Abstracts of some of Robin Room's papers - 3

Room R; Weisner C. Financing and ideology in human services: The alcohol treatment system as a case study. 10th World Congress of the International Sociological Association, Mexico City, Mexico: 16-21 Aug 1982. 20 p.

Shifts in the scope, structure, and financing of alcohol and mental health services which emerged in response to ideological and material shifts both in the specific fields of alcohol and mental problems and in society at large are discussed. It is contended that these shifts in human services have had deep effects on the ideology and practice of the treatment enterprise in its daily functioning. Some of these changes, as they have occurred in alcohol treatment agencies in California, are outlined. 52 Ref.

Room R. "Reverence for strong drink": The lost generation and the elevation of alcohol in American culture. American Sociological Association, San Francisco, CA: 8 Sep 1982. p. 9.

The literary works of writers born in the late 1880s and the 1890s are examined, and an apparent link is seen between great American writers and alcoholism. Some explanations offered for this link include focus on the intrinsic loneliness of writing and some other artistic activities, with loneliness seen as both lending itself to solitary drinking and as leading to compensatory drinking for general well being. Alternative explanations emphasize alcohol's properties as a psychoactive drug, under the influence of which the writer or artist can envision an alternative reality or be opened to creative urges. It is contended that, at the very least, the writings of this generation of writers have helped to crystallize the position which alcohol has continued to occupy in American culture for almost a half-century since the repeal of prohibition. 23 Ref.

Room R. Alcohol and crime: alcohol and criminal behavior and events. 1982. p. 18.

An overview is presented of literature that explores relationships between the use of alcohol and criminal events. The proportion of drunken events which involve criminal activity are also examined. The cumulation of studies on alcohol in criminal events allows for substantial comparisons of the rate of occurrence of alcohol factors by type of crime, by sex and age, and by ethnicity. A large portion of all reported crimes are accounted for by two alcohol-specific types of crime: (1) drunk driving, and (2) public inebriation. This discussion, however, is concerned with alcohol's role in nonalcohol-specific crimes. 84 Ref.

Room R. Legislative strategies and the prevention of alcohol problems. Berkeley, CA: Alcohol Research Group, 1982. p. 8.

Legislative strategies to reduce alcohol-related problems, those which seek to limit or shape the individual's drinking or behaviors associated with drinking, either directly by influencing the individual drinker or indirectly by influencing those around the drinker, are examined. Examples of laws attempting a direct influence are public drunkenness and drunk driving laws. Those laws with indirect influence are alcohol control and dramshop laws. Attention in this paper is focused on public drunkenness, drunk driving, and alcohol control laws. Primary consideration is given to the public health and public order functions of these laws.

Room R. Concepts of alcohol problems and their relation to policy. 1982. 3 p.

In recent years there has been an emergence in American sociology of a self-conscious tradition of "historical social constructionist" or " constructivist" analysis of social problems, with alcohol sociology playing an important role in this emergence. This tradition focuses explicitly on the social processes or definition of a field of conditions or behaviors as a problem, in an historical perspective particularly interested in changes in these definitions. Several articles are cited in a review of how alcohol problems have been analyzed from this constructivist perspective, noting the transition from a moral to a medical model (i.e., from crime to illness) to wider social models. Ways in which these social models have been employed in policy discussions are described. It is concluded that, in reconciling these different traditions, it is important to relate the shifts in dominant conceptualizations to changes in the material organization of societies and in the objective alcohol condition.

Room R. Editor's introduction: Alcohol availability and public health in an international perspective. Contemporary Drug Problems, 11(4):493-499, 1982.

Alcohol trade and production is viewed in an international public health perspective. Research data, in recent years, have shown that the rates of disease and mortality related to alcohol tend to respond directly to changes in overall consumption levels in a population. Thus, alcohol availability has become a substantial public health concern. The World Health Organization (WHO) and others have pointed with increasing urgency to the public health considerations of expanded alcohol production and trade. The WHO has recognized the need to develop a solid foundation of research and analysis into these areas, and to give close attention to existing and future trade policies and agreements affecting the availability of alcoholic beverages. 9 Ref.

Bunce R; Cameron T; Collins G; Morgan P; Mosher J; Room R. California's alcohol experience: Stable patterns and shifting responses. In: E. Single, et al., Eds., Alcohol, Society, and the State (2), Toronto, Ontario, Canada: ARF, 1981. 200 p. (pp. 159-197).

Relationships between alcohol consumption, control, and alcohol-related problems, and their relationships in turn, to California State policies, and to the social, political, and economic milieu, are outlined. Between 1950 and 1979, policies concerned with both alcohol-related problems and alcoholic beverage controls were shaped by common political and economic forces and shifts in public values, but they were addressed to different audiences and did not exert influence one over the other. Changes in control policies favored increasing availability and the spread of consumption, a stable marketing climate for the growth of the alcohol beverage industry, and increased revenues to the state of California. The shift in policy on alcohol-related problems during this time from a moral model to a medical one was accompanied by a significant increase in expenditures on alcohol-related problems. 84 Ref.

Makela K; Room R; Single E; Sulkunen P; Walsh B. Alcohol, society, and the state: A comparative study of alcohol control. Toronto, Ontario, Canada: Addiction Research Foundation, 1981. 146 p.

In order to understand the social dynamics of the post war increase in alcohol consumption and to study the control measures in their historical context, this project was carried out as a series of comparative case studies. The results of this project are drawn together in this report and its companion volume. This first volume is an international discussion of the post war (1950-1975) experiences of seven societies: the United States, Canada, Poland, Switzerland, Finland, Netherlands, and Ireland. Issues included are alcohol consumption, production, and trade, alcohol-related problems, and alcohol control policies. Each of the seven case studies are summarized in the second report. 247 Ref.

Room R. Case for a problem prevention approach to alcohol, drug, and mental problems. Public Health Reports, 96(1):26-33, 1981.

