Abstracts of some of Robin Room's papers -1

Wagenaar, A.C.; Maynard, A.; Moskalewicz, J.; West, D.S.; Romanus, G.; Giesbrecht, N.; Her, M.; Room, R.; Rehm, J. Comments on Her et al.'s "Privatizing alcohol sales and alcohol consumption evidence and implications" Addiction, 94(8):1141-1153, 1999.

Comments on the article, "Privatizing alcohol sales and alcohol consumption: evidence and implications," are presented. The aim of the original work was to provide an overview of recent privatization/deregulation experiences in North America and other settings and to draw conclusions about the impacts that might be expected from such changes on rates of alcohol consumption and related problems. Five commentaries are provided as well as a response by the authors of the original article. The commentaries address the science of such research; the regulatory effects of deregulation ("No market is free and all privatized markets are highly regulated."); the assessment of government proposals in relation to health effects; non-synchronic waves in consumption and privatization; the fact that the results of such studies are largely inconclusive; and the need for a systematic study of the marketing and lobbying activities of the alcohol industry. The areas addressed by the authors of the original study include: (1) the relationships between privatization and context; (2) privatization and alcohol consumption rates; (3) interpretation of the experience in Alberta, Canada; (4) social factors in planning and post hoc analysis; and (5) policy considerations, research questions, and study design. They conclude that the critical issue from a public health perspective will be what happens to rates of alcohol-related problems with privatization of alcoholic beverage sales. 50 Ref

Room, R. Measuring drinking practices: How far we've come and how far we need to go. Alcoholism: Clinical and Experimental Research, 22(2 suppl):70S-75S, 1998.

The presentations by three panelists following the technical review workshop on "Consumption Measures and Models for Use in Policy Development and Evaluation" are summarized. Dr. Lorraine Midanik's remarks focused on measures of volume and pattern of alcohol consumption and on the validity of self-report evaluation of alcohol use. Dr. Klaus Makela addressed the importance of volume as an indicator of overall involvement with drinking, measurement of consequences of drinking, and the importanceof modeling drinking behaviors. Dr. Robin Room reviews the development and current status of traditions in methodology used for measuring drinking patterns. A summary of the discussion by the workshop's participants follows. 18 Ref.

Room, R. Mutual help movements for alcohol problems in an international perspective. Addiction Research, 6(2):131-145, 1998.

Mutual help groups in the alcohol field were first organized 150 years ago, and some European groups continue from the late 19th century. After the Second World War, Alcoholics Anonymous (AA) began to spread internationally, and new national mutual help movements were founded, to some extent drawing on or reacting to the AA model. While AA is dominant in North America and many English-speaking countries, other mutual help movements are stronger in such countries as France, Germany, Italy, Sweden, and Japan. Several dimensions of differentiation between the movements are discussed, including: profession or institutional sponsorship versus autonomous organization; the movement's religious, spiritual, or secular basis; whether family members and others are members as well as alcoholics; whether there are external affiliations and activities; and patterns of internal organization and functioning. 40 Ref.

Room, R. Thirsting for attention. Addiction, 93(6):797-798, 1998.

This editorial comments on D. Jernigan’s publication "Thirsting for Markets: The Global Impact of Corporate Alcohol" in terms of its contribution to the understanding of the international aspects of alcohol issues. The issues addressed include (1) the globalization of alcohol production and trade, (2) case examples of alcohol marketing from three developing countries, (3) public health approaches, and (4) examples of alcohol advertising.

Edwards, G.; Anderson, P.; Babor, T.F.; Casswell, S.; Ferrence, R.; Giesbrecht, N.; Godfrey, C.; Holder, H.D.; Lemmens, P.; Makela, K.; Midanik, L.T.; Norstrom, T.; Osterberg, E.; Romelsjo, A.; Room, R.; Simpura, J.; Skog, O.-J. Alcohol policy and the public good: A good public debate. Addiction, 91(4):477-481, 1996.

This is a reply by the authors of the book to commentaries published in the February and November 1995 issues of Addiction. The commentary series turned out to be a highly significant publication in its own right. It constitutes an international debate on alcohol policy issues of a kind seldom previously achieved in published form. The countries from which the commentaries were derived include: Australia, Canada, China, Ecuador, Finland, France, Germany, India, Japan, Nigeria, Poland, Spain, United Kingdom, United States, and Zambia. The issues raised in the commentaries include: (1) Alcohol policies and national diversities; (2) Harm reduction: aims and means; (3) The CMO's (Chief Medical Officer) dilemma; (4) Bias as an issue deserving constant watchfulness; and (5) Considerable consensus. 2 Ref.

Makela, K.; Arminen, I.; Bloomfield, K.; Eisenbach-Stangl, I.; Bergmark, K.H.; Kurube, N.; Mariolini, N.; Olafsdottir, H.; Peterson, J.H.; Phillips, M.; Rehm, J.; Room, R.; Rosenqvist, P.; Rosovsky, H.; Stenius, K.; Swiatkiewicz, G.; Woronowicz, B.; Zielinski, A. Alcoholics Anonymous as a mutual-help movement: A study in eight societies. Madison, WI: University of Wisconsin Press, 1996. 310 p.

This collaborative study offers the first comprehensive examination of Alcoholics Anonymous (AA) as a social movement, a belief system, a model for small group interactions, and an international phenomenon, as evidenced by its adoption by many countries. In this book, the authors look at what actually happens in an AA meeting, how members interact and how the 12 step model has been adopted into varying sociocultural environments. The six parts into which this book has been divided address the following: (1) AA as a mutual-help movement; (2) Early years and the diffusion of AA; (3) AA as a social organization; (4) AA as a belief system and a program for action; (5) AA and the outside world; and (6) Conclusion.

Rehm, J.; Bondy, S.; Room, R. Towards effective low risk guidelines on alcohol consumption. Addiction, 91(1):31-32, 1996.

These authors also applaud the report by the British Medical Association (BMA) on arguing against increasing sensible drinking limits. The authors then go on to comment about ways in which the BMA guidelines can be improved. 8 Ref.

Room, R.; Janca, A.; Bennett, L.A.; Schmidt, L.; Sartorius, N. Back to the drawing board? Addiction, 91(2):229-230, 1996.

This response by the original authors is directed at the comments made on their original paper on the cross-cultural applicability research (Room et al, "WHO Cross-Cultural Applicability Research on Diagnosis and Assessment of Substance Use Disorders: An Overview of Methods and Selected Results" Addiction, 91(2):199-220, 1996). They express their appreciation on the constructive comments and their reservations about some of the suggested solutions such as reliance on biological markers in solving problems of cross-cultural comparability of addiction and/or dependence diagnoses.

Room, R. Drinking patterns and drinking problems: From specifying the relationship to advising the public. Addiction, 91(10):1441-1444, 1996.

This is a commentary on paper by Midanik et al. (Midanik LT, Tam TW, Greenfield TK, and Caetano R. "Risk functions for alcohol-related problems in a 1988 US national sample." Addiction, 91(10):1427-1437, 1996). R. Room observes that for many alcohol-related problems, the pattern of drinking is very important, and that whatever a drinker's volume of drinking, the odds of experiencing problems are much reduced if the respondent does not drink too much on an occasion. He notes that Midanik et al. use risk curves in a different way than usual. Their classic epidemiologic use has been to help establish a causal relation, whereas in Midanik et al.'s study, causality is already built into the measurement of the dependent variable. Room emphasizes the need to pay sustained attention to what is going on when respondents who drink rather small amounts report experiencing alcohol-related problems. He also discusses the puzzling shape of the curves in one of Midanik et al.'s figures, in which the rates of reported problems rise steeply with the frequency of drinking 5 or more drinks in a day level off at higher frequencies of drinking this amount. He concludes by arguing that the issue of when and by what rationale drinking guidelines should be differentiated by gender needs rethinking. 13 Ref.

