The family: bulwark against alcoholism

What makes an alcoholic an alcoholic? Scientists do not always know, but recent well-documented studies are beginning to provide the answers.

Winton H. Beaven, Ph.D., is dean of Kettering College of Medical Arts, Kettering, Ohio.

Society today camouflages, ignores, evades, and denies both the nature and the seriousness of the problems caused by alcohol. Facts are obscured by prejudice and ancient myths. Advocates of total abstinence are often ridiculed. Those favoring beverage alcohol tend to deny the extent of the problem of abuse, to be critical of those who objectively analyze the problems, and to heap scorn upon those who suggest that the drinking act should be inhibited either by legislation or public opinion.

Ten years ago, in the keynote address for the First International Congress for the Prevention of Alcoholism, I declared that the problems created in society by the use and abuse of beverage alcohol must be attacked by the whole of society. This includes such measures as taxation, enforcement of existing regulations, and legislation limiting production, outlets, hours of service, and general availability. It also includes making every effort in the care and treatment of the alcoholic to return him to society as a useful member. But beyond all this, it must include attempts to educate a whole generation of young people with a value system powerful enough to help them protect themselves from dependence upon a destructive chemical.

Today I wouldn't change a single word I said in that speech ten years ago. The needs and misinformation remain largely unchanged.

One of the most pervasive myths over the past thirty years has been the idea that alcoholics and social drinkers are two entirely distinct breeds with nothing in common. According to this idea, two fundamental types use alcohol those who become alcoholics and those who do not. And for those who do not, drinking does not cause severe problems. As a result, although the original premise has not been realistically investigated, alcoholics have been widely blamed for society's alcohol problems. The prevalent idea that alcoholism is a disease has provided the foundation for the development of this whole concept.

In the past ten years, however, significant research has challenged the prevailing view of the alcoholic who drinks to damage and the nonalcoholic who drinks harmlessly. Indeed, some evidence now indicates that certain alcoholics have more control over their drinking than our usual ideas about alcoholism would permit. There are even a few well-documented cases of alcoholics who have returned to a low intake of alcohol. Nancy Mello is one researcher challenging the concept that an alcoholic can exert no control over his drinking. Her work and that of others show that alcoholics do not necessarily drink as much as possible and that the degree of control demonstrated depends on the situation and the individual.

The literature today also rejects to a large degree the belief that a common set of personality factors exists predisposing individuals to alcoholism. There is no evidence that alcoholics share significant common psychological, biological, or physiological traits beyond the pharmacological one of tolerance for and dependence upon alcohol. Instead, alcoholics are quite diverse, differing from nonalcoholics mainly in the amount of alcohol they consume.

The emerging consensus of such research, then, is that alcoholism's claim to constitute some unique and definable clinical entity is a "myth." This challenge has produced a similar scrutiny of what may be called the "myth of social drinking" the notion that the social drinker has mysterious abilities or capacities in regard to alcohol that are possessed by most members of society. This myth is based on a simple, and in some contexts quite legitimate, observation. Some people do possess certain powers, abilities, capacities, or resources that account for their success or failure in specific difficult or hazardous activities, for example, flying an airplane, skiing a steep slope, riding a wave, or performing complex surgery. The trouble begins when the notion of such abilities is used as an unverifiable analogy that distorts the phenomena to which it refers. There is no such special skill involved in alcohol consumption.

The challenge to the myth of social drinking began in 1968 when an article by Jan de Lint and Wolfgang Schmidt, two Canadian researchers at the Addiction Research Foundation in Ontario, Canada, appeared in the quarterly Journal of Studies on Alcohol. The study began with this sentence: "An important question in the study of alcohol use is the statistical distribution of consumption in a population." The fact was that until this project, almost no one doing research on alcoholism, or even on the drinking behavior of national populations, regarded the statistical distribution of alcohol consumption in a population as an "important question" to study. The article reported the results of a 1960 survey investigating the purchasing practices of those buying distilled beverages and wine from retail stores in Ontario. Since purchasers were required to fill out forms giving their names and addresses and the amounts ordered, the researchers had a convenient source of data on the pattern of sales. Records showed that the largest number of purchasers bought small quantities. A much smaller group bought what might be called moderate amounts, and a very small group purchased large amounts of alcohol. Schmidt and De Lint argued that this consumption pattern confirmed the findings of the French alcohol researcher Sully Ledermann, who had argued that all Western societies fol lowed a similar pattern. Ledermann had done his studies years before on French, Swedish, and Italian subjects living in America. The same patterns appeared in each group.