The concepts of disease prevention and health promotion are discussed in relation to alcohol, drug, and mental problems. In a discussion of preventive efforts for children, the author contends that the primary rationale for the focus on children is the assumption that the mental illness or mental health of adults is determined largely by what happens during childhood; thus, improving the experience of childhood is seen as resulting not only in happier children in the short run but in mentally healthier adults in the long run. A disaggregative approach to the prevention of alcohol problems is proposed. This approach, it is felt, would be an improvement on a disease prevention strategy in that it avoids the constraints of a nosology designed for purposes other than prevention, and is also preferable to an exclusive health promotion approach, which tends to focus on specific strategies of persuasion and education about behavior that is commonly difficult to change. 22 Ref.

Room R. Sketches for realistic pitches to heavy drinkers. Journal of Alcohol and Drug Education, 26(3):37-40, 1981.

The author contends that little of the current public information material on alcohol problems addresses itself to the realities of " serious drinkers," i.e., people who "know their way around" in bars and get drunk every now and then without regarding it as a problem. Some lines of argument regarding drinking behavior that might be listened to by such an audience are described. It is noted that these sketches have not been tested in any way, and are intended only to provide further thought about possible efforts in this direction.

Room R. Farewell to alcoholism? A commentary on the WHO 1980 Expert Committee Report. British Journal of Addiction, 76:115-123, 1981.

A commentary on the World Health Organization (WHO) 1980 Expert Committee report concerning alcohol-related issues is presented, noting the change in concerns and analysis from previous WHO reports. 26 Ref.

Room R. International study of alcohol control experiences in perspective. Contemporary Drug Problems, 10(2):145-153, 1981.

An overview of the papers drawn from work connected with the International Study of Alcohol Control Experiences (ISACE) is presented. This compilation of papers is intended to be complementary to the two ISACE volumes by presenting a series of analyses, not otherwise available in English. Most of the range of topical areas and styles of analysis in the ISACE project are covered. 14 Ref.

Bunce R; Cameron T; Morgan P; Mosher J; Room R. California's alcohol control experience, 1950-1975. 3rd Conference of the International Study of Alcohol Control Experiences, Warsaw, Poland: Apr 1980. 37 p.

The historical development of alcohol beverage control and alcohol- related problems policies is outlined, and their relationship to each other and to their social, political, and economic milieu in California from 1950 to 1975 is examined. A brief socioeconomic and political overview of California is presented, followed by an outline of popular sentiment on drinking and drinking problems in California, including a discussion of ways alcohol control policy and actions toward problems were presented in the media. An analysis of developments in the alcohol beverage market in California is presented, including production, advertising, and retailing. Alcohol consumption in California is addressed both in terms of overall patterns and trends, and in terms of aggregate consumption. Alcohol-related problems, alcohol treatment, alcohol-related arrests, accidents, and mortality, are analyzed in terms of both the problems themselves and the state's role in addressing those problems. 75 Ref.

Room R; Mosher J F. Out of The Shadow of Treatment: A Role For Regulatory Agencies in the Prevention of Alcohol Problems. Alc. Hlth Res. World, 4 (No. 2): 11-17, 1979-80.

A series of proposals are made concerning the reduction or stabilization of alcoholic beverage consumption in the interest of public health in the United States. State or local alcoholism authorities should be actively involved in forming alcoholic beverage control (abc) policies, and enforcement practices should be reformed. When violations are detected, the abc agency should offer the offending licensee training or educational programs; such alternatives could be offered after an administrative hearing, rather than at the point of detection, and special restrictions or requirements could be imposed in lieu of license suspension or revocation. Other proposals include focusing pilot prevention programs on drunken driving to generate public support, developing training materials for abc enforcement personnel on means of educating licensees who have served persons later arrested for drunken driving, encouraging licensees to train their employees to recognize and deter potential drunken drivers, encouraging insurance companies to lower dram shop liability premiums for such licensees and providing educational material for bar patrons. The more generally-oriented voluntary reforms proposed include serving free or low-cost food or nonalcoholic beverages in bars, providing forms of entertainment to slow the drinking rate, providing drinking and nondrinking sections, house limits on the number of drinks allowed in a given period and introducing mandatory bartender training on how to handle problem drinkers as a licensing requirement.

Room R. Introduction: Drug and alcohol problems, social control and normative patterns. Journal of Drug Issues, 10(1):1-5, 1980.

Literature is cited and discussed in an introduction to articles in the Journal of Drug Issues (Winter 1980) on drug and alcohol problems, their social control and normative patterns. This issue is a project of the Society for the Study of Social Problems, the primary American organization for those interested in sociological studies of alcohol and other drugs. 18 Ref.

Room R. Treatment-seeking populations and larger realities. In: G. Edwards, and M. Grant, Eds., Alcoholism Treatment in Transition, London, England: Croom Helm, 1980. 327 p. (pp. 205-224).

The issue of numbers of alcoholics within a population, and the issues that it raises are addressed, including the relation between a treatment system and those who might need its services. The following topics are discussed: (1) the alcoholism movement and the treatment establishment in the US; (2) general population studies and the issue of numbers; (3) general population alcohol problems versus clinical alcoholism; (4) problems in defining and measuring the need for services; (5) some features of the US treatment system; (6) finding clients to fill the beds (treatment slots); and (7) problems with too much treatment. 51 Ref.

Room R. New curves in the course: A comment on Polich, Armor and Braiker, 'The Course of Alcoholism'. British Journal of Addiction, 75(4):351-360, 1980.

This article critiques the reports of a series of NIAAA contracts for follow-up studies of samples of clients drawn from eight treatment centers (NAPIS monitoring system), who were reinterviewed eighteen months after (Rand Report), and then four years (Course of Alcoholism) after entry into treatment. 41 Ref.

Room R. Concepts and strategies in the prevention of alcohol-related problems. Contemporary Drug Problems, 9(1):9-47, 1980.

The author contends that as current thinking about alcohol policy turns away from treatment and toward a broader policy mix including prevention, it is crucial to be clear in the conceptualizations of alcohol problems and their prevention. Concepts and strategies are presented in a discussion of the following topics: (1) types and characteristics of alcohol-related problems; (2) American drinking patterns and problems in relation to prevention; (3) the policy environment for alcohol problems prevention; and (4) "natural alliances" in the prevention of alcohol problems. It is concluded that, for the foreseeable future, the task of any government agency concerned with alcohol problems can be described as managing and perhaps minimizing the problems of alcohol rather than preventing them; what is needed is to study systematically all organized alcohol prevention efforts, whether they are formally funded or spontaneous occurrences, to find out what happens.

