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JOHN GARTRELL
DAVID GARTRELL
ALCOHOL
INTRODUCTION
The sociological study of alcohol in society is
concerned with two broad areas. (1) The first area
is the study of alcohol behavior, which includes: (a)
social and other factors in alcohol behavior, (b) the
prevalence of drinking in society, and (c) the group
and individual variations in drinking and alcoholism. (2) The second major area of study has to do
with social control of alcohol, which includes: (a)
the social and legal acceptance or disapproval of
alcohol (social norms), (b) the social and legal
regulations and control of alcohol in society, and
(c) efforts to change or limit deviant drinking
behavior (informal sanctions, law enforcement,
treatment, and prevention). Only issues related to
the first area of study, sociology of alcohol behavior, will be reviewed here.
PHYSICAL EFFECTS OF ALCOHOL
There are three major forms of beverages containing alcohol (ethanol) that are regularly consumed.
Wine is made from fermentation of fruits and
usually contains up to 14 percent of ethanol by
volume. Beer is brewed from grains and hops and
contains 3 to 6 percent ethanol. Liquor (whisky,
gin, vodka, and other distilled spirits) is usually 40
percent (80 proof) to 50 percent (100 proof) ethanol. A bottle of beer (12 ounces), a glass of wine (4
ounces), and a cocktail or mixed drink with a shot
of whiskey in it, therefore, each have about the
same absolute alcohol content, one-half to threefourths of an ounce of ethanol.
Alcohol is a central nervous system depressant, and its physiological effects are a direct function of the percentage of alcohol concentrated in
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the body’s total blood volume (which is determined mainly by the person’s body weight). This
concentration is usually referred to as the BAC
(blood alcohol content) or BAL (blood alcohol
level). A 150-pound man can consume one alcoholic drink (about three-fourths of an ounce) every
hour essentially without physiological effect. The
BAC increases with each additional drink during
that same time, and the intoxicating effects of
alcohol will become noticeable. If he has four
drinks in an hour, he will have an alcohol blood
content of .10 percent, enough for recognizable
motor-skills impairment. In almost all states, operating a motor vehicle with a BAC between .08
percent and .10 percent (determined by breathalyzer or blood test) is a crime and is subject to
arrest on a charge of DWI (driving while intoxicated). At .25 percent BAC (about ten drinks in an
hour) the person is extremely drunk, and at .40
percent BAC the person loses consciousness. Excessive drinking of alcohol over time is associated
with numerous health problems. Cirrhosis of the
liver, hepatitis, heart disease, high blood pressure,
brain dysfunction, neurological disorders, sexual
and reproductive dysfunction, low blood sugar,
and cancer, are among the illnesses attributed to
alcohol abuse (National Institute on Alcohol Abuse
and Alcoholism 1981, 1987; Royce 1990; Ray and
Ksir 1999).
SOCIAL FACTORS IN ALCOHOL
BEHAVIOR
Alcohol has direct effects on the brain, affecting
motor skills, perception, and eventually consciousness. The way people actually behave while drinking, however, is only partly a function of the direct
physical effects of ethanol. Overt behavior while
under the influence of alcohol depends also on
how they have learned to behave while drinking in
the setting and with whom they are drinking with
at the time. Variations in individual experience,
group drinking customs, and the social setting
produce variations in observable behavior while
drinking. Actions reflecting impairment of coordination and perception are direct physical effects of
alcohol on the body. These physical factors, however, do not account for ‘‘drunken comportment’’—
the behavior of those who are ‘‘drunk’’ with alcohol before reaching the stage of impaired muscular coordination (MacAndrew and Edgerton 1969).
Social, cultural, and psychological factors are more
important in overt drinking behavior. Cross-cultural studies (MacAndrew and Edgerton 1969),
surveys in the United States (Kantor and Straus
1987), and social psychological experiments (Marlatt
and Rohsenow 1981), have shown that both
conforming and deviant behavior while ‘‘under
the influence’’ are more a function of sociocultural and individual expectations and attitudes than
the physiological and behavioral effects of alcohol.
(For an overview of sociocultural perspectives on
alcohol use, see Pittman and White 1991)
Sociological explanations of alcohol behavior
emphasize these social, cultural, and social psychological variables not only in understanding the way
people act when they are under, or think they are
under, the influence of alcohol but also in understanding differences in drinking patterns at both
the group and individual level. Sociologists see all
drinking behavior as socially patterned, from abstinence, to moderate drinking, to alcoholism.
