Drugs in American Society, 5th, 6th, 7th, and 8th editions, Erich Goode, McGraw-Hill,
1999/2005/2008/2012. Chapters 4 and 8, and Drugs, Society, and Human Behavior
(7th ed), Ray and Ksir, Mosby, 1993. Chapters 9 and 10 and the disclaimer)
Dependence; Addicting in the Classic Sense
from nicotine and caffeine, most commonly used psychoactive substance
from cigarettes, most common form of drug addiction:
The alcoholic is the typical
dependence is a reality for a sizeable minority who drink heavily despite
Drinkers of alcohol ARE DRUG USERS!
American public does not equate alcohol use with drug use
Sale, and Purchase not a crime in most places and for most people
and Distribution has been illicit (1920-1933)
Chemistry and Variety
was discovered in 8327 B.C. on a warm afternoon by "Grog" who returned
to his cave and drank the fermented milk of a coconut that had been cracked
and left out in the sun. ;-) (it's a joke)
much did they drink in medieval Europe?
natural process: Most fruits and airborne yeast (watch animals getting drunk in Africa)
+ yeast and Water==> recombines carbon, hydrogen and oxygen to produce
ethyl alcohol and carbon dioxide.
- C6H12O6 (Glucose)
+ H2O==(Yeast)==> 2C2H5OH (ethyl
alcohol) + 2CO2
about 15-20% ETOH the alcohol level kills the yeast and fermentation stops
basic effects: Euphoria, Sedation, Narcosis, Pain relief. It is almost universally
accepted in some form or other for some purpose or other.
Grains can also be used: starch versus sugar- The Malting Process:
(sprouting) produces enzyme
drying kills sprout, preserves enzyme
mix with water, enzyme converts starch to sugar
added to increase starch levels
To produce higher levels of ETOH; heat mixture to evaporate
alcohol, trap vapors in condensing coil-- Voila!: Hard Liquor (early distillation
technology probably resulted in concentrations of about 50% (100 proof)
~800 A.D. (Alcohol is a derivative of the Arabian word for "finely divided
spirit"-- the part of the wine derived from distillation.
fermented beverages were known in Europe until the 10th Century when Italians
began to distilled wine.
Ethyl Alcohol has been studied and used medicinally ever since.
Century professor of Medicine at Montpelier called it "Aqua Vitae"
(Water of Life)
the 17th Century the Dutch came up with the name Brandy (Brandtwein): Burnt
(Irish-Gaelic equivalent for Aqua Vitae- visgebaugh):
- The Encyclopaedia
Brittannica lists in its article on 'Alcoholic Beverages' the following dates
and places of origin of several distilled alcoholic beverages. (credit
17th Century: 95% Alcohol possible
of grains used==> Grain Neutral Spirits ("Everclear")
of uses now: add to gasoline, industrial solvent, and (of course)--
at which distillation occurs==> Taste
twice the percentage of Alcohol: British army-- add to gunpowder and
ignite==> "pooooff!" (57% alcohol)
the proof, lower the by-products: Congeners, other alcohols (methyl,
- Whiskey became Common
- Scotch whisky
(no "e"): Scotch:
(1) malted barley,
malt is dried in kilns fired by peat, and the liquor is stored for at
least 3 years in barrels originally used to transport sherry
- Whiskey was Introduced
to the Americas ~late 1700's
- Became the chief export
of settlements west of the Appalachian Mountains: Grain to expensive to transport.
10 bushels of corn could be reduced to 1 barrel of whiskey.
- 1789: Elijah Craig
of Bourbon, KY: Store whiskey in new, charred
oak barrels: American bourbon. (Canadian
Typically distilled at less than 160 proof (grain flavors)
- 51% of grain-
rye==> straight rye whiskey
- 51% of grain-
- 80% corn===>
- Dilute to 120
proof: age 2 or more years=> acquire more flavors. Typically further
- Up until Prohibition:
almost all whiskey in U.S.- bourbon, during Prohibition- Smuggled Canadian
and Scotch: Lighter and Blended (2/3 straight whiskey, 1/3 GNS)
- Trend away
from heavy whiskey==> Lighter mixables.
- 1983: domestic
vodka production higher than whiskey
consumption peaked in 1984-7 for gin, vodka, rum: now down.
