Week 3: Drunkenness and alcoholism as

deviancy

According to Clinard and Meier, “Despite expressions of substantial concern about ‘drug’ use, alcohol is by far the most popular mood-altering drug consumed in the United States today. In fact, two drugs – alcohol and tobacco – actually cause more physical, medical, social, and psychological problems than any other drugs” (2004, 254)The same can be said for Australia as “Alcohol is part of the Australian culture and way of life. Australians drink alcohol to relax, socialise, celebrate, and for its taste. The challenge for Australian society is to balance alcohol's place in the culture with the health risks associated with drinking too much and drinking more than is healthy over a longer period. {http://www.dassa.sa.gov.au/site/page.cfm?u=122#effects}Alcohol has been used in society for thousands of years with taverns recorded in early Greek and Roman history (Clinard and Meier 2004, 265)

So what is alcohol?“Alcohol is a chemical substance created through processes of fermentation or distillation” (Clinard and Meier 2004, 255) – how does this definition fit with the definition of a ‘drug’ as discussed in week 5? “Alcohol is a naturally occurring chemical that is produced by the action of yeast on sugar. The chemical process that produces alcohol is called fermentation; chemicals from the sugar are converted into a substance that chemists call ethanol and most people know as alcohol” (Rooney 2013, 6)“Alcohol is a central nervous system depressant, although in smaller amounts it may appear to have a mild stimulant effect”. {http://www.dassa.sa.gov.au/site/page.cfm?u=122#effects}“Alcohol has been used for thousands of years. In the past in places where there was no clean drinking water, fermented drinks were the safest thing to drink, as alcohol kills germs. People have drunk alcohol as a medicine, as part of religious or magic rituals, and just because they like it” (Rooney 2013, 7)The blood can never hold more than 1% alcohol and even the smallest amount of alcohol intake has been shown to affect the brain and people die from alcohol poisoning every year

As alcoholic drinks vary in strength, measures have been adopted to help people understand how much they are drinking and how much is safe to drink. In Australia “A standard drink contains about 10 grams of pure alcohol. Hotels and restaurants usually serve alcohol in standard drink size glasses. Wine, however, is normally sold in 140 mL or 200 mL glasses. One 200 mL glass of wine contains approximately two standard drinks. Glasses used at home are unlikely to be standard drink size. The labels on alcoholic drink bottles and cans show the number of standard drinks they contain”. {http://www.dassa.sa.gov.au/site/page.cfm?u=122#effects}

Alcohol is widely used around the world and across many cultures and Australia has a high rate of alcohol consumption. If you want to find the actual figures across all countries, the World Health Organisation 2004 report on alcohol has some very interesting figures and clearly shows where Australia’s consumption and abuse figures sit amongst the rates for the rest of the world. The url link for this document is found in resources for this lecture.

According to the ABS, alcohol consumption in Australia has declined slightly over the last 6 years from 2006 to 2011.The ABS also estimate that in 2008, Australian’s consumed “10.3 litres of pure” (for persons aged 15 years and over) which is more than “the OECD average of 9.6 litres of pure alcohol per person” During this period, 13% of people aged over 15 yrs were at risk of long term negative health risks from alcohol consumption. {http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features20Jun+2012}

According to the World Health Organisation, “The harmful use of alcohol results in the death of 2.5 million people annually. There are 60 different types of diseases where alcohol has a significant causal role. … In 2005, the worldwide total consumption was equal to 6.13 litres of pure alcohol per person 15 years and older. Unrecorded consumption accounts for nearly 30% of the worldwide total adult consumption” and as at 2005 “58% of adults abstained from alcohol in the past 12 months, and only 31% of member states reported having an alcohol policy”. {http://www.who.int/gho/alcohol/en/index.html}If we compare the figures in the tables on the next two slides, Slide 10 shows the disease burden is clustered within the 15-29 and 30-44 year age brackets, but when we look at Slide 11 we see the effects of time with alcohol related deaths clustered around age brackets 30-44 and 45-59 yrs suggesting a 10-20 year period of alcohol abuse before death.

As a socially accepted ‘drug’ people often use alcohol to deal with stress, sleeplessness, to make them more social, and to relaxAs deviancy and alcohol use are both social constructs there is a fine line between what is acceptable and what is notClinard and Meier argue “a determination of deviance requires more information than a simple statement about the presence of alcohol; this judgment also depends on information about the conditions under which people drink” (2004, 255)Compare for example, young people staggering out of night clubs versus race-goers staggering away from Melbourne cup venues or a drink driver unknowingly over the limit after a business lunch versus someone who has spent all afternoon at the pub – we see one as more excusable than the other. Thus, we have many contradictions in our social norms about alcohol.

