Alcoholic beverages have been a part of the
Nation's past since the landing of the Pilgrims. According to the
Alcohol and Public Policy: Beyond the Shadow of Prohibition, a publication
commissioned by the National Institute on Alcohol Abuse and Alcoholism
(NIAA) and prepared by the National Academy of Sciences, the colonists
brought with them from Europe a high regard for alcohol beverages,
which were considered an important part of their diet. Drinking was
pervasive because alcohol was regarded primarily as a healthy substance
with preventative and curative powers, not as in intoxicant. It played
an essential role in rituals of conviviality and collective activity,
such as barn raisings. While drunkenness was condemned and punished,
it was viewed only an abuse.
The first temperance movement began
in the early 1800s in response to dramatic increases in productions
and consumption of alcoholic beverages, which also coincided with
rapid demographic changes. Agitation against spirits and the public
disorder they spawned gradually increased during the 1820s. In addition,
inspired by the writings of Benjamin Rush, the concept that alcohol
was addicting and that this addictions was capable of corrupting
the mind and body, took hold. The American Society of Temperance,
created in 1826 by clergymen, spread anti-drinking gospel. By 1835,
out of a total population of 13 million citizens, 1.5 million had
taken the pledge to refrain from distilled spirits. The first wave
of the temperance movement (1825 - 1855) resulted in dramatic reductions
in consumption of distilled spirits, although beer drinking increased
sharply after 1850.
The second wave of the temperance
movement occurred in the late 1800s with the emergence of the Women's
Christian Temperance Movement, which unlike the first wave, embraced
the concept of prohibition. It was marked both by recruitment of
women into the movement and the mobilization of crusades to close
down saloons. The movement set out to remove the destructive substance,
and the industries that promoted its use, from the country. The
movement held that while some drinkers may escape problems of alcohol
use, even the moderate drinkers flirted with danger.
The culmination of this second wave
was the passage of the 18th amendment and to Volstead Act, which
took effect in 1920. While prohibition was successful in reducing
per capita consumption and some problems related to drinking, its
social turmoil resulted in appeal in 1933.
Since the repeal of prohibition,
the dominant view of alcohol problems has been that alcoholism is
the principal problem. With its focus on treatment, the rise of
the alcoholism movement depoliticized alcohol problems as the object
of attention, as the alcoholic was considered a deviant from the
predominant styles of life or either abstinence or "normal"
drinking. The alcoholism movement is based on the belief that chronic
or addictive drinking is limited to a few, highly susceptible individuals
suffering from the disease of alcoholism. The disease concept of
alcoholism focuses on individual vulnerability, be it genetic, biochemical,
psychological or social/cultural in nature. Under this view, if
the collective problems of each alcoholic are solved, it follows
that society's alcohol problem will be solved.
Nevertheless, the pre-Prohibition
view of alcohol as a special commodity has persisted in American
society and is an accepted legacy of alcohol control policies. Following
Repeal, all States restricted the sale of alcoholic beverages in
one way or another in order to prevent or reduce certain alcohol
problems. In general, however, alcohol control policies disappeared
from the public agenda as both the alcoholism movement and the alcoholic
beverage industry embraced the view, "the fault is in the man
and not the bottle."
This view of alcoholism problems
has also been the dominant force in contemporary alcohol prevention.
Until recently, the principal prevention strategies focused on education
and early treatment. Within this view, education is intended to
inform the society about the disease and to teach people about the
early warning signs so that they can initiate treatment as soon
as possible. Efforts focus on "high-risk" populations
and attempt to correct a suspect process or flaw in the individual,
such as low self-esteem or lack of social skills. The belief is
that the success of education and treatment efforts in solving each
alcoholic's problems will solve the society's problem as well.
Contemporary alcohol problem prevention
began in the 1970s as new information on the nature, magnitude and
incidence of alcohol problems raised public awareness that alcohol
can be problematic when used by any drinker, depending upon the
situation. There was a renewed emphasis on the diverse consequences
of alcohol use - particularly trauma associated with drinking/driving,
fires and violence, as well as long-term health consequences.
The history of nonmedical drug use
and the development of policies in response to drug use, also extends
back to the early settlement of the country. Like alcohol, the classification
of certain drugs as legal or illegal has changed over time. These
changes sometimes had racial and class overtones.
By the end on the 19th Century, concern
had grown over the indiscriminate use of drugs, especially the addicting
patent medicines. Cocaine, opium, and morphine were common ingredients
in various potions sold over the counter. Until 1903, cocaine was
an ingredient in Coca-Cola. Heroine, which was isolated in 1868,
has hailed as a non-addicting treatment for morphine addiction and
alcoholism. States began to enact control and prescription laws,
and in 1906 Congress passed the Pure Food and Drug Act. It was designed
to control opiate addiction by requiring labels on the amount of
drugs contained in products, including opium, morphine, and heroine.
It also required accurate labeling of products containing alcohol,
marijuana, and cocaine.
The Harrison Act (1914) imposed a
system of taxes on opium and coca products with registration and
record-keeping requirements in an effort to control their sale or
distribution. However, it did not prohibit the legal supply of certain
drugs, especially opiates.
Increases in per capita alcohol consumption
as well as increased use of illegal drugs during the 1960s raised
public concern regarding alcohol and other drug problems. Prevention
issues gained prominence on the national level with the creation
of the National Institute on Alcohol Abuse and Alcoholism (NIAA)
in 1971 and the National Institute on Drug Abuse (NIDA) in 1974.
In addition to mandates for research and the management of national
programs for treatment, both Institutes included prevention components.
To further prevention initiatives
at the federal level, the Anti-Drug Act of 1986 created the U.S
Office of Substance Abuse Prevention (OSAP), which consolidated
alcohol and other drug prevention activities under the Alcohol,
Drug Abuse and Mental Health Administration (ADAMHA). The ADAMHA
block grant mandate called for states to set aside 20 percent of
the alcohol and rug funds for prevention. In 1992 reorganization,
OSAP was changed to the Center for Substance Abuse Prevention (CSAP),
part of the new Substance Abuse and Mental Health Service Administration
(SAMHSA), retaining its major program areas, while research instates
of NIAA and NIDA transferred to NIH.
The Office of National Drug Control
Policy (ONDCP) was established by the Anti-Drug Abuse Act of 1988.
Its primary objective was to develop drug control policy that included
roles for the public and private sectors to "restore order
and security to American neighborhoods, to dismantle drug trafficking
organizations, to help people break the habit of drug use, and to
prevent those who have never used illegal drugs from starting."
In early 1992, underage alcohol use was included among the drugs
to be addressed by ONDCP.
Although federal, state, and local
governments play a substantial role in promoting prevention agendas,
much of the activity takes place at grass-roots community levels.
In addition to funding from CSAP's "Community Partnerships"
grant program, groups receive support from private sources, such
as the Robert Wood Johnson "Fighting Back" program.
Although, alcohol and other drug
problems continue to plague the nation at intolerably high levels,
progress is being made. National surveys document the decline in
illicit drug use and a leveling off of alcohol consumption.
References:
A Promising Future: Alcohol and
other Drug Problem Prevention Services Improvement. CSAP Prevention
Monograph 10 (1992) BK191
National Household Survey on Drug
Abuse: Main Findings 1990 (1991) BKD67 Mosher, J.F., and Yanagisako,
K.L. "Public Health, not Social Warfare: A Public Health Approach
to Illegal Drug Policy," Journal of Public Health Policy, 12(3)
Prevention Primer, Rockville,
MD: National Clearinghouse for Alcohol and Drug Information, 1993.
