Category: Alcoholism

Alcohol consumption is accepted by most people in our society. This is because of course it is legal, after the age of 21 here in the United States. More than half of the adults in the US consume alcohol. Alcohol is the most used psychoactive drug in the United States. It is becoming a norm for adults to eat their dinner every night with a cup of wine. There are many disagreements of whether alcoholism should be considered a disease. Maltzman stated some of the theories of the causes of alcoholism, they vary from genetic influences to personal choice (1). There are so many effects alcoholism has on the individual and most people are unaware. Although alcohol consumption is socially accepted, society is not aware of the effects of alcoholism.

Alcoholism is defined as “a compulsion to drink that leads to a breakdown in the victim’s ability to function” (Manzardo 33). Manzardo categorized the effects of alcoholism into three major groups: Psychological effects, Medical effects, and Social effects (35). Alcohol is made from ethanol. When ethanol enters the body, within minutes it is distributed throughout the body, through the bloodstream. The more the person drinks the higher the tolerance to alcohol. Tolerance can be defined as the either acute or chronic. Acute is easily developed, over the course of a couple hours of binge drinking. Chronic tolerance is defined by the ability to appear sober while having high levels of alcohol in the blood. Diamond and Messing stated that “Tolerance is caused by adaptive molecular changes in the brain” (280).

Some of the Psychological effects of alcoholism are self-deception, guilt, amnesia, anxiety and depression. Self-deception might be a little obvious to others except the person suffering from alcoholism. They are aware of the situation but cannot come to admit it is a problem. They believe that they are in control because they are the perpetrator not the victim of alcohol. Guilt is something they feel due to the constant reminders that they have a problem which they won’t admit to. Many have reminders like the constant fights with their spouses, or the inability to be an overall functional adult in society. Amnesia is the most common effect in almost anyone who is over drinking. When someone suffers from alcoholism, they have temporary memory loss anytime they are drinking. They don’t have the ability to drink moderately so instances of amnesia occur regularly. Anxiety and depression are almost always closely associated. It can almost be a trigger to drink and with a rewarding feeling. When you’re feeling down, you drink and feel good due to endorphins being released, but then it wears off. Alcohol is technically a depressent, it impedes the function of the Central Nervous System. Alcoholism changes the chemistry in your brain making the individual more predisposed to suffering from anxiety and depression.

Medical effects of Alcoholism are many. Some of the organs that are affected by alcoholism are the heart, stomach, liver, pancreas, and the brain. Additionally, to that there is also nerve fibers being damaged, impotence, and Alcohol Withdrawal Syndrome. The heart becomes weak over time of being exposed to chronic drinking. Eventually, it impacts how oxygen and nutrients are delivered to the vital organs. In the stomach alcoholism affects it over time with the development of gastritis. Gastritis as defined by Manzardo as the inflammation of the stomach lining (39). Ulcers are connected to heavy drinking as well; they may develop for other reasons as well, but they are highly linked to alcoholism as well. The liver might be the most well-known organ to be damaged due to high drinking. The liver is the organ responsible for breaking down alcohol and removing it from the blood. There are several diseases that affect the liver due to alcoholism, like Fatty Liver, Alcoholic Hepatitis, Cirrhosis and fibrosis. Fatty Liver, also known as Steatosis, is an accumulation of fat inside the liver cells. It affects a high amount of people suffering from alcoholism. Alcoholic Hepatitis is a little more complex because the illness is not always generated from alcoholism, it may occur to anyone. Alcoholic Hepatitis is the inflammation of the liver. Cirrhosis is when the individual becomes jaundiced. Inflammation of the liver cells occurs and causes them to eventually die out. Many of the effects of cirrhosis in men include breast growth, testes shrink, loss of baritone voice, loss of body and facial hair. The liver becomes smaller and unable to sustain life. Many of the liver issues from alcoholism lead to fibrosis of the liver, which is scarring. The Pancreas, which helps regulate blood sugar levels can also be affected by alcoholism. Manzardo stated that the “blood vessels around the Pancreas swell causing Pancreatitis” (39). Over time the individual is at risk for developing Diabetes type 2. Another essential organ affected by alcoholism is the Brain. There are two commonly known brain illness that occur due to chronic alcoholism. They aren’t as common as some of the other organ illness. Wernicke’s Encephalopathy and Korsakoffs Psychosis are illness’ that affect the brain function. Wernicke’s Encephalopathy is categorized by three major symptoms, ataxia, oculomotor abnormalities, and global confusion (Diamond and Messing 283). Ataxia is impaired balance and coordination. Oculomotor abnormalities is when the eye moves abnormally. Global confusion defined by the inability to pay attention, disorientation, and sleepiness. Wernicke’s Encephalopathy is caused by a long-time deficiency of Thiamine, a Vitamin B. Many times, it is left untreated and if it is there is a 10% to 20% mortality rate (Diamond and Messing 283). Korsakoff’s Psychosis goes hand in hand with Wernicke’s Encephalopathy, it occurs to most patients that survive Wernicke’s Encephalopathy. Korsakoff’s Psychosis is an amnestic disorder. Retrograde amnesia for recent memories but the long-term memory remains unaffected. Many times, disorientation occurs, they are unable to keep up with time and place. Anterograde Amnesia occurs, which is when they are unable to learn any new information. Another medical effect of alcoholism is Alcoholic Cerebellar Degeneration, doesn’t occur to all alcoholics, which is why many researchers suggest that it genetics play a role. Alcoholic Cerebellar Degeneration is characterized as Giat Ataxia, it is abnormal uncoordinated movements (Diamond and Messing 284). Alcoholic Dementia is one of the common side effects of the ethanol in the brain, it is due to loss if neurons and brain tissue. This primarily affects the frontal cortex of the brain. It may occur to anyone who is drinking more than they should, not only alcoholics. Central Pontine Myelinolysis (CPM) is uncommon and usually occurs to individuals going through Alcohol Withdrawal. The disorder is when there is a loss of myelin in the white matter of the cerebellum. Nerve fibers are damaged after a long exposure to alcoholism. Nerve fibers extend from the spinal cord to the muscles. They can degenerate and cause many of the illness’ affecting coordination. It is not physically due to the alcohol, it is due to a vitamin deficiency (Manzardo 40). Manzardo stated that “Overall brain damage in alcoholics occurs when there is a high deficiency of Thiamine which is a type of Vitamin B” (41). This may be prevented if Thiamine supplements are given with time. Impotence is very common in alcoholics, although they still experience sexual desire their performance is impaired. The reason is that alcohol suppresses testosterone in men production in men and estrogen production in women. This is more prominent in people suffering from alcoholism for a long period of time. If this occurs during adolescence the effect can be more severe. It can irreversibly affect hormone regulation. Manzardo also stated that “some alcoholics not only have trouble with sexual performance when drinking, but the problem persists long into sobriety” (42). Alcohol Withdrawal Syndrome is a temporary condition that last from two days to a week. The symptoms vary according to the length of time the person suffered from alcoholism and the amount they consumed regularly. The mildest symptoms are shakiness, a few hours after the last drink. The morning shakes occurs to everyone experiencing withdrawal. The hands start to shake throughout the day. Some individuals start to hallucinate. Some even have convulsions after one to three they stop drinking. The severe symptoms of withdrawal are when they experience delirium (Manzardo 43).

The Social effects of Alcoholism as explained by Iranpour and Nakhee “alcohol is a crucial risk factor for intentionally inflicted and unintentionally acquired injuries” (132). Alcoholism causes both emotional and physical problems on both the alcoholic and the society. There many affected by alcoholism “It has a huge impact on family life, employment, violence, and crime” (Korlakunta and Reddy 127). Many children of alcoholics grow up to have long term emotional problems. There are many failed marriages due to alcoholism. Overall, alcoholism affects innocent people when it comes to violence or accidents. Iranpour and Nakhee stated “According to a 2016 WHO report, interpersonal violence induced by alcohol consumption causes 90,000 deaths every year” (132). Suicide is highly associated with alcoholism. 1 out of 4 suicides in the US is an alcoholic (Manzardo 46). There are an estimated 20,000 automobile deaths a year that are alcohol related. This accounts for 40% of all traffic fatalities (Manzardo 46).

Although society deems drinking alcohol as normal. The country has to be educated on the full effects of alcoholism. Due to the nature of alcohol it is easily something that can become an addiction. Many innocent people, especially children are affected by alcoholism. The effects that alcohol has on the society are major and should be taken less lightly because it is a legal substance.

The tone of a social setting is often set by the alcohol which is consumed. Participants can use its significance to “manipulat[e]…cultural systems, values…and expectations”(‘Social and Cultural Aspects of Drinking’). Early on in North America’s colonial history, traders used alcohol to acquire “sought-after skins and other resources” from Indigenous people (Beauvais 1998 253). Note the terms Aboriginal and Indigenous, here, this vocabulary specifically addresses First Nations people affected by the Indian Act and colonization. This does not always include Métis or Inuit people. Their relationships to the matters relevant to this paper warrant further exploration which, for lack of space, will not happen here. The rapid distribution of distilled spirits and wine set the stage for Indigenous and White relations for the following centuries. Introduction to Western culture through trading and drinking of high-proof spirits with frontiersmen normalized alcoholism among trading colonies (McPherson & Wakefield 174). Canada later viewed First Nations adopted consumption habits as Aboriginal inability to participate in Canadian economic growth, which engendered a paternalistic mindset over the course of colonization (Joseph 2018 43; King 2018 91). Canada would later legislatively perpetuate such paternalism through the Indian Act amendments of 1884. This mindset still affects First Nations and Non-Indigenous relations. To understand Aboriginal peoples’ contemporary struggles with alcohol and stereotypes imposed upon them, one must look at Canada’s history of consumption and distribution of alcohol. Establishing the root cause of the issue at hand can mend First Nations and Non-Indigenous relations in this country.

Scattered Indigenous communities in pre-contact North America practiced some consumption of alcohol, usually in the form of fermented corn or cactus beverages. This was typically associated with spiritual rituals or took place in specific ceremonial settings. These drinks would have had a low alcohol content (Frank, Moore, & Ames 2000 347-348). The social context in which one consumes alcohol creates associations with what, how, and how much one is to drink (‘Social and Cultural Aspects of Drinking’). The social customs of Indigeous communities were not prepared for the norms that were to be introduced with colonization. Contact brought with it European traders to acquire sought after raw materials. Beauvais notes that frontiersmen quickly caught on to the trading abilities of their European high-proof brandies and wines and began trading these beverages for pelts (1998 253). “Traders also found that providing free alcohol during trading sessions gave them a distinct advantage in their negotiations.” (Beauvais 1998 253). This would be many Indigenous communities introduction to alcohol or its consumption in high volumes within a casual setting. These communities were simultaneously introduced to the grim of Europe’s social class: the antisocial trader (Frank, Moore, & Ames 2000 348).

“New World governments were unable to enforce sensible alcohol control policies… in frontier settings that were far from legislative centers. We suggest that these lawless edges of the new societies provided for intense role modeling of antisocial alcohol use” (Frank, Moore, & Ames 2000 348)

These were men away from their families, culture, and country and its code of laws. With nothing holding them to the established etiquette of consumption of their society across the ocean, many of the men sent to North America committed unsavory acts with little to no repercussions (Frank, Moore, & Ames 2000 348). North America began seeing many Indigenous communities plagued by lewd acts committed under the influence of alcohol that could not have been permissible without its introduction (Frank, Moore, & Ames 2000 348).

