his study window. If he observed a man frequenting the place too often, the clergyman could go next door and escort the drinker home." Rorabaugh, W.J., The Alcoholic Republic: An American Tradition, Oxford University Press, New York, 1979, pp. 26-30.
- A special site for appropriate drinking was the colonial tavern, where (as in church) people of all ages met. It was like a public lecture hall and meeting place.
"The tavern was a key institution, the center of social and political life. Frequently located near the meeting house, it provided the main source of secular recreation and entertainment. Wedding parties, funerals, and even church services were held in the tavern." Levine, H.G., "The Good Creature of God and the Demon Rum," pp. 111-161 in National Institute on Alcohol Abuse and Alcoholism, Research Monograph No. 12: Alcohol and Disinhibition: Nature and Meaning of the Link, NIAAA, Rockville, MD, 1983, p. 115.
- Children were regularly exposed to alcohol and taught how to drink.
"White males were taught to drink as children, even as babies. `I have frequently seen Fathers,' wrote one traveller, `wake their Child of a year old from a sound sleap [sic] to make it drink Rum, or Brandy.' As soon as a toddler was old enough to drink from a cup, he was coaxed to consume the sugary residue at the bottom of an adult's nearly empty glass of spirits. Many parents intended this early exposure to alcohol to accustom their offspring to the taste of liquor, to encourage them to accept the idea of drinking small amounts, and thus to protect them from becoming drunkards." Rorabaugh, The Alcoholic Republic, p. 14.
- The 19th century saw the breakdown of the colonial consensus about alcohol and the rise of the temperance movement.
"In the colonial period the tavern had been an important part of social and community life; in the 19th century, the tavern was stigmatized, identified with the lower classes and immigrants, and an essentially male preserve. In the 19th century the saloon was where middle class men went slumming, and where all men went to get away from their families." Levine, "The Good Creature of God and the Demon Rum," p. 127.
"Any drinking, [Lyman Beecher] argued, was a step toward `irreclaimable' slavery to liquor; people simply could not tell when they crossed the line from moderate use to inebriety -- could not tell, that is, until too late. Look out, he said, if you drank in secret, periodically felt compelled to drink, and found yourself with tremors, inflamed eyes, or a `disordered stomach.' `You might as well cast loose in a frail boat before a hurricane, and expect safety,' Beecher explained, `and you are gone, gone irretrievably, if you do not stop.' But most could not stop; the power of alcohol was too strong." Lender, M.E., and Martin, J.K., Drinking in America (rev. ed.), Free Press, New York, 1987, p. 69.
"Politicized morality thus seemed well on its way to rolling back the tide of over two hundred years of American drinking habits. By the mid-1850s, many dry reformers were congratulating themselves on having destroyed the old consensus on drinking as a positive good.... The Reverend John Marsh...proclaimed the days gone `when drinking was universal; when no table was thought...properly spread unless it contained a supply of intoxicating drink; when no person' was held respectable who failed to `furnish it to his guests,' when no man thought of refusing liquor or of working without it, when `Ministers of the Gospel...were abundantly supplied by their people; when drinkers and rumsellers were unhesitatingly received as members of Christian churches." Lender and Martin, Drinking in America, pp. 84-85.
- The result is the ambivalence toward alcohol we see in the U.S. today:
"...`Americans drink with a certain sadness,' a sadness probably rooted in their culturally derived ambivalence toward the social and individual character of drinking. This cultural ambivalence has been forged and reforged during each historical period, each social and economic upheaval, and each era of immigrant assimilation. The resulting negation of alcohol use has led to a curious worship of abstinence, which is little practiced and, when practiced, little respected." Zinberg, N.E., "Alcohol Addiction: Toward a More Comprehensive Definition," pp. 97-127 in Bean, M.H., and Zinberg, N.E., eds., Dynamic Approaches to the Understanding and Treatment of Alcoholism, Free Press, New York, 1981, p. 99.
"Our society lacks a clear and consistent position regarding the scope of the excuse [of drunkenness] and is thus neither clear nor consistent in its teachings. Because our society's teachings are neither clear nor consistent, we lack unanimity of understanding; and where unanimity of understanding is lacking, we would argue that unanimity of practice is out of the question. Thus, although we all know that in our society the state of drunkenness carries with it an `increased freedom to be one's other self,' the limits are vague and only sporadically enforced.... [As a result], what people actually do when they are drunk will vary enormously...." MacAndrew, C., and Edgerton, R.B., Drunken Comportment: A Social Explanation, Aldine, Chicago, 1969, p. 172.
