Alcoholism and Alcohol Abuse
Beverage alcohol consumption occurs in most societies, and an extensive anthropological
literature documents worldwide variations in the social patterns of alcohol use (Gefou-Madianou
1992; Heath 2000; McDonald 1997), much of it emphasizing the integrative functions served by
alcohol consumption, a theme that also informs early sociological studies of the topic (Bacon
1943). Organized social research and publication in industrialized nations have, however,
increasingly moved away from viewing alcohol as an integral part of community, work and
family life. Modern sociological research deals almost exclusively with the problems associated
with the use of alcohol. This is due in part to cultural ambivalence towards this potent yet widely
available drug (Room 1976), but is also a consequence of the political and economic investments
that have accumulated around the production and distribution of alcohol and the myriad of
organizations involved in prevention, intervention and treatment of alcohol problems (Wiener
1980). The result is that research funding is very largely targeted on dysfunctions and problems
associated with alcohol, and most research by social scientists in alcohol studies is grounded in
four overlapping concerns: harm associated with alcohol consumption, the medical disease of
alcohol dependence or alcoholism, the co-occurrence of both alcohol consumption and alcohol
dependence with other physically and socially destructive behaviours, and the social and
organizational characteristics of interventions designed to deal with problems of alcohol
consumption and alcohol dependence.
This represents a narrowing of earlier interests. Since the 1960s, researchers had identified social
factors in the aetiology of alcohol dependence. Trice (1966) offered a theory of individually
rewarding drinking experiences followed by selective and sequential associations with drinking
groups within which increasingly heavy and chronic alcohol use was socially accepted. In a
similar vein, Akers (1977) developed a model of patterned rewards in social interaction wherein
alcohol dependence could develop. Bacon (1973) and Mulford (1984) constructed somewhat
parallel theories centred on the interaction of selfand social definitions over time as alcohol
dependency and recovery evolved. Building on the work of other researchers who had examined
homeless and disaffiliated alcoholics, Wiseman (1970) uncovered social patterns and social
structure in the lives and interactions within these groups. She later documented patterns of
social interaction in couples where the husband was a recovering alcoholic, strongly suggesting
that social role relationships could develop around a spouse’s chronic alcoholism and serve to
prolong it (Wiseman 1991).
Despite considerable promise, these aetiological studies did not attract research support. Social
theories of alcoholic aetiology may be seen as potentially supportive of controls on alcohol
availability, and so they are unpopular within the drinks industry. Instead the explanation of
aetiology has shifted almost exclusively towards a biomedical model of causation, based on
inferred individual variations in alcohol metabolism, and often suggesting that these aberrant
patterns are caused by genes. Such hypotheses are consistent with a disease model of alcoholism
that has been the cornerstone of much research and practice, particularly in the USA since the
Repeal of National Prohibition. (Prohibition was adopted in the USA in 1919 and repealed in
1933.) The disease model suggests that a minority of the drinking population is at risk for
developing drinking problems due to biological reasons outside their control. By inference, this
model implies that the vast majority of the population can drink without physical harm or social
consequence, thus undermining support for the strategy of universal prohibition. Given the
argument that those afflicted by the disease of alcoholism can recover through lifelong
abstinence, the concept of prohibition is effectively shifted away from the entire population and
focused exclusively on a small segment. It is evident that the centrality of such a model would be
supported by the drinks industry, which constitutes a substantial political force in most
industrialized nations.
While institutional forces have come to discourage social scientists from paying attention to the
causes of alcohol problems, their expertise has been called on to examine the consequences of
drinking (Gusfield 1996). Studies of these consequences have drawn attention to different social
groupings and institutions over the past 75 years. From the ending of Prohibition to about 1960
the central icon in the definition of alcohol problems was the homeless public inebriate. The
social problem of alcohol, which had only recently been ‘resolved’ through the Repeal of
Prohibition, could be seen as manageable if it was centred and contained in this small and
socially isolated segment of the population. This group was managed through periodic
imprisonment for short terms and came to be characterized as a ‘revolving door’ population
because its members kept returning to jail. Social activism became oriented towards
‘decriminalizing’ public inebriates and directing them towards treatment for their alcoholism,
which would move them in the direction of recovery and social reintegration.
While legislation was passed to support decriminalization, it did not compel a high degree of
public interest. From the 1960s to the 1990s, the central symbol of the problem shifted away
from a tiny segment of the drinking population towards a large majority, the hidden alcoholic in
the workplace, who collectively were said to constitute 95 per cent of the alcoholic population
while the public inebriates made up only 5 per cent (Roman and Blum 1987). Intervention
mechanisms were developed in the form of employee assistance programmes that were designed
to identify and direct employed persons with alcohol problems into newly developed systems of
treatment designed specifically for ‘respectable’ segments of the population. The growth of such
privately based treatment in the USA was substantially supported by legislatively mandated
health insurance coverage.
In the 1980s and 1990s, a shift occurred away from the ‘rehabilitative ideal’ (Garland 2001) and
towards a demonization of persons with alcohol problems. The first step was the discovery of the
‘drinking driver’, and the imposition of various means of social control to detect and punish such
behaviour (Jacobs 1989). This led to a tendency to use alcohol impairment as the explanation of
all injury, damage and death in traffic mishaps if evidence of alcohol consumption by drivers
could be established. The major factor that fostered the demonized view of the alcohol abuser
was the escalation of efforts directed towards the prohibition of illegal drug traffic in the USA
and the intermingling of imagery (and treatment) of alcohol and drug users. Constructive work-
based programmes for alcohol problems were challenged by the rise of federal support for
workplace testing for illegal drug use, and the suggested elimination of drug users from
employment (Roman and Blum 1992). As the new millennium began, the demonized imagery
remains but has been supplemented by a new target population, college age youth. A substantial
research investment in prevention and intervention of alcohol and drug problems in this group
has been made in the USA since the early 1990s. Social scientists have been at the forefront of
designing these strategies. Curiously, these strategies do not pay attention to the larger segment
of youth that enters the workforce after secondary education or a brief college experience, and
does not attend residential higher education. This emphasis coincides with the drawing of sharp
new lines of socioeconomic stratification in the USA as well as other Western nations, and may
reflect the direction of alcoholrelated societal resources towards that segment of society
perceived to have the greatest social value.