“Numerous historical accounts describe extremely violent bouts of drinking among Indian tribes during trading sessions and on other occasions, but at least as many accounts exist of similar behavior among the colonizing traders, military personnel, and civilians (Smart and Ogborne 1996). History may have therefore sown the seeds for the prevalence of alcohol abuse in North American indigenous populations. Early demand, with no regulation and strong encouragement, may have contributed to a “tradition” of heavy alcohol use passed down from generation to generation, which has led to the current high level of alcohol-related problems.”(Beauvais 1998 253)

This “tradition” as Beauvais puts it was later seen by Canadian legislative assemblies to impede the assimilation of First Nations into the country’s economic practices, such as farming (Joseph 2018 43).

The learned alcoholism of these Aboriginal communities was one of many tools which colonial powers used to adopt a paternalistic control of Indigenous people. A term coined by Rudyard Kipling best encapsulates this mindset as the “White Man’s Burden,” that is: “To serve your captives’ need/…/ Your new-caught, sullen peoples,/ Half devil and half child” (Kipling; emphasis added). Canada took on Kipling’s “Burden” with its colonial hold over the “new-caught sullen” First Nations. The prohibition of sales of alcohol to Indigenous people was a performance of this paternal restraint. Note the following passage from an Indian Act amendment in 1884: “Every one who… on any pretense or by any device, (a) sells, barters, supplies or gives to any Indian or non-treaty Indian, or to any person male or female who is reputed to belong to a particular band, or who follows the Indian mode of life, or any child of such person any intoxicant ….shall… be liable to imprisonment”(“Indian Act” 1884)

The logic behind the government’s prohibition of alcohol sales to Indigenous people was protection of First Nations from themselves and the temptation of alcohol, as well as Canadians to not “rub elbows” with Aboriginals at drinking establishments (Joseph 2018 43). This line of reasoning subscribes to the condescending paternalism of the White man’s burden, to protect the nation’s Indigenous “child” from the “devil” which possessed the inebriated, rendering them both “[h]alf devil and half child” (Kipling; Frank, Moore, & Ames 2000 346). Prohibition laws often target the symptoms of an issue, rather than the issue itself. Alcohol consumption was not addressed. The frontiersmen influenced and subsequently intergenerational pattern of alcohol abuse remained. Prohibition only drove Indigenous people away from safe drinking establishments, and deprived them the privilege of consumption in healthy moderation (Joseph 2018 43). As civil rights progressed, more Canadians recognized these laws as oppressive.

The 1884 amendment to the Indian Act which prohibited the sale of alcohol to First Nations was contested after the Second World War. This pushback began when Canadian soldiers returned home from their military service, only to find that their Indigenous brothers-in-arms were forbidden entrance to Canadian legions. These legions provided veterans information on the benefits they had access to, as well as moral support for emotional turmoil, and what we now know as post-traumatic stress disorder. This inaccessibility of privileges to Indigenous veterans was mentioned in the Royal Commision on Aboriginal People and presented to the Canadian Government. Between 1946 and 1948 the Committee of the Senate and the House of Commons began to investigate the effects of the Indian Act. Rather than revoke the 1884 amendment following this legal pushback, the Canadian government went on to revise the amendment, criminalizing all Indigenous people found in possession of intoxicants or under their influence in 1951(Joseph 2018 43-45). Because Canada knew that “the more the oppressed can be led to adapt to that situation, the more easily they can be dominated”(Freire 74). Affirming that the government’s ultimate goal for Indigenous people was assimilation through legislation.

The Indian Act was also responsponsible for the creation of residential schools which forced Indigenous children to attend a government regulated “boarding school” up to the age of eighteen (“Indian Act” 1884). This school system followed the mandate to “Kill the Indian in the child”(Truth and Reconciliation Commission of Canada, 2015). Some survivors of the residential school system turned to alcohol to forget the atrocities committed at these institutions. The use of alcohol as a coping mechanism was inadvertently inherited by later generations, and is still seen on reservations today. As explained by Bob Joseph, many communities recognize the issues of alcoholism they face, but are on the “healing” process of overcoming such adversities (2018 47). Despite working to solve the issue of alcohol consumption on reserves, many Aboriginal people still face descrimination from Canadian citizens. Although heavy drinking affects nearly 20% of all Canadians, First Nations are overrepresented as alcoholics, because, as Thomas King points out “they [non-Indigenous people] get to make their mistakes as individuals and not as representatives of an entire race” (Statistics Canada 2017; 2018 187). The key to fighting these racist stereotypes is through education on this subject. As stated by critical pedagogue Henry Giroux: “education produces the modes of literacy, critique, sense of social responsibility, and civic courage necessary to imbue young people with the knowledge and skills needed to enable them to be engaged critical citizens willing to fight for a sustainable and just society”(Giroux 2013)

The contemporary issue of alcoholism in First Nations communities is a multifaceted issue that cannot be dissected without proper consideration and education of Canada’s colonial past and present.

Distilled Alcohols and wines were introduced to Indigenous people living in North America by colonial settlers, imposing their way of life on the First Nations. Following the implementation of alcoholic and antisocial behaviors on the Aboriginal populations by the frontiersmen of Canada, the government was able to enact strict discriminatory laws to hold power over their subjects. Although Canadians have become increasingly aware of civil rights over the last decade, society has been unable to overcome their miseducation of First Nations issues. This delayed education on these matters perpetuates racially motivated stereotypes against Indigenous people. The effects of Canada’s history of colonization is seen in various parts of its past not covered in this paper for lack of space. Current issues involve missing and murdered aboriginal women, the ongoing reconciliation efforts, the acceptance of the reservation school system as a cultural genocide, and the construction of pipelines through reservation lands, to name a few. Piece by piece Canadians are building a better relationship with the First Nations communities whose lands they currently inhabit.

Alcoholism is very prevalent in today’s society. It has actually been prevalent for much longer, but now with more laws and research surrounding it, there are more reasons than ever to be concerned about alcoholism. Many people believe that alcohol should be used to have fun and be more social, but there is a large group of people that alcohol affects every aspect of their lives. I wanted to research alcohol addiction because I am concerned about how many people that I know may develop it over their lifetime. What may start as drinking with friends on weekends may turn into years and years of dependence on alcohol. I assume that the majority of people will not become dependent on alcohol because of cost, risks, and many other issues, however, there is a smaller group that may be overwhelmed by the stresses of life and will turn to alcohol to cope with issues. Another reason why I wanted to research alcoholism is to know how it affects crime rates. I think that a lot of crime is alcohol related, as alcohol consumption can lead to a lack of thinking and poor choices. Many people may have not committed their crimes if it wasn’t for them being intoxicated. The last reason I chose to research alcoholism is to learn more about the health effects associated with it. Does alcoholism make your likelihood of getting cancer or diseases higher? How common is liver failure in alcoholics? These questions are what brought me to researching alcohol addiction.

Methods

When starting my research, I figured that the best place to find information would be databases. This is because many of the articles on online databases contain numerical statistics to backup their statements. The articles that I eventually chose were ones that fitted all of my qualifications. All of the articles I chose were factual, didn’t factor in opinions, had sources for their information, and many were peer reviewed by people that are professionals in the field of alcohol addiction. For the most part, finding information was easy. However, many of the articles I found were spouting out the same information. This made it challenging to find facts that were more than surface level details. My interview with Steve Brownrigg did not prove to be very useful. Many of his responses to questions were very similar to information that was easily found online. Even when asked specific questions, he gave vague responses that were not useful to furthering my research. Nevertheless, I was able to gather enough information to become knowledgeable on how alcohol affects people’s lives.

Results

There are many health effects that come along with consuming alcohol. This doesn’t mean that any amount of alcohol is going to cause problems with the function of your body. The problems arise when alcohol is consumed regularly over a period of time, or a large amount is consumed at once. For the people that abuse alcohol regularly, their bodies might react poorly to not having alcohol. People who suffer from alcoholism may be affected by involuntary shaking or cravings for alcohol (Gale). When alcohol is consumed regularly over a long period of time, a person is more likely to get several different types of cancer such as; mouth cancer, throat cancer, colon cancer, and liver cancer (Gale). Another effect of alcoholism is that a person may want to quit drinking but is unable to because of their body being physically dependent on it, rather than emotionally or psychologically (Gale). The health effects are not limited to what alcohol can do to a person’s body. Many injuries occur while under the influence. More than half of trauma patients that had a positive blood alcohol level (BAC) are diagnosed as alcoholics (BJS).

Alcohol can also affect how families function. Alcohol can cause a lot of problems between spouses, siblings, and children. About 60 to 70 percent of physical altercations between spouses involved alcohol (AAC). Drinking can also put a strain on the financial aspect of a person’s life. Not only does the alcohol cost money, but being intoxicated makes people more likely to impulsively purchase things that they wouldn’t have otherwise (AAC). In many cases, drinking also causes poor performance at work, which could lead to an early termination. About 80 percent of children who are abused by parents and siblings are raised in families that contain alcoholics (AAC). Children in alcoholic families are also more likely to become alcoholics in their later years (AAC). Another problem that comes with alcoholism in families is the lack of expressiveness, independence, and emotional bonding (AAC). A lack of emotional bonding can lead to people expressing the same thing to their family and children later in life.

As most people know, alcohol can lead to poor judgement and decision making. About 36 percent of all crimes committed happen when the offender is under the influence of alcohol (BJS). Many people assume that DUIs are uncommon and not a very large percentage of drivers have been convicted of driving under the influence. However, in 1996 there were over 1.4 million arrests made across the United States for driving under the influence (BJS). Alcohol also accounted for about 40 percent of all traffic fatalities in 1996. In fact, there is 1 intoxicated driver involved in a fatal crash for every 17,200 drivers. To put this in perspective, Omaha will have about 30 intoxicated drivers every year that are involved in a fatal car crash. Alcohol doesn’t only lead to problems on the streets. According to the Bureau of Justice Statistics, 41 percent of all violent crimes happen when the offender is under the influence of alcohol. Of that 41 percent, 20 percent of those crimes are committed with weapons other than hands and fists. Alcohol is a large factor to the amount of crime in the United States.

While many people are affected by alcoholism, there are some groups that are more liable to developing the problem. People who grow up in families with alcoholics are often encouraged to participate from a young age. On the other hand, people who are strongly religious are less likely to be alcoholics. An interesting fact is that the more education a person has, the more likely they are to experience a problem with alcohol (Elkins). Alcohol use in teenage years also makes a person more likely to develop AUD (Elkins). As a general rule, where alcohol use is acceptable, abuse disorders are more likely to occur. People’s environments play a major factor in developing this condition.

Discussion

After doing research on how alcoholism affects people’s lives, I feel much more knowledgeable in the subject. Even though I am nowhere near an expert in the subject, I have a good start to being able to learn more. I am more interested in the crime aspect of the subject, but the other aspects seemed like common knowledge to me. For the most part, it wasn’t very engaging and didn’t offer many different viewpoints. The criminal aspect was very interesting because I didn’t know how much alcohol really affects crime rates. The best part of the project was finishing the research because it made everything else a breeze. Having all the information laid out in front of me made compiling paragraphs simple. The most interesting thing to me was how much alcohol affects crime. It made me wonder if alcohol was outlawed, would crime rates be lower, or would it shift to different types of crime as what happened in the prohibition era. More common crimes such as stealing and violent crimes shifted into criminal organizations and illegal production and sales of alcohol.

Summary

Alcoholism affects every aspect of a person’s life. From family to financial, it has the ability to cause problems as well as make crime more prevalent in their life. People need to know how alcohol may affect their lives because if they don’t, they may fall into the same trap that so many others have already. Living with alcohol addiction is not living. It is going from day to day causing problems for others and putting yourself in danger. I believe that research needs to be done to give people living with alcoholism an easier way to quit. Maybe there could be a new drug or counseling practice that relieves the stresses of ditching alcohol. If I were to research this topic again, I would focus on how alcohol affects crime. Crime is the most important aspect of this topic because it affects not just the person living with alcoholism. It has the ability to take people’s lives and scar family and friends for life.