V Throughout history, wine and other alcoholic beverages have been a source of pleasure and aesthetic appreciation in many cultures.
"In most of the cultures...the primary image is a positive one. Usually drinking is viewed as an important adjunct to sociability. Almost as often, it is seen as a relatively inexpensive and effective relaxant, or as an important accompaniment to food.... Its use in religions is ancient, and reflects social approval rather than scorn.... Most people in the United States, Canada, and Sweden, when asked what emotions they associate with drinking, responded favorably, emphasizing personal satisfactions of relaxation, social values of sociability, an antidote to fatigue, and other positive features...."
Heath, D.B., "Some Generalizations about Alcohol and Culture," pp. 348-361 in Heath, D.B., ed., International Handbook on Alcohol and Culture, Greenwood Press, Westport, CT, 1995, p. 350-351.
"[In colonial America] Parents gave it [alcohol] to children for many of the minor ills of childhood, and its wholesomeness for those in health, it appeared, was only surpassed by its healing properties in case of disease. No other element seemed capable of satisfying so many human needs. It contributed to the success of any festive occasion and inspirited those in sorrow and distress. It gave courage to the soldier, endurance to the traveller, foresight to the statesman, and inspiration to the preacher. It sustained the sailor and the plowman, the trader and the trapper. By it were lighted the fires of revelry and of devotion. Few doubted that it was a great boon to mankind."
Levine, H.G., "The Good Creature of God and the Demon Rum," pp. 111-161 in National Institute on Alcohol Abuse and Alcoholism, Research Monograph No. 12: Alcohol and Disinhibition: Nature and Meaning of the Link, NIAAA, Rockville, MD, 1983, p. 115.
"British attitudes are generally favorable to drinking in itself while disapproving of heavy or problematic drinking. The drinking scene in the UK has undergone marked changes during recent decades. Public bars are now far more congenial and attractive to drinkers of both genders.... The British generally enjoy drinking, and recent legislation has attempted to increase the social integration of alcohol use and to discourage alcohol-related problems, but not drinking in itself."
Plant, M.A., "The United Kingdom," pp. 289-299 in Heath, D.B., ed., International Handbook on Alcohol and Culture, Greenwood Press, Westport, CT, 1995, p. 298.
"Passover: Passover is a happy time. We are happy to be free. On the first and second nights we have a Seder. My whole family is there, singing and having a good time. Everybody drinks four glasses of wine....
Shabbat: Shabbat comes once a week.... It is a day of rest. It starts on Friday evening, when mother lights the candles. Then daddy comes home and says the kiddush over the wine and challah.
Next morning we all go to the synagogue. Back home again, we have a nice dinner and sing songs and take it easy. In the evening, when the three starts are out, daddy says the habdolah. I hold the candle, smell the spices and sip a little wine from the kiddush cup."
Garvey, R., and Weiss, S., The First Book of Jewish Holidays, KTAV Publishing, New York, 1954.
"The Shabbat wine slurps and slips and glides into the cup. It almost spills over. Listen! Then say, `Amen,' to Kiddush, the blessing over the wine. Taste the cool, sweet, delicious Kiddush wine. Feel it slide down your throat."
Kobre, F., A Sense of Shabbat, Torah Aura Productions, Los Angeles, 1989, pp. 20-22.
"...we want to assure moderate drinkers that the age-old bromides they learned from their grandmothers (like putting Amaretto on a teething baby's gums) or their grandfathers (who told them a glass of wine completes a good meal) or their fathers (a beer on a hot day with friends is one of the great pleasures in life) are still sound and are worth passing on."
Peele, S., Brodsky, A., and Arnold, M., The Truth About Addiction and Recovery, Simon & Schuster, New York, 1991, p. 339.
VI Young people in many cultures are introduced to drinking early in life, as a normal part of daily living.
Whereas educational programs in the U.S. typically emphasize that children must never taste alcohol, the reverse is true in societies that maintain the best moderate drinking practices.
"The idea of a minimum age before [which] children should be `protected' from alcohol is alien in China and France; where it is a matter of law, the mid or late teens are favored.... Children learn to drink early in Zambia by taking small quantities when they are sent to buy beer; children in France, Italy, and Spain are routinely given wine as part of a meal or celebration."
Heath, D.B., "An Anthropological View of Alcohol and Culture in International Perspective," pp. 328-347 in Heath, D.B., ed., International Handbook on Alcohol and Culture, Greenwood Press, Westport, CT, 1995, p. 339.