Room R. Case for a problem prevention approach to alcohol, drug and mental problems. 1979. 20 p.

It is noted that both disease prevention and health promotion strategies are well rooted in each of the three fields of alcohol, drug, and mental health problems. The author contends that in the alcohol field the dominance of alcoholism movement conceptualization has until recently directed attention away from prevention, and that in the drunk driving field primary emphasis has been on "disease prevention", while for youthful drinking "health promotion" has predominated. As a way of transcending the health promotion and/or disease prevention debate, a reconceptualization of aims is suggested, in terms of a disaggregated focus on specific alcohol, drug, and mental problems. 19 Ref.

Room R; Cameron T; Friedman J; Smith D; Wallack L. Profile of policies and programmes for the prevention of alcohol- related problems: United States of America. May 1979. 24 p.

This paper presents profiles of policies and programs for the prevention of alcohol-related problems in the United States. It was prepared for the World Health Organization Project on Prevention of Alcohol-Related Problems. 60 Ref.

Room R. Treatment seeking populations and larger realities. 1979. 26 p.

The issue of numbers of alcoholics and other related issues, generally, the relation between a treatment system and those who might need its services, are addressed. Research studies are cited in an overview of the alcoholism movement in the US. Statistics on drinking problems in clinical populations of alcoholics are compared to those found in the general populations, and it is concluded that alcohol problems outside the clinic are not simply the projection onto a larger population of alcohol problems inside the clinic. The following four kinds of responses to the problem of filling treatment slots in the public and private sectors are discussed: (1) to make the treatment more attractive to the clients; (2) to seek out new " underserved" demographic segments of the population and provide special alcoholism treatment services for them; (3) diversification into treatment of specific problem areas; (4) compulsory treatment in one form or another. It is concluded that perhaps the most astonishing thing about the American alcoholism treatment system and its social ecology (where its clients come from, under what conditions, and who and what it misses) is how little has been studied. 44 Ref.

Room R. Alcohol as an instrument of intimate domination. 1979. 11 p.

The way that drugs, particularly alcohol, have been used as an instrument of domination, i.e., as an excuse or explanation for physical violence or other aggressive action on the part of the dominant is outlined. The author contends that the use of alcohol in this manner is related to two cultural conditions on alcohol use: (1) the tendency for alcohol use, and particularly drunkenness, to be prerogative of statuses with full citizenship rights in a society, i. e., for alcohol to be denied to slaves, women, servants, native populations, children, and other such subservient estates; and (2) the cultural belief that alcohol causes "disinhibition," thus that drinking or drunkenness explains violent, vicious or otherwise unconscionable behavior. The use of alcohol for domination in the family situation is discussed. 26 Ref.

Room R. Trends in Neighborhood Drinking Characteristics in the U.S., 1964-1970. Drinking & Drug Pract. Surveyor, Berkeley,, No. 14, pp. 13-15, 1979.

Two studies of the same 100 neighborhood clusters in the United States, one conducted in 1964 (D. Cahalan et al.) and the other conducted in 1970 (G. D. Mellinger et al.) were compared. The clusters were classified as ''dry'' (if 50 percent of the respondents were abstainers), ''wet'' (if 33 percent or more had drunk at least 5 drinks at some occasions during the past year) or ''medium.'' There were 23 dry, 56 medium and 21 wet clusters in 1964 vs 21, 24 and 55 in 1970. When the u.s. was split into drier and wetter regions on the basis of historical and present-day patterns, it was found that the tendency to become wetter between 1964 and 1970 was stronger in the wetter regions. When the data were split by urbanization, increased wetness was found in two-thirds of the urban vs one-third of the rural neighborhoods whose wetness could increase (i.e., that were dry or medium in 1964). The changes were heaviest in the wet-region towns (2500-50,000 population) for clusters which were in the medium category in 1964 (9 out of 11 changed to wet in 1970) and in the dry-region cities (5 out of 7 changed from medium to wet). The proportion of dry rural areas remained the same. the historical split in the u.s. between wetter and drier regions thus tended to be refocused onto a widening gap between the cities and countryside in the traditionally drier regions.

Room R. Priorities in social science research in alcohol. J. Stud. Alc.,, Suppl. 8, pp. 248-268, 1979.

The priorities in social science research on alcohol are discussed including the diversity of populations and aspects of alcohol studied; influence of social science research, social science research and alcoholism movement and funding. The current research agenda indicates studies of the normative and ecological structure of drinking behaviors and problems, studies of drinking careers and the natural history of drinking problems, community response to alcohol problems and formal and informal treatment processes, and studies of the formation and effects of alcohol controls and policies. The section on trends in design and methods includes disaggregation, convergent methodologies, time and history, change and natural experiments and policy relevance. The lack of organization and group consciousness among social scientists is noted.

Room R. Evaluating the effect of drinking laws on drinking. In: J.A. Ewing and B.A. Rouse, Eds. Drinking: Alcohol in American Society, Chicago, IL: Nelson-Hall, 1978. 444 p. (pp. 267-289).

Current efforts to evaluate the relationship between drinking laws and drinking behavior are reviewed, and a number of barriers which inhibit the evaluation process are discussed. Three hypotheses which attempt to explain the relationship between drinking laws and drinking practices are: (1) that there is no relationship ("null" hypothesis); (2) that the proportion of excessive drinkers in a population directly depends on the amount of drinking in the population ("constant proportion" theory); and (3) that the proportion of excessive drinkers can be reduced by increasing the proportion of the population practicing certain styles of moderate drinking (" innoculation" theory). Implications and assumptions of the three theories are discussed and evaluated as to how well they fit the available evidence.

Room R. Priorities in alcohol social science research. Alcoholism Digest, 8(4):1-9, 1978.

Nonexperimental social psychology literature is cited in a discussion of the priorities in alcohol social science research. The following topics are addressed: (1) growth and scope of the literature; (2) the influence of alcohol social science research; (3) social science research and the alcoholism movement; (4) funding of alcohol social science research; (5) current agendas for social science research; (6) trends in research design and methods; and (7) organization of alcohol studies. 16 Ref.

