CHAPTER 2
ALCOHOL, TOBACCO, AND CAFFEINE—CENTURIES OF USE

Alcohol, tobacco, and caffeine have been used around the world for centuries. They are firmly entrenched in modern life—socially, economically, and politically. Virtually every society uses one or more of these drugs.

Alcohol has been used for medicinal purposes for centuries, primarily for sedation. Until 1842, when modern surgical anesthesia began with the use of ether, only heavy doses of alcohol were consistently effective to ease pain during operations.

Tobacco is a commercially grown plant that contains nicotine, an addictive drug. Nicotine is primarily found in tobacco products, such as cigarettes and chewing tobacco, but is also used in the manufacture of certain pesticides.

Caffeine is the most commonly used stimulant in the world. It comes from several commercially grown plants: beans of the coffee plant; leaves of the tea plant; cocoa beans of the cacao tree, from which chocolate is made; and kola nuts from kola trees, from which the flavoring agent in cola drinks is derived. Caffeine is often added to foods and medications. Compared to alcohol and tobacco, it is only mildly addictive, but caffeine can have effects on behavior and health.

ALCOHOL

Ethyl alcohol (ethanol), the active ingredient in beer, wine, and other liquors, is the oldest known mood-altering or psychoactive drug. It is also the only type of alcohol used as a beverage. Ethanol can cause a feeling of well-being or induce sedation, intoxication, or unconsciousness. It can also produce toxic effects on the body. Other alcohols, including methanol and isopropyl alcohol, can have the same toxic effects as ethanol, but much smaller amounts produce severe negative health effects and often death.

Early Fermentation and Distillation

Prehistoric humans probably "discovered" rather than "invented" alcoholic beverages. With the help of airborne yeast, a fruit or berry mash left in a warm corner of a cave or hut would ferment; that is, the yeast would convert sugars in the fruit to alcohol. Pleased with the effects of the beverages they had unintentionally created, early humans most likely advanced quickly from accidental discovery to intentional production. Archaeological records of the oldest civilizations indicate the presence of wine and beer.

Until about the Middle Ages, most alcoholic beverages were produced only by fermentation and consisted of beers and wines with an alcohol content of up to 14%. When this percentage of alcohol is reached, yeasts die and fermentation stops.

In Europe in the fifteenth century, distillation was used to produce alcoholic beverages stronger than fermented wines and beers. These distilled products were known as spirits of wines (usually referred to as liquors today). Beverages with an alcohol content of 50% or more soon became the choice of those desiring quicker or more potent effects.

The distillation process works as follows: a liquid is heated to the lowest boiling point of one of the compounds it contains. This compound (such as ethanol) then vaporizes. The vapor is cooled and condenses (returns to the liquid state). The liquid condensate is then collected. This process of distillation produces a purer and more concentrated liquid (the condensate) than the liquid in which the condensate initially was found. In the case of liquors, ethanol is separated from water and other substances in which it is dissolved, producing a highly concentrated alcoholic product.

The basic characteristics of alcoholic beverages have remained unchanged from early times. Contemporary alcoholic beverages are little more than old recipes refined by technology and produced in much larger quantities.

Early Uses and Abuses

Beer and wine have been used since ancient times in religious rituals, both as a salute to the gods and as sacred drinks from which humans could receive the "divine" power of alcohol. Alcoholic beverages not only were required in worship and the practice of magic and medicine, but also were central to the celebrations of councils, coronations, war, peacemaking, festivals, hospitality, and the rites of birth, initiation, marriage, and death.

In ancient times, just as today, use of beer and wine sometimes led to drunkenness. One of the earliest tracts on temperance (controlling one's drinking or not drinking at all) was written in Egypt nearly three thousand years ago. These writings can be thought of as similar to present-day pamphlets espousing moderation in alcohol consumption. Similar recommendations were found in early Greek, Roman, Indian, Japanese, and Chinese writings, as well as in the Bible.

Drinking in America

In colonial America people drank much more alcohol than they do today, with estimates ranging from three to seven times more alcohol per person per year. Many drank considerable amounts of liquor daily, especially rum, which was readily available through trade with the West Indies.

Liquor was used to ease the pain and discomfort of numerous illnesses and injuries such as the common cold, fever, broken limbs, toothaches, frostbite, and the like. Parents often gave liquor to children to relieve their minor aches and pains or to help them sleep. It was also part of many social and religious occasions and was used to give courage to some individuals and to reduce tensions in others. Because of the important role alcohol played, taverns rapidly became the social and political centers of towns.

