Ruth C. Engs, Responsibility and Alcohol: Teaching Responsible Decisions About Alcohol and Its Use for Those who Choose to Drink, Health Education, January/February, 1981:20-22.

Please note this education article was written about 20 years ago but is very timely for today's "new" thought concerning harm reduction and moderate drinking
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Responsibility and Alcohol: Teaching Responsible Decisions About Alcohol and Its Use for Those Who Chose to Drink

Ruth C. Engs, Professor,
Applied Health Science, Indiana University, Poplars 615 Bloomington, IN 47405

History of Alcohol Use

In most cultures, alcoholic beverages have been consumed since prerecorded history for religious, medicinal, or recreational purposes (6). Beer was used by the ancient Babylonians and wine by the Hebrews in religious ceremonies. The community drank together to achieve a sense of belonging and good fellowship. Medicinally, alcohol has been used to relieve pain and to increase the appetite, and in many cultures it is still considered an essential ingredient for good health and a well-balanced meal. However, most cultures employing alcohol had rigid guidelines as to what constituted responsible drinking. Drunkenness was frowned upon and anyone displaying outward signs of intoxication was often punished, in some cases even put to death. These cultures, along with most present societies with guidelines for responsible drinking and a cultural opposition to drunkenness, have encountered few problems associated with alcohol abuse. On the other hand, societies which ignore or encourage drunkenness are plagued with behavior problems resulting from drinking.

Research has revealed low incidence of alcoholism or alcohol abuse among cultural groups who use alcohol as part of their daily lives. As a rule these groups have developed attitudes and habits to foster responsible drinking within their culture. Some of these attitudes follow (16):

    1. Children are exposed to alcohol early in life, within an established family or religious context. Whatever the beverage, it is served diluted and in small quantities, with consequent low blood-alcohol levels.

    2. The beverages used are commonly those containing large amounts of non-alcoholic components (wines or beers), which help to retain low blood-alcohol levels.

    3. The beverage is considered mainly as a food and is usually consumed with meals.

    4. Parents present a constant example of moderate drinking.

    5. No moral importance is attached to drinking. It is considered neither a virtue nor a sin.

    6. Drinking is not viewed as proof of adulthood or virility.

    7. Abstinence is socially acceptable. It is no more rude or ungracious to decline a drink than to decline a piece of cake.

    8. Excessive drinking or intoxication is not socially acceptable and is not considered stylish, comic, or tolerable.

    9. Alcohol is not a prime focus for any activity.

    10. Finally, and perhaps most importantly, there is wide and usually complete agreement among members of the group on the ground rules of drinking.

Many of the cultures adopting these attitudes have developed and manufactured a particular alcoholic beverage to be used for recreational or religious purposes. The Germans became known for their beers, southern Europeans for wine, Russians for vodka. Each of these beverages has contributed greatly to the economy of the culture, and in many cases even influenced its politics.

In America, alcohol was enjoyed by puritan settlers. One of the first industries to be established in the New World was a brewery. As Americans began to move west, beer became too bulky to carry and settlers switched to corn liquor and other distilled beverages used both for medicinal and recreational purposes. However, as immigrants of various cultural backgrounds began to arrive in this country, they brought a wide variety of drinking habits and attitudes with them. Over time, these conflicting attitudes caused disagreement about what constituted responsible drinking. This lack of consensus led to confusion about drinking laws, rights, and responsibilities. This in turn produced the social ills associated with problem drinking (6).

History of Alcohol Education

Teaching about alcoholic beverages and drinking in the schools has been controversial due to the differing philosophies and values of Americans concerning drinking. A variety of alcohol education methods reflecting these points of view have been tried over the past century with little change in drinking patterns or increase of responsible drinking. The following have been the most common alcohol education approaches used in this country (5).

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    1. Abstinence model. One of the most common models of alcohol education is, "Don't do it." This model, which portrays alcohol as "bad" or "sinful," assumes that if you tell students not to drink for moral, religious, health, or other reasons, they will abstain. However, because we are a multi-cultured nation, this method has not been successful. Many individuals feel because of their cultural heritage that drinking is a basic right, a pleasure, and a necessary ingredient for a well-rounded life. Perhaps the only groups within our culture which have been able to accomplish abstinence are certain religious organizations. Children are brought up with the attitude that all drinking is morally wrong and causes problems. As long as the individual stays within this group, he usually does abstain. However, if he leaves the group and begins to drink, he is likely to have problems with drinking. The reason for this is thought to be a lack of role models for responsible drinking. Since most Americans (about 75%) do drink, the abstinence model, over time, has not proven successful. This was true a hundred years ago, during prohibition, and is true now.

