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REPORT
OF THE
PANEL
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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 drinkers—and 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.
Representative terms from entire chapter:
policy approaches