"A book on practical child-raising, known in [a French] village since the early twenties, [states that when a child has reached the age of two]: `One can also give at mealtime a half-glass of water lightly reddened with wine, or some beer or cider very diluted with water.' In general, the recent literature is more cautious. It suggests, as a more suitable time for introducing children to alcoholic beverages, four years of age rather than two. Generally, though, wine is first offered when the child is two or more, can hold his own glass quite safely in his hand, and can join the family at table."
Anderson, B.G., "How French Children Learn to Drink," pp. 429-432 in Marshall, M., ed., Beliefs, Behaviors, & Alcoholic Beverages: A Cross-Cultural Survey, University of Michigan Press, Ann Arbor, MI, 1979, pp. 431-432.
"Eighteen...remains the minimum age for purchase in the United Kingdom. However, it is not illegal for those aged five and above to drink outside licensed premises."
Plant, M.A., "The United Kingdom," pp. 289-299 in Heath, D.B., ed., International Handbook on Alcohol and Culture, Greenwood Press, Westport, CT, 1995, p. 292.
"[In Spain] The undifferentiated beverage and food shops flourish not only in the community, but also in high schools and technical schools, which have students generally between the ages of 14 and 18. Such educational centers usually have a cantina (a bar or saloon) which closely duplicates the products sold in bars of the outside community; snacks, lunches, coffee, tea, sodas, beer, wine, and brandies are available.... Beer is generally available to students in all educational centers. However, a policy may be mandated that beer be the only alcoholic beverage available to students under 18 years of age, or that no alcohol be sold before noon, or that there be a two-drink limit for each person. These regulations may or may not be enforced, however. Observations in high school cafeterias reveal that the majority of students consume coffee or soft drinks and fewer than 20% take beer either separately or with lunch."
Rooney, J.F., "Patterns of Alcohol Use in Spanish Society," pp. 381-397 in Pittman, D.J., and White, H.R., eds., Society, Culture, and Drinking Patterns Reexamined, Rutgers Center of Alcohol Studies, New Brunswick, NJ, 1991, p. 382.
"Although the minimum legal age for purchasing alcohol in Spain is 16 years, no one is concerned with formalities of the law.... Spaniards sharply distinguish legality from morality. The penal code originates from the central government, whereas the code of moral behavior comes from the norms of the people. Consequently, there is a large part of the penal code to which the citizenry is morally indifferent.... My own observations reveal that youngsters of 10 and 12 years are able to buy liter bottles of beer in grocery and convenience stores if they choose."
Rooney, "Patterns of Alcohol Use in Spanish Society," p. 393.
"In sum, Spain along with other Southern European countries allows its youth early access to alcoholic beverages without the concomitant problems of rowdy behavior, vandalism, and drunk driving that Americans typically associate with youth drinking."
Pittman, D.J., "Cross Cultural Aspects of Drinking, Alcohol Abuse, and Alcoholism," pp. 1-5 in Waterhouse, A.L., and Rantz, J.M., eds., Wine in Context: Nutrition, Physiology, Policy (Proceedings of the Symposium on Wine & Health 1996), American Society for Enology and Viticulture, Davis, CA, 1996, p. 4.
VII Many cultures teach their young to drink moderately and responsibly.
The alternative is often a fear of alcohol associated with excessive drinking.
- How Italian youth, as distinct from American youth, are taught to drink:
"Italians, like Jews, are a group whose members tend to drink and to have low rates of alcohol problems. The attitudes and behaviors of Italians in the United States are a reflection of those in Italy, where children are introduced to alcohol as part of their regular family life and learn to drink moderate amounts while still young. In both countries, alcohol is commonly drunk with meals and is considered a natural and normal food. Most people agree that alcohol in moderation, for those who choose to drink, is necessary, and that abuse is unacceptable and results in immediate sanctions. People are not pressured to drink, and abstention does not offend others; drinking reflects sociability and social cohesion rather than a means to achieve them. Very few people drink for the physiological effect, and most people take alcohol for granted, with no mixed feelings or uncertainty about it." Hanson, D.J., "The United States of America," pp. 300-315 in Heath, D.B., ed., International Handbook on Alcohol and Culture, Greenwood Press, Westport, CT, 1995, p. 309.
"In Italy, in contrast to America, drinking is institutionalized as part of family life and dietary and religious custom; alcohol (wine) is introduced early in life, within the context of the family, and as a traditional accompaniment to meals and a healthful way of enhancing the diet. Drinking is not, as it is in America, associated with transformation of status from adolescence to adulthood; alcohol use is not an illicit activity for Italian youth; and heavy, consistent use of alcohol in Italy does not carry with it the same `problem' connotation that it does in America. Such an approach to the socialization of alcohol use should make it less likely in Italy than in America that drinking will be learned as a way of trying to solve personal problems or of coping with inadequacy and failure." Jessor, R., et al., "Perceived Opportunity, Alienation, and Drinking Behavior Among Italian and American Youth," Journal of Personality and Social Psychology, 1970, Vol. 15, 215-222 (quote pp. 215-216).