Odonnell John A; Voss Harwin L; Clayton Richard R.; Slatin, G.T.; Room, R. Young Men and Drugs - A Nationwide Survey: NIDA Research Monograph No. 5. Rockville, MD: National Institite on Drug Abuse, 1976. 144 P.

The preliminary report on a study of nonmedical use of psychoactive drugs among 2510 young men in the United States, conducted between October 1974 and May 1975, is presented. Lifetime use and current use statistics are reported for nine drug categories: cigarettes, alcohol ( 97 percent and 92 percent respectively), marijuana, psychedelics, stimulants, sedatives, heroin, opiates, and cocaine.

Room R. Governing Images and the Prevention of Alcohol Problems. Preventive Medicine, 3:11-23, 1974.

Three major governing images of alcohol problems are reviewed -alcohol as an irresistably attractive but dangerous substance, alcohol as the cause of disruptive and compulsive social behavior, and alcoholism as a specific disease of unknown but preexisting etiology. Although the three images focus on different aspects of alcohol problems, each involves a disease concept. yet, according to the author, these assumptions do not always fit the empirical data of drinking patterns and problems in the general population. It is concluded that governing images have distorted and limited discussions on the prevention of alcoholism and created a cultural ambivalence toward the subject. Measures to encourage nondrinking behavior are suggested. 41 ref.

Moore R A; Dewes P B; Dumont M P; Room R. Comment on "The Alcohologist's Addiction". Quarterly Journal of Studies on Alcohol, 33(4):1043-1059, Des. 1972.

A consensus of opinion by four authorities is offered on the need to reestablish the criteria for alcoholism diagnosis, especially as regards the medical profession. The authors express the need for a more responsible approach by the medical profession in classifying alcoholism as a disease. The consensus of opinion is that the " disease" concept of alcoholism might allow the patient to escape responsibility by becoming overly dependent on the clinician. The clinician needs to reformulate his conception of disease and to renounce his exclusive jurisdiction over its control. By assigning " sick role" properties to the condition of alcoholism, the medical professional may preclude the necessary social, and self imposed curative processes required by the alcoholic person for rehabilitation. We need to develop social procedures that allow a person remission of responsibility without the necessity for a medical label. 40 ref.

Room R. The relation between alcohol control policies and individual behaviour. In: Proc. 30th International Congress on Alcoholism and Drug Dependence, volume 1, 39, 1972.

The relationship between drinking laws and drinking behavior is analyzed. Three hypotheses are discussed: That drinking laws have no effect on behavior, that any factor raising or lowering consumption of alcohol will raise or lower the rate of alcoholism, and that the number of excessive drinkers can be reduced by policies aimed at responsible drinking. Not much evidence is available in support or denial of these hypotheses. Further study is recommended.

Room, R., Giesbracht, N., Graves, K., & Greenfield, T. (1995). Trends in public opinion about alcohol policy initiatives in Ontario and the US 1989‐91. Drug and alcohol review, 14(1), 35-47.

Trends in public opinion about 11 possible alcohol policy initiatives are analysed in probability surveys of adults in the United States and in Ontario in 1989, 1990 and 1991. In both sites, public opinion is fairly conservative on alcohol policies, with majorities favoring either the status quo or decreased availability on such dimensions as tax levels, opening hours, sale of alcoholic beverages in corner stores and the minimum legal drinking age. Between 1989 and 1991, the most substantial net change in attitudes was in favor of warning labels in Ontario, although it was in the United States and not in Canada that warning labels were introduced after the 1989 surveys. For some other alcohol policies, public support for restrictions tended to decline in Ontario but not in the United States. In logistic regressions predicting attitudes on each policy with gender, age, education, drinking pattern, study site and year of study, the strong and consistent secular trend for support for warning labels held up; the only other significant and consistent secular trend was against increased efforts to prevent drunken customers being served. Since public support for alcohol controls is crucial to their effectiveness and long-term viability, regular tracking of public opinion on them is needed, along with efforts to increase their public understanding and support.

Room, R., & Greenfield, T. (1993). Alcoholics anonymous, other 12‐step movements and psychotherapy in the US population, 1990. Addiction, 88(4), 555-562.

Based on the 1990 US National Alcohol Survey, this note provides the first available comprehensive findings on self-reported utilization of a variety of sources of personal support and counselling for alcohol and other problems. Respondents were queried about lifetime attendance and number of times they went to identified sources of help in the prior year. Twelve-step groups included Alcoholics Anonymous, Al-Anon, Adult Children of Alcoholics, and other non-alcohol-oriented groups like Gamblers Anonymous, Narcotics Anonymous, and Overeaten Anonymous; additional questions inquired about support or therapy groups and individual counselling for non-alcohol problems. Of the US adult population, 9% have been to an AA meeting at some time, 3.6% in the prior year, only about one-third of these for problems of their own. About half these percentages, mostly women, have attended Al-Anon. Of the same population, 13.3% indicate ever attending a 12-step meeting (including non-alcohol-oriented groups), 5.3% in the last year. During the prior year a further 2.1% used other support/therapy groups and 5.5% sought individual counseling/therapy for personal problems other than alcohol. In contrast to this high reported utilization, only 4.9% (ever) and 2.3% (12-months) reported going to anyone including AA for a problem (of their own) related to drinking.

Room, R. (1991). Drug policy reform in historical perspective: movements and mechanisms. Drug and alcohol review, 10(1), 37-43.

The use of psychoactive drugs is regarded by many as a basic human drive, but it is one that induces a variety of societal responses to curb it. The present review examines two aspects of government policy on drugs: first, the influence of social movements on drug policy; and secondly, the choices for constraining drug use as an alternative to total prohibition. Addiction is essentially a repeated behaviour which is viewed as excessive or harmful. As such, it has many similarities with a wide range of human behaviours. With the concept of addiction becoming progressively banalized, there is the possibility of a more natural debate about decriminalization and legalization of drugs in terms of a balance between harm and benefits. The current public debate may create a climate for serious political consideration of the strategies.

Room, R. (1992). The impossible dream?—Routes to reducing alcohol problems in a temperance culture.

