History of Alcohol Use

Alcohol is a ubiquitous substance in our society and is widely used in alcoholic beverages for its beneficial effects; both social and medicinal. Alcoholic beverages are considered to have both nutritional and drug effects. As such, alcohol is unique among drug preparations. Alcohol ingestion per capita has been steady in the United States since 1850, with the exception of the “Prohibition” period from 1919 to 1933 when the 18th Amendment to the US Constitution was ratified, prohibiting the sale of alcohol (the only two states that voted against the amendment were Rhode Island and Connecticut).

Alcohol is a well known “social lubricant” used to produce disinhibition in social situations, but at the same time excessive use produces the most harm to society of all drugs of abuse. The following address to the legislature by Mississippi State Senator Judge Noah S. Sweat in 1952 represents the dilemma faced by society in addressing the various aspects of the impact of alcohol on society:

“You have asked me how I feel about whisky. All right, here is just how I stand on this question: If when you say whisky, you mean the devil’s brew, the poison scourge; the bloody monster that defiles innocence, yea, literally takes the bread from the mouths of little children; if you mean the evil drink that topples the Christian man and woman from the pinnacles of righteous, gracious living into the bottomless pit of degradation and despair, shame and helplessness and hopelessness, then certainly I am against it with all of my power … But if when you say whisky, you mean the oil of conversation, the philosophic wine, the stuff that is consumed when good fellows get together, that puts a song in their hearts and laughter on their lips and the warm glow of contentment in their eyes, if you mean holiday cheer; if you mean the stimulating drink that puts the spring in the old gentlemen’s step on a frosty morning; if you mean the drink that enables a man to magnify his joy, and his happiness and to forget, if only for a little while, life’s great tragedies and heartbreaks and sorrows, if you mean that drink, the sale of which pours into our treasuries untold millions of dollars, which are used to provide tender care for our little crippled children, our blind, our deaf, our dumb, our pitiful aged and infirmed, to build highways, hospitals and schools, then certainly I am in favor of it. This is my stand. I will not retreat from it; I will not compromise.”

(Associated Press. Ex-judge Sweat, of “Whisky Speech” fame, dies. The Commercial Appeal, Memphis TN. Feb 24, 1996: A4.)

An overwhelming majority of persons in the United States have used alcohol at least once in their lives. The 2011 United States National Survey on Drug Use and Health from the Substance Abuse and Mental Health Services Administration estimated that 211.7 million people aged 12 and older (82.1%) had ever engaged in alcohol use, and 170.4 million people aged 12 and older were last-year users of alcohol (65.9%). Notable statistics from this survey included the following. In 2011, of those people aged 12 or older who ever consumed alcohol in the last year, 16.7 million (6.5%) showed alcohol abuse or dependence (Substance Use Disorder based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition [DSM-5], criteria), and 7.8 million (4.6%) of those who ever consumed alcohol in the last year showed alcohol dependence (DSM-IV criteria; see What is Addiction?).

Alcohol abuse and alcoholism can lead to numerous medical conditions, ranging from cirrhosis of the liver and heart disease to pancreatitis, Korsakoff’s dementia, and fetal alcohol syndrome. According to the State Trends in Alcohol-Related Mortality, 1979–92 by the National Institute on Alcohol Abuse and Alcoholism, alcohol was implicated in 32% of all deaths in the United States, including fatal automobile crashes, other accidents, liver disease, heart disease, neurological diseases, and cancer. Although the number has steadily declined since the early 1980s, alcohol was involved in 37% of all traffic deaths in the United States in 2008 among persons aged 16 to 20. In 2006, the Centers for Disease Control and Prevention reported that the cost of alcohol to US society was over $223 billion, including losses in workplace productivity (72% of the total cost), healthcare expenses (11%), criminal justice expenses (9%), and motor vehicle crashes (6%).

TABLE 6.2

Representative Listing by the World Health Organization of per Capita Alcohol Consumption (in Liters) in 2000

These values estimate the level of alcohol consumption per adult (15 years of age or older) of pure alcohol during a calendar year as calculated from official statistics on production, sales, import, and export, taking into account stocks whenever possible. Conversion factors used to estimate the amount of pure alcohol in (barley) beer is 5%, wine 12%, and spirits 40% of alcohol (other conversion factors were used for some types of beer and other beverages). Data were collected and calculations were made mainly using three sources: FAOSTAT – United Nations Food and Agriculture Organization’s Statistical Database, World Drink Trends, regularly published by Produktschap voor Gedistilleerde Dranken (Netherlands), and in some cases direct government data. Data are available from the World Health Organization “Adult Per Capita Alcohol Consumption” database for most countries of the world since 1961 onward. Data are presented for the groups of total, and also beer, wine, and spirits separately. The category Beer includes data on barley, maize, millet, and sorghum beer combined. The amounts from beer, wine, and spirits do not necessarily add up to the presented total, as in some cases the total includes other beverage categories, including palm wine, vermouths, cider, fruit wines, and so on. It is important to note that these figures comprise in most cases the recorded alcohol consumption only and have some inherent problems. Factors which influence the accuracy of per capita data are: informal production, tourists, overseas consumption, stockpiling, waste, spillage, smuggling, duty-free sales, variation in beverage strength, and the quality of the data upon which this table is based. In some countries there exists a significant unrecorded alcohol consumption that should be added for a comprehensive picture of total alcohol consumption.