    2. Social-economic model. This model uses statistics on a variety of problems encountered when people drink irresponsibly, such as fatal automobile accidents, crime, and family problems related to alcohol abuse. Facts, such as the billions of dollars lost each year by industry due to alcohol abuse among workers, and the money spent in alcohol-related health costs, are presented. However, this approach is one-sided in its treatment. The billions of dollars gained by the economy through production and employment in alcohol-related industries is not discussed. The social-economic model of alcohol education has not been considered very effective.

    3. Alcoholism approach. This approach seeks to establish alcohol as a disease. To this end, many audio-visual productions and pamphlets stress the similarity of alcoholism to other physical ills. In some of these productions, it is implied that if you drink at all, you will become an alcoholic. However, only 10 to 15% of all people who drink are alcoholics. This approach focuses on the negative physiological and psychological effects of the drug; little time or space is given to the positive effects of alcohol. The alcoholism approach is excellent for pointing out signs and symptoms of possible alcohol abuse, but does little to help an adolescent decide realistically if he will drink, the kind of beverage to be drunk, and the methods of responsible drinking if he chooses to drink.

    4. Alternative approach. The alternative approach to alcohol education offers up a variety of alternatives to drinking. Alternatives to drinking or drug taking can be successful in some cases as long as they are available. This approach, however, often fails to change drinking attitudes and patterns, other than to lessen the amount of alcohol consumed while the individual is involved with the alternative. Another problem with the alternative approach is the fact that drinking is tied up with such sports as bowling, fishing, and skiing, and other recreational activities. Exercise has also been shown, by some individuals, not to change drinking patterns (5).

Responsible Decisions and Responsible Drinking

During the 1970's, the philosophy of responsible use of alcohol evolved from many sources. It was first proposed in 1969 by the churches at a North Conway Institute conference 921). During the middle 1970's, the National institute of Alcohol Abuse and Alcoholism adopted the philosophy and proposed guidelines for teaching the facts about alcohol and fostering a responsible attitude in the use of alcoholic beverages. Their general guidelines were as follows (16):

  • Alcohol is a drug that can cause positive and negative social, psychological, and physical effects.
  • The responsible use of alcohol can be socially, psychologically, and physically beneficial.
  • To drink or not to drink should be a personal decision. However, those who choose to drink have a responsibility not to damage themselves or society.
  • People who drink need to respect the decision of those who do not drink.
  • People who serve alcoholic beverages need to contribute to a healthy drinkiing environment and not "push" drinks on others.
  • Intoxication is not responsible drinking. There is a direct link between responsible attitudes toward drinking and the alleviation of problem of alcoholism..

By the end of the 1970's, many alcohol education programs reflected this philosophy (20). The Jaycees' Operation Threshold encourages its members and others to consume alcohol in a responsible way through small group discussions, lectures, and educational pamphlets (4). Indiana University developed a four-hour module, Booze and You's (8), and integrated it into the existing residential life and educational structure. It contains a film giving hints for responsible drinking, value clarifications, objective, factual information, and discussion exercises. A government grant sponsored a program called CASPAR in Sommerville, Massachusetts in both the public schools and the community. It describes the nature of alcohol, gives hints for using it responsibly, and offers alternatives to drinking (2).

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Because this philosophy has only been recently introduced to communities and schools, its evaluation has not, as yet, been forthcoming, and longitudinal studies are needed to determine its effectiveness. However, most educators in the area of alcohol education feel that, since we are a drinking society, we need to help people learn to drink in a responsible manner if they choose o drink, as an aid in curbing societal and personal problems related to the irresponsible consumption of alcohol (2, 6, 8, 9, 11, 20, 21).

Teaching Responsible Drinking

The educator needs to remember that, just because students learn factual information concerning alcohol, they will not necessarily change their drinking or other behavior (6, 7, 14, 19). Over the years, several studies have indicated this. In addition, a change in attitudes does not necessarily change drinking patterns themselves 93, 12, 14, 15, 19). Furthermore, engaging students in alternatives such as sports appears to have mixed results as far as responsible drinking is concerned 910, 13, 17, 18). Educational programming concerning responsible drinking and drinking choices, needs to include some definite factors. Suggested content in the area of alcohol education in schools or the community would include the following:

1. Objective factual information concerning both positive and negative effects of alcohol on physical, mental, and social health.

2. Objective factual information concerning the religious, medicinal, cultural, and personal reasons why individuals do and do not consume alcoholic beverages.

