Items in cart [0]
| [ Top of Page ] [ Home ] [ Contact Us ] [ Help ] [ The National Academies Home ] | ||
Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page R1
ALCOHOL AND
PUBLIC POLICY
Beyond the Shadow
of Prohibition
PANEL ON ALTERNATIVE POLICIES AFFECTING
THE PREVENTION OF ALCOHOL ABUSE AND ALCOHOLISM
Mark H. Moore and Dean R. Gerstein,
Editors
Committee on Substance Abuse and Habitual Behavior
Assembly of Behavioral and Social Sciences
National Research Counci I
NATIONAL ACADEMY PRESS
Washington, D.C. 1981
OCR for page R2
NOTICE: The project that is the subject of this report was approved by the Governing
Board of the National Research Council, whose members are drawn from the councils
of the National Academy of Sciences, the National Academy of Engineering, and the
Institute of Medicine. The members of the committee responsible for the report were
chosen for their special competences and with regard for appropriate balance.
This report has been reviewed by a group other than the authors according to procedures
approved by a Report Review Committee consisting of members of the National Academy
of Sciences, the National Academy of Engineering, and the Institute of Medicine.
The National Research Council was established by the National Academy of Sciences
in 1916 to associate the broad community of science and technology with the Academy's
purposes of furthering knowledge and of advising the federal government. The Council
operates in accordance with general policies determined by the Academy under the au-
thority of its congressional charter of 1863, which establishes the Academy as a private,
nonprofit, self-governing membership corporation. The Council has become the principal
operating agency of both the National Academy of Sciences and the National Academy
of Engineering in the conduct of their services to the government, the public, and the
scientific and engineering communities. It is administered jointly by both Academies and
the Institute of Medicine. The National Academy of Engineering and the Institute of
Medicine were established in 1964 and 1970, respectively, under the charter of the National
Academy of Sciences.
Library of Congress Cataloging in Publication Data
Main entry under title:
Alcohol and public policy.
Includes 7 studies commissioned by the panel.
1. Alcoholism~overnment policy United States-
Addresses, essays, lectures. I. Moore, Mark
Harrison. II. Gerstein, Dean R. III. National
Research Council (U.S.~. Panel on Alternative
Policies Affecting the Prevention of Alcohol Abuse
and Alcoholism. [DNLM: 1. Alcoholism Prevention
and control. WM 274 P19lb]
HV5292.B49 362.2'9256'0973 81-11217
ISBN 0-309-03149-4 AACR2
Available from
NATIONAL ACADEMY PRESS
2101 Constitution Avenue, N.W.
Washington, D.C. 20418
Printed in the United States of America
First Printing, October 1981
Second Printing, October 1988
OCR for page R3
PANEL ON ALTERNATIVE POLICIES AFFECTING
THE PREVENTION OF ALCOHOL ABUSE AND
ALCOHOLISM
MARK H. MOORE (Chair), John F. Kennedy School of Government,
Harvard University
GAIL B. ALLEN. Department of Psychiatry, St. Luke s-Roosevelt Hos-
pital Center, New York
D A N E . B E A U C H A M P. Department of Health Administration, School
of Public Health, University of North Carolina
PHILIP J. COOK, Institute of Policy Sciences, Duke University
JOHN KAPEAN. School of Law, Stanford University
NATHAN MACCOBY Institute for Communication Research, Stanford
University
DAV! D MUSTO . Child Study Center and Department of History, Yale
University
ROBIN ROOM. Social Research Group, School of Public Health, Uni-
versity of California, Berkeley
THOMAS C. SCHELEING. John F. Kennedy School of Government,
Harvard University
WOLFGANG SCHMIDT. Social Sciences Department, Alcoholism and
Drug Addiction Research Foundation, Toronto
NORMAN SCOTCH. Department of Socio-Medical Sciences and Com-
munity Medicine, School of Medicine Boston University
DONALD J. TREIMAN. Department of Sociology, University of Cali-
fornia. Los Angeles
JACQUELINE P. WISEMAN Department of Sociology. University of
California San Diego
DEAN R. GERSTEIN. Study Director
. . .
