Drinking and Alcoholism
Drinking and Alcoholism
I. Psychological AspectsEdith S. Lisansky
II. Social AspectsCharles R. Snyder and David J. Pittman
I PSYCHOLOGICAL ASPECTS
Drinking and alcoholism will be considered as related but distinct phenomena. The use of alcoholic beverages by almost all societies over recorded history as a stimulant, anesthetic, social lubricant, and ceremonial substance is well known. Ingestion of alcohol may be normal or pathological; here the problem of definition begins. There is moderate drinking, acceptable in many (but not all) human groups; there is excessive drinking, for example, intoxication; there are behavior problems associated with drinking; and there is alcoholism. A recent definition of alcoholism states that “alcoholism is a psychogenic dependence on or a physiological addiction to ethanol, manifested by the inability of the alcoholic consistently to control either the start of drinking or its termination once started …” (Keller 1962, p. 312). Loss of control is the pathognomic symptom here, and the definition specifies for the epidemiologist those behaviors that will permit him to define the alcoholic—marked and repetitive drinking—as well as the ill effects on the drinker’s health or on his social or economic functioning.
Drinking behavior has been interpreted in terms of different theoretical systems in psychology: for example, drinking has been viewed as a reducer of fear and conflict, by behaviorists, or as a dissolver of the superego, by psychoanalysts. Studies of the influence of alcohol on human behavior may be viewed as a wedge into related areas of knowledge: knowledge of the effects of alcohol on learning efficiency or motor coordination may be considered data about learning efficiency or motor coordination per se, about general drug effects, or about individual differences in response. The relation of deviant drinking behavior to human misery, personal and social, gives some insight into the dynamics of psychic pain and how ways of coping are passed on and learned. Alcohol studies in social anthropology may suggest usable hypotheses about the relationship of individual maladjustment and social organization in different societies. There are some groups in which drinking is virtually universal, where the lone drinker or abstainer is unknown, and where frequent intoxication and spree drinking is not the symptomatic, deviant behavior of a relatively few, for example, the fiesta drinking of Central American and South American Indian groups. In some social groups and societies, such as nineteenth-century European Jewish communities, alcohol may serve to reinforce social organization. In other groups, alcohol may hasten processes of disorganization and deculturation; the example of many North American Indian tribes is well known. Alcohol has been used occasionally as an instrument to achieve the submission of and control over others.
Drinking
The term “drinking” seems simple enough: an organism ingests an alcoholic beverage. But as a behavioral term, it includes many related aspects: in describing drinking behavior, one needs to know the kind and amount of beverage ingested and the circumstances of ingestion, such as where it is drunk, how rapidly, with whom, how diluted, whether before or during meals, etc. The term “drinking” encompasses the determination of the blood-alcohol level produced by the drinking; the effects on efficiency, mood, and social interaction; the past experiences of the drinker; and the drinking customs of the social group.
Organic and psychological aspects
The physiological aspects of drinking have been summarized in an excellent review that includes much of the recent physiological and biochemical research on alcohol (Kalant 1962, pp. 52–93).
The psychological aspects of drinking will be narrowed here to a review of research on the behavioral effects of alcohol on individual organisms.
There is a vast literature involving animal subjects and the effects of alcohol on their behavior. Often, these are studies of alcohol effects in classical or operant conditioning procedures, reaction time and maze behavior, but there have also been many laboratory reports demonstrating increased voluntary consumption of alcohol under different experimental conditions, such as vitamin deficiency or stress, as well as some reports of laboratory work demonstrating genetic strain differences in alcohol preference. The term “experimental alcoholism” to describe these studies was criticized by the World Health Organization, Expert Committee on Alcohol (1954), which expressed the opinion that the phenomenon of alcoholism was closer to experiments dealing with “the relief by alcohol of experimentally induced neurotic manifestations in animals.” Such experiments include studies of experimenter-induced conflicts and stress and of “experimental neurosis.” Whether such experiments relate to alcoholism or to the relief afforded by alcohol in everyday, nonpathological social drinking may be a legitimate question, but there is another caveat: not to go too far in generalizing from the responses to alcohol of the animal in laboratory-generated stress to the complex, socially patterned drinking behavior of the human subject.
There was a sizable amount of laboratory experimentation during the first four decades of this century on the effects of alcohol on different psychological variables. These have been summarized and evaluated in a monograph by Jellinek and McFarland (1940). Experiments were grouped under these headings: chronaxy, reflexes, sensations, perception and attention, simple reaction time, muscular strength and coordination, miscellaneous tests of dexterity and skill, learning and simple learned performances, memory, the associative functions, judgment, reasoning and intelligence, volition, emotion and personality. The generalization made from the authors’ analysis of the experiments was that “alcohol has a depressing effect on all psychological functions yet measured, and … such stimulation as has been reported for some psychological variables is a pseudostimulation” (ibid., p. 362–363). The reviewers also concluded that “the simple psychological functions are less affected by alcohol than the complex ones” (ibid., p. 363).
These conclusions are now under critical re-examination and challenge. There is some evidence that small amounts of alcohol may in some task situations have a facilitating effect. It turns out, too, that inferences about “pseudostimulation” are based on a melange of psychology and neurology: if behavior or performance improves with alcohol, the argument is that such improvement occurs because cortical inhibitions are disinhibited by the alcohol. But studies of behavior need to be described in behavioral and not in neurological terms (particularly not in oversimplified neurological terms that have been superseded by newer concepts of cerebral activity). As it appears now, alcohol in small and moderate amounts is frequently a behavioral depressant, but may—under some conditions, for some tasks, for some individuals—act as a facilitator (Lisansky 1964, pp. 104–121).
The issue of simple versus complex psychological functions has also been critically re-evaluated: “The traditional idea that intellectual functions are particularly susceptible to deterioration by alcohol is questioned … a reevaluation of the idea that intellectual functions are a ’complex’ or ’higher’ or ’fragile’ activity is necessary …” (Carpenter 1962, p. 310).
Experimental study of the effects of alcohol on emotional behavior and the relationship of such effects to personality variables is in its infancy. There is some research suggesting that individual characteristics related to the effects of alcohol may be a subject’s general adjustment, his introversive or extroversive tendencies, his past experience with alcohol, and his familiarity with a task. Interestingly enough, when people are asked to report their subjective feelings about how alcohol affects them, they almost invariably reply in terms of stimulating effects; this is true whether the people are laboratory subjects or participants in surveys. Experiments involving groups and the effects of alcohol on the emotional behavior of individuals drinking together have been conducted by the Finnish Foundation for Alcohol Studies. The limited number of group studies to date report increases in aggressive behavior, in the sexual content of fantasies, and in emotionality of behavior generally.
Drinking practices in the United States, in some Central American and South American communities, among several African peoples, in many countries of Europe and Asia, and in preliterate primitive societies have been described (McCarthy 1959; Pittman & Snyder 1962). Jellinek (1960) has reported on attitudes toward intoxication and alcoholism in the different countries of Europe and the Americas.