Within a society persons are subject to different
group and cultural influences, depending on the
communities in which they reside, their group
memberships, and their location in the social structure as defined by their age, sex, class, religion,
ethnic, and other statuses in society. Whatever
other biological or personality factors and mechanisms may be involved, both conforming and deviant alcohol behavior are explained sociologically
as products of the general culture and the more
immediate groups and social situations with which
individuals are confronted. Differences in rates of
drinking and alcoholism across groups in the same
society and cross-nationally reflect the varied cultural traditions regarding the functions alcohol
serves and the extent to which it is integrated into
eating, ceremonial, leisure, and other social contexts. The more immediate groups within this
sociocultural milieu provide social learning environments and social control systems in which the
positive and negative sanctions applied to behavior sustain or discourage certain drinking according to group norms. The most significant groups
through which the general cultural, religious, and
community orientations toward drinking have an
impact on the individual are family, peer, and
friendship groups, but secondary groups and the
media also have an impact. (For a social learning
theory of drinking and alcoholism that specifically
incorporates these factors in the social and cultural context see Akers 1985, 1998; Akers and La
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Greca 1991. For a review of sociological, psychological, and biological theories of alcohol and drug
behavior see Goode 1993.)
SOCIAL CHARACTERISTICS AND TRENDS
IN DRINKING BEHAVIOR
Age. Table 1 shows that by time of high
school graduation, the percentages of current teenage drinkers (still under the legal age) is quite high,
rivaling that of adults. The peak years for drinking
are the young adult years (eighteen to thirty-four),
but these are nearly equaled by students who are in
the last year of high school (seventeen to eighteen
years of age). For both men and women, the
probability that one will drink at all stays relatively
high from that time up to age thirty-five; about
eight out of ten are drinkers, two-thirds are current drinkers, and one in twenty are daily drinkers.
The many young men and women who are in
college are even more likely to drink (Berkowitz
and Perkins 1986; Wechsler et al. 1994). Heavy
and frequent drinking peaks out in later years,
somewhat sooner for men than women. After that
the probability for both drinking and heavy drinking declines noticeably, particularly among the
elderly. After the age of sixty, both the proportion
of drinkers and of frequent or heavy drinkers
decrease. Studies in the general population have
consistently found that the elderly are less likely
than younger persons to be drinkers, heavy drinkers, and problem drinkers (Cahalan and Cisin
1968; Fitzgerald and Mulford 1981; Meyers et al.
1981-1982; Borgatta et al. 1982; Holzer et al. 1984;
Akers 1992).
Sex. The difference is not as great as it once
was, but more men than women drink and have
higher rates of problem drinking in all age, religious, racial, social class, and ethnic groups and in
all regions and communities. Teenage boys are
more likely to drink and to drink more frequently
than girls, but the difference between male and
female percentages of current drinkers at this age
is less than it is in any older age group. Among
adults, men are three to four times more likely
than women (among the elderly as much as ten
times more likely) to be heavy drinkers and two to
three times more likely to report negative personal
and social consequences of drinking (National
Institute on Alcohol Abuse and Alcoholism 1987).
Age Group Lifetime Past Year Past Month
12-17 39.7 34 20.5
High School 81.7 74.8 52.7
Seniors
18-25 83.5 75.1 58.4
26-34 88.9 74.6 60.2
35+ 87 64.1 52.8
Percentages Reporting Drinking
by Age Group (1997)
Table 1
SOURCE: Substance Abuse and Mental Health Services
Administration 1998; University of Michigan (for high school
seniors) 1998.
Social Class. The proportion of men and
women who drink is higher in the middle class and
upper class than in the lower class. The more
highly educated and the fully employed are more
likely to be current drinkers than the less educated
and unemployed. Drinking by elderly adults increases as education increases, but there are either
mixed or inconsistent findings regarding the variations in drinking by occupational status, employment status, and income (Holzer 1984; Borgatta
1982; Akers and La Greca 1991).
Community and Location. Rates of drinking
are higher in urban and suburban areas than in
small towns and rural areas. As the whole country
has become more urbanized the regional differences have leveled out so that, while the South
continues to have the lowest proportion of drinkers, there is no difference among the other regions
for both teenagers and adults. Although there are
fewer of them in the South, those who do drink
tend to drink more per person than drinkers in
other regions (National Institute on Alcohol Abuse
and Alcoholism 1998a).