(2009) per capita (distilled spirits): ~1.4 gal/year (see USDA Economic Research Service data on food and beverage availability)(local file)
malt (some rice or corn, even soy
beans) and water
out solids and add yeast==> the Mash (at the Brewhouse--link
to Budwieser.com , navigate to the tour) (German
- Hops (a)
(1) (2) added for flavor (1/4 lb for 31 gallon
at AB Brew House)
- Age after
- Beershots at Molecular
(to store)Yeast settles on bottom (4%)
Top rising yeast, fermentation temperature warmer, higher concentrations of
malt and hops-- more flavor.
Liquor: Aged longer, more flavor (6-8%)
beer: 10% less alcohol, 30% fewer calories. Fermentation is done at lower
temperatures==> More alcohol and less sugar. Add water.
and Ice beers: same, without diluting (1990's)
Beer (since prohibition, recent popularity)
Breweries and the Consumption of Beer
culture: (a new section just getting started)
1920: Thousands of Breweries (over 60 here in St. Louis)
about 750 left
less than 50
breweries dominate 90% of the market: Busch: Over 48% (2007);
Budweiser alone: 14% (2003)
Beers: 30% of sales
around 5% and growing
limited distribution, although providing wider variety of choices.
- Microbreweries: 6.5% for market in 2012 (up from 5.7% in 2011)
- 13.2 million barrels (31 gallons/barrel)
- Overall beer market up 1% for 2011-2012.
- Microbrewery sales: for 2012: $10.2 billion (up from $8.7 in 2011). Total beer market for 2012: $99 billion
- Local: Schlafly: 49,442 barrels in 2012. O'Fallon: 10,000 in 2012 (target of 15,000 for 2013). 6th Row: 1,200 barrels in 2012
- Source: STL Post, 3/19/13, page A9 (Lisa Brown reporting)
form of alcohol
- Today, highly
- But, still
lots of small traditional vintners
vines brought from Europe. In the late 1800's, and again in the 1960's; massive
disease destroyed many of the European (France, Spain, Italy) vines, so the
American vines were re-introduced.
European names, but blended (Chablis, Rhine, etc)
51% of a specific grape. Individual bottles.
- Red wine:
leave skin on during fermentation
- White: white
grape, skin off
- Rose': leave
skins for a couple of days, generics- mix red and white.
- Blush: juice
of particular grapes is dark enough (Zinfandel)
- Sweet vs.
Dry: sugar content, Sweeter wines are heavier- sweetness overrides harsh flavors.
wines: special grapes or processing ("Eiswein" (in Canada),
- Spain: add
brandy- kills yeast, stops fermentation, and wine will not spoil.
- Seal in
charred oak casks- refines taste: "Sherry"
"Muscatel," "Madeira" and Port-- sweeter, after dinner
- Pre 1960-
little in USA, mostly sweet and dessert
- Now, use
of those varieties is in decline, others (drier) are consumed more.
- Over 2.5
- 1980's and
1990's-- Wine Cooler: Kool-aid taste, marketed as "soft drink,"
25% of wine market. Replacing beer as the "Gateway Drug."
Sites Relating to Alcohol Use and Consumption
Absorption and Metabolism
requires no digestion
- 20% is absorbed
in the stomach, most through small intestine
or empty stomach speeds absorption- etoh passes more rapidly into the small
is not stored by the body, the calories it provides are used first- tied to
weight gain (you gain weight from the food you eat along with the alcohol)
- Fat cells
versus muscle cells (alcohol is water soluble): Males vs. Females
- 90% metabolized
- 2% excreted:
Alcohol Dehydrogenase: Alcohol=> acetaldehyde [toxicity] (acetaldehyde (aldehyde) dehydrogenase)
=> acetate (derivative of acetic acid). Used as fuel by cells.
- Most drugs,
if consumed at high levels, metabolized at high levels.
- Alcohol--relatively steady metabolism: 100 milligrams of alcohol per kilogram of body
weight. About .33 oz. (about one drink) per hour.
- Some note
of a second enzyme (microsomal ethanol-oxidizing system [MEOS]) that is associated with chronic, heavy drinking-- permanent:
speeds up metabolism.
coffee, etc==> no effect
use- destroys liver- impedes metabolism of other drugs
Impact on CNS
- Used until
1800's in surgery: replaced by nitrous oxide. Problem in controlling the effect
of alcohol. Effective dose-- close to lethal dose. Slows blood clotting.
- Tied to
GABA receptor complexes in the brain. Similar to neurotransmission processes
that relate to an understanding of benzodiazepines.
- GABA produces
an inhibitory function in the brain's neural processing. Seems alcohol and
drugs like Valium enhance this activity.
labs: RO 15-4513 ?? "Sober-up" pill ??
