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. 9 p.

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. 18 p.

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. 8 p.

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.

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