Alcohol Consumption Policies and the Prevention of Alcohol Consumption-Related Problems: Needs, Duties, and Responsibilities*
Post on 24-Mar-2017
Substance Use & Misuse, 47:12521259, 2012Copyright C 2012 Informa Healthcare USA, Inc.ISSN: 1082-6084 print / 1532-2491 onlineDOI: 10.3109/10826084.2012.716483
DIALOGUE: CONTROLLING ALCOHOLIC BEVERAGES, THEIR CONSUMPTION, AND CONSUMERS
Alcohol Consumption Policies and the Prevention of AlcoholConsumption-Related Problems: Needs, Duties, and Responsibilities
Agenzia Regionale di Sanita Toscana, Firenze, Italy
Alcohol-related policies and the prevention of alco-hol use-related problems, as well as their creation,are accomplished through planned interventionslaws, social and health programs, community-basedinitiativesas well as through complex social move-ments and efforts implemented by the communities.Among both citizens and alcohol use intervention ex-perts, the following three human dimensions are con-sidered: needs, duties, and responsibilities.
Keywords needs, duties, responsibilities, pleasure, changes,control, prohibition, prevention, alcoholic beverages, utilitarianand universal approaches
Struggling for de-criminalizing all types of drugs is the only way-out
Alcohol-related policies and the prevention of alcoholuse-related problems, as well as their creation, are ac-complished through planned interventionslaws, socialor health programs, community-based initiativesas wellas through complex social movements and forces imple-mented by the communities. Among both citizens andalcohol use intervention experts, the following three be-havioral dimensions are considered and have been con-sensualized for many: needs, duties, and responsibilities.
Needs are linked to satisfaction. They are related to theprinciple of utility and change over time. Needs relatedto drinking require physiological, relational, social, work-labor leisure time, and even religious and spiritual satis-factions. Moreover, needs are not only individual but arealso collective, such as drinking at the table with family orfriends as well as being involved in community activities.
This article is based on a presentation made at the 37th Annual Alcohol Epidemiology Symposium of the Kettil Bruun Society, Melbourne,11th15th April, 2011.Thanks to Shlomo Einstein, Deborah R. Gordon, and Silvia Mattiacci for their inspiration and help in imaging and explaining some ideas in thisarticle.Address correspondence to Dr Allaman Allamani, MD, via Toselli 140 50144, Firenze, Italy. E-mail: firstname.lastname@example.org.
Further, alcohol use intervention experts need to imple-ment preventive actions, which should be evident at local,national, and international levels, while they should be ap-propriately appreciated as a professional.
Duties are related to the principle of control, namelythat someone can check if they are enforced. In the fieldof addiction, control is the opposite of motivation. Citi-zens should not only follow the laws of the state, but alsoimplement the informal control of their own and othersbehavior. Alcohol use intervention experts have to copeboth with the opinions, agendas and goals of politiciansand the ideas of scientific communities.
Responsibility is a key concept in ethics. It appliesto any individual, independent of her/his role. One mayconsider responsibility in the frame of universal ethics,which stretches beyond the individual and encompassesthe whole of humanity. These universal moral laws gov-ern human behavior, requiring mutual respect, solidarity,and reciprocity and offer an opportunity, if not an obliga-tion, to become engaged as active witnesses and changeagents.
AIM OF THE ARTICLE
This article examines some thoughts about drinking alco-holic beverages as a human need, which is usually asso-ciated with the daily experience of individuals; and aboutthe inefficient, if not counterproductive, recursivity, whichmay occur in the long-term of control efforts designed toprevent alcohol consumption. This article may raise morequestions than provide answers. Even the quote abovefrom the sociologist Ivan Illich (which is from a personaldedication to the author of this article in 1984) would be amore suitable prologue for a discussion about the issue ofdrug and alcohol use and misuse, but here it is reported as
NEEDS, DUTIES, AND RESPONSIBILITIES 1253
a radical approach against any negative approach towardhuman behavior.
Overall, the article argues against the pervading per-spective in the alcohology literature that considers alco-holic beverage as being intoxicating and that considersthe goal of alcohol consumption prevention as singularlyaimed to avoid the short- as well as long-term harmscaused by such intoxication. Instead, it opts for the al-ternative or complementary approach that treats drink-ing alcoholic beverages as a normed civilizing socialhuman behavior, and prevention as mainly promotingthe development of healthy lifestyles, including a health-responsible drinking.
