Hi again Hans Olav...
 
Thanks for your reply.  I'm not sure we are on quite the same
wavelength in this exchange.  It seems to me that at least two
questions floating around in front of us.  My responses are
interspersed below:
 
Hans Olav Fekjaer wrote (much has been snipped):
>
>This thread started in the ADDICT-L-group by my abstract of a
>population study I made in the Oslo population. In his reply,
>Ron Roizen confirmed that "this abstract very economically
>retells the story that survey research started telling us in the
>late 60ies".
 
RR: Yes.
 
>I replied that one of the most consistent findings in population
>studies is that alcohol problems to a large extent are caused by
>drinkers who may not be labeled addicted and never seek
>alcoholism treatment. Seen together with the close relationship
>between per capita consumption and the extent of problems, I
>maintained that it seems hard to avoid the conclusion that
>reduction alcohol problems most effectively is done by reducing
>per capita consumption.
>
RR: Yes, and I read the above, or words quite very like them, as
laying out a conceptual claim that the "disaggregative" or
"alcohol problems" perspective that emerged from U.S. survey
research on drinking problems in general populations in the early
1970s was, in effect, "of a piece" or seamlessly conceptually
integrated with an emergent focus on per capita alcohol
consumption controls that emerged in the mid-1970s.  (Maybe I was
wrong in that?)
 
My response addressed this point exclusively.  It was/is that the
disaggregative/alcohol problems perspective is NOT as seamlessly
conceptually connected to the per-cap-consumption focus as your
post and its brief argument suggested.
 
The first counterevidence I offered was historical:  I pointed
out that the "alcohol problems perspective" (APP) in an earlier
incarnation at Yale's alcohol studies center had actually served
the conceptual and policy utilities of _distancing_ E.M. Jellinek
and his fellow alcohologists from the Dry paradigm's
preoccupation with alcohol (per se), alcohol consumption, and, by
extension, per cap alcohol consumption.  The plurality of the
"alcohol problems" conceptualization, I argued, served as a
device for offering an alternative, polycentric focus to the Dry
movement's traditional (singular) focus on "the alcohol problem"
--i.e., alcohol (per se), consumption, and per cap consumption.
 
In logical terms I thought this a pretty good argument, actually!
In the most schematic terms, you had suggested that "A" (the
alcohol problems perspective) was conceptually of a piece with
"B" (a focus on alcohol [per se] and per cap alcohol
consumption).  I countered with an historical instance in which
"A" on the contrary was part of an argument for "not-B" (i.e., a
perspective on alcohol-related problems that quite consciously
and deliberately drew attention away from alcohol, per se, and
per cap consumption).
 
Consequently I was a bit surprised when you response suggested
that you didn't think much of my argument!  You countered:
 
>I do not believe the diversity of alcohol problems may have been
>unknown to the temperance movement, and none of the terms may be
>called erroneous. Thus, Jellinek's phrase does not reflect new
>research findings, but mainly reflects his wish to demonstrate a
>distance to the temperance movement and rhetoric...
 
RR: Yes, temperance advocates certainly saw a "diversity of
alcohol problems."  But all of those problems led back, in the
classical American temperance model (Bacon, 1967--_Brit. J.
Addiction_ 62:5-18) to a focus on the inherent perniciousness of
alcohol.  Jellinek's pluralist emphasis was a deliberate effort
to de-vilify or domesticate (in Harry Levine's term) alcohol, per
se.  In fact, the Yale science group's perspective was quite
protective of alcohol, per se.  For good examples of this point
see Haggard and Jellinek's popular-audience volume, _Alcohol
Explored_ (1942) or, even better, Jellinek's (1947--"Recent
trends..." QJSA) classic account of how World War II's dramatic
increases in apparent U.S. per cap consumption in fact reflected
an increasing moderationism in the nation's drinking (because the
rise reflected that more people were drinking rather than that
drinkers were consuming more).  If you are still unconvinced on
this point, take a look at Brian Katcher's wonderful paper on
"The post-repeal eclipse in Knowledge about the harmful effects
of alcohol" (_Addiction_ 88:729-744, 1993) or even Dry savant
Ernest Gordon's bitter assault on Jellinek and his Yale crowd's
"wet" disposition toward alcohol (in his book _Alcohol Reaction
at Yale_ [1946]).  (May I note that I made as exacting a
rhetorical analysis of Jellinek's alcohol problems paradigm as I
could muster in my paper, "Paradigm Sidetracked: Explaining Early
Resistance to the Alcoholism Paradigm at Yale's Laboratory of
Applied Physiology, 1940-1944" [unpublished MS, 1993, see esp.
pp. 10-20].)
 