Two main prescriptions are offered for reducing rates of alcohol problems in English-speaking and Nordic cultures: a “dry” solution of reducing the physical and cultural availability of alcohol, and a “wet” solution of reducing problems of intoxication by better integrating drinking into the culture. Empirical evaluations of change in particular cultures have tended to support the dry, and not the wet, solution. But such studies focus on relatively short-term effects, and there is evidence that long-run effects may be weaker or may even be reversed from short-term effects. Some particular societies that have been put forward as examples of the long-term success of wet strategies are considered. The most likely success from this perspective is the Netherlands, which is also an exceptional society in terms of the wetness of its drug policies. In the light of these cases, consideration is given to some issues concerning the criteria for evaluating the success of one or the other solution. It is argued that alcohol policy discussions need to recognize that intoxication has a particular social position in our societies, in terms of characteristics of the drinker and of the occasion, in terms of intoxication's cultural significance, and in terms of its entrenchment in social worlds of heavy drinking. Some implications for policy are noted.

Room, R. (1990). Recent research on the effects of alcohol policy changes. Journal of Primary Prevention, 11(1), 83-94.

As the agenda of alcohol problems prevention has broadened, new traditions of research have emerged: of experimental studies at the community or the societal level, of “natural experiment” studies of the effects of sudden changes such as strikes or new legislation, and of sophisticated time-series analyses of the effects of sudden and of long-term changes. While it has been shown that control measures can influence alcohol problems rates, substantial change seems to require changes in the political status quo, often also involving popular movements. Except for taxes, raising the drinking age and drinking-driving countermeasures, the political will to restrict availability has been lacking in market-oriented industrial societies in the modern era, so that the modern experience of the effects of other control measures is based on centrally-planned or non-industrial economies.

Room, R. (1989). Alcoholism and Alcoholics Anonymous in US films, 1945-1962: the party ends for the" wet generations". Journal of Studies on Alcohol, 50(4), 368-383.

At least 34 Hollywood films were made between The Lost Weekend (1945) and Days of Wine and Roses (1962) with an alcoholic as a major character; six depicted an Alcoholics Anonymous-like self-help organization. Presentations of alcoholism's origin as mysterious competed with psychodynamic interpretations and situational explanations, often in the same film and sometimes concerning the same character. Will-power and mutual help were each frequently shown as paths to recovery, whereas neither professional treatment nor AA's spiritual side were often shown. For the women alcoholics (17 of 39 depicted), drinking went with sexuality, but for men it replaced it. "Creative" occupations were hugely overrepresented among screen alcoholics, in part reflecting the personal struggles with drinking of the movies' creators. These writers, actors and directors were drawn from the "wet generations" of middle-class youth, who had adopted heavy drinking in their college years as a generational revolt against "Victorian morality." Alcoholics Anonymous was founded and peopled by members of these same cohorts as a generational solution to their eventual life-problems. The flurry of alcoholism films represented a parallel and overlapping generational response.

Room, R. (1990). Symposium on experiences with community action projects held in Toronto. Addiction, 85(4), 577-578.

A Symposium on Experiences with Community Action Projects for the Prevention of Alcohol and Other Drug Problems was held in Scarborough, a suburb of Toronto, on March 12-16, 1989. The meeting was co-sponsored by Health and Welfare Canada, by the US Office of Substance Abuse Prevention (OSAP), and by the Addiction Research Foundation (ARF) of Ontario, and was hosted by Norman Giesbrecht and other ARF staff. Members of the planning committee included: Peter Conley, Robert Denniston, Louis Gliksman, Norman Giesbrecht (chair), Harold Holder, Robin Room, Irving Rootman and Martin Shain. The symposium was a thematic meeting of the Kettil Bruun Society for Social and Epidemiological Research on Alcohol.

Room, R. (1989). Drugs, consciousness and self-control: popular and medical conceptions. International Review of Psychiatry, 1(1-2), 63-70.

Psychoactive drugs alter human consciousness, but the meaning and results of the alteration are mediated by cultural and individual expectations. Industrialization has greatly increased the availability of drugs, while bringing new expectations of self-control and concentration. There are recurrent scenarios of entrenchment and ‘disentrenchment’ of drugs, and for alcohol, at least, there is enough cyclicality to speak of ‘long waves of consumption’. Popular ideas of addiction arose with the 19th century temperance movement as an explanation of life failure: the loss of control is double, not only over the drug use, but also over one's life. The emergence of the Adult Children of Alcoholics movement suggests the continuing vitality of a linkage between life failures and drug use. In medical thought, the ‘loss of control’ formulation was applied only to the drug use; while loss of control used to be the ‘pathognomic symptom’ of alcoholism, such cognitive and experiential symptoms have been marginalized in recent diagnostic criteria. Disjunctive criteria of dependence (e.g. 3 out of 9 symptoms) expand the numbers defined as dependent; where much treatment is coercive, they expand the scope of treatment as social control. The retention of an element of consciousness as a necessary element in dependence definitions would impede the link with coercion.

Room, R. (1989). The US general population's experiences of responding to alcohol problems. Addiction, 84(11), 1291-1304.

Respondents in a 1984 national adult sample report on the experiences of treatment for alcohol problems, of talking to someone about an alcohol problem of their own, and of others' suggestion that the respondent cut down. Most who have been treated (3.4% on a lifetime basis, 1.3% within the last year) have also encountered informal pressures. A majority of respondents have pressured others to cut down their drinking; such efforts do not appear to be clustered in a few ‘control specialists’, and heavier drinkers are about as likely as lighter drinkers to pressure others. Within the family, the flow of pressure is from older to younger generations, and from women to men, but a heavy-drinking woman is as likely to be pressured as a heavy-drinking man. Somewhat more men than women report applying pressure on friends.

Room, R. (1988). Shifting perspectives in studies of alcohol in the media. Contemp. Drug Probs., 15, 139.

