Alcohol Special Edition

Utah Addiction Center University of Utah Health Sciences Center 410 Chipeta Way, Suite 280 Salt Lake City, Utah 84108

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Non-profit Organization

Special

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Addiction Center

U.S. POSTAGE PAID Salt Lake City, Utah Permit No. 1529

Volume 2 Issue 11

June 2010

Report

Dedicated to research, clinical training, and education in chemical addiction

Drugs: A Historical Perspective

Alcohol

Contact Us University of Utah Health Sciences Center 410 Chipeta Way, Suite 280 Salt Lake City, Utah 84108 Phone: (801) 581-8216 Fax: (801) 587-7858 E-mail: abbie.paxman@hsc.utah.edu Internet: http://uuhsc.utah.edu/uac/

While other drug issues such as the social impact of illicit methamphetamine and prescription drug abuse have captured the media headlines lately, the problems of alcohol abuse and alcoholism continue to be the cornerstone of many of our public health and social problems. For this reason, we have selected alcohol as the second in our historical series on drugs of abuse. The prominence of alcohol in drug abuse concerns is underscored by the 2009 findings that in Utah alcohol is by far the number one drug of choice in adults receiving stateassisted treatment for substance dependence. While there are many issues relevant to alcohol-related problems worthy of discussion, of particular concern is the fact that the vast majority of those who eventually develop severe alcohol dependence began exposure to this drug in their teenage years. This is supported by the national 2009 Monitoring the Future Survey findings in adolescents (available: http://www. monitoringthefuture.org/data/data.html ).

The Utah Addiction Center is based in the office of the University of Utah Senior Vice President for Health Sciences INSTITUTIONAL ADVISORY BOARD

A. Lorris Betz, M.D., Ph.D. Louis H. Callister, J.D. Edward B. Clark, M.D. M. David Rudd, PhD, ABPP Patrick Fleming, LSAC, MPA Raymond Gesteland, Ph.D. Jay Graves Ph.D. John R. Hoidal, M.D. Glen W. Hanson Ph.D, D.D.S, Maureen Keefe, RN, Ph.D Jannah Mather, Ph.D. Chris Ireland, Ph.D. John McDonnell, Ph.D. Barbara N. Sullivan, Ph.D. Ross VanVranken, ACSW Kim Wirthlin, MPA

In summary, it was reported that during the previous month the percent of 12th, 10th, and 8th graders who consumed alcohol were 42, 36 and 17, respectively. This alarmingly high rate of frequent alcohol consumption by adolescents is at least partly due to easy access (considered to be “easy” by ~80% of the adolescents polled) despite the fact that 50-60% of these teenagers considered alcohol consumption to be To understand drug of abuse issues of great risk. such as why they are so popular, The fact that almost half of the young population in their effects on society and its the United States are regular consumers of alcoholic institutions, and attitudes toward beverages by the time they reach adulthood is their regulation, it is helpful to particularly troubling in light of repeated scientific appreciate where these substances findings that brain systems such as the frontal came from and their historical lobes (responsible for functions such as emotional highlights. regulation, planning and organization and decisionmaking) undergo delicate development during To this end, we devote occasional adolescence and are especially vulnerable to the toxic UAC Newsletters to historical and addictive actions of alcohol. discussions of drugs of abuse. This The brain damage caused by early drinking issue is devoted to alcohol. substantially increases the likelihood of emotional and personal problems, is long-lasting and dependent All articles in this issue are used with permission from the book Drugs and upon the frequency and intensity of alcohol Society, Tenth Edition unless otherwise consumption (Moyer, C. Teen Alcohol Use Interferes noted. with Brain Development. American Medical News, May 10, 2010). » See Alcohol page 7

A new look?

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Alcohol: Historical Considerations

“Alcoholism” Over the Years - from wikipedia

Alcohol has a long history of use and misuse throughout recorded human history. Biblical, Egyptian and Babylonian sources record abuse and dependence on alcohol. In some ancient cultures alcohol was worshiped and in others its abuse was condemned. Excessive alcohol misuse and drunkenness were recognized as causing problems thousand of years ago. However, the defining of habitual drunkenness (as it was then known as) and its adverse consequences were not well established medically until the 1700s. In 1647 a Greek monk was the first to document that chronic alcohol misuse was associated with toxicity to the nervous system and body which resulted in a range of medical disorders such as seizures, paralysis and internal bleeding.