- Attitudes conveyed to Spanish children:
"Clearly, alcohol is not placed in a separate moral category in the Spanish cognitive map but rather constitutes one class of beverages among others, all of which are sold in the same establishment and generally have some degree of association with food consumption. Martinez and Martin (1987, p. 46) well summarize the integral position of alcohol in Spanish culture: `The consumption of alcohol is [as] integrated into common behaviors as sleeping and eating.'" Rooney, J.F., "Patterns of Alcohol Use in Spanish Society," pp. 381-397 in Pittman, D.J., and White, H.R., eds., Society, Culture, and Drinking Patterns Reexamined, Rutgers Center of Alcohol Studies, New Brunswick, NJ, 1991, pp. 382-383.
- How Chinese children are introduced to drinking:
"[Chinese-Americans] drink and become intoxicated, yet for the most part drinking to intoxication is not habitual, dependence on alcohol is uncommon and alcoholism is a rarity.... The children drank, and they soon learned a set of attitudes that attended the practice. While drinking was socially sanctioned, becoming drunk was not. The individual who lost control of himself under the influence of liquor was ridiculed and, if he persisted in his defection, ostracized. His continued lack of moderation was regarded not only as a personal shortcoming, but as a deficiency of the family as a whole. Barnett, M.L., "Alcoholism in the Cantonese of New York City: An anthropological study," pp. 179-227 in Diethelm, O., ed., Etiology of Chronic Alcoholism, Charles C Thomas, Springfield, IL, 1955.
- Attitudes about drinking learned by Jewish children:
"The protective social processes [that put the Jew in a special lifelong relationship with alcohol] are as follows: (1) association of alcohol abuse with non-Jews; (2) integration of moderate drinking norms, practices, and symbolism for oneself and significant others during childhood by means of religious and secular ritual; (3) continual reiteration of moderate drinking through restriction of most primary relationships to other moderate drinkers; and (4) a repertoire of techniques to avoid drinking more than one wants to drink amid social pressure." Glassner, B., and Berg, B., "How Jews Avoid Alcohol Problems," American Sociological Review, 1980, Vol. 45, 647-664 (quote p. 653).
"In the Jewish culture the wine is sacred and drinking is an act of communion. The act is repeated again and again and the attitudes toward drinking are all bound up with attitudes toward the sacred in the mind and emotions of the individual. In my opinion this is the central reason why drunkenness is regarded as so `indecent'--so unthinkable--for a Jew." Bales, R.F., "Rates of Alcoholism: Cultural Differences," Quarterly Journal of Studies on Alcohol, 1946, Vol. 6, 480-499 (quote p. 493).
"Jewish alcohol socialization practices virtually duplicate the five conditions that are correlated cross-culturally with nonabusive drinking patterns and low rates of alcoholism." Zinberg, N.E., "Alcohol Addiction: Toward a More Comprehensive Definition," pp. 97-127 in Bean, M.H., and Zinberg, N.E., eds., Dynamic Approaches to the Understanding and Treatment of Alcoholism, Free Press, New York, 1981, p. 111.
"...drinking itself cannot cause the many problems associated with alcohol, since orthodox Jews clearly demonstrate that virtually every member of a group can be exposed to drinking alcoholic beverages without suffering from drinking pathologies. Drinking norms, along with socio-cultural ritualism, are instituted early for the orthodox Jew. Alcoholic consumption, while occurring frequently and regularly throughout the Jew's lifetime, is closely related to social and religious ritual, which in turn provides the substance for his cultural lifestyle." French, L., and Bertoluzzi, R., "The Drunken Indian Stereotypes and the Eastern Cherokees," pp. 15-24 in Hornby, R., ed., Alcohol and Native Americans, Sinte Gleska University Press, Mission, SD, 1994, p. 17 (citing Snyder, C., Alcohol and the Jews, Free Press, Glencoe, IL, 1958).
- The Southern Baptist ambivalence toward alcohol:
"...The Protestant fundamentalist churches, which have no culturally defined role for alcohol, i.e., those which advocate abstinence, have the highest probability rate for drinking pathologies. Of these groups, the southern Baptists have the highest drinking pathology probability rate. The probable reason for this is that they isolate attitudes toward drinking from other inhibitory and controlling aspects of the personality.... [These conditions] necessitate that drinking be learned from dissident members of the group or members of other groups who may suggest and reinforce utilitarian drinking attitudes." French and Bertoluzzi, "The Drunken Indian Stereotypes," p. 17.
