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Current trends in alcohol use in the USA

Alcohol History and Trends

Alcohol

World’s most important psychoactive drug
Alcoholic beverages have been consumed for thousands of years, perhaps as far back as 8000 BC
A central nervous system depressant
Society’s love-hate relationship with alcohol
Social lubricant?
Adjunct to a fine meal?
“Demon rum”?

Image sources: PhotoAlto/PunchStock (Image Ch09_33RedWineGrapes); Burke/Triolo Productions/Getty Images (Image Ch09_32ChiantiBottle)

Fermentation Products

Fermentation = the production of alcohol from sugars through the action of yeasts
Forms the basis of all alcoholic beverages
Fruits + yeast = fermentation will begin
Fruits naturally contain sugar
Cereal grains contain starch, which must be converted to sugar by malt before fermentation can begin
Yeast has a limited tolerance for alcohol
When alcohol concentration reaches 15 percent, the yeast dies and fermentation ceases

Distilled Products

Distillation = evaporation and condensing of alcohol vapors to produce beverages with alcohol content higher than 15 percent
First used in Arabia around AD 800
Introduced into Europe in about the 10th century
In U.S., began on a large scale at the end of the 18th century
Proof = alcohol content of a distilled beverage; twice the percentage of alcohol by weight
90-proof whiskey is 45 percent alcohol

Temperance Movement

Benjamin Rush (1745-1813)
Heavy drinking = health problems
Alcohol use damages morality
Alcohol addiction = a disease
Temperance societies
Initially promoted abstinence from distilled spirits and moderate consumption of beer and wine
Later promoted total abstinence
Became fashionable to “take the pledge” (see right)

Image source: Library of Congress Prints and Photographs Division, Temperance Pledge (Image Ch09_13TemperancePledge)

Prohibition

States began passing prohibition laws in 1851
By 1917, 64 percent of Americans lived in “dry” territory
Laws reflected issues of class, ethnicity, religion, immigration, and politics
People still drank illegally in speakeasies and private clubs and legally through purchase of patent medicines

Prohibition

Federal prohibition
18th Amendment to the U.S. Constitution, banning the sale of alcohol, was ratified in January 1919
National prohibition went into effect in January 1920
People continued to buy and sell alcohol illegally, and enforcement was challenging and expensive
Organized crime became more organized and profitable
Alcohol dependence and alcohol-related deaths declined

Enforcement activities during Prohibition

Image source: Library of Congress Prints and Photographs Division (Images Ch09_14Prohibition1, Images Ch09_15Prohibition2, Images Ch09_16Prohibition3, Images Ch09_17Prohibition4)

Prohibition Repealed

Concerns that widespread disrespect for Prohibition laws encouraged a general sense of lawlessness
Taxation: Alcohol taxes had been a major source of revenue
Repealed by the 21st Amendment
Ratified in 1933
Alcohol per capita sales and consumption increased slowly until after World War II, when they returned to pre-Prohibition levels

Regulation and Taxation

Regulation after 1933
Some states remained dry after national prohibition ended, but most allowed at least beer sales
Laws were slowly relaxed until the last dry state, Mississippi, became wet in 1966
Drinking ages were lowered in some states but raised again to 21 following concerns over increased drinking rates and alcohol-related traffic accidents
Taxation
Federal and state taxes and licensing fees = about half the price of an alcoholic beverage
When taxes go up, consumption goes down

Who Drinks and Why?

Cultural influences on drinking—ethnic and social factors
Trends in U.S. alcohol consumption
Use peaked in 1981, followed by a decline, mirroring patterns of illicit drug use
Decline particularly significant for distilled spirits
About one-third of Americans abstain
Average consumption among drinkers = about 3 drinks per day—but most drink far less
Half of all alcohol consumed in the United States is consumed by about 10 percent of the drinkers

U.S. Alcohol Consumption

Per capita ethanol consumption by beverage type

Source: NIAAA Surveillance Report No. 73

Figure 9.1 from text

U.S. Alcohol Consumption

Regional differences in the United States
Stress index: Drinking rates higher in states where people experience a great deal of social stress and tension
Drinking norms: Drinking rates higher in states where people tend to approve of the use of alcohol to relieve stress

U.S. Alcohol Consumption

Total estimated U.S. per capita ethanol consumption in gallons per year by state

Source: Data from NIAAA

Figure 9.2 from text

Alcohol as a Drug

Alcohol is an addictive substance. Of the approximately 2 million receiving treatment for drug abuse, 64% are being treated for alcoholism.
Social psychologists refer to the perception of alcohol as a social lubricant.
Four reasons why many people view alcohol as a non-drug:
Alcohol is legal.
Advertising and media promote drinking as normal.
Large distribution and sales of alcohol.
Long history of alcohol use.

