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1. Simplifying Conceptions of Alcohol Problems
Pages 6-15

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From page 6...
... There are too many people with diverse perceptions and interests and too little time and inclination to create a shared perception of a complex structure. Consequently, influential policy ideas are typically formulated at a quite general level and borrow heavily from commonly shared understandings and conventional opinions.
From page 7...
... Or one might consider the appearance of public sobriety to be of overriding importance and choose policy instruments that will simply but effectively keep drunkenness out of public view. In short, by choosing a limited range of effects to be the dominant objective of alcohol policy effects that are the largest, or most important, or the only ones that are conceived to be an appropriate concern of government the problem can be simplified sufficiently to gain confidence in designing and recommending alcohol policy.
From page 8...
... Before looking at the kinds of policy choices that our analysis suggests are available, it is well worth understanding the basic structure of the three ideas that have succeeded in profoundly shaping alcohol policy as well as two others that are interesting and have appeared historically but have made lesser claims on credibility. GOVERNING IDEAS A review of the history of alcohol in the United States reveals three dominant conceptions associated with its use (see Aaron and Musto in this volume; Beauchamp 1973;N.
From page 9...
... The institutional carriers of this conception were the temperance pledge societies voluntary associations whose core tenet was the mutual renunciation of liquor by their memberships. Most of these societies were evangelical in tone and middle class in origin.
From page 10...
... These problems were seen to result neither from moral weakness in the drinker nor from the universally addicting power of alcohol itself, but from a little-understood chemistry that occurred between the substance and certain drinkers. In contrast to the colonial view that although alcohol is physically and morally innocuous, some morally defective individuals take to perpetual drunkenness as a sign of their dissipation, this modern view holds that although alcohol is innocuous for most people, a minority fine people in all other respects—cannot use it without succumbing to alcoholism, a disease process for which there is no known cure except total abstinence.
From page 11...
... At the same time, there have been efforts to institutionalize alcoholism treatment in occupational programs and in health care financing by favorable federal regulation as well as private-sector action. It is also notable that this governing idea, projecting the conception of vulnerability onto a small part of the population, has been able to establish and maintain support from the alcohol industry itself.
From page 12...
... The other idea- the public health perspective has made its appearance more recently. Following the repeal of Prohibition, the direction of alcohol policy was strongly influenced by an organization called the Association Against the Prohibition Amendment, a business-based alliance that drew heavily on the intellectual resources of Columbia University.
From page 13...
... The concern that proponents of repeal expressed in seeking to inhibit abusive drinking through the management of social contingencies around drinking has been revived- with a different institutional base in the public health perspective. As with the other ideas, the public health perspective focuses attention on selected aspects of alcohol problems and carries with it a variety of normative and empirical assertions.
From page 14...
... In going beyond the alcoholism view and its preoccupation with chronically dependent drinkers, it departs from another conceptually satisfying and institutionally entrenched idea. In addition, since it focuses on drinking in the general population and tinkers with the idea of restricting alcohol availability, it cannot quite shed the taint of "the great experiment." Since Prohibition has been so widely repudiated as a clumsy, ineffective, if not malicious social intervention, anything that looks like a move toward Prohibition will now be stubbornly resisted.
From page 15...
... The diversity, in turn, suggests the fundamental complexity of the underlying problem. More particularly, however, these simplifying conceptions point to the crucial dimensions in which simplifying choices must be made.


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