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The main purpose of this book is to describe the variety of drinking occasions that exist around the world, primarily in modern, industrialized countries. As such, it celebrates the diversity of normal drinking behavior and illustrates a wide range of beneficial drinking patterns. Attention is also paid to the relations between drink and culture that prevail in non-Western societies and in developing countries. The aims of the book are twofold: to deal directly with the challenge of how to define responsible drinking in the face of the world's many different drinking styles, and to portray the many ways in which people have thought about or used alcohol as an integral part of their culture
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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 This vacillation turned to mayhem in 1919, when the 18th Amendment to the Constitution (later repealed) introduced Prohibition, which banned the manufacture and sale of alcohol nationwide.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.
Morris E. Chafetz, M.D.
Copyright © 2000 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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