- Number of
grams of Alcohol per 100 ml. blood. (100mg./100ml. = .10% BAL)
- At lowest
effective doses: Poorly learned behaviors deteriorate; at higher levels: inhibitions
decline and behaviors elevate, critical thinking also declines
- The quicker
the volume of etoh increase, the greater the effect, yet modified by "Behavioral
likely at .12%, especially if reached quickly.
beers in one hour)
beers in one hour
quart of whiskey in one hour)
from Bogen in Ray and Ksir, 8th ed. 1999, p. 222)
Calculator (The Drink
of .4==> LD50, BAC .8==> LD100
- 1 drink=
~ .5oz alcohol
- DWI: ~3
drinks in one hour, all other things equal
- 1 drink
every hour (sipping): Theoretically "no problems" (normal liver)
- 6 drinks
over 2 hours=> ~4 drinks in system: at least .1% BAL
- Rule of
equivalency (a drink is a drink):
ounce (5%) Beer =1-4 ounce glass of wine (15%)= 1 ounce of (80 proof)
Other Acute Objective
- Sexual behavior:
- Increases desire=>
Expectancy (cultural conditioning)
- Decreases capacity
- For males: lowers
Circulation increases, Core temperature drops
suppresses ADH (anti-diuretic hormone)
- Testosterone drop=>
- Increase in Lutenizin
- Lutenizin=> direct
impact on aggression/sex centers of brain
- "You don't
buy beer, you only rent it" (Archie Bunker)
- Link to hangover
- Germans: "wailing
of cats" (Katzenjammer), French: "woody mouth" (gueule
de boise), Swedes: "pain in the roots of my hair" (hont
i haret) (Ksir, Hart, and Ray, Drugs, Society, and
Human Behavior, 12th ed, 2008, page 220).
- Element of withdrawal
- Effect of congeners
- Irritation, especially
- Blood sugar levels
Chronic Objective Effects
- Alcoholic Dementia;
intellect down, difficulty with low level skills- swallowing, manipulating
Syndrome; deficiency of thiamine: Confusion, Difficulty walking, Abnormal
eye movements, and Korsakoff's Psychosis: inability to remember recent events
or learn new information.
diseases: Malnutrition, "Body disease"
- Tremors, increase
heart rate, insomnia
- Delusions: Delirium
- Seizures, death
- Fatty liver (metabolizing
of etoh, prevents processing)
- Alcoholic hepatitis
- Damage to heart
- High blood pressure
- Moderate use factor
in lower rates of above: Increases HDL "good cholesterol"
behavior, Immune system
- Growth retardation
- Pattern of abnormal
features: head size, nose, etc.
- CNS abnormality
Drinkers Live Longer than Nondrinkers (2010)(local
Other Effects: Alcohol
worse than heroin and cocaine?
- Variety of other
alcohol abuse may be the most frequent known environmental cause of mental
retardation in the western world." (Oakley Ray, 1993)
- Little doubt
that when consumed in sufficient quantities, there is significant impairment.
- But: in
most cases subjective effects seem to be dependent on who happens to be drinking
- Yuruma (S.
Am. Rain forest): Withdrawn
- Japan (Takashima):
Laughter and Song
(Mestizos, Columbia): Somber, morose, controlled, rigidly serious- Regardless
- Camba (Bolivia):
Drink 180 proof. Early- happy; later- stupefied, stare at ground. Total lack
of any form of aggressiveness.
- Cross and
- Pipage (desert dwelling
North Am): Cactus wine during rainy season- drink till drunk and vomit;
no fighting. After contact with whites and ready availability of etoh- violence
- Bantu (S. Africa):
Tribal setting- peaceful. Urban- violent
- Rural Okinawa: Sake
(2 type of use) Male only- anger and violence; Male and female- no aggression
- As circumstances
change, so to does drunken comportment
Behavior: Same patterns and variations
and Object Selectivity==> violence and sex under the influence.
for socially defined limits
is not fixed, Drug use is a part of understanding behavior
In the USA:
Enormous range, Lots of violence=> Viewed as "legitimate."
organized character of drunken comportment"
- Camba: rigidly puritanical
- Tarhumana (Mexico):
typically chaste and timid; Drunk- wife swapping
(Sikkim)(see also, and this): Most sexually active people around. Adultery common and expected.