“People of all ages are drinking more now than in the past, and drinks contain more alcohol than they used to. The average American drank 7.8 litres of alcohol in 1960, and this has risen to 8.3 litres by 2000. In the United Kingdom, alcohol consumption doubled in the same period” (Rooney 2013, 7).Alcohol consumption generally declines with ageMales drink more than females (although in young drinkers this may not necessarily always be the case)Younger and younger children are experimenting with alcoholBinge drinking is more commonly associated with teenagers and young adultsDrinking also varies by religion, culture, education and income levels (increases in one, increases the other – ie, higher education = higher rates of consumption, higher income level = higher consumption level)Religion is also a factor on drinking with the heaviest drinkers being: Jewish, Catholic, and LutheranThere is more drinking in larger cities than in smallAnd unmarried people have higher rate consumption rates than married people.

“Many contemporary drinking patterns have come as an inheritance from pervious generations. The knowledge, ideas, norms, and values concerned with consumption of alcoholic beverages, passing from generation to generation, have maintained the continuity of an alcohol-related subculture” (Clinard and Meier 2004, 261)Thus, just like addicts need a community in order to become an addict (as discussed in week 5), people are socialised to alcohol use. There are no universal patterns to alcohol use across societies and cultures (although some familiar patterns are found). For example, in the US, drinking is not socially accepted at funerals. In Ireland drinking is an important aspect of a wake. In Australia, people generally do not drink at the social gathering immediately following a funeral but many will later meet at a pub to drink in memory of the deceased. In New Zealand, alcohol consumption is often an important part of the funeral ritual, especially for Maori and Islander cultures where a wake for the deceased is held over a number of days.Europeans do not view alcohol as a vice and it is an important element in everyday life with alcoholic drinks like wine often accompanying main meals.Alcohol has a significant role in everyday life, as people:Drink to celebrate all manner of occasions from national holidays, sporting competitions, weddings, births, to job promotions, anniversaries and other important social events and milestonesFood and alcohol are often important components in business meetingsAnd many clubs (sporting, private, and business) provide bars for their members

According to the Australian Bureau of Statistics, drinking patterns are generally declining. A report released in 2010 looks at trends in alcohol consumption, alcohol-related harm, alcohol beverage of choice, and under-age drinking. It found that consumption at the population level has remained stable over the six year period from 2001-2007, with around 83% of the population aged 14 years and over identifying themselves as recent drinkers. Those who identified their drinking habit as harmful were also those mostly likely to be engaging in risky drinking behaviour.{http://www.drinkwise.org.au/free-resources/research/drinking-patterns-in-australia-2001-2007/}Another recent report into young peoples’ drinking influences found that drinking is positively associated with Australian culture and identity. “Friendship and the ease of access to cheap alcohol make drinking an attractive activity, whilst the key deterrents are risks of drink driving, parental pressures and the responsibilities of work and study. Most young people did not agree with the stereotypes of youth drinkers as ‘out of control’ and do not feel that the new drinking guidelines applied to them. … clubs play an important role as community hubs where families spend leisure time. The serving of alcohol to under-age members in the presence of parents was flagged as a grey area and clubs nominated training, education and surveillance as key to responsible club practices around alcohol consumption … the study found that young people would prefer to face the negative consequences of being drunk than the social exclusion associated with staying sober, as those who choose not to drink have to come up with several reasons why they are not drinking. To fit in, young people expect that all members of the group will drink to the same level of intoxication, however, exclusion is not just applied to those who don’t drink – it is also a potential consequence for those who drink too much”.{http://www.drinkwise.org.au/free-resources/research/what-a-great-night-the-cultural-drivers-of-alcohol-consumption-among-young-people/}

There are different types of drinkers identified by researchers:• Social or controlled drinkers – someone who is an occasional drinker and often drinks at social

occasions to be sociable and to conform to social norms – they are not controlled by alcohol as they ‘can take it or leave it’