As early as 1619, drunkenness was illegal in the American colony of Virginia. It was punished in various ways: whipping, placement in the stocks, fines, and even wearing a red "D" (for "drunkard"). By the eighteenth century, all classes of people were getting drunk with greater frequency, even though it was well known that alcohol affected the senses and motor skills, and that drunkenness led to increased crime, violence, accidents, and death.

Temperance

In 1784 Dr. Benjamin Rush, a physician and signer of the Declaration of Independence, published a booklet called An Inquiry into the Effects of Ardent Spirits on the Mind and Body. The pamphlet became popular among the growing number of people concerned about the excessive drinking of many Americans. Such concern gave rise to the temperance movement.

The temperance movement in the United States began in the early 1800s and lasted until roughly 1890. By 1833 there were thousands of local temperance societies in the United States. The goal of the temperance movement initially was to promote moderation in the consumption of alcohol. By the 1850s large numbers of people were giving up alcohol completely, and by the 1870s the goal of the temperance movement had become to promote abstinence from alcohol.

Women and churches played a significant role in the growth of temperance organizations. Reformers were concerned about the effects of alcohol on the family, the labor force, and the nation, all of which needed sober participants if they were to remain healthy and productive. Temperance supporters usually saw alcoholism as a problem of personal morality. They believed that the use of alcohol eventually led the user down the path to ruin. Early women's rights activists supported the temperance movement because they recognized a connection between heavy drinking and spousal abuse.

Prohibition

In 1919 reform efforts led to the passage of the Eighteenth Amendment of the U.S. Constitution, which prohibited the "manufacture, sale, or transportation of intoxicating liquors" and their importation and exportation. The Volstead Act of 1919, passed over President Woodrow Wilson's veto, was the Prohibition law that enforced the Eighteenth Amendment.

The Eighteenth Amendment and the Volstead Act did not have the intended effect. Outlawing alcohol did not stop most people from drinking; instead, alcohol was manufactured and sold illegally by gangsters, who organized themselves efficiently and gained considerable political influence from the money they earned. Some of the modern organized crime syndicates operating in the United States can be traced back to Prohibition. In addition, the apparent corruption of government and law-enforcement officials contributed to a decline in citizens' respect for these agencies. During Prohibition, some citizens took matters into their own hands, brewing alcoholic beverages at home in places like attics, sheds, and basements. Other Americans smuggled in alcohol from countries that border the United States—Canada and Mexico. Ultimately, the Eighteenth Amendment was repealed in 1933 with the passage of the Twenty-first Amendment.

Changing Attitudes

As the decades passed, recognition of the dangers of alcohol increased. In 1956 the American Medical

Association endorsed classifying and treating alcoholism as a disease. In 1970 Congress created the National Institute on Alcohol Abuse and Alcoholism, establishing a public commitment to alcohol-related research. During the 1970s, however, many states lowered their drinking age to eighteen when the legal voting age was lowered to this age. The rationale was that if people were old enough to vote or to be drafted into the military at eighteen, they were old enough to drink alcoholic beverages.

Traffic fatalities rose after these laws took effect, and many such accidents involved people between the ages of eighteen and twenty-one who had been drinking and driving. Organizations such as Mothers against Drunk Driving (MADD) and Students against Drunk Driving (SADD) sought to educate the public about the great harm drunk drivers had done to others. As a result, and due to pressure from the federal government, by 1988 all states raised their minimum drinking age to twenty-one. Beginning in 1989, warning labels noting the deleterious effects of alcohol on health were required on all retail containers of alcoholic beverages. Courts began to hold restaurants and bars accountable when they permitted obviously intoxicated patrons to drive.

The National Highway Traffic Safety Administration estimates that laws making twenty-one the minimum drinking age have reduced traffic fatalities involving drivers eighteen to twenty years old by 13% and have saved an estimated 21,887 lives since 1975 (Traffic Safety Facts 2002—Alcohol, National Highway Traffic Safety Administration, 2003). Still, the misuse and abuse of alcohol remain major health and social problems in the world today.

Beneficial and Harmful Health Effects of Moderate Alcohol Consumption

Not all of the effects of alcohol consumption are harmful to health. Table 2.1 shows levels of alcohol consumption that can provide beneficial health effects as well as levels that can provide harmful health effects. The number of scientific studies that support the data listed in each row of the table are noted in the "comment" column.

For example, findings of eighteen studies show that alcohol consumption of less than fourteen grams per day lowered the risk of coronary heart disease (CHD) for both men and women compared to no alcohol consumption. (In the United States, a standard drink contains fourteen grams of alcohol, which is about one five-ounce glass of table wine, one twelve-ounce glass of beer, or 1.5 ounces of eighty-proof gin, vodka, or whiskey.) Risk was lowered the most for women drinking fourteen to twenty-nine grams of alcohol per day and for men drinking twenty-nine to forty-three grams of alcohol per day.