Sex is main topic of conversation. Harvest festival: drink lots, "unbridled
promiscuity," linked to better harvest. Yet, incest taboo (4th cousins,
any in-law, blood relatives on father's side for 9 generations.....) Is
and Control in the USA
- Native Americans
stopped at Plymouth==> Out of Beer
(later ship): 10,000 gallons of wine, 42 tons of beer, 14 tons of water
was not a luxury, but considered a necessity
- 1673- Increase
Mather: Warned of too much use, but considered alcohol good in itself.
drinking: Frequent and Heavy
- At work
- Politician and votes
- Normal ration in
1784- Benjamin Rush: Alcoholism as a disease
5.8 gallons of grain spirits per person (2x current)
rarely viewed as problematic: Family and community control
Matter of Choice (Drunk==> Sinner, Poor Choice==>Punish)
Temperance Society- 1808
American Society for Promotion of Temperance: Moderation
- Use rose
in 19th Century- 1830: 7.1 gallons=> more distilled. Viewed as vital to
health and well-being (even for school children)
National Movement- Abstinence (1.5 million members), success at limiting use
in some settings.
Decline (except for Civil War years
people: likely to oppose its use (no moderation- abstain or drunk)
classes and new ethnics: approve (Drinker==>Threat==>Enemy)
- 1900: 2
- 1920: 2.5
- Feasibility of enforcement
- Thought it would
automatically reduce drinking
- Variations and exceptions
- Seen as a solution
to a variety of problems
Prohibition, Alcohol Control" (Harry G. Levine and Craig Reinarman,
FROM PROHIBITION TO REGULATION: LESSONS FROM ALCOHOL POLICY FOR DRUG
- Status Struggle:
Deviance and Moral Entrepreneurs
Rural, native-born (Nativism), white-collar/middle-class, farmers and land
Urban, immigrants, labors, Catholic.
represented the values of the "Ascetic, Protestant Middle-Class."
- The drinker
as deviant was redefined from Sinner=> Enemy (and since prohibition,=>
Sick). Control the cultural behavior of the threatening group and control
the group itself.
of Social Change (1920-1933)
- Old middle-class
- Urban dwellers found
increasing mobility and political power
- A "new"
middle-class emerged: Industrialization- Urban, cosmopolitan, college educated,
- Old entrepreneurial
capitalists lost hold to the new managerial class
- New middle class
viewed drinking as recreation
- Symbolic aspect
of abstention declined
the Volstead Act had become so unpopular- no one wanted it.
State's Temperance and Prohibition resources
Minnesota Historical Society resources
- Means of controlling
and regulating workers- Power Elite
- But, failure of prohibition:
Massive law violation=> undermined authority=> repeal= Co-optation
to more potent forms (prior, beer dominates)
absolute alcohol, more potent forms
and dangerous substances ("Jake")
and organized crime
"decentralized production and distribution" outside of the major
of lack of regulation- Licensing and state regulation now control central
elements of production and distribution
the effectiveness of Criminalization
Control after Prohibition: See "Shedding
a Tier" from the St. Louis Post-Dispatch (4/28/05) for an account of
contemporary revisions to the policies put in place to control alcohol production
and sale after prohibition.
Prohibition Resource Page: http://www.authenticwinecountry.com/Prohibition
Marin Institute: The Alcohol Industry and Policy Database
rose following prohibition, peaked in 1980: 2.76 gal.
(2010)- about 2-2.2
gal./person/year- pure alcohol (GNS)
abstain (Ray and Ksir 1993: Suggests relative stability over past few years)
(mythical) drinker"-- 2-3 drinks a day (1.33 drinks per capita)
of those who drink account for as much as 80% of the alcohol consumed.
Of this group, 1/3 (10% of drinkers) consume 50% of the alcohol. (Levanthal,Charles. 1999. Drugs, Society and Modern Behavior,
2nd edition. Boston: Allyn and Bacon)
- 2000: 47%
report having used alcohol in the past month, 20% listed as binge drinkers.
- 2005: 51.8%
- 1998 National
Household Survey: 51.7% (112 million) report having used alcohol in the past
one-fifth (20.6 percent) of persons aged 12 years and older (46 million people)
participated in binge drinking at least once in the 30 days prior to survey.
This represents approximately 44 percent of all current drinkers. These 2000
estimates are all similar to the estimates for 1999.
- Heavy drinking
was reported by 5.6 percent of the population aged 12 and older, or 12.6 million
- Most Drinking:
Lighter drinks, far less distilled spirits.
- 21 year
old laws in all states (1979 only 14): Impact- significant, fewer children
and teens drinking (although no longer declining), Auto deaths down- 25-30%
correlated with alcohol use (1990-50%).