Race, Ethnicity, and Religion. The percent of
drinking is higher among both white males and
females than among African-American men and
women. Drinking among non-Hispanic whites is
also higher than among Hispanic whites. The proportion of problem or heavy drinkers is about the
same for African Americans and white Americans
(Fishburne et al. 1980; National Institute on Drug
Abuse, 1988; National Institute on Alcohol Abuse
and Alcoholism 1998a). There may be a tendency
for blacks to fall into the two extreme categories,
heavy drinkers or abstainers (Brown and Tooley
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1989), and black males suffer the highest rate of
mortality from cirrhosis of the liver (National Institute on Alcohol Abuse and Alcoholism 1998b).
American Indians and Alaskan Natives have rates
of alcohol abuse and problems several times the
rates in the general population (National Institute
on Alcohol Abuse and Alcoholism 1987).
Catholics, Lutherans, and Episcopalians have
relatively high rates of drinking. Relatively few
fundamentalist Protestants, Baptists, and Mormons
drink. Jews have low rates of problem drinking,
and Catholics have relatively high rates of alcoholism. Irish Americans have high rates of both drinking and alcoholism. Italian Americans drink frequently and heavily but apparently do not have
high rates of alcoholism (see Cahalan et al. 1967;
Mulford 1964). Strong religious beliefs and commitment, regardless of denominational affiliation,
inhibit both drinking and heavy drinking among
teenagers and college students (Cochran and Akers
1989; Berkowitz and Perkins 1986).
Trends in Prevalence of Drinking. There has
been a century-long decline in the amount of
absolute alcohol consumed by the average drinker
in the United States. There was a period in the
1970s when the per capita consumption increased,
and the proportion of drinkers in the population
was generally higher by the end of the 1970s than
at the beginning of the decade, although there
were yearly fluctuations up and down. The level of
drinking among men was already high, and the
increases came mainly among youth and women.
But in the 1980s the general downward trend
resumed (Keller 1958; National Institute on Alcohol Abuse and Alcoholism 1981, 1987, 1998).
Until the 1980s, this per capita trend was caused
mainly by the increased use of lower-content beer
and wine and the declining popularity of distilled
spirits rather than a decreasing proportion of the
population who are drinkers.
Alcohol-use rates were quite high in the United States throughout the 1970s and into the 1980s
(see table 2). Since then, there have been substantial declines in use rates in all demographic categories and age groups. In 1979 more than two-thirds
of American adolescents (twelve to seventeen years
of age) had some experience with alcohol and
nearly four out of ten were current drinkers (drank
within the past month). In 1988, these proportions
had dropped to one-half and one-fourth respectively. In 1997, adolescent rates had dropped even
lower to four out of ten having ever used alcohol
and only two out of ten reporting use in the past
month. Current use in the general U.S. population
(aged twelve and older) declined from 60 percent
in 1985 to 51 percent in 1997. Among the adult
population eighteen years of age and older, current use declined from 71 percent in 1985 to 55
percent in 1997. Lifetime use rates have also declined from 88.5 percent in 1979 to 81.9 percent in
1997 (aged twelve and older). Generally, there
have been declines in both annual (past year)
prevalence of drinking (decreases of 3 to 5 percent) and current (past month) prevalence of drinking (decreases of 7 to 10 percent) among high
school seniors, young adults, and older adults.
Although lifetime prevalence is not a sensitive
measure of short-term change in the adult population (since the lifetime prevalence is already fixed
for the cohort of adults already sampled in previous surveys), it does reflect an overall decline in
alcohol use. It should be remembered, however,
that most of this is light to moderate consumption;
the modal pattern of drinking for all age groups in
the United States has long been and continues to
be nondeviant, light to moderate social drinking.
The relative size of the reductions in drinking
prevalence over the last two decades have been
rather substantial; however, the proportions of
drinkers remains high. By the time of high school
graduation, one-half of adolescents are current
drinkers and the proportion of drinkers in the
population remains at this level throughout the
young adult years. Three-fourths of high school
seniors and young adults and two-thirds of adults
over the age of thirty-five have consumed alcohol
in the past year (see table 1).
Although lifetime use and current use rates
appear to be continuing a slight decline in all
categories, there have been some slight increases
in rates of frequent (daily) drinking among high
school seniors and young adults. While these increases do not approach the rates observed in the
1980s they may indicate that the overall rates are
stabilizing and hint of possible increases in alcohol
use rates in the future.
