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.

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