For many years, Native Americans have encompassed a negative pool of stereotypes; one of these negative stereotypes is the attachment to the term “alcoholics”. In today’s society, the propaganda, that “all Native Americans” are being insensitively addicted to alcohol, is extremely offensive; this is because it stigmatizes an unfortunate disease some members, within their culture, face. Members of this discourse community whom are authors are commonly attracted to this method (of exposing reality). For instance, Sherman Alexie — a prominent Native American author – puts an aggressive highlight on alcoholism within the Native American community; this meaning he constantly brings up harmful rhetoric to attack his own community. In his novel, The Absolutely True Diary of a Part-Time Indian, written by Alexie, his characters all seem to be alcoholics. Within the text Alexie uses Arnold’s (the main character who voices the novel) close relationships with his immediate family to show the negative impacts of alcohol. Everyone Arnold has ever loved eventually gets affected, or dies; because of the effects alcohol has on the characters. Arnold’s repetitive sarcastic comments, about alcohol, generalize the image all Native Americans; further, Alexie’s writing adds to the continuation of negative stereotypes encircling his own marginalized community. This harms the novel by strengthening the normalcy of these negative (and societal) stereotypes while inadvertently allowing a general/improper viewpoint – about the Native American culture – to be passed onto non-Native American readers (Kern 3).

From the start of the novel, we see Arnold struggling for a better life — one that is away from his [alcoholic] community. As he struggles, it is evident that he is perpetually stuck – he continually battles to keep a close relationship with everyone he loves (Alexie, 1). Despite his father’s alcohol addiction, once Arnold leaves the reservation, he witnesses firsthand how alcoholism has ruined his loved one’s and his people. He is disappointed [and angered] about how many lives were taken away by alcohol. In fact, the subject begins to dominant to Arnold’s mind; this can be seen when he comments,“ I know only, like five Indians in our whole tribe who have never drunk alcohol” (158). He labels the majority of the tribe as being “alcoholics”; this imposes inherent normality to the portrayal of Native American culture – and their behaviors, this toxic portrayal fathers negative stereotypes about their culture as well. Moreover, one may see that the main character carried only a single perspective to frame the negative situation he is in. This lens allowed him to understand the implications of alcohol, as well.

The consequences of alcoholism are typically seen with his relationship with his father. He continuously forgives his father and excusing his faults; this action proves the love Arnold has for his father. Despite his father’s addiction, he wants to see the better in him. However, his thoughts, towards, his father, begin to shift during Christmas-time. He explains, “ When the holidays rolled around, we didn’t have any money for presents, so Dad did what he always does when we don’t have enough money. He took what little money we did have and ran away to get drunk” (150). Arnold’s anger does not last long when his father gives him his Christmas present – it is a five-dollar bill. Arnold comments, “Drunk for a week, my father must have really wanted to spend those last five dollars. He could have spent that five bucks and stayed drunk for another day or two. But he saved it for me” (151). Rather then rejecting it, he accepts it with open hands and immediately understands his fathers love and sacrifice (“Alcoholism”). His father is not the only loved one who carries the impact of alcohol on their shoulder.

In addition to his father’s addiction, several of Arnold’s loved ones die due to alcohol. His idolized grandma passes away because of an accident by a drunk Native American driver. This event results in Arnold’s greatest emotional defeat. His grandmother was the person that kept him on the edge of hope, for his people on the reservation. She is Arnold’s favorite person in the world, a wise woman and a role model to Arnold. His grandma was one of the many of the Indians that did not drink (and was not portrayed in a negative tone) throughout the novel; this made her a great source for advice (Jill D 02:56). Arnold emphasizes the rarity of his Grandmother’s character through sarcastically stating, “ that’s the rarest kind of Indian I know”(158). This comment is making a bold statement – it displays Native Americans as [excessive drinkers], at large. Her death makes him irritated and unable to cope with the fact that she died – especially in relation to alcohol. He explains, “ Grandparents are supposed to die first, but they’re supposed to die of old age. They’re supposed to die of a heart or stoke or cancer of Alzheimer’s THEY ARE NOT SUPPOSED TO GET RUN OVER AND KILLED BY A DRUNK DRIVER”(158). Instead of holding in the resentment of the action – he blames those on the reservation (and his culture). This motivates him to leave the reserve and to turn back on his own identity; this event cements the idea that alcoholism will forever be attracted to his people. The death of his grandmother is not the only event that emotionally hurts him.

As one progresses through the text, they can see that Arnold also struggles with his sister’s death, Mary. Arnold’s father explains to him the details of his sisters death (205). Arnold angrily comments, OF COURSE THEY HAD A BIG PARTY! OF COURSE THEY WERE DRUNK! THEYRE INDIANS!” (205). Her death allows him to find another way to group Native Americans into one mistaken category: alcoholics. Arnold’s anger did not allow for his fathers comfort to alter his attitudes towards the situation; he asserts, “My dad was trying to comfort me. But it’s not too comforting to learn that your sister was TOO FREAKING DRUNK to feel any pain when she BURNED TO DEATH” (205). In this situation, he’s upset; he clearly felt his sister doesn’t deserve to die in this way. Arnold really looks up to her, and admires her dreams/passions about romantic novels (26). She inspires him to leave the reservation behind (similar to herself). This event, along with the passing of his loved ones truly dispersed Arnold in to a world of misery. He feels unhappy, incomplete and believes that everything that causes him unhappiness is in relation to alcohol. When he leaves the reservation, to attend his new school, he reads a book and argues that, “ unhappy families are all alike; every unhappy family is unhappy in its own way.” He continues, “Well I hate to argue with a Russian genius, but Tolstoy didn’t know Indians. He didn’t know know that all Indian families are unhappy for the same exact reason: the fricking booze” (200). This statement allows for an open door of assumption about Native American culture; additionally, it harms the true nature of their culture. Reading this work can distort the Native American culture as whole.

However, some readers may find issue with the idea that the novel is an attack (or slander) on Native Americans. They may argue that Alexie’s uses of his main character; Arnold is to break stereotypes of Native American (specifically regarding their ethnic background being synonymous with being “alcoholics.” This out look on the novel – however – is incorrect. While the protagonist (Arnold) is not an alcoholic, the rest of the characters are alcoholic; there is no balancing act (of this unfortunate stereotype) within the novel. Specifically, the ratio of having only one character shadow the majority of native American character (whom are alcoholics) – is ignored in a wrongful view. The negative impact – of having a majority of Native American characters be alcoholics — outweighs any positive idea (of social progression) within the story. One character is not enough to deconstruct the stereotypical “Indian.” Instead, the text leaves one with the impression that Native Americans are incapable of having a positive image; this ideology can be damaging for uneducated individuals (on Native American society). This meaning, it directly paints an inappropriate image of the Native American culture by portraying most Native Americans as alcoholics. In addition, Alexie proposes no solution to the problem of alcoholism within the Native American society. The only resolution that is given is the act of “escaping” the reservation; this means leaving his best friend and family behind (Kern 17). In addition to displaying Native Americans as alcoholics, he matches this negative (and unfortunate stereotype) with a barrage of sarcastic comments.

Within the text, despite all the heartaches, and the painful regularity of deaths Arnold endures, he as able to surpass all his problems; this occurs through the realization of hatred within himself. This is the eventual cause and drive for his decision to flee the reservation. Primarily, one could argue that this is caused from his surrounding environment; this being, his family attachment onto a web of alcohol. This leaves the reader such to facing an unfortunate stigma. Moreover, it puts Arnold in a tough position (of endlessly forgiving his fathers bad faults, his sisters passing, and his grandmothers’ passing – due to alcohol). The cryptic nature of alcohol, shown within Arnold’s relationships, empathizes a problematic issue; it allows for a negative impression of Native American culture to grow. This stereotype is extremely harmful for readers who are not familiar with Native American culture. Alexie, as the author, uses his voice to display the negative aspects of Native American culture within his novel. Since his work is famous (and commonly distributed in schools around the world), his negative message carries even more weight – it is a tool used to convey culture. Instead of providing a comprehensive and diverse text to uneducated individuals – about this culture, he chooses a rather harsh approach; this is he generalizes Native Americans into one category: alcoholics.

There are differences in the prevalence of alcoholism all over the world. Although I will be discussing the differences between the United States, France and Canada. Alcoholism is a humongous problem in all three states. Also, there are different ways how people cope with alcoholism. Plus, the rates have increased over the years of alcoholism. The way the brain is generated alcohol can very much cause brain injuries. The damage on the brain can change a person’s life. Also, affecting the way their path of life is heading. Even though these states have similarities of how alcoholism is started. It is how the government enforces the laws and that is what it makes them different. Also, how hard the government is being strict on the issues. With alcoholism, it is very different actions and signs an individual will show when they are impaired.

In the United States the laws of alcohol are very strict when it comes to the age of purchasing or even consuming alcohol. The United Sates also has a high rate of poverty, so alcohol is a huge coping mechanism for that. “The United states also require the display of health warnings posters at places were alcohol is sold” (Sharma). That is simply because, the companies want their customers to be aware what risks their taking. Even though in individuals minds they do not care, it is all about the taste. In addition, to individuals in the United States who get attached to alcohol usually tend to ignore their health. The United States is ranked as number twenty-one for alcohol consumption. The alcoholics is in the age group of eighteen through twenty-four. The percentage is eighty-six-point four percent. Plus, there are new laws that regulate and appear to be affected in the law enforcement to help with decreasing alcoholism.

In France, alcoholism is “very different from the American alcoholics… to comprehend the different elements of the idea of contagion in contrast of medical definitions of a contagious disease” (Fainzang). While in France, the laws have finally changed a little. The age to buy alcohol was sixteen years old, now it is eighteen. That is very different, because children should not be consuming alcohol as a teenager. Also, the consumption was mostly wine for adults and hard liquor and beer for teens. Teens drunk the hard liquor and beer just to be cool. So, they tend to think alcoholism is no big deal. France is ranked as number three as the highest state to consume alcohol. The alcoholics age group is fifteen years old and older. The population is around eighty three percent.

In Canada, although “there are similar levels of alcohol and non-medical prescription opioid use, poisoning deaths have markedly increased” (Imtaiz). Canada is ranked as number twenty-five for their alcohol consumption. The legal drinking age happens to be nineteen, except in some areas in Canada where it is eighteen. In Canada surveys have been taken to see how many people alcoholics. Also, Canada tried to put more polices and regulations on pricing and taxing alcohol. To help reduce the impact of the youth from alcoholism. Plus, consuming alcohol is mostly for casualness in Canada. Most people just drink for social reasons, to fit in and they get attached. Studies show that, Canadians drink a little bit more of the average limit of alcohol. The alcoholic age group is twelve years old and older. The percentage is approximately nineteen-point one percent. That is because the youth is exposed to the alcohol at such a young age. Also, they think that it is a good thing. Which it is not, because the younger they are the more addicted they get. Most teens get pressured into drinking and later become an alcoholic. The common difference in all three states are the thought of why individuals want their next drink ,

References

1. Fainzang, Sylvie. “Alcoholism, a Contagious Disease. A Contribution towards an Anthropological Definition Of..” Culture, Medicine & Psychiatry, vol. 20, no. 4, Dec. 1996, p. 473. EBSCOhost, doi:10.1007/BF00117088.
2. Imtiaz, Sameer, et al. “Substance Use and Population Life Expectancy in the USA: Interactions with Health Inequalities and Implications for Policy.” Drug & Alcohol Review, vol. 37, Apr. 2018, pp. S263–S267. EBSCOhost, doi:10.1111/dar.12616.
3. Sharma, Manoj. “Role of Labeling in Prevention of Alcohol Abuse.” Journal of Alcohol & Drug Education, vol. 53, no. 3, Dec. 2009, pp. 3–6. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=pbh&AN=48003268&site=ehost-live.