CHANGES IN CONSUMPTION AS COMPLEXPHENOMENA
A few studies during the last decades have considered al-cohol consumption policy prevention measures not as iso-lated policy interventions but as part of an historical, cul-tural, and economic context and process which affects,and is able to be affected by, drinking patterns; similarly,drinking alcoholic beverages have been understood not asa single pattern but as a complex behavior, like many otherhuman comportments. For example, consider a statementof the International Study of Alcohol Control Experiences(ISACE) in 1981:
[We cannot] forget the pleasure that drinking gives to the majorityof consumers. Neither do we question the legitimacy of the interestof those who gain their livelihood from the drink trade. Moreover,our study has shown that changes in alcohol legislation and in theavailability of alcoholic beverages occurred as an integral aspectof an overall process of historical change. (Makela, Room, Single,Sulkunen, & Walsh, 1981, p. 95)
Also compare a recent statement by the AMPHORAWP3 project, which started in 2008:
Preventive alcohol consumption policies alone do not cause nor ex-plain changes in alcohol consumption, drinking patterns and alcoholconsumption-related harm. These changes can only be explainedwhen other contextual factors such as social, cultural, economic,religious, demographic and big events factors are considered si-multaneously. This broader perspective, incorporating the contex-tual determinants of changes and their interrelationships with con-sumption, must be considered, in order to identify the most effec-tive, and cost effective consumption prevention policies aimed atreducing the consequent alcohol consumption-related harm. Theseconsiderations would enable appropriate policies to be adapted foreach country. (Allamani et al., 2011)
Moreover, the causal1 and somewhat tautological at-tribution that an alcohol consumption-related problem iscaused by excessive drinking, and conversely the propo-sition that alcohol policy measures are efficient causes of
1The reader is referred to Hillss criteria for causation that were de-veloped in order to help assist researchers and clinicians determine ifrisk factors were causes of a particular disease or outcomes or merelyassociated. (Hill, A. B. (1965). The environment and disease: associa-tions or causation? Proceedings of the Royal Society of Medicine, 58,295300.). Editors note.
changes in consumption and alcohol consumption-relatedharm, have been questioned for theoretical and practicalreasons (Edwards et al., 1994; Holder, 1999; Rothman,Greenland, Poole, & Lash, 2008).
Further, to causally attribute social or health prob-lems to someones drinking is to overlook possible struc-tural or broader situational explanations of these problems(Makela et al., 1981, p. 110).
In sum, changes in alcohol consumption may occurboth through planned interventionspart of which arepolicy measures such as laws, social or health programs,community-based initiatives, etc.and through complexsocial movements and forces implemented by the commu-nities and society at large.
HISTORY AND LITERATURE OF NEED
It is important to note the frequent connection of drink-ing with daily life activity, which, contrary to the preva-lent contemporary attitude that regards alcoholic bever-ages as extra-ordinary objects of social transactions, isclearly demonstrated in the disciplines of history and an-thropology. In fact, thanks to art and literature, there isa wealth of information about the close association be-tween drinking and human everyday activities, as passeddown through the centuries. This section briefly summa-rizes some findings of recent studies in archaeology andliterature.
In fact molecular archaeological research has recentlyconfirmed how long, like the baking of bread, alco-holic beverages have been associated with human lifethrough the millennia. A Neolithic wine was discoveredthat indicates the cultivation of Vitis vinifera in northernMesopotamia at least as late as 6,000 BC (McGovern,2003, 2010).
Neolithic communities of the ancient Near East andEgypt were permanent, year round settlements made pos-sible by domesticated plants and animals. From this a Ne-olithic cuisine emerged. Using a variety of food process-ing techniquesfermentation, soaking, heating, spicing,etc.Neolithic peoples are credited with first producingbread, beer, and an array of meat and grain foods. Craftsimportant in food preparation, storage, and serving weredeveloped.
Through an extensive bio-molecular archaeology gene-mapping project, which analyzes ancient organic remains,the American scientist McGovern and his colleagues ana-lyzed the heritage of many modern grape cultivars; theynarrowed their origin to Georgia and Armenia, whereresidues of wine were also discovered on the inner sur-faces of old ceramic storage jars. The appearance of pot-tery vessels around 6,000 BC. made it possible to formshapes through the plasticity of clay, such as narrow-mouthed vats and storage jars for producing and keep-ing wine. FromGeorgia and Armenia, winemaking spreadsouth to Iran, Egypt, and Greece.
