While most Americans are aware of the Prohibition era from 1920 to 1933, when the production and sale of beer, wine and spirits was illegal in the United States, few recognize that there is a "new temperance movement" afoot today. This term began to appear in alcohol research literature and the popular press in 1984 (Heath, 1989; Beauchamp, 1984; Musto, 1984; Danovich, 1984). The goal of the "new temperance movement" is not outright prohibition, rather it is to reduce overall consumption which will theoretically reduce alcohol problems and alcohol abuse.
The attitude toward alcohol in the United States can best be described as ambivalent (Pittman, 1980). During the Colonial period, drinking and drunkenness were an accepted part of the social environment. Habitual drunkenness was a problem of moral character. After the Revolutionary War, the focus of attention changed from the individual to alcohol itself. Considered toxic and addictive, distilled spirits especially were deemed evil, with some argument over whether there might be a place in society for the lower alcohol beverages: beer, wine and cider (Moore & Gerstein, 1981).
What was to become the very powerful temperance or prohibitionist movement began with voluntary pledge societies. These societies, remarked upon by de Toqueville as an expression of need to share common causes and an effective method of developing political clout in a democratic society, required its members to "pledge" not to drink alcohol (Tocqueville, 1969). These groups attracted people, mostly of the middle class, with different underlying motivations. For example, business leaders had a vested interest in a sober and controllable workforce, particularly in the relatively new industrial age. Women's societal roles were being usurped by both local governments that had taken over the children's education and industry that was producing household crafts. Becoming involved in groups that addressed social problems gave middle and upper class women an acceptable outlet for their energies (McCarthy, 1982). As these groups grew in number and membership, they developed political aims and enacted legislation principally directed against taverns and saloons (Moore and Gerstein, 1981). In 1913, the Anti-Saloon League proposed national Prohibition barring the manufacture, distribution and sale of alcoholic beverages. Victory came with the passage of the 18th Amendment in 1919 and the Volstead Act in 1920.
After the repeal of Prohibition in 1933, the regulation of alcoholic beverages was primarily in the hands of the states. There was little in the way of a national public policy regarding alcohol, and politicians as well as religious leaders (also an active group in the prohibitionist movement), were reluctant to become involved in any debate that might label them "dry" (Room, 1984). In 1935, two people, one a physician, started Alcoholics Anonymous based on the revolutionary concept that alcoholism is not a moral failing, but a treatable and preventable physical disease. Ten years later, Marty Mann, herself an alcoholic, established the National Council on Alcoholism, to develop education and prevention programs. Mann's primary goal was to educate public about alcoholism as a disease and to reduce the stigma associated with alcoholism (NCA, 1988).
While the disease concept represented a very new approach to alcoholism, it had at least two problems as a theory. It implied that there are only two types of drinkers, those who can drink with no negative effects and those who are alcoholics. It also did not address other issues related to alcohol, such as drunk driving. Alcohol theorists began to talk about alcoholism and alcohol abuse, or alcohol-related problems (Pittmann, 1988).
Levine cites Alcohol Problems: A Report to the Nation published in 1967 as the first book to focus on "alcohol problems." This report defined "alcohol problems" as any controversy, disagreement or dispute about alcohol use whether it be moral, empirical, medical, scientific, or political. Although the definition of alcohol problems has evolved and is not quite so all-encompassing, the major effect of this approach was to greatly expand the field beyond the limits of alcohol addiction (Levine, 1984).
A 1975 report sponsored by the World Health Organization, Alcohol Control Policies in Public Health Perspective, developed the "control theory" and outlined a multi-pronged approach to reducing alcohol abuse and alcoholism (Bruun, 1975). The authors applied a public health approach (host-agent-environment), that has been used very effectively to reduce the incidence of infectious diseases like smallpox and malaria. In the alcohol model, the host is the individual drinker, the agent is alcohol (including packaging, labeling and pricing), and the environment includes the social and physical structures where alcohol problems occur. The major strategies that the authors proposed to reduce alcoholism and alcohol abuse included: restriction of the availability of alcohol, taxation policies, restriction of advertising and promotion, warning labels on products and special protections for "at risk" populations (Mosher and Jernigan, 1989).
This approach was very attractive to Ernest Noble, the second director (1975-1978) of the National Institute of Alcohol Abuse and Alcoholism (NIAAA). This federal agency was created within the National Institute of Mental yHealth of the Department of Health, Education, and Welfare by the "Comprehensive Alcohol Abuse and Alcohol Prevention, Treatment, and Rehabilitation Act of 1970." It has been posited that the adoption of this "public health" strategy, also called the control of consumption theory, for alcohol problems and alcoholism was adopted in the U.S. by Noble to increase the influence of his agency and make it more competitive for federal funds.