“Drinking has been thoroughly integrated into mainstream culture today” (Thombs and Osborn, 2013, pp230). They execute that drinking alcohol has become an expected behaviour of social interactions and that if you were to be asked to “go for a drink”, then alcohol consumption is expected. However, it is important to discuss if this legal drug is abused and used without limits, it can have a detrimental effect on the lives of young people. As supported by the Advisory Council of Misuse and drugs (ACMD, 2019) who advise that excessive and inappropriate use of alcohol can result physical, social, legal and psychological issues.

It is useful initially to consider the effects of alcohol on an individual’s functioning. Short-term effects of alcohol on the body can start with, increased heart rate and the expansion of blood vessels, giving a warm, talkative and sociable feeling associated with moderate drinking, which would highly appeal in social situations for young people. After more units of alcohol the body experiences slower reaction times, poor judgements and decision making due to the effects of alcohol on the nervous system, slurred speech and blurred vision. This is due to the incapability of the liver to filter units of alcohol from the body quick enough. More units would affect coordination, putting an individual at risk of an accident. More than 12 units of alcohol can occur alcohol poisoning, this is when someone’s breathing, heart rate and gag reflex can be interfered with. Alcohol poisoning can cause a person to fall into a coma and could lead to their death. However, more severe long-term effects of excessive alcohol can result in high blood pressure, stroke, pancreatitis, liver disease, liver cancer, mouth cancer, head and neck cancer, breast cancer, bowel cancer, depression, dementia, sexual problems, such as impotence or premature ejaculation and infertility (The National Health Service, NHS, 2019). Also, Drinking is more harmful to adolescents as their brains are still developing and a lot of alcohol consumption in this critical growth period can lead to lifelong damage in brain function, particularly as it relates to memory, motor skills and coordination, (Marshall, 2014). Furthermore, these are just the physical repercussions of alcoholism; The NHS (2019) also discusses the short term social issues of an increase in violence and antisocial behaviour, loss of personal possessions, unsafe sex, unplanned time off work or studies. As well as long-term social repercussions of alcohol abuse such as domestic abuse, unemployment, family break-up and divorce and financial problems.

Initially, it is useful to understand why the misuse of alcohol within young people takes place. Socio-cultural models execute a key understanding of where alcoholism can originate from. Theories such as these consider the environmental influence on the individual, and the progression from an experimental user, to a recreational user, to ultimately a dependant user of alcohol. ‘Structural functionalism’ in relation to drug and alcohol abuse, suggests that this is a result of an individual conforming to rules and discourses of a social group. Heath (1988) suggests that within mainstreaming of sociodemographic groups, drug use and alcoholism ultimately promote solidarity and cohesion within social groups and cultures. This is supported by Thombs and Combs (2014, p239), “individuals will get intentionally ‘wasted, smashed, totalled or bombed’ because this type of behaviour is part of a ritual that is essential to group solidarity.” It is discussed that individuals will go to exceptional lengths to fit in and abide by social norms of a group situation, no matter how it affects their health.

However, ‘symbolic interactionism’ focuses more on someone’s intrinsic motivations of drug and alcohol use, in order to “make meaning in their own lives, derive meaning from them & attribute meaning to them” (Heir, 2005:87). This theory suggests that people use alcohol to create more significance and meaning within their lives. For example, Stephens (1991) argued that individuals use drugs, at least initially, because they receive recognition, validation & status from doing so. Similarly, Nugent and McNeill (2017) put forward the view that if youth feel excluded, for example if they they don’t belong in a specific social group, then drug and alcohol may become a form of community, status and security in otherwise very bleak circumstances. Additionally, Thombs and Osborn, (2013) discuss how the “time-out hypothesis” (p230) is an explanation of how young people use intoxicants as a means of escaping their social obligations, such as parents, studies or employment. As supported by MacAndrew and Edgerton (1969) as they observed that cultures are lenient and flexible in their expectations of norms and role obligations during drunkenness, asthough there is a level of expectation within cultures to behave this way. Stephens (1991) highlights that validation, recognition, status and meaning within social groups all originated from the ways that young people were able to ignore dangers and stand up to a challenge of potential dangers of substance use.

However, in contrast to this, the ‘normalisation theory’ suggests that young people misuse use substances as a means of pleasure, excitement and enjoyment that reside within leisure-searching lifestyles. However, it is key to understand that in majority of circumstances, there is interplay between all three models and drug and alcohol use should be understood in terms of coactions between structure and agency. It is evident that within youth and student cultures, excessive and extreme drinking have become an current issue within society, (Martinic & Measham, 2008). Pre-partying or ‘pre-drinking’ has been defined by Pederson & Labrie (2007) as, consumption of alcohol prior to attending a pre-planned event. Jayne et al (2016) also suggest that when interviewing young people, alcohol was an imperative part to a successful night out, and they would use ‘drinking games’ to accelerate alcohol consumption. Furthermore, not only does Zamboanga et al (2015) suggest that excessive drinking poses increased health risks, but a study by Borsari et al. (2013) found that young people that participated in excessive drinking and drinking games often find that due to lower inhibitions, they engaged in unplanned sexual activity, resulting in ‘sexual regret’.

Alcohol is the world’s third greatest instigator for disease and creates 4% of the global concern of health risks (Rehm et al., 2009). It is predicted that 2.5 million deaths annually a consequence of alcoholism, and 9% of deaths between 15- to 29-year olds are alcohol-related (WHO, 2011). Furthermore, a young person’s brain, primarily the hippocampus, may be particularly exposed to the effects of alcohol (Welch et al., 2013), therefore predisposing the young drinker to alcohol, mental health and neuro-cognitive problems which can perseverate into adulthood. Also, alcoholism, and particularly binge drinking, is associated with sleep disorders (Popovivi and French, 2013). Additionally, regular alcohol use, binge drinking and other high risk behaviours such as substance abuse, smoking and risky sexual activity develop in young people and all of these behaviours are relative to one another (Wiefferink et al., 2006). This is supported by McCambridge et al. (2011) that found a link between early alcohol use in young people, later dependence in adulthood and an association with mental health issues and social harms. Furthermore, Young people that drink alcohol before 15 year old are considered to be four times more likely to meet criteria for alcohol dependence, (Grant and Dawson, 1997). This is supported by the 2011 European School Survey Project on Alcohol and Other Drugs (ESPAD) was carried out in 37 countries (Hibell et al., 2012). The target age for the study was 15 years of age. The study found that 79% of students had consumed alcohol at least once in the past 12 months and 57% had consumed alcohol in the past 30 days. Therefore, the negative effects of alcohol on young people overall are undeniable.

Moreover, it is therefore important to consider the link between alcoholism, parental control and a young person’s home setting as perhaps a rooted issue within society. (Bremner et al., 2011) found that lower levels of parental guidance and supervision influenced excessive drinking in their adolescent children. They also found that children that are exposed to a family member that regularly becomes intoxicated and makes alcohol accessible, are more likely to have a positive attitude towards drinking alcohol. This is supported by Young et al (2007) through a longitudinal study in west Scotland that found that antisocial behaviour in ages 11-15 were the main indicator of alcohol misuse. Therefore, as a result of anti-social behaviour not being monitored and maintained by the children’s parents and teachers, the children are at a greater risk of early alcohol exposure. Furthermore, Rose et al (2001) discuss that around half of the risk in a young person developing alcohol dependence is usually as a result of genetic predisposition. Young people with a family history of alcohol abuse are at high risk of developing an alcohol problem, and at a younger age, than their peers with no family history of alcoholism.

Moreover, whilst considering how adult intervention within a home can effect youth and alcoholism, it is also vital to consider how a parent’s misuse of alcohol can affect the young person. Patterson (1982) uses a model of crisis disruption of family management practices to explain how management skills such as child monitoring, house rules, appropriate and consistent consequences, and problem management are important within a home. If a parent’s alcoholism prohibits implementing these management or supervision practices consistently, the child becomes confused and less well-adjusted, resulting in a low-quality parent-child relationship. This could consequently result in delinquent behaviours and the consumption of alcohol in the young person themselves. Additionally, a parent suffering from an addiction to alcohol can create an absence of adequate emotional support and poor relationship skills with their child/young person. Social control theory (Kobak et al, 1993), suggests adolescent problem behaviour and low emotion regulation are outcomes of caregivers’ lack of physical and emotional availability throughout childhood. This supports ‘attachment theory’ in which communication and trust are essential for development and how such negative adult behaviours would be indicative of poor parent-child attachment, (Ainsworth, 1978).

In consequence of alcohol addiction and adolescent/youth issues surrounding alcohol, there are many facilities approaches to support users’ addictions. Organisations such as ‘Alcohol Anonymous’ use medical models like a 12 step approach that focus on addiction as an illness. They do this by self-help groups, Meetings, sharing, support, sponsorship, service roles, adherence to philosophy, and serenity prayer & slogans as a model of abstinence for people recovering from alcohol dependence (Abraha and Cusi, 2012). The user’s addiction is attributed to a loss of control with long term consequences. It’s seen as a primary disease- not caused by other factors like psychological, social or emotional factors. It’s a disease, which requires treatment and monitoring to be maintained across the patient’s lifetime. A meta-analysis of 12 step treatments for adolescent substance abuse found that treatment was effective in reducing alcohol use (Tripodi et al., 2010). The number of participants included was relatively small (16), so the results should be interpreted with caution. However at a 12-month follow-up) the 12 step approach did appear to be associated with long-term change. Overall, this approach gives a platform for addicts to support each other and make meaning of their ‘disease’, to be able to function without alcohol long-term. However, this approach is criticised as it has a long treatment process and requires a lot of dedication from an individual in order to not relapse as it is abstinence based. Consequently addicts become extremely reliant and ‘addicted to meetings. Also this approach isn’t beneficial to everyone as it is very based on religion and a means on ‘turning to god’; meaning atheists are unlikely to find it useful. This approach also ignores social aspects that are an issue to addicts as alcoholism is viewed as a ‘disease’. For example, Robins (1974), states that it was estimated that half of the enlisted men in Vietnam War had taken opiates. Most of the men used the drugs repeatedly over time in combat zone, as they were freely available. At least 20% stated they felt “addicted” to opiates. However, once returned home, less than 1% continued use. This study supports that social circumstances are a major determinant on ways people use drugs and that availability has such a powerful effect on drug taking.

However, psycho-social models take into account the complexity of the individual’s psychological, environmental, social, cultural & financial factors. Models such as these make the addict aware that it is their choice to do drugs and they have to take ownership of their choices. For example, Prochaska & Di Clemente’ s (1986) ‘Cycle Of Change’ which conveys that although the amount of time someone spends in a specific stage varies, everyone has to achieve the same stage-specific tasks in order to move through their addiction. The steps to this model are a basis of an individual changing their addictive behaviours, achieving it for a length of time, and then a relapse into previous behaviours. These models highlights the inevitable humanity of the difficulty of addiction and how an individual may need to go through this cycle numerous times, learn from their mistakes and behaviours, to really get to the root of their addiction. Similarly, Rollnick & Miller (1995) discuss how motivational interviewing with alcohol addicts by concentrating on motivation to change specific negative behaviour, with the assistance of interventions by GP’s.