Negative Impact of Alcohol

100,000 deaths associated with alcohol
each year.
Nearly 50% of all Americans will be involved in an alcohol-related traffic accident sometime during their lives.

More than 2% of night-time drivers have blood alcohol that exceeds legal amounts (0.08%).

Negative Impact of Alcohol

Alcohol causes severe dependence.
Disrupts personal, family, social, and professional functioning.
Illness, accidents, violence, and crime related to alcohol use.
Consumption by college students causes approximately 2000 deaths per year.

Negative Impact of Alcohol

Fetal alcohol syndrome.
Alcohol is the second leading cause of premature death in America.
Approximately $176 billion is spent annually dealing with social and health problems related to alcohol use.

U.S. Alcohol Consumption

Gender differences: Males more likely to drink than females, and more likely to drink more
Drinking among college students
College students drink more than their nonstudent peers
Many campuses have banned sale and advertising of alcohol, and many fraternities have banned keg parties
Alcohol use and drinking behavior hasn’t changed significantly in response
Today’s college students are less likely to drink and drive compared to students in the early 1980s

How Serious Is
Alcohol Consumption?

Approximately 51% (129 million) of Americans are past month alcohol drinkers (also referred to as current drinkers).
Approximately 23% (58.1 million) of Americans binge drink and 6.9% (17.3 million) reported heavy drinking.

How Serious Is Alcohol Consumption?

Alcohol use (age 12 or older):
56.2% of whites
47.5% of persons reporting two or more races
43.3% of American Indians or Alaska Natives
43.2% of Hispanics
41.9% of blacks
37% of Asians

How Serious Is Alcohol Consumption? (continued)

Estimated spending for yearly healthcare services for alcohol problems and medical consequences of alcohol: $18.8 billion.
Alcohol is officially linked to at least half of all highway fatalities.
To date, alcohol has been tried by 38.9% of 8th graders, 58.3% of 10th graders, 78.9% of 12th graders, and 83.5% of college students.
An estimated yearly $82 billion was lost in potential productivity due to alcohol and other drug use.

Alcohol and Marijuana Use and the Very Young

Use of alcohol to the point of inebriation: 18% of 8th graders, 37% of 10th graders, and 55% of 12 graders.
Self-reported drunkenness 30 days prior to being surveyed: 5% of 8th, 14%, of 10th, and 30% of 12th graders.
On a daily basis for 8th, 10th, and 12th graders, marijuana usage now exceeds alcohol usage.
45% of all 12th graders reported some marijuana use in their lifetime (34% reported past year and 20% reported past month).

Current, Binge, and Heavy Alcohol Use, by Age: 2003

Fig

3.1

Age in Years

12-13

14-15

16-17

18-20

21-25

26-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65+

Percent Using in Past Month

4.5

17.0

31.8

51.5

67.8

61.7

59.2

59.5

58.6

57.7

54.0

52.9

46.2

34.4

Current Use

Heavy Alcohol Use

Binge Use

Current, Binge, and Heavy Alcohol Use among Persons Aged 12 to 20, by Gender: 2002 and 2003

Percent Using in Past Month

Total 12-20

Males 12-20

Females 12-20

6.2

6.1

8.1

4.2

7.9

4.3

28.8

29.0

29.6

28.0

29.9

28.1

Current Use

Heavy Alcohol Use

Binge Use

Heavy Alcohol Use, by College Attendance and Age: 2003

Fig

3.4

Enrolled Full Time in College

Not Enrolled Full Time in College

Graduated from College

Some College or Less

Aged 18 to 22

Aged 26 or Older

Percent Using in Past Month

Alcohol Use / College

Where do young people drink?
http://www.oas.samhsa.gov/2k8/location/underage.htm
From 2002 to 2005, an average of 5.2 million young adults aged 18 to 20 were enrolled full time in college each year. This represents 41.3 percent of young adults in this age range. Full-time college students included an average of 2.8 million women aged 18 to 20 (46.0 percent of women in this age group) and 2.4 million men aged 18 to 20 years (36.9 percent of men in this age group) each year. Over half of full-time college students aged 18 to 20 (58.2 percent) lived in the same household with a parent, grandparent, or parent-in-law, while 41.8 percent lived independently of a parental relative

