Chairman's Corner
                 by Edward W. Schneider, Ph.D.
                         ACA Chairman
                                        (1996-2000)  

ACA is devoted to educating the public about alcoholism, not lobbying for or against legislation. Even so, we can’t avoid commenting on public policies that address alcohol and alcoholism because they have a direct impact on our goals of reducing the incidence of alcoholism and reducing the toll on life and property that alcoholism exacts.

Recently, we have heard several calls for discussion or reassessment of our nation’s programs to mitigate the havoc caused by alcohol abuse. It is obvious to us that, after a period of decline in the early ‘90’s, alcoholism and alcohol abuse are no longer waning, unlike some other forms of substance abuse, and that such a disquieting trend provides adequate justification for at least considering some changes.

For ACA, the appeal of an "open dialogue" about alcohol policy is the possibility of including all of the stakeholders in the same discussion, and for all parties to strive for a common understanding of both the problems caused by alcohol abuse and the problems caused by our attempts at prevention. If this dialogue has any hope of succeeding, it has to be truly open: no point of view should be ruled out a priori, and no conclusive policy positions should be presupposed.

That said, there are some starting points, some premises, that we should state for the purpose of framing the discussion, without presupposing its outcomes.

First, we should distinguish between the substance, alcohol, and the behavior, alcohol abuse. Efforts to control the behavior by controlling the substance have always led to unintended consequences, such as smuggling, home production, fraud, theft, and bribery. To cite but one example, our laws concerning driving with open containers of beverage alcohol in the vehicle have led to highways littered with cans and broken bottles, and vehicle occupants who drink faster than they would prefer, in order to dispose of the container promptly. There is no reason to expect renewed efforts of the same sort to yield different outcomes. Beverage alcohol is simply too easy to manufacture, store, transport, and consume.

Second, we should distinguish between acute and chronic patterns of alcohol abuse. At its most extreme, acute abuse leads to unconsciousness and death, while chronic abuse leads to cirrhosis of the liver and classic alcoholism. We should not expect a policy that is effective against one pattern to necessarily be effective against others.

Third, we must distinguish between policies that have been implemented and have failed, and policies that have failed to be implemented. Prohibition is an example of the former, while revoking driver’s licenses of those convicted of drunk driving is an example of the latter; the license is definitely revoked, but it rarely inhibits subsequent driving, because the likelihood of apprehension appears so small.

Fourth, we should strive for policies that have the broadest possible application, yet can be stated simply. Jurisdiction, age, experience, and the type of machinery being operated should be excluded as qualifiers whenever possible. Airline pilots, subway motormen, forklift operators, bulldozer operators, taxicab drivers and private motorists are all affected by alcohol in much the same way. Similarly, alcohol has the same effect in Texas as it does in Maine. Simple, consistent policies are more likely to be understood and remembered by an increasingly mobile citizenry.

Fifth, the consequences for violating alcohol policies must be commensurate with the risk to other parties. Flying a commercial airplane with 200 passengers while intoxicated places more people at greater risk than driving a baggage tractor at the airport with the same BAC.

Sixth, the consequences should be structured so as to reduce significantly the probability of future violations. For this to be so, both the immediate circumstances of the violation and the long-term history of the violator must be fully considered. Specifically, evidence of alcoholism must be countered with treatment, and the type of treatment must be tailored to the circumstances of the violator. Simply incarcerating an alcoholic postpones, but does not prevent, further intoxication.

Seventh, we should recognize that dealing with alcohol appropriately has cultural and learned components. Policies that inhibit or thwart the development of rational, moderate drinking habits will exacerbate in the long term the problem of alcohol abuse.

When the dialogue is convened, other parties may have premises of their own to add. The first test of the discussion will be to find a starting point that everybody accepts. Any progress beyond that point will be progress indeed.

June 2000

The Darwin Awards for 2000 arrived in my e-mail in-basket today.  If you haven't heard of the Darwin Award before, it is bestowed annually on the person or persons that most notably improved the human gene pool, in most cases (all that I've seen) by removing from it all possibility of their own reproductive capability.  The presentation ceremony is nonexistent because the Award is bestowed posthumously.