• Heavy drinker – regularly consumes alcohol, often consuming large quantities • Alcoholic drinker – someone who needs to consume alcohol on a regular basis with this need

potentially interfering with health, social, or economic functioningAnother study has classified drinkers according to social situations as:• Light drinkers• Frequent early evening drinkers• Heavy hotel-tavern drinkers• Club drinkers• Solitary drinkers• Party drinkers As there is much disagreement and disparity over categorising drinkers, especially those regarded as alcoholics, a new term is used – the problem drinker

The problem drinker does not necessarily need to be an alcoholic or even a heavy drinker (although they often are), the term is used to signify when alcohol consumption has created “complications in personal living” (Clinard and Meier 2004, 260)The effects of problem drinking are: • Ugly hangovers• Physical collapse• Blackouts• Nausea• Deteriorating interpersonal relationships, and• Encounters with police“problem drinkers are those who experience some problem as a result of their drinking, regardless of how much they consume or the circumstances surrounding that consumption” (Clinard and Meier 2004, 260)Alcoholism is a different concept to problem drinking.

Alcoholism is a chronic condition reached ”after consuming large quantities of alcohol over long periods of time” (Clinard and Meier 2004, 260)Symptoms of chronic alcoholism:• Solitary drinking• Morning drinking• General physical deterioration• Preoccupied with drinking“Alcoholics deeply fear the prospect of life without a drink, so they may resort to hiding containers of liquor under pillows, under porches, and in any place likely to escape detection” (Clinard and Meier 2004, 260)“The link between alcohol consumption and consequences depends a) on the two main dimensions of alcohol consumption: average volume of consumption and patterns of drinking; and b) on the mediating mechanisms: biochemical effects, intoxication, and dependence” (WHO Global Status Report on Alcohol 2004, 35-36) “Direct biochemical effects of alcohol may influence chronic disease either in a beneficial (e.g., protection against blood clot formation of moderate consumption, which is protective for coronary heart disease) or harmful way (e.g., toxic effects on cells triggering pancreatic change). Intoxication is a powerful mediator mainly for acute outcomes, such as accidents, or intentional injuries or death, domestic conflict and violence. Alcohol dependence is a powerful mechanism sustaining alcohol consumption and thus impacting on both chronic and acute consequences of alcohol, though it is also a consequence of drinking itself” (WHO Global Status Report on Alcohol 2004, 35-36)

“Someone who is physically dependent on alcohol will experience withdrawal symptoms when they stop drinking or substantially reduce their intake. Symptoms usually commence 6-24 hours after the last drink, last for about five days and include:• tremor• nausea/vomiting• anxiety/agitation• depression• sweating• headache• difficulty sleeping (may last several weeks).Alcohol withdrawal can be very dangerous. People drinking more than eight standard drinks a day are advised to discuss a decision to stop drinking with a doctor as medical treatment may be required to prevent complications”.http://www.dassa.sa.gov.au/site/page.cfm?u=122#effects

The economic costs to countries from the abuse of alcohol are significant. The WHO 2004 report estimated Australia’s cost of alcohol abuse at $7560.3 million. Interestingly, a report released in 2010 has this estimate at $36 billion which it states is more than double previous estimates. This increase encompasses all alcohol related harm, such as, assaults, hospitalisations, drink driving, vandalism, health problems, and significantly, child abuse (McDonald, 2010)

There is well documented evidence of heavy drinking and:• Physical and psychological dependency• Physical illnesses• Breakdown in social relationships• Poor work performance• Work related injuries• Absenteeism• Lower productivity• Unemployment • Lower parenting skills• Child abuse and neglect• “Intoxication is the most common cause of alcohol-related problems, leading to injuries and premature deaths. As a

result, intoxication accounts for two-thirds of the years of life lost from drinking. Alcohol is responsible for:• 30% of road accidents• 44% of fire injuries• 34% of falls and drownings• 16% of child abuse cases• 12% of suicides• 10% of industrial accidents.As well as deaths, short-term effects of alcohol result in illness and loss of work productivity (eg hangovers, drink driving offences). In addition, alcohol contributes to criminal behaviour - in 2010 it was reported that more than 70,000 Australians were victims of alcohol-related assault, among which 24,000 were victims of alcohol-related domestic violence” {http://www.dassa.sa.gov.au/site/page.cfm?u=122#effects}

Drink driving is a serious social problem in Australian society. All governments in Australia have implemented alcohol blood limits on drivers in order to reduce the number of deaths attributed to drink driving. As this chart indicates, the higher the blood alcohol level, the higher the risk of a road accident.