Alcohol / Drug Patterns USA

OAS Home: Alcohol, tobacco & drug abuse and mental health data from SAMHSA, Office of Applied Studies

Substance Dependence or
Abuse among Persons Aged 12 or Older:
2002 and 2003

Fig

7.1

Numbers in Millions

3.2

3.1

22.0

21.6

Both Alcohol and Illicit Drug

Alcohol Only

Illicit DrugOnly

Culture and Alcohol (continued)

Culture provides how alcohol use is perceived (e.g., violation of norms, “normal” to drink, sexy, sophisticated, mature).
Cultural rules state how much one can drink and where one can drink.
Cultures provide ceremonial
meaning to alcohol use.
Drinking rates among Jews
Drinking rates among Irish
Culture provides a model of alcoholism.
Culture provides attitudes and stereo-

types regarding drinking behavior.

Alcohol Abuse Among College and University Students

CORE Institute (2006) research results:

Approximately 72% of college students consumed alcohol and 42% to 55% engaged in binge drinking within 30 days when survey was given.
College students consume an average of 5.4 alcoholic drinks per week.
Of all the drugs reported, alcohol was the most heavily abused on college campuses, followed by tobacco (44%) and marijuana (31%).

Alcohol Abuse Among College and University Students (continued)

Other studies found that …

The main reason given for binge drinking was “to get drunk.”
Males binge drink more than females.
For binge drinkers, the impact on impaired academic performance is just as great for women drinkers.
Being white, involved in athletics, or a resident of a fraternity or sorority made it more likely that a student would be a binge drinker.

Alcohol Abuse Among College and University Students

On U.S. campuses, alcohol is a factor in 40% of all academic problems and 28% of all dropouts.
Seventy-five percent of male students and 55% of female students involved in acquaintance rape had been drinking or using drugs.
The transition into college is associated

with a doubling of the percentages of

those who drink for both males

and females.

For heavier drinkers, grades suffered

for both male and female students.

Women and Alcohol

Women possess greater sensitivity to alcohol, have a greater likelihood of addiction, and develop alcohol-related health problems sooner than men (e.g., stomach cancer, cirrhosis of the liver).
More women in alcohol treatment come from sexually abusive homes (70%) in comparison to men (12%).

Women and Alcohol (continued)

Three major reasons why women are more sensitive to the effects of alcohol:

Body size (men generally larger than women)

Women absorb alcohol sooner—women possess more body fat and body fat does not dilute alcohol

Women possess less of a metabolizing enzyme—this enzyme gets rid of (processes out) alcohol

Women and Alcohol (continued)

Alcohol consumption patterns of women:
Women 21 to 34 years of age were least likely to report alcohol-related problems if they had stable marriages and were working full time.
Women tend to marry men whose drinking habits match their own.
Between 35 to 49 years of age, the heaviest drinkers were divorced or separated women without children.
Between 50 to 64 years of age, the heaviest drinkers were women whose husbands/partners drank heavily.
Women 65 and older comprised less than 10% of drinkers with drinking problems.

Dependence or Abuse of Specific Illicit Drugs among Persons Aged 12 or Older: 2003

Numbers (in Thousands) of Users with Dependence or Abuse

Need for and Receipt of Specialty Treatment for Illicit Drugs among Persons Aged 12 or Older:
2002 and 2003

Fig

7.8

Numbers in Millions Needing Treatment in Past Year

7.7

7.3

,  = Significant change 2002 to 2003



Need for and Receipt of Specialty Treatment for Alcohol or Illicit Drugs among Persons Aged
12 or Older: 2002 and 2003