Ashley, M.J.; Ferrence, R.; Room, R.; Rankin, J.; Single, E. Moderate drinking and health: Report of an international symposium. Canadian Medical Association Journal, 151(6):809-824, 1994.

The effects of moderate alcohol consumption on health were discussed at the International symposium on Moderate Drinking and Health, Toronto, Canada, 10 April-1 May 1993. This article presents a report of the symposium. A joint policy statement developed to assist physicians and policy makers by symposium participants is also included. This summary covers potential benefits and risks, and the parameters and determinants of moderate drinking. Topics discussed included: (1) cardiovascular risks and its underlying mechanisms; (2) limitations of available data on moderate drinking;(3) confounding factors such as diet, tobacco, etc. (4) other health benefits and risks of moderate alcohol consumption; (5) drinking and driving; and (6) moderate drinking and alcohol policy; (6) research priorities. It is concluded that the basic issue for the individual drinker is to balance rewards from drinking against the increasing probability of harm as alcohol consumption increases. As a general guideline, persons should not drink more than two standard drinks in any day.

Caetano, R.; Room, R. Alcohol dependence in the 1990 US National Alcohol Survey: Operationalizing and comparing two nosological systems. Drug and Alcohol Review, 13(3):257-267, 1994.

The criteria for alcohol dependence in both the ICD-10 and DSM-III-R nosologies were measured in a national general population survey, using 24 stem items and follow-ups. For current (12-month) dependence (at the criterion of 3 + components), the rate was 3.2 percent according to DSM-III-R criteria, and 5.4 percent according to ICD-10. The Kappa coefficient of agreement between the two systems for classification of individuals as currently dependent was 0.62, and for lifetime diagnosis the Kappa coefficient was 0.68. Prevalence for the individual components of each diagnosis and for the underlying items are given, and the contribution of each component to the overall dependence score is examined. Implications of the results for future epidemiological work with the two classifications are discussed. 15 Ref.

Edwards, G.; Anderson, P.; Babor, T.F.; Casswell, S.; Ferrence, R.; Giesbrecht, N.; Godfrey, C.; Holder, H.D.; Lemmens, P.; Makela, K.; Midanik, L.T.; Norstrom, T.; Osterberg, E.; Romelsjo, A.; Room, R.; Simpura, J.; Skog, O.-J. Alcohol policy and the public good. New York: Oxford University Press, 1994. 226 p.

This book is the product of a two-year effort by 17 authors from nine countries to review the alcohol literature and extract information relevant for policymaking. The book has two major sections: the individual's drinking, population consumption levels, and risk relationships; and multiple policy options and the evidence for their efficacy. Individual chapters cover international trends in alcohol consumption and drinking patterns, individual's drinking and degree of risk, population drinking and aggregate risk of alcohol problems, retail price influences on alcohol consumption and taxation of alcohol as a prevention strategy, access to alcohol and the effects of availability on consumption and alcohol-related problems, public safety and drinking within particular contexts, effects of information about alcohol on drinking and on the social climate, individually directed interventions as a component of the public health response to alcohol, and policy implications. An appendix discusses research opportunities.

Room, R. Adolescent drinking as collective behavior and performance. In: R. Zucker, G. Boyd and J. Howard, Eds., Development of Alcohol Problems: Exploring the Biopsychosocial Matrix of Risk. NIAAA Research Monograph No. 26. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism, 1994. 435 p. (pp. 205-208)

The author highlights the importance of normative social expectations as externally determined motivations for adolescent drinking. He discusses the special meaning of adolescent social drinking as a group performance. Drinking helps underscore and define social roles and membership status in peer groups. Because alcohol consumption by minors is illegal, drinking represents both rebellion against adult sanctions and a claim to adult status. Thus, the solidarity of adolescent drinking groups is further reinforced by their symbolic role in the struggle between the generations. 15 Ref.

Ferris, J.; Room, R.; Giesbrecht, N. Public health interests in trade agreements on alcoholic beverages in North America. Alcohol Health and Research World, 17(3):235-241, 1993.

The health and social costs of the international alcohol trade have drawn little public attention. However, recent trade disputes between Canada and the United States (U.S.) have brought public health issues into focus. Section headings in this report include: (1) United States-Canada alcohol control; (2) public health implications; (3) how the trade agreements work; (4) the General Agreement on Tariffs and Trade (GATT); (5) the Free Trade Agreement (FTA; U.S. and Canada); (6) North American Free Trade Agreement (NAFTA; U.S., Mexico, and Canada); (7) trade disputes since 1985; and (8) the larger meaning of the disputes. It is concluded that there is a need for alcohol, with its potential harmful effects and social control, to receive special treatment in trade agreements. The challenge for public health, in domestic and international politics, is to strive for a balance between economic and public health interests in the trade and marketing of alcoholic beverages. Because of the public health implications of the alcohol trade, some trade barriers that are not acceptable for other commodities should be allowed, or even encouraged. Alcohol's special status could be recognized in addenda to both the NAFTA and the GATT. The chronology of the U.S.-Canada beer dispute is presented in table form. 30 Ref.

Room, R. Drugs, science, and policy: A view from the USA. In: G. Edwards, J. Strang, J.H. Jaffe, Eds., Drugs, Alcohol, and Tobacco: Making the Science and Policy Connections. Oxford: Oxford University Press, 1993. 350 p (pp 26-33)

The relationships between drugs, science, and public policy in the United States are discussed. Section headings in this chapter include: ( 1) how scientific effort may be maximally useful; (2) planning to include serendipity; (3) deficiencies in current research; (4) the problems are not only health problems; (5) alcohol, tobacco, and drugs should often be studied in a common frame; (6) alcohol and drug problems are largely local issues; (7) policy-oriented research needs quick-response mechanisms; and (8) the research agenda should not be distorted by prestige considerations. It is noted that today, the United States, in which policy processes often ignore science, stands at a turning point in the relationships between science, policy, and practice. The National Institute on Alcohol Abuse and Alcoholism ( NIAAA) and the National Institute on Drug Abuse (NIDA) may be split off from service-oriented organizations of the Office of Substance Abuse Prevention (OSAP) and the Office of Treatment Improvement (OTI). Although this may present opportunity to rethink relationships between science and policy, the result of this may be a further reduction in the relationships between scientific effort and practical practices and policies. 9 Ref.

Room, R. Research, policy, and the problems set by rapid social, economic, and political change. In: G. Edwards, J. Strang, J.H. Jaffe, Eds., Drugs, Alcohol, and Tobacco: Making the Science and Policy Connections. Oxford: Oxford University Press, 1993. 350 p (pp 156-165)

The effects of rapid social, economic, and political change on research and public policy are discussed. Section headings in this chapter include: (1) change and scientific laws; (2) change, science, and human drug use; (3) studying small-scale purposive change; (4) studying big changes; and (5) a program of research with a global scope. It is concluded that programs should be undertaken that reach across cultures and populations, across time, and across drugs. The most serious problem with the current literature is its narrowness of coverage, with current work bounded by time, by type of drug, and by societal setting. 6 Ref.

Room, R. Evolution of alcohol monopolies and their relevance for public health. Contemporary Drug Problems: An Interdisciplinary Quarterly, 20(2):169-187, 1993.