3. Methods for using and serving alcoholic beverages in a responsible manner.

4. Ideas and methods for responsible alternatives to drinking.

5. Responsible abstinence and the rights of the non-drinker.

6. Problem-solving skills, to cope with life by means other than alcohol and drugs.

7. The clarification of values concerning one's present or future drinking or non-drinking behavior.

To teach alcohol education in any setting, the health educator must always be aware of his values and biases concerning drinking, so that information may be presented in as objective a manner as possible. Because the teaching to teenagers of responsible choices concerning alcohol is controversial in many communities, the support of the school administration and the community is crucial in public schools. Even the most conservative community needs to be aware that the average onset of drinking outside the home occurs at thirteen years of age, that over 50% of all high school students drink once a month or more, and that alcohol abuse leading to crime, fatal automobile accidents, and other problems is highest among youth (16).

Administrative Concerns

As with any subject matter in the public schools, steps must be taken to gain support for educational programming. The model for this kind of organizational work is as follows: (1) A group of interested parents and teachers forms a steering committee, which carries out a need study to determine specific local problems. The type and philosophy of the educational program is also discussed. (2) Out of this group, a curriculum committee is formed to develop the program. (3) Approval by the school board is obtained for a pilot project which is established in selected classes. (4) Next, an evaluation is done. If the pilot is shown not to be detrimental to students or to increase irresponsible behavior, the program is instituted in the total school system. (5) Frequent evaluations are necessary to determine the effect of the program (5, 8).

Summary

In summary, beverage alcohol has been successfully and safely used since prerecorded history for medicinal, religious, and recreational purposes. Societies with a consensus of what constituted responsible drinking had few problems with alcohol abuse, while multicultural societies such as the United States had, and still have, problems in the area of alcohol consumption because of conflicting views of what constitutes responsible drinking. Various models of alcohol education have been tried - most have not been successful. Since individuals in this country do, in fact, drink, the teaching of responsible drinking for those who choose to drink has lately emerged as a more hopeful model of alcohol education.

1. Boozing versus heart attacks. Science News, Nov. 10, 1979, p. 326.

2. DiCicco, L. The Somerville Story. A two year progress report. Somerville, Mass: CASPAR, 1976.

3. DeHaes, W. and Schuurman, J. Results of an evaluation study of three drug education methods. International Journal of Health Education, 18, 1975, 1-16.

4. Dolan, J.S. and Boutiette, F. Operation Threshold. Tulsa, Oklahoma: United States Jaycees, 1975.

5. Engs, R. Again - let's look before we leap: the effects of physical activity on smoking and drinking patterns. Journal of Alcohol and Drug Education, in press.

6. Engs, R. Responsible drug and alcohol use. New York: MacMillan, 1979.

7. Engs, R. College students' knowledge of alcohol and drinking. Journal of The American College health Association, 1978, 26, 189-19 3.

8. Engs, R. Let's look before we leap: the cognitive and behavioral evaluation of a university alcohol education program. Journal of Alcohol and Drug Education, 1977, 22(2), 39-48.

9. Engs, R. Drinking behaviors among college students. Journal of Studies of Alcohol, 1979, 38(11), 2144-2156.

10. Girdano, D. Biofeedback. Health Education, 1976, 7(1).

11. Globetti, G. Alcohol education in the schools. Journal of Alcohol and Drug Education, 1971, 1, 241-248.

12. Hanson, D.J. Drinking attitudes and behaviors among college students. Journal of Alcohol and Drug Education, 1974, 20(3), 7-13.

13. Hayes, R., and Tevis, B.W. A comparison of attitudes and behavior of high school athletes and non-athletes with respect to alcohol use and abuse. Journal of Alcohol and Drug Education, 1977, 23(1), 20-28.

14. Hurt, T. and Martin, G. A comparison of three instructional approaches in health education. Journal of School Health. 1974, 44, 504-507.

15. Osman, J. The use of selected values clarifying strategies in health education. Journal of School Health, 1974, 4, 21-25.

16. NIAAA. Alcohol and health: first special report to the U.S. Congress. (DHEW Pub. No. ADM-75-212) 1974.

17. NIAAA. Whole college catalog about drinking. (DHEW Pub. No. ADM 76-361) 1976.

18. Pollack, M. The quantification of endurance training programs. In J. Wilmore (Ed.), Exercise and sport sciences review. New York: Academic Press, 1973.

19. Sime, W. A comparison of exercise and meditation in reducing physiological response to stress. Medicine Science in Sports, 1975, 9, 55.

20. Sine, R. The comparative effect of a values approach with a factual approach on the drug abuse and smoking behavior of college students. Paper presented at the American College Health Association Annual Convention. Denver, April, 1976.

21. Works, D. Attitudes on alcohol and drugs: time for a change. Boston: NCI, 1970.

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This article is reprinted with permission from the JOURNAL OF HEALTH EDUCATION, January/February 1981:20-22. The JOURNAL OF HEALTH EDUCATION is a publication of the American Alliance for Health, Physical education, Recreation and Dance, 1900 Association drive, Reston, VA 22091. Link to its webpage

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