Alcoholism
Any discussion of alcoholism must begin by distinguishing between “drinking related misbehaviors” (Keller 1962, p. 310) or “intoxication-caused problems” (Tongue 1962) on the one hand and alcoholism on the other. Jellinek commented: “International experience leads to the conclusion that in many countries more serious problems of national magnitude arise from other types of drinkers than from those who are termed ’alcoholics’ in America” (1960, p. 15). Other types of drinking, like occasional excessive drinking, may lead to behaviors that present a problem to society; examples of these would be “explosive drinking” in Finland, or “fiesta drinking” in Spain, Portugal, Brazil, and Argentina. Jellinek (1960) described the so-called ”inveterate drinker” in France, who may consume two or even three liters of wine daily, rarely becoming intoxicated yet frequently presenting the medical symptoms of the diseases of chronic alcoholism.
European state programs have concerned themselves with both alcoholism and alcohol-related problems; most of the programs in the United States have dealt more or less exclusively with the treatment and rehabilitation of alcoholics. This difference does not seem to be related to the severity of the alcoholism problem. It is more likely related to differing national attitudes toward social legislation and government responsibility.
Etiology
When we refer to “etiology” or “treatment,” we are speaking of alcoholism per se as it presents itself in the industrialized, urbanized countries. Alcoholism is viewed by many in these countries as a disease or a symptom of a disease process, and the concepts of etiology and treatment relate to this view. To perceive the most extreme of alcohol problems, alcoholism, as a disease requires a kind of mental-health viewpoint not universal in the medical profession or welfare agencies, to say nothing of the lay public. It is a deviant behavior, and as such it is seen by many as immorality, weakness of will, perversity, or a bad habit.
Physiopathological theories. Etiological theories have been primarily physiopathological or psycho-pathological. Among physiopathological theories, there are explanations in terms of allergy, brain pathology, biochemical substances, nutritional deficiencies, and glandular disorder. These theories have not gained more than limited acceptance; one of the major problems has been the difficulty of demonstrating that the particular physiopathological condition offered as the cause actually predated the onset of alcoholism. Generally, evidence has been based on the condition of patients with long-standing alcoholism.
The World Health Organization, Expert Committee on Alcohol (1954) placed alcohol “in a category of its own, intermediate between addiction-producing and habit-forming drugs.” The questions of alcohol and physical dependence or craving, alcohol and withdrawal, and alcohol and tolerance changes (craving, withdrawal, and tolerance changes being the criteria of addiction) have not been solved and are still in debate.
Psychopathological theories. Psychopathological theories were divided by Jellinek (1960) into those viewing alcoholism as the illness per se and those viewing it as a symptom of illness. Overriding this distinction is the common view that some personality deviation or difficulty in social-emotional development is a necessary condition of alcoholism. The psychoanalytic view emphasized “the oral and narcissistic premorbid personality,” and various writers, theorizing from clinical data, have written of passivity, self-destruction, guilt, infantile traits, anxiety, and oral regression. There has been debate as to whether there is a single psychological predisposition, several such predispositions, or whether, indeed, any personality is vulnerable. Psychological test research has failed to turn up a single “alcoholic type.” Psychological clinical research with emphasis on social as well as psychological data about subjects and on behavioral criteria for differentiating among alcoholics might yet make a contribution. There has been some speculation by psychologists about how alcoholism is learned, for instance, whether it is a result of the reinforcement involved in reduction of fear, conflict, and tension. A little has been written about the function alcohol serves in solving conscious and unconscious emotional needs. This literature has been reviewed (Zwerling & Rosenbaum 1959; Lisansky 1960).
There would probably be agreement by most who work with alcoholic patients in the United States that the alcoholic is an individual with low tolerance for frustration and stress, that he has not developed much by way of ego defenses other than denial, and that he has weak sexual drives, his affectional bind being largely with alcohol.
The weakness of psychopathological theories standing alone as an explanation of alcoholism is the difficulty of answering this question: If, as seems to be the case, there is no absolutely unique set of predispositional psychological circumstances, why do some people become alcoholic while others do not? There is, for example, no absence of neurotic problems or depression or guilt among the Jews, who maintain an extremely low rate of alcoholism. Psychopathology may be a necessary but not a sufficient causal explanation of alcoholism.
Sociopsychological theories. The most promise lies in a sociopsychological theory of etiology. One needs to know not only about individual tensions and frustrations but also about the group’s methods of coping and its attitudes toward and perception of alcohol. Jellinek (1960), for example, has offered a hypothesis relating a society’s degree of acceptance of “large daily alcohol consumption” and the psychological vulnerability of individuals. It is a start. In the United States, different normative orientations toward drinking (Pittman & Snyder 1962) appear in different ethnic and religious subcultures, the Irish-American orientation producing higher rates of alcoholism than the Jewish-American. The question remains: Why do some Irish-Americans become alcoholics and not others? Perhaps the same psychological vulnerability that predisposes toward alcoholism in the Irish-American group predisposes toward other psychopathologies in the Jewish-American group.
In several European and South American viti-cultural countries, there is widespread belief in the “economic origin” of alcoholism. This may refer to economic deprivation of individuals or of the country, and the view that intoxication and alcoholism are related to want and economic misery may be valid for certain times and groups and parts of the world. The “economic origin” theory also refers to pressure from a national economy in which viticultural interests loom large, but the oversimplification of such an explanation is manifest in the differences in alcohol consumption and the rates of alcoholism in France and in Italy, both viticultural countries.
There is no all-embracing explanation of alcoholism in sight, but if one begins with a distinction between alcoholism and problems related to alcohol, if one is aware of the need for a classification of variants within the diagnosis of alcoholism, and if one is willing to include physiological, psychological, and social variables in an explanation of etiology, some ground is cleared. Probably no theory can ever account for all the problems men have with alcohol.
Treatment
In spite of the lack of solutions to questions about alcoholism, there has been a great proliferation of state programs in Europe and the Americas since World War ii. The emphasis has been primarily on the treatment and rehabilitation of alcoholics, with secondary emphasis on educational programs and, in a few places, some support for a research program. With pressure coming from a variety of sources—the government itself, welfare workers and physicians, temperance organizations, or those concerned with the relationships between alcohol and acting-out crimes—some attempt has been made to offer treatment.
Treatment programs fall into three major categories:
(1) Residential treatments place the alcoholic in ((a)) a hospital or a ward in a general or psychiatric hospital, (b) rehabilitation living quarters, like a halfway house, for chronic drunkenness offenders or, relatively new, day-or-night-care centers.
(2) Among psychological and rehabilitative treatments are (a) individual and group psychotherapy, frequently psychoanalytically oriented, (b) a special form of group help, Alcoholics Anonymous (a brotherhood of former alcoholics that has taken hold in many countries other than the United States, for instance, the “Ring i Ring” in Denmark), (c) groups of religious and quasi-religious organizations, including the churches and the Salvation Army, (d) the use of hypnosis and its variations, and (e) the use of conditioned-reflex treatment.
(3) Drug treatments include (a) ataractic and antidepressant drugs in current use as the sole treatment or as adjunct to other forms of treatment and (b) the administration of disulfiram (Antabuse), discovered by Dr. Erik Jacobsen of Denmark, very widely used in alcoholism treatment.
A particular treatment program is organized, hopefully, in terms of the needs of the patients it seeks to reach. Where the patients are physically ill or debilitated or homeless, more than outpatient service is needed. There are some countries, for example, Sweden and Norway, in which the supervision and rehabilitation of alcoholics is compulsory under law. In most countries treatment is more or less voluntarily undertaken.
