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An American Dilemma
By James B. Jacobs
The University of Chicago PressCopyright © 1989 The University of Chicago
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Alcohol in American Society
Beverage alcohol plays a central role in American life and culture (see Lender and Martin 1982). It is an accompaniment of celebrations, leisure activities, fine dining, romance, and business deals. Its role is so pervasive and important that its absence in many social situations would be defined as inappropriate and deviant. In short, we Americans live in an alcohol-rich environment.
Alcohol consumption and intoxication also serve important psychological and emotional functions. Drinkers seek reduction of tension, guilt, anxiety, and frustration. From personal experience and from viewing countless television and movie dramas, we have become accustomed to people turning to alcohol to cope with a hard day, family problems, or bad news. People also imbibe alcohol to loosen up, let down their hair, release inhibitions, and enhance fantasy and sensuality. Thus we are accustomed to drinking as a prelude to seduction or romance. In addition, people turn to alcohol to fortify confidence, enhance self-esteem, and increase aggressiveness. It seems normal for people to have a drink before proposing marriage, asking the boss for a raise, or going into battle.
The chemical ingredient that gives alcoholic beverages their intoxicating effect is ethyl alcohol (Olson and Gerstein 1985). Beer is generally 3–6 percent alcohol by volume, with light beer at the low end and malt liquor at the high end; wine is generally 10–20 percent alcohol, with table wine low and fortified dessert wine high; and spirits are generally bottled at 40 percent alcohol (80 proof). Despite these differences in alcoholic content per volume, alcoholic drinks generally contain approximately the same alcoholic content. A 12-ounce can of 4-percent beer, a 4-ounce serving of 12-percent wine, and a cocktail with 1.2 ounces of 80-proof spirits contain identical amounts of ethyl alcohol. One drink of any of these alcoholic beverages usually contains about one-half ounce of pure alcohol. While drinkers can and do become intoxicated by drinking all types of alcoholic beverages, wine drinking is more likely to be an accompaniment to meals and not a means of intoxication. Spirits drinking, while by no means always associated with intoxication, provides a method of becoming intoxicated very quickly. Because beer so dominates the alcoholic beverage scene in the United States, it is not surprising that most alcohol abusers are beer abusers.
Patterns of Alcohol Consumption
Alcohol consumption is not unique to American society. In fact, the drinking practices that immigrants brought to America continue to be reflected in different ethnic drinking customs and patterns. Nevertheless, there are certain distinctive features of the American drinking environment — for example, a distinctive mix of spirits, beer, and wine; a large tavern and bar culture; and drunkenness as a social activity for certain segments of the population.
There are large differences in consumption patterns within the United States. The northeastern states show the highest per-capita rates of consumption, the south-central states the lowest. The mid-Atlantic states have the lowest proportion of abstainers, the southern Bible Belt states the highest. There are also wide differences in the rates of alcohol abuse among ethnic groups, with Jews and Italians showing far less dangerous drinking than the Irish.
The levels of consumption in colonial America have never been surpassed; for eighteenth-century Americans alcohol was considered safer and healthier than water. During the nineteenth century per-capita alcohol consumption declined from the astronomical rates of the colonial period. From 1850 to 1914 the per-capita consumption hovered around two gallons. Consumption decreased markedly during Prohibition, but since 1946 it has risen steadily to about 2.7 gallons per capita (Gerstein 1981; Malin et al. 1982) (see table 1.1). Per-capita alcohol consumption has increased approximately 35 percent since theearly 1960s but has increased only slightly and perhaps has leveled off since the early 1970s. While wine drinking has increased somewhat, there has been a steady decline in the consumption of whiskey and other spirits. Today, in comparison with other Western societies, Americans are not problem drinkers. In per-capita alcohol consumption we rank far below the Italians, French, Portuguese, and Germans. Nevertheless, per capita, Americans consume more alcoholic beverages than they do milk; and the number of Americans either referring themselves or being referred by others to alcohol treatment programs has vastly increased over the past decade (Weisner and Room 1984).
While the other heavy-drinking countries consume most of their alcohol in beers and wines, Americans drink comparatively more whisky and other distilled spirits, although beer drinking exceeds the drinking of wine and spirits combined.
American alcohol consumption is unusual in the high percentage of abstainers in the adult population; approximately one-third of the population abstains completely, female abstainers (42 percent) outnumbering male abstainers (27 percent) by about three to two. Another third of the population reports drinking, on average, fewer than three drinks per week. The next fifth or so of the population averages about two drinks per day. About the next tenth of all adults averages three or more drinks per day. Finally, the remaining 1–4 percent of the population averages ten or more drinks per day (U.S. Department of Health and Human Services 1983; Olson and Gerstein 1985). Thus the per-capita alcohol consumption statistic is primarily affected by the drinking behavior of the heaviest 5–10 percent of drinkers, who account for more than half of all alcoholic beverages consumed.