The subtitle of this thematic issue might be "beyond counting sips and mentions." In the last decade or so, international research on representations of alcohol in the media, particularly on television, has included a number of thorough studies coding well-designed samples of media material in terms of distributions of drinking acts and mentions of alcohol (see references in Hansen, in this issue). These studies, several of which were performed by authors represented in this issue, have contributed considerable information to policy discussions, and have also taught us something about the distribution of drinking in media representations by such factors as demography, situation, and role. But when a conference on "cultural studies of drinking" in Helsinki in 1985 (Paakkanen and Sulkunen, 1987) brought together researchers from several countries who had performed such content analyses, it became apparent that they no longer found such studies sufficient in themselves. This impatience can also be seen in Howard Blane's article (1988) in the preceding issue of this journal.

Room, R. (2005). Banning smoking in taverns and restaurants—A research opportunity as well as a gain for public health. Addiction, 100(7), 888-890.

In jurisdiction after jurisdiction, bans on cigarette smok-
ing in pubs, bars and restaurants are coming into effect.
This is no longer just a phenomenon of north American
cities, where the trend started. Ireland and Norway
changed last year, Italy last January, Sweden this June.
The Publican
, a British trade journal, carries forebodings
that even England is likely to follow suit before too long.
Taverns and restaurants are places of public accom-
modation, and in many places just about the last enclosed
public space where smoking has been still allowed. Ten
years ago banning smoking in taverns seemed unthink-
able, in large part reflecting an unspoken recognition that
drinking and smoking have been strongly associated
behaviours. The winning arguments, in political terms,
have been the effects on the health of others, and partic-
ularly on those for whom the tavern or restaurant is their
In many jurisdictions, taverns have also ended up
being the main place where gambling machines have
been placed. There was already an age limit on the drink-
ing, so drinking places were a convenient location for
lawmakers to specify where an age limit on gambling
might be enforced.
In jurisdiction after jurisdiction, bans on cigarette smoking in pubs, bars and restaurants are coming into effect. This is no longer just a phenomenon of north American cities, where the trend started. Ireland and Norway changed last year, Italy last January, Sweden this June. The Publican, a British trade journal, carries forebodings that even England is likely to follow suit before too long. Taverns and restaurants are places of public accommodation, and in many places just about the last enclosed public space where smoking has been still allowed. Ten years ago banning smoking in taverns seemed unthinkable, in large part reflecting an unspoken recognition that drinking and smoking have been strongly associated behaviours. The winning arguments, in political terms, have been the effects on the health of others, and particularly on those for whom the tavern or restaurant is their workplace. In many jurisdictions, taverns have also ended up being the main place where gambling machines have been placed. There was already an age limit on the drinking, so drinking places were a convenient location for lawmakers to specify where an age limit on gambling might be enforced.

PAGLIA, R. R. A. (1999). The international drug control system in the post-Cold War era. Managing markets or fighting a war?. Drug and Alcohol Review, 18(3), 305-315.

The core institutions and scope of the international drug control system are described. The system has grown in participation and particularly in scope and ambitions since it was studied in the early 1970s by Bruun and colleagues. Its premises are notably in conflict with the currently dominant ideologies of a free-market global economy although, as earlier, the United States plays a dominant role in the drug control system. At a time when it is seen as a failure in its primary aims both from inside and from outside, defenses of the system have ranged from rousing rhetorical appeals to efforts to "de-sensationalize" the issues.

Room, R. (2018). Relevant to all disciplines and professions but central to none: How may social alcohol and drug research flourish?. Nordic Studies on Alcohol and Drugs, 35(2), 104-107.

This commentary is written from my experience as a sociologist who has worked primarily in alcohol research, and also off and on in drug and gambling studies, in five countries: the US, Canada, Norway, Sweden and Australia (Room, 2007). All of these are “temperance cultures” (Levine, 1993) with strong temperance movements in the past, of which the comparatively strong commitment to social research on alcohol problems could be seen as a “residual legatee” (Room, 1990). The countries north of the Baltic, in particular, have long stood out in social alcohol research; as young alcohol sociologists in California in the 1970s, we thought of Helsinki as devout Catholics might think of Rome.

Room, R. (2017). Prevention of alcohol-related problems in the community context. Preventing Alcohol-Related Problems: Evidence and Community-based Initiatives, 19-32.
Many problems from alcohol occur within the community, impinge on others in the community, and often are responded to – whether informally or formally -- by community members and institutions. 1 The community is thus a primary locus for policies, actions and efforts to prevent the problems occurring.

The Northern Territory (NT) stands out compared with
the rest of Australia in terms of rates of alcohol-related
harms. A dramatic example is the rate of deaths attribut-
able to alcohol3.5 times as high as the national rate,
including twice as high for the non-Indigenous popula-
tion [1]. An intrinsic element in the problem is that the
level of alcohol consumption per person aged 15+ years
in the NT is higher than elsewhere in Australia. In 2014,
NT consumption, at 12.30 l of pure alcohol per year [2],
was the highest in any Australian jurisdiction26.7%
higher than the 9.71 average for Australia as a whole [3].
Room, R. (2017). The case for government‐run liquor stores in the Australian Northern Territory: Looking outside the box in regulating the supply of alcohol. Drug and alcohol review, 36(5), 575-577.
The Northern Territory (NT) stands out compared with
the rest of Australia in terms of rates of alcohol-related
harms. A dramatic example is the rate of deaths attribut-
able to alcohol—3.5 times as high as the national rate,
including twice as high for the non-Indigenous popula-
tion [1]. An intrinsic element in the problem is that the
level of alcohol consumption per person aged 15+ years
in the NT is higher than elsewhere in Australia. In 2014,
NT consumption, at 12.30 l of pure alcohol per year [2],
was the highest in any Australian jurisdiction—26.7%
higher than the 9.71 average for Australia as a whole [3].

The Northern Territory (NT) stands out compared with the rest of Australian in terms of the rates of alcohol-related harms. A dramatic example is the rate of deaths attributable to alcohol - 3.5 times as high as the national rate, including twice as high for the non-Ingifenous population [1]. An intrinsic element in the problem is that the level of alochol consumption per person ages 15+ yeats in the NT is higher than elsewhere in Australia. In 2014, NT consumption, at 12.30 1 of pure alcohol per year [2], was the highest in any Australian jurisdiction - 26.7% higher than the 9.71 average for Australia as a whole [3].