Research and problems
Research activity has been most fruitful at those interdisciplinary centers designed for research in alcohol studies. These centers, which combine the efforts of physiologists, physicians, and biochemists, psychiatrists, psychologists, and social workers, sociologists, anthropologists, and economists, demonstrate the usefulness of a multidisciplined research approach to problems like drinking and alcoholism. The Alcohol and Drug Addiction Research Foundation of Ontario in Canada, the Finnish Foundation for Alcohol Studies, the Department of Alcohol Research of the Karolinska Institutet in Sweden, and the Rutgers (formerly Yale) Center of Alcohol Studies in New Jersey have been outstanding. These centers have produced research results over a wide range of problems: physiological and biochemical action of alcohol, the effects of alcohol on behavior and performance, alcohol usage in different cultural and social groups, attitudes, prevalence of alcoholism, the effectiveness of various drug treatments, drinking and driving, governmental policy and social controls—the gamut of alcohol-related problems.
There are many unanswered questions, but the most pressing problems in the psychological aspects of drinking and alcoholism, those which should have priority in research development, are: first, basic research on the effects of alcohol on mood, feelings, emotional response, and group behavior and, second, a meaningful classification of the alcoholisms, probably in behavioral terms objectively defined, which can be used internationally and which will, hopefully, lead to an understanding of the different etiologies and most effective treatments.
Edith S. Lisansky
[Other relevant material may be found inDrugs; Smoking.]
BIBLIOGRAPHY
Alcoholism and Drug Addiction Research Foundation of Ontario 1962 A Decade of Alcoholism Research: A Review of the Research Activities of the Alcoholism and Drug Addiction Research Foundation of Ontario, 1951–1961. Univ. of Toronto Press.
Bacon, Margaret K. et al. 1965 A Cross-cultural Study of Drinking. Quarterly Journal of Studies on Alcohol Supplement No. 3.
Carpenter, John A. 1962 Effects of Alcohol on Some Psychological Processes: A Critical Review With Special Reference to Automobile Driving Skill. Quarterly Journal of Studies on Alcohol 23:274–314.
Jellinek, Elvin M. 1960 The Disease Concept of Alcoholism. New Haven: Hillhouse.
Jellinek, Elvin M.; and McFarland, Ross 1940 Analysis of Psychological Experiments on the Effects of Alcohol. Quarterly Journal of Studies on Alcohol 1:272–371.
Kalant, Harold 1962 Some Recent Physiological and Biochemical Investigations on Alcohol and Alcoholism: A Review. Quarterly Journal of Studies on Alcohol 23:52–93.
Keller, Mark 1962 The Definition of Alcoholism and the Estimation of Its Prevalence. Pages 310–329 in David J. Pittman and Charles R. Snyder (editors), Society, Culture, and Drinking Patterns. New York: Wiley.
Lisansky, Edith S. 1960 The Etiology of Alcoholism: The Role of Psychological Predisposition. Quarterly Journal of Studies on Alcohol 21:314–343.
Lisansky, Edith S. 1964 The Psychological Effects of Alcohol. Pages 104–121 in Raymond G. McCarthy (editor), Alcohol Education for Classroom and Community. New York: McGraw-Hill.
McCarthy, Raymond G. (editor) 1959 Drinking and Intoxication: Selected Readings in Social Attitudes and Controls. New Haven: Yale Center of Alcohol Studies.
Pittman, David J.; and Snyder, Charles R. (editors) 1962 Society, Culture, and Drinking Patterns. New York: Wiley.
Selected Statistical Tables on the Consumption of Alcohol, 1850–1962, and on Alcoholism, 1930–1960. Prepared by Vera Efron and Mark Keller. 1963 New Brunswick, N.J.: Rutgers (Univ.) Center of Alcohol Studies.
Tongue, Archer 1962 What the State Does About Alcohol and Alcoholism: An International Survey. Pages 594–600 in David J. Pittman and Charles R. Snyder (editors), Society, Culture, and Drinking Patterns. New York: Wiley.
VÄki Juomakysymyksen TutkimussÅÅtiÖ (Finnish Foundation for Alcohol Studies) 1964 Report on Activities, 1958–1963. Helsinki: Maalaiskuntien Lilton Kirjapamno.
Washburne, Chandler 1961 Primitive Drinking: A Study of the Uses and Functions of Alcohol in Pre-literate Societies. New Haven: College & Universities Press.
World Health Organization, Expert Committee on Alcohol 1954 First Report. World Health Organization, Technical Report Series [1954], No. 84.
Zwerling, Israel; and Rosenbaum, Milton 1959 Alcoholic Addiction and Personality (Nonpsychotic Conditions). Volume 1, pages 623–644 in American Handbook of Psychiatry. Edited by Silvano Arieti. New York: Basic Books.
II SOCIAL ASPECTS
A generation ago Donald Horton (1943) pioneered the first systematic cross-cultural study of drinking patterns in a report on the functions of alcohol in primitive societies. In this work he offered an eloquent plea for intensifying systematic research on drinking behavior and for moving toward the goal of incorporating empirical findings into a general theory of the social and psychological functions of alcohol. Since then, the systematic study of drinking behavior has proceeded at an accelerated pace in various branches of social science. Yet it cannot be said that the research of the past two decades has produced the general theory which Horton had in mind. At best it has yielded new facts, questions, and hypotheses suggestive of the directions that synthesis may eventually take. Here we shall first consider some of the more general findings of comparative studies of drinking in primitive societies and of sociological and related studies of drinking in complex societies. Attention will then be given to the nature of alcoholism; to its prevalence, patterning, and genesis; and to social responses to alcoholism.
Drinking in primitive societies
Alcohol and anxiety reduction
Central to Horton’s research was the view that patterns of drinking behavior are determined by the interrelations of psychological and cultural variables and, more specifically, the proposition that the primary function of alcoholic beverages in all societies is the reduction of anxiety. Horton recognized other functions of alcohol as well as the seeming paradox that drinking, in net balance, may not be anxiety-reducing where social controls give rise to powerful and inhibiting counteranxieties. Yet, weaving the basic notion of anxiety reduction into a larger complex of psychocultural assumptions, he derived some important theorems, enabling indirect tests of his basic proposition on a sample of 56 culturally distinct societies thought to represent a cross section of primitive societies throughout the world (Horton 1943).
It was reasoned, for instance, that drinking tends generally to be accompanied by the release of aggressive and sexual impulses; all societies must to some extent inhibit expression of these impulses, and to reduce impulse-anxiety through alcohol is, in effect, to release the inhibition. Moreover, the strength of the drinking response, which Horton indexed by “the degree of insobriety,” was thought to vary inversely with the occurrence of painful social experiences associated with the release of these impulses—experiences which, in turn, might vary from culture to culture. The ethnographic data reviewed by Horton corroborated the hypothesis that aggressive behavior tends to be associated with drinking, although a marked range of variation became apparent. To explain this variation, he proposed, with some supporting evidence, that societies characterized by high levels of inhibited aggression (indexed by the prevalence of sorcery) and coordinate systems of social control, as contrasted with superordinate systems capable of effectively punishing aggression, exhibit a maximum of drunken aggression. With regard to sexuality, the results were not, on the whole, what had been expected, although the suggestion of an inverse relation between premarital sexual restrictions and the degree of insobriety highlighted the possible role of counteranxiety in restraining drinking.
