by Edward M. Brecher and the Editors of Consumer Reports Magazine, 1972
Heroin, LSD, and marijuana are prohibited in the United States today, in part on the ground that they are dangerous and in part on the ground that they serve no useful medical purpose. The prohibition of the barbiturates, the nonbarbiturate depressants, and the minor tranquilizersdespite their potential hazards-is rarely suggested even by antidrug extremists; their unquestioned importance as medicines stands in the way. But what about alcohol? Should it not be banned on the same grounds that heroin, LSD, and marijuana are prohibited?
Let us put aside the weighty arguments against alcohol prohibition, and try to consider seriously for the moment the arguments in its favor.
Alcohol addiction is second only to nicotine addiction in incidence and prevalence in the United States today. A conservative estimate is that five million Americans are alcoholics, but figures of as high as seven to nine million alcoholics and "problem drinkers" are also cited.1 Alcohol addicts are unable to refrain from their drug even though they decide to, want to, and try to quit drinking alcohol; those who succeed for a time remain in imminent danger of relapse.* To the millions of alcohol addicts must be added millions of "spree drinkers" who are not addicted but who get roaring drunk from time to time. Alcohol prohibition, if enacted and effectively enforced, would keep these addicts and drunks away from their drug; and it would prevent new cohorts of young people from becoming addicted-or so it might be logically argued.
* It is commonly supposed that alcohol addicts, like narcotics addicts, are weak willed and that it is their weakness of will that led them to become-and to remain addicts. The evidence is superficially plausible: even though two people may drink alcohol (or take barbiturates) in precisely the same pattern, it is said, only one of them may become addicted. The difference between the two may not be in strength of will, however; it is at least equally plausible to hypothesize a difference in enzymes or in other biochemical factors distinguishing the metabolism of alcohol in the addict and in the similarly exposed nonaddict. Nobody really knows. The preponderance of the evidence currently available favors the view that the difference lies in the childhood of the two drinkers, in their social environment, and in the stresses to which they are exposed as adults. But, as noted with respect to narcotics (see Chapter 10), most researchers through the decades have been looking for psychological and sociological evidence; it is hardly surprising (or convincing) that that is what they have found. If as much research, energy, and ingenuity were devoted to the search for biochemical factors, the preponderance of evidence might soon shift to the biochemical explanation. There has recently been a small increase in biochemical studies of alcoholism, but it is still too early to review or evaluate the findings here.
Alcohol addiction, unlike morphine addiction, is utterly destructive to the human mind. Among 70,000 first admissions of males to state mental hospitals in 1964, for example, more than 15,000 (22 percent) were given a diagnosis of alcoholism at the time of admission. Among female mental hospital admissions, the proportion with an alcoholism diagnosis was 5.6 percent. "In nine states, alcoholic disorders lead all other diagnoses in mental hospital admissions. Maryland, for example, reports that 40 percent of all male admissions are for alcoholism." 2 The remarkable absence of narcotics addicts among mental hospital admissions was noted in Part 1.
Alcohol is similarly destructive of the human body. "The impact of problem drinkers on the medical-surgical wards of general hospitals is illustrated by a study in which the extent of drinking problems among 100 consecutive male admissions to a general hospital was determined. No preselection was made in terms of the diagnosis of the patients, and the hospital did not have a psychiatric service. The admitting physicians identified twelve of the 100 men as problem drinkers, and seventeen additional cases of probable alcoholism were uncovered by the researcher, making a total of 29 percent." 3
Whether alcohol is solely responsible for this damage to mind and body, or whether defective nutrition also plays a role, has long been debated. Alcohol contains calories; indeed, a heavy drinker may consume half or more of his caloric needs in the form of alcohol. The result is to reduce quite drastically his consumption of proteins, vitamins, and other essential nutrients. The informed consensus is that the two effects march hand in hand; irreversible brain and liver damage, for example, is less severe in the alcoholic who maintains adequate nutrition-but it can occur all the same.* Making alcohol unavailable would thus contribute enormously to physical as well as mental health.