This paper describes the evolution of alcohol monopolies and their relevance for public health. Alcohol sales have been monopolized by states for many purposes including the minimization of alcohol problems. Motivations for monopolies, development of government alcohol monopolies, inclusions and exclusions in current North American and Nordic monopolies, performance of monopolies, and alcohol monopolies as instruments of public health are discussed in this context. Considering the historical development of alcohol monopolies, it is argued that state monopolies are potentially effective instruments for both public health purposes and for maximizing the state's revenue from total alcohol sales. 37 Ref.

Midanik, L.T.; Room, R. Epidemiology of alcohol consumption. Alcohol Health and Research World, 16(3):183-190, 1992.

The measurement of alcohol consumption in the population, which is essential to prevention of adverse health and social consequences of alcohol, is discussed. Section headings in this review of the literature include: (1) measuring alcohol consumption; (2) analyzing production and distribution statistics; (3) surveying population samples; (4) social variations in drinking patterns; and (5) developments in population surveys of drinking. Per capita consumption in gallons of 100 percent alcohol; and percentages reporting five patterns of drinking by gender, age, education level, and family income are presented in table form. It is concluded that the need for a multidimensional approach to measuring alcohol consumption and the need for consideration of norms and contexts surrounding the drinking occasions will become increasingly significant to considering alcohol' s role in accidents and social problems.

Rehm, J.; Room, R. Mutual help for alcohol-related problems: Studies of Al-Anon and of alternatives to Alcoholics Anonymous. Contemporary Drug Problems, 19(4):555-562, 1992.

This introduction to the Winter 1992 edition of Contemporary Drug Problems provides an overview of the issue's contents. Topics include the Al-Anon movement for family members of alcoholics, which was the first of a proliferation of movements applying the Twelve Steps program of Alcoholics Anonymous and, to some degree, its Twelve Traditions. The range of variation in these twelve-step movements is examined. There are now hundreds of such movements, although Alcoholics Anonymous and Al-Anon remain the largest. A number of mutual-help groups regard Alcoholics Anonymous as exemplary but reject the spiritual nature of its program. Groups founded by professionals for their clients or patients differ in several ways from traditional mutual-help groups that follow the Alcoholics Anonymous model, notably lack of anonymity, roll taking at meetings, organization, and financing arrangements. Overall, the greatest variation among these groups is in organization. Although the Twelve Steps of Alcoholics Anonymous have spread widely to other mutual-help groups, the Twelve Traditions have not. In the area of alcohol problems, only Alcoholics Anonymous and Al-Anon continue to adhere to the organizational principles codified in the Twelve Traditions. 6 Ref.

Room, R. "Healing ourselves and our planet": The emergence and nature of a generalized twelve-step consciousness. Contemporary Drug Problems, 19(4):717-740, 1992.

The emergence of a generalized "Twelve-Step Consciousness," largely centered in the San Francisco Bay Area is discussed. It is noted that in the 1980s it became common and praiseworthy for people to shift sequentially from one 12-step group to another in the process of dealing with different issues in their lives. The emergence of the Adult Children of Alcoholics (ACOA) movement in the early 1980s may have played an important role in this trend. ACOAs, drawn together by the idea that their life problems were caused by the behavior of someone else in the past, began applying the 12 steps to general life problems, for example, moving in some instances from ACOA to Alcoholics Anonymous (AA) to deal with their own drinking problems, then to Women Who Love Too Much groups or Sex and Love Addicts Anonymous to deal with their relationship patterns. Codependence ideology, in contrast to the traditional AA emphasis on mutual support and community, is becoming increasingly common in many 12-step groups, and since its focus is on individualism and responsibility to self rather than to others, it could weaken the 12-step movement. There is some evidence that the 12- step movement in the United States and California may be approaching a saturation point, in which all those likely to join such groups have already done so. It appears unlikely that a 12-step movement explicitly dedicated to social change could develop, although this does not preclude the emergence of a 12-step-based movement to provide a critical voice for ecological, feminist, pacifist, and community- building interests. 23 Ref.

Room, R. Paradigms of social research on alcohol and drug use and dependence. In: J. Cohen-Yanez, J.L. Amezcua-Gastelum, J. Villarreal, L.S. Zavala (Eds.), Drug Dependence: From the Molecular to the Social Level. Proceedings of the International Symposium on Drug Dependence: From the molecular to the social level, Mexico City, 22-25 January 1991, Amsterdam: Elsevier Science Publishers, B.V., 1992. 404 p (pp 213-220)

Social research in alcohol and other drug studies is discussed. Section headings in this literature review include: (1) ethnographic research; (2) survey interviewing and research; (3) social psychological questionnaires and experiments; (4) social and health indicator studies; (5) policy, cultural and historical document-based studies; and (6) emerging trends. It is concluded that social research has a double role in alcohol and other drug studies: (1) descriptions of the patterning of attitudes, behavior and responses to drug taking; and (2) contributions to general scientific knowledge about the meaning, patterning, and etiology of human use of psychoactive drugs. Current trends lean toward more frequent combining of two or more paradigms in the same study; toward a stronger emphasis on the time dimension; and toward bringing different phenomena of drug use into a common analytical frame. 25 Ref.

Room, R. Trade issues and alcohol monopolies: An international perspective. In: J. Ferris, R. Dunning, N. Giesbrecht, P. West, Eds., International symposium on alcohol monopolies and social and health issues: Proceedings of a Symposium Held in Toronto, Canada, October 27-30, 1992. 230 p (pp. 21-31)

This paper highlights recent trade agreements and issues and shows how they have impacted on alcohol monopolies. With the assumption that the Ontario experience is not unique, this paper proposes that government adherence to trade agreements results in a relative weakening of their monopolies' ability to establish independent alcohol policy. Also touched on are the effects of recent trade agreements on the domestic beverage alcohol industries.

Barrows, S.; Room, R. Drinking: Behavior and belief in modern history. Berkeley, CA: University of California Press, 1991. 454 p.

A social history of drinking in modern Europe, North America and Africa is presented by blending theoretical and symbolic interpretations with new studies of drinking practices. The emphasis is on symbols, ideologies and cultural meanings of drinking. The symbolic culture of drink existed in a matrix of circumstances of material production and distribution. The book is divided into four parts: (1) Many worlds of drink in Europe and America; (2) Politics, ideology, and power; (3) The inebriate, the expert, and the state; and (4) Perspectives on drinking and social history.

Room R. Cultural changes in drinking and trends in alcohol problems indicators: Recent U.S. experience. In: W.B. Clark and M.E. Hilton, Eds., Alcohol in America: Drinking Practices and Problems: New York. State University of New York Press, 1991. 380 pgs. (pp 149-162).

A shift of public awareness towards less acceptance of alcohol consumption and in particular towards heavy drinking of alcohol- containing beverages is noted. It is hypothesized that while levels of consumption, physical dependence, and other alcohol-related problems may fall, feelings of loss of control may rise, as public awareness increases. It is suggested that people in 1984 were better able to recognize symptoms in themselves causing an increase in dependence symptom indicators. Further research is required to expand the repertory of drinking-related indicators and their use.

Room, R. Social science research and alcohol policy making. In: P.M. Roman, Ed., Alcohol: The Development of Sociological Perspectives on Use and Abuse, New Brunswick, NJ: Center of Alcohol Studies, 1991. 391 p (pp 315-339)

Alcohol policy making is discussed, with a focus on social science research. Using six specific examples of interactions between alcohol social science and research and policy making, it is seen that the discovery of new knowledge does not always lead to appropriate policy decisions. It may be, in fact, that policy developments have produced knowledge and that social scientists may not be able to differentiate between the world as it is and the world as they would like it to be. However, as knowledge is accumulated, it is disseminated with long-run effects being far more important than short-run effects. While per capita alcohol consumption in the United States has been dropping, public concern over heavy drinking has been rising. As the alcoholism movement developed, its institutions have returned to coercive approaches and to alcohol control policies. While the common assumptions of social science research have conflicted with the assumptions of the alcoholism movement, and while support for social science research has decreased, the relationship between social science research and policy making must be maintained. 118 Ref.