Of the nine nominees this year, three of the citations mention the consumption of copious amounts of alcohol.  If ever there was any doubt that massive ingestion of beverage alcohol is a cohort of public lunacy, the Darwin Awards offer truly compelling evidence.

The citation that caught my eye was only a runner-up, but it was certainly worthy.  It reports that last August, an Australian computer technician named Allan entered a drinking competition held at the bar of a Sydney hotel.  The event, known as Feral Friday, set a 100-minute time limit, and scored the number of drinks consumed on a sliding scale, ranging from one point for a beer to eight points for a shot of really "hard stuff".  Allan, the clear winner, managed to rack up a total of 236 points, downing 34 beers, 4 bourbons, and 17 shots of tequila.  His blood alcohol level at the morgue was 0.353, which puzzled the forensic pathologist because he calculated that it should have been 0.43.  The discrepancy was explained when investigators learned that Allan had managed to regurgitate quite a bit in the lavatory before being taken home to "sleep it off".

The hotel was fined the equivalent of $13,100 for "failing to intervene".  It should have been bulldozed, and the site sprinkled with salt, for engaging in such a wicked promotion.  What were they thinking?

Granted, we humans have an innate desire to excel, but we have come to accept that our various civilizations condone certain avenues of competition, and prohibit others.  In many primitive cultures, the purpose of drinking alcohol is to get drunk, and pass out.  By this standard, a lot of our college students are as completely savage as any tribes in the Amazon forests.  Why is this tolerated?  Why, at this late date in our cultural development, is there any question about the evils of alcohol as a competitive sport?

This ambivalence about alcohol has been with us a long time.  The Greeks of antiquity taught us the ideal of "moderation in all things" as well as the debauch of the Festivals of Dionysus.  We may surmise that the party of the first part, i.e., Greek Philosophers, may well have constituted a distinct culture from the parties of the second part, i.e., the devout worshippers of the God Bacchus, that being his Roman name, but I don't believe that the Philosophers could have arrived at their conception of "moderation" without substantial experimentation to discover what constituted the appropriately moderate dosage of wine.  The Greeks were pragmatists; they saw moderation as a good strategy for avoiding unpleasant outcomes.  Our Victorian ancestors were the ones who enshrined it as a virtue in its own right.  While understandable, this elevation may have played into the hands of the very rogues it was supposed to intimidate.  We can defend moderation as a very practical strategy, but they can ridicule it as timid and cowardly when it is offered up a virtue.

I suggest that this ambivalence will continue as long as we keep taking shortcuts in educating people about the effects of alcohol and the consequences of drinking.  Most alcoholism treatment programs have an educational component to provide extensive remediation on precisely these concepts.

"Just say no" may have its place in the education of ten-year-olds, but it doesn't wash with college students, or apparently, with computer technicians.  Instead, we must teach that alcohol is a much more subtle compound than its chemical structure would suggest.  Just because a little is good, more is definitely not better.  Granted, this is easy to say, and hard to learn, but it's a lesson worth learning.  Once learned, the master of it begins to see that many other life situations have those same properties, and starts to act like a discerning, responsible adult.

March 2000

Learning to Drink by Non-Example

Obscured by all of the debate and speculation about the genetic component to alcoholism, we have lost sight of the conceptual and behavioral components.  Yet these pieces of the puzzle are the malleable ones, the ones we can shape to prevent or mitigate abusive use of alcohol.

Before a person drinks, some thought about the subject has taken place.  The drinker has definite opinions about the purpose of drinking and the effects of alcohol, however misguided those opinions may be.  If we inquire how they are formed, it's the rare person who recounts dinners around the family table, with their parents sharing their enjoyment of wine and beer with their adolescent children.  People don't learn how to use alcohol at their family's table for a number of reasons, the foremost being that children don't wait until their parents are ready to teach them, or stated from the opposite perspective, parents wait too long to introduce alcoholic beverages to their children.  The second reason is that all too many parents are themselves ignorant of how to use alcohol to best advantage, and certainly don't know how to introduce it in a positive way to their children.