Furthermore, another ‘psychosocial’ model is harm and risk reduction. This refers to universal prevention strategies that may address a population or group within a particular setting, like schools, colleges, families or communities). The aim of universal prevention is to deter or delay the onset of a disorder or problem by providing all individuals the information and skills necessary to prevent the problem. In school settings, it typically takes the form of alcohol and drug awareness, social and peer resistance skills, normative feedback or development of behavioural norms and positive peer affiliations. “Prevention programmes can be either specific curriculum delivered as school lessons or classroom behaviour management programmes, and can be educational, psychosocial or a combination.” (Abraha and Cusi, 2012). However, Visser (2013) argues that prevention is not enough and that during his research many young people do not consider their drinking habits to be problematic or harmful. During Visser’s (2013) research, adolescents discussed that they were not as concerned with the long-term health impacts as a result of heavy drinking. Whereas young people were concerned about more superficial concepts like weight gain or threats to their reputations, rather than actual health risks.

Interestingly, Thombs and Osborne (2013) put forward the view that labelling an addiction to alcohol as an ‘illness’ functions as a means of social control. This example of labelling has been described as a sophisticated form of propaganda that is created by professions (Gambrill, 2010). “Medicalization gives credibility to physicians’ and mental health professionals’ efforts to control, manage, and supervise the care given to persons with substance abuse problems.” (Thombs and Osborne, 2013, p226) They execute that there is a means of profitable endeavours like hospital admissions, insurance company billings, expansion of the client pool, consulting fees etc. Furthermore, a diagnosis of an addiction can paradoxically prohibit individuals in day to day life. Robinson (2010) discusses how ‘labelling’ theory projects stereotypes onto someone and can actually result and act as a catalyst for relapses, if that’s how others are going to view them either way. Moreover, Thombs and Osborne (2013) also discuss how criteria for addiction are derived from cultural discourses. Therefore, people that drink alcohol are considered as ‘addicts’ because they deviate from the social norms. They discuss that from a sociological perspective, addictive behaviours are considered forms of social deviance rather than medical issues, therefore treatment is seen as an effort to persuade the addicted individual to conform to socially “correct” standards of conduct. Furthermore, Thombs and Osborne (2013) discuss how addiction is portrayed as a social construct as a diagnosis can completely change depending on factors such as the professional or social/historical context. For example, a diagnosis of a client may not be very different from a personal opinion, as it’s a diagnosis can be missing solid scientific evidence. Therefore a diagnosis is made on the values and beliefs of the practitioner. However, he practitioner’s own history, relative to his or her involvement in addictive behaviour, can consequently have an influence on the opinion of diagnosis. Similarly, Heath (1988) viewed that 150 years ago, Americans consumed three times more alcohol than they do now. Therefore the notion of what an alcoholic was then differs exceptionally from our conception today. Thus, Thombs and Osborne (2013) make note that perhaps these cultural factors also should sensitize clinicians as to the repercussions, both positive and negative, of applying the diagnosis/label of an ‘addict’ to someone, especially a young person. “In the best of cases, the diagnosis will motivate the client to change his or her behaviour. However, a diagnosis also could lead to overly intrusive treatment, social stigma, estrangement from family members, loss of employment, feelings of worthlessness and humiliation, or even exacerbation of existing problems in living.”(Thombs and Osborn, 2013, p228)

In conclusion, it is evident that there is a colossal and extensive sociological effect on excessive drinking in young people. Socio-cultural models highlight the effect of how a young person’s environment can act as a catalyst for alcoholism. This consequently emphasises why medical models to rehabilitation, such as the (AA) and the 12 steps of progression, are not always an effective method. Whereas after exploring some psychosocial means of rehabilitation, it could be argued that these methods tackle more of a wide range of an individual’s issues due to involving social contexts. Overall, it has become apparent that concepts around young people and addiction to alcohol are extremely versatile/complex and every individual’s circumstance is relative and individual to themselves, thus making it difficult to treat and diagnose. However, as discussed by Thombs and Osborn (2013), it is important to note that social constructs and labels, as well as being positive if needed, can also be especially detrimental to young people’s transitions, such as employment, if they are ‘labelled’ as an addict; therefore diagnosis ‘ are to be made with care and precaution.

If asked what country has the highest consuming rate in the world, many would be quick to say America. However, not a lot of people know that it is a small country in Eastern Europe, Belarus. Alcohol use and abuse is also a leading cause, to the suicides and homicides, within this country. Alcoholism in Belarus has become an epidemic as studies have shown only 11% of Belarusians are completely not drinking alcohol (Williams, 2018).

Alcohol drinking in Belarus is extremely high, with people drinking an average of 4.62 gallons of alcohol every year (Rudnik, 2017). Excessive drinking of alcohol has left many in Belarus physically reliant on the drug. Alcohol is also one of the contributing factors leading to the country’s suicides rate, which has one of the highest rates in the world. People who live in rural areas lack entertainment activities, and recreational places to pass time. This leads to an increase in alcohol drinking and abuse (Williams, 2018).

Unlike the U.S.A, Belarus rural areas have no recreational parks, public libraries, or gyms. That being the case, drinking has become a popular activity for farmers and those in their community. Liquor is readily available at just about every local store for purchase. Drinking at a young age is another problem to take into consideration. The legal age of drinking is 18 years old in Belarus (Williams, 2018).

In Belarus alcohol prices are much cheaper than countries that border it. During elections, or economic difficulties, the prices of alcohol are lower. Cheap alcohol is being used to manipulate the public masses. It is a tool used to neutralize and numb the minds of any would be activist against the Belarusian government. By making alcohol prices lower, the authorities of this dictatorship regime are able to achieve further support and loyalty (Rudnik, 2017). It’s also a tool to hide the economic and social difficulties that Belarus has yet to overcome. Some Belarusians make their own homemade liquor. This has become a huge problem, and at times leads to death. The Belarusian government has begun to combat the alcohol epidemic, trying to slow the alcohol use, but still try and gain from the sale of alcohol. Starting in 2011, the government presented an anti-alcohol program. This program put restrictions on the sales and promotion of alcohol. However, in 2013, Belarusian president, Lukashenko A., took the restrictions put in place back. He was convinced not to ban the sale of cheap wine, also called ‘Charnila’ or “Byrlo”; which is one of the most well liked alcoholic drinks in Belarus. Also in 2013, the Ministry of Trade considered selling alcohol online. This corrupt government not only ignores the alcoholic epidemic before their eyes, they encourage its sales. Beginning 2015, Belarusians could buy alcohol at night with the law cancelled, which had not allowed it to be sold between 10pm and 9am. In 2016 there was 18,370,788.69 gallons of alcohol purchased (Rudnik, 2017). With alcohol benefiting the country, being sold cheap, and common availability, its highly unlikely a ban will ever take place. It is believed by Cavusau a scientist that a ban is nearly impossible and highly doubtful due to the local resources being filled with around 30% of the profit from the sale of alcohol He also believes that local finances completely depend on these profits. Alcohol has led to poverty and wide spread drinking among the majority of the population of Belarus (Rudnik, 2017).

Alcohol related suicide, is one of the most common causes of death, for young adults in Belarus. Suicides in females have been found to be much lower than men in of Belarus. One study shows the ratio of women to men, who committed suicide, at 1 to 4. Also those who attempted suicide, yet lived, called ‘parasuicide’ had these same statistics. In the ages between 18-29 years of age (34.2% in women and 57.8% men were found reliant on alcohol, and with a BAC- positive result (Davidouski, Razvodovsky, 2017).

There was a disturbing rate of growth in suicides beginning in the 1990s in Belarus, which led to the country becoming one of the highest for suicide rates in the world (Razvodovsky, Kandrychin, 2014). Studies were done to consider regional alcohol consumption with suicides. It was found that specific regions of Belarus did indeed have a much higher rate of suicides due to alcohol consumption of the individuals. In Minsk region (0.68) and Mahilow region (0.55) there was found the highest rates of suicide, while lower rates were found in Brest and Vitebsk at (0.41) This study supported the hypothesis that specific regions had higher suicide rates due to alcohol consumption and alcohol related psychoses in Belarus (Razvodovsky, Kandrychin, 2014).

In another study of premature death in Belarus, it was found again that alcohol played a major role. Alcohol intoxication was stated as (AAF) Alcohol- attributable fraction. The results of AAF were compared with the BAC (blood alcohol concentration) based on suicides found. Blood alcohol concentration related suicides were shown to be lower in women (30.6%) than in men (60.2%). Likewise the AAF gave results of males (63.4%) and females to be (35.2 %). This study also established that the relationship between alcohol related suicides was higher in men 30-44 and 45-59 years old (Razvodovsky, 2016). From the 5 examples of evidence shown above, we can correlate how the lower incomes farming, and rural areas, have a higher death rate, with suicide as the cause, because of drinking alcohol.

Next we will look at, the well documented connection, between alcohol, and homicide in Belarus. In an analysis study, done between the years of 1970 to 2005, revealed a close relationship between homicide, and alcohol poisoning, in Belarus. This evidence will support the hypothesis that homicide and alcohol are closely related in areas where drinking prevails. This evidence will suggest that a significant amount of the homicides that occurred in Belarus is due to the effects of excessive drinking alcohol. Alcohol has been considered as a major reason for aggressive behavior (Razvodovsky, 2008).

The cause in this relationship is not known. In terms of alcohol lowering a persons inhibitions, which is also known as disinhibition hypothesis; alcohol use is shown to lower the person’s inhibitions which can cause acting out in thoughtless violence. The individual’s frontal lobe has essentially been shutdown, causing the neurons to misfire, and miss connections with other neurons all together. This lack of connection causes a lack of inhibition. In the economic deprivation model it shows poverty or unfairness as the reason that may increase the chances of violent conduct. Showing alcohol and violence as directly related is not easy, but actually it’s quite complex. Several researchers believed that stressful conditions resulting from political, economic, and social changes were the main reason for more drinking alcohol, and homicide rates (Razvodovsky, 2008). From these examples, we can get a clear understanding, that alcohol effects those under stress, in making the good decisions .The link between alcohol and homicide is a complicated one, but it can be shown to be related through these studies.

With Belarus officially having on record 170,000 alcoholics, and 80% of murders and serious injuries committed under the influence of alcohol, drastic measures need to be taken to save my home country, Belarus, from the alcohol epidemic. Suicides, and violence due to the drinking of alcohol, are not going to stop, unless measures are put into place. Belarus is the leading country for alcohol consumption, and suicides related to alcohol use, in the world. This has been shown in countless studies and documents.

There are many solutions we could implement to lower the rates of suicide and homicidal deaths related to alcohol in Belarus. First, they could implement alcohol awareness, and cognitive intervention behavior classes. These classes would focus on teaching people how to make healthy decisions. It would show them their incorrect behaviors and choices they believed to be correct. Through self-recognition of these destructive behaviors, and learning the process of the addictive cycle, their lives could be transformed for the best. Also, training in Suicide awareness, and the early warning signs to be aware of those thinking about suicide, could help prevent suicide attempts. 12 steps related programs such as Narcotics Anonymous, Alcoholics Anonymous, and Winner’s Circle could be offered for free. Those wanting a change in their alcohol consumption, tired of being tired, and ready to surrender their lives over to a higher power, could find freedom from their addiction in such programs. With these programs, classes, and help given from the Belarusian government, as a solution to the current alcoholic epidemic (Rudnik, 2017). I believe we would see a decrease in homicide, suicide, and alcoholism among my native people of Belarus.

Abstract

The terminology and typologies used to describe alcoholics and diagnose alcoholism have changed dramatically from when William Carpenter first published “On the Use and Abuse of Alcoholic Liquors in Health and Disease” in 1850 to the publication of the DSM V in 2013. E.M. Jellinek had a profound impact on emphasizing the importance of treating alcoholism as a disease that should be studied scientifically, thus paving the way for the changes of these typologies and how people are diagnosed. The first treatment institutions were “Sober Houses” implemented by Benjamin Rush – the so called “father of American psychiatry.” These were followed by the Washingtonians and Fraternal Temperance organizations. While both of these ultimately failed, this was the beginning of seeing alcoholism as a disease. In addition, they paved the way for future treatment centers including the American Association for the Cure of Inebriates and the Keeley Institutes. It wasn’t until after the prohibition era that Alcoholics Anonymous was founded, creating a global and long-lasting process of recovery without stigmatization.

