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OCR for page 95
8
Reducing
Environmental
1~1~1\
TO MAfTER HOW EFFECTIVE an educational campaign, no
|\ | matter how the availability of alcohol is changed, some
people will still drink in dangerous, careless, or just un-
lucky ways. As a result, alcohol-related problems will always
occur. But there is another way to reduce the number or severity
of these problems. This third category of preventive instru-
ments does not focus on how much or where people drink, as
do educational programs, increased taxation, and so on. In-
stead, these preventive actions ask how the physical and social
environment might be changed to protect people from the
harmful consequences of drinking.
Changing the environment rather than behavior has long
been seen as a way to protect people from their own actions,
and not only in the area of drinking. "When we have a dan-
gerous traffic intersection we very seldom mount a campaign
to educate the public about the dangers of the intersection,"
says Robert Reynolds of San Diego County's Department of
Health Services. "Instead, we install a traffic light or in serious
instances we construct an overpass. In short, we alter the phys-
ical environment in lieu of attempting to modify individual
behavior through increased awareness of the problem."
, . . ~
95
OCR for page 96
96 / ALCOHOL IN AMERICA
Such steps to make the environment more forgiving benefit
everyone, not just those who have been drinking. Drunkenness
is only one of a number of impairments, including fatigue,
absent-mindeclness, illness, anger, or previous minor injuries,
that can increase the danger in certain activities. If the world
is made safer for people who have been drinking, it is made
safer for everyone.
Changes in the Physical Environment
Accidents are a major cause of death in the United States.
Approximately 100,000 people die each year as a result of ac-
cidents—about ~ in every 20 deaths. Many more people are left
with serious injuries, some of which will impair them for the
rest of their lives.
As noted in Chapter 3, roughly half of these 100,000 acci-
dental deaths per year involve motor vehicles. But that leaves
in excess of 50,000 deaths a year that are caused by other kinds
of accidents falls, fires, cirownings, and so on. Limited studies
have suggested that alcohol may be involved in as many or
more—of these deaths as in traffic accidents. This is a hard
statistic to pin down, however, because blood alcohol mea-
surements, which are routinely made after traffic accidents, are
not as commonly made after other kinds of fatal acciclents.
The most efficient physical devices now available for pre-
venting accidental deaths are passive restraints in automobiles.
If every automobile were equipped with airbags or automatic
restraining belts, a substantial fraction of the people now killed
in traffic accidents wouIcl be saved. Just how many people
would be saved, and at what economic and social costs, have
long been subjects of debate within government and the au-
tomobile industry.
Other environmental modifications could also have a signif-
icant effect on safety. An example is that of fires in homes
caused by cigarettes and other smoking materials. Accorcling
to James Mosher and Joseph Mott] of the University of Cali-
fornia at Berkeley, residential fires caused by smoking "are
surprisingly common in the Unitecl States." In ~L97S, according
to the U.S. Fire Administration, some 70,000 smoking-related
OCR for page 97
REDUCING ENVIRONMENTAL RISK / 97
Fires and other accidents kill as many people as do traffic accidents, and similar
proportions of these deaths may be related to alcohol abuse.
fires caused 1,800 deaths, 4,000 injuries, and $130 million in
economic losses. The U.S. per capita rate of fire deaths is one
of the highest in the world. Moreover, note Mosher and MottI,
alcohol is involved in many of these cleaths. In one study in
Maryland, 67 percent of the people aged 30-59 killed in resi-
dential fires were legally drunk.
There are many ways to reduce the risk of residential fires
in the United States. According to Mosher and MottI, manu-
facturers of home furnishings and cigarettes do not use a variety
of fireproofing techniques that are available. For instance, for
several years the Consumer Product Safety Commission sought
to institute regulations requiring that cigarettes be manufac-
tured to go out if not smoked within a few minutes. These
proposals were backed by most of the major fire prevention
lobbying groups. But the cigarette industry exerted enough
pressure to keep them from becoming law.
OCR for page 98
98 / ALCOHOL IN~ERICA
The debates over passive restraints in automobiles and self-
extinguishing cigarettes are two examples of how public policy
affecting safety is established in the United States. The process
involves a delicate balancing of concern for the public, pressures
from private inclustry, and general ideas about the role of gov-
ernment in society. It is a clifficult, inevitably political process.
Yet in the area of alcohol-related problems it determines the
realm in which preventive initiatives will be able to take effect.
