Governing images and the prevention of alcohol problems

doi:10.1016/0091-7435(74)90059-0

Preventive Medicine

Volume 3, Issue 1, March 1974, Pages 11-23

https://doi.org/10.1016/0091-7435(74)90059-0 Get rights and content

Abstract

Discussions of the prevention of alcohol problems are commonly organized around particular “governing images,” which characterize alcohol problems in terms of a coherent perspective. Three such governing images in current discussions of prevention are described. The image of alcohol as an irresistibly attractive but dangerous substance, suggesting restrictions on availability, fits easily into a public health epidemiological perspective. The image of alcohol problems as problems of disruptive or compulsive behaviors ascribed to a cultural ambivalence towards alcohol, pointing to general educational campaigns, is attractive to social psychiatrists and sociologists. The image of alcoholism as a specific disease of unknown but pre-existing etiology, calling for casefinding of “hidden alcoholics,” has been a fundamental tenet of the “alcoholism movement,” aimed at securing more humane treatment for the alcoholic. Though the three images focus on different aspects of alcohol problems, each involves a disease conceptualization. Yet the assumptions of a disease conceptualization often do not fit the empirical data on drinking patterns and problems in the general population, which show continua of severity, modest overlaps between drinking problems, and only a moderate persistence of problems in time. A disease conceptualization of behavior also presumes the abnormality and undesirability of the behavior, a presumption not shared by many heavy drinkers. The ethics of prevention needs detailed discussion; some possible ethical considerations are listed. Overall, governing images have distorted and limited discussions of the prevention of alcohol problems. Some strategies of prevention which do not fit present governing images are suggested, including measures encouraging nondrinking behaviors, modifications of popular images of and reaction to drinking, and insulating drinking behavior from social damage.

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Problems associated with risk overprediction in studies of offspring of alcoholics: Implications for prevention
1982, Clinical Psychology Review
The offspring of alcoholics have been described as being at risk for a variety of social and psychological problems. However, many studies contain biases that lead to the overprediction of offspring vulnerability. Suggestions for obtaining more accurate data are offered. Particularly lacking are data on the frequency of positive adjustment outcomes, or on the characteristics that distinguish offspring likely to have achieved successful adjustment from those who have developed symptomatic behavior. Future prevention researchers could use this information to design programs to increase coping capacity and/or provide environmental supports to reduce the risk associated with alcoholic parentage.
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The social science model for reducing alcohol problems stresses changing norms about drinking, integrating drinking into other meaningful activities, and gradual socialization of drinking behavior by means of mass persuasion, consciousness raising, youth education, legal measures, and voluntary efforts. Although the traditional public health model based on epidemiological method, agent-host-environment relationships, and a levels conception of prevention underlies most approaches to reducing alcohol problems, the transfer of methods effective for control of infectious diseases to social-behavioral problems is subject to question. The distribution of consumption model, arguing that alcoholism rates vary directly with consumption levels, proposes to lower consumption and therefore alcoholism by raising the relative price of absolute alcohol. The proscriptive model, historically abjuring the use of beverage alcohol in any form, has recently shown tendencies toward accepting moderation. Against this background, analysis of relationships among vested alcohol interests—the alcoholism movement and helping professions, the alcohol industry, and the alcoholic beverage control system—indicates that consistent policy about alcohol is not possible without a mechanism for their coordination and participation. Further, assumption by the helping professions of primary responsibility for reducing alcohol problems would likely increase rather than decrease problems. Separate, autonomous, and co-equal institutional status for prevention, shifting it from an exclusive emphasis on a problems perspective, is necessary to reduce alcohol problems effectively.
The myth of alcoholism prevention
1975, Preventive Medicine
Although practically every article about alcoholism contains at least one or two paragraphs that stress the importance and need for prevention programs, the “hows” and the “specifics” are rarely spelled out in any detail.
The analysis of why this situation exists points to the existence of three central premises around which the present alcohol prevention model is constructed. Each of these premises has at its core the existence of some invalid statements, the perpetuation of which effectively blocks the establishment of more appropriate prevention models.
Awareness of “facts” about alcohol leads to a change in drinking. The paper cites evidence from experimental and empirical sources, illustrating that the presentation of facts, although in some cases altering attitudes, does not result in changes in certain behaviors. An explanation and model are provided stating the conditions under which “facts” do and do not result in behavioral change and where “alcohol facts” fit into this paradigm.
Prevention programs centered around “consequences” are an effective way to produce change in drinking. The common theme most alcohol prevention programs share today is that their “message” deals with the consequences of drinking. This approach is highly unsuccessful in appealing to alcoholics whose characterological style ties them to the present and not the distant consequences of their behavior.
Applicability of a medical primary and secondary prevention model to alcohol education. This section of the paper deals with the misapplication of the medical primary and secondary prevention models to alcoholism. It discusses why the etiology of alcoholism must be understood prior to the establishment of a primary prevention program. It also questions the methodological premises around which the early warning signs of alcoholism are built and their validity in successfully predicting the later development of alcoholism. The need for more longitudinal studies is suggested.
USING NATURAL RESOURCES FOR PREVENTING DRINKING PROBLEMS
2023, The Misuse of Alcohol: Crucial Issues in Dependence Treatment and Prevention
Preventing alcohol problems and improving drinking habits among employees: An evaluation of alcohol education
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^☆: The research program of which this paper is a part has been supported by grants from the National Institute on Alcohol Abuse and Alcoholism. The author wishes to acknowledge the influence of others at the Social Research Group, and particularly Ronald Roizen, on this analysis.

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Governing images and the prevention of alcohol problems☆

Abstract

Alcohol and drugs: Government responsibility

Alcoholism: Its extent, therapy, and prevention

Federal Probation

The role of law in meeting problems of alcohol and drug use and abuse

Implications of legislation relating to alcoholism and drug dependence: Government policies

Problem Drinking Among American Men

Alcoholism prevention and reality

Quart. J. Stud. Alc.

The prevention of alcoholism

Internat. J. Psychiat.

Introduction

Alcohol problems: The conceptual framework

Changes in Problem Drinking over a Four-Year Span

The distribution of alcohol consumption in Ontario

Quart. J. Studies Alc.

Consumption averages and alcoholism prevalence: a brief view of epidemiological investigations

Brit. J. Addict.

The lognormal distribution of blood alcohol concentration in drivers

Quart. J. Studies Alc.

Drinking notes

The Sunday Paper

The Penal System and Drugs: Criteria for Criminalization and Decriminalization

Phases in the drinking history of alcoholics

Quart. J. Studies Alc.

Phases of alcohol addiction

Quart. J. Studies Alc.

Alcoholism, a genus and some of its species

Can. Med. Assoc. J.

The Disease Concept of Alcoholism

On the loss-of-control phenomenon in alcoholism

Brit. J. Addict.