OCR for page R4
OCR for page R5
Preface
The Panel on Alternative Policies Affecting the Prevention of Alcohol
Abuse and Alcoholism was charged by its sponsor, the National Institute
on Alcohol Abuse and Alcoholism (NIAAA), to produce a systematic
analysis of alternative policies affecting the prevention of alcohol abuse
and alcoholism. Prevention is not, of course, a new idea in the alcohol
field. It has turned up with increasing frequency in recent years as an
attractive way to think about an intractable issue. There are a number
of recent reports from committees, both domestic (Plaut 1967, Wilkinson
1970, Joint Committee of the States 1973, Medicine in the Public Interest
1979) and international (Bruun et al. 1975, World Health Organization
1980), in which prevention ideas have had a prominent place. A chapter
on prevention was included in each of the last three official reports to
Congress on alcohol and health (National Institute on Alcohol Abuse
and Alcoholism 1974, 1978, 1981~.
Despite all this attention it seemed to us- and to those at the NIAAA
and on the Committee on Substance Abuse and Habitual Behavior who
chartered our project that the concept of prevention policies had not
been systematically developed. The particular kinds of interventions,
the nature of the arguments that could be made, and the assessment of
existing evidence on the effectiveness of various instruments could all
profit from sustained consideration. The panel was assembled, com-
prising experts in the study of alcohol problems prevention methods
used in other fields and other relevant academic disciplines to lend
structure and content to this inquiry. Our concerns were not entirely
abstract or academics however. In formulating ideas about prevention
v
OCR for page R6
V1
Preface
policies, we sought to ground our thinking in the existing historical and
institutional context.
In view of the expansive territory of policies affecting prevention, we
could hardly expect to cover intensively every possible track within it.
We have therefore taken the role of scientific survey party: systemati-
cally noting the lay of the land; describing the prominent features; ex-
amining closely and marking for further attention conformations that
seemed especially interesting and accessible. We have had to invent
some of our survey equipment along the way. In particular, our typology
of policies for modifying alcohol's effects did not come to us ready-made
but was crafted over the course of writing, intensive discussion, and
rewriting. The result, we hope, strikes a useful balance of the mandates
to be systematic, analytical, disciplined and crisp.
We have had considerable help in writing this report from seven
studies commissioned by the panel, discussed at length during our de-
liberations, revised by the authors, and published in this volume. Two
of these studies were written to help get us under way by concisely
summarizing the relevant historical and scientific background. The first
of these, by Paul Aaron and David Musto, is an overview of drinking
in U.S. political and cultural history, beginning with colonial times and
concluding with some speculations about the possible impact of current
social movements on drinking policies and practices. This paper was an
important element in building the perspective of the first, historical
chapter of this report and especially in tempering our understanding of
the Prohibition experience. In the second paper, Dean Gerstein de-
scribes the principal methodological and conceptual controversies that
surround the measurement and evaluation of alcohol use and its con-
sequences, including the interaction of drinking with a variety of envi-
ronments: biological, physical, and social. This paper was a starting
point in the development of our second chapter, on the structure of the
alcohol problem.
Dan Beauchamp's analysis of the closely studied 1969 Alcohol Act
in Finland provides a general perspective on the strategic limits to al-
cohol-related policy choices available to democratic governments. This
analysis points toward the concerns involved in the transition from def-
inition of the problem to specific policy proposals. In this sense, Beau-
champ's work speaks to our third chapter, regarding perspectives on
. .
current po lcles.
The papers written by Philip Cook, John Hochheimer, and David
Reed address the efficacy of several of the better-known policy instru-
ments that might be (and have been) used to prevent alcohol problems.