The Government's Role in Safety
Since the federal government passed the Pure Food and Drug
Act in 1906, its involvement in various aspects of safety has
continually increased. Today a variety of federal, state, and local
governmental agencies are charged with safeguarding the pub-
lic health. At the federal level these include the Occupational
Safety and Health Administration, the Consumer Product Safety
Commission, the Food and Drug Administration, the Environ-
mental Protection Agency, the National Highway Traffic Safety
Administration, the Nuclear Regulatory Commission, and the
National Transportation Safety Board. Many other agencies
within the federal government have also been given heightened
responsibilities for safety.
This increased involvement with safety has had a measurable
impact on mortality rates. "The federal concern for safety has
made our society much safer than it was at the turn of the
century in at least some regards," write Mosher and MottI.
"Working conditions in many industries have become less haz-
ardous; dangerous pesticides and canning chemicals have been
banned; the number of fatal accidents (including automobile
deaths) has been reduced by nearly one-half proportionate to
the population."
But this expansion of governmental oversight has not come
without controversy. "While reducing potential risks of harm
may be a proper goal for government, providing overprotection
has its own social costs," write Mosher and MottI. "Individual
freedoms may be jeoparclized; creativity, both of individuals
and business, may be stifled; the viability of a small business
may be eroded by the prohibitive costs of safety requirements.
OCR for page 99
REDUCING ENVIRONMENTAL RISK / 99
Defining when and how to intervene to promote safety, then,
-
is an important topic of current federal practice."
Consider the case of passive restraints in automobiles. The
government has a number of options to try to encourage their
use. It can educate consumers to buy or demand them. It can
sponsor research to improve them. It can tax automobiles that
do not have them. It can require that manufacturers offer them
as options. It can require them outright. Or, if the government
sees the costs of action as too high, it can do nothing.
Not all governmental initiatives involve as much controversy
as do passive restraints in automobiles. In fact, Mosher and
Mott! believe that many federal agencies are overlooking fairly
straightforward ways to significantly reduce alcohol-related
problems. In the field of transportation, for instance, several
agencies including the Department of Transportation, the
Federal Aviation Administration, and the Coast Guard—rec-
ognize the role that alcohol plays in accidents yet have not
moved forcefully to deal with the problem. "There appears to
be a heavy emphasis on safety and a general recognition of
alcohol involvement in transportation accidents among most of
the federal agencies we stuctied," write Mosher and MottI. "It
is therefore surprising that there has been so little effort to
evaluate the scope of the problem or to plan and implement
programs to contend with it."
To some extent, these agencies are hamstrung by their own
limited view of what can be done about alcohol problems. In
general, safety-related federal agencies see alcoholism as the
major problem to be addressed. When solutions are pursued,
they almost invariably involve treatment and rehabilitation pro-
grams directed at alcoholics. Such treatment has little or no
chance of affecting the many accidents that happen to people
who are not alcoholics. Moreover, even when governmental
agencies do become aware of preventive options, they may fail
to act out of a belief that such initiatives are not included in
their mandate.
One way to overcome these institutional barriers is through
an oversight, coordinating, or watchdog body. Such an au-
thority could encourage the relevant agencies or groups to take
action where alcohol-related accidents are a problem. One ex-
OCR for page 100
100 / ALCOHOL IN AMERICA
ample of such a body is the National Transportation Safety
Board, which has a specific jurisdiction in the activities of a
number of federal agencies. The National Institute on Alcohol
Abuse and Alcoholism could be the tomcat site of a similar
watchdog body focused on alcohol.
One of the first responsibilities of such a body should be to
bring the same attention given to reporting blood alcohol con-
tent after traffic deaths to nontraffic deaths. This information
would be a valuable guide in designing safer products and
surroundings, not only for drinkers but for nondrinkers as well.
Such an agency could also explore alternative policies to deal
with alcohol-related problems, thus clarifying some of the trade-
offs involved.
Public Drunkenness
Another important place where drinking and environmental
factors intersect is in the laws and attitudes surrounding public
drunkenness. There are two general justifications for such laws.
The first is that they keep people who are drunk in public from
harming or offending others. The second is that they keep these
people from being the victims of crime, exposure, or illness.
These laws constitute one of the most significant involve-
ments of the government in shaping drinking practices. Ac-
cording to the Federal Bureau of Investigation, over one minion
arrests are made each year for public intoxication. This offense
and drunk driving are the two most common reasons for arrest
in the United States.
in recent years a social movement has developect to decrim-
inal~ze public drunkenness. This movement has argued that
people drunk in public need social and medical services more
than they need to be locked up in jail. To the extent that public
violence and disorcler related to alcohol use are a problem, laws
against these offenses are more specific than blanket laws against
drunkenness.