Conversely, alcohol consumption of greater than twelve grams per day in women and twenty-four grams per day in men raised the risk of cirrhosis of the liver, a chronic and sometimes fatal disease in which the liver becomes scarred and does not function properly (see Table 2.1). Additionally, alcohol consumption of greater than thirty grams per day in women was associated with an increased risk in breast cancer.

The national drinking guidelines of the United States, Canada, the United Kingdom, and Scandinavia are shown in Table 2.2, and reflect the concept that alcohol has both beneficial and harmful effects.

TOBACCO

When Christopher Columbus and his crew arrived in the "New World" in 1492, he wrote of the indigenous peoples "perfuming" themselves by puffing on "a lighted firebrand." The Indians inhaled smoke through a Y-shaped tube called a tobaca or tobago, which are thought to be possible origins for the name of the tobacco plant.

As European settlers came to North America, Native Americans introduced them to tobacco, which is indigenous to North America and was an important part of Native American social and religious customs at that time. It was used to communicate with the sacred spirits, to produce visions, and to initiate new shamans (medicine men). Additionally, Native Americans believed that tobacco had medicinal properties, so it was used to treat pain, epilepsy, colds, and headaches.

From Pipes to Cigarettes

The use of tobacco, chewed or smoked in pipes, spread quickly throughout Europe during the sixteenth century. In 1560 Jean Nicot (for whom nicotine is named), counselor to the king of France, introduced tobacco to his country. Ben Jonson (1572-1637), an English poet and dramatist, said, "Tobacco, I do assert … is the most soothing, sovereign and precious weed that ever our dear old mother Earth tendered to the use of man!" Smoking spread as far as Turkey, Russia, and China, although many countries prohibited the use of tobacco.

Despite the disapproval of Louis XIV of France, snuff became fashionable in France during his reign (1643-1715). Snuff is a powdered tobacco that can be chewed, rubbed on the gums, or inhaled through the nose, the process that gave it its name (to snuff means to draw in through the nose).

Cigar smoking was introduced to the United States about 1762. A cigar consists of small rolls of tobacco leaves. Cigars became very popular, and by 1898 the yearly U.S. consumption of cigars exceeded four billion, according to various tobacco-related Web sites.

Cigarettes, narrow tubes of cut tobacco enclosed in paper, originated in Brazil during the early 1800s. By the mid-1800s cigarette smoking was popular in Spain, France, and the United States, although most American tobacco users smoked cigars or chewed tobacco. In 1881, however, the cigarette-making machine was invented. It could manufacture 200 cigarettes per minute, or 120,000 in a ten-hour day. Ultimately, mass production meant that cigarettes could be produced more cheaply and in larger numbers.

Antismoking Movements

Despite its widespread popularity, tobacco use was not always greeted with enthusiastic approval. James I of England (1603-1625) personally disapproved of tobacco use, forbade tobacco planting in England, and taxed the importation of tobacco. Russia and Turkey outlawed the use of tobacco, imposing penalties of mutilation or even death. A 1683 Chinese law threatened tobacco users with beheading. Frederick the Great of Prussia forbade his mother to use snuff at his 1790 coronation. Louis XV banned snuff from the court of France.

Popes Innocent X and Urban VIII excommunicated smokers from the Roman Catholic Church. Queen Victoria of the United Kingdom (1837-1901) hated the tobacco habit and tried unsuccessfully to outlaw it from the British army. Sylvester Graham (1794-1851), an early health advocate and inventor of the Graham cracker, advised total abstinence from both alcohol and tobacco in order to maintain good health.

Antismoking Efforts in the United States

In the United States the first antismoking movement was organized in the 1830s (just as the temperance movement was growing in the country). In his book For Your Own Good: The Anti-Smoking Crusade and the Tyranny of Public Health (New York: Free Press, 1998), Jacob Sullum describes preachers lecturing on the evils of "the filthy weed" and maintaining that smokers were "men possessed, who are in need of exorcising." Reformers characterized tobacco as an unhealthy and even fatal habit. Tobacco use was linked to increased alcohol use and lack of cleanliness. Antismoking reformers also suggested that tobacco exhausted the soil, wasted money, and promoted laziness, promiscuity, and profanity. It was even blamed for causing baldness and the reading of novels, then considered an unwholesome pastime.