Giesbrecht, N.; Conley, P.; Denniston, R.W.; Gliksman, L.; Holder, H.; Pederson, A.; Room, R.; Shain, M. (Eds.) Research, action and the community: Experiences in the prevention of alcohol and other drug problems. OSAP Prevention Monograph-4, Rockville, MD: Office for Substance Abuse Prevention, 1990. 326 p.

Prevention programs are described in a knowledge-based manner and state- of-the-art findings and practices drawn from recent scientific research are incorporated. The volume contains conceptual papers, case studies, and workshop reports, which all focus on community action projects. Containing 32 separate papers authored by representatives from 11 countries, this volume describes the problems encountered while developing and initiating action research programs in various settings such as schools, workplaces, and drinking establishments. Division headings within this volume include: (1) conceptual issues; (2) brief case studies; (3) extended case studies; (4) prevention settings and opportunities; and (5) symposium reflections. Three appendices include reports of four workshops, the symposium program, and a contact list.

Room, R. Measuring alcohol consumption in the United States: Methods and rationales. In: L.T. Kozlowski, H.M. Annis, H.D. Cappell, F.B. Glaser, M.S. Goodstadt, Y. Israel, H. Kalant, E.M. Sellers, and E.R. Vingilis, Eds., Research Advances in Alcohol and Drug Problems: Volume 10, New York, NY: Plenum Press, 1990. 409 p. (pp. 40-80)

The author lays out the methods for measuring alcohol consumption that have been used in survey studies of the general population of the United States and discusses their developments and rationales. In sketching the history and development of measurements of the amounts of drinking, this chapter is focused on surveys of the general adult population, although two other quantitative research traditions: studies of teenage drinking, and studies of amount of drinking among clinical alcoholics, have intersected with the tradition of adult drinking practices surveys. Emphasis is on the logic and procedures of measurement and of aggregation for reporting. Topics covered in this chapter are: (1) North American approaches to measuring amount of drinking; (2) aggregate measures of alcohol consumption; and (3) differences in results with different question approaches. 130 Ref

Giesbrecht, N.; Gonzalez, R.; Grant, M.; Osterberg, E.; Room, R.; Rootman, I.; Towle, L. (Eds.) Drinking and casualties: Accidents, poisonings and violence in an international perspective. New York, NY: Routledge, 1989. 444 p.

This book is a compilation of studies addressing the issue of drinking and casualties from a wide variety of disciplines, including the fields of biochemistry and epidemiology. The studies examine the effects of heavy drinking on the victims, friends and relatives of those who have a drinking problem. The authors analyze theories and practices of treatment from an international perspective. The studies' contrasting viewpoints of the role of research and of methods of prevention enable the book to make a major contribution to the current debate and indicate the direction of future policy. The book is an important reference volume for doctors practicing in the fields of emergency and acute care, and for alcohol researchers and public health professionals.

Room R. Epidemiology of alcohol problems: Conceptual and methodological issues. In: R. Ray and R.W. Pickens, Proceedings of the Indo-US Symposium on Alcohol and Drug Abuse, Bangalore, India, Nov 21 -26, 1986, Bangalore, India: National Institute on Mental Health and Neurosciences, 1989. 304 p (pp 13-34)

The field of alcohol-related problems is unusual and perhaps unique among public health and social problems in the diversity of problems which can be related to the use of alcohol. A review of the epidemiology of alcohol problems, focusing on conceptual issues of measurement, is presented. How alcohol-related problems are conceptualized strongly influences how they are measured, and sometimes the measurements point the way to a reconceptualization. Also, the review considers the developments in the conceptualization of alcohol- related problems in an historical perspective. It then gives a discussion of major dimensions involved in the measurement of alcohol- related problems. Emphasis is placed on understanding such data to serve as a basis for improving the prevention and management of such problems. 58 Ref.

Room, R. Responses to alcohol-related problems in an international perspective: Characterizing and explaining cultural wetness and dryness. La ricerca Italiana sulle bevande alcoliche nel confronto interrnazionale, Santo Stefano Belbo, Italy, 22-23 Sept 1989. 15 p.

Cultural differences in wetness and dryness are discussed. Section headings in this conference paper include: (1) North American analyses, integrated vs. ambivalent drinking customs; (2) comparing the problem of dryness and the problems of wetness; (3) components of the wet/dry distinction; (4) per capita recorded sales, expressed in liters of absolute alcohol; (5) proportion of abstainers; (6) spirits vs. other drinking; (7) patterns of drinking; the cultural meaning of drinking; (8) cirrhosis mortality and other long-term physical consequences; (9) overdose and other acute physical effects of drinking; (10) problematization of alcohol, the propensity to define social and health problems as alcohol-related; (11) the discovery of addiction; (12) public drunkenness and other alcohol-specific arrests; (13) alcohol-related casualties and crimes; (14) marginalization of the deviant drinker; (15) patterns of professional treatment handling; (16) popular movements and the politicization of alcohol; (17) alcohol control measures and alcohol policymaking; (18) alcohol research; (19) getting from here to there, explanations of wetness/dryness and of processes of change, including Apollonian vs. Dionysian, Catholic vs. Protestant, Ambivalence vs. Integration, and Wine cultures vs. the rest; (19) the spirits "epidemic"; (20) industrialization, capitalism, urbanizations, "complex society"; (21) populism, feminism; and (22) cyclical theories, theories of generational change. 33 Ref.

Room R. Changes in the cultural position of alcohol in the United States: The contribution of alcohol-oriented movements. 1988: 11 p.

Changes in the American cultural climate on drinking are discussed. While the focus is often on the most material signs of change, such as sales or mortality statistics, changes have also been seen at the ideological and social levels. As the alcohol treatment establishment has developed, its alcohol politics have shifted. As the treatment system grew, its societal role also changed and it became an active entrepreneur in raising public consciousness about societal alcohol problems. Similarly, the movement against drinking and driving has also developed through the establishment of groups such as Mothers Against Drunk Driving (MADD), and has been effective in toughening laws and enforcement on drinking driving, although it appears to have somewhat subsided. In addition, the program of Adult Children of Alcoholics ( ACA), alcoholism and its treatment have provided explanations of a wide variety of social and personal difficulties and the Alcoholics Anonymous program of 12 Steps has become a way to solve many problems. It is suggested that these movements may shift the consciousness of those mobilized into the movement itself, and then by extension of these individual shifts of consciousness, spread into society at large. 41 Ref.

Room R. Maintaining recovery. In: Evaluating Recovery Outcomes: A National Conference, San Diego, CA: UCSD Extension, 1988. (pp. 43-45).

This paper sums up a conference on the evaluation of treatment for alcoholism. The author's points include the following: Regardless of how alcoholism is conceptualized, heavy drinking is very difficult to change permanently, although much of it is sporadic. Heavy drinking is widespread in the same social environment in which the treatment enterprise and its clientele exist. That clientele stands for an extreme end of the population who drinks. Many individuals with less severe problems are now receiving treatment, and coercion into treatment is growing. Little information on treatment effectiveness is now available. Few treatments that have been well evaluated are adopted. Treatment capacity has grown in nonprofessional counseling and mutual help as well as professionalized help. Significant problems exist in sharply rising costs and the application of theory to the real treatment world. It is recommended that ways of coding and analyzing the facts of the treatment experience be developed and that the research grant review process be made more accepting of more open-ended research.