National Survey on Drug Use & Health
in the USA (1995 data- no significant change: Goode, 1994, 1999)
||% of Households
frequently, too) social expectations? Up from 75% in 1991 (45%
based on 50% in 1991)
based on 50% in 1991)
||54% (up from
46% in 1991) (18% regularly)
Higher the level of education, more likely to drink regularly: 68% College
Degree vs. 35% No high school degree.
- 2010 NSDUH:
- Among adults aged 18 or older, the rate of past month alcohol use increased with increasing levels of education. Among adults with less than a high school education, 36.8 percent were current drinkers in 2010, significantly lower than the 69.1 percent of college graduates who were current drinkers.
- Among adults aged 18 or older, rates of binge and heavy alcohol use varied by level of education. Among those with some college education, 27.4 percent were binge drinkers, and 8.0 percent were heavy drinkers. Among those who had graduated from college, rates of binge and heavy drinking were 23.1 and 6.6 percent, respectively.
- Young adults aged 18 to 22 enrolled full time in college were more likely than their peers not enrolled full time (i.e., part-time college students and persons not currently enrolled in college) to use alcohol in the past month, binge drink, and drink heavily. Among full-time college students in 2010, 63.3 percent were current drinkers, 42.2 percent were binge drinkers, and 15.6 percent were heavy drinkers. Among those not enrolled full time in college, these rates were 52.4, 35.6, and 11.9 percent, respectively.
- The pattern of higher rates of current alcohol use, binge alcohol use, and heavy alcohol use among full-time college students compared with rates for others aged 18 to 22 has remained consistent since 2002
- 2005 NSDUH:
Among adults aged 18 or older, the rate of past month alcohol use increased
with increasing levels of education. Among adults with less than a high
school education, 36.7 percent were current drinkers in 2005, significantly
lower than the 69.4 percent of college graduates who were current drinkers.
However, among adults aged 26 or older, binge and heavy alcohol use rates
were lower among college graduates (18.9 and 4.9 percent, respectively)
than among adults who had not completed college (21.9 vs. 6.0 percent, respectively).
Young adults aged 18 to 22 enrolled full time in college were more likely
than their peers not enrolled full time (i.e., part-time college students
and persons not currently enrolled in college) to use alcohol in the
past month, binge drink, and drink heavily. Past month alcohol use was
reported by 64.4 percent of full-time college students compared with
53.2 percent of persons aged 18 to 22 who were not enrolled full time.
Binge and heavy use rates for college students were 44.8 and 19.5 percent,
respectively, compared with 38.3 and 13.0 percent, respectively, for
18 to 22 year olds not enrolled full time in college.
- The pattern
of higher rates of current alcohol use, binge alcohol use, and heavy
alcohol use among full-time college students than the rates for others
aged 18 to 22 has remained consistent since 2002.
- In 2009, 57.6 percent
of males aged 12 or older were current drinkers, higher than the rate for
females (46.5 percent). However, among youths aged 12 to 17, the percentage
of males who were current drinkers (15.1 percent) was similar to the rate
for females (14.3 percent).
- Among young adults
aged 18 to 25, an estimated 57.7 percent of females and 65.9 percent of
males reported current drinking in 2009. These rates are similar to those
reported in 2008 (58.0 and 64.3 percent, respectively).
- Men drink about 2x
as much as females, have more problems
- Women's drinking is
increasing; more likely to drink alone. Male's drinking declining--yet daily
use is still twice that of females.
- 1999 NHS:
- With the
exception of adolescents, males were more likely than females to report
past month alcohol drinking. In 1999, 54.0 percent of males (ages 12
and older) were current drinkers compared to 41.1 percent of females.
- For the
youngest age group (12 to 17), males and females had comparable rates
of current alcohol use (19.2 percent of males and 18.1 percent of females).
pregnant women age 15-44 years, 13.8 percent used alcohol and 3.4 percent
were binge drinkers. These rates are substantially lower than the rates
for nonpregnant women of that age (49.3 percent and 19.4 percent, respectively).