Estimates of Prevalence of Alcoholism. In
spite of these trends in lower levels of drinking,
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1979 1985 1991 1993 1997
Lifetime 88.5 84.9 83.6 82.6 81.9
Past Year 72.9 72.9 68.1 66.5 64.1
Past Month 63.2 60.2 52.2 50.8 51.4
Percentages Reporting Lifetime, Past Year, and Past Month Use of Alcohol
in the U.S. Population Aged 12 and Older (1979–1997)
Table 2
SOURCE: Substance Abuse and Mental Health Services Administration 1998.
alcoholism remains one of the most serious problems in American society. Alcohol abuse and all of
the problems related to it cause enormous personal, social, health, and financial costs in American
society. Cahalan et al. (1969) in a 1965 national
survey characterized 6 percent of the general adult
population and 9 percent of the drinkers as ‘‘heavyescape’’ drinkers, the same figures reported for a
1967 survey (Cahalan 1970). These do not seem to
have changed very much in the years since. They
are similar to findings in national surveys from
1979 to 1988 (National Institute on Alcohol Abuse
and Alcoholism 1981, 1987, 1988, 1989; Clark and
Midanik 1982), which support an estimate that 6
percent of the general population are problem
drinkers and that about 9 percent of those who are
drinkers will abuse or fail to control their intake of
alcohol. Royce (1989) and Vaillant (1983) both
estimate that 4 percent of the general population
in the United States are ‘‘true’’ alcoholics. This
estimate would mean that there are perhaps 10.5
million alcoholics in American society (see also
Liska 1997). How many alcoholics or how much
alcohol abuse there is in our society is not easily
determined because the very concept of alcoholism (and therefore what gets counted in the surveys and estimates) has long been and remains
controversial.
THE CONCEPT OF ALCOHOLISM
The idea of alcoholism as a sickness traces back at
least 200 years (Conrad and Schneider 1980).
There is no single, unified, disease concept, but
the prevailing concepts of alcoholism today revolve around the one developed by E. M. Jellinek
(1960) from 1940 to 1960. Jellinek defined alcoholism as a disease entity that is diagnosed by the
‘‘loss of control’’ over one’s drinking and that
progresses through a series of clear-cut ‘‘phases.’’
The final phase of alcoholism means that the
person is rendered powerless by the disease to
drink in a controlled, moderate, nonproblematic way.
The disease of alcoholism is viewed as a disorder or illness for which the individual is not personally responsible for having contracted. It is
viewed as incurable in the sense that alcoholics can
never truly control their drinking. That is, sobriety
can be achieved by total abstention, but if even one
drink is taken, the alcoholic cannot control how
much more he or she will consume. It is a ‘‘primary’’ self-contained disease that produces the problems, abuse, and ‘‘loss of control’’ over drinking by
those suffering from this disease. It can be controlled through proper treatment to the point
where the alcoholic can be helped to stop drinking
so that he or she is in ‘‘remission’’ or ‘‘recovering.’’
‘‘Once an alcoholic, always an alcoholic’’ is a central tenet of the disease concept. Thus, one can be
a sober alcoholic, still suffering from the disease
even though one is consuming no alcohol at all.
Although the person is not responsible for becoming sick, he or she is viewed as responsible for
aiding in the cure by cooperating with the treatment regimen or participation in groups such as
Alcoholics Anonymous.
The disease concept is the predominant one
in public opinion and discourse on alcohol (according to a 1987 Gallup Poll, 87 percent of the
public believe that alcoholism is a disease). It is the
principal concept used by the vast majority of the
treatment professionals and personnel offering
programs for alcohol problems. It receives widespread support among alcohol experts and continues to be vigorously defended by many alcohol
researchers (Keller 1976; Vaillant 1983; Royce
1989). Alcoholics Anonymous, the largest single
program for alcoholics in the world, defines alcoholism as a disease (Rudy 1986). The concept of
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alcoholism as a disease is the officially stated position of the federal agency most responsible for
alcohol research and treatment, the National Institute of Alcoholism and Alcohol Abuse (National
Institute on Alcohol Abuse and Alcoholism 1987).
