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ALCOHOL PROBLEMS: NEW ATTITUDES.

The new attitudes toward alcoholism have become the foundation for public policy. Since 1960 alcoholism has been gaining recognition by the federal government as a major public health problem. At the center of the federal efforts is the National Institute of Alcohol Abuse and Alcoholism (NIAAA), established in 1971. The NIAAA sponsors research, training, public education, and treatment programs. The legislation creating NIAAA is a landmark in the history of society's responses to alcoholism. This bill, the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970, is known as the Hughes Act. Its sponsor was former Senator Harold Hughes, himself a recovering alcoholic. Beyond creating the NIAAA, it established what might be called a bill of rights for alcoholic individuals. It recognizes that they suffer from a "disease that requires treatment"; it provides protection against discrimination in hiring recovering alcoholics. In a similar vein, the Uniform Alcoholism and Intoxication Treatment Act, dealing with public intoxication, was recommended for enactment by the states. This act mandates treatment rather than punishment. These acts incorporate the new attitudes emerging toward alcoholics and alcohol abuse: it is a problem; it is treatable.

On the heels of this, there was a rapid increase during thel970s in alcoholism treatment services, both public and private, both residential and outpatient. In addition, each state mandated alcohol (and drug abuse) services that focused on public information and education as well as treatment. Similarly, community mental health centers that received federal support were required to provide alcohol services. Though far from being totally transformed, health insurance coverage began to include rather than exclude alcoholism treatment services for its subscribers.

With this increase in alcohol services, there has emerged a new profession, the alcohol counselor. This group of professionals has formed the backbone of alcohol treatment. And too, alcohol education for all helping professionals is far more common, with a proliferation of workshops, special conferences, and courses. With the emergence of alcohol treatment as a new health care field, there have been efforts to develop standards for the treatment personnel and alcohol treatment agencies. In many states, alcohol counselors' associations have been formed. In some instances these groups certify alcohol counselors; in others, state licensure boards have been established. The concern with credentialing of alcoholism counselors began in the mid-'70s. Interestingly, a decade later, physicians in the field of substance abuse are beginning to look at the same questions. What qualifications should a physician have to work in the field? Is personal experience, the route by which many physicians initially entered, still sufficient? Tentative steps are being taken to consider establishing examinations or possibly a certification process similar to other medical specialties. These efforts have resulted from, and contributed to, our society's response to alcoholism as a major public health problem.

The attention that has been directed toward alcoholism over the past 15 years is just now broadening to the larger issue of alcohol problems and even alcohol use. Previously, the public's attitude could have been summarized as "the only real alcohol problem is alcoholism and that wouldn't happen to me." Now alcohol problems don't seem to be viewed as far removed from the average person. Drunken driving has captured public attention. This alcohol-related problem can potentially touch anyone. It has led to heated discussions as to the proper penalties/approaches to those who receive DWIs, to responsibilities of hosts, to setting the legal drinking age. Citizen groups such as Mothers Against Drunk Driving (MADD) have to be given a large measure of credit for this. Furthermore, the concern about driving while intoxicated seems to have spilled over to attention to intoxication in general. It appears that intoxication is less acceptable and as likely to elicit disgust as to be considered funny or amusing. Other alcohol-related issues are beginning to hit the public policy agenda. Questions have been raised in some quarters about the advertisement of alcohol and how alcohol use is portrayed in the media. Some have called for the labeling of contents of alcoholic beverages, as is required for other foodstuffs or household products. There are also those lobbying for warning labels to be required on alcoholic beverages.

Alcohol use in relation to health and fitness is receiving greater attention. An ironic twist is the fact that the alcohol manufacturers are spending undisclosed amounts of the 1 billion plus dollar advertising budgets to sell lower alcohol content beverages! Alongside "lite" and near beers and wine coolers, there has been a dramatic growth in sales of sparkling waters and non-alcoholics wines and beers. Whether all this reflects a trend or a passing fad remains to be seen.

But it does appear that significant changes are underway in respect to our views on alcohol's problems and what constitutes appropriate alcohol use. A book published in late 1985, How to control your social drinking, is to our knowledge a first. It starts off by noting that it is not intended for alcoholics, for whom controlled drinking is not possible, but it is directed to the social drinker, who, in our drinking society, may find that it is easy to drink more than is intended. Basically it is a compilation of tips from hosts, party-goers, and top-level business executives on techniques to keep consumption down and the benefits of moderation. Its significance is not that it contains any startling new information, but that it was published, and presumably seen as a topic of sufficient general interest to generate book sales.

Another window on public attitudes is the way in which alcohol use is portrayed in the media, especially television programming. Within the past year, several network feature films aired in prime time with alcoholics as major characters. And on the soap operas, not only are several of the major characters alcoholics, some are recovering. Over all, from the soaps to cop shows, drinking behavior is portrayed less glamorously and far less frequently than in the past.

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