Alcohol and Public Policy Beyond the Shadow of Prohibition (1981) / Chapter Skim
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3. Perspectives on Current Alcohol Policies
3. Perspectives on Current Alcohol Policies
Pages 48-60
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From page 48... ...
CURRENT ALCOHOL POLICIES AND INSTITUTIONS Characterizing current alcohol policies with precision is no simple task; the very term "policy" is ambiguous. It may refer to publicly stated goals, to specialized institutions predominantly concerned with alcohol, or to the net effect of all institutions.
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From page 49... ...
The third feature of the institutional setting pertaining to alcohol control policies is the National Institute for Alcohol Abuse and Alcoholism and the network of state agencies and treatment programs partially spawned and supported by NIAAA's most influential client groups. This institutional nexus is important in part because it absorbs a substantial volume of economic resources.
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From page 50... ...
The overall institutional picture, then, is one in which a few major institutions play important but largely unintentional roles in shaping drinking practices; and in which the government institution that is most responsible for shaping our social response to alcohol problems reflects the current conception of the problem as largely one of alcoholism. The juxtaposition of this institutional setting with the analytic conception of the problem developed in chapter 2 prompts an important question: Is full advantage being taken of the current institutional capacity to cope with the diverse aspects of alcohol problems, or is the current concept of alcoholism narrowing our conception of the appropriate objectives of alcohol policy and diverting society from some important policy alternatives?
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From page 51... ...
Second, the analysis of existing institutions suggests that while there is little institutional focus for prevention efforts, there is a surprising amount of institutional capability. The regulatory apparatus governing commercial availability remains intact but underutilized for the prevention of alcohol problems.
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From page 52... ...
It is too broad because all instruments of alcohol policy can be understood as devices to prevent some bad effects of drinking. Treatment programs, for example, can be understood as devices for preventing cirrhosis from reaching terminal proportions, forestalling suicides, and preventing accidents by motivating chronic alcoholics to reduce their alcohol use and change other aspects of their lives.
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From page 53... ...
Although not confined to people who are already in severe trouble related to or dependent on drinking, the ability of such efforts to reach people who may be potentially at risk will be strongly limited by reliance on personalized services that are expensive, vaguely defined, and demanding of the client and on detection capabilities that are still at the basic research stage (Institute of Medicine 1980)
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From page 54... ...
Prevention programs seek to avoid the intrusions associated with therapy and concentrate on managing the set of external contingencies that operate on drinkers as they drink, pair their drinking with other activities, and accept a variety of risks associated with their drinking from the external environment. In fact, even education programs avoid the most penetrating kinds of intrusions simply because, although they carry personal significance for drinkers, they do not seek out specially identified individuals and track their behavior.
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From page 55... ...
Since drinking produces adverse external effects only occasionally, general drinking practices seem for the most part inappropriate matters for official concern. Thus, any governmental effort to influence drinking practices may be seen as an inappropriate paternalistic restriction on freedom irrespective of how gentle or heavy-handed the intrusion.
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From page 56... ...
Such efforts will be at best redundant and at worst self-defeating. A slightly less extreme view holds that government may indeed influence current drinking practices, but in unexpected and potentially dangerous ways.
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From page 57... ...
Interestingly enough, because the vast majority of the population drinks safely most of the time, the government, if it did nothing more than reflect prevailing practices back to the population, would be exercising an important moderating influence. The normative objections suggest a second important principle: We should be aware of who and how many people are the intended beneficiaries of certain kinds of prescriptions and select the particular policy instruments accordingly.
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From page 58... ...
But the dominant and most important thrust of policies regulating commercial availability is to shape broad patterns of consumption over time with the management of contexts as an important additional factor. Second are policies that seek to influence drinking practices directly by suggesting (with varying degrees of force)
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From page 59... ...
SUMMARY AND CONCLUSION When current alcohol control policies are viewed in the context of the current institutional setting and against the backdrop of the analytic conception of the problem developed in chapter 2, an interesting opportunity appears. It may be desirable to diversify our policies in the direction of prevention programs that operate on the general population, through the management of contingencies that affect drinking, the contexts commonly paired with drinking, and the general features of the environment that make drinking in given contexts more or less risky.
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From page 60... ...
. At the conclusion of the second part of the report, we shall have a more sharply defined view of the potential of what are here described as prevention policies.
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