From a peak in 1830, when the amount of alcohol ingested by the average American was 7.1 gallons per year, use declined continuously until 1871-1880, when the average was 1.72 gallons. Numbers then rose to a high in 1906-1910 to 2.6 gallons, then fell to 1.96 gallons just before Prohibition, 19161919. Under Prohibition, less than a gallon of absolute alcohol per person was consumed annually, on average. During the last half of the 20th century, alcohol consumption stayed constant, within the 2- to 3-gallon range. Wine and beer gained in popularity, while the popularity of “spirits” (hard liquor) declined (Lender 1985). Alcoholic beverages have played an important role in the history of the United States as well as in most countries throughout the world. Most likely, fermentation was the first method for making alcohol, dating to 4200 B.C. As early as A.D. 100, it appears that brandy was the first distilled beverage. In Ireland and Scotland, whiskey was first distilled in the 1400s, and gin began appearing in the 1600s, after being initially distilled by a Flemish physician. Other types of liquor also have distinct origins. For example, rum was first invented in Barbados in the 1650s. Bourbon was first made near Georgetown, Kentucky, in the late 1700s. In the United States, the first distillery was created in the 1600s in the area that is now New York City.

Historically the name dipsomania was coined by German physician Dr. C. W. Hufeland in 1819 before it was superseded by alcoholism. The term “alcoholism” was first used in 1849 by the Swedish physician Magnus Huss to describe the systematic adverse effects of alcohol. A 1960 study by E. Morton Jellinek is considered the foundation of the modern disease theory of alcoholism. The modern medical definition of alcoholism has been revised numerous times since then. The American Medical Association currently uses the word alcoholism to refer to a particular chronic primary disease.

In colonial America, alcohol was viewed very favorably. From an Pirates carrying rum to shore to purchase economic standpoint, the manufacturing of rum became New England’s largest and most profitable industry in the so-called triangle trade. It slaves as depicted in The Pirates Own Book by Charles Ellms acquired this name because Yankee traders would sail with a cargo of rum to the West Coast of Africa, where they bargained the “demon” for slaves. From there, they sailed to the West Indies, where they bartered the slaves for molasses. Finally, they took the molasses back to New England, where it was made into rum, thus completing the triangle. For many years, New England distilleries flourished and the slave trade proved highly lucrative (see Figure 8.6). This process continued until 1807, when an act of Congress prohibited the importation of slaves. From a social standpoint, the consumption of alcohol was seen as a part of life. The colonial tavern “was a key institution, the center of social and political life” (Levine 1983, p. 66) . In the 17th and 18th centuries, alcohol flowed freely at weddings, baptisms, and funerals. Especially in the 18th century, people drank at home, at work, and while traveling. In the 19th century, largely because of the temperance movement, taverns became stigmatized and were viewed as dens where the lower classes, immigrants, and mostly men would congregate. “Any drinking, [Lyman Beecher] argued, was a step toward “irreclaimable’ slavery to liquor” (Lender and Martin 1987). People in the 19th century began to report that they were addicted to alcohol. Here is where the temperance movement had its effects in bringing about a change in attitudes regarding drinking. The Utah Addiction Center Report

Stereotypes of alcoholics are often found in fiction and popular culture. The 1904 Advertisement ‘town drunk’ is a stock character in Western popular culture. Stereotypes of drunkenness may be based on racism or xenophobia, as in the depiction of the Irish as heavy drinkers.

» Alcohol

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Because alcohol is the most commonly used and abused drug by the youth in this country according to the Centers for Disease Control and Prevention, the American Academy of Pediatrics has recently published an updated policy statement on alcohol use by youth and adolescents in order to help prevent and reduce underage drinking (American Academy of Pediatrics, “Policy Statement Alcohol Use by Youth and Adolescents: A Pediatric Concern,” published online April 12, 2010 (available: pediatrics.aappublications. org/cg/reprint/peds.2010-0438v1 ). These recommendations include: • Be aware of potential genetic and family influences regarding alcohol use • Recognize risk factors for adolescent use and be aware of mental health problems that can occur in this group • Screen youth regularly for alcohol consumption and intervene appropriately during early stages of use • Parents should be advised to aggressively discourage alcohol consumption by their children • Parents should be encouraged to be good role models for healthy life choices • Support continuation of 21 as the minimum legal drinking age In summary, the most effective approaches to dealing with alcohol abuse is to be vigilant early in adolescence, understand the particular risks to teenagers, educate yourself and the youth about consequences and prevention, and do all you can to discourage adolescent exposure to this drug.