The Civil War (1861-65) and the Spanish-American War (1898)—and the political and social changes that came with them—further challenged reform movements. In 1892 reformers petitioned Congress to prohibit the manufacture, import, and sale of cigarettes. The Senate Committee on Epidemic Diseases agreed that cigarette use was a public health concern but concluded that each state must regulate tobacco matters for itself. By the late 1800s, four states had outlawed cigarette sales to both adults and minors. These bans were later lifted.

Cigarette usage increased dramatically in the early 1900s, with total consumption increasing from 2.5 billion in 1901 to 13.2 billion in 1912, according to the Centers for Disease Control and Prevention (CDC). By 1919 cigarette consumption reached forty-eight billion. In 1913 the R. J. Reynolds company introduced Camel cigarettes, an event that is often called the birth of the modern cigarette. During World War I (1914-18) cigarettes were shipped to troops fighting overseas (this also occurred during World War II from 1939 to 1945). They were included in soldiers' rations and were dispensed by groups such as the American Red Cross and the Young Men's Christian Association (YMCA). As a sign of rebellion, women began openly smoking in larger numbers as well, something tobacco companies surely noticed. In 1919 the first advertisement featuring a woman smoking cigarettes appeared.

In July 1957, following a joint report by the National Cancer Institute, the National Heart Institute, the American Cancer Society, and the American Heart Association, U.S. Surgeon General Leroy E. Burney (a smoker himself) delivered a cautious statement that "the weight of the evidence is increasingly pointing in one direction: that excessive smoking is one of the causative factors in lung cancer." Nevertheless, cigarette ads of the 1950s touted cigarette smoking as pleasurable, sexy, relaxing, flavorful, and fun.

On January 11, 1964, Luther L. Terry released the first Surgeon General's Report on Smoking and Health. This landmark document was America's first widely publicized official recognition that cigarette smoking is a cause of cancer and other serious diseases. On the basis of more than seven thousand scientific articles, the report concluded that cigarette smoking is a cause of lung cancer and laryngeal cancer in men, a probable cause of lung cancer in women, and the most important cause of chronic bronchitis.

Increased attention was paid to the potential health risks of smoking throughout the rest of the 1960s and the 1970s. The first health warnings appeared on cigarette packages in 1966. In 1970 the World Health Organization (WHO) took a public stand against smoking. On January 1, 1971, the Cigarette Act of 1969 went into effect, removing cigarette advertising from radio and television. A growing number of individuals, cities, and states filed lawsuits against American tobacco companies. Some individuals claimed they had been deceived about the potential harm of smoking. Some states filed lawsuits to recoup money spent on smokers' Medicaid bills. In 1998 forty-six states, five territories, and the District of Columbia signed an agreement (Master Settlement Agreement) with the major tobacco companies to settle all state lawsuits for $206 billion. Excluded from the settlement were Florida, Minnesota, Mississippi, and Texas, which had already concluded previous settlements with the tobacco industry. (See Chapter 8 for more information on the Master Settlement Agreement.)

CAFFEINE

Stone Age peoples were probably familiar with most of the caffeine-producing plants. Early humans chewed the leaves, bark, and seeds of many plants and learned to enjoy the sensations of alertness and elevated mood produced by some. Consequently, caffeine-producing plants were cultivated widely from early times. It was not until much later, however, that people discovered that steeping the plants in hot water released more of the stimulant. From that discovery came all of the present-day caffeinated beverages, including coffee, tea, colas, and cocoa.

Coffee

As early as the sixth century C.E. (Common Era), Ethiopians were cultivating the coffee plant and chewing its berries, although the first written record of coffee was found in tenth-century Arabic documents. At first the berries were mashed, fermented, and made into a wine called qahwah. It was not until five hundred years later that the Arabians began to brew a hot beverage from roasted coffee beans. They called this beverage qahwah as well, from which the word coffee is derived.

In the 1600s the Dutch established coffee plantations on Java, an island of Indonesia. By the mid-1700s the French and British did the same in their Caribbean colonies. Coffee cultivation spread from the Caribbean islands to Central and South America, and by the early 1800s Brazil was the major producer and exporter of coffee. By the mid-1800s the United States was the largest consumer of coffee, using more than three-quarters of the world's production of this beverage. At that time more than half the coffee consumed in the United States was imported from Brazil.

By the twenty-first century the United States was still the largest consumer of coffee, using annually about one-fifth of all the coffee grown in the world. Other leading coffee consumers are Brazil, France, the United Kingdom, Italy, and Japan. Although Brazil produces about one-fourth of the world's coffee, the crop is vital to the economies of many Latin American countries.

