Nancy and Ron --
    First, let me add Ron's thanks for this account.
    There are at least two other published accounts of how estimates of the number of alcoholics were arrived at in the late 1960s and early 1970s, which view the elephant from different legs.  One is pp. 55-60 in Joseph Gusfield, The Culture of Public Problems: Drinking-Driving and the Symbolic Order,  Chicago: University of Chicago Press, 1981.  I believe there is another in Carolyn Weiner,  The Politics of Alcoholism, Transaction Books, 1981 -- I can't find a copy of that with me here.   And there is a third short discussion of the issue in Don Cahalan, Understanding America's Drinking Problem, San Francisco: Jossey-Bass, 1987, p. 17.  All three of these accounts depend to some extent on recollections from Don Cahalan or myself.
    As I remember hearing it from Don at the time (slightly different from Gusfield's account), the original "nine million alcoholics" came from when Jack Mendelson, then the head of the Center in NIMH which immediately preceded NIAAA, was testifying to Congress, presumably in 1969 or 1970.  Someone on the hill asked him the one question of any political interest in those days: how many alcoholics were there in the U.S.?  Nate Rosenberg, our project officer at NIMH, was told to call Don Cahalan and ask him the question.  Don demurred, going into a long song-and-dance about how it depended how you defined it, and anyway we weren't measuring "alcoholism" in our surveys.  Eventually Nate gave up.  But this was not an acceptable answer.  Shortly after, Nate called back to say that NIMH was funding us to do epidemiology, and we had to provide an answer.  After further demurrers, Don eventually said something like: well, if you want to provide a number, here is where you should look in our publications.  My memory is that the 9 million came from the rate of Heavy Escape drinkers in the 1964 national survey (not the 1967 survey, which Gusfield attributes it to -- so it was actually even father from a measure of "alcoholism" than Gusfield realized). 
    In the first Alcohol and Health report to Congress (1971), Mark Keller played a major editorial role.  He was basically a problem deflator -- concerned that the number be kept down rather than up.  I don't have the report in front of me, but I believe it distinguishes between "alcoholics and "problem drinkers", with 5 million for the former and 9 million if you included the latter.
    For the second report to Congress (1974),  Tom Harford from NIAAA was deputed to ask me to write a paragraph about how many alcoholics there are in the US.   The sentence which finally appeared in the report read as follows:
      "The number of Americans whose lives alcohol has adversely affected depends on definition: those under active treatment for alcoholism in public or private agencies are probably in the upper hundreds of thousands, but there may be as many as 10 million people whose drinking has created some problem for themselevs or their families or friends or employers, or with the police, in the past year."
    I had written a further sentence which said something like: "The number whose drinking has created such problems sometime in their life may be as many as 20 million".  Apparently this number was too high for the political process to stand, and the sentence was dropped.
    The "10 million" was chosen as a way of expressing that we were talking about orders of magnitude, rather than hard figures (see Ron's post on the problem that we are dealing with a continuum, or maybe more than one).
    But I was told that someone got up in Congress and, pointing to the 10 milllion figure, said something like: Look how bad things are.  We've been fighting alcoholism for three years and the numbers have gone up by one million!
    Note that "whose lives alcohol has adversely affected" in those far-off days referred only to the drinkers themselves -- the focus on and estimates of the numbers other than the drinkers whose lives were affected by the drinkers lay in the future. 
    There is a paper by Popham from the 1960s which argues for the validity of the Jellinek formula because look, all these other estimates agreed with it.  My argument against that (I'm not sure if and where I put it in writing) was that the Jellinek estimate tended to yield figures which were about the geometric mean of the politically believable range. Noone would believe a figure below 1 million.  But neither would anyone believe a figure above 13-15 million.  So any estimate which did not fall in this range would be discarded -- probably not published in the first place. This way, there would be fair agreement with any estimate which ended up with figures around 5 million or so. 
    The puzzling thing about all this is that the numbers in Nancy's recollections don't look at all the same as the numbers in the tradition coming from Alcohol Research Group recollections.  I wonder how the stwo histories can be put together. 
    -- Robin 

-----Original Message-----
From: Ron Roizen <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: den 4 februari 2000 19:57
Subject: How many alcoholics?


>Nancy,
>
>Accidental or not, thanks for posting this to the whole list!
>
>I'd like to take issue with one element of your account, though.
>
>There were, and there are, no epidemiological studies that did or could
>confirm your 13+ million figure regarding the prevalence of alcoholism in
>the U.S.  The central problem was that survey measures of "drinking
>problems" resulted in continuous rather than bi-modal distributions on
>their drinking problems measures.  Hence, the results did not lend
>themselves to drawing an easy cutting point between alcoholic and
>subalcoholic drinking and drinking problems.  (The problem was first
>articulated in Walter Clark's classic paper -- "Operational Definitions of
>Drinking Problems and Associated Prevalence Rates," Quart. J. Stud. Alcohol
>27:648-668, 1966 -- and then echoed and ramified through countless
>publications at the Alcohol Research Group in years following.)  A
>secondary problem was that general population surveys would tend to miss
>what's called the "nonhousehold population" of alcoholics -- i.e., residing
>in one or another institutional or "group quarters" or even homeless
>circumstances.
>
>Of course, this did not stop the movement on behalf of the expansion of
>alcoholism treatment in the U.S. from pressuring survey researchers to
>produce alcoholism prevalence estimates regardless.  And the meeting of
>these two forces -- survey researchers saying they couldn't do it and
>political-social advocates saying "Give us a number anyhow!" -- produced
>the sort of comedy and absurdity you described in your own experience in
>Congress.  In due course the folly of the scientific situation was reported
>to a wider scientific public -- see, Barnes, Deborah M., "Drugs: Running
>the Numbers," Science 240:1729-1731, (24 June) 1988.  Robin Room has
>somewhere recounted the situation surrounding prevalence estimation, too,
>but at the moment I can't remember where.  Also see Hilton, M.E., "What I
>would most like to know: How many alcoholics are there in the United
>States?". British Journal of
>Addiction, 84(5):459-460, 1989.
>
>There may have been 13+ alcoholics in the U.S.; your guess was as good as
>the epidemiologists'!