|
the Dulwich Centre website
|
... a gateway to narrative therapy, community work and
psychosocial support
Dulwich Centre Publications Pty
Ltd |
 |
|
|
www.dulwichcentre.com.au |
Alcohol: A drug with many dimensions
by
Melissa Raven
When people think about drug problems, they tend to think about illicit drugs
such as heroin, cocaine, and marijuana. However, by far the most problematic
drugs in contemporary western society are alcohol and tobacco.
Alcohol contributes to many cases of traumatic injury and death through car
crashes, accidental injury at home and at work, violence, and suicide. It also
contributes to foetal alcohol syndrome and many common diseases such as heart
disease, cancer, and diabetes. It features prominently in relationship problems
and many cases of crime. It has profound economic costs, such as those related
to medical treatment, absenteeism and reduced productivity. Collins and Lapsley
(1996) conservatively estimated the social costs of alcohol use in Australia in
1992 to be AS18.845 billion. The US National Institute on Alcohol Abuse and
Alcoholism (1991) quoted estimates of the cost to society of alcohol abuse
ranging from $70.3 to $116 billion per year between 1980 and 1988.
A problem only for 'alcoholics'?
When the issue of alcohol-related problems is raised, most people think of
'alcoholics', people who are dependent on alcohol, who constantly drink to
excess and are unable to control their drinking. However, non-traumatic medical
problems such as heart disease are often associated with excessive regular use
rather than dependence per se, and many alcohol-related injuries and deaths,
both accidental and deliberate, are associated with intoxication, not
dependence. A review by Hayward, Zubrick & Silburn (1992) of suicide research
found reports of alcohol involvement in 20% to 50% of suicide cases. Although
suicide is sometimes associated with alcohol dependence, more often it seems to
be triggered by acute intoxication coupled with interpersonal conflict.
To many people, the idea that intoxication and excessive regular use may be
more important than dependence is surprising and unsettling. Many of us drink
frequently and occasionally drink too much. Many people believe that it is only
people who are dependent whose drinking creates problems - and there is often a
circular logic applied: if someone gets into strife, they must be dependent.
This logic is comforting to many of us, and exceedingly useful to the alcohol
industry, which argues that alcohol is not a problem, it's just that there are a
small number of unfortunate individuals who have this disease called
'alcoholism' which means they shouldn't drink at all - but the rest of us can
cheerfully drink to our health.
However, empirical evidence shows that there is a continuum of alcohol use,
with no clear cut-off between non-alcoholic and alcoholic, and although people
who drink very heavily have a much greater individual risk of experiencing
problems, the rest of us are not immune. Alcohol problems are distributed
throughout the entire drinking population: They occur at lower rates but
among much greater numbers as one moves from the
heaviest drinkers to more moderate drinkers (Moore
& Gerstein 1981, p.44). Thus, most alcohol problems occur to, or are caused by,
drinkers who are not dependent on, or addicted to, alcohol. Within the general
population, alcohol problems occur more often among men and most often at
younger ages - 18 to 24 years (Moskowitz 1989).
This is not to say that there is no need for concern about people who suffer
from 'alcoholism'. However, the situation is not straightforward. Hilton (1989,
p.459) asked the question, 'How many alcoholics are there in the United
States?', then proceeded to give three different answers:
• / can't answer your question because it is based on a false premise
[that 'alcoholism' is something you either have or don't have, there is a clear
division between 'alcoholics' and 'non- alcoholics'].
• Well, it all depends on how you measure it.
• There are an estimated 10.4 million 'alcoholics' in the country, an
estimated 7.1 million men and 3.3 million women [an official estimate].
The concept of alcoholism is predicated on the disease model (or more
accurately models - there are several variants) which is closely linked to the
twelve-step model used by Alcoholics Anonymous (AA). Disease models have
dominated the treatment field in the USA and have had significant influence
elsewhere. However, the value of other models is increasingly being recognised.