Glaser F B; Mendelson J; Makela K; Room R; Uchtenhagen A; Moser J; Heitman L; Nicolas C. Future of the word "alcoholism." Comments on the editorial: No ' alcoholism' please, we're British. British Journal of Addiction, 82(10):1061-1071, 1987.

Seven commentaries to the editorial "No Alcoholism Please, We're British" (British Journal of Addiction, 82(10):1059-1060, 1987) are presented. The editorial discusses the need for a more precise and acceptable word than "alcoholism" in scientific writing. The seven commentators address the question in philosophical, serious, and/or humorous terms. No definitive answer is developed: ". the resolution of such issues awaits the completion and painstaking consideration of emerging and future investigations" (Glaser); "In America, repackaging is the tour de force of change. The same terminology appears in a modified sequential context, and the glitz of the wrapping only temporarily conceals the paucity of the contents" (Mendelson); "Once these conceptual requirements can be agreed upon the rest is linguistic inventiveness and should be left to native speakers of each language" (Makela); "It would be better in my view, if we could devise ways of delivering services and thinking about policies, in fields like alcohol-related problems, that do not identify particular people as the locations of the problems and do not impose divisive and potentially pejorative labels on them" (Room); "A pluralism of etiologies must be accepted. Reducing alcohol dependence to 'problem drinking' would seem to be a move parallel to reducing gastrointestinal dysfunction in general to psychosomatic eating disorders alone" (Uchtenhagen); "A factor that is likely to affect terminology is the growing recognition of the importance of the quantity and frequency of alcohol consumption in the development of both acute and chronic alcohol problems" (Moser); and "Though the word 'addiction' in the French language is now obsolete, the problem is as far reaching as in all other western countries; and even if it is not quite a 'plague,' it poses a serious problem for people working in the fields of physical and mental hygiene to find relevant and humane solutions" (Heitman and Charles-Nicholas). 46 Ref.

Room R. Alcohol control, addiction and processes of change: Comment on "The limitations of control-of supply models for explaining and preventing alcoholism and drug addiction". Journal of Studies on Alcohol, 48(1):78-83, 1987.

Legal controls of consumption and availability of substances are compatible with other approaches used to prevent drug and alcohol abuse. The symbolic impact of such controls pales next to other attacks on drug and alcohol use. Control policies must be distinguished from prohibition, to which they are often offered as an alternative. They have more of an impact on direct physical consequences of consumption such as cirrhosis than on mental problems, just as physical indicators of addiction like withdrawal -as opposed to psychological indicators like loss of control -may be directly tied to level of consumption. The implementation of control policies reflects popular sentiment and depends for its success in large on popular support. 31 Ref.

Room R. U.S. general population's experiences with responses to alcohol problems. International Council on Alcohol and Addictions. Alcohol Epidemiology Section, Aix-en-Provence, France: 7 Jun - 12 Jun 1987. 26 p.

In a 1984 sample of the US adult household population, 3.4 percent reported having some experience of treatment for alcohol problems during their lifetime, and 1.3 percent reported such experience in the last year. The leading treatment sources on a lifetime basis were Alcoholics Anonymous, some other alcoholism program, a medical group or private physician, a general hospital, and a health or mental program. 19 Ref.

Room R. U.S. general population's experiences with responses to alcohol problems. Alcohol Epidemiology Section Meetings, Aix-en-Provence, France, June 7- 12, 1987. 18 p.

The responses of the general population of the United States to alcohol- related problems are discussed, with an emphasis on responses by either the drinker or someone else to the consumption of alcohol. The information is based on a 1984 survey of the United States adult household population. The results indicate that the informal social control of expressed disapproval of someone's drinking is common. Attempts at social control are generally exerted by the older on the younger generations and by women on men. It has even been suggested that women must control drinking twice: for themselves and for their men. It is also suggested that such informal control is far more widespread than the more formal efforts of alcoholism treatment. Efforts at control and pressure may be part of a broader effort to influence each other's behavior and the results of studies of these issues would be useful in a cross cultural context. It is concluded that strengthening the informal community responses to heavy drinking is a major strategy for reducing alcohol-related problems in society. 19 Ref.

Room R. Social dimensions of alcohol dependence. Invitational Conference on Alcohol Dependency, Lexington, KY, May 22, 1987. 10 p.

The parameters of and differences between alcohol dependence and alcoholism are discussed. It is noted that the modern meaning of alcoholism developed when Alcoholics Anonymous (AA) began to use the medical term alcoholism to describe a loss of control over both drinking and life. It is suggested that in studying dependence, all elements of the concept of dependence must be examined. It is then hypothesized that at this point in history, the rate of dependence as a cognitive and existential experience is rising while the rate of physical dependence is actually falling; in "wettening" periods, these phenomena would be reversed. In fact, the current rise in concerns over alcohol consumption has been predominant among women, while the increase in heavy drinking that appeared in the 1960s appears to have been specific to men. The results support the hypothesis that different aspects of dependence can show differently at different times in history, although further research is needed to establish this conclusively.

Room R, 2005. Multicultural contexts and alcohol and drug use as symbolic behaviour. Addiction Research & Theory, 13(4), pp.321-331.

Diverse forms of cultural contact, from living together in the same society to tourism, are considered in terms of what they mean for substance use. In a multicultural society, ethnicities are partly assigned and partly constructed, and can also be a performance in front of an audience of others. Alcohol or drug use or nonuse often becomes an ethnic marker, which helps to sustain differentiations in patterns. Drinking and drug use patterns in immigrant communities are thus not simply a matter of acculturation to some “mainstream”. Cultural diffusion may flow in both directions. In the modern world, mass tourism has also become a vehicle for cultural contact and transmission of drinking and drug use, although tourists’ behaviour is often different from their behaviour back home. Studies of psychoactive substance use in multicultural contexts need to take account both of the symbolism of the use, particularly in the context of the performance of ethnicity, and of the influence of power and status relations on the ethnic performance and its reception.

Rehm, J., Room, R., van den Brink, W. and Jacobi, F., 2005. Alcohol use disorders in EU countries and Norway: an overview of the epidemiology. European Neuropsychopharmacology, 15(4), pp. 377-388.

Based on a systematic literature search and an expert survey, publications after 1990 on prevalence of alcohol use disorders (AUD) in EU countries and Norway were reviewed. The search was restricted to studies using the DSM-IIIR or DSM-IV, or ICD-10, plus validated instruments to assess AUD. Using only representative general population surveys, the weighted median estimates for 12-month prevalence rates for dependence alone are 6.1% for males (arithmetic mean 5.0%; interquartile range 0.4% to 7.5%) and 1.1% for females (arithmetic mean 1.4%; interquartile range 0.1% to 2.1%). Results thus showed, that AUD constitute a high burden of disease in Europe, but there was high variability of prevalence. Men have higher prevalence rates of AUD than women. No clear pictures emerged with respect to age and AUD prevalence, or with respect to urban vs. rural and AUD prevalence. The discussion highlights potential explanations for the high variability of prevalence between countries, and the fact, that AUD constitute only a small part of all alcohol-related harm.

Room, R. (2005). Fetal alcohol syndrome: a biography of a diagnosis. The Lancet, 365(9476), 1999-2000.

In 1973, The Lancet published two articles from a research team in Seattle on a topic that was named fetal alcohol syndrome (FAS). The claims of the articles—that there is a specific set of pathological symptoms in infants whose mothers had drunk alcohol heavily during pregnancy—won quick and broad acceptance, as did the naming of the syndrome. Janet Golden's Message in a Bottle is, as she puts it, a “biography of a diagnosis”: a brief sketch of the prehistory of thinking on alcohol and pregnancy, and a more detailed consideration of what happened, particularly in the USA, after the diagnosis was born.