The Business of Alcohol
Not surprisingly, alcohol is big business. The industry is composed of brewers (beer), distillers (whiskey), and vintners (wine); importers and distributors; and a vast infrastructure of liquor stores, taverns, bars, and restaurants. Like any other industry, its goal is to sell as much of its product as possible. A principle marketing strategy is intensive advertising, linking alcoholic beverages to positive cultural symbols and psychological needs (Jacobson, Atkins, and Hacker 1983). Another marketing strategy is to make drinking and drinking environments as desirable, attractive, and competitive as possible. All told, Americans annually spend $60 billion on alcoholic beverages.
Liquor advertising links beverage alcohol consumption to sex, power, success, esteem, patriotism, thrills, risk taking, relaxation, and practically every other positively valued cultural symbol (see Jacobson, Atkins, and Hacker 1983). Alcohol is suggested as a solution to life's stresses and disappointments. The alcohol industry, supported by a body of advertising research, has long claimed that alcohol advertising is meant to compete for the patronage of existing drinkers (brand loyalty), not to bring new drinkers into the fold or to increase the consumption of present drinkers. Whatever is meant by "meant," it is hard to take this claim seriously; but even if we do there is no reason to believe that advertising is so surgically precise that its messages can carefully bypass certain segments of the population and strike only intended subaudiences.
There is also reason to doubt that the industry has such limited goals. To the contrary, it is quite likely that many or most beverage executives consciously strive to increase both the number of drinkers and their consumption levels. Wine producers are the most explicit about their expansionist goals. They have frequently expressed the view that wine is directly competitive with tea, coffee, and soda and that it should become a staple of the American refrigerator and dinner table. A new generation of light (i.e., carbonated) wines is being marketed in six-packs, cans, and cardboard containers. The advertising campaign accompanying this effort attempts to convince the public that wine drinking need not await special occasions or even meals — that wine should be drunk, like soda, as an accompaniment to recreation or simply to quench thirst.
The impact of advertising on problem drinkers raises the most serious concern. These are the industry's best customers. The heaviest-consuming 10 percent consume more than 50 percent of all beverage alcohol. It is extremely important for the industry that this group at least maintains its consumption level. This does not mean that evil men in the liquor industry want to produce alcoholics. What they want is to sell alcohol and to produce an impressive bottom line. Their best customers are heavy drinkers and people addicted to alcohol. It would be a disaster for the industry if all alcohol abusers became moderate drinkers.
Magazines compete for alcohol advertising dollars by stressing the number and percent of their readers who drink heavily. Consider the observation of Robert McDowell, Anheuser-Busch group marketing manager. In an article entitled "How We Did It," published in Marketing Times, he explained the beer company's strategy for staying on top: "We created a new media strategy to achieve a share of voice dominance within the industry and increased advertising expenditures fourfold with greater sports programming to reach the heavy beer drinker" (Jacobson, Atkins, and Hacker 1983, P.32). As Robert Hammond, Director of the Alcohol Research Information Service, wryly notes, "if all 105 million drinkers of legal age consumed the official 'moderate' amount of alcohol, the industry would suffer a whopping 40 percent decrease in the sale of beer, wine, and distilled spirits, based on 1981 sales figures" (Jacobson, Atkins, and Hacker 1983 P. 25).
Youth and Alcohol
Americans grow up in a cultural environment where the transition from soda to alcohol is normal and expected and where alcohol is associated with good times, pleasure, and occupational and social success. Drinking alcohol marks a transition from youth to adulthood, so it is not surprising that many adolescents and teenagers are anxious to begin drinking.
Johnston, O'Malley, and Bachman's (1985) major study of high school students' drinking and drinking/driving practices surveyed students in seventy-five high schools in seven states. Students were asked to indicate how many days during the last month (excluding religious services) they drank any beer, wine, or liquor. The students reported that the frequency of their drinking increased throughout the high school years. By age fifteen the majority of both males and females drank on at least one occasion during a given month. More than one-quarter of male high school students age seventeen or older said that they drank on ten or more occasions in a given month. Two of five high school seniors reported that they had five or more drinks on a single occasion during the two weeks prior to the survey. A significant proportion of adolescent binge drinkers claimed that alcohol intoxication is a necessary part of their lives.
Young people are an important market for alcohol advertisers. Producers know that if they can recruit a young drinker they may have a lifetime customer. Therefore they advertise heavily in magazines appealing to young audiences (e.g., National Lampoon, Ms, and Rolling Stone). At least until very recently, many beer companies hired college students to serve as campus representatives, who arrange for beer at campus functions and sponsor youth events such as rock concerts and sports contests.
Television and Alcohol
Television programs (not to mention movies), which the average American watches for six hours per day, also project important messages about alcohol consumption. Dillon (1975) found that 80 percent of prime-time television shows contain alcohol events. One content analysis found that television programs portrayed drinking positively 60 percent of the time and negatively 40 percent of the time (McEwen and Hanneman 1974). A steady television watcher is exposed to a constant imagery of heavy drinking associated with sociability, success, power, sex, and coping. By way of contrast, he or she sees only an occasional public service announcement (PSA) on alcohol. In fact, McEwen and Hanneman (1974) found that not more than 3 percent of alcohol messages were PSAs and that they appeared at the rate of once every sixteen hours of viewing time.