The widespread consumption of wine in ancient Greeksociety and the use of toasting as a social phenomenonof greeting were the subjects of recent study by Simone
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Beta (Beta, 2006). He reports on 150 Greek epigrams onwinehow wine inspired poetical production, how it wasthe subject of poetical declarations over 11 centuries. Thelast chapter offers an informative brief history of toasting.
Even in times of Homer, Greek gods and heroes cametogether, toasting with golden bowls, acting in a way thatis described by the Greek verb deidecath (to welcomesomeone with a welcome greeting). At the end of a ban-quet Ulysses thanks Alcynous, king of Pheaci, associatingwine and food:
It is a good thing to hear a bard with such a divine voice. . . . Thereis nothing better or more delightful than when a whole people makemerry together . . . sitting orderly to listen, while the table is loadedwith bread and meats, and the cup-bearer draws wine and fills hiscup for every man. (Homer, 19942009)
Among the many memorable toasts is the ode by theLatin poet Horace (Nunc est bibendum), which celebratedthe victory of Augustus over Anthony and the QueenCleopatra of Egypt, who until then threatened the great-ness of Rome:
Now drink we deep, now featly treadA measure; now before each shrineWith Salian feasts the table spread;The time invites us, comrades mine . . . . (Horace, 1999)
According to Robin Room and others, some drinkingcustoms are part of everyday sociability, such as the cus-tom in many cultures of informal toastingmaking agesture or speaking some verbal formula as an invitationto drink together (Room et al., 2002). In all societies,drinking is primarily a social activity. The drinking groupcan function in almost any locationin someones home,on the street, out in the bush or countryside, or in a restau-rant or tavern. Anthropological accounts from many soci-eties have emphasized the congruence of drinking behav-ior with cultural values such as hospitality, kinship, andreciprocity.
Toasting also occurred later in the literary forms of theMiddle Ages, for example, in the 13th century CarminaBurana and of the Renaissanceas in the compositionsof Lorenzo de Medici in his Florence court. From the17th to the 20th centuries, it had a special representation inmusic, from Monteverdi to Lulli, from Handel to Mozart,Beethoven, and Puccini. Here, we just recall the famoustoast in La Traviata by Giuseppe Verdi:
Violetta salza:Tra voi sapro dividereIl tempo mio giocondo;Tutto e follia nel mondoCio che non e piacer.Tutti:Godiam la tazza e il canticoLa notte abbella e il riso;In questo paradisoNe scopra il nuovo d.
Violetta (rising from her chair)Among youI spend such happy days;
Lets not waste our time with thingsThat dont give us pleasure.allAh! Lets enjoy life!Wine and songBeautify night and laughter,Until the new days dawnFinds us in this paradise.
(Piave, F. M./Verdi, G. Libiam ne lieti calici from LaTraviata, Atto I, English translation, 2012, Lets drink)
The convivial drinking and toasting has been memo-rably portrayed in several movies. Among others, I liketo quote the beautiful 1987 Danish film Babettes Feastdirected by Gabriel Axel. The films screenplay was writ-ten by Gabriel Axel, based on the story by Karen Blixen.Although the other celebrants, part of a strictly religiouscongregation, do their best to reject the earthly pleasuresof the food and drink, Babettes extraordinary gifts as achef de cuisine breaks down their distrust and supersti-tions, elevating them both physically and spiritually.
Even in the so-called dry cultures of Northern Europe,convivial drinking and toasting are acceptable and enjoy-able parts of life. Much like the splendor of the Danishdinner described by Axel, there is another well-known sayexpressed by the person of Iago:
Come, come, good wine is a good familiar creature if it be wellused;exclaim no more against it. (Shakespeare, 2005, Act II, Scene III)
In addition to that, many references in general confirmthe association between drinking and human experiencesin the monotheistic religions. One can see it in sentenceslike, a feast of rich food for all peoples, a banquet ofaged wine (Isaiah, 2011, 8th century BC, in Israel) and thegrapes of my body, which become wine (Rumi, 1995, 13thcentury AD in the Persian area). Similarly is the exhorta-tion of St. Benedict that Christian monks in good healthmay drink no more that a hemina (probably a quarter)of wine (The Holy Rule of St Benedict, 6th century AD;Verheyen, 1949)
Hence, I believe we should revisit and reinterpret atheory of needs applied to drinking that might integratethe concept of drinking as an extra-ordinary need, whichis potentially...