No matter what temperance folk may have thought, then, Jellinek's
alcohol problems paradigm was certainly, in this historical
example, part of an argument that deflected attention _away from_
alcohol (per se) and per cap consumption.  Q.E.D., no?
 
You continued:
 
>In paragraphs 9 and 10, Ron argues that he and "even Robin"
>(Room) has written about other preventive efforts than reducing
>per capita consumption, i.e. making the world safer for heavy
>drinkers or refrain from drunk driving.
>Who are you arguing against, Ron?
>Of course, all prevention agencies do such things -  this does
>not contradict the fact that per capita consumption is the main
>factor determining the extent of alcohol problems.
 
RR: Well, Hans Olav, we may have to disagree here.  I was arguing
that the "alcohol problems" approach that spawned out of survey
research launched a good many conceptual possibilities for
conceptualization and prevention (normative, contextual,
regional, etc.)--and my memory of the "office line" at that time
is that per cap consumption was by no means regarded as "the main
factor determining the extent of alcohol problems," as you
contend.  (Indeed, I can remember when the "agent" [i.e.,
alcohol] part of the epidemiological "agent-host-environment"
model was regarded with some disdain in the impromptu discussions
we used to enjoy with one another.)
 
>In paragraph 11, Ron argues that not everything called "alcohol
>problems" really must be seen as alcohol problems. His example
>is that "spending too much money on drinking" may as well be
>called a budgeting or income problem. I agree in the example,
>and if he could not drink, he might have wasted his money on
>gambling. So what?
>
RR: Again, I seem to have made my argument so poorly that it did
not communicate my meaning.  I was asserting in effect that at
least one researcher at the Berkeley group (namely, myself) saw
the alcohol problems perspective as an invitation to examine
whether the place of alcohol, per se, in our notion of "drinking
problems" had been overestimated.  (Harry Levine also explored a
similar theme actually.)  Again, my central point remains the
same:  There was no seamless link between the alcohol problems
approach and a conceptual or policy focus on per cap alcohol
consumption.
 
BTW, and without wanting to confuse matters, it is well to
distinguish two "directions" of perception between the alcohol
problems perspective and the per cap consumption perspective.  As
survey researchers interested in accounting for the distribution
of alcohol problems in our survey data, per cap alcohol
consumption offered a not very inviting conceptual direction (for
many reasons).  On the other hand, looking from the perspective
of a policy analyst keen on promoting the per cap consumption
perspective, the survey-based alcohol problems perspective
offered an attractive element for one's argument indeed!  In a
policy world focused on "alcoholism" alone, of course, alcohol
controls made nearly no sense.  Hence the purple book's authors
made ample reference to how the "alcohol problems" findings of
survey research supported their case (see Bruun et al., 1975, p.
66).  But--and of course--one should not confuse the two quite
different _directions_ of this utility relationship.
 
Second Issue:  Another sort of point melded into your response,
Hans Olav, was the purely empirical assertion that reductions in
per cap consumption offer effective means for reducing the sorts
of alcohol-related problems that surveys measure.  The U.S.
survey evidence relating to this contention is on the whole
pretty weak I believe.  Maybe the most relevant paper in the
American literature is Mulford and Fitzgerald's examination of
survey drinking problem measures in 1961 and 1979 general
population samples in the state of Iowa ("Changes in Alcohol
Sales and Drinking problems in Iowa, 1961-1979," _J. Stud. Alc.
44:138-161)--in a period in which per cap consumption grew by 81%
between the two years.  Their results showed little change in
survey problem indicators.
 
Similarly, I (at least) read the quantitative trend analysis
chapters (7-9) in Walter Clark and Michael Hilton's book,
_Alcohol in America. Drinking Practices and Problems_ (SUNY,
1991) as falling rather short of confirming a reliable
relationship between change in per cap consumption and change in
survey-measured alcohol-problems indicators.  To these generally
negative results may also be added Room, Greenfield, and
Weisner's intriguing finding that interpersonal pressures and
frictions (one of the kinds of alcohol-related problem measures
surveys have collected) have _risen_ in the U.S. general
population between 1979 and 1990 even though U.S. per cap
consumption was in a decade-long declining trend by the latter
year (Room et al., "'People who might have liked you to drink
less': changing responses to dirning by U.S. family members and
friends, 1979-1990," _Contemporary Drug Probs._ n.v.:573-595,
1991).  The American case, then, does not offer strong evidence
that changes in per cap consumption occasion commensurate changes
in the sorts of alcohol-related problems that general population
surveys measure.
 
This is a big issue area, Hans Olav.  My own feeling is that the
contemporary conceptual & policy focus on per cap consumption is
considerably more problematic than some of my colleagues regard
it.
 
Hope I've made my argument more clear this time.
 
Yours,
 
Ron
 
 
 
--
Ron Roizen
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