Introduction

Alcoholism dates back to over 12,000 years ago and since then the disease has held a fascinating place in human history. This paper will detail in particular the history of alcoholism in America. I will begin by addressing many of the various ways that the classification of alcoholics and alcoholism has changed. This terminology will be broken down into three time periods – Pre-Jellinek, Jellinek Era, and Post-Jellinek. By addressing this first, it will provide a base of understanding of how the disease was perceived not only socially, but also through the eyes of physicians and psychologists. Similar to the pattern of recovery from alcoholism, the history of the disease is tumultuous at best. I will discuss alcoholism in three sections – the beginning of the disease concept of alcoholism in America, followed by the controversy that led to the prohibition era, and finally the emergence of alcoholics anonymous. For each of these sections I will include discussion regarding notable psychologists and their impact. In addition, I will detail the popular treatment centers of the time.

Classification of Alcoholics and Alcoholism

Pre-Jellinek

E.M. Jellinek was a prominent activist in the disease concept of alcoholism and is known for developing the first scientific terminology to describe the disease and the people who suffer from it (Babor, 1996.) However, there was a long period of time prior to Jellinek’s contributions where the classifications were largely founded solely on observation and reflection.

William Carpenter was one of the first physicians to create typologies for people struggling with alcoholism (Babor, 1996.) Carpenter’s publication “On the Use and Abuse of Alcoholic Liquors in Health and Disease” was published in 1850 and described the “wine mania” he had observed as a physician. His classifications included acute, periodic, and chronic. Persons dealing with the acute category dealt with irregular sudden urges to become intoxicated. Periodic was categorized as regular binge-drinking, and chronic abusers could be described as constant drinking that took over one’s life (Babor, 1996.) Carpenter’s terminology, while not based on empirical research, provided a foundation for alcoholism to be studied on a professional level. The path to understanding not only the disease itself, but also the people suffering from it had begun.

20 years after Carpenter’s publication, several American physicians, including Thomas Crothers, founded the Association for the Study of Inebrity. Through this association, Crothers formed a journal in hopes of providing professional, clinical information regarding alcoholism (White, 2014. ENTER PAGE) Based on his clinical observations, Crothers classified three types of alcoholics as well as separated the difference between acquired and hereditary alcoholism. These typologies were presented to the public in 1911. Crothers claimed alcoholics could be classified as either continuous, explosive, or periodic. For continuous drinkers, alcohol was a daily part of one’s life. Crothers’ explosive drinkers were most similar to Carpenter’s acute typology in that drunkenness came irregularly and suddenly. For periodic drinkers, drinking was heavily correlated with environmental factors and was unpredictable, yet infrequent (Babor, 1996.)

While many of Crothers’ typologies seem to rely heavily on Carpenter’s previous publications, Crothers went a step further and claimed that alcoholism could be either acquired or be hereditary. Acquired alcoholism was claimed to come from the environment, specifically stress and a lack of hygiene (Babor, 1996.) Hereditary alcoholism was founded on “psychopathic disorders” that one was born with (Babor, 1996.) It is important to note that while Crothers’ certainly spread information regarding alcoholism and the causes, the information he presented was still largely unscientific as there were no empirical studies.

In 1938, Robert Knight developed the idea that alcoholism was a symptom that could be treated by reforming the personality (White, 2014, p. 132.) Many of his beliefs and publications seem very related to Freud’s beliefs and teachings. Knight termed three types of alcoholics – essential, reactive and symptomatic. The essential alcoholic, also called psychopaths, had an oral fixation which was the cause for chronic drinking (White, 2014, p. 132.) Reactive alcoholics drink in response to a tangible event and symptomatic drinkers are similar to Crothers’ hereditary alcoholism in that it is caused by psychotic disorders (Babor, 1996.) Knight’s terminology was important to the history of alcoholism because it demanded a psychoanalytical approach of treatment due to the involvement of a person’s personality. Following Knight’s logic, recovery from alcoholism was very rare and highly unlikely as being able to change a person’s personality is extremely difficult (White, 2014, p. 133.)

Jellinek and the DSM

While all of these aforementioned terminologies were highly unscientific, confusing at times, and created a difficulty for reliable diagnoses, they did place an emphasis on the importance of studying alcoholism. In 1952 the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was published. This was the first time that psychologists in America had attempted to create a unifying, broad terminology to understand alcoholism (Nathan, Conrad, & Skinstad, 2016.) The call for the inclusion of alcoholism in this DSM was largely due to the soldiers returning home from World War II, many of which were now struggling with the disease (Nathan et al., 2016.) The first DSM seemed to draw largely on similar ideas as Knight presented – the DSM I classified alcoholism and addiction under the “sociopathic personality disturbance” category of disorders (Nathan et al., 2016.) Another major fault of the first edition of the DSM was that nomenclature was still largely based on clinical observations rather than empirical research. This publication further allowed for alcoholism to be studied non-scientifically and for individuals who were struggling with the disease to be shamed by the public.

E.M. Jellinek was an American scholar who arguably had the most impactful contributions to the early study of alcoholism. His theories were far more sophisticated than previous scholars and physicians and his emphasis was that alcoholism should be studied scientifically (Ward, Bejarano, Babor, & Allred, 2016.) Jellinek was involved in many of the leading world research on alcoholism, including the Yale Summer School of Alcohol Studies, the World Health Organization, and the International Institute for Research on Problems of Alcohol (Ward et al., 2016.) Drawing heavily on his observations, knowledge from working for these institutions, and his own statistically based survey data, Jellinek published The Disease Concept of Alcoholism in 1960 that outlined 5 types of alcoholism as well as the Jellinek curve outlining the phases of alcoholism. Jellinek’s publications were widely accepted not only in America but also in many European countries. In addition, they were extremely influential in promoting that alcoholism was a disease that could be treated, and individuals could recover (Ward et al., 2016.)

In 1968, the idea of alcoholism as a disease had another set-back through the publication of DSM II. Similar to DSM I, alcoholism was a subsection of “Personality Disorders and Certain Other Non-Psychotic Disorders” (Nathan et al., 2016.) The publishers were almost unanimously white males who did not provide hardly any empirical research to support what they considered necessary to diagnosis someone with alcoholism. This publication again brought shame to alcoholics as the disease was classified with other syndromes such as sexual deviations and dissocial reactions (Nathan et al., 2016.) In addition, DSM II used “brief and sketchy” diagnosis criteria which lead to, again, an inability to properly diagnose individuals (Nathan et al., 2016.)

Post Jellinek: DSM III – DSM V

DSM III was published in 1980 and heavily relied on Jellinek’s teachings and research – a huge step in the right direction for people hoping to truly understand alcoholism as a disease. This was the first publication of the DSM that categorized alcoholism in a separate section from personality disorders, instead it was grouped with other substance abuse disorders in the “Diagnostic Categories: Text and Criteria” chapter (Nathan et al., 2016.) In addition, DSM III used research to defend their clear outlining of signs, symptoms and reasons for diagnosis (Nathan et al., 2016.) This allowed for physicians and psychologists to better diagnosis individuals suffering from the disease and therefore generated more valid, reliable research-based data.

DSM IV was published in 1994 followed by the publication of DSM V in 2013. Both publications had goals of being better able to diagnosis individuals suffering from the disease. By this time, society and scientists were largely on the same page that alcoholism was a disease that could result in recovery if patients were helped accordingly – partly due to the emergence of Alcoholics Anonymous in 1935. While all previous publications had maintained that dependency was clearly founded almost entirely on the presence of tolerance and withdrawal, the newest publications wanted to provide clear criteria that also outlined social, psychological, and interpersonal problems as well (Schuckit, Nathan, Helzer, Woody, et al., 1991.) These changes are arguably based heavily on the changes in treatment that was offered to patients. With the emergence of Alcoholics Anonymous and continued research from psychologists such as Jellinek, it was argued that focusing solely on the physical impacts of the disease was not enough to allow for recovery. Although the publication of DSM V came with much backlash from the psychological community, it did provide a clear outline of someone suffering from alcoholism – a huge milestone for anyone hoping to understand the disease as well as properly diagnosing someone suffering from the disease.

Alcoholism as a Disease

While alcoholism dates back over 12,000 years ago, it was first considered a disease in America during the beginning of the 1800s. (White, 2014, p. 2) Dr. Benjamin Rush is often considered the “father of American psychiatry” (Nathan et al., 2016) and was an early advocate for the rights of mentally ill persons (Hergenhahn & Henley, 2014) and people suffering from alcoholism were no different in his eyes. In 1784, Rush first described the uncontrollable urges for people to consume alcohol. Rush was a prominent person in the United States – he was a member of the Continental Congress and an original signer of the Declaration of Independence (White, 2014, p. 2), and therefore his beliefs and publications had a huge effect on America’s views of alcoholism.

Rush was one of the first to emphasize that alcoholism is not due to a person’s character but rather is a medical condition that needs to be treated scientifically (Nathan, et al., 2016.) Rush emphasized that alcoholism was a separate disease itself, attempting to remove the stigma associated with its previous relation to moral character flaws (White, 2014, p. 3.) In addition to publishing the first American psychiatry textbook in 1812, Rush can also be accredited for developing the first institutions, “Sober Houses,” that focused solely on treating alcoholism in 1841 (Nathan, et al., 2016.) Clearly Rush had a huge impact on how the history of alcoholism would unfold. He sought rights for people struggling with the disease, emphasized the importance of removing the sufferer from the environment by giving them time to recover in an institution, and fought to treat alcoholism as a disease.

Rush himself was not an advocate for complete abstinence, but rather that beer and wine should be drank in moderation and hard liquor should be avoided completely (Nathan, et al., 2016.) This was the beginning foundations for the first temperance movement in the 1820s (White, 2014, p. 5.) Unfortunately, society took the temperance to the next level during the 1830s and 1840s, preaching abstinence and once again shaming alcoholics (White, 2014, p. 13.)

With the reformed temperance movement came some of the first treatment centers in America – the Washingtonians and Fraternal Temperance organizations. The Washingtonian society was arguably the first step towards modern Alcoholics Anonymous (Maxwell, 1950.) The Washingtonian Society was founded in 1840 by a group of alcoholics in Baltimore who allegedly wanted to get sober (Maxwell, 1950.) This treatment program focused on sharing personal stories, which was the first of its’ kind and probably the reason for its massive, rapid growth across the America. At one point, the treatment program claimed to have reformed over 600,000 men. The success rate of the program was notably low, however, as 450,000 later relapsed (White, 2014, p. 22.)

The treatment program provided hope of recovery for people and families struggling with alcoholism and promoted the temperance movement and it’s push for abstinence in America (Maxwell, 1950.) Unfortunately, the Washingtonian society was highly unorganized in leadership and, in addition, was founded on a separation of temperance from religion which ultimately caused its demise in the beginning of the 1850s (Maxwell, 1950.)

With the crumbling of the Washingtonian Society came a void for long-term treatment for people struggling with alcoholism. This void was filled by the fraternal temperance organizations (White, 2014, p. 22.) Unlike the Washingtonian Society whose members marched in parades and spoke openly of their drunken mistakes to the public, these fraternal organizations were “secret societies” that demanded anonymity in hopes that more people would join without being stigmatized (White, 2014, p. 22.) This is perhaps the foundation for the “anonymous” in Alcoholics Anonymous. Arguably the most profound impact that the fraternal temperance organizations had on the history of alcoholism was their focus on continued abstinence from alcohol (White, 2014, p. 24.) Many past treatment programs and teachings had focused solely on quitting drinking, with much less emphasis on remaining sober.