Subsequent research by Ledermann, Skog, Brunn, Cartwright, Popham, and Smart has tended to support the broad outlines of Ledermann's thesis, at least to the extent of indicating that alcohol consumption is not normally or bimodally distributed in the population, and that the level of general alcohol consumption is directly related to the prevalence of problems caused by alcohol. Ledermann's' work, practically unknown to English and American scholars, was introduced to the English-speaking world by the Canadian researchers De Lint and Schmidt and is now referred to as "The Distribution of Consumption Thesis." This thesis states that in a general population, drinking will be distributed according to the following pattern: a very large group that drinks very little and seldom, a much smaller group that drinks regularly but not at risk, and a very small group that drinks heavily and alcoholically. The progression from each category to the next is relatively smooth; there is no "bump" or shift in the curve for heavy alcoholic drinkers. One implication is that drawing a line dividing "nonalcoholic" from "alcoholic" consumption is difficult and ultimately arbitrary. All the problems alcohol causes in society are directly correlated with levels of consumption.

The Canadians argue that three key propositions flow from their and Ledermann's work:

1. A change, either up or down, in the average consumption of alcohol by a given population is likely to be accompanied by a similar change in the proportion of heavy consumers.

2. Since heavy use of alcohol generally increases the probability of physical and social damage, the average consumption should be closely related to the prevalence of such damage in any population.

3. Any measures that may be expected to affect overall alcohol consumption (such as regulating its avail ability) are likely to also affect the prevalence of alcohol problems, and hence should be central considerations in any program of prevention.

In addition to the research that supports these findings, we have historical evidence as well. The experience of England during the war, of America during prohibition, and of Finland and other parts of Scandinavia, where changes in alcohol legislation in recent years have liberalized alcohol control laws, all indicate that the Ledermann thesis is valid. All measures that liberalize the availability of alcohol increase consumption and thus increase the negative social effects of its use.

Drinking tastes seem to be converging throughout Europe, North America, and the rest of the industrialized world. Unfortunately, these customs, social and otherwise, are being spread to the developing countries. The same trends that have been experienced in the societies of Europe, the United States, Argentina, New Zealand, Chile, and Japan bode ill for the rest of the world if these habit patterns spread widely. Since 1980 the level of alcohol consumption in the Western world has increased markedly and so have related problems. The only conclusion any fair-minded observer can reach is that the only way to reduce the problems of alcohol in society is to reduce consumption.

History has taught us that positive changes in this area can be achieved through the family, education in the schools, and legal restraints.

Children learn by two principal methods: by imitating and identifying with their parents, and by formal education either at school or at home. The former type of learning involves absorbing emotions, attitudes, and character traits, as well as ideas. Studies have shown that a tendency to drink is associated to a great degree with the extent of drinking in the home. Children of alcoholics have a one-in-three chance of becoming alcoholics if one parent is alcoholic, and more than a 50 percent chance if both parents are alcoholics. Attempts should, therefore, be made to establish negative home attitudes toward drinking. A child's identification with his parents is unconscious and based on his emotions and attitudes toward them. If the parents do not drink, and if, in addition, the child is taught from the earliest age that there is no good evidence that drinking is beneficial, he may seek the real gratifications in life, rather than the spurious ones involved in alcohol. In the Western world, children are constantly exposed to radio, television, and newspaper advertising that associates liquor with pleasure, relaxation, beauty, and even love. It is difficult to combat this type of propaganda; therefore, it seems a reason able exercise of society's prerogatives to prohibit such advertising—indeed, all advertising—of liquor.

