------- Forwarded Message Follows -------
Date: Wed, 21 Apr 1999 13:17:41 -0400
Reply-to: Kettil Bruun Society <[log in to unmask]>
From: Stanton Peele <[log in to unmask]>
Subject: Cahalan & Room -- lost classic?
To: [log in to unmask]
Dear Robin:
1999 is the 25th anniversary of the publication by the Rutgers Canter of
Alcohol Studies of "Problem Drinking Among American Men," which I regard
as the classic work associated with your name. I wonder if you could
share with the list some reflections on the status of this book -- and
the alcohol epidemiology field -- on this anniversary.
For me, Cahalan and Room was the first application of modern
multivariate techniques to large-scale survey research data. The work
set base rates and identified themes in alcohol epidemiology which it
has been hard for the field to improve upon.
Among its results were the verification of strong ethnic and
socioeconomic determinants of drinking behavior and problems -- for
example, that lower SES respondents were both more likely to abstain and
to have drinking problems, and that Jews and Ialians had both low
abstinence and problem rates. Even more determinative of drinking was
the impact of immediate social groups -- i.e., those with whom the
drinker associated and drank. While these findings arose from
traditional sociological areas of concern, C & R firmly established them
as epidemiologic realities.
A subtheme of C & R was the empirical questioning of the disease model
of alcoholism, particularly its central focus on loss-of-control
drinking. C & R did not find loss-of-control to be the wheel horse for
alcohol problems as Jellinek had indicated. It was Likewise, Cahaln &
Room did not find progression of drinking problems to be typical.
Indeed, the complex analyses in C & R of the interrelationships and
ordering of drinking problems identified far more prescient discoveries.
For example, C & R identified the highest correlating problem with
"symptomatic drinking" (tolerance/withdrawal) to be psychological
dependence (with which it was more highly correlated than it was with
heavy intake). I thought of this relationship particularly when reading
the recent publications by the WHO/NIJ Cross-Cultural Applicablity (of
alcohol dependence criteria) Research Project, in which you were a key
participant, which found that, "Contrary to expectation, descriptions of
physical dependence criteria appeared to vary across sites as much as
the more subjective symptoms of psychological dependence" (Schmidt &
Room, 1999). Not contrary to expectation if you believed Cahalan &
Room!
C & R also gave empirical grounding to policy concerns such as the
counterproductive potential of control and regulation of alcohol. For
example, it found that problems asociated with outburst-type drinking
were more prevalent in dry areas of the country. This was obviously
related to issues of availability (if you had to drive to get alcohol,
you would be more likely to drink quite a bit at once), but it also had
social-modeling implications. The latter perspective was established by
findings such as that "both problematic intake and tangible
consequences. . . have a curvilinear relationship with the father's
drinking, so that both heavy drinking and, to a lesser extent,
abstinence on the part of the father predict heavy intake and problems
on the part of the son" (p. 116).
Robin, I wonder to what extent you feel the field has progressed beyond
Cahaln & Room. What do you feel are the main new epidemiologic
discoveries made since 1974? That is, what do we know now that we
couldn't divine from C & R? More broadly, do you feel that policy is
better grounded in knowledge than it was in 1974? Are we wiser
drinkers, and policy makers, based on what was learned from C & R and
since then?
Thanks, in advance, for sharing your thoughts.
Yes, SP
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