* Data from 2001.

** Data from World Drink Trends: International Beverage Alcohol Consumption and Production Trends. Produktschap voor Gedistilleerde Dranken, Henley-on-Thames, Oxfordshire, 2002.

Patterns of alcohol use vary between cultures (Table 6.2, Box 6.2). Per capita alcohol consumption also varies between countries, from a low of 1 liter per person in India to a high of over 11 liters per person in France. France, Spain, Greece, and Italy have the highest per capita consumption, corresponding to a pattern of high wine drinking that pervades nearly all facets of daily life.

BOX 6.2

CULTURAL DIFFERENCES IN PATTERNS OF ALCOHOL CONSUMPTION

France. France has the highest per capita alcohol consumption (approximately 12 liters per person per year) of any country. Two-thirds of this total consumption is in the form of wine drinking. For men, and to a lesser extent women, wine is drunk at meals as part of the diet. This has declined, however, in the last 50 years. Wine also is consumed as part of social and festive occasions, and as part of an entirely aesthetic experience (i.e., for oenological reasons). There has existed a purported popular French belief that “wine is not alcohol” (which stems from the mid-1800s when Pasteur deemed wine as beneficial and “hygienic” because it could kill microbes) and the word alcohol had two meanings, one in the singular referring to a chemical element in fermented beverages, and the other referring to distilled drinks. The majority of habitual or excessive drinkers are men – although drinking has increased in women – and alcohol consumption remains an expression of the masculine identity (Nahoum-Grappe, 1995).

Italy. Similar to France, wine pervades most public and private sectors of life in Italy, with wine drinking being the most prevalent. Italians rank 5th in alcohol consumption. Abstainers are viewed with curiosity, as “odd persons” who should explain why they do not drink. In young people, males drink more than females, more wine in northeastern Italy, and in the home, and more beer in southern Italy and outside the home. Although Italians do not stigmatize heavy consumption, they do tend to blame problem drinkers who lose control. Italian physicians are known to suggest moderate wine consumption to prevent cardiovascular disease, an approach that has recently received scientific justification, but both media and medical lobbies of late are increasingly emphasizing the breadth of alcohol-related problems, particularly drunk driving and cirrhosis of the liver (Cottino, 1995).

Sweden. Sweden has half the alcohol consumption of France, but Swedes often are characterized as binge-drinkers, being one of the countries of the so-called “vodka belt” across northeastern Europe, a long-standing drinking pattern that has ancient cultural roots. The most prevalent beverage is beer that is drunk on rare occasions, usually weekends; therefore, a small part of the population is responsible for a large part of total consumption. For men, getting deliberately intoxicated is a sign of masculinity, but for women, the act can bring condemnation. Swedes also look down on those with persistent alcohol problems, with blame directed toward the individual rather than the family or workplace. Even though the Swedes are labeled as binge-drinkers, they have a relatively low incidence of alcohol-related problems compared with other Western countries and a significantly lower overall consumption (Nyberg, 1995).

China. China ranks low on total alcohol consumption, with per capita consumption that is significantly less than half that of France, with the majority in the form of spirits (liquors). The Chinese stress the role of alcohol in all aspects of life, affecting structures of belief, behavior, values, attitudes, and religion. It is an important adjunct to hospitality, with both the host and guest honoring each other with drink as a combined expression of welcome and appreciation. Everyone toasts for the Chinese New Year, for good health, and for long-lasting prosperity for their elders. Alcohol still plays a role in Chinese medicine (in fact, the Chinese written characters for “alcohol” and “medicine” share the same root). The majority of men (64%) are moderate drinkers, while the majority of women (51%) abstain. A very low percentage of the population (10%, all male), however, are heavy drinkers. Overall, approximately 30% abstain. There is a high proportion of individuals (50%) with the inactive allele for acetaldehyde dehydrogenase which produces a flushing reaction which is hypothesized to form a protective factor against excessive drinking and subsequent alcoholism. However, socially, the Chinese people seem generally unaware of the flushing reaction, and if they are, it has little or no impact on their attitudes in relation to alcohol despite the high abstinence rate and very low heavy drinking (Xiao,1995).

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