Room, R. (2016). Pekka Sulkunen and international alcohol sociology. Beyond the Sociological Imagination: A Festschrift in Honour of Professor Pekka Sulkunen, 97-99.
Finland held a special attraction for sociologists elsewhere who became involved in alcohol studies in the 1960s or early 1970s. In Finnish society, unlike elsewhere, sociological perspectives on alcohol problems really mattered. And, for that matter, Finnish alcohol sociology looked outwards -- was engaged with the world. My first connections with Pekka reflected these frames. He and I were invited at different times onto the team led by Kettil Bruun which produced the ‘purple book’, the slim volume which became the core document of a new international public health paradigm for alcohol problems (Bruun et al., 1975). Behind the purple book stood a much fatter ‘brown book’ (Sulkunen & Lumio, 1977), which Pekka played a large role in producing, and which may be seen as the founding document for what is now the World Health Organization’s Global Information System on Alcohol and Health

Room, R., & Livingston, M. (2017). The distribution of customary behavior in a population: The total consumption model and alcohol policy. Sociological Perspectives, 60(1), 10-22.

This paper is concerned with a particular strand of thinking that has been interwoven in sociological alcohol research for half a century and has, in some times and places, had a strong influence on policy. We will describe the inception and development of the model, the political context in which it emerged and was fought over, and various strands of development building on the model over the decades. The paper then proceeds to consider some limits and anomalies in the model as they have emerged and been debated over the years. It is concluded that the model has always been inherently sociological in its framing, being concerned with change both at the level of interpersonal interaction and at the level of patterns in a society as a whole and with the relationship between changes at the different levels.

Room, R. (2016). Book review - Virginia Berridge, Demons: Our Changing Attitudes to Alcohol, Tobacco, and Drugs. Social History of Alcohol and Drugs 28(2): 199-200.
This book, by a leading historian of opium and other public health matters, considers the history of conceptions, behaviours and policies about tobacco, alcohol and other drugs (particularly opiates) in the last two centuries. Britain is in the centre of the picture, but the US history is also discussed, often in comparison to Britain’s, and there are also briefer discussions of particular contrasting patterns in Europe, and occasional references to patterns elsewhere.

Room, R. (2016). Building social and population science in alcohol and other drug studies. Addiction, 111(8), 1326-1327.
The arena of knowledge covered by Addiction is not central to any traditional profession or academic discipline. As Jim Rankin once put it, ‘the drug and alcohol field does not fit into any single professional area: it is truly interdisciplinary, and therein lies both its professional strength and its political weakness’ 1. In medicine, for instance, efforts to gain coverage of alcohol issues in the basic medical curriculum, even when successful, tend to be abandoned when the next ‘reform’ comes along. For other professional schools, whether of welfare, public health or criminology, our arena is also peripheral. In academic departments, it is a rare undergraduate curriculum which has more than a few lectures specifically on alcohol, tobacco or drugs. For biosciences, while alcohol and drugs is an arena from which much research funding is sought, again it is not at the heart of any discipline. Specialists in our arena are thus not required for the teaching faculty either in professional schools or in academic departments; we have ‘not managed to acquire an established tag and compartment in the system’ 2.

Room, R. (2016). Integrity without extinction: Paths forward for gambling research. Addiction, 111(1), 11-12.
Livingstone & Adams 1 are responding to what is apparent to anyone with some familiarity with the gambling literature: that for much of the research the orientation and research questions have been constrained by the influence of the funding sources. In countries which I know well the gambling field is unusual in the high proportion of its funding which comes from agencies or interests with a vested interest in the gambling market. There are two main reasons for this imbalance. First, gambling is not a central interest of primary research funding bodies, and of the academic establishments they serve: it is peripheral to medical research, and on the fringes of concerns of academic social science. Therefore (even more than for alcohol and other drugs), it is difficult to gain funding through general research support mechanisms. Secondly, gambling research money comes from bodies which are connected strongly to organizations involved in promoting or preserving the market. It has almost always been a form of ‘conscience money’, often as a counterbalance in the course of legalizing previously prohibited forms of gambling. However, despite this provenance the funding bodies, including government authorities (e.g. 23), have often exerted control on what research is conducted, defining research agendas in ways compatible to market interests.

 Room, R. (2015). Portraying the alcoholic: Images of intoxication and addiction in American alcoholism movies, 1931-1962. Substance use & misuse, 50(4), 503-507.
Around 1980, Pekka Sulkunen, Juha Partanen and others around the Social Research Institute of Alcohol Studies in Helsinki conducted a project on the portrayal of drinking and intoxication in Finnish movies (Partanen, 1980). The project attracted the interest of social alcohol researchers elsewhere; for instance, Sulkunen played a role in stimulating a French project on portrayals in French films (Steudler, 1987). In Berkeley, California, inspired by the Finnish project, Denise Herd and I were the main movers in a group project which set out to study the role of alcohol in American feature films. Our methodology might most kindly be described as "eclectic". We asked film buffs and historians for leads on interesting films. We were interested in normalised as well as in problematised drinking. The normalised drinking was sometimes in the foreground, particularly towards the end of the Prohibition period, but was more often a taken-for-granted part of the background. Indeed, we found that film buffs, working from memory, could much more readily guide us to films with problematised than those with normalised drinking. We examined indexes, plot summaries, reviews and content analyses, as well as some of the enormous hagiographic literature on filmmakers and films; we made detailed notes on films as and after we watched them; Herd also undertook a more formal, shot-by-shot analysis of a few films. As a way of pushing the enterprise forward, we arranged for four evening film programs to be shown under the rubric "Images of Alcohol in American Films" at the Pacific Film Archive in Berkeley (Herd and Room, 1982).

Room, R. (2015). Public health, the public good, and drug policy. Nordic Studies on Alcohol and Drugs, 32, 367-370.
Ole Rogeberg’s commentary critiques what he takes to be “the public health approach” to drug policy, offering in counterpoint what he identifies as four “lessons” from drug policy reform movements. He takes as his exemplar of the public health approach a book, Drug Policy and the Public Good (Babor et al. 2010), which has twelve co-authors, including myself. As authors, we owe Rogeberg thanks for the compliment of being taken seriously.