Room, R., Babor, T., & Rehm, J. (2005). Alcohol and public health. The Lancet, 365(9458), 519-530.

Alcoholic beverages, and the problems they engender, have been familiar fixtures in human societies since the beginning of recorded history. We review advances in alcohol science in terms of three topics: the epidemiology of alcohol's role in health and illness; the treatment of alcohol use disorders in a public health perspective; and policy research and options. Research has contributed substantially to our understanding of the relation of drinking to specific disorders, and has shown that the relation between alcohol consumption and health outcomes is complex and multidimensional. Alcohol is causally related to more than 60 different medical conditions. Overall, 4% of the global burden of disease is attributable to alcohol, which accounts for about as much death and disability globally as tobacco and hypertension. Treatment research shows that early intervention in primary care is feasible and effective, and a variety of behavioural and pharmacological interventions are available to treat alcohol dependence. This evidence suggests that treatment of alcohol-related problems should be incorporated into a public health response to alcohol problems. Additionally, evidence-based preventive measures are available at both the individual and population levels, with alcohol taxes, restrictions on alcohol availability, and drinking-driving countermeasures among the most effective policy options. Despite the scientific advances, alcohol problems continue to present a major challenge to medicine and public health, in part because population-based public health approaches have been neglected in favour of approaches oriented to the individual that tend to be more palliative than preventative.

Room, R., Matzger, H., & Weisner, C. (2004). Sources of informal pressure on problematic drinkers to cut down or seek treatment. Journal of Substance Use, 9(6), 280-295.

Objective: To examine how patterns of expressions of concern about drinking from family members and friends differ according to the demographic characteristics of the drinker. Method: A probability sample of adult treated (n~926) and untreated (n~672) problem-drinking individuals from a Northern California county. Logistic regression analysis was used to predict having received pressure about drinking from a specific family member or friend. Results: Spouses and significant others were the most common relations to have said anything about the respondent’s drinking, suggested they cut down or given an ultimatum to enter treatment. When controlling for severity, the respondent’s degree of dependence and number of social consequences strongly predicted pressure from all sources. Having a higher income remained a strong predictor of pressure by a spouse, while having a lower income was significant in receiving pressure from siblings and other relatives and friends. Younger respondents were more likely to be pressed by a father or mother, while older respondents were more likely to be pressed by sons and daughters. Conclusions: Results show the importance of family relationships other than that with a spouse or significant other, in the efforts at informal control of drinking and efforts to seek treatment.

Stenius, K., & Room, R. (2004). Measuring “addiction” in Europe: The diffusion of the Addiction Severity Index, and its purposes and functions. Journal of Substance Use, 9(3-4), 105-119.

This paper discusses what an instrument like the Addiction Severity Index (ASI) offers to various actors in the diverse addiction treatment systems of Europe and what the use of the ASI means and implies at the treatment system level. It is concluded that the adoption of the ASI can be linked to a number of factors, including the demands for cost-efficiency, scientific legitimacy of addiction treatment, professionalization, internationalism, and unification of a diverse system. Furthermore, it considers the specific choices embedded in the structure and content of the ASI—how the use of the ASI structures the user’s view of the situation and life-trajectory of the individual client. Features such as the length of the interview, the time frames of the question, the exclusion of measures of dependence and alcohol-/drug-attributable problems and the inclusion of client’s rating, are discussed. It is concluded that the opinions about the usefulness of the ASI in Europe vary. For the future of measurement of alcohol and drug problems in Europe, for system monitoring and international comparisons, shorter instruments seem to be the likely path forward. The article draws to a large extent on the papers presented at a conference, ‘‘Measuring ‘addiction’ in Europe: clinical, sociological, cultural and policy aspects of Addiction Severity Index (ASI) and other international instruments’’, at SkarpoĻ, Sweden, in January 2003.

Rehm, J., Fischer, B., Graham, K., Haydon, E., Mann, R. E., & Room, R. (2004). The importance of environmental modifiers of the relationship between substance use and harm. Addiction, 99(6), 663-666.

Taking into consideration patterns as well as levels of substance use has improved the understanding of disease consequences and social harm on both the individual and the population levels (alcohol: Rehm et al. 2004; tobacco: Ferrence et al. 2000; illegal drugs: van Ameijden et al. 1994). However, considerable variance in the aetiology of these consequences remains unexplained. It has become apparent that variance in substance use-related harms cannot be explained solely by agent-intrinsic concepts (e.g. level of use or even pattern or mode of use). Both individual characteristics and environmental factors moderate the occurrence and severity of harms from substance use (Evans, Barer & Marmor 1994; Berkman & Kawachi 2000). Here we focus on characteristics of the social or physical environment which are associated with increased risk of negative social or health consequences from use of various substances.

Room, R., & Bullock, S. (2002). Can Alcohol Expectancies and Attributions Explain Western Europe's North–South Gradient in Alcohol's Role in Violence?. Contemporary Drug Problems, 29(3), 619-648.

Recent time-series analyses provide further support to the idea of a north-south gradient in Western Europe in alcohol's role in homicide. Differences in drunken comportment have long been hypothesized as part ofthe explanation. Five items about expectations about alcohol's role in violence, and the potential excuse-value ofintoxication, were asked ofi,OOO adults in an RDD survey in each ofsix countries: Finland, Sweden, the United Kingdom, Germany, France and italy. The results were not in the expected direction. Finnish respondents were more likely than others to value not showing any effects after drinking. Italian, French and British respondents were the most likely to believe that getting drunk leads to violence. Italian, German and British respondents were most likely to believe that friends should forgive and forget after drunken anger, and Italians and British were the most likely to excuse behavior because ofdrunkenness. The results are discussed, and the interplay of the items, and within-population variations in responses to them, are explored comparatively in the six national samples.

Room, R., & Sato, H. (2002). Drinking and drug use in youth cultures: 1. Building identity and community.

This is the first of two issues of Contemporary Drug Problems on qualitative studies of drinking and drug use in youth cultures. The papers are revised from papers presented and discussed at a conference at Skarpo, Sweden, on 23-26 April, 2001. The conference, funded by the Swedish National Public Health Institute, was hosted by the Centre for Social Research on Alcohol and Drugs, Stockholm University, and was a thematic meeting of the Kettil Bruun Society for Social and Epidemiological Research on Alcohol.

Room, R., & Sato, H. (2002). Drinking and drug use in youth cultures: 2. Intoxication, camaraderie and control.

This is the second of two issues of Contemporary Drug Problems on qualitative studies of drinking and drug use in youth cultures.* As noted in the introduction to the first issue (Room and Sato, 2002), the papers are selected and revised from those given at a meeting in April 2000 in Skarpo, Sweden. The aim of the conference was to bring perspectives and approaches from various traditions of cultural and subcultural studies to bear on issues related to drinking or drug use in different youth cultures/subcultures.

Room, R., & Rossow, I. (2001). The share of violence attributable to drinking. Journal of substance Use, 6(4), 218-228.

While analysts have differed on whether alcohol causes crime, the differences primarily reflect varying definitions of causation. At a population level, more drinking tends to lead to more violence, and less drinking to less. Estimates of the fraction of violence attributable to alcohol have been based both on individual-level and on population-level data. At the individual level, there seem to be cultural differences in the proportion of violent episodes involving drinking, although it is difficult to determine what proportion of these episodes should be attributed to alcohol. At the aggregate level, there are clear variations between different drinking cultures in the fraction of violence attributable to drinking, with the proportion higher in northern and eastern than in southern Europe. These cultural differences underline that there is no single invariant attributable fraction for alcohol’s role in violence. The advantages and disadvantages of further individual- and aggregate-level studies are discussed. Suggestions are made for future lines of research on the connection between drinking and violence.