"There is much to suggest that the NIAAA was forced by dint of its position within the department of Health, Education and Welfare (HEW) to move away from a strict disease and treatment orientation to embrace a philosophy that explicitly emphasizes prevention, advocacy, and increasing conflict with the alcohol industry. That position is founded on a number of forces: the need to state maximally the magnitude of the agency's fundamental problems, the need to compete with other federal agencies for jurisdiction of the agency's own problem areas, and the imperative to see the agency's role as, in part, an adversary role in relation to the alcohol industry..." (Beauchamp, 1980, p. 153).
The first head of the agency, Morris Chafetz (1971-1975), was criticized for exaggerating the problems of teenage drinking, suggesting that the agency "has seized on an emotionally charged topic certain to generate demands for a variety of educational and treatment programs" (Chauncey, 1981). Ironically, this critical work was sponsored by a training grant from the NIAAA.
A public health approach to alcohol policy was congruent with the various consumer movements, like the environmental movement, the consumer safety movement, etc., that had begun to affect public policy. Though focusing on different perceived problems, these movements shared a common aim of providing maximum information about consumer products, and a common assumption that unchecked growth of industries and development of technologies posed a threat to the public welfare (Pittmann, 1988; Beauchamp, 1980). In these movements, "the emphasis is on adversary relations with an industry or industrial sector, legal stratagems, and the expansion of the federal government's regulatory power" (Beauchamp, 1980, p. 157).
Patricia O'Gorman, former director of the Prevention Branch of the NIAAA, is credited with recognizing the role that consumer advocacy groups could play in expanding the scope of the NIAAA's mission. The Center for Science in the Public Interest (CSPI) was the first American non-profit organization to get actively involved in the "new temperance movement" (Pittmann, 1988).
CSPI and other advocacy groups took advantage of additional highly emotional issues, adding fuel to the "new temperance movement," namely drinking and driving, the "War on Drugs" and concerns about alcohol and pregnancy.
Drinking and driving was brought to the attention of the public and legislators by the various grassroots organizations like Mothers Against Drunk Driving (MADD), Students Against Drunk Driving (SADD), and Remove Intoxicated Drivers (RID). These groups, often organized by people who were personally affected by a drunk driver, in cooperation with other alcohol advocacy groups campaigned for a permanent nationwide minimum drinking age of 21, and tougher drunk driving laws. As these groups have matured, they have adopted the public health approach.
The "war on drugs," declared by the Anti-Drug Abuse Act of 1986 set up federal agencies to combat the use of illegal drugs and the abuse of alcohol. The phrase "alcohol and other drugs" began to appear in the materials created by the Office of Substance Abuse Prevention, later to be called the Center for Substance Abuse Prevention. The editorial guidelines developed by this agency provided the ""war on drugs" terminology. Disseminated widely to an expanding network of prevention and treatment programs, this terminology also began appearing in the public media. For example, CSAP advises not to use the terms "substance use or abuse." Instead use "alcohol and other drug use or abuse." Instead of referring to "responsible use," say "use since there is risk associated with all use." When referring to "alcohol and other-drug -use-related accidents," say "crashes" since the term "accident" suggest the event could not have been avoided (CSAP, 1988).
Civilizations as early as the Greeks were aware that a woman who drank heavily during her pregnancy could harm her unborn child. There has been a major rediscovery of that knowledge stemming from research conducted in the past twenty years. The principal issues raised by alcohol control advocates are what, if any, safe level of consumption there might be and how women of childbearing years should be informed of the risks of drinking during pregnancy . Respected and knowledgeable scientists disagree upon the dangers of light alcohol consumption during pregnancy, but the government and newly formed non- profits like NOFAS take the position that it is better to be safe. In California, the first warning labels were ordered to be posted wherever alcohol beverages were sold, based on Proposition 65 citing alcohol as a reproductive toxin. Federal warning labels were mandated in 1988 on all containers of alcoholic beverages advising not only the risk of fetal damage but safety and general health risks as well (Pittmann, 1988). The warning reads: "(1) According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects. (2) Consumption of alcoholic beverages impairs your ability to drive a car or operate machinery, and may cause health problems."