The most dramatic of Horton’s findings, however, related to the deduction that the strength of the drinking response (”insobriety”) varies directly with the general level of anxiety, which is an expression of the state of the total social structure and especially of the economy. As a clue to this, Horton referred to “subsistence anxiety” or insecurity, which he indexed by the type of economy (scaled from hunting through higher agriculture) and by specific subsistence hazards, including the hazards of acculturation. As Horton himself put it, the statistical findings supported the conclusion that “insobriety varies directly with anxiety as measured indirectly in terms of the anxiety-provoking conditions of subsistence insecurity and acculturation” (1943, p. 294).
Patterns of drinking behavior. Because his method of analysis treated variables in isolation from one another, Horton also offered a generalized qualitative sketch of three distinctive drinking patterns, found in different parts of the world, which are expressions of the similarity in the crucial psychocultural variables seen as systems. The first pattern is associated with societies having high subsistence anxiety, strong belief in sorcery, weak sexual restraints, and coordinate social control. Here inebriety is extreme and, because of the vacuum in social power capable of restraining it, is almost always accompanied by extreme aggression. Cultural adaptation to this condition typically involves precautions of various kinds that are usually entrusted to the women, who drink less than the men. The second pattern occurs where the belief in sorcery is absent or relatively unimportant but where subsistence anxiety is also high and the anxiety motive too strong to be countered by sexual anxieties. Horton made no attempt to characterize the control of aggression in these societies but assumed from the unimportance of sorcery a minimum of motivation and thus little need for control. In any event, in the second pattern insobrietry is seen as invariably excessive but as accompanied by only moderate aggression in most cases. Finally, in the third pattern, fear and restraint in drinking are predominant, sometimes even extending to a complete taboo on alcoholic beverages. This sketch of patterns was not intended as exhaustive, but it offers the nucleus of a typology of patterns that have recurred with some frequency in primitive societies on a world-wide basis. Regrettably, little has been done to verify or modify this sketch, Although it would seem to offer a fruitful point of departure for research.
Social organization
A note of challenge to Horton’s basic proposition on anxiety reduction was sounded in a crosscultural study by Field (1962), who used Horton’s original sample of primitive societies but extended the investigation to include variables not previously considered. Noting the highly inferential nature of Horton’s measures of anxiety, Field introduced new indexes of “fear,” which were thought to be more direct reflections of levels of anxiety, and found no consistent correlation with “extent of drunkenness.” In his reconsideration, the relation between subsistence insecurity and extent of drunkenness seemed more indicative of differences in economy, and hence in social organization, than of strikingly different levels of anxiety. Consequently, Field abandoned Horton’s anxiety-reduction view in favor of exploring further the relations between social organization and drunkenness in primitive societies. Although, for reasons given elsewhere (Snyder 1964), we do not share Field’s apparent dismissal of the role of anxiety in drinking, important relations between drunkenness and social organization are suggested by his research. For instance, he found that societies with strong corporate kin groups (organized on unilineal principles, exhibiting continuity in time, capable of concerted social action, and having elaborate collective ceremonial and symbolism) seemed markedly sober, whereas those structured bilaterally, with amorphous, fragmented, and loosely organized social relationships, appeared marked by extensive drunkenness. Generalizing his findings, Field proposed a distinction between “corporate” and “personal” types of social organization as the principal determinant of sobriety or drunkenness in primitive societies.
In a later large-scale research study of drinking in primitive society, Margaret Bacon and others (1965) offered an important commentary on parts of Horton’s and Field’s earlier work and another hypothesis to account for part of the cultural variation in drinking and drunkenness. Their research has advantages over previous work since it virtually doubled the societies sampled (to 110), increased the number of key variables, developed a factor analysis of dimensions of drinking, and employed independent ratings of variables and more sensitive measures of association. The findings corroborate Morton’s linkage of type of economy and drunkenness, call into question certain other aspects of his work, and diminish the significance of the findings reported by Field. Yet, because the relevant variables are treated singly rather than in combination, it cannot be said that the configurations of psychocultural factors and drinking patterns suggested by Morton are without substance. Also, the pattern of correlations established by Field remains, by and large, in the predicted direction, suggesting some validity to his conclusions on drunkenness and social organization.
Socialization and dependency needs
The study by Bacon and others took as its starting point the repeated clinical observation that persons with drinking problems exhibit marked conflict over the expression of dependency needs and the fact that, while the helplessness of the infant is a universal aspect of the human situation and the socialization of dependence a universal cultural imperative, there are pronounced differences among societies in the attention paid to and indulgence of infants; in the cultural pressures toward achievement, self-reliance, and general independence in childhood; and in the extent to which cultural attitudes prescribe, tolerate, or enjoin the expression of dependency needs in adult life. These initial observations were expanded into the hypothesis that amounts and patterns of alcohol consumption have their roots partly in the degree of nurturing in infancy, the extent of demands for self-reliance and achievement in childhood, and the extent to which the expression of dependent needs is permitted in adult life. It was assumed further that alcohol would be especially rewarding where dependency conflict is acute, because of its triple function of reducing anxiety and tension, permitting the satisfaction of dependency needs, and facilitating uncritical indulgence of unrealistic achievement fantasies. As a test of this view, various indexes bearing on the indulgence of dependency and pressures toward independent behavior were correlated with independently rated measures of alcohol consumption and frequency of drunkenness, and the statistical results support the hypothesis with consistency. Thus, the conclusion that “frequent drunkenness or high consumption, or both, tend to occur in cultures where needs for dependence are deprived or punished, both in childhood and in adult life, and where a high degree of responsible independent and achieving behavior are required” (M. Bacon et al. 1965, p. 43) seems warranted by the facts.
Ceremonial usage and solidarity
The extensive ceremonial usage of alcohol among primitive peoples has been explored by Klausner (1964) in a comparative study of 48 societies. He classified ceremonies in terms of their underlying meaning and characteristic form, according to the basic problems on which they center and the means employed, whether exorcism, scapegoating, sacrifice, prayer, or other. Like M. Bacon and her associates, Klausner found no regular bond between ceremonial usage and sobriety but even noted a tendency, at the cultural level, for usage in religious ceremonies to be associated with heavy drinking in nonreligious situations. The findings also pointed up a connection between heavy drinking in non-religious situations and the use of alcohol in sacrifice (relative to other religious means), especially when religious ceremonies were oriented toward “moral integration and control of the human world.” And regardless of the ceremonial orientation, alcohol was more likely to be used in conjunction with sacrifice than with any other religious means. To account for cultural cases in which there was virtually no drinking beyond the boundaries of ceremonial situations, Klausner suggested—in the light of the ancient symbolic equation of life-giving power, blood, and alcohol—that when blood is considered holy, its symbolic equivalent, alcohol, will not be drunk heavily in secular situations.