More recently, Wallach, Breed, and Cruz (1987) carried out a content analysis of alcohol episodes that were shown on prime-time television. They found that while depictions of problem drinking are few,
the alcohol message is not neutral. The frequency of drinking acts and the high level of alcohol reflects a "wet" environment which exceeds that of the real world. Conversations are held over drinks, cocktail parties are the setting for action, and bars are commonly seen as background settings for talks and meetings. Alcohol is ubiquitous in television life. The strong suggestion conveyed to viewers is that alcohol is taken for granted, routine and necessary, that most people drink and that drinking is part of everyday life. The drinkers are frequently glamorous; for many viewers they are setting an example regarding lifestyle. (P. 37)
In 1978 the NIAAA estimated that, of all Americans who drank, 36 percent could be classified as "either being problem drinkers or having potential problems with alcohol" (10 percent and 26 percent respectively). This translated into approximately 9.3 million to 10 million people or about 7 percent of the American population over the age of eighteen. The same NIAAA report also suggested the possibility of an additional 3.3 million problem drinkers among fourteen-to-nineteen year olds.
Drinking problems span a continuum from minor and infrequent to uncontrolled drinking, associated with physical, psychological, and social problems. Some problem drinkers may be psychologically habituated to alcohol while others are physically addicted. For some people drinking problems are mostly physical, while for others they are mostly psychological or social. Almost all types of emotional, psychological, social, and family problems can be exacerbated by alcohol. Likewise, alcohol problems are exacerbated by other types of problems. Therefore, sorting drinkers into such categories as social, abusive, and alcoholic is necessarily subjective. Nevertheless, in a 1982 Gallup survey one-third of persons interviewed said that alcohol had caused problems in their families.
Alcohol researchers now tend to regard alcoholism as a multidimensional problem with multiple causes; some abjure the term "alcoholic" altogether, preferring simply to speak of drinkers who suffer from lesser and greater physical, social, and psychological problems associated with alcohol. In any event, even those who find alcoholism a useful concept recognize that not all problem drinking is symptomatic of alcoholism but that alcoholism is always associated with physical, social, or psychological problems. Depending on how one defines alcoholism, 3–21 percent of all Americans will be afflicted at some point in their lives. In his masterful analysis of alcohol abuse and alcoholism, Harvard psychiatrist George Vaillant (1983, P. 310) has written that
the course of alcoholism can be conceived broadly as comprising 3 linked stages. The first stage is heavy "social" drinking — frequent ingestion of 2 to 3 ounces of ethanol (3 to 5 drinks) a day for several years. This stage can continue asymptomatically for a lifetime; or because of a change in circumstances or peer group it can reverse to a more moderate pattern of drinking; or it can "progress" into a pattern of alcohol abuse (multiple medical, legal, social, and occupational complications), usually associated with frequent ingestion of more than 4 ounces of ethanol (8 or more drinks) a day. At some point in their lives, perhaps 10–15 percent of American men reach this second stage. Perhaps half of such alcohol abusers either return to asymptomatic (controlled) drinking or achieve stable abstinence. In a smaller number of such cases such alcohol abuse can persist intermittently for decades with minor morbidity and even become milder with time. Perhaps a quarter of all cases of alcohol abuse will lead to chronic alcohol dependence, withdrawal symptoms, and eventual need for detoxification. This last stage is reached by perhaps 3–5 percent of American adults, with men probably outnumbering women 3 or 4 to 1. This last stage is much less plastic than the earlier stages and most commonly ends in either abstinence or in social incapacity or death.
Health and Social Problems
Alcohol abuse is involved in a quarter of all admissions to general hospitals. Approximately thirty thousand Americans a year die of cirrhosis of the liver, a disease prevalent among alcoholics. In addition, heavy abusive drinking is involved in a high percentage of both violent crime and suicide (Ford et al. 1979; Collins 1981). It is frequently associated with spouse and child abuse (Hamilton and Collins 1981), although causality is impossible to establish. While drunk driving deaths have been given the most attention in recent years, an equivalent number of deaths occur in other types of alcohol-related accidents — for example, drownings, fires, and falls.
Excerpted from Drunk Driving by James B. Jacobs. Copyright © 1989 The University of Chicago. Excerpted by permission of The University of Chicago Press.
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Table of ContentsForeword
Part I: The Anatomy of a Social Problem
1. Alcohol in American Society
2. Highway Safety as a Social Problem
3. Drunk Driving and Traffic Casualties
4. Patterns of Offending
Part II: Criminal Law and Procedure
5. The Crime of Drunk Driving
6. Defining and Grading Drunk Driving
7. Aggravated Forms of Drunk Driving
8. Criminal Procedure and Drunk Driving
Part III: Institution Building in the Social Control of Drunk Driving
10. Insurance Surcharges and Tort Liability for Drunk Drivers
12. Public Education and Drinking Driving
13. Opportunity Blocking
14. Rehabilitating the Offender