The results of formal education regarding the effects of alcohol consumption and alcoholism have not been very promising. Largely, this is because attitudes are usually crystallized by the time formal education is given, and cannot readily be changed. If, however, we provide this teaching by the third, fourth, or fifth grades, experimental evidence indicates attitudes can be changed.

We may all need to do some rethinking about the implications of early drinking in the home. In 1972, Dr. Forrest S. Tennant, a physician in charge of the U.S. Army's drug abuse program in Europe, completed a doctoral study at the University of California in Los Angeles. Its results, while widely disseminated, do not seem to have affected society very greatly. His study, conducted on young U.S. Army soldiers stationed in Europe in 1971, indicates that authorities interested in preventing alcoholism will have a difficult time predicting who is likely to become an alcoholic. The study also covered abuse of amphetamines, hashish, and such opiates as heroin. All five thousand subjects reported their childhood experiences with 107 different activities—hobbies, raising pets, games, outdoor activities, membership in social organizations, school sports, school programs such as band and debate, et cetera. They were also asked whether they had had household chores, how often they were spanked, the amount of time their parents spent with them, the frequency with which their parents drank at home, and about their church attendance.

Dr. Tennant found only one correlation with subsequent drinking patterns: drinking at home before the age of 15. He found two activities, spanking and church attendance, which correlated inversely with the abuse of amphetamines and opiates. Subjects who had been spanked as children tended to be nonusers of either amphetamines or opiates, unless they were punished more than three times a week, in which case they did tend to become abusers. And those who had been to church fifty or more times before the age of 15 had a far less chance of becoming drug abusers.

"Never before have I been involved in a study with results so far different from what I expected," Tennant said. "I thought that both the nondrug and nonalcohol users would have played the most games, belonged to the most clubs, and so on. I was hoping to come up with a kind of recipe for parents, but it didn't turn out that way."

Tennant's final word of advice? "Spank them moderately, send them to church, and don't give them anything to drink until they are older than 15! That is about all we can say."

It seems clear, then, that the problems created in society by alcoholic beverages are directly related to the amount consumed, and thus the only way to reduce those problems is to reduce consumption. It also seems clear to me that the chief bulwark against any social deviation is the home. Society, from the dawn of history, has demonstrated that strong homes make strong societies. Therefore, one of the three basic foundations for a concerned alcohol policy for all of society must focus on improving the quality and character of the home. Studies confirm that families who have firm discipline, who have a strong religious foundation, and who do not drink have the greatest likelihood of protecting their children against alcohol use and abuse.

In this effort, churches can perform a major function. The Seventh-day Adventist Church has taken an official stand for total abstinence and carries on an active program of narcotics education and temperance activities. * Other churches have similar stands against the use of alcohol.

The largest branch of the Christian church, the Roman Catholic Church, teaches that alcoholic beverages are a gift of God, yet at the same time millions within that church are total abstainers. These members take a formal vow of abstinence because of their conviction that many members of society are so weak that they will fall victims to alcoholic abuse if they are not provided with good models. This abstinence is noble. It says that I am my neighbor's keeper, and in the language of the New Testament, I will abstain for the good of the greater number.

The privilege of rearing children carries with it the responsibility of preparing those children to lead useful and productive lives. The evidence clearly indicates that one of the greatest benefits parents can provide for their children is an alcohol-free environment and role models who protect them from the insidious effects of beverage alcohol when they are young, immature, and incapable of appropriate self-protection. Anything that any society can do to provide the parental education and support to increase abstinence in the home will pay untold dividends.

* More information on the temperance activities of the church may be obtained by writing Narcotics Education, Inc., 6830 Laurel Street NW., Washington, D.C. 20012.
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Winton H. Beaven, Ph.D., is dean of Kettering College of Medical Arts, Kettering, Ohio.

July 1983

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