Village Tavern by American painter John Lewis Krimmel (1787-1821)

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The Utah Addiction Center Report

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The Temperance Movement (1830-1850)

The Great American Fraud: Patent Medicines

The time from the temperance movement to the Prohibition era was a very turbulent period in the history of alcohol in America. The period of heaviest drinking in America began during Jefferson’s term of office (1800-1808). The nation was going through uneasy times, trying to stay out of the war between Napoleon and the British allies. The transient population had increased, especially in the seaport cities, and the migration westward had begun. Heavy drinking had become a major form of recreation and a “social lubricant” at elections and public gatherings. The temperance movement never began with the intention of stopping alcohol consumption but with the goal of encouraging moderation. In fact, in the 1830s, at the peak of this early campaign, temperance leaders (many of whom drank beer and wine) recommended abstinence only from distilled spirits, not from the other forms of alcohol such as beer or wine. This movement developed from several very vocal spiritual leaders who preached that alcohol harms “the health and physical energies of a nation” and that alcohol interfered with the spreading of the gospel. Later, as is explained shortly in more detail, the temperance movement went against all other forms of alcohol.

In the late 1800s and early 1900s, before the days of FDA legislation, the sales of uncontrolled medicines flourished and became widespread. Many of these products were called patent medicines, which signified that the ingredients were secret, not that they were patented. The law of the day seemed to be more concerned with someone’s recipe being stolen than with preventing harm to the naive consumer. Some of these patent medicines included toxic ingredients such as acetanilide in Bromo-Seltzer and Orangeine and prussic (hydrocyanic) acid in Shiloh’s Consumption Cure. Most patent medicines appear to have been composed largely of either colored water or alcohol, with an occasional added ingredient such as opium or cocaine. Hostetter’s Stomach Bitters with 44% alcohol could easily have been classified as liquor. Sale of Peruna (28% alcohol) was prohibited to Native Americans because of its high alcoholic content. Birney’s Catarrh Cure contained 4% cocaine. Wistar’s Balsam of Wild Cherry, Dr. King’s Discovery for Consumption, Mrs. Winslow’s Soothing Syrup, and several others contained opiates as well as alcohol.

In 1905, Collier’s Magazine ran a series of articles called the “Great American Fraud,” which warned of the abuse of patent medicines. This brought the problem to the public’s attention (Adams 1905). Collier’s coined the phrase “dope fiend” from “dope,” an African word meaning “intoxicating substance.” The American Medical Association (AMA) joined in and widely distributed reprints of the Collier’s story to inform the public about the dangers of these medicines, even though the AMA itself accepted advertisements for patent medicines that physicians knew were addicting. The publicity created mounting pressure on Congress and President Theodore Roosevelt to do something about these fraudulent products.

Because the temperance movement was closely tied to the abolitionist movement as well as to the African American church, African Americans were preeminent promoters of temperance. Leaders such as Frederick Douglass stated that “it was as well to be a slave to master, as to whisky and rum. When a slave was drunk, the slaveholder had no fear that he would plan an insurrection; no fear that he would escape to the north. It was the sober, thinking slave who was dangerous, and needed the vigilance of his master to keep him Frederick Douglass a slave” (Douglass 1892, p. 133). Over the next decades, partly in connection with religious revivals, the meaning of temperance was gradually altered from “moderation” to “total abstinence.” All alcoholic beverages were attacked as being unnecessary, harmful to health, and inherently poisonous. Over the course of the 19th century, the demand gradually arose for total prohibition (Austin 1978).

In 1905, Roosevelt proposed that a law be enacted to regulate interstate commerce of misbranded and adulterated foods, drinks, and drugs. This movement received further impetus when Upton Sinclair’s book The Jungle was published in 1906 - this nauseatingly realistic expose detailed how immigrant laborers worked under appalling conditions of filth, disease, putrefaction, and other extreme exploitations at Chicago’s stockyards. Two substances used in patent medicines helped shape attitudes that would form the basis of regulatory policies for years to come: the opium derivatives (narcotic drugs, such as heroin and morphine) and cocaine.

By the late 19th and early 20th centuries, a number of countries either passed legislation or created alcohol restrictions. Most of these laws and restrictions eventually failed. In the United States, attempts to control, restrict, or abolish alcohol were made, but they all met with abysmal failure. From 1907 to 1919, 34 states passed prohibition laws. Finally, on a national scale, the 18th Amendment to the Constitution was ratified in 1919 in an attempt to stop the rapid spread of alcohol addiction.