Persuaded by these arguments, about half of the cities and
states in the United States have decriminalized public drun-
kenness. However, the actual way in which people drunk in
public are handled has changed little. In many places, police
OCR for page 101
REDUCING ENVIRONMENTAL RISK / 101
are still the only public servants trained to handle such people.
Even if intoxicants are now more often taken to detoxification
units than to jail, they are still usually taken there by the police.
Moreover, the police can hold people they pick up in protective
custody before releasing them or transferring them to a treat-
ment facility. Finally, the treatment facilities that were to pro-
vide the social and medical services still for the most part do
not exist.
There are virtually no data on how the decriminalization of
public drunkenness has affected public violence. in fact, the
only clear effect of these changes has been the often repeated
assertion that drunken people are more visible on city streets.
Decriminalization does not seem to have made much difference
to the health and welfare of chronic violators, though this may
reflect the lack of services for them. It is possible that public
drunkenness has increased, and that violence, vandalism, and
disorder are associated with this increase. But the lack of studies
in this area makes it almost impossible to suggest directions for
reform.
The other side of the public drunkenness laws concerns the
victimization of such people. Someone who is drunk in public
is an easy mark for a criminal. As long as there has been drink-
ing there have been jackrollers- people who mug and steal
from drunken victims. Furthermore, American cities make it
easier for jackrollers by concentrating their victims in certain
districts.
There has been little discussion among the general public
about such victimization. This is partly due to the issues of
morality and culpability associated with intoxication. Drunk-
enness somehow seems to implicate the victim in the crime, to
suggest that the victims deserve what they get. No one has yet
studied the possible ways to shield people drunk in public from
crime. It has not even been included in general accountings of
the costs of alcohol abuse.
Some of the local, environmental approaches to public drunk-
enness that have been taken in the past may be a good starting
point for such study. One problem is that urban renewal has
demolished the traditional institutions of skid row, obliterating
the old havens for impoverished drinkers. For several years
OCR for page 102
102 / ALCOHOL IN AMERICA
San Francisco used federal Mode! Cities money to run a "wet
hotel," similar to the old municipal lodging houses. There the
poor, like the rich, had a residential hose! in which they couic!
drink. An improvement on this idea would be to offer the
possibility of treatment on a voluntary basis through the facility.
Those who continued to drink in the hotel could do so, but
they could have access to care if they so desired.
Reducing Hostility Toward Drinking
Most adult Americans have been drunk or have been around
someone who has been drunk. These experiences have prob-
ably helped to make many people hesitant to criticize or inter-
vene in the drunken behavior of others. Given the potential of
excessive drinking to cause harm, most people probably un-
derreact to intoxication.
But the opposite situation can occur. People can use drinking
as an excuse to deny another person's civil liberties or human
rights. Hostility toward alcohol can reduce a ctrinker's normal
opportunities for work or leisure. In some cases, a reduction
in this hostility would be a step forward.
The most prominent area in which reducing hostility toward
drinking could have a beneficial effect is that of recovery from
alcoholism. Recovered alcoholics need tolerance and under-
standing as they try to reenter society. Even if they are currently
abstemious, recovered alcoholics often face discrimination when
looking for work and quickly learn to conceal their drinking
histories. At the same time, this concern about stigmatization
keeps some alcoholics from seeking treatment in the first place.
This prejudice against recovered alcoholics also has an insti-
tutional component. Until recently, the majority of health in-
surance plans did not cover treatment for alcoholism. Now this
has begun to change. Laws in some states require that Blue
Cross/Blue Shield cover alcoholism treatment. Other legislation
forbids discrimination against alcoholics in housing and em-
ployment and regulates the confidentiality of medical records.
Another possible problem concerns attitudes about drinking
in different parts of the country. The South, the Great Plains,
and the mountain areas of the United States are much drier
OCR for page 103
REDUCING ENVIRONMENTAL RISK / 103
than the Northeast and West Coast regions. A nationwide gov-
ernmental program to raise the level of concern about drinking
may be out of place in these drier parts of the country. Similarly,
someone who drinks in these parts of the country may fee}
unnecessarily condemned for doing so, although it is not known
if this is a serious problem.
In general, there are potential risks in raising people's level
of concern about their own and others' cirinking. As more and
more drinking behaviors are defined as unacceptable, the rate
of those practices may decline. But the people who continue
to drink in those ways will have a greater chance of being
labeled as deviants and feeling at odds with the larger society.
For some problems caused by drinking, it may be wiser to
continue to deal with symptoms as they occasionally occur than
to tackle an underlying cause.
Representative terms from entire chapter:
reducing environmental