- How Irish children learn to drink:
"With the Irish, the treatment is tried--and untrue. All his life the kid has been hearing of the evils of the drink, and how his loving mother suffered at the hands of his rotten father because of it. And, at the end of the threnody, `Ah, but it's in the blood, I guess.' [After the boy gets drunk] the wrath of God descends. The priest comes into the house. He makes it clear that what you have done is worse than the violation of a vestal virgin. The mother of the house sobs quietly. The old man, craven, orders another beer at the corner saloon.... If a system has been devised to produce a confirmed alcoholic to exceed this one in efficiency, I know it not." McCabe, C., The Good Man's Weakness, Chronicle Books, San Francisco, 1974, pp. 31-32.
"It is consistent with Irish culture to see the use of alcohol in terms of black or white, good or evil, drunkenness or complete abstinence." Vaillant, G.E., The Natural History of Alcoholism, Harvard University Press, Cambridge, MA, 1983, p. 226.
- How negative socialization patterns have been imposed on Native Americans and others by conquest and cultural disruption:
"Clearly, it is within the cultural context that genetics and familial considerations of Indian alcoholism become meaningful. Not only was distilled alcohol unknown to this group prior to white contact, severe controls administered by the federal government through the General Indian Intercourse Act (1832-1953) denied American Indians the opportunity to establish acceptable drinking norms. Given this situation, subcultural, deviant drinking norms emerged to fill the therapeutic void alcohol seems to offer. And since a de facto policy of enforced abstinence still prevails in Indian/white interaction these deviant drinking patterns continue to the present." French, L., "Substance Abuse Treatment Among American Indian Children," pp. 237-245 in Hornby, R., ed., Alcohol and Native Americans, Sinte Gleska University Press, Mission, SD, 1994, p. 241.
"The major colonial powers exported to those areas of the globe that fell under their control not only models of drunken behavior but also a host of beliefs about the effects of alcohol on human beings. It may be that the widespread belief in alcohol as a disinhibitor is nothing but an ethnocentric European folk belief foisted on subject peoples around the world during the heyday of colonialism." Marshall, M., "`Four Hundred Rabbits': An Anthropological View of Ethanol as a Disinhibitor," pp. 186-204 in Room R., and Collins, G., eds., Alcohol and Disinhibition: Nature and Meaning of the Link (Research Monograph No. 12), U.S. Dept. of Health and Human Services, Rockville, MD, 1983, p. 198.
- How cultures known for positive drinking practices usually rely on wine as their main alcoholic beverage:
"...the Italian samples, as expected, had wine most frequently for their first drink, more than twice as often as the Boston sample." Jessor, R., et al., "Perceived Opportunity, Alienation, and Drinking Behavior Among Italian and American Youth," Journal of Personality and Social Psychology, 1970, Vol. 15, 215-222 (quote p. 217).
"Most of the sample first tasted wine, and nearly the entire sample report that most drinking in their parents' homes involved wine....Our interviewees tend to drink only a glass or two of wine when they do drink, and they tend to view wine as quite apart from intoxicating alcohol, indeed as almost nonalcoholic." Glassner, B., and Berg, B., "How Jews Avoid Alcohol Problems," American Sociological Review, 1980, Vol. 45, 647-664 (quote p. 657).
VIII A recipe for moderate drinking can be constructed from such successful examples as the Italian, Spanish, French, Greek, Jewish, and Chinese cultures:
"There are five conditions that cross-cultural researchers have found to be correlated in most societies with nonabusive drinking practices and low rates of alcoholism...:
- Group drinking is clearly differentiated from drunkenness and associated with ritualistic or religious celebrations.
- Drinking is associated with eating, preferably ritualistic feasting.
- Both sexes and several generations are included in the drinking situation, whether all drink or not.
- Drinking is divorced from the individual's effort to escape personal anxiety or difficult (intolerable) social situations....
- Inappropriate behavior when drinking (aggression, violence, overt sexuality) is absolutely disapproved, and protection against such behavior is offered by the `sober' or the less intoxicated. This general acceptance of a concept of restraint usually indicates that drinking is only one of many activities, that it carries a relatively low level of emotionalism, and that it is not associated with a male or female `rite of passage' or sense of superiority."
