Two Items Almost Related to US Temperance History
- posted by Jim Leitzel @ 9:31 AM

Alcohol and Drugs History Society provides pointers to two stories about drinking in America. The first is the news that George Washington's still has been reconstructed on its original site, and has begun producing whiskey. Visitors can purchase a taste, too, though one shouldn't expect anything, well, palatable, from the unaged fire water. The reconstruction of the Washington distillery was financed by the Distilled Spirits Council. This industry group has developed a Code of Responsible Practices for Beverage Alcohol Advertising and Marketing, which includes (among other things) rules for not targeting or appealing to the underage in alcohol ads, and not marketing drinks through associations with sexual prowess. Their semi-annual report featuring ads challenged under the rules and the responses to the challenges makes for fairly fascinating reading. Here (32-page pdf) is the most recent (July-December 2006) report.

Oh yeah, the temperance connection: The temperance society that shot through the US like a comet in the 1840s (with a template paralleled by Alcoholics Anonymous 90 years later) was named after the distillery-owning George Washington.

The other story concerns ice cream sundaes. Why are they called sundaes? The term apparently derives from Sundays. But what is an ice cream Sunday? It's an ice cream soda of the type that you consume on a Sunday. Why don't you consume standard ice cream sodas on Sundays? Because soda water is sometimes used as a mixer with alcohol, so its sale on Sundays had to be proscribed, of course. (Here is the book from which this information is drawn, according to the linked article.)

Labels: AA, alcohol, marketing, temperance

 
Twelve-Step Success?
- posted by Jim Leitzel @ 1:18 PM

Treatment programs for addiction often have vocal adherents, but rarely is there much solid scientific evidence for dramatic (or even not so dramatic), replicable success. The sense of futility that infuses the war on drugs* has a parallel with respect to drug treatment. Here is Jon Elster, in the Introduction (page xvii) to his 1999 edited volume, Addiction: Entries and Exits: "There is a wide range of drug treatments. The main thing they have in common is that they rarely work."

Alcoholics Anonymous and similar 12-step-style treatment programs have been popular for decades, but again, the evidence for their success is more anecdotal than systematic. AA itself generally has not been subjected to randomized trials, which offer the best hope for gauging treatment effects. Claimed success rates often seem to cherry-pick, ignoring, for instance, those patients who drop out of treatment or who cannot be located post-treatment. But researchers have been chipping away at this longstanding dearth of evidence.

The May 2006 issue of Addiction opens with a two-page editorial by Keith Humphreys ("The Trials of Alcoholics Anonymous") that summarizes what has been learned so far from methodologically sophisticated analyses of 12-step programs. One study, for instance, documented a harm reduction-versus-abstinence-style result, in which intensive referral to couples therapy (AA and Al-Anon) led to more abstinence but also to more severe problems for those drinkers who did not achieve abstinence.

The systematic evidence remains far from conclusive. Here is how Humphreys, however, concludes his editorial:

Strong views about AA one way or the other will always survive, no matter what evidence accumulates, but the studies of the past 15 years have established beyond any reasonable doubt that high-quality AA trials are possible, and that such studies usually reinforce rather than undermine the excellent reputation the fellowship enjoys around the world.

Update: A less sanguine view, however, is found in a review undertaken under the auspices of The Cochrane Collaboration, an organization that evaluates the evidence concerning the effects of healthcare interventions. The Cochrane review of AA, written by M. Ferri, L. Amato, and M. Davoli, offers these "Authors' conclusions":

No experimental studies unequivocally demonstrated the effectiveness of AA or TSF [Twelve Step Facilitation] approaches for reducing alcohol dependence or problems. One large study focused on the prognostic factors associated with interventions that were assumed to be successful rather than on the effectiveness of interventions themselves, so more efficacy studies are needed.

*Incidentally, I don't accept that the war on drugs is futile -- if only it were! With respect to an alcohol-style regulatory structure, our current prohibition probably does lower the consumption of some drugs, while worsening a host of other social ills.