The National Council on Alcoholism, as mentioned earlier, was one of the first post- Prohibition non-profits. Its inaugural mission was to educate the public about the alcoholism as a treatable disease. In 1987 it adopted the public health approach to include "other drug addictions and related problems." The NCA also removed representatives of the alcoholic beverage industry from its board of directors (Moser and Jernigan, 1989). The NCA's national office and 193 state and local affiliates are financed by private contributions, foundations and corporations (NCA, 1988)
The Center for Science in the Public Interest (CSPI) was founded in 1971 by scientists who believed that "consumers need knowledgeable experts to represent their interests before the government and to counter-balance industry's billion-dollar lobbying efforts." CSPI is financed by dues-paying members, sales of educational publications and foundation grants. A model consumer advocacy organization, CSPI created its Alcohol Policies Project in 1981 and has been particularly vocal and active in promoting the public health approach to alcohol policy. They have produced several publications, including Tainted Booze, Marketing Booze to Blacks, Marketing Disease to Hispanics, Alcohol Warning Signs: How to Get Legislation Passed in Your City, and Citizen's Action Handbook in Alcohol and Tobacco Billboard Advertising. In 1984, CSPI launched Project SMART, a grassroots campaign to require equal broadcast time vis-a-vis alcohol advertisments for health and safety messages about alcohol. The agency also coordinates the National Alcohol Tax Coalition which lobbied for and won, in 1990, the first increase in federal beer and wine excise taxes since 1951. CSPI led a coalition of organizations that obtained the federal legislation requiring a health and safety warning on all alcoholic beverages (CSPI, 1991).
The Marin Institute for the Prevention of Alcohol and Other Drug Problems was established in 1987 by a grant from the Beryl Buck Trust to develop ways of reducing the toll of alcohol and other drug problems on society. This mission was to be accomplished by developing, applying, evaluating and disseminating community based, national and global strategies which empower communities to prevent problems associated with alcohol and other drug use. In addition to funding from the Buck Trust, the Marin Institute receives funding from federal and state governmental agencies. Leaders of the Marine Institute, namely Jim Mosher and David Jernigan, have published several articles about alcohol policy and guidelines for community action programs (Marin Institute, 1988).
Several foundations have found alcohol control issues to be compatible with their missions. The Pew Charitable Trusts have supported education of policy makers about alcohol policy issues. The Kaiser Family Foundation has funded the development of consensus document from researchers and activists on funding priorities. The Rockefeller Family Foundations has supported alcohol policy activities of CSPI.
The S.H. Cowell Foundation has funded alcohol policy organizing and educational work in California (Mosher and Jernigan, 1989). The Robert Wood Johnson has supported annual reports on the impact of alcohol and other drug abuse on American society.
The first Alcohol Studies Research Center was begun at Yale University in 1940. The center also began publishing the Quarterly Journal of Studies on Alcohol that same year. Rutgers University and Brown University also have alcohol research centers. Boston University supports the Fetal Alcohol Syndrome program, working to intervene with heavy- drinking pregnant women for the health of their unborn children. Within the School of Public Health, Harvard University developed and promoted the "Designated Driver" program, encouraging people who were planning to spend the evening at a party, dinner or other activities where alcohol would be consumed to designate a driver who would not drink during the evening.
There are many industry trade organizations, the Distilled Spirits Council of the United States (DISCUS), the Beer Institute, the California Wine Institute, the American Vintners Association, Winegrape Growers of America, state associations of the forty-plus wine-producing states, national and state associations of wine, beer and spirits distributors, and national and state associations of retailers, restaurateurs and bar owners, etc. All of these groups are involved to varying degrees in alcohol control issues, usually by lobbying against increased taxes, restrictions of advertising and promotion, warning labels and other efforts that would limit their members' abilities to conduct their respective businesses.
Since one of the major tenets of modern consumer movements is to attack industry interests, funding from the wine, beer and spirits industries is generally not accepted by the previously mentioned organizations. In an effort to show concern for the problems of alcohol abuse, several new non-profit organizations funded by industry have been created.
The Licenced Beverage Information Council was founded in 1979 with funding from associations which represent members of the alcohol beverage industry. The LBIC is a 501(c)(6) organization with the purpose of providing public and medical information on the prevention of alcohol abuse. LBIC supports programs conducted by other non-profit organizations as well as programs conducted by federal, state and local governmental agencies (LBIC, 1993). The Alcoholic Beverage Medical Research Foundation (ABMRF), created in 1982, was an outgrowth of the Medical Advisory Group founded by the United States Brewers Association (later to become the Beer Institute) and the Health Advisory Council established by the Brewers Association of Canada. Originally affiliated with Johns Hopkins University (an alliance that ended in 1988), the ABMRF was set up as a 501(c)(3) to fund medical, behavioral, and social research on the use of alcoholic beverages, and prevention of alcohol-related problems. Since funds for the foundation are limited, a decision was made to support areas of research not addressed by the NIAAA (Turner and Bennett, 1993).
In 1989, the American Wine Alliance for Research and Education (AWARE) was instituted as a 501(c)(3) educational foundation in order to monitor, compile and disseminate the results of medical research on the health effects of moderate alcohol consumption. A national network of physicians and scientists contributes expertise on a voluntary basis to produce summaries of the latest research and to conduct seminars for health care professionals. Funding comes from the industry, health care professionals and private individuals (AWARE, 1992).