Zinberg, N.E., "Alcohol Addiction: Toward a More Comprehensive Definition," pp. 97-127 in Bean, M.H., and Zinberg, N.E., eds., Dynamic Approaches to the Understanding and Treatment of Alcoholism, Free Press, New York, 1981, p. 110.
"A literature review provides evidence of five major informal controls -- cultural recipes that describe what substances should be used in what amounts to achieve what effects: learning to use through association with others who teach people what, when, why, how, where, and with whom to use; sumptuary rules specifying eligibility requirements for use; sanctions that reinforce the learning of substance use conventions and norms; and everyday social relations that make it expedient for people to use in some ways and inconvenient to use in others."
Maloff, D., et al., "Informal Social Controls and Their Influence on Substance Use," pp. 53-76 in Zinberg, N.E., and Harding, W.M., Control Over Intoxicant Use, Human Sciences Press, New York, 1982, p. 53.
Moderate-Drinking Cultures
- Alcohol consumption is accepted and is governed by social custom, so that people learn constructive norms for drinking behavior.
- The existence of good and bad styles of drinking, and the differences between them, are explicitly taught.
- Alcohol is not seen as obviating personal control; skills for consuming alcohol responsibly are taught, and drunken misbehavior is disapproved and sanctioned.
Immoderate-Drinking Cultures
- Drinking is not governed by agreed-upon social standards, so that drinkers are on their own or must rely on the peer group for norms.
- Drinking is disapproved and abstinence encouraged, leaving those who do drink without a model of social drinking to imitate; they thus have a proclivity to drink excessively.
- Alcohol is seen as overpowering the individual's capacity for self-management, so that drinking is in itself an excuse for excess.
Peele, S., and Brodsky, A., "The Antidote to Alcohol Abuse: Sensible Drinking Messages," pp. 66-70 in Waterhouse, A.L., and Rantz, J.M., eds., Wine in Context: Nutrition, Physiology, Policy (Proceedings of the Symposium on Wine & Health 1996), American Society for Enology and Viticulture, Davis, CA, 1996, p. 67.
IX Government control policies are misguided and ineffective in regulating cultural drinking practices.
In most cases, strict government controls represent inadequate efforts to remedy weak or harmful cultural rules for drinking.
"Official or formal controls are far less effective in shaping behavior than are the unofficial informal controls that people exert in their daily interactions, through gossip, exhortations, or other forms of social sanction.... Addressing attitudes and values is probably the most effective way, in the long run, to change patterns of belief and behavior, because even the strictest nation-state is hard put to enforce its laws and regulations when they conflict with the culture of the people."
Heath, D.B., International Handbook on Alcohol and Culture, Greenwood Press, Westport, CT, 1995, pp. 343, 358-359.
"The evidence is...that control-of-supply policies will never reduce substance abuse significantly and that such policies may backfire by propagating images of substances as being inherently overpowering."
Peele, S., "The Limitations of Control-of-Supply Models for Explaining and Preventing Alcoholism and Drug Addiction," Journal of Studies on Alcohol, 1987, Vol. 48, 61-77 (quote p. 61).
"[Among states in the U.S.], the more proscriptive the norms concerning alcohol consumption [and the lower the overall rate of consumption], the greater the incidence of behavior that is defined as socially disruptive.... The results of the present study suggest...that societies that fear alcohol soon encounter problems with disruptive alcoholics."
Linsky, A.S., et al., "Stress, Drinking Culture, and Alcohol Problems," pp. 554-575 in Pittman, D.J., and White, H.R., eds., Society, Culture, and Drinking Patterns Reexamined, Rutgers Center of Alcohol Studies, New Brunswick, NJ, 1991, pp. 567, 570.
"In general, those societies and groups that place a high value on sobriety and a low value on intoxication do not have a need for extensive social control.... Societies that place a high premium upon the pleasures of drink and that have the greatest need for control are inclined to reject programs of control or to sabotage them if they are established.... Large societies with mixtures of ethnic minorities, diverse locality, and occupational groups make it unlikely that any one model will suffice to eliminate socially harmful drinking."
Lemert, E.M., "Alcohol, Values, and Social Control," pp. 681-701 in Pittman, D.J., and White, H.R., eds., Society, Culture, and Drinking Patterns Reexamined, Rutgers Center of Alcohol Studies, New Brunswick, NJ, 1991, p. 697.
"The control model of prevention...has been increasingly espoused by policymakers and others throughout the world, calling for increasing restrictions on the availability of alcohol as the best way to lessen alcoholism or a wide range of alcohol-related problems. In light of this case study (among others), the sociocultural model of prevention appears more plausible, stressing that the meanings, values, norms, and expectations associated with drinking have more effect than sheer quantity does in determining how many and what kinds of problems may be associated with alcohol -- or whether, as is strikingly the case among the Bolivian Camba, such problems appear not to occur at all."