Cook focuses on the effects of controlling alcoholic beverage market
prices by taxation. Hochheimer analyzes the use of educational media
OCR for page R7
Preface
. .
V11
and personnel (and the educational use of media and personnel) to
reduce alcohol abuse. Reed discusses the use of deterrence, education,
risk reduction, and mixed strategies for handling drinking-driving prob-
lems. Finally, James Mosher and Joseph Mottl examine the surprisingly
extensive roles of government agencies not specifically concerned with
alcohol in affecting drinking behavior and consequences. These four
papers were quite instrumental in developing the analyses of specific
policy alternatives in chapters 4 through 6.
In short, the commissioned papers, with their more extensive consid-
eration of many of the points covered in our report, have enabled the
report to be written more efficiently and with a broader understanding
than might otherwise have been possible. While the panel does not
necessarily concur in every detail of what the supporting papers have
to say, we are pleased to include them, to indicate points of concurrence
in the text of the report, and to encourage readers to turn to these
studies for further insight into the specific areas covered.
We are grateful to the many other people who have contributed to
this venture. The participants in the panel's Workshop on Alcohol Pol-
icies held May 15-17, 198~Kettil Bruun, Daniel Horn, H. Laurence
Ross, Gerald Wilde, Joseph Gusfield, Klaus Makela, Phil Davies, and
Irmgard Vogt helped to inform and shape the panel's report. Individ-
ual reviewers read and constructively criticized drafts of the report. The
library and administrative offices of the National Academy of Sciences
provided needed assistance. In the Assembly of Behavioral and Social
Sciences, David Goslin? executive director, and Eugenia Grohman, as-
sociate director for reports, gave expert guidance; Christine McShane,
editor, and Elaine McGarraugh, editorial assistant, polished the report
and papers and prepared the volume for publication. And at NIAAA,
the project management staff? especially David Promisel, provided sup-
port and encouragement.
This project has benefited from start to finish from the good judgment
and dedication of the staff of the Committee on Substance Abuse and
Habitual Behavior: Marie Clark' administrative secretary; Beverly
Blakey and Charlotte Simpson, secretaries; Deborah Maloff, research
associate; and the committee's study director? Peter Levison. It only
remains for me to acknowledge the hard, essential work of the panel
itself, and of the study director and coeditor of this volume, Dean
Gerstein.
MARK H. MOORE. Chair
Panel on Alternative Policies Affecting the
Prevention of Alcohol Abuse and Alcoholism
OCR for page R8
OCR for page R9
Contents
REPORT OF THE PANEL
INTRODUCTION
1 SIMPLIFYING CONCEPTIONS OF ALCOHOL PROBLEMS
AND POLICIES
Governing Ideas, 8
Minority Conceptions? 12
Conclusion, 15
2 THE NATURE OF ALCOHOL PROBLEMS
Effects of Drinking, 20
Underlying Patterns of Drinking Practices, 24
Definition of Drinking Practices, 24; Consumption:
Quantity and Frequency, 27; Stability of Individual
Drinking Practices, 39; Causes of Drinking Practices, 40
The Problem of Attributing Effects, 42
Conclusion: Avenues for Affecting Alcohol Problems, 44
3
6
16
3 PERSPECTIVES ON CURRENT ALCOHOL POLICIES 48
Current Alcohol Policies and Institutions, 48
The Prima Facie Case for Prevention, 50
The Definition of Prevention Policies, 52