* Proposals to fortify alcoholic beverages with vitamins-especially the B vitamins have occasionally been made, but have been rejected on the ground that doing this might encourage drinking. Hence neurological and liver damage continues to be needlessly frequent among alcoholics.
Alcohol is also by a wide margin the biggest law-enforcement problem in the United States today. "In 1965, out of close to five million arrests in the United States for all offenses, over 1,535,000 were for public drunkenness (31 percent). In addition, there were over 250,000 arrests for driving while intoxicated. Another 490,000 individuals were charged with disorderly conduct, which some communities use in lieu of the public drunkenness charge. Thus at least 40 percent of all arrests are for being drunk in a public place or being tinder the influence while driving. . . . Many persons arrested for public drunkenness are no more intoxicated than countless other individuals who escape arrest because they are not exposed and vulnerable to police detection as are skid row men. The public is more likely to insist on the police removing the unshaven, toothless, poorly clothed men than an equally drunk visiting business man." *5
* In 1966, New York City police stopped arresting for drunkenness, with no perceptible effects except to free the police (and courts and jails) for other kinds of crimes.4
Homicide is also an alcohol-related crime. A 1954 Ohio study revealed that 43 percent of those who committed homicide had been drinking.,, A Texas study the following year indicated that 28.5 percent of all homicides took place in bars, cocktail lounges, and other public places where liquor was served.7 More remarkable still, drinking increases the likelihood that a man or woman will be a victim of homicide. A 1951 Baltimore report indicated that 69 percent of homicide victims had been drinking." Among 588 Philadelphia homicides, according to a careful study by Dr. M. E. Wolfgang in 1958, alcohol was absent from both killer and victim in only 36 percent of the cases. In 9 percent of the cases, alcohol was found only in the corpse of the victim; in 11 percent it was found only in the bloodstream of the killer-and in 44 percent of the cases, both killer and victim had been drinking.* 9
* In the Isbell study (see Chapter 29), it will be recalled, four of the five experimental subjects, though peaceful and friendly when sober, quarreled and fought when drunk.
The Wolfgang report on Philadelphia homicides also revealed that alcohol is associated with specific methods of homicide; thus 72 percent of the stabbings involved the presence of alcohol, as compared with 69 percent of the beatings, 55 percent of the shootings, and only 45 percent of the "miscellaneous" methods.
"On the basis of the present data," Dr. Richard H. Blum-who assembled the figures above-concludes, "one can say that there is a strong link between alcohol and homicide and that the presumption is that alcohol plays a causal role as one of the necessary and precipitating elements for violence. Such a role is in keeping with the most probable effects of alcohol as a depressant of inhibition control centers in the brain-leading to release of impulses." 10
In sum, the total of alcohol-related arrests reaches 55 percent of all arrests." Surely it makes more sense, alcohol prohibitionists might argue, to ban the drug itself rather than to arrest millions of users of the drug after they have committed murder or lesser offenses.
Alcohol is a significant factor in the "battered child syndrome." In a high proportion of cases in which a parent beats his young child so severely that hospitalization is required or that death ensues, the parent is drunk at the time.
The relationship between alcohol and suicide is also very close. A 1962 Washington State study, for example, showed that 23 percent of suicide attempts were made by persons who were known to be alcoholics and 31 percent of the successful suicides were known to be committed by alcoholics .12 The true figures, the investigators warned, were almost certainly higher. Other studies report similar findings-and also indicate that many suicides were drinking or drunk at the time of the act. Dr. Karl Menninger and other psychiatrists have suggested, indeed, that alcoholism is itself a form of "chronic suicide." No one knows how many cases of death from acute and chronic alcoholism are in fact suicides, with alcohol as the deliberately chosen means of rapidly or slowly achieving death. Nor is it possible to estimate the number of suicides among drunken drivers who are found dead at the wheel following a crash. But most drivers found dead at the wheel have been drinking.