Fig

7.8

Numbers in Millions Needing Treatment in Past Year

22.8

22.2

,  = Significant change 2002 to 2003



Rethinking Drinking

http://rethinkingdrinking.niaaa.nih.gov/

Rethinking Drinking - NIAAA

DUII 2008

http://oas.samhsa.gov/spotlight/Spotlight014DUIPatients.pdf

1.5 million DUI arrests
A person died every 38 minutes in alcohol involved car crash
Increases referrals to treatment

Driving Under the Influence of Alcohol among Persons Aged 12 or Older: 2002 and 2003

Percent Driving Under the

Influence of Alcohol in Past Year

,  = Significant change 2002 to 2003



Driving Under the Influence of Alcohol, by Age: 2003

Fig

3.6

Percent Driving Under the Influence in Past Year

Age in Years

16-17

18-20

21-25

26-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65+

Alcohol / Drug Patterns USA

OAS Home: Alcohol, tobacco & drug abuse and mental health data from SAMHSA, Office of Applied Studies

Driving Under the Influence

Alcohol-related and nonalcohol-related traffic crash fatalities for the United States

Figure 9.4 from text

Driving Under
the Influence

About one-third of all traffic crash fatalities are linked to alcohol use
Risk of a fatal crash is dose-related
Single-vehicle fatalities are more likely to involve alcohol than are multiple-vehicle fatalities
Alcohol-related fatalities: more likely to occur during dark hours and on weekends

Image source: Tomi/PhotoLink/Getty Images (Image Ch09_22DrunkDriving)

Image source: Library of Congress Prints and Photographs Division (Image Ch09_35WPADrunkDriving)

Driving Under the Influence

Men are more likely than women to be involved in an alcohol-related fatal crash
Anyone who drinks and drives is a potential threat, not just problem drinkers
Current efforts
Keep repeat offenders off the road
Publicize the dangers of drinking and driving
Target younger drinkers for special prevention efforts

Image source: S. Solum/PhotoLink/Getty Image (Image Ch09_23DWIEnforcement)

Defining Alcoholism

There is no agreement regarding at what specific point someone is an alcoholic.
Alcoholism is a state of physical and psychological addiction to a psychoactive substance known as ethanol.
Most definitions include chronic behavioral disorders, repeated drinking to the point of loss of control, health disorders, and difficulty functioning socially and economically.

Defining Alcoholism:
First Definition

World Health Organization (WHO) definition:

“Alcohol dependence syndrome
is characterized by a state, psychic
and usually also physical, resulting
from drinking alcohol. This state is
characterized by behavioral and
other responses that include a compulsion to take alcohol on a continuous or periodic basis to experience its psychic effects and sometimes to avoid the discomfort of its absence; tolerance may or may not be present” (NIAAA, 1980).

Defining Alcoholism:
Second Definition

“Alcoholism is a chronic behavioral disorder manifested by repeated drinking of alcoholic beverages in excess of the dietary and social uses of the community, and to an extent that interferes with the drinker’s health or his social or economic functioning” (Keller, 1958).

Defining Alcoholism:
Third Definition

“Alcoholism is a chronic, primary,
hereditary disease that progresses
from an early, physiological
susceptibility into an addiction
characterized by tolerance changes,
physiological dependence, and loss
of control over drinking.
Psychological symptoms are
secondary to the physiological
disease and not relevant to its onset’’
(Gold, 1991).

Major Known Components of Alcoholism

Craving: A compulsion to drink alcohol even during inappropriate times (e.g., while driving, working, at a formal event)
Very impaired or loss of control: Inability to limit drinking once begun
Physical dependence: Withdrawal symptoms when attempting to abstain (e.g., nausea, sweating, anxiety)
Tolerance: Need to increase usage to achieve the effect, the “buzz” from alcohol

Types of Alcoholics by Jellinek

Alpha alcoholics: Mostly a psychological dependence
Beta alcoholics: Mostly socially dependent on alcohol
Gamma alcoholics: Most severe; suffers from emotional and psychological impairment
Delta alcoholics: Constantly losing control over the amount of alcohol consumed
Epsilon alcoholics: Constantly binge drinking and at times days at a time
Zeta alcoholics: Moderate drinker who becomes abusive and violent

Types of Alcoholics by Moss et al.

