Alcohol consumption and social harm—conceptual issues and historical perspectives

Abstract

The historical primacy of social harm from drinking In modern industrial societies, the primary rubric under which alcohol-related problems are usually considered is that of health or mental health. The main governing image for individuals with drinking-related problems-alcoholism or the alcohol dependence syndrome-is classed in the International Classification of Diseases as a mental health disorder. Treatment or counseling agencies for alcohol problems are usually under the aegis of the ministry of health. Substantial attention is often paid to the health consequences of heavy drinking: liver cirrhosis, head and neck cancers, the fetal alcohol syndrome, and so on. These days, a new health consequencethe potential protective effects of moderate drinking for heart disease-is being factored into individual and policy decisions. But typically, the factoring is in an equation where only health consequences are considered-where the issue is defined in terms of balancing livers against hearts. It is thus easy for us to forget that it is historically more common for societies to define alcohol-related problems in terms of social harms from drinking. While there is a wide variety of harms for which alcohol has somewhere been seen as responsible, in European and North American societies the major social harms with which alcohol has been identified form a fairly short list: problems of public order or demeanor and of alcohol-related violence; problems in the performance of family and parental roles; and problems in work roles and of lost productivity. In recent decades, casualties related to drinking-particularly those due to driving while intoxicated-have also been identified as a serious social problem (Gusfield, 1981). Although there have been variations over time in the degree of social attention paid to the problems, the profile of social harms attributed to alcohol, with the exception of drinkingdriving, has remained fairly constant since the heyday of the classical temperance movements. By the end of the 19th century, public drunkenness was criminalized in France, northern Europe and English-speaking countries. An early preoccupation of the U.S. temperance movement was with the contribution of drinking to crime; a mid-19th-century study estimated that three-quarters of all prisoners were in jail for drinkingrelated offenses. In the classical temperance era, the husband's drinking was also commonly blamed for wife-whipping-i.e., family violence (Levine, 1983). By the late l9th century, a main theme of the temperance movement's struggle against alcohol was home protection; stereotypically, the male's drinking was seen as threatening the peace, stability, and finances of the family, and more generally as opposed to women's interests (Levine, 1980). The concern over labor productivity actually dates much further back; in medieval Europe, this lay behind the criminalization of loitering in taverns, particularly in times of labor shortage. In the l9th century, many industrial capitalists sided with temperance interests and often built alcohol-free factory towns, seeing workers' drinking as a threat to the efficiency and safety of their industrial enterprises. During the First World War, Britain nationalized the brewers and taverns in shipbuilding areas as a way of maximizing shipyard productivity for the war effort. Alcohol and social harm today: perceptions and records To a greater or lesser extent, the same general issues and concerns continue today. In some but not all developed societies, public drunkenness continues to be seen as problematic, although in many places there has been at least a partial decriminalization. In the Soviet alcohol reforms of 1985, the official rhetoric was primarily directed against two main problems: public drunkenness-particularly in the form of street drinking groups-and loss of productivity from workplace drinking (Partanen, 1987). In terms of numbers of arrests and convictions, two major alcohol-specific crimes, drinking-driving offenses and public drunkenness, continue to hold a prominent place in U. …