Sacrifice as a ceremonial means is, as Klausner has noted, closely linked to the establishment of social solidarity, enabling worshipers to transcend barriers when their solidarity is threatened by sin and guilt. Broadly, then, he sees the widespread use of alcohol in the sacrificial ritual of primitive peoples as suggesting a link between its use and coping with the problem of evil in man’s relationship to man (and God) and proposes that this stamp of meaning most frequently extends to secular drinking situations. Indeed, it is suggested that the modern “cocktail party” exhibits (in its group nature, normative prescriptions, sentiments of betrayal for failure to participate, removal of social distinctions among participants) formal similarities to ancient sacrificial ritual and serves a “guilt-ridding” and integrating function equivalent to that formerly met through these rituals. The proliferation of cocktail parties and related social drinking in contemporary society may be thus viewed as an integrating response to structural breakdowns in society that have left individuals in socially and normatively ambiguous situations with consequent high anxiety.
Interrelationships of factors
Although the comparative studies of drinking in primitive societies touched upon here hardly display the richness of anthropological investigations of particular cultures, they highlight the importance of sociocultural factors in shaping drinking behavior and, without offering a total explanation, are indicative of crucial factors in variation. Moreover, there is reason to think that significant interrelationships exist among the variables brought to light by these studies. For instance, socialization maximizing conflict over dependency needs, as described by Margaret Bacon and her associates, may be functionally linked to the characterological requirements of the kinds of economies identified by Horton as associated with extensive drunkenness. Or, again, the amorphous social organization depicted by Field may intensify dependency conflict and engender acute problems in sustaining the social solidarity emphasized by Klausner. However, substantiation of these probable interrelationships awaits research that treats systematically the interaction of variables provisionally identified as crucially affecting patterns of drinking behavior.
Drinking and alcoholism in complex society
Bold attempts to portray the functions of drinking in complex society have been rare in the writings of social scientists. An exception is Selden Bacon’s (1945) essay depicting large, highly specialized society as broadly “anomic”—characterized by rapid change, lack of normative integration, compartmentalized social controls, the paradox of heightened individualism and functional interdependence, intense competition, mobility, and impersonality. The social value of alcohol is presumably enhanced in this context not only because it affords relief for tension-ridden individuals but also because it offers a needed mechanism of social integration, and the absence of generally held drinking norms is conducive to extremes of drinking. This is a setting that also seems likely to precipitate rapid deterioration and isolation of the person who is prone to excessive drinking and to lend drinking a greater individualistic significance than it is likely to have in better integrated societies.
Although such a portrait is admittedly speculative, there are a number of empirical investigations which have yielded findings consonant with it. Studies in the United States and Canada by E. M. Jellinek (1947) and John R. Seeley (1962), for example, have demonstrated a relationship, within broad cultural limits, between concentration of population, on the one hand, and alcohol consumption and alleged rates of alcoholism, on the other. The research of Richard Jessor and others (1963) has established connections between extreme drinking and peaks of “anomie”—both in the sense of dissociation of cultural goals and means (after Robert K. Merton) and in terms of simple breakdown in normative consensus. Excessive drinkers have also been found, in a scattering of studies, to exhibit signs of anomie and alienation. And alcoholics and incipient alcoholics, as studied by Ralph G. Connor (1962) and Peter Park (1962), evidenced difficulty in structuring their social roles in accordance with the role requirements of an impersonal complex society.
From a historical standpoint, there is evidence of the increasingly widespread use of alcohol in rapidly urbanizing societies such as the United States, although this does not necessarily imply an increase in per capita consumption among drinkers. The United States, like several European countries, experienced a strong temperance movement during the nineteenth and early twentieth centuries. Joseph Gusfield (1962) has suggested that the relative dominance of the abstinence orientation in the United States signified the ascendance in the status structure of a middle class whose values were congruent with the needs of small-scale capitalism and were generally hostile to the expression of emotional impulses. Abstinence was important as a criterion for acceptance in the middle class, and membership in the Woman’s Christian Temperance Union was an important symbol of status in smalltown and rural America in the nineteenth century. Yet, even prior to the repeal of prohibition in the United States in 1933 there had been a decay in the abstinence tradition that reflected deeper shifts in the styles of life and the organization of society. The cosmopolitanism of the new middle classes (Stone 1962) apparently supports a relatively permissive drinking norm, and thus abstinence has undergone devaluation in its status connotations.
At the bottom of the modern urban social structure lies “Skid Row,” which is increasingly an object of study and concern on the part of social scientists (for example, Jackson & Connor 1953; Pittman & Gordon 1958; Rubington 1958; Bogue 1963). In broad sociological perspective, Skid Row may be viewed as embracing varieties of the retreatist mode of adaptation to the anomie of modern society. For several decades its population appears to have been declining, becoming less geographically mobile, and undergoing other demographic changes, although it is still almost exclusively male in composition. A significant proportion of these men are permanent residents—living in the cheap hotels, flophouses, and missions indigenous to the area—and a majority of them are characterized by casual labor, poverty, and homelessness. Although it must be emphasized that only a small fraction of all alcoholics are inhabitants of Skid Row, the incidence of alcoholism and related drinking pathologies, and of other psychiatric and physical disease as well, is unquestionably high among habitues, even though comprehensive statistics are unavailable. While men on Skid Row are largely alienated from the mainstream of social life, popular imagery of complete social isolation needs to be corrected by awareness that Skid Row constitutes a subcultural system, binding men in a complex network of social relationships with distinctive norms and values. This has now been recognized among the better informed as having an important bearing on the outcome of ameliorative approaches to Skid Row—a matter in which the policies and programs of several European nations are in advance of those prevailing in the United States [seeHomelessness].
Group rates of alcoholism
For the most part, recent sociological investigation of drinking in complex society has focused on diverse, fragmentary problems, such as the examination of drinking patterns and pathologies of ethnic groups, age and sex categories, and socioeconomic strata, or has aimed at delimiting the parameters and gross social correlates of drinking through surveys of drinking behavior and attitude among state, regional, or national populations (for example, Gadourek 1963; Lawrence & Maxwell 1962; Mulford & Miller 1960). Although the scope of this article does not allow summarization of the varied findings of these studies, some of them have, potentially, a broader relevance for understanding alcohol problems than might be supposed at first glance. This is because marked differences in rates of alcoholism have unequivocally been established for various subgroups and categories of contemporary society. Although absolute rates of alcoholism are not known with certainty, it has been established, for instance, that there are sex differences in rates (and that sex ratios vary from one social milieu to another) and that there are marked differences in alcoholism rates among ethnic groups. These facts pose problems for social scientists analogous to the problem which Durkheim saw in varying group rates of suicide and likewise seem to call for explanation, in part at least, at the sociocultural level.
An illustration of the broader relevance of specific sociological studies to understanding alcohol problems may be seen in research on the Jews, whose traditional drinking patterns were studied in contrast to those of the Irish by Robert F. Bales (1944) and in the aspect of change by Charles R. Snyder (1958). The case is instructive because alcoholism is rare among Jews, although virtually everyone in the group is exposed to alcohol, and there is no absence of psychic tensions of the sort that may play a role in alcoholism. Moreover, there is sufficient heterogeneity of physical type to make biological immunity implausible. Careful study of the drinking patterns, cultural settings, and incidence of psychic disorders led Bales to the conclusion that the distinctive normative orientation to drinking in traditional Jewish culture accounted for much of the difference in rates of alcoholism between the Jews and groups like the Irish. More generally, it led to the formulation that group rates of alcoholism may be thought of as resultants of the interaction of three major sets of factors: dynamic factors, or the group incidence of acute psychic tensions or needs for adjustment sufficient to provide the driving force in drinking pathologies; alternative factors, or culturally defined possibilities of adopting behavior patterns that are functional equivalents of excessive drinking from the standpoint of relieving acute psychic tensions; and orienting factors, or the kinds of normative attitudes toward drinking itself carried in the cultures of different groups. Although this scheme poses methodological difficulties in application, it offers, heuristically, a more satisfactory provisional framework for analyzing the etiology of alcoholism than do one-sided schemes which neglect either the psychological or the sociocultural dimension.