Heath, D.B., "Continuity and Change in Drinking Patterns of the Bolivian Camba," pp. 78-86 in Pittman, D.J., and White, H.R., eds., Society, Culture, and Drinking Patterns Reexamined, Rutgers Center of Alcohol Studies, New Brunswick, NJ, 1991, p. 85.
X Researchers have derived important lessons from cross-cultural research on drinking practices.
"[The following are] some of the most significant generalizations that derive from cross-cultural study of the subject:
- In most societies, drinking is essentially a social act and as such, it is embedded in a context of values, attitudes, and other norms.
- These values, attitudes, and other norms constitute important sociocultural factors that influence the effects of drinking, regardless of how important biochemical, physiological, and pharmacokinetic factors may also be in that respect.
- The drinking of alcoholic beverages tends to be hedged about with rules concerning who may and may not drink how much of what, in what contexts, in the company of whom, and so forth. Often such rules are the focus of exceptionally strong emotions and sanctions.
- The value of alcohol for promoting relaxation and sociability is emphasized in many populations.
- The association of drinking with any kind of specifically associated problems -- physical, economic, psychological, social relational, or other -- is rare among cultures throughout both history and the contemporary world.
- When alcohol-related problems do occur, they are clearly linked with modalities of drinking, and usually also with values, attitudes, and norms about drinking.
- Attempts at prohibition have never been successful except when couched in terms of sacred or supernatural rules."
Heath, D.B., "Drinking and Drunkenness in Transcultural Perspective: Part II," Transcultural Psychiatric Research Review, 1986, Vol. 23, 103-126 (quote p. 121).
- Beverage alcohol usually is not a problem in society unless and until it is defined as such.
- When members of a society have had sufficient time to develop a widely shared set of beliefs and values pertaining to drinking and drunkenness, the consequences of alcohol consumption are not usually disruptive for most persons in that society. On the other hand, where beverage alcohol has been introduced within the past century and such a set of beliefs and values has not developed completely, social -- and sometimes physiological -- problems with ethanol commonly result.
- Socially disruptive drinking occurs only in secular settings.
- Where opportunities for group or community recreation are few and alcoholic beverages are available, alcohol consumption will become a major form of recreational activity in a community ("the boredom rule").
- Typically, alcoholic beverages are used more by males than by females and more by young adults than by preadolescents or older persons. Hence in any society the major consumers of beverage alcohol are most likely to be young men between their mid-teens and their mid-thirties.
- The drinking of alcoholic beverages occurs usually with friends or relatives and not among strangers. Where drinking among strangers does take place, violence is much more likely to erupt.
- Peoples who lacked alcoholic beverages aboriginally borrowed styles of drunken comportment along with the beverages from those who introduced them to "demon rum."
- When alcoholic beverages are defined culturally as a food and/or a medicine, drunkenness seldom is disruptive or antisocial.
- Alcoholic beverages are the drug of choice for a majority of persons in any society, even if alternative drug substances are available.
Selected points from Marshall, M., "Conclusions," pp. 451-457 in Marshall, M., ed., Beliefs, Behaviors, & Alcoholic Beverages: A Cross-Cultural Survey, University of Michigan Press, Ann Arbor, MI, 1979.
XI Summary: Historical and cross-cultural research point the way to more responsible, healthful, and pleasurable drinking practices today.
"The human experience abounds with evidence, both cross-cultural and international, that people can use alcohol in a variety of responsible and fruitful ways."
Heath, D.B., "Some Generalizations about Alcohol and Culture," pp. 348-361 in Heath, D.B., ed., International Handbook on Alcohol and Culture, Greenwood Press, Westport, CT, 1995, p. 359.
"Drinking is essentially a social act, performed in a recognized social context. If the focus is to be on alcohol abuse, then the anthropologists' work suggests that the most effective way of controlling it will be through socialization."
Douglas, M., Constructive Drinking: Perspectives on Drink from Anthropology, Cambridge University Press, Cambridge, UK, 1987, p. 4.
"The attitudes that characterize both ethnic groups and individuals with the greatest drinking problems are being propagated as a national outlook.... A range of cultural forces in our society has endangered the attitudes that underlie the norm and the practice of moderate drinking. The widespread propagation of the image of the irresistible dangers of alcohol has contributed to this undermining."