Nonetheless, many sociologists and behavioral scientists remain highly skeptical and critical of
the disease concept of alcoholism (Trice 1966;
Cahalan and Room 1974; Conrad and Schneider
1980; Rudy 1986; Fingarette 1988, 1991; Peele
1989). The concept may do more harm than good
by discouraging many heavy drinkers who are
having problems with alcohol, but who do not
identify themselves as alcoholics or do not want
others to view them as sick alcoholics, from seeking help. The disease concept is a tautological (and
therefore untestable) explanation for the behavior
of people diagnosed as alcoholic. That is, the
diagnosis of the disease is made on the basis of
excessive, problematic alcohol behavior that seems
to be out of control, and then this diagnosed
disease entity is, in turn, used to explain the excessive, problematic, out-of-control behavior.
In so far as claims about alcoholism as a disease can be tested, ‘‘Almost everything that the
American public believes to be the scientific truth
about alcoholism is false’’ (Fingarette 1988, p.1;
see also Peele 1989; Conrad and Schneider 1980;
Fingarette 1991; Akers 1992). The concept preferred by these authors and by other sociologists is
one that refers only to observable behavior and
drinking problems. The term alcoholism then is
nothing more than a label attached to a pattern of
drinking that is characterized by personal and
social dsyfunctions (Mulford and Miller 1960; Conrad and Schneider 1980; Rudy 1986: Goode 1993).
That is, the drinking is so frequent, heavy, and
abusive that it produces or exacerbates problems
for the drinker and those around him or her
including financial, family, occupational, physical,
and interpersonal problems. The heavy drinking
behavior and its attendant problems are themselves the focus of explanation and treatment.
They are not seen as merely symptoms of some
underlying disease pathology. When drinking stops
or moderate drinking is resumed and drinking
does not cause social and personal problems, one
is no longer alcoholic. Behavior we label as alcoholic is problem drinking that lies at one extreme
end of a continuum of drinking behavior with
abstinence at the other end and various other
drinking patterns in between (Cahalan et al. 1969).
From this point of view, alcoholism is a disease
only because it has been socially defined as a
disease (Conrad and Schneider 1980; Goode 1993).
Genetic Factors in Alcoholism. Contrary to
what is regularly asserted, evidence that there may
be genetic, biological factors in alcohol abuse is
evidence neither in favor of nor against the disease
concept, any more than evidence that there may
be genetic variables in criminal behavior demonstrates that crime is a disease. Few serious researchers claim to have found evidence that a
specific disease entity is inherited or that there is a
genetically programmed and unalterable craving
or desire for alcohol. It is genetic susceptibility to
alcoholism that interacts with the social environment and the person’s drinking experiences, rather than genetic determinism, that is the predominant perspective.
The major evidence for the existence of hereditary factors in alcoholism comes from studies
that have found greater ‘‘concordance’’ between
the alcoholism of identical twins than between
siblings and from studies of adoptees in which
offspring of alcoholic fathers were found to have
an increased risk of alcoholism even though raised
by nonalcoholic adoptive parents (Goodwin 1976;
National Institute on Alcohol Abuse and Alcoholism 1982; U.S. Department of Health and Human
Services 1987; for a review and critique of physiological and genetic theories of alcoholism see Rivers 1994). Some have pointed to serious methodological problems in these studies that limit their
support for inherited alcoholism (Lester 1987).
Even the studies finding evidence for an inherited
alcoholism report that only a small minority of
those judged to have the inherited traits become
alcoholic and an even smaller portion of all alcoholics have indications of hereditary tendencies.
Whatever genetic variables there are in alcoholism
apparently come into play in a small portion of
cases. Depending upon the definition of alcoholism used, the research shows that biological inheritance either makes no difference at all or makes a
difference for only about one out of ten alcoholics.
Social and social psychological factors are the
principal variables in alcohol behavior, including
that which is socially labeled and diagnosed as
alcoholism (Fingarette 1988; Peele 1989).
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RONALD L. AKERS
THOMAS R. HEFFINGTON
ALIENATION
Since 1964, many commentators have been speaking of a crisis of confidence in the United States, a
malaise marked by widespread public belief that
major institutions—businesses, labor unions, and
especially the government, political parties, and
political leaders—are unresponsive, remote, ineffective, and not to be trusted (Lipset and Schneider
1983). Alienation became the catchword for these
sentiments, detected among discontented workers, angry youth, and militant minority groups.
American leaders concerned about the increase in
alienation found new relevance in ongoing discussions among sociologists and other social scientists, who have defined alienation, used survey
research to measure the level of alienation in
society, and have debated the causes, significance,
and consequences of alienation and particularly,
political alienation.

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