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JU IS . Bring Senior lo Prevent douse Steve Olson in collaboration with Dean R. Gerstein Foreword by Elizabeth Hanford Dole Panel on Alternative Policies Affecting the Prevention of Alcohol Abuse and Alcoholism Commission on Behavioral and Social Sciences and Education National Research Council NATIONAL ACADEMY PRESS Washington, D. C. 1985

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National Academy Press 2101 Constitution Avenue, NW Washington, DC 20418 This publication is based on two reports from the Commission on Behavioral and Social Sciences and Education of the National Research Council: Alcohol arid Public Policy: Beyond the Shadow of Prohibition (Washington, D.C.: National Academy Press, 1981) and Toward the Prevention of Alcohol Problems: Government, Business, and Community Action (Washington, D.C.: National Academy Press, 1984). It has been reviewed according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of En~neer~ng, 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 authority 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 Olson, Steve, 1956- Alcohol in America. Bibliography: p. 1. Alcoholism United States Prevention. 2. Drinking of alcoholic beverages United States. I. Gerstein, Dean R. II. National Research Council (U. S. ). Panel on Alternative Policies Affecting the Prevention of Alcohol Abuse and Alcoholism. III. Title. HV5296.063 1985 ISBN 0-309-03449-3 362.2'9286 85-13667 Copyright (a) 1985 by the National Academy of Sciences No part of this book may be reproduced by any mechanical, photographic, or electronic process, or in the form of a phonographic recording, nor may it be stored in a retrieval system, transmitted or otherwise copied for public or private use, without written permission from the publisher, except for the purposes of official use by the United States government. Printed in the United States of America First Priniing, October 1985 Second Printing, April 1987 Third Priniing, March 1988 Fourth Priniing, March 1989 Fifth Priniing, February 1991

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Foreword THIS BOOK IS A THOUGHTFUL and useful contribution to the worthiest of national causes: continuing public awareness of alcohol abuse. When ~ became Secretary of Transportation, ~ resolved to have no higher priority than safety on our highways, rail- ways, airways, and waterways. ~ learned very quickly that al- coho! abuse is a major cause of many transportation accidents, whether it is a drunk driver on our highways or a recreational boater who has had one drink too many. Alcohol abuse affects transportation safety in a very dramatic and tragic way. More than 44,000 people were killed on our highways last year, many of them by drunk drivers. Thousands of others were maimed and injured, and millions of dollars of property were destroyed. The tragedy does not end with the victims. The injury and heartache of families and loved ones linger. Our campaign to get drunk drivers off our highways aroused public consciousness throughout America, and the public out- cry to stop senseless killing on our highways is just beginning to pay diviclencTs in lives saved and accidents prevented. The campaign against drunk drivers is strong today because of a grassroots movement that began at the local level, in the clubs, the churches, the city halls, courthouses, and state houses all across America. As a result we have stronger laws against cirunk drivers and stricter enforcement. We must keep this momen- ~

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iv / ALCOHOL IN AMERICA turn going. We need to work for continuing awareness of all the many problems associated with alcohol abuse. This book is a useful too} for maintaining that heightened awareness. It deserves to be read by parents, teachers, stu- clents, legislators, community organizers, government officials, and anyone searching for ways to translate concern about al- cohol abuse into action aimed at preventing it. 1[ congratulate the National Academy of Sciences on giving us this book, which provides just the kind of timely, provoc- ative, and practical contribution that the research community can make toward action on one of our most pressing national concerns. ~ urge you to take this book home, take it to your hearts, and, where it strikes a responsive chord, take action. ELIZABETH HANFORD DOLE, Secretary U.S. Department of Transportation August 1985 1V

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Preface IN 1978 THE NATIONAL RESEARCH COUNCIL initiated a study of alternative policies affecting the prevention of alcohol abuse and alcoholism. The study pane! brought together research- ers in anthropology, economics, education, epidemiology, psy- chiatry, psychology, and sociology along with experts on the analysis of historical, legal, and political dimensions of public policy. A list of its members appears on page Il9. In 1981 the pane! issued a report entitled AZcoho! and Public Policy: Beyond the Shadow of Prohibition, which thoroughly re- viewed the relevant research literature and policy questions, and concluded: Alcohol problems are permanent, because drinking is an important and ineradicable part of this society and culture. Alcohol problems tend to be so broadly felt and distributed as to be a general social problem, even though they are ex- cessively prevalent in a relatively small fraction of the pop- ulation. The possibilities for reducing the problem by preventive measures are modest but real and should increase with ex- perience; they should not be ignored because of ghosts from the past. Shortly after this report was published, the National Institute on Alcohol Abuse and Alcoholism (the federal agency that had

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vi / ALCOHOL IN~ERICA commissioned the study) asked that the National Research Council organize a conference for some of the report's authors, other researchers, and participants from all walks of life con- cerned with alcohol-related problems to examine the study pan- el's findings and discuss their implications for public policy and private action. The conference papers and discussions were turned into a book, Toward the Prevention of Alcohol Problems: Government, Business, and Community Action, published in 1984. The present volume represents a third phase of this National Research Council effort to inform and advance the discussion of preventive approaches to alcohol problems. Steve Olson was commissioned by the National Academy Press, publisher of the two earlier volumes, to distill those works into a shorter and more accessible form, with advice from members of the study panels responsible for those efforts, other reviewers, and me. The present volume, while derived from the earlier efforts, has been written and reviewed with an eye toward current trends in research on prevention and relevant areas of public and private action. A test of further readings and resources appears as an appendix. The subject of preventing alcohol problems is itself repre- sentative of a broad range of public concerns that have sub- stantial, though not always well-known, technical and scientific dimensions. This type of extension and guide to more technical National Research Council activities and reports is a relatively new enterprise. it symbolizes a commitment by the National Research Council> the National Academy Press, and their par- ent organizations, the National Academy of Sciences, the Na- tional Academy of Engineering, and the Institute of Medicine, to place greater emphasis on the provision of advice and in- formation not only to the federal government but also to other levels of government and to the public. DEAN R. GERSTEIN, Studly Director Pane} on Alternative Policies Affecting the Prevention of Alcohol Abuse and Alcoholism

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Contents Foreword Elizabeth H anford D ole ~ . Drinking in America ............. 2. Why Prevention? . . . ............. 111 20 3. Preventing Drunk Driving 32 4. The Price and Availability of Alcohol 5. What Servers Can Do 6. Drinking by Young People 7. Drinking and the Mass Media 8. Reducing Environmental Risk 9. Summary and Outlook 45 70 95 Guide to Information Sources .................. Pane! Members Index ........... V11 ........ 113 ~9 ..................... 121

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