Predominant type of alcoholism
The important problem of the definition of alcoholism will not be treated in this article; here we will simply note that alcoholism should be distinguished from drinking and even from excessive drinking, and that this matter of definition is very complex.
The extent of alcoholism in primitive societies remains largely unknown. In complex societies, such as the United States and several countries of northern Europe, what Jellinek (1960, p. 37) has referred to as “gamma” alcoholism is the predominant type, “in which (1) acquired increased tissue tolerance to alcohol, (2) adaptive cell metabolism … (3) withdrawal symptoms and ’cravings’ … and (4) loss of control are involved.” Gamma alcoholism is patterned in terms of a definite progression of symptoms (phases), moving from psychological to apparent physical dependence and entailing marked behavioral changes. Jellinek’s research on the drinking of male alcohol addicts found that the symptoms associated with gamma alcoholism could be sequentially arranged into four phases: the prealcoholic symptomatic phase, associated with the relief of personal tension in drinking situations; the prodromal phase, characterized by, among other symptoms, the appearance of repeated blackouts; the crucial phase, identified by the drinker’s loss of control; and the chronic phase, marked by prolonged bouts of intoxication. This view of the phasic development of gamma alcoholism has received some support in other research (Trice & Wahl 1958; Park 1962) and seems to be in accord with typical drinking histories of members of Alcoholics Anonymous. It has certainly colored the thinking of much social science research bearing upon alcoholism and has led not only to the construction of indexes of incipient alcoholism, enabling study of the illness at its inception, but also to the possibility of therapeutic intervention before alcoholism has run its course.
Personality factors
The sociological and related literature on alcoholism runs the gamut of assumptions regarding the relevance of personality factors to the etiology of alcoholism and about their variable or unitary nature, aside from speculation as to the specific factors involved. Moreover, critical reviews by sociologists such as Edwin H. Sutherland and others (1950) and Leonard Syme (1957), who focused on the methodological inadequacies of a host of investigations purporting to identify personality factors in alcoholism, serve to reinforce an attitude of caution in this regard. Nevertheless, recent longitudinal and quasi-longitudinal research that avoids the pitfall of confusing possible consequences of alcoholism with conditions at or prior to its inception (for example, Park 1962; McCord & McCord 1962; Robins et al. 1962) tends, in our judgment, to support the view that disturbances in socialization experience and personality prior to alcoholism are the rule rather than the exception (at least in so-called “Anglo-Saxon” cultures). Taken together with a growing body of retrospective analyses of life histories of alcoholics, these studies strengthen the impression that, without viewing alcoholism as the invariable outcome of a single personality type, certain types of personality under certain environmental stresses are particularly prone to alcoholism as a means of adjustment. Howard Jones’s (1963) diagnostic grouping of alcoholics into types characterized by acute adjustment needs centering on maternal dependence, ego need, social inadequacy, social dependence, escapism, latent homosexuality, and Oedipal fixation is suggestive in this connection. Rather typically, current studies of alcoholism are, like Jones’s, replete with allusions to socialization experiences and personality dynamics in relation to the root problems of early emotional deprivation and dependency conflict.
Prevalence of alcoholism
While there are a variety of ways of estimating the extent of alcoholism in small, circumscribed populations (for example, field studies, analyses of hospital admissions, arrest records), the Jellinek Estimation Formula has been widely used in estimating the prevalence of alcoholism in large populations. This formula is A = (PD/K)R, where A signifies all alcoholics, D reported deaths from cirrhosis of the liver in a given year, P an assumed constant percentage of such deaths attributable to alcoholism (different for men and women), K a constant representing the percentage of all alcoholics-with-complications who die of cirrhosis, and R a presumed ratio of all alcoholics to alcoholics-with-complications in the given time and place. This formula has been criticized (Seeley 1959; Brenner 1959), but Mark Keller (1962) has maintained that the underlying theory of the formula is sound. From statistical data on alcohol consumption and numbers of drinkers, Keller has contended that current alcoholic rate estimates have approximate validity. Although the available data are insufficient to permit exact international comparisons, alcoholism rates for a dozen countries estimated by means of the Jellinek formula for various years in the decade following World War ii show the following rank order (from higher to lower): France, United States, Chile, Sweden, Switzerland, Denmark, Canada, Norway, Finland, Australia, England and Wales, Italy (Alcoholism Research Foundation of Ontario 1958). Keller (1962) has concluded that there were approximately 4,470,000 alcoholics in the United States in 1960. This figure is suggestive of the magnitude of the alcoholism problem, but the costs of alcoholism in all its ramifications from the standpoint of human values are not amenable to precise calculation, although they are certainly enormous.
Social responses to alcoholism
Legislation in the Netherlands and Norway aimed at treating alcoholism dates back to the turn of the century (for accounts of the development of national programs on alcoholism and alcohol problems in Europe, see Tongue 1962; Pittman & Tongue 1963). However, it was not until the 1930s in the United States that a large-scale movement with a treatment orientation toward alcoholism first took shape, with the appearance of Alcoholics Anonymous in 1934 and the establishment of an American Research Council on Alcoholism four years later. In 1940 the first issue of the Quarterly Journal of Studies on Alcohol, a scientific journal dealing with such problems as the physiological, psychosocial, and cultural ramifications of alcohol and alcohol usage, was published at Yale University’s Laboratory of Applied Physiology by the Journal of Studies on Alcohol, Inc. In 1943 the Yale Summer School of Alcohol Studies was established to train persons interested in this field, and in 1945 the National Council on Alcoholism was organized to disseminate information to the general public. This new approach focused on removing the stigma from alcoholism and on making it the object of scientific investigation. In the past the state and local governments had conceived of their roles as controlling the sale of alcohol and punishing the alcoholic offender, whereas the new emphasis predicated alcoholism as a problem of public health. In accordance with this outlook, Oregon, in 1943, became the first state to institute a public health program aimed at alcoholism. By 1965, 42 American states, the District of Columbia, and seven Canadian provinces had official agencies on alcoholism.
It would be a mistake, however, to imply that the public health approach to alcoholism was widespread and always accepted with little or no resistance. Although the repeal of prohibition in 1933 dealt a serious blow to the older “moralistic” view of alcoholism, attitudes which had predominated for generations were not easily discarded. Resistance to the treatment of the alcoholic is indicated by the slow acceptance by many professional health and social welfare personnel of the proposition that alcoholism is a disease requiring their special knowledge and skills. It was not until 1956 that the American Medical Association expressed the opinion that alcoholism should come under the scope of medical practice, that hospitals should make provisions for the care of alcoholics, and that medical interns should be trained in the treatment of alcoholics. In 1957 the association finally gave its official approval to the statement that alcoholism is a disease, and the American Hospital Association also urged that each case of alcoholism be examined individually to determine whether or not the condition was amenable to medical treatment. This represents a notable change from the situation prevailing a generation ago.