Young Adult (31.5% of U.S. alcoholics): Young adult drinkers without major problems regarding their drinking
Young Antisocial (21% of U.S. alcoholics): Mid-20s, had earlier onset of regular drinking and alcohol problems, and come from heavy alcohol use families
Functional (19.5% of U.S. alcoholics): Middle-aged, well-educated, with stable jobs and families
Intermediate Familial (19% of U.S. alcoholics): Middle-aged, with 50% from families with multigenerational alcoholism
Chronic Severe (9% of U.S. alcoholics): Mostly middle-aged, high rates of antisocial personality disorder and criminality

Additional Facts Regarding Alcohol Use/Abuse

Drinking and driving: On most
weekend nights throughout the
United States, 70% of all fatal
single-vehicle crashes involve a
driver who is legally intoxicated.
Income/wealth: Less affluent
people drink less than more affluent individuals.
The average “alcoholic”: The largest percentage of alcoholics are secret or disguised drinkers who look very much like common working people.
On average: Most people who consume alcohol do not become problem drinkers.

Alcohol and the Family

Co-dependency (or co-alcoholism): A relationship pattern in which addicted or nonaddicted family members identify with the alcohol addict and deny the existence of alcohol consumption as a problem.
Enabling: Denial or making
up of excuses for the excessive

drinking of an alcohol addict to

whom someone is close.

Alcohol and the Family (continued)

Children of alcoholics (COAs) 2–4 times more likely to become alcoholics themselves.
Adult children of alcoholics (ACOAs) 2–4 times more likely to develop alcoholism.
Approximately, 9.7 million children age 17 or younger are living in households with one or more adults classified as having an alcohol abuse or dependence problem.
Seventy percent of these children were biological, foster, adopted, or stepchildren.
As a result, 6.8 million children, or about 15% of children aged 17 or younger, meet the formal definition of children of alcoholics.
COAs and ACOAs are more likely to marry into families where alcoholism is prevalent.
Twenty-five percent of American children are exposed to an alcoholic before the age of 18.

Helping the Family Recover

Psychodrama: A family therapy in which significant inter- and intra-personal issues are enacted in a focused setting using dramatic techniques.
Genogram: A family therapy technique that records information about behavior and relationships on a type of family tree to elucidate persistent patterns of dysfunctional behavior.
Role-playing: A therapeutic technique in which group members play assigned parts to elicit emotional actors.

Helping the Family Recover (continued)

Post-traumatic stress disorder: A psychiatric syndrome in which an individual who has been exposed to a traumatic event or situation experiences psychological stress that may manifest itself in a wide range of symptoms, including re-experiencing the trauma, numbing of general responsiveness, and hyper-arousal.

Resources

Ksir, C., Hart, C., Ray,O. Drugs, Society and Human Behavior, Twelfth Edition. McGraw Hill Publisher
Hanson,G., Venturelli,P., Fleckenstein, A. (2011) Drugs and Society, Eleventh Edition. Jones and Bartlett Publisher.
National Institute on Drug Abuse (NIDA) (2005), National Household Survey: Population Estimates. Available http://www.nih.gov/nida/Alcohol Abuse and Alcoholism
National Institute on Alcohol Abuse and Alcoholism, (NIAAA) National Institute of Health (NIH), U.S. Department of Health and Human Services (USDHHS) (2007). Surveillance Report, Available http://www.nih.gov/niaaa
Substance Abuse and Mental health Services Administration (SAMHSA) (2008) Overview of Findings from National Survey on Drug Use and Health, Office of Applied Studies (OAS) NSDUH

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30.0

35.0

200220032002200320022003

17.6

13.4

4.4

6.5

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20022003

158

169

189

321

378

435

1,424

1,515

4,198

05001,0001,5002,0002,5003,0003,5004,0004,500

Sedatives

Inhalants

Heroin

Hallucinogens

Stimulants

Tranquilizers

Pain Relievers

Cocaine

Marijuana

1.4

1.1

6.3

6.2

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

20022003

Did Not Receive Specialty Treatment

Received Specialty Treatment

2.3

1.9

20.5

20.3

0.0

5.0

10.0

15.0

20.0

25.0

20022003

Did Not Receive Specialty Treatment

Received Specialty Treatment

14.2

13.6

0.0

5.0

10.0

15.0

20022003

9.7

20.1

28.7

23.8

19.1

17.5

17.0

14.2

11.9

9.6

4.1

3.2

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0