The fraternal organizations began to lose memberships during the 1870s due to political conflict regarding women and black membership rights. In addition, the secrecy and the dues that were required by members made the groups too exclusive to join for many individuals (White, 2014, p. 24.)

On the Path to Prohibition

As previously mentioned, the treatment programs in place during the latter half of the 19th century brought many changes to the previous beliefs society held regarding alcoholics. The fraternal organizations taught that sobriety must be considered an on-going process and therefore patients should be considered “recovering” rather than “recovered” (White, 2005.) Dr. Robert Parrish continued building off the foundation that had been built by Rush’s contributions as well as the treatment programs’.

Parrish founded the idea that today would be considered relapse prevention and emphasized that people struggling with alcoholism needed medical treatment and support in an environment that was removed from society (White, 2005.) In 1870 Parrish launched the “first professional organization within the addiction treatment field” (White, 2014, p. 37) called The American Association for the Cure of Inebriates (AASCI.) The number of institutions grew rapidly – in 1878 the number had grown from the original six to 32. AASCI put a focus on scientific treatment by attracting medical professionals to work in the institutions. They also created a journal in hopes of better exchanging accurate, verifiable information regarding the disease (White, 2014, p. 38.)

Parrish founded AASCI explicitly on the idea that alcoholism was a disease that could be cured in a similar fashion to any other disease a person may struggle with. This disease concept ultimately caused many problems that created a path towards demise for AASCI. Many of the institutions began to rebel against Parrish’s founding principles with statements such as, “We do not, either in our name or management, recognize drunkenness as the effect of a diseased impulse; but regard it as a habit, sin and crime” (White, 2014, p. 37.)

Several other attempts were made at treating alcoholism during this time. Inebriate Homes and Societies utilized their belief of the importance of “alcoholic-to-alcoholic mutual support” that originated from both the Washingtonian and fraternal societies previously discussed. In the Inebriate Homes and Societies in the late 1800s, recovered individuals were given a place to work in a sort of peer-mentoring setting (White, 2014, p. 45.) This was one of the first of its kind to employ recovered individuals to help treat others that were suffering. While the idea was revolutionary and, at its core, a positive one. Unfortunately, it also brought backlash as the workers often relapsed therefore not able to provide the treatment needed to help others recover (White, 2014, p. 45.)

The Keeley Institutes were perhaps the most popular treatment facilities during this time period. The first Keeley Institute was founded by Dr. Leslie Keeley in 1879 and “franchises” continued to expand across America until the 1890s, ultimately treating over 400,000 people (White, 2014, p. 82.) The Keeley institutions taught that dependence on alcoholism was due to the change in cell structure that occurred after use of alcohol (White, 2014, p. 71.) The cure for alcoholism was a “Double Chloride of Gold Cure” that was given to patients of the institutions four times a day for four weeks and was supposed to cure them of the disease.

At the height of Keeley Institutions’ popularity, the founder was distributing the cure via mail to provide an option for people who did not wish to enter the treatment facility in person. As probably expected, this distribution quickly ended as the success rate of users was extremely low (White, 2014, p. 76.) The formula for this cure was never revealed (White, 2014, p. 74.) Ultimately, the Double Chloride of Gold Cure injection brought the Keeley Institutes criticism from other medical professionals claiming that Dr. Leslie Keeley was participating in fraud by making a large profit and not actually providing a reliable cure (White, 2014. P. 80.) The ‘beginning of the end’ for the popular treatment facilities began.

As in the past with every previous attempt at treating alcoholism and moving further away from prejudice notions, in the beginning of the 1900s most institutions and asylums closed. During this time, societies’ views of alcoholism again returned to the former state of stigmatization of the disease and its sufferers. The criticisms from the Keeley institutions brought a loss of confidence in treatment centers. Many institutions closed down and the concept of recovery began to again feel farfetched (White, 2005.) The ideas of Prohibition were beginning to build.

The Rise of Alcoholics Anonymous

Alcoholics Anonymous was founded in 1935 and “was part of a larger modern alcoholism movement that between 1935 and 1970 redefined America’s conception of alcoholism and the alcoholic” (White, 2005.) Alcoholics Anonymous (AA) was founded by Bill Wilson and Bob Smith when the two men met to discuss their own personal experience with alcoholism and their desire for recovery (Korsmeyer & Kranzler, 2009.) The founders emphasized the disease concept of alcoholism and worked to push the framing away from being “cured” to the idea of an ongoing recovery process (Korsmeyer & Kranzler, 2009.) The program grew extremely rapidly with over 50,000 members by 1950 (Korsmeyer & Kranzler, 2009.)

The founders seemed to have learned a lot through previous tried and failed attempts at treatment recovery programs. For instance, AA emphasized the importance of working with and sharing stories with other people also struggling from alcoholism with the argument that support comes from sponsorship. This idea traces back to the Inebriate Homes and Societies of the late 1800s. In comparison to the fraternal organizations, AA moved away from required fees and a “secret society” mentality in hopes of being more inclusive by holding numerous free meetings daily that were open to the public while still allowing for members to keep their anonymity. While the Washingtonian society suffered greatly from not being affiliated with a religion, AA found a middle ground in that many of their beliefs and steps of the program involve finding a “higher power” but the program itself claims to be entirely separate from religion (Korsmeyer & Kranzler, 2009.) The Keeley Institutes were in part so successful because of their business-like approach that allowed for unanimity across the country. Similarly, AA keeps meetings very structured and organized allowing for easy access to meetings.

AA teaches the belief that alcoholism holds more than just physical components, also accounting for moral and spiritual components (White, 2005.) This teaching had a profound effect on Jellinek who, as previously mentioned, paved the way for terminology regarding alcoholics being founded on empirical research (Ward et al., 2016.) While AA certainly received backlash similar to past treatment programs and institutions, including the debates that alcoholism is not a disease (White, 2005), the program prevailed. The prevalence can be recognized in part because of the aforementioned change in terminology and an increase of empirical research being conducted regarding the disease. According to the Alcoholics Anonymous website, the program is now immersed in approximately 180 nations worldwide with over 2 million members.

Conclusion

The history of alcoholism in America is tumultuous with as many setbacks as there are steps in the right direction. Benjamin Rush was the first American scholar to

References

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According to the American Psychiatric Association addiction is a multiplex condition, a brain disease that manifests itself as compulsive substance use despite detrimental consequences. It is an urge to indulge in something for the pleasure it provides despite its destructive outcome. Addiction can be physical like drug and alcohol abuse or behavioral like shopping, gambling, eating etc. Out of all addictions alcoholism and drug dependency are the most destructive forms with great intensity and cataclysmic outturn. It is mind boggling as to how the authors De Graaf. Wann and Naylor call the addiction to shopping as the “most destructive” of all addictions. “And at least ten million can’t stop buying more and more stuff- an addiction that in the long run may be the most destructive of all” (10). Yes, all addictions are bad and have inimical consequences but some addictions produce effects that are severe, grave and totally destructive not only to the addict and his/her family but also to innocent members of society. It is the outcome, results, consequences of alcohol addiction that make it the most serious, the most destructive of all addictions. Hence the authors’ argument can be refuted through critical reasoning and powerful examples.

Before evaluating the authors’ statement, it is imperative to learn about the underlying causes of addictive behavior, which could be biological and/or psychological (NIH). The biological bases of addiction explains that a person is addicted to a substance not because of a lack of willpower or an understanding of the terrible consequences of his dependency, but because of the changes brought about in his brain by the substance itself (NIH). Dr. George Koob, director of the National Institute of Health says “A common misperception is that addiction is a choice of a moral problem, and all you have to do is stop. But nothing could be further from the truth, the brain actually changes with addiction and it takes a good deal of work to get it back to its normal state” (newsinhealth.nih.gov). Researchers have found that the power of addiction lies in its potential to seize and even demolish key brain areas that aid in survival. Repeated use of substance can damage the pre-frontal cortex, the very area that helps in recognizing the injurious effects of addictive substance (NIH). Psychologists propose several possible causes of addiction. Metal illness or psychopathology, learning addictive behavior as a response to the surroundings, unfeasible or malfunctional actions stemming from people’s thoughts and feelings are all thought to be contributing to addictive behavior (American Addiction Centers Resources). Low self-esteem, loneliness and feelings of neglect and anxiety are all considered to be causes giving rise to addictive behavior. Having understood the causes of addictive behavior it will be easier to proceed with the critical analysis and comparison of shopping addiction to alcoholism.

Shopping addiction involves repeated urge to buy things as a way to acquire pleasure and avoid feelings of anxiety and depression. It is much more than a bad habit (Psych Guides). It can cause havoc to relationships, deplete one’s bank account, push one into perpetual borrowing and ultimately causing bankruptcy and even homelessness. Sometimes it can force people to steal or shoplift. According to Shopaholics Anonymous there are different types of shopaholics. There are compulsive shoppers who shop when they are undergoing emotional distress, trophy shoppers who are looking for the perfect item, addictive shoppers who love the image of a big spender and bulimic shoppers who get caught in a vicious cycle of buying and returning (Psych Guides). According Ruth Engs from Indiana University “ Some people who develop shopping addictions are actually, deeply addicted to how their brain feels while shopping, and as they shop their brain releases endorphins and dopamine which relieve pain and stress, making a person happy” (psychguid). Over a period of time these feelings become addictive. In April 2013, Buzz Bisenger, author of the book “Friday Night Lights” wrote an extraordinary story in GQ Magazine where he admitted to owning 81 leather jackets, $5000 pair of pants and a $22,000 coat and how it took him many years before he started to grapple with the addiction. According to a Stanford University Study, “oniomania” – a compulsive shopping and spending addiction affects six percent of the American population. It is not to be misunderstood that addictive shopping affects only people with less or little money. There have been many rich celebrities who went from riches to rags eg Mc Hammer, an American rapper and dancer who made millions had to declare bankruptcy in the end with a thirteen million dollar debt due to his lavish lifestyle and uncontrollable shopping addiction. Another celebrity is singer Britney Spears who has openly admitted that she shops when she is depressed “ I can be in the dump of dumpsters and go buy a pair of new shoes and feel a bit better” (Spears).

The deadliest form of addiction amongst all is the addiction to alcohol. According to the National Institute on Alcohol Abuse and Alcoholism drinking more than three drinks in any one day constitutes addiction for women, and more than four days for men (www.alcohol.org) . If a person exceeds more than fourteen drinks a week he/she is considered an alcoholic. Once a person starts to drink heavily chances are that he may develop a physical and emotional dependency on alcohol. Dr. Nora Volkow, director of NIH’s National Institute On Drug Abuse says “addiction is a devastating disease with a relatively high death rate and serious social consequences” (Volkow). Ann Pietrangelo writes in the health line magazine that alcohol’s impact on one’s body starts from the moment the first sip is taken. “Being an alcohol addict can lead to a whole range of serious health problems and increased risked of developing high blood pressure, stroke, heart and liver disease, pancreatitis and even cancer” (Pietrangelo). According to Web MD eighteen million adults are chronic addicts and nearly one hundred thousand Americans die each year as a result of this addiction. Alcohol is a factor in more than half of the homicides, suicides and traffic accidents in the United States. An alcohol addict causes injury and harm not only to himself/herself but could also cause social obliteration and destruction. For example on September 14, 2008 the pilot of AeroFlot- Nord, the flight that originated in Moscow, Russia crashed due to severe pilot intoxication. All eighty eight passengers and crew members perished because of the pilot’s alcohol addiction (Aviation Accident Data Base). A drunken pilot who had consumed more than six times the legal limit of alcohol piloted an airplane killing four people in Anchorage, Alaska in 2019 (CBC News). The deadliest drunk driving accident in the U.S. happened on May 14, 1988 outside Carrolton, Kentucky where a drunken school-bus driver crashed his bus killing twenty seven people out of which twenty four where children. As attested by CDC there is one death every fifty minutes in the U.S. twenty-nine people in a day caused by vehicle crashes due to intoxicated drivers. On the testimony of Mothers Against Drunk Driving (MADD) an organization founded by a mother who’s daughter was killed by a drunk driver, two out of three people will be involved in a DUI accident during their lifetime (www.pendslaw.com) .

