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Introduction As representatives of the scientific community examining and consid- ering the implications of available evidence about alcohol policies, we recognize three peculiar aspects of our topic. First, alcohol is hardly an obscure, socially neutral topic. Two amendments to the Constitution concern alcohol. Intense controversy about drinking has surfaced several times in our history. The controversies have pitted cherished but di- vergent values about the proper role of the state in a free society against concern for vivid human suffering. The resulting strong sentiments make objective evaluation of policies difficult. Second, drinking and its consequences have been the object of careful scientific study for only a short time, and the coverage is spotty. About a few things scientists know quite a lot, because intense public, political, or scientific concern has produced bursts of research. About many other things knowledge is rather superficial, and for some important things only speculation is possible. Third, personal and institutional responses to drinking have been varied. Medical intervention, regulatory action, law enforcement, com- mercial activity, and moral mobilization have all played a role in shaping the contemporary context in which alcohol policy is managed. Given the divergent circumstances of these different responses, there is much honest intellectual disagreement about the nature of the problem, about what information is relevant, and about how to interpret relevant in- formation. In planning and framing our inquiry, we have first had to escape~r

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4 REPORT OF THE PANEL at least loosen~onstraints that follow from the peculiarities noted above. The first type of constraint comes from prior history, which conditions how one conceives the problem and subtly biases one's judg- ment about it. We have found that social policies on alcohol and other matters tend to form and be formed by "governing ideas," in which specific ends and means are fused together into distinct agendas for action, agendas that often crystallize in specific historical programs or movements. When this happens, it is easy to overlook gaps in the seams that bind policy targets, instruments, and outcomes together in a specific historical instance. The seemingly inevitable connection of the temper- ance movement with Prohibition and the disease model of alcoholism with Alcoholics Anonymous furnish convenient, familiar examples. If only one or a small number of potent governing ideas exists in a policy area, any search for alternatives may be reduced to a very narrow range of all-or-none (or all-of-one versus all-of-the-other) choices. To canvass an interesting array of policy options, one must loosen the hold of these . . gOVerIllng 1C teas. The second type of constraint derives from a common confusion about the ends and means of alcohol policy. For many people, drinking as such is the thing to be evaluated as good or bad, apart from its specific consequences. Some see it as fundamentally immoral or morally weak; others see it as a positive sign of modernity, liberal social values, or traditional conviviality. Thus, they evaluate policies as good or bad depending on whether they discourage or encourage drinking. These moral values are important and relevant, since they determine much of the political and social context of drinking and drinking policies. But in guiding an objective analysis of alcohol use and its consequences, they cannot be decisive. It becomes necessary to look beyond these simple conceptions, to evaluate the specific effects of drinking on a more complex set of criteria, including the health, satisfaction, and well-being of drinkers; the economic status of families of drinkersand of those whose livelihood involves the selling of alcohol; the magnitude of public expenditures dealing with alcohol problems and of public receipts from taxes on alcoholic beverages; and the like. Whether drinking increases or decreases is then considered important only as these attributes are affected. Distinguishing drinking per se from the socially relevant con- sequences of drinking and considering drinking itself and attitudes to- ward drinking as intermediate variables in the analysis are difficult but essential steps in studying alternative alcohol policies. The third type of constraint involves the breadth of evidence that might be considered. Once one has held current governing ideas at arm's length, framing them within a history of such ideas and a careful ex-

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Introduction s planation of the complex attributional structure of the problem, it be- comes possible to conceive and seriously consider some alternative or additional approaches. At a conceptual level, one is tempted by a variety of appealing, hypothetical policy ideas. At an empirical level, one is strongly motivated to search the experience of the world for relevant policies and their effects, making both historical and cross-cultural evi- dence interesting. These searches, both logical and empirical, must be disciplined by the limitations of time and resources. This discipline re- quires a conceptual ordering of different kinds of approaches, so that the search for information becomes a systematic sampling of policy approaches within broad categories that seem interesting and appealing. These considerations have guided our inquiry and given shape to this report. Chapters 1, 2, and 3 of the report seek to create some critical distance from current conceptions of and approaches to the problem. Chapter 1 examines the ideas that have guided alcohol policy in the past as well as those now making claims on our credibility. Chapter 2 develops a complex conception of alcohol use and its effects, which seeks to hold the moral qualities of drinking to one side while it explores the under- lying causal systems. Chapter 3 critically reviews current policy ap- proaches in light of the historical experience and the complex conception of the problem, and in light of institutional and normative factors that need to be taken into account. It identifies the broad policy approaches in the domain of prevention that seem worth investigation. Chapters 4, 5, and 6 of the report pick up this agenda, presenting arguments and evidence useful in evaluating the potential of three broad classes of alcohol-related prevention policies. Chapter 4 examines strat- egies focused on the supply of alcoholic beverages and the regulation of drinking premises. Chapter 5 addresses policies that seek to shape drinking practices as such without operating through or on supply chan- nels. And chapter 6 considers policies designed to change the conse- quences of drinking by altering features of the physical and social en- vironment that now create hazards for drinkers. The report concludes with a summary of our judgments about the evidence that is available and the research that is needed; about the practical, normative, and historical considerations that condition our current options; and about the actions that we think are possible, ra- tional, and legitimate in light of our investigations. Readers who are interested above all in our conclusions may proceed directly to the summary. Those who are principally interested in the detailed analysis of particular policy instruments may turn to chapters 4, 5, and 6. Those whose interests in prevention policies are general should begin at the beginning.