Objections to Prevention Policies, 55
IX
OCR for page R10
Categories of Prevention Policies, 58
Summary and Conclusion, 59
4 REGULATING THE SUPPLY OF ALCOHOElC BEVERAGES
The Lessons of Prohibition, 62
Current Institutions and Policies, 64
The Single Distribution Theory, 66
Taxation and Prices, 68
Controlling Off-Premise Retail Sales, 73
Controlling On-Premise Sales, 75
Minimum Age Restrictions, 76
Conclusion, 78
SHAPING DRINKING PRACTICES DIRECTLY
Concepts of Safer and More Appropriate Drinking, 81
Drinking Practices and the Law, 83
Drunken Driving and the Law, 83; Public
Drunkenness, 87
Education, Information, and Training Programs, 89
School Education Programs, 90; Mass Media Informa-
tion Campaigns, 92; Community-Based Health Informa-
tion and Training, 93; Conclusions About Education, In-
formation, and Training Programs, 96
Setting a Good Example: A Note on Symbolic Effects of
Government Actions, 96
Conclusion, 98
6 REDUCING ENVIRONMENTAL RISK
Damage in the Physical Environment, 102
Physical Safety Measures, 102; Social Safety Measures,
105
Damage in the Social Environment, 106
Victimization, 106; Public Drunkenness and the Urban
Environment, 106; Deemphasizing Hostility, 107
Conclusion, 109
SUMMARY
RE FE R EN C E S
Contents
79
100
112
117
OCR for page R11
Contents
COMMISSI ONED PAPERS
TEMPERANCE AND PROHIBITION IN AMERICA:
A HISTORICAL OVERVIEW
Paul Aaron and David Musto
ALCOHOL USE AND CONSEQUENCES
Dean R. Gerstein
THE PARADOX OF ALCOHOL POLICY: THE CASE OF
THE 1969 ALCOHOL ACT IN FINLAND
Dan E. Beauchamp
THE EFFECT OF LIQUOR TAXES ON DRINKING
CIRRHOSIS, AND AUTO ACCIDENTS
Philip J. Cook
REDUCING ALCOHOL ABUSE: A CRITICAL REVIEW
OF EDUCATIONAL STRATEGIES
John L. Hochheimer
REDUCING THE COSTS OF DRINKING AND DRIVING
David S. Reed
THE ROLE OF NONALCOHOL AGENCIES IN FEDERAL REG-
ULATION OF DRINKING BEHAVIOR AND CONSEQUENCES
James F. Mosher and Joseph R. Mottl
BIOGRAPHICAL SKETCHES OF PANEL MEMBERS
AND STAFF
X1
127
182
225
255
286
336
388
459
OCR for page R12
Tables
1. Distribution of Alcohol Consumption by Adults in the
United States
2. Average Daily Consumption and Number of "Drunk Days"
Per Year in a Sample of Air Force Men
3. "Drunk Days" Within Different Levels of Average Con-
sumption in a Sample of Air Force Men
4. Changes in Apparent Consumption of Absolute Alcohol in
20 Countries by the Population Aged 15 Years and Over
5. Where, When, and With Whom People Drink (Drinking
Contexts), by Age of Drinker
6. Alcohol Incidents by Total Consumption Level in a Sample
of Air Force Men
7. Percentage of U.S. Population Experiencing Different Prob-
lems Associated With Drinking, by Level of Consumption
S. Contribution of Different Consuming Groups to Reported
Experience of Problems
9. Ranking of 39 "Test Cases" of Alcohol Tax Increases by Net
Percentage of Change in Rates of Liquor Consumption,
Highway Deaths, and Cirrhosis Deaths
. ~
X11
28
30
33
36
38
44
45
45
71
OCR for page R13
F.
1gures
1. Schematic View of the Relationship Between Drinking and
Consequences of Alcohol
2. Important Effects of Drinking and Policies for Dealing With
Drinking
3. Relationship Between Average Daily Consumption and
"Drunk Days" in a Sample of Air Force Men
4. Time Trends of U.S. Consumption of Absolute Alcohol,
Cirrhosis Death Rate, and Alcoholism Death Rate in the
Drinking Age Population, 183~1977
5. Reported Drinking Status of Men and Women in College
and 25 Years Later
6. Schematic View of the Causal System Underlying Alcohol
Problems
. . .
x~
18
22
31
35
39
46
OCR for page R14