The medical profession of the mid- and late 19th century was ill prepared to do battle with the ever-present manufacturers and distributors of patent medicines. Qualified physicians during this time were rare. Much more common were medical practitioners with poor training and little scientific understanding. In fact, many of these early physicians practiced a brand of medicine that was generally useless and frequently more life-threatening than the patent medicines themselves.

The Utah Addiction Center Report

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The Utah Addiction Center Report

Women of the temperance movement outside a saloon

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The Prohibition Era (1920-1933)

becoming addicted to alcohol during this period. Second, enforcement of laws against alcohol use was thwarted by corrupt law enforcement officials, enforcement was uneven (in some areas of the United States, enforcement was lax, while in other areas very strict), and law enforcement experienced more than 50% turnover in its ranks. Corruption of law enforcement officials stands out as a paramount concern. Reportedly, 10% of law enforcement was “on the take” and had to be continually discharged.

In January 1920, alcohol was outlawed. As soon as such a widely used substance became illegal, criminal activity to satisfy the huge demand for alcohol flourished. Illegal outlets developed for purchasing liquor. Numerous not-so-secret speakeasies developed as illegal establishments where people could buy and consume alcoholic beverages, despite the laws of Prohibition. Bootlegging was a widely accepted activity. In effect, such “dens of sin” filled the vacuum for many drinkers during Prohibition.

Third, among the Western Europeans who immigrated to the United States en masse during this period, the consumption of alcohol was culturally prescribed. Prohibition against alcohol usage to the Italian, German, French, Polish, Irish, and other Europeanbased immigrants was perceived as unnecessary and an infringement to the right to common existence. One 93-year-old Italian American emigre to Chicago exemplified some of these attitudes:

During the temperance movement and Prohibition period, doctors and druggists prescribed whiskey and other alcohol known as patent medicines. By 1928, doctors made an estimated $40 million per year writing prescriptions for whiskey. Patent medicines flourished, with alcohol contents as high as 50%. Whisko, a “nonintoxicating stimulant,” was 55 proof (or 27.5% alcohol). Another, This is an official government document from the 1920s, a Medicinal Alcohol form. This form was Kaufman’s Sulfur Bitters, was used during the American Prohibition to acquire prescription alcohol, usually whiskey, for strictly labeled “contains no alcohol” but medicinal purposes. was 40 proof (20% alcohol) and did not contain sulfur. There were

Well, when we were not allowed to drink because of the government, I thought it was a stupid law. Many of us here in the neighborhood [a fading Italian American community in Chicago’s West Side and the original home of Venturelli] made lots of money as “alki cookers.” We would make the alcohol in our bathtubs and sell to other people or even to those mafia types. Oh, it was horrible cheap and crappy alcohol; if you drank too much the night before, it gave you headaches sometimes for days. On Sunday afternoons, if you walked through this neighborhood Prohibition era Chicago news clipping in the hot summer days, you could smell the alcohol oozing from people’s windows. Nearly everyone my

dozens of others, many of which contained other types of drugs, such as opium.

Detroit police inspecting equipment found in a clandestine underground brewery during the prohibition era.

Both Prohibitionists and critics of the law were shocked by the violent gang wars that broke out between rivals seeking to control the lucrative black market in liquor. More important, a general disregard for the law developed. Corruption among law enforcement agents was widespread and organized crime began and grew to be an enormous illegitimate business. In reaction to these developments, political support rallied against Prohibition, resulting in its repeal in 1933 by the 21st Amendment. Early in the 20th century, women suffragettes had been prominent temperance organizers; paradoxically, flappers organized against Prohibition and were vital in gathering the signatures for its repeal.

mother’s and father’s age and older at the time made extra money as alki cookers. It was actually a good law [referring to Prohibition] for making a few bucks to help out the family expenses. No one around here gave a damn about the law, because too many were “on the take” soto-say ... and it was not just us [referring to the local Italian Americans]. At least for us when we meet together and eat for fun, alcohol is like the air we breathe. Who the hell is going to change that, especially something so deep? (From Venturelli’s research files, interview with a 93-year-old male, May 26, 2000.)

Three main developments occurred as a result of Prohibition. First, alcohol use continued to diminish for the first 2 or 3 years after Prohibition was in effect. This trend had begun several years before the law was passed. More importantly, after 3 years of steady decline, the use of distilled liquors rose every year afterward. Further, even minors were The Utah Addiction Center Report

Prohibition era Chicago news clipping

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The Utah Addiction Center Report

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