Pubdate: Thu, 7 Dec 2000
Source: New England Journal of Medicine (MA)
Vol. 343, No. 23
Copyright: 2000 by the Massachusetts Medical Society
Contact:  10 Shattuck Street, Boston, MA 02115-6094
Fax: (617) 739-9864
Auhtor: Morris E. Chafetz, M.D. Health Education Foundation


By Dwight B. Heath. 240 pp., illustrated. Philadelphia, Brunner/Mazel, 
2000. SBN 1-5839-1047-6

Americans have a long history of ambivalence about the role of alcohol in 
their society. This vacillation turned to mayhem in 1919, when the 18th 
Amendment to the Constitution (later repealed) introduced Prohibition, 
which banned the manufacture and sale of alcohol nationwide. Today in the 
United States, a person legally becomes an adult at the age of 18: he or 
she becomes a citizen who can vote, serve in the military, sign a contract, 
marry, buy a gun, or buy a pack of cigarettes, but who cannot buy a beer or 
a glass of wine. Out of this gloomy picture shines a bright light: Dwight 
Heath's eminently sensible, intelligent, and hopeful book, Drinking 
Occasions: Comparative Perspectives on Alcohol and Culture, in which he 
describes the variety and versatility of drinking in many other parts of 
the world. In contrast to the negative view of alcohol in the United 
States, the reader is treated to descriptions of relaxed and positive 
experiences of drinking.

We must keep in mind that any product can be misused, even water and 
oxygen. Some long-distance runners have collapsed and died from drinking 
too much water, and some physicians have unknowingly caused blindness in 
premature babies by pumping too much oxygen into their incubators. Heath's 
book gives us the opportunity to learn about the drinking experiences of 
cultures that enjoy the social and health benefits of alcohol while 
avoiding the pitfalls of misuse. Can Americans take some practical advice 
about drinking behavior from, for example, cultures across the Atlantic? I 
confess to having reservations about such a possibility, because the 
"virus" of Puritanism continues to infect the United States in many ways, 
especially in relation to pleasure.

Right now, the federal government is prescribing a "safe" formula for those 
who choose to drink: two drinks per day for a man and one drink per day for 
a woman. In some other cultures, Heath reports, it is customary during a 
meal to serve a different wine with each dish and then a liquor or brandy 
with dessert. He goes on to state that although a person "may consume six 
or more drinks in the course of a meal, it is rare that anyone shows any 
[untoward] effects from doing so." Moreover, people may "match specific 
beers with specific foods." Heath emphasizes that "expectation plays a 
major role in shaping the effects (or lack thereof) of ethanol on a 
person's awareness and behavior." In many parts of the world, "popular 
beliefs based on generations of experience and reinforced by folk proverbs 
hold that those who drink are more healthful and hardy than those who do 
not, and their offspring are also [healthful and hardy]." In addition, 
alcohol use is integrated with many other human activities and is not 
viewed as an isolated phenomenon.

Contrast that with advice given to the American people. Experts seem to 
have a license to extrapolate findings as cause, exaggerate the 
consequences of alcohol misuse, manipulate people with misleading 
statistics, and frighten women who are even thinking about becoming 
pregnant into refraining from imbibing alcohol. During an era when the 
Surgeon General and social scientists are telling Americans how to live by 
the use of correlation as cause, Heath warns us, "Don't confuse numbers 
with science, and don't interpret a lack of numbers as implying an absence 
of science."

After studying the use and abuse of alcohol for 47 years, I have concluded 
that personal and social responsibility, not the substance, is the issue. 
Alcohol should be viewed as an inert, inactive substance put in a bottle or 
can to be used for health and pleasure by reasonable people.

Absent from Heath's examination of alcohol is the complicated problem of 
the self-destructive impulses and behaviors we all have to a lesser or 
greater degree. As we read his carefully crafted book, we come to see that 
the use of alcohol reflects a society's circumstances, experiences, and 
values. There should be more emphasis on the person and the surroundings in 
which alcohol is consumed and less emphasis on alcohol itself. Drinking 
behavior varies widely -- socially, culturally, and personally. The journey 
through life consists not of simple yes-or-no decisions and good or bad 
choices but the assumption of personal responsibility for these choices and 
decisions. Heath unfolds the vagaries of the use of alcohol by exploring 
when, where, how, what, and why people drink or do not drink. Whether we 
like it or not, alcohol is woven into the fabric of our world.

The physical, psychological, and social benefits of alcohol are well 
established. Heath's book provides a well-documented glimpse into the use 
of alcohol in other cultures and reveals how the United States -- in 
purportedly trying to produce a good, by dictum and denial -- often ends up 
doing harm.
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