Alcohol Consumption Policies and the Prevention of Alcohol Consumption-Related Problems: Needs, Duties, and Responsibilities*

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  • 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

    Allaman Allamani

    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

    Ivan Illich

    INTRODUCTION

    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: allamana@gmail.com.

    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

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  • 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 g

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