The Century Council is a 501(c)(6) established in 1991 by funding from wine, beer and spirits producers and distributors to reduce the abuse and misuse of alcoholic beverages. Founders opted for the (c)(6) designation in order to lobby for tougher laws to deal with alcohol misuse. The Council's focus is on the issues of drunk driving and underage drinking with an emphasis on joint programs with other non-profits and federal, state and local governmental agencies and business associations (Century Council, 1992).
Since Prohibition, federal regulation of alcohol is limited, with the states having the primary jurisdiction. The Bureau of Alcohol, Tobacco, and Firearms (BATF) and NIAAA are the major federal agencies that have jurisdiction in alcohol control. BATF regulations are mandatory but cannot supercede any state regulations that are more strict. However, most states have chosen to regulate alcohol at the retail level, so the BATF develops regulations that affect production of all alcoholic beverages produced or sold in the US. They also regulate trade practices at the levels of production, distribution and retail sales. At the state level, alcohol is regulated by the Alcoholic Beverage Control Agencies (Beauchamp, 1980).
The mission of the NIAAA is to develop the knowledge and promote the strategies needed to treat and prevent alcoholism and alcohol-related problems. To accomplish its mission, the NIAAA conducts and funds research and develops prevention and treatment programs. NIAAA's research findings are disseminated through the Alcohol Research Utilization System, monographs and reports, a bibliographic database, and a quarterly journal, Alcohol Health and Research World. Within the NIAAA, the Division of Intramural Clinical and Biological Research includes laboratories engaged in metabolic, preclinical and clinical research. The Institute's Divisions of Basic Research, Clinical and Prevention Research, and Biometry and Epidemiology fund extramural research primarily at medical schools and universities. The extramural funds are divided roughly equally between non- profit and state-sponsored institutions (NIAAA, 1988). The Center for Substance Abuse Prevention (CSAP), initially named the Office for Substance Abuse Prevention, was created by the Anti-Drug Abuse Act of 1986 as a part of the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) of the Public Health Service of the U.S. Department of Health and Human Services. Its original mission to lead efforts toward the prevention of alcohol and other drug abuse with special emphasis on youth and families in high risk environments was expanded in scope and function by the Anti-Drug Abuse Act of 1988. It serves as a national clearing house of information and has created an extensive network of voluntary and federal, state and local agencies for the communication of ideas that can be adapted for use in community programs. CSAP provides grants to community-based organizations for prevention demonstration grants targeting youth at high risk, model projects for pregnant and postpartum women and their children, conferences, and to states for the community action youth activity program. The National Clearing House for Alcohol and Drug Information (NCADI) provides print and audiovisual materials. The communications network, the Regional Alcohol and Drug Awareness Resource (RADAR) Network, consists of more than 125 state agencies and non-profit organizations located throughout the U.S. (CSAP, 1990).
Centers for Disease Control collects and reports on a variety of health status indicators for the population of the United States. As part of their mission, they collect data on alcohol problems such as cirrhosis, violence, and fetal alcohol syndrome. Additionally, they have developed a model for estimating the numbers and types of alcohol-related deaths.
Some economic theorists hold that non-profit organizations exist to meet an unsatisfied demand for goods or services in the market or from the government. In "the new temperance movement" it appears that there is the sort of "cooperation and mutual support" between the government and non-profits that has been described in the United States (O'Neill, 1989) and other countries (Gidron, Kramer, and Salamon, 1992, p. 9). This cooperation and support works whether the government initiates policy, as in the public health approach to alcoholism and alcohol problems, or advocacy groups demand action from the government, as in the campaigns against drunk driving.
Funding for programs in "the new temperance movement" come from the three sectors of the U.S. economy. Some advocacy groups like CSPI refuse to accept funding from either government or industry, while others like the Marin Institute will accept funding from the government, but not industry. The government funds research to support its public health approach through the NIAAA and the CDC. NIAAA research funds go to its own researchers and those at non-profit and state-supported medical schools or research organizations. The industry funds research that is not addressed by government and that will support the industry agenda, such as the effects of moderate alcohol consumption
Changes in public policy provide opportunities for the non-profit sector. The adoption of a public health approach to the prevention and treatment of alcoholism and alcohol- related problems by a federal agency in the late 1970's has resulted in expanded activities of existing non-profits and the creation of many new non-profit organizations in the United States. This paper has attempted to note the principal actors in the government and non- profit sector that have had a major role in the evolution of "the new temperance movement." There are literally thousands of treatment centers and programs and community prevention programs that cannot be included due to lack of space.
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