Having analyzed the consequences of shopping and alcohol addictions it will be easy for any reader to humbly refute or disagree with authors De Graaf, Wann and Naylor who say that shopping addiction is the “most destructive” of all addictions. Although addiction in general is dangerous and deleterious, addiction to some substances are much worse than others. Addictive shopping may deplete a person’s bank account and land him/her in financial crisis leading to severe problems like bankruptcy and even homelessness. This is bad no doubt. But on the other hand alcohol addiction not only expends an individual’s finances but also leads to catastrophic consequences. As seen in the examples laid out, alcoholism not only causes havoc to an individual’s body by destroying organs like the liver, brain, pancreas and so on but it also causes devastative, calamitous, annihilatory effects on others- innocent members of society. Intoxicated pilots kill passengers by crashing planes. Drunken drivers fataly crash into people on the streets. These are lethal, pernicious, detrimental consequences. No one has heard of an addictive shopper crashing into people with his shopping bags filled with goods and killing them. Though the two may stem from the same causes, as they grow they diverge to two separate destinations. Alcohol addiction produces grave, drastic, grievous consequences not only to the addict but also to innocent members of society unlike addictive shopping which affects only the addict (maybe some family members). Therefore the “most destructive” addiction is definitely alcoholism and not addictive shopping.

Works Cited

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Alcohol is an important part of Bhutanese culture, especially in the eastern parts of Bhutan, they serve it as a gesture of showing respect, honor and hospitality. Alcohol is served in a number of forms including welcome drink, farewell drink, drink with food and other ceremonial forms. The basic nature of alcohol is underplayed to promote it as a socially acceptable commodity in Bhutan. Due to which it becomes one of the reason for being widely available in country, an easy access to alcohol for every individuals. According to one of the report published by Movendi (Movendi, 2019), there is one alcohol outlet for every 177 Bhutanese. Though there are enforcement of strictly ban of illicit alcohol but cheap industrial alcohol are available in almost every retail stores. Through such availability, it becomes easier for every consumers to indulge in alcohol.

The BLSS (Bhutan Living Standard Survey, 2007) data revealed that about 86% of the total alcohol consumed by the Bhutanese in 2007 was made up of local homebrews, which becomes one of the factors of the easy access to alcohol in Bhutan for the consumers. Public consumption of alcohol is high. Alcohol abstention rate among the Bhutanese population 15 years and older is 64.7%, notably lower than the South East Asian rate of 80.4% (World Health Organization, 2011). A survey conducted in 2001 in eastern Bhutan found that more than 58 percent of the respondents were alcoholics; of which 50 percent of the males were the sole bread earners in their families (Report on IECH survey 2001, 2001). In urban Thimphu, of the 36.4 % of the adults who had consumed alcoholic beverages in the past year, 10.5% engaged in binge drinking (Royal Government of Bhutan, 2009). High school surveys showed that 37.3% among Grade 7-8 and 48.3% among Grade 9-10 and 59.1% consumed alcohol (Bhutan Narcotic Control Agency and United Nations Office on Drugs and Crime, 2009), indicating that underage drinking may be common.

The usual main for such factor is due to availability of alcohol and easy access of it, which will somehow lead to more alcohol abuse and cause domestic violence as well. Hundreds of families throughout Bhutan are victims of domestic violence. It not only affects adults but has a more adverse impact on children as well. RENEW (Respects, Empower, Nurture and Educate Women) sees such cases of domestic violence every month, where the main factor for such issue is due to alcohol abuse. As Bhutan views alcohol and traditional games as a good mixture in Bhutanese society, such events lead up to consuming alcohol and affecting the living environment after consumption of alcohol in their home environment.

The 7th session of the first parliament held on 2011 directed relevant agencies to strengthen alcohol use prevention programs focusing on demand and supply reduction policies to improve the wellbeing of the people aspiring to GNH and free from alcohol related harm (Royal Government of Bhutan, 2015). Following Parliament’s directions, stakeholders coordinated by the Ministry of Health conducted a series of consultations to develop alcohol control strategies outlined in this document. After passing the GNH Policy Screening Test, the document was reviewed and approved after deliberations by the Cabinet Members in the three sessions of the Lhengye Zhungtshog: the 63rd (January 20, 2015), 82nd session (28 July, 2015) and 90th (December2,2015) (Royal Government of Bhutan, 2015).

The strategy focuses on alcohol control through a holistic public policy approach. In addition to public health interventions, the strategy includes strengthening the enforcement of existing policies pertaining to the sale of alcohol to minors, hours of operation, places of sale, and advertisement and promotion of alcohol products. Though such implementation are done by the government which addresses the issues or challenges related to alcohol, there are no monitoring or any follow-ups done for the implementation, which result to another factor of retailer to sell it in more ambiguous manner and not biding the law.

Studies in Thimphu (2013) and Trashigang (2014) revealed a very low compliance with alcohol rules among sellers (Dorji, 2014). Alcohol service policies were violated 90% of the time in licensed outlets in Thimphu. Even on Tuesdays when compliance was greatest (43%), it is far below acceptable levels. Similarly, compliance was poor in all 35 outlets in Trashigang town. However, the studies illustrated that a single information session on alcohol control policies with a follow up implementation check visit to outlet owners/managers significantly improved practices from a low base.

Go Youth Go (GYG), a youth based organization, during the implementation of an education program among 437 alcohol outlets in Thimphu city in January 2015, noted many unlicensed outlets selling alcohol (Royal Government of Bhutan, 2015). Poor practices are expected to be an issue in the country due to minimal enforcement of existing alcohol control legislation and policies. Even though, there is enforcement, the consumer who are dependent on alcohol will find means to consume alcohol, therefore for such issue, there is a need for proper treatment plans for them. Included implementation of an education program for alcohol was done only in Thimphu sub-regions and based on it only, it was given as a report with the perspective of the whole country when the survey hadn’t been done in other parts too. Therefore such implementation need to be conducted in other parts of Bhutan included it will also help to motivate young youths to advocate themselves which doing the survey.

Royal Government of Bhutan incorporation with Ministry of Health and RSTA (Road Safety and Transport Authority) implemented integrative well-funded, time bound comprehensive national and sub-national action plans to reduce the harmful use of alcohol, enhanced inter-sectoral coordination to implement alcohol policies at all levels by establishing a National Alcohol Control Committee (NACC) at the national level, Dzongkhag committee, Thromdey committee and Gewog Committee chaired by Prime Minister, Dzongda, Thrompon and Gup respectively and lastly they built partnership with mass media organizations to raise awareness on harms associated with alcohol use where they allocate adequate funds to implement alcohol policies (Royal Government of Bhutan, 2018). There are limitations to advocacy and implementation of such practices, where one of the downfall could be people would not to adequate enough to listen to the whole advocacy program instead there will be littering (advocacy brochures and pamphlets) of the surrounding only.

One of the actions mandated for Bhutan InfoComm and Media Authority (BICMA) is to ensure that minors (below 18 years) are restricted from entering entertainment venues such as drayangs and discotheques that exclusively promote alcohol consumption (Pelden, 2016). The policy also mandates the authority to notify drayangs, nightclubs and other places of entertainment where alcohol is sold to conduct age identification checks to restrict underage entry. The authority will also develop a joint enforcement implementation plan with the economic affairs ministry to enforce the prohibition of sale of alcohol in entertainment venues after 10 PM (Pelden, 2016). Though such implementation are done, there is need for close monitoring in the entertainment venues, they could either monitor through letting a stakeholder (RSTA) to regulate the policies and patrol the venues or the government can implement like other countries to check individual’s citizenship card for minors to not enter freely and have easy access to the entertainment venues.

In one of the report, bylaw there was reduction of home brewing of alcohol was discouraged in the communities, where alcohol use during religious rituals was replaced by soft drinks, disallowing sell of alcohol in grocery shops and communities started contributing a fixed amount instead of alcohol during bereavement in the communities (Dil K. Subba, 2018). A group was identified in the chiwog to monitor the bylaws and the group have been continuously monitoring the compliance of the bylaws agreed in the communities. All community events like tshechus, religious rituals and bereavements were monitored to reduce alcohol use. Gewog administration restricted unlicensed sale of industrial alcohol in the communities (Dil K. Subba, 2018). There has been good cooperation from the community as well as the group who are responsible for monitoring. The Mental Health Programme of the Ministry of Health has been periodically following-up with the monitoring group to ensure compliance ever since the start of the study project.

Bhutan has an alcohol control policy in place, the National Policy and Strategic Framework to Reduce Harmful use of Alcohol was adopted in 2015 (Royal Government of Bhutan,2015). The policy contains measures which can reduce alcohol consumption and harm if implemented correctly. Nevertheless, there are weak enforcement of laws, weak coordination among implementing agencies, and lack of clarity among local governments on their enforcement authority have been recognized as major barriers to effective implementation of the law. By strengthening the implementation of these laws the country can reduce the growing alcohol abuse and harms.

The report, the National Policy and Strategic Framework to Reduce Harmful use of Alcohol was adopted in 2018 (Royal Governement of Bhutan, 2018), added that laws are not implemented properly due to lack of human capacities and inadequate financial resources. Due to one of factors for increase in youth alcohol use were lack of communication with parents and lack of recreational activities for youth. There is a lack of adequate support for rehabilitation services, necessary aftercare services and social stigma surrounding the issue alcohol use disorders for the youths and the alcohol dependents. Currently centers only cater to about 20% of the substance use disorder cases. The recommendation for the report and implementation is that government focus on addressing the issues, affirmative actions to ensure responsible parenting, affordable recreational facilities, and rehabilitation services and to explore taxation and pricing policy.

Non-governmental organizations are essential partners for alcohol policy; they are a vital component of a modern civil society, raising people’s awareness of issues and their concerns, advocating change, creating a dialogue on policy and exposing harmful actions of the alcohol industry. They should be one of the stakeholder for the implementation of policy related to alcohol, NGOs in particular, those organizations which deal with families, civil, cultural, economic, political, and social rights, including those that deal with the rights of children and young people would be the most prominent stakeholder for it.

Agencies such as Royal Bhutan Police and Dessungs, should be one the stakeholder for the implementation as they will be more aware of minors who are abusing alcohol, where they won’t be focusing only on the general age group. The perception from these agencies group will make it more prominent on how to go on and which policies or implementation needs more focus to make it more effective.

Consumption of alcohol is widely accepted and ingrained in the Bhutanese society and culture; alcohol is served during the religious rituals and festivals. Alcohol is an addictive drug; it alters cognitive and physiological motor, and causes behavioral disinhibition causing severe risks to individuals and society. In Bhutan and also globally, the basic nature of alcohol is underplayed to promote it as a socially acceptable commodity. Excessive use of alcohol can result in serious health problems; affect interpersonal relationships, increase violence, accidents and road crashes. Alcohol use also has adverse socio-economic consequences due to loss of productivity, premature deaths and disabilities. Therefore, to adverse those issues and challenges, there is a need for more effective and efficient implementation of policies with the joint multistakeholder to make it more prominent.

References

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