Aside from the other social and economic costs of alcohol, the health consequences of alcohol consumption are significant. According to the ABS, alcohol is one of the risk factors that account for “much of the morbidity and mortality attributed to noncommunicable diseases” in Australia, along with smoking, obesity, lack of exercise, cholesterol, lack of dietary fibre etc.There are many health related problems from the body’s absorption of alcohol. Diseases which have been shown to be fully attributable to alcohol are:• Alcoholic psychoses• Alcohol-dependence syndrome• Alcohol abuse• Alcohol polyneuropathy• Alcohol cardiomyopathy• Alcohol gastritis• Alcohol liver cirrhosis• Excess blood alcohol• Ethanol and methanol toxicity

Diseases and health problems where alcohol plays a contributory role are:• Gastrointestinal disorders• Pancreatitis• Liver disease• Haemorrhagic stroke• Nutritional deficiency• Impairments of the central nervous system functions• Disorders of the endocrine system• Cardiovascular defects – coronary heart disease, hypertension, cardiac arrhythmias, heart failure• Myopathy• Some birth defects• Some cancers – breast cancer, stomach, pancreas, colon, rectum, prostate salivary glands, ovarian,

endometrium bladder, oropharyngeal, oesophageal, liver.There all also some health conditions where alcohol has a beneficial effect, such as some forms of stroke, diabetes, and gallstones (however moderation is the key). Research appears to suggest those cultures where alcohol is part of the meal generally experience the positive health benefits of moderate consumption of alcohol. Whereas those where heavy or binge drinking occurs suffer more from the negative health consequences of alcohol. (WHO 2004, 42).

A serious consequence of alcohol use during pregnancy is fetal alcohol syndrome. In the same way that children who are born to mothers who take drugs, babies born to mothers who drink during their pregnancies often suffer from the physical effects of alcohol on their fetal development. National guidelines have been developed by the National Health and Medical Research Council advising pregnant women to abstain from alcohol consumption for the duration of their pregnancies in order to avoid the problems of babies born with fetal alcohol syndrome.

• There are a number of control strategies used in society to attempt to limit alcohol consumption.• Prohibition is most often associated with the US policies of the 30s and were largely unsuccessful

due to the high rates of crime this policy generated (think of gangsters like Al Capone capitalising on prohibition policies). Australia has also had prohibition policies with many Indigenous communities required by law to be alcohol free. Some street signage indicates areas that are or were alcohol free.

• Legal regulation limits the age of persons allowed to drink alcohol, permissible blood alcohol levels for driving and performing certain tasks, and for regulating venues serving alcohol such as closing times and lock out times.

• The Victorian government is currently proposing the implementation of policy requiring convicted drink drivers to fit their cars with interlock devices where they have to blow into the device and record a zero alcohol level before the car will start.

• National guidelines are produced to educate people about safe drinking practices, the negative consequences of drinking too much, and the adverse outcomes for others from drinking such as children, spouses, and developing foetus.

• Media campaigns are also used as an education device, to promote policy initiatives, and to change society’s tolerance for acceptable drinking.

• Social responses, such as alcoholics anonymous offer treatment strategies for recovering alcoholics.

Advocates for social change use the negative consequences of alcohol to promote their views about other substances. For example, supporters of legalising marijuana argue alcohol creates more social problems, causes more health issues, and has a greater social and economic cost for society than marijuana and yet marijuana is illegal and alcohol is legal.

Questions/activities:1. Think back to week 5, how similar or different is alcohol to illicit drugs? (discuss for

both: definitions, effects, dependency, withdrawal, social cost etc).2. Identify the many ways in which alcohol abuse impacts society. (discuss economic

costs, social costs, crime, health, domestic/family violence, loss of productivity, road deaths and injuries, work place deaths and injuries, etc).

3. Discuss all the ways in which we embrace alcohol as part of Australian culture (ie, beer and barbeques, drink to celebrate marriage, sports events, births, deaths, other forms of achievement, to socialise, to feel happy, to relax, to sleep etc).

4. How do we react to non-drinkers in social situations? (try to get students to reflect on their own ideas about drinking and how they view their parents drinking, their friends drinking, drinking by older people etc – idea is to reveal their implicit beliefs about drinking).

5. If alcohol causes so many problems for society, why do we simply not ban it? (there are so many aspects here for discussion from prohibition to over-regulation of society, to the social/economic costs, to the practical issues of policing a total ban etc).