There is considerable evidence that problem
drinking is a learned behaviour which can be unlearned and
relearned in different ways, and that many people who drink excessively
gradually moderate their drinking with little or no intervention. In other
words, people can move along the continuum, in both directions. Treatment
approaches based on these ideas are proving effective for some people. There is
good evidence that no one form of treatment is appropriate for everybody, and
that there needs to be a range of options available.
Within the drug field there is still a tendency to individualise problems and
pay little attention to structural and social justice issues such as gender,
class, ethnicity, poverty, and racism. One important issue is that problematic
alcohol use is often a response to poverty and unemployment and racism and other
forms of disadvantage and discrimination. However, the implications of such
structural factors are complex. For example, a requirement of AA is to admit
powerlessness and this can have very different implications for people
disadvantaged by their race, gender and socioeconomic status than for people
from affluent and successful backgrounds.
A good thing?
It is important to recognise that alcohol's negative effects sit side by side
with what many people see as its positive social effects. It is used for
celebration and relaxation, and in many cultures it is an integral part of happy
family life. It provides livelihoods for countless people and generates huge
revenues for governments. This quote, from a Mississippi state senator in 1958
(cited in Goodwin 1988, p.8) illustrates the paradoxical effects of alcohol:
You have asked me how I feel about whisky. All right, here is just how I
stand on this question:
If, when you say whisky, you mean the devil's brew, the poison scourge, the
bloody monster that defiles innocence, yea, literally takes the bread from the
mouths of little children; if you mean the evil drink that topples the Christian
man and woman from the pinnacles of righteous, gracious living into the
bottomless pit of degradation and despair, shame and helplessness and
hopelessness, then certainly I am against it with all of my power.
But, if when you say whisky, you mean the oil of conversation, the
philosophic wine, the stuff that is consumed when good fellows get together,
that puts a song in their hearts and laughter on their lips and the warm glow of
contentment in their eyes; if you mean the drink that enables a man to magnify
his joy, and his happiness, and to forget, if only for a little while, life's
great tragedies and heartbreaks and sorrows, if you mean that drink, the sale of
which pours into our treasuries untold millions of dollars, which are used to
provide tender care for our little crippled children, our blind, our deaf, our
dumb, our pitiful aged and infirm, to build highways, hospitals, and schools,
then certainly I am in favour of it.
This is my stand. I will not retreat from it; I will not
compromise.
Moderate alcohol use is purported to have significant health
benefits, particularly in relation to the risk of heart disease. However, the
issue is controversial and there is sound empirical evidence that there is no
genuinely safe level of consumption. Alcohol has been used for millennia, by
most known societies. It touches most lives, with both positive and negative
effects. It has been the subject of much writing and many debates. It has been
celebrated and vilified and cautiously accepted. It is likely that it will
continue to be widely used. How we face the dilemma of dealing with the many
dimensions of alcohol remains to be seen.
References
Collins, David J. & Lapsley, Helen M.1996:
The social costs of drug abuse in Australia
in 1988 and 1992. National Drug Strategy Monograph
Series No.30. Canberra: Australian Government Publishing Service.
Goodwin, D.W. 1988: Is alcoholism hereditary? (2nd
ed.). New York: Ballantine.
Hayward, Linda, Zubrick, Stephen R. & Silburn, Sven, 1992: 'Blood alcohol
levels in suicide cases.' Journal of Epidemiology and
Community Health, 46, 256-260.
Hilton, Michael E. 1989: 'How many alcoholics are there in the United
States?' British Journal of Addiction, 84(5):459-460.
Moore, M.H., & Gerstein, D.R. (eds) 1981: Alcohol and public policy:
Beyond the shadow of prohibition. Washington, DC: National Academy
Press.
Moskowitz, Joel M. 1989: 'The primary prevention of alcohol problems: A
critical review of the literature.' Journal of Studies on
Alcohol, 50, 54-88. National Institute on Alcohol Abuse and Alcoholism,
1991, January: 'Estimating the economic cost of
alcohol abuse.' Alcohol Alert, No.l 1.
back to deconstructing addiction page
back to homepage
|