Charles R. Snyder and David J. Pittman
BIBLIOGRAPHY
A representative bibliography, indicating the growing number of anthropological studies with a special focus on drinking patterns, may be found in Heath 1958, and an overview of systematic work, particularly in sociology, may be gained from Pittman & Snyder 1962.
Alcoholism Research Foundation of Ontario 1958 Statistics of Alcohol Use and Alcohol in Canada: 1871–1956. Compiled by Robert E. Popham and Wolfgang Schmidt. Univ. of Toronto Press.
Bacon, Margaret K. et al. 1965 A Cross-cultural Study of Drinking. Quarterly Journal of Studies on Alcohol Supplement no. 3.
Bacon, Selden D. 1945 Alcohol and Complex Society. Pages 179–200 in Yale University, Laboratory of Applied Psychology, School of Alcohol Studies, Alcohol, Science and Society. New Haven: Quarterly Journal of Studies on Alcohol.
Bales, Robert F. 1944 The “Fixation Factor” in Alcohol Addiction: An Hypothesis Derived From a Comparative Study of Irish and Jewish Social Norms. Ph.D. dissertation, Harvard Univ.
Bogue, Donald J. 1963 Skid Row in American Cities. Univ. of Chicago, Community and Family Study Center.
Brenner, Berthold 1959 Estimating the Prevalence of Alcoholism: Toward a Modification of the Jellinek Formula. Quarterly Journal of Studies on Alcohol 20: 255–260.
Connor, Ralph G. 1962 The Self-concepts of Alcoholics. Pages 455–467 in David J. Pittman and Charles R. Snyder (editors), Society, Culture, and Drinking Patterns. New York and London: Wiley.
Field, Peter B. 1962 A New Cross-cultural Study of Drunkenness. Pages 48–74 in David J. Pittman and Charles R. Snyder (editors), Society, Culture, and Drinking Patterns. New York and London: Wiley.
Gadourek, Ivan 1963 Riskante gewoonten en zorg voor eigen welzijn (Hazardous Habits and Human Well-being). Groningen (Netherlands): Wolters. → Contains a summary in English.
Gusfield, Joseph R. 1962 Status Conflicts and the Changing Ideologies of the American Temperance Movement. Pages 101–120 in David J. Pittman and Charles R. Snyder (editors), Society, Culture, and Drinking Patterns. New York and London: Wiley.
Heath, Dwight B. 1958 Drinking Patterns of the Bolivian Camba. Quarterly Journal of Studies on Alcohol 19:491–508.
Horton, Donald 1943 The Functions of Alcohol in Primitive Societies: A Cross-cultural Study. Quarterly Journal of Studies on Alcohol 4:199–320.
Jackson, Joan K.; and Connor, Ralph 1953 The Skid Road Alcoholic. Quarterly Journal of Studies on Alcohol 14:468–486.
Jellinek, Elvin M. 1947 Recent Trends in Alcoholism and in Alcohol Consumption. Quarterly Journal of Studies on Alcohol 8:1–42.
Jellinek, Elvin M. 1960 The Disease Concept of Alcoholism. New Haven: Hillhouse Press.
Jessor, Richard et al. 1963 Tri-ethnic Research Project. Research Report No. 25. Unpublished manuscript, Univ. of Colorado.
Jones, Howard 1963 Alcohol Addiction: A PsychoSocial Approach to Abnormal Drinking. London: Tavistock.
Keller, Mark 1962 The Definition of Alcoholism and the Estimation of Its Prevalence. Pages 310–329 in David J. Pittman and Charles R. Snyder (editors), Society, Culture, and Drinking Patterns. New York and London: Wiley.
Klausner, Samuel Z. 1964 Sacred and Profane Meanings of Blood and Alcohol. Journal of Social Psychology 64:27–43.
Lawrence, Joseph J.; and Maxwell, Milton A. 1962 Drinking and Socio-economic Status. Pages 141–145 in David J. Pittman and Charles R. Snyder (editors), Society, Culture, and Drinking Patterns. New York and London: Wiley.
McCord, William; and McCord, Joan 1962 A Longitudinal Study of the Personality of Alcoholics. Pages 413–430 in David J. Pittman and Charles R. Snyder (editors), Society, Culture, and Drinking Patterns. New York and London: Wiley.
Mulford, Harold A.; and Miller, Donald E. 1960 Drinking in Iowa. II: The Extent of Drinking and Selected Sociocultural Categories. Quarterly Journal of Studies on Alcohol 21:26–39.
Park, Peter 1962 Problem Drinking and Role Deviation: A Study in Incipient Alcoholism. Pages 431–454 in David J. Pittman and Charles R. Snyder (editors), Society, Culture, and Drinking Patterns. New York and London: Wiley.
Pittman, David J.; and Gordon, C. Wayne 1958 Revolving Door: A Study of the Chronic Police Case Inebriate. Glencoe, III.: Free Press.
Pittman, David J.; and Snyder, Charles R. (editors) 1962 Society, Culture, and Drinking Patterns. New York and London: Wiley.
Pittman, David J.; and Tongue, Archer (editors) 1963 Handbook of Organizations for Research on Alcohol and Alcoholism Problems. Lausanne (Switzerland): International Bureau Against Alcoholism.
Robins, Lee N.; Bates, William M.; and O’Neal, Patricia 1962 Adult Drinking Patterns of Former Problem Children. Pages 395–412 in David J. Pittman and Charles R. Snyder (editors), Society, Culture, and Drinking Patterns. New York and London: Wiley.
Rubington, Earl 1958 The Chronic Drunkenness Offender. American Academy of Political and Social Sciences, Annals 315:65–72.
Seeley, John R. 1959 Estimating the Prevalence of Alcoholism: A Critical Analysis of the Jellinek Formula. Quarterly Journal of Studies on Alcohol 20: 245–254.
Seeley, John R. 1962 The Ecology of Alcoholism: A Beginning. Pages 330–344 in David J. Pittman and Charles R. Snyder (editors), Society, Culture, and Drinking Patterns. New York and London: Wiley.
Snyder, Charles R. 1958 Alcohol and the Jews, Glencoe, III.: Free Press.
Snyder, Charles R. 1964 Inebriety, Alcoholism, and Anomie. Pages 189–212 in Marshall E. Clinard (editor), Anomie and Deviant Behavior: A Discussion and Critique. New York: Free Press.
Stone, Gregory P. 1962 Drinking Styles and Status Arrangements. Pages 121–140 in David J. Pittman and Charles R. Snyder (editors), Society, Culture, and Drinking Patterns. New York and London: Wiley.
Sutherland, Edwin H.; Shroeder, H. G.; and Tordella, C. L. 1950 Personality Traits and the Alcoholic: A Critique of Existing Studies. Quarterly Journal of Studies on Alcohol 11:547–561.
Syme, Leonard 1957 Personality Characteristics and the Alcoholic: A Critique of Current Studies. Quarterly Journal of Studies on Alcohol 18:288–302.