Tea

Tea, called ch'a (or t'e, pronounced "tay" in the Chinese Amoy dialect), may have been used in China as early as five thousand years ago. Around 600 C.E., many aspects of Chinese culture, including tea drinking, spread to Japan, although tea would not become a regular part of Japanese life for another seven hundred years.

In the seventeenth century Dutch traders with China introduced tea to Europeans. Although tea was very expensive, its popularity spread quickly throughout Europe, and in some areas tea became more popular than coffee. Tea was particularly popular in the North American colonies, where a visitor in the 1760s reported that American women "would rather go without their dinners than without a dish of tea."

During the colonial period the British, through their East India Company, had a virtual monopoly on the importation of tea, most of which came from China. The British levied a special tax on tea and other items imported into the American colonies. This tax became a rallying point for colonists dissatisfied with British rule, and Americans began a tea boycott, primarily using coffee as a substitute. They also destroyed cargoes of tea. On December 16, 1773, a group of citizens disguised themselves as Mohawk Indians, boarded three ships in Boston Harbor, and dumped the cargoes of tea overboard. This incident, known as the Boston Tea Party, and the reprisals undertaken by the British government against the colonists, helped consolidate resistance to British rule and ultimately hastened the start of the American Revolutionary War (1775-83).

During the early 1800s the popularity of tea declined in Britain because of high taxation (the tax on tea was fifteen times the domestic tax on coffee). As a result, between 1800 and 1840, coffee use grew tenfold, and coffee became more widely used than tea. A series of coffee adulteration scandals (situations in which contaminants were added to coffee) and reductions in the tea tax led many people to return to tea drinking in the mid-1800s. Today, the countries that consume the most tea per capita include India, Indonesia, Kenya, Sri Lanka, China, Japan, the United Kingdom, Australia, and New Zealand.

Cacao and Kola (Chocolate and Colas)

Both the cacao bean and the kola nut are longtime companions of humans. Cacao (from which the word cocoa is derived) is native to Central and South America; as early as 1000 b.c.e. the Mayas, Toltecs, and Aztecs made a drink from roasted cacao beans. On one of his voyages to the New World, Christopher Columbus was served a cacao drink. Since it was unsweetened, however, he found it unpleasantly bitter. Later, in Mexico, Hernando Cortés tasted the chocolate drink of the Aztecs, who sweetened theirs with honey and added spices and vanilla. Cortés liked it so much that he took cacao powder back to Europe with him. Europeans who could afford cacao powder liked to drink this chocolate beverage as well. Even before coffee and tea were introduced to Europe, wealthy Europeans were drinking hot chocolate.

In the early 1800s the Dutch learned to make cocoa powder from cacao beans. The English learned to make solid dark chocolate and, later, solid milk chocolate. Today, people all over the world enjoy chocolate in hot and cold drinks, cakes, pies, ice cream, candies, and other sweets.

Kola trees are native to West Africa, where the inhabitants chewed the kola nuts to enjoy the stimulating flavor. The kola nut was first used in a beverage in the United States in the mid-1800s. Although carbonated "soft" drinks (called that to differentiate them from "hard" alcoholic drinks) were popular in the United States in the early 1800s, they were usually made from local herbs, roots, and other flavorings. A pharmacist in Georgia created the first cola soft drink in the 1880s, making syrup from coca leaves (from which cocaine is derived), kola nuts, citrus flavoring, cinnamon, and other spices and flavorings. At first, the syrup was mixed with plain water to make the drink, but some enterprising person tried mixing it with carbonated water. The result was the first successful soft drink, Coca-Cola, followed closely by other brands with slightly different formulas.

Caffeine in Modern America

A wide variety of caffeinated beverages are popular in the United States. Soft drinks are very popular, and many soft drinks on the market today contain caffeine. Americans have more than doubled their consumption of carbonated soft drinks since 1966. According to U.S. Department of Agriculture figures, the consumption of carbonated soft drinks increased from 20.3 gallons per person in 1966 to 46.4 gallons per person in 2003. Americans have also increased their annual consumption of tea, from 6.5 gallons per person in 1966 to 7.6 gallons in 2003. However, Americans have reduced their coffee consumption during the same time span. In 1966 per capita consumption of coffee was 35.7 gallons. In 2003 per capita consumption was 24.3 gallons. The rise in tea consumption could be related to sales of green tea, a beverage deemed healthy because it is rich in antioxidants. Although coffee consumption is down, Americans are drinking more specialty coffees, now thought to be an estimated $7 billion industry. Caffeine appears to have a significant place in the diet of many Americans.