Medina-Mora, M. E., Monteiro, M., Room, R., Rehm, J., Jernigan, D., Sánchez‑Moreno, D., & Real, T. (2016). Alcohol Use and Alcohol Use Disorders. Disease Control Priorities, 4, 127-43.
Alcohol is one of the most important risk factors for premature mortality and disability. Premature mortality disproportionatley affects low- and middle-income countries (LMICs) (WHO 2011a); more than 85 percent of all deaths attributable to alcohol occur in these nations (Room and others 2013; WHO 2011a). This chapter updates the chapter on alcohol in Disease Control Priorities in Developing Countries, 2nd ed. (DCP2) (Regm and others 2006), with new scientific evidence for interventions based on population, community, and individuals with an emphasis on evidence from LMIC's.

Room, R., Sankaran, S., Schmidt, L.A., Mäkelä, P. & Rehm, J. (2015) Addictive substances and socioeconomic development. In: Anderson, P., Rehm, J. & Room, R., eds. Impact of Addictive Substances and Behaviours on Individual and Societal Well-Being, pp. 189-213. Oxford, etc.: Oxford University Press.
This chapter considers the interplay of socioeconomic factors with a set of habit-forming behaviours, and the social and health problems that may result from them. The behaviours for consideration, as in the rest of this book, include the use of alcohol, tobacco, and other psychoactive substances. While the patterns we discuss are also often applicable to gambling and other behavioural addictions, the main focus of this chapter will be on psychoactive substances, for which populationbased research findings are globally available and robust. The socioeconomic factors to be considered include the relative penury or affluence of a society, and the socioeconomic status of people and families within a given society. These factors are set in a context of consideration of socioeconomic development at a global level—of rising though unevenly distributed standards of living globally—and the implications for addictive behaviours and for population rates of social and health problems arising from those behaviours.

Giesbrecht, N., & Room, R. (2015). Alcohol–Wide-Ranging Problems, Inadequate Responses. The Handbook of Drugs and Society, 15-52.
Alcohol is greatly valued, deeply integrated into social and cultural contexts, used extensively, or its consumption banned or distribution strongly controlled-- depending on the era and socio-cultural contexts. In many western countries it is currently a very popular drug, with 70-80% of adults having consumed alcohol in the past year. In many countries, on the other hand, its use is uncommon, with dramatic differences in prevalence and average consumption between men and women (WHO, 2014).

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. (2015). The history of psychoactive substance use and problems and of social responses to them. Addiction Medicine: Principles and Practice, 3-8.
Psychoactive substances have been used throughout recorded human history.1 The most widely used are alcoholic beverages of one type or another.2 These were commonly used before European contact everywhere except in Australia, Oceania and North America north roughly of the United States– Mexico border, and even in such areas there may have been some pre-contact use. 3 Other psychoactive substances were derived in many cultures from a wide variety of organic materials. Very few human societies have used no psychoactive substances, and in various parts of the world today there are widespread folk traditions of use of leaves of khat, coca and tobacco; nuts, seeds and pods of betel, cola, coffee and opium; and roots of kava.

Room, R. (2014) Regulating Australian alcohol markets for public health and safety. In: Manton, E., Room, R., Giorgi, C. & Thorn, M., eds., Stemming the Tide of Alcohol: Liquor Licensing and the Public Interest, pp. 3-8. Canberra: Foundation for Alcohol Research and Education, in collaboration with the University of Melbourne.
This book is concerned with the regulation of retail marketing of alcoholic beverages in Australia. This is approached from the public-interest perspective of preserving public health and safety, with attention also to broader issues of community amenity. These issues are usually discussed as ‘liquor licensing’, and the book includes much attention to legislation and regulation under that heading. But the book also attends to other laws and regulations which govern or affect the retail marketing of alcoholic beverages, such as community planning laws, criminal laws and sanitary and noise regulations. The aim is to provide a handbook for policymakers, public health advocates, researchers, and community groups and members which is informative about historical and current trends – how we got here, the current situation and where things are going – and about the state of research evidence on what is effective in what circumstances for public health purposes, and on what is not.

Published in Finnish as: Room, R. (2014) Kansainvälinen tutkija ([Klaus Mäkelä and] international research). In Hakulinen, A. & Jaakola, R., eds. Klaus Mäkelän: Tekstit, Teot ja Elämä (Klaus Makela: Texts, Actions and Life), pp. 165-168. Helsinki: Sosialipoliittisen Yhdistyksen Tutkimuksia.
From early in his research career, Klaus was involved in collaborative international research, in a variety of different capacities. As a leader and manager in Finnish alcohol studies, he played an important role in making and facilitating arrangements for study visits to and from Finland, and for Finnish participation in cross-national collaborative studies. He was an active and productive participant in the “purple book” (Alcohol Control Policies in Public Health Perspective) and a project on Alcohol in Developing Societies. And he organised and led two important international collaborative and comparative projects, the study of Alcohol Control Experiences (ISACE) and the international Alcoholic Anonymous study (ICSAA), which were not only collaborative but also comparative.

Room, R., & Örnberg, J. C. (2014). . THE GOVERNANCE OF ADDICTIONS AT THE INTERNATIONAL LEVEL. Reframing addictions: policies, processes and pressures, 45.
This chapter considers the governance of addictions in an international perspective, focusing on structures and actions at a global level and within the European Union (EU) in the fields of drugs, pharmaceuticals, alcohol, tobacco and gambling. Both at a global level and within the EU, there is great disparity between different addictive substances and behaviours in the extent of and priorities in international governance of markets and their customers. Nonmedical use of psychoactive substances under international drug control treaties is subject to a strict prohibitory regime, and at the EU level implementing that regime has been a political project of unification. In contrast, alcohol and gambling are subject to no public health-oriented international regulation, and trade treaties and agreements have been used as instruments to weaken national and local control regimes. Tobacco and psychopharmaceuticals (along with other medications under prescription regimes), are at intermediate positions. At the EU level, court decisions on trade and national control issues have paid substantial attention to considerations of public health and interest. But at the global level, international trade and investment law has fairly systematically operated to undercut control for public health or in the public interest in all areas other than the drug prohibition treaties. Particularly globally, there has been a tendency toward a Manichean system where an addictive commodity either is forbidden entirely or is subject to free-market rules with diminishing restrictions on the market and promotion.

Back to the home page