Peele, S., "The Cultural Context of Psychological Approaches to Alcoholism: Can We Control the Effects of Alcohol? " American Psychologist, 1984, Vol. 39, 1337-1351 (quotes pp. 1347, 1348).
"It is important to realize that drinking problems are virtually unknown in most of the world's cultures, including many where drinking is commonplace and occasional drunkenness is accepted. This suggests that even a technologically advanced culture might have something to learn from other cultures.... To speak of adopting traits from other cultures is problematic, because each culture is itself a complex web of interrelationships in which the parts have more meaning to each other than in isolation.... Nevertheless, it is apparent that certain ways of thinking and acting with respect to alcohol, ways that are consistently associated with drinking problems, might fruitfully be rejected, while others, those that correlate with unproblematic drinking, might well be fostered."
Heath, D.B., "Sociocultural Variants in Alcoholism," pp. 426-440 in Pattison, E.M., and Kaufman, E., eds., Encyclopedic Handbook of Alcoholism, Gardner Press, New York, 1982, pp. 436.
"Influences from numerous nations and cultures strongly affect alcohol beliefs, attitudes, and behaviors in the United States. The family plays a central role in teaching these alcohol norms and behaviors. Parents, through their power of example, may be the most important long-term influence on the behavior of their offspring. The strength of their power, often reinforced by religious teachings, is usually underestimated.... The thrust [of alcohol education programs in U.S. schools] has largely been to stress problems associated with alcohol abuse and to portray alcohol as a dangerous substance to be avoided. In spite of the enormous human and monetary resources employed in this educational approach, it has not been effective. Not surprisingly, any alcohol education that is inconsistent with prevalent beliefs and behaviors in a group or society is likely to be ineffective."
Hanson, D.J., "The United States of America," pp. 300-315 in Heath, D.B., ed., International Handbook on Alcohol and Culture, Greenwood Press, Westport, CT, 1995, p. 312.
"Understandings based on the cross-cultural and scientific evidence yield recommendations that the current control-of-consumption attack upon alcohol should be ended; that all attempts to stigmatize alcohol as a `dirty drug,' as a poison, as inherently harmful, or as a substance to be abhorred and shunned should be ended; that governmental agencies formulate and implement policies that incorporate the concept of moderate or responsible drinking along with the choice of abstinence; that systematic efforts be made to clarify and emphasize the distinctions between acceptable and unacceptable drinking; that unacceptable drinking behaviors be strongly sanctioned, both legally and socially; that parents be permitted to serve alcohol to their offspring of any age, not only at home, but in restaurants, parks, and other locations under their direct control and supervision; and that educational efforts encourage moderate use of alcohol among those who choose to drink."
Hanson, D.J., Preventing Alcohol Abuse: Alcohol, Culture, and Control, Praeger, Westport, CT, 1995, pp. xiii-xiv.
XII Conclusions:
- Historical, cultural, and ethnic comparisons show clearly that alcohol can be used in very different ways, for better and for worse.
- The destructive personal and social consequences of alcohol abuse are not entirely or even largely due to the prevalence of drinking or the amount of alcohol consumed.
- Indeed, one factor often identified as predisposing a culture to lower rates of alcohol abuse is a comfortable acceptance of beverage alcohol, together with broad agreement about and consistent application of clearly defined limits to its consumption and to people's behavior when drinking.
- In a culture with positive drinking habits, responsible drinking typically is taught to children early in life, along with an image of alcohol as a beneficent and controllable force that offers pleasure and positive social experiences.
- These experiences allow us to create a recipe or template incorporating the elements of successful cultural control of drinking. They suggest a policy for educating the young to become moderate, healthy, social drinkers.
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Cocaine
As if we needed more evidence that what cultural standards decree as a suitable weight for women and what the body regards as normal may be two entirely different things. The latest proof is in reproductive function of women with the eating disorder bulimia.
Just as most men have difficulty on some occasions 
Firstly, don't rush intercourse (penetration). Allowance must be made for arousal and excitement to do their job - to stimulate both the male and female sexual organs. Foreplay and stimulation are essential to successful and pleasurable lovemaking, and they are the triggers to vaginal lubrication. A woman will usually become "moist" during this phase of sex, making penetration easier and more enjoyable for both partners.
It is important to remember that when you first approach the person you suspect has an eating disorder, they may react with anger or they may deny that anything is wrong. Do not push the issue, just let them know that you will always be there for them if they need to talk. In cases where the person is extremely underweight or is bingeing/purging several times a day, you may need to step in and take control. I would only recommend doing that if the individuals health is in extreme danger. If that is the case, you may need to speak to a doctor about a forced hospitalization.