Tongue, Archer 1962 What the State Does About Alcohol and Alcoholism: An International Survey. Pages 594–600 in David J. Pittman and Charles R. Snyder (editors), Society, Culture, and Drinking Patterns. New York and London: Wiley.
Trice, Harrison M.; and Wahl, J. Richard 1958 A Rank Order Analysis of the Symptoms of Alcoholism. Quarterly Journal of Studies on Alcohol 19:636–648.
Drinking and Alcoholism
Drinking and Alcoholism
Alcohol Consumption. The poor health of most nineteenth-century Americans cannot be separated from their overwhelming consumption of alcoholic beverages. From 1790 to 1840 adult males drank nearly one-half pint of hard liquor each day, more than at any other time in American history. Because of the poor quality of water and milk, and the inordinate expense of tea and coffee, settlers in the West consumed mostly whiskey and cider. They drank these beverages in small amounts with family meals or in communal binge drinking, which generally led to public drunkenness. Settlers transported their drinking habits with them when they moved west of the Appalachians. Far removed from Eastern markets, settlers often used jugs of locally distilled liquor as the standard medium of exchange. Given the scarce opportunities for entertainment on the frontier, practically any occasion where two or three men gathered provided a reason for drinking. Soldiers, traders, fur trappers, and miners all imbibed to excess, and often suffered harsh physical consequences such as nausea, vomiting, and even death as a result. Drinking, it seems, became an integral part of Westerners’ daily activities, leading to gambling, fighting, and, not infrequently, murder. Today, twentieth-century Americans comprehend a little better the psychological effects of alcoholism. However, few understand or even acknowledge how Western settlement occurred in the context not only of constant sickness and disease but in an almost continual state of intoxication.
Whiskey. By 1800 whiskey replaced rum as Americans’ favorite beverage for a variety of reasons. The use of imported sugar in the distilling process made rum, like wine, more expensive than whiskey. During the late eighteenth century Scots-Irish settlers, who had long known how to distill grain, migrated into the western reaches of British America and produced their own whiskey. The opening of agricultural lands in the Upper Midwest during the early nineteenth century created a corn surplus that could then be used to make alcohol. Whiskey, unlike most agricultural products, could be hauled without fear of spoilage. Since settlers in the West were limited to local ingredients in their manufacture of medicines, locally grown foods dominated their diets. As a result they had a rather monotonous diet of pork and corn supplemented by distilled whiskey. Many adhered to the popular notion that alcohol served as an efficient preventive to disease; Westerners sometimes distributed free liquor during cholera and smallpox epidemics because of the belief that alcohol had curative power. Western pioneers also lived in isolation, far from towns and sometimes even far from family. The exhaustive work, loneliness, danger, worry, and even boredom that haunted their lives encouraged many to seek refuge in a whiskey jug, causing the West to develop a reputation for drunkenness that surpassed every other region of the country.
Indian Drinking. Native Americans in Mexico and the Southwest had fermented local plants to make alcohol long before European contact, which they used almost exclusively in religious rituals. However, most natives in North America first obtained alcohol through exchange with white traders. Some of the natives perhaps learned the joys and trials of liquor consumption from some of the heaviest drinkers in the world. Because of its imperishability, liquor became more valuable on the frontier than money, providing a medium of exchange between disparate cultures. Many Indians enjoyed the sense of power and liberation that accompanied drunkenness, even integrating its use into their ceremonies and rituals. At times, when natives experienced the devastation of epidemics, food shortages, and warfare, drinking habits increased, a characteristic response of cultures undergoing rapid transformation. Especially after the 1830s, when federal officials paid Indians in cash for lands they ceded to the government, some natives often bought alcohol rather than invest in agricultural improvements. Natives such as the Kansa even became regular suppliers to other Indians, providing alcohol to their neighbors the Osages and to nomadic bands along the Arkansas River. The image of Indians inebriated on government annuity payments stirred the resentment of whites, fueling the stereotype of “the drunken Indian” that had started during the colonial period.
Temperance Movements. Consumption of spirituous liquor peaked in the 1820s and then plummeted the following decade, reflecting the partial successes of temperance and other reform organizations. Originating in New England, antiliquor crusaders depicted drink as an agent of the devil. Clergymen and civic leaders held monthly meetings where they urged drunkards to “take the pledge” and become abstinent. These reformers cast drunkenness as a family problem since men under the influence often engaged in domestic violence or deprived their families of basic needs after squandering their resources on drink. On the frontier a wave of religious revivalism brought Methodist and Baptist missionaries to the West who exhorted the evils of “Demon Rum” at every opportunity. When more settlers entered the region and began establishing communities, the sense of isolation that had led to alcohol abuse faded amid a new popular movement for abstinence, reinforced by regular camp meetings and temperance sermons. Obviously such efforts never completely succeeded. As a result many reformers campaigned long and hard to convince state and federal legislators to enact prohibition laws. Overall, as churches, schools, and other institutions followed pioneers westward, alcohol use and its accompanying destructive effects tended to decrease.
Indian Prohibition. At the same time that voluntary temperance spread among white Americans, reformers, government officials, and tribal leaders preferred to prohibit alcohol availability altogether in order to combat Indian drinking. Many tribes passed their own legislation to prohibit alcohol use. The nineteenth century also had several federal laws that aimed to eliminate the liquor trade on reservations. An act of 1834 prohibited the introduction of alcohol into Indian country, and an 1847 revision mandated imprisonment for any person providing alcohol to Indians in Indian Territory and denied annuities to any tribe that failed to pledge themselves to abstinence. Yet such laws had power only on federal lands, not in areas under territorial or state governance. Further, these acts proved virtually impossible to enforce, and by maintaining the image of the drunken Indian, federal prohibition policies helped to sour Euro-American/Native American relations. As long as Indians desired drink, suppliers could always be located to sell them liquor, a lesson that Americans learned much more painfully a century later during the era of federal prohibition.
Sources
Peter C. Mancall, “Men, Women, and Alcohol in Indian Villages in the Great Lakes Region in the Early Republic,” Journal of the Early Republic, 15 (1995): 425-448;
Robert J. Miller and Maril Hazlett, “The ‘Drunken Indian’: Myth Distilled into Reality Through Federal Indian Alcohol Policy,” Arizona State Law Journal, 28 (1996): 223-298;
W. J. Rorabaugh, The Alcoholic Republic: An American Tradition (Oxford: Oxford University Press, 1979);
William E. Unrau, White Man’s Wicked Water: The Alcohol Trade and Prohibition in Indian Country, 1802–1892 (Lawrence: University Press of Kansas, 1996).
drinking and alcoholism
Alcoholism was coined as a term to denote a special medically diagnosable condition of serious dependence upon or addiction to alcohol. Dating from the mid-nineteenth century, acceptance of the term is the cornerstone of the self-help philosophy of groups like Alcoholics Anonymous, founded in the United States in the 1930s. Alcoholism has been described in terms of a disease, a genetic disorder, a psychological problem, and as the product of the dysfunctional family. Undoubtedly, drink and its heavy consumption are related to the incidence of petty and serious crime (especially violence and motor accidents), health problems, and workplace injuries. However, the term alcoholism has been justifiably criticized in recent years: the World Health Organization and others would no longer accept its description as a disease, and a broader set of perspectives, including social and cultural theory, now generally inform work on alcohol dependence.