Labels: AA, addiction, alcohol, treatment

 
Alcoholics Anonymous at 70
- posted by Jim Leitzel @ 6:19 PM

The BBC has an article today about Alcoholics Anonymous, founded in 1935. It offers a couple short paragraphs on three participants, a "regular," a "newcomer," and a "professional." Then there is a section on critics of AA, where Stanton Peele is quoted. One criticism that isn't mentioned is that there is, as far as I know, almost no serious statistical evidence that AA is more effective than other treatments for alcoholism, or than no intervention. Here's a paper that provides some evidence in support of weekly 12-step-style meetings, but the literature review is valuable in pointing out the paucity of other evidence.

Labels: AA, alcohol, treatment

 
The Washingtonians
- posted by Jim Leitzel @ 6:17 PM

I recently finished reading Drunkard's Progress: Narratives of
Addiction, Despair, and Recovery, edited by John W. Crowley,
Baltimore: Johns Hopkins University Press, 1999. The volume collects
excerpts from "temperance narratives" of the 1840s: some of these
are drawn from books that were quite big sellers in their day.

U.S. drinking habits underwent a sea-change between 1830 and 1840.
Around 1830, the per capita consumption of alcohol in the US peaked
at approximately 7.1 gallons per adult (it's never been nearly
that high since); ten years later, drinking had fallen to well less
than half of that figure, to 3.1 gallons per adult. In part, the fall
was due to the success of myriad temperance societies that had formed
to combat, well, intemperance, but more mechanized workplaces (and
overall productivity gains) also made drinking more hazardous and
costly. Despite or because of the decline in drinking, temperance societies
were themselves in serious decline by the late 1830s.

In 1840, however, in my hometown of Baltimore, a new type of
temperance society was founded. Naming themselves after alcohol
drinker and manufacturer George Washington (they considered but
rejected the option of honoring a famous oenophile by adopting the
sobriquet of Jeffersonians), the initiates were themselves inebriates,
or at least tending in that direction. Rather than temperance, they
signed a pledge of abstinence, and they vowed mutual support to
help themselves and other drinkers throw off the habit. (Some of the
earlier temperance societies preached abstinence, too, though
others even served wine at their meetings.) The early Washingtonians
generally were hostile to moral reformers or religious
exhortations, and to upper class efforts to reform the hoi polloi.

According to Crowley's introduction to Drunkard's Progress, "The
heart's blood of Washingtonianism was the confessional narrative.
Instead of cerebral clergymen talking down to the inebriated
unwashed, drunkards gave hope and inspiration to each other through
the unadorned telling of their own life stories [p. 7]."

Washingtonianism spread like the proverbial wildfire throughout the
land. Closed meetings grew into large public affairs, and within a
couple of years, a pledge first signed by six Baltimore friends was
joined by 600,000 followers. (The seriousness with which drinkers
signed the pledge -- sometimes steeling themselves with drink for
the purpose -- is a constant throughout the narratives in Drunkard's
Progress.) Parallel Martha Washington Societies were formed
to help women drinkers and the families of male drinkers. Meeting
attendance and pledge signing were engaged in by many people
who were not inebriates -- indeed, in all likelihood, the vast majority
of participants were not drunkards. Nevertheless, Washingtonianism
was a very positive development, if not a lifesaver, for many
thousands of drinkers and their families.

But the Washingtonian wildfire soon burned itself out, with almost
no active chapters remaining after 1847. It isn't clear why, though
the interested reader should see Chapter 2 ("The Washingtonian
Revival") in the masterful Slaying the Dragon: The History of Addiction
Treatment and Recovery in America, by William L. White
(Bloomington, Illinois: Chestnut Health Systems, 1998), which I have
drawn upon here. Some 95 years after the first Washingtonian meeting,
however, a new group formed to help intemperates -- Alcoholics
Anonymous -- unknowingly adopted many of the strategies first
developed by their all-but-forgotten Washingtonian forebearers.

Labels: AA, alcohol, temperance