Giesbrecht, N., Ialomiteanu, A., Room, R., & Anglin, L. (2001). Trends in public opinion on alcohol policy measures: Ontario 1989-1998. Journal of studies on alcohol, 62(2), 142-149.

Objective: This article presents trend data concerning public opinion on alcohol policy in the Canadian province of Ontario over a 10-year period (1989-98), highlights the currently debated issue of private venues for retail alcohol sales and assesses correspondence between public opinion and actual and proposed policy decisions. Method:Selected policy-related items from nine probability surveys on representative samples of male and female Ontario adults (range of unweighted n 's: 953 to 1,947) were analyzed by means of logistic regression. Results: We found strong support for the status quo for a number of items, including beer and liquor store hours, corner store sales and taxes. Across all years, less than 6% of the total sample wanted to lower the legal drinking age. Over time, a linear trend showed a gradual but not entirely consistent development of attitudes among the Ontario public, favoring relaxation of some controls. However, contrary to this trend, disapproval of retail sales in corner stores increased significantly from 1992 to 1996. Demographic breakdown shows that relaxation of controls is most favored by those who report consumption of five or more drinks per occasion at least weekly over the past 12 months, and most strongly opposed by women and nondrinkers. Of those who seldom or never consume five or more drinks per occasion, the majority express satisfaction with the status quo. Conclusions: These data call into question the suitability of changes in alcohol policy that would diminish controls. It is of particular interest that there seems to be little public support for privatization proposals in the province. Public opinion against comer store sales of alcoholic beverages increased over time.

Room, R. (1999). The Kettil Bruun Society: an international forum for social and epidemiological research on alcohol. Addiction, 94(11), 1621-1624.

In June, 1999 the annual Alcohol Epidemiology Symposium met for the 25th time. At first, these June meetings were held as the Alcohol Epidemiology Section of the International Council on Alcohol and Addictions (ICAA). At the 1974 ICAA Institute in Manchester, Eva Tongue had tapped me to be chair of the new Section (the tap on the head, to get my attention, was literal). At the first Section meeting in Helsinki in 1975 (which I did not attend), 15 papers from seven countries were presented.

Room, R., & Rosenqvist, P. (1999). Drugs in a global perspective: The international Control system's best foot forward. Addiction Research, 7(3), 177-192.

With the World Drug Reporr, the United Nations Drug Control Programme offers a textbook on global trends and developments in drug use and in the illicit market, theories and interpretations of drug use, health and social harms from use, counterstrategies and programs, the drug control structure, and “regulation-legalization” debates. Country profiles for 8 countries summarize available data, making use also of two problematic comparative indices. Harms from alcohol and tobacco figure heavily in the arguments for maintaining drug prohibition, but these drugs are otherwise excluded from consideration. The report highlights deficiencies in available data, particularly on adverse consequences of drug use. though they are the premise for the drug control system. The report’s picture of trends in drugs use and in the illicit market is realistically gloomy, and its presentation of the effectiveness of counterstrategies is usually appropriately cautious. The report is often internally inconsistent in its premises and arguments, but is true to its aim to “de-sensationalize the drugs issue”. De-sensationalizing drugs may, however, undercut the justification for a drug control system of such extraordinary ambitions and scope.

Room, R. (1998). Alcohol and drug disorders in the International Classification of Diseases: a shifting kaleidoscope. Drug and alcohol review, 17(3), 305-317.

This paper considers the development of the alcohol and drug categories in the mental disorders section of successive editions of the International Classifications of Diseases, and the current definitions of the key categories. With respect to “dependence”, it is argued that the concept was originally defined with respect to culturally close societies, but even between those societies there remain differences in nuance; that in current definitions dependence is not unitary; that there are difficulties in applying the concept across drugs; that technical definitions have drifted far from lay concepts; and that there are substantial questions about its cross-cultural applicability. As practitioners struggle to keep up with the shifts in nosological terminology and definitions over the last 30 years, the terms and criteria may well be quite vague in application despite their concreteness in appearance.

Room, R. (1998). Drinking patterns and alcohol-related social problems: Frameworks for analysis in developing societies. Drug and Alcohol Review, 17(4), 389-398.

The relation of alcohol to social and casualty problems is considered, with particular attention to patterns in developing societies. Potential problems for the drinker include accidental and intentional injuries; problems in major social roles: in the family, at work and in public roles; and problems from the reaction of others to the drinking. Potential problems for those in the drinker's environment include mental health problems, injuries and social problems from role failure. Potential problems for a society or collectivity include social disintegration, and aggregate-level equivalents of the problems for the drinker and those around the drinker. Cultures vary in the dominant type of drinking pattern and, accordingly, in the extent and mixture of alcohol-related social and casualty problems. A series of cultural factors influencing the relation between drinking patterns and problems are considered.

Room, R. (1996). Alcohol consumption and social harm—conceptual issues and historical perspectives. Contemporary Drug Problems, 23(3), 373-388.

Developing ideas of privacy rights and the continued moral loading against heavy drinking have resulted in a decline in the measurement of alcohol's role in social harms. Room discusses conceptual issues in the relation of drinking to social harms.

Room, R., Janca, A., Bennett, L. A., Schmidt, L., & Sartorius, N. (1996). WHO cross‐cultural applicability research on diagnosis and assessment of substance use disorders: an overview of methods and selected results. Addiction, 91(2), 199-220.

The cross-cultural applicability of criteria for the diagnosis of substance use disorders and of instruments used for their assessment were studied in nine cultures. The qualitative and quantitative methods used in the study are described. Equivalents for English terms and concepts were found for all instrument items, diagnostic criteria, diagnoses and concepts, although often there was no single term equivalent to the English in the languages studied. Items assuming self-consciousness about feelings, and imputing causal relations, posed difficulties in several cultures. Single equivalent terms were lacking for some diagnostic criteria, and criteria were sometimes not readily differentiated from one another. Several criteria–narrowing of the drinking repertoire, time spent obtaining and using the drug, and tolerance for the drug–were less easy to use in cultures other than the United States. Thresholds for diagnosis used by clinicians often differed. In most cultures, clinicians were more likely to make a diagnosis of drug dependence than of alcohol dependence although behavioural signs were equivalent. The attitudes of societies to alcohol and drug use affects the use of criteria and the making of diagnoses.

Room, R. (1996). Patterns of family responses to alcohol and tobacco problems. Drug and Alcohol Review, 15(2), 171-181.

Patterns of family response to drinking and smoking were studied in a sample of 1034 adults in Ontario in 1993. Concerning tobacco smoking, 69% of respondents reported having said something to a relative and 82% to a friend; concerning drinking, 46% had said something to a relative and 65% to a friend. Having said something did not vary much with the respondent's age, educational level and smoking or drinking status, except that current smokers were less likely than others to have said something to a friend or acquaintance, while heavier drinkers were more likely to have said something to a friend or acquaintance, and ex-drinkers were more likely to have said something to a relative. About half of all who had ever smoked reported a family member (57%) or a friend (47%) had said something to them about their smoking, compared with much smaller proportions of ever-drinkers who reported that a family member (14%) or a friend (8%) had ever said anything about their drinking. Both drinking and smoking are recognized by many respondents as imposing burdens on the family. Family members often comment on drinking and smoking, and make suggestions about cutting down or quitting.