"Coroners' reports on levels of blood alcohol found in autopsies reveal high concentrations . . . in fatal accident victims," Dr. Blum notes. "Among drivers rated as probably responsible for their accidents, 73 percent had been drinking to some extent whereas only 26 percent of the similarly exposed (site-matched controls) * had been drinking. Forty-six percent of the accident responsible group had blood alcohol concentrations in the very high 0.25 percent and over range. In contrast, not a single one of the drivers in the large control group had a concentration in this range." 13 In another study, 50 percent of the fatally injured drivers had blood alcohol levels of 0.15 percent or more at the time of death .14 Among fifty pedestrians dying within six hours after an automobile accident in yet another study, 74 percent had been drinking, as compared with 33 percent of the controls sampled at the same accident site. One third of those killed had blood alcohol levels greater than 0.15 percent as compared with only one-sixteenth of the controls.15 "It appears clear," Dr. Blum concludes, "that drinking is a factor not only in driver accidents but also in pedestrian (victim) fatalities." 16
* In a site-matched control study, the blood alcohol level of the drivers responsible for accidents is compared with the level in other drivers, randomly selected from among those present in the same vicinity at the same time.
The possibility remains, of course, that alcohol in small amounts insufficient to impair driving skills-may actually prevent some accidents as a result of its calming effect. But on balance, alcohol almost certainly causes far more accidents, and far more fatal accidents, than it prevents.
Alcohol drinking leads in some cases to narcotic addiction. "In Western society," Dr. Jaffe wrote in Goodman and Gilman's textbook (1965), "individuals who later become addicts invariably have experiences with alcohol prior to using opiates. A considerable number of such persons also experimented first with marijuana, amphetamines, barbiturates, and tranquilizers. Such agents seem to serve the function of alerting the individual to the fact that substances exist which may be able to alter feelings of inner tension." 17 In addition, as noted in Part 1, many narcotic addicts first turn to heroin in order to escape the ravages of alcoholism.
Many people worry about the effects of drugs taken during pregnancy, but alcohol consumed during pregnancy is rarely included in this concern. Does alcohol pass through the placenta, and if so, does it damage unborn babies? It is shocking indeed to have to report that no one really knows; few studies have been made. The probability is that alcohol does pass through the placenta; and that if taken by a pregnant woman in large quantities over long periods it is unlikely to do the fetus any good.
An opponent of alcohol prohibition might argue that alcohol, after all, is drunk by adults; drugs such as marijuana and LSD are more in need of prohibition because high-school and college-age students use them. But the facts do not bear this out. A survey published in the September 1971 issue of Playboy magazine found alcohol rather than marijuana to be the drug of choice among college students by a vote of two to one. Even in high schools where marijuana and LSD are readily available and in common use, surveys indicate that alcohol remains the chief drug problem. High-school students not only drink alcohol; they get roaring, stinking drunk on it. They vomit. They "black out" (forget what has happened). And they pass out cold. A further discussion of alcohol and marijuana use among high-school and college students %vill be found in the discussion of marijuana in Part VIII.
One of the most powerful arguments in favor of alcohol prohibition is rarely advanced-that it is useless to prohibit other drugs, even heroin, so long as alcohol remains freely available. Many heroin addicts deprived of heroin promptly turn to alcohol instead and become alcoholics (see Part I). Many marijuana smokers whose marijuana supply is cut off increase their alcohol consumption (see table on Page 442). Many barbiturate addicts also turn to alcohol-and the same is presumably true of the users of other drugs as well. Thus, banning other drugs accomplishes little of value; it simply increases the number of those who turn to alcohol (or increases the amount they drink). Until people are willing to enforce alcohol prohibition, this argument therefore concludes, they are simply wasting their efforts in trying to enforce heroin prohibition, marijuana prohibition, and other drug prohibitions.
This discussion hardly exhausts the arguments for alcohol prohibition, but it is perhaps sufficient to demonstrate the inherent logic of such a proposal. From the humanitarian as well as the societal point of view, for the benefit of drinkers and potential drinkers as well as teetotalers, for the benefit of ex-heroin addicts and users of other drugs, and especially for the benefit of young people, alcohol should be promptly prohibited except for one consideration.