Our legal system exacerbates this dearth of learning at the family hearth.  The legal fiction is that at the moment when citizens reach the age of 21, they are miraculously transformed into adults who are wise in the ways of the world, and apprehend intuitively the appropriate use of all the powerful elixirs and machines that have both the ability to preserve and the ability to destroy.  As a direct result of this pernicious fallacy, we must endure horrible counter-examples, young college students who literally drink themselves to death on their 21st birthdays.

There are two notable (and fortunate) exceptions to this blanket permission: one is driving an automobile on the public highways, and the other is hunting on properties other than one's own.  In these cases, prescribed courses of instruction must be completed, tests must be taken and passed, and a license must be carried when engaged in the activity.  In the case of driving, the law acknowledges that practical experience is necessary to develop the required skills.  To this end, learner's permits are issued.  The learner is allowed to drive, with important restrictions: with a licensed driver in the front seat, and only during daylight hours.

Yet, if a family is eating in a restaurant, the establishment's liquor license is technically in jeopardy of any minors are served alcoholic beverages in any amount.  European countries, most of them pillars of the civilized world, have no such restrictions.  Their downfall as a consequence does not appear eminent.  In fact, they enjoy a somewhat easier and definitely more graceful transition to adulthood.  As a good number of social scientists have observed, cultures that use alcohol routinely in family ceremonies, as opposed to public drinking with friends or strangers, have a lower rate of alcoholism than cultures that do not.

So who is preparing and distributing educational materials for home schooling on the appropriate use of alcohol?  Not the brewers, not the vinters, not the distillers, not the restaurants, not the temperance societies, and certainly not the Alcoholic Beverage Control Commissions.  Nobody.  We're not surprised in the least because we all know the reason why.  Anybody  who did this would be a sitting duck for the vitriol of Neoprohibitionists.  "Shame!" they would quickly and loudly say.  "You are corrupting the young, encouraging young people to drink, when you should be dissuading them from this dangerous vice."  Who needs the hassle?  Especially when some young people, in spite of good teaching, would still test their limits and abuse the substance, sometimes with fatal consequences to themselves, and more frequently with legal consequences for the educational publisher.

To the prohibitionist's mind, the established fact that alcohol, consumed with meals in small amount is beneficial to most people's health and longevity, doesn't offset in the least the many lives that have been ruined by insidious, untreated alcoholism.  The equally well-documented fact that some people can use alcohol their entire lives and never lose control is also irrelevant, as long as some people can't handle the stuff.

Strategically, it advances the prohibitionist's position to "just say no" as long as possible, and then publicize the failure of those drinkers who are unable to learn solely from the non-examples of others.  How can we muster shock or surprise if people who have never been taught fail to exercise a discernment that must be learned?  Don't we have a moral responsibility to educate them before we attempt to hold them responsible for their actions?

December 1999

Help from an Unexpected Quarter

We're all aware of Hollywood's alarming intrusions on real life, but every so often real life turns the tables, and forces its way into the "entertainment" biz.  Since 1992 MTV has been airing a documentary series called "The Real World".  The premise is simply observing the lives of seven young people living in the same house, as they are followed around by camera crews for four months.

Since this season began in June the show has had a 41% increase in viewership, and has become MTV's top-rated series.  One of the reasons is Ruthie Alcaide, a 21 year-old journalism major at Rutgers University.  Ruthie, unbeknownst to the producers, has a serious problem with alcohol.  She had to leave the show this summer to spend a month in an alcoholism treatment program.  Before she left, she treated viewers to the sights of her downing drink after drink, being carried out of a watering hole by a bouncer after she became belligerent and unable to walk, having her stomach pumped in an ambulance, passing out on her bathroom floor, and trying to drive a van after a bout of heavy drinking.

At a few junctures, MTV producers have had to intervene, something that any documentary producer would do with only greatest reluctance.  An MTV executive, Brian Graden, was quoted in the Wall Street Journal: "If you saw what was happening to Ruthie, it would be very hard to think that alcoholism or excessive drinking is glorious."

Confronted by her housemates, Ruthie agreed to see a therapist.  That seemed to help a bit, but when she got drunk again and started throwing things around the kitchen, the group insisted on stronger medicine.

Well, Ruthie Alcaide has returned from her treatment program to "The Real World".  Stay tuned to see how she and her six cohorts handle it.  As with any gripping drama, it could go either way.

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