Room, R., Bondy, S., & Ferris, J. (1996). Determinants of suggestions for alcohol treatment. Addiction, 91(5), 643-656.

Entry to treatment is often precipitated by suggestions or pressure from relatives or friends, but we know little of the circumstances in which suggestions to cut down on drinking include advice to seek professional help. In 1993, 1034 Ontario adults were asked in a random digit dialling telephone survey if they had said something to a friend or relative about their drinking, or suggested they cut down. About 35% had said something within the last year, and 15% had taken the further step of suggesting they seek professional help or helping them get assistance. Respondents were asked a series of questions about the circumstances of the most recent time they had said something to the person. Whether respondents who said something recommended seeking professional help is related to these circumstances, and to the respondent's demographics and relationship to the drinker.

Room, R. (1996). Gender roles and interactions in drinking and drug use. Journal of substance abuse, 8(2), 227-239.

In gender-focused discussions of alcohol and other drug use and problems, the emphasis has usually been on the individual male or female or on the genders as aggregates of individuals. But most drinking and much drug use have strong social and interactional elements, where gender roles and often gendered interactions come into play. Drawing on the existing literature, opportunities for research on gender roles and interactions in drinking and drug use and problems are discussed under the following headings: courtship and affectional preference; sexuality; marriage and partnership; parenthood; friendship and peer relations; work roles; informal social control (spouse, relatives, friends); and domination, violence, and abuse.

  Room, R. (2016). Sources of funding as an influence on alcohol studies. The International Journal of Alcohol and Drug Research, 5(1), 15-16.

When I first read Thomas Kuhn’s (1962) seminal work, shortly after its first publication, I was awakened to the historical evidence that even the “hardest” science is a human construction deeply influenced by the social order and the conceptual traditions in which the scientist works. On the other hand, as constructivism took hold in sociology, I realized I was a “soft” constructivist, willing to acknowledge that our conceptual and other constructions face some limits from the physical world and its operating rules (Room, 1984). But in fields like ours, the constraints are quite broad, so that what constitutes alcohol social science—what its research questions are, and how it approaches them—has varied a great deal over the last century or so, and varies considerably among the societies which have been willing to fund such research. I remember discovering that temperance-oriented survey studies, when they turned attention at all beyond the boundary between drinker and abstainer, focused only on frequency of drinking, ignoring amount per occasion (Lindgren, 1973)— a pattern found also in drug war–era drug surveys. What we collect as material for study and what we focus on in analyzing it are deeply influenced by our intellectual and cultural-political heritage and environment.

Room, R., Hellman, M., & Stenius, K. (2015). Addiction: The dance between concept and terms. The International Journal Of Alcohol And Drug Research, 4(1), 27-35.

The paper discusses the relation between a concept of addiction and the terminology used for its communication, drawing on and analyzing historical citations from the Oxford English Dictionary. The history of words used in English illustrates that terms for a concept change over time, often by an existing word being repurposed. “Addiction” as a term existed prior to the contemporary concept, but with a descriptive meaning that did not carry the explanatory power intrinsic in the modern variant. So its use as a word for the modern conception of the addiction phenomenon was delayed well beyond the emergence of the concept. The experience in English of interplay between concept and terms is discussed in the context of two frames: of influence in both directions between medical and popular concepts and terms, and of cross-cultural variations in the concept and of terms for it.

Room, R. (2014). Alcohol control policies in low- and middle-income countries: Testing impacts and improving policymaking practice. The International Journal Of Alcohol And Drug Research, 3(3), 184 – 186.

Alcohol is a major contributor to the global burden of disease (Lim et al., 2012), and is a major source of health and social harm in many middle- and low-income countries, as well as in high-income countries. In recognition of this, a Global Strategy to Reduce the Harmful Effects of Alcohol was adopted in 2010 by the World Health Organization’s governing body, the World Health Assembly (WHA) (WHO, 2010). Since then, there has also been increasing international recognition of alcohol’s role in social problems, including crime, family problems, and lost work productivity: "beyond health consequences," WHO notes, "the harmful use of alcohol brings significant social and economic losses to individuals and society at large" (http://www.who.int/mediacentre/ factsheets/fs349/en/). New emphasis has been put, too, on alcohol’s major contribution as a risk factor for non-communicable diseases (NCDs) such as cancer, heart disease, and liver cirrhosis; WHO’s global goals for NCD control include the (somewhat fuzzily defined) goal of a 10% reduction in the "harmful use of alcohol . . . as appropriate" by 2020 (WHO, 2013). Together, these steps reflect a greater international recognition of alcohol as a major issue to be addressed in improving global health.

Room, R. (2015). The UN Drug Conventions: Evidence on Effects and Impact. In Textbook of Addiction Treatment: International Perspectives (pp. 1377-1385). Springer Milan.

The three international drug treaties cover many psychoactive substances (“drugs”), although not tobacco (now under a separate treaty) or alcohol. They include a penal regime to enforce the limitation of use to medical or scientific purposes, a trade regime concerning drugs for medical use, and a planning scheme to ensure adequate supplies of medical opiates. The system, initiated in 1912, had shifted its main focus by the 1988 treaty to combating the illicit markets which accompany a prohibitory system. The place of the drug treaties in the United Nations system and the bodies which compose the system are briefly characterized. Nearly every country has signed each treaty, though often with reservations. The option this involves of denouncing and reacceding with reservations has now been successfully used by Bolivia concerning coca leaves. The system has assured access to pain medication in most high-income countries, but not in much of the world, where the system’s emphasis on law enforcement has often indirectly but effectively cut off supplies. In terms of controlling legal medical markets, the system has had mixed success. But the system has mostly failed in cutting off the illicit drug trade. In a system which has been committed to a prohibitory approach, there are recent signs of change, particularly in the Americas, which are briefly discussed.

Room, R. (2015). Cultural aspects and responses to addiction. Textbook of addiction treatment: international perspectives, 107-114.

The use of psychoactive substances and our interpretations of the effects of the substances are affected by culture, defined broadly to include social worlds and subcultures as well as tribal, societal, and linguistic groupings. Prototypical patternings of use include medicinal use, customary regular use, and festival and other intermittent uses (where the psychoactivity is most attended to). A fourth pattern, addictive or dependent use, was a conceptualization arising after the Enlightenment. Cultural norms may both encourage and discourage use and heavy use and may make the use more or less problematic. Cultural factors also shape responses to substance use, including the social handling of problematic situations and persons. Thus, there are characteristic differences between cultures in the institutional and professional location of the handling of substance use problems. In the modern world, there is substantial diffusion of practices and understandings between cultures, and in multicultural societies, drinking or drug use patterns often serve as markers of cultural distinctions. Despite all the diffusion, there are persisting cultural differences in thinking about, patterns of, and responses to psychoactive substance use.

Room, R. (2012). Individualized control of drinkers: Back to the future?. Contemporary Drug Problems, 39(2), 311-343.

In recent years, Anglophone countries are increasingly resorting to individualized control of drinkers. Thus, the Australian Northern Territory government has implemented legislation for electronically verifiable identification that must be checked against a list of adults prohibited from purchasing alcohol. For another example, alcohol-purchase banning orders were instituted in England and Wales by the Blair government. This article considers the earlier history of such individualized drinking controls, particularly in the alcohol-control regimes of the 1920s-1960s, which succeeded prohibition regimes, or were set up in response to prohibition movements. Questions addressed include: what were the rationales of such individualized controls, how were they enforced, why were they largely abandoned, and what evidence is available on their effects? The present-day resurgence of individualized controls is interpreted as the path of least resistance for politicians who need to be seen to do something about alcohol problems without substantially impinging upon the alcohol market.

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