6. 2005: 58.1
percent of males aged 12 or older were current drinkers, higher than the rate
for females (45.9 percent). However, among youths aged 12 to 17, the percentage
of females who were current drinkers (17.2 percent) was higher than that for
males (15.9 percent).
problems for those who drink
||Many problems attached
to those who drink
- In 2009, rates of
current alcohol use were 3.5 percent among persons aged 12 or 13, 13.0
percent of persons aged 14 or 15, 26.3 percent of 16 or 17 year olds,
49.7 percent of those aged 18 to 20, and 70.2 percent of 21 to 25 year
- Among older age groups,
the prevalence of current alcohol use decreased with increasing age, from
66.4 percent among 26 to 29 year olds to 50.3 percent among 60 to 64 year
olds and 39.1 percent among people aged 65 or older.
- Rates of binge alcohol
use in 2009 were 1.6 percent among 12 or 13 year olds, 7.0 percent among
14 or 15 year olds, 17.0 percent among 16 or 17 year olds, 34.7 percent
among persons aged 18 to 20, and peaked among those aged 21 to 25 at 46.5
- The rate of binge
drinking was 41.7 percent for young adults aged 18 to 25. Heavy alcohol
use was reported by 13.7 percent of persons aged 18 to 25. These rates
are similar to the rates in 2008 (41.0 and 14.5 percent, respectively).
- The binge drinking
rate decreased beyond young adulthood from 36.3 percent of 26 to 34 year
olds to 19.2 percent of persons aged 35 or older.
National Survey on Drug Use & Health
- African Americans:
High abstinence, low rate of heavy drinking, high risk of problems
High abstinence, high rates of heavy drinking, high rates of problems
- Asians: Highest
rate of abstainers, lowest rate of heavy drinking, lowest rate of problems
- Native Americans:
Great deal of variation, extremely high rates of problems
- Whites: High
use rates. Heaviest: Irish (most likely to drink and high rate of problems)
Italians, Northern WASPs, Slavs, Germans. Low rates: Latins and Southern Whites.
- 2009 NSDUH:
- Among persons aged
12 or older, whites in 2009 were more likely than other racial/ethnic groups
to report current use of alcohol (56.7 percent). The rates were 47.6 percent
for persons reporting two or more races, 42.8 percent for blacks, 41.7 percent
for Hispanics, 37.6 percent for Asians, and 37.1 percent for American Indians
or Alaska Natives.
- The rate of binge
alcohol use was lowest among Asians (11.1 percent). Rates for other racial/ethnic
groups were 19.8 percent for blacks, 22.2 percent for American Indians or
Alaska Natives, 24.1 percent for persons reporting two or more races, 24.8
percent for whites, and 25.0 percent for Hispanics.
- Among youths aged
12 to 17 in 2009, Asians had lower rates of current alcohol use than any
other racial/ethnic group (6.5 percent), while 10.6 percent of black youths,
11.9 percent of American Indian or Alaska Native youths, 15.2 percent of
Hispanic youths, 16.1 percent of white youths, and 16.7 percent of youths
reporting two or more races were current drinkers.
- Defining the
5oz.; ? Of individual variation, Moderate drinkers and problems; binge drinkers.
Dependence: Vague; Testing?; Signs?-- Answering yes to how many?
- Physical Dependence:
OK, but restrictive.
Social setting; Who's defining?; Heavy use vs. No "objective" problems?
- Moral: Free
will; choice; lack of control; punish and therapy
Uncontrollable; Disease; Bio-genetic; Recover vs. Cure; Alcoholic=> different
from moderate drinker. Seems applicable to some (twin studies, COA)
Difference? (TIQ, genetic marker?)
Alpha--inadequate, Beta-social dependence, Gamma-typical: emotional
impairment, Psi-physiological, Delta-maintenance (sips all day), Epsilon-binge,
Zeta-moderate, but problems when use.
style does not fit all.
Court (1989): Not a disease (cannot be used as excuse--Vets and benefits).
abuse or dependence
Social learning, reinforcement, and socio-cultural values/attitudes. Family
structure and dynamics: Exposed early- diluted and small quantities- in conjunction
with meals- abstaining accepted. Parents model appropriate use- heavy use
unacceptable. No moral importance attached to use: Not proof of adulthood.
Agreed upon "ground rules."
- Social norms
- Early Cure?
- Is Alcoholism
Drinking for the Alcoholic?
- Abstention as deviant
in many setting
- Doesn't work for
- How many (~30%):
Practical issues and treatment?
- RAND study (1976)(8
treatment center, chronic users-9 times typical drinker)
- At 18 months 70%
improved: controlled use (even though abstinence was treatment goal).
- At 4 years 41%
of controlled had relapses, 30% of those who had abstained.
- Yet, majority
of those who were controlled stayed that way.
Owner: Robert O. Keel firstname.lastname@example.org
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