Search databaseBooksAll DatabasesAssemblyBiocollectionsBioProjectBioSampleBioSystemsBooksClinVarConserved DomainsdbGaPdbVarGeneGenomeGEO DataSetsGEO ProfilesGTRHomoloGeneIdentical Protein GroupsMedGenMeSHthedailysplash.tv Web Sitethedailysplash.tv CatalogNucleotideOMIMPMCPopSetProteinProtein ClustersProtein Family ModelsPubChem BioAssayPubChem CompoundPubChem SubstancePubMedSNPSRAStructureTaxonomyToolKitToolKitAllToolKitBookgh
thedailysplash.tv Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
National Research Council (US) Panel on Alternative Policies Affecting the Prevention of Alcohol Abuse and Alcoholism; Moore MH, Gerstein DR, editors. Alcohol and Public Policy: Beyond the Shadow of Prohibition. Washington (DC): National Academies Press (US); 1981.
National Research Council (US) Panel on Alternative Policies Affecting the Prevention of Alcohol Abuse and Alcoholism; Moore MH, Gerstein DR, editors.
In a democracy, government policy is inevitably guided by commonly shared simplifications. This is true because the political dialogue that authorizes and animates government policy can rarely support ideas that are very complex or entirely novel. There are too many people with diverse perceptions and interests and too little time and inclination to create a shared perception of a complex structure. Consequently, influential policy ideas are typically formulated at a quite general level and borrow heavily from commonly shared understandings and conventional opinions.
Alcohol policy is no exception to this rule. Current policy is profoundly shaped by a body of conventional wisdom, including the belief that alcohol problems are created largely by a small group of alcoholics who require intensive, prolonged treatment and that any effort to restrict drinking practices in the general population is doomed to failure. The power of these ideas is apparent in that they are widely treated as the most obvious and incontrovertible facts—the foundation of an informed and intelligent discussion of alcohol policy.
Much can be said for the wisdom of governing through commonly shared perceptions. If many people understand and agree with an idea, a prima facie legitimacy much valued in democratic society is established. Moreover, widespread understanding and acceptance establishes a necessary condition for effective implementation in a society in which governmental power is broadly dispersed. Finally, it is often the case that although the shared simplifications fail to reflect or capture all the important aspects of a problem, they often do focus attention on some of the most important. Thus, the simplifications help to concert social attention and action—something that a more complicated idea could not achieve.
There is also a price to be paid for simple ideas. Simplification inevitably distorts our perception of a problem. While some important features of the problem are elevated, others that could plausibly claim equal importance are subordinated. While some avenues for social intervention are brightly illuminated, others plausibly as effective are obscured or condemned to darkness. Moreover, precisely because the simplifications are so powerful and seem so much a part of our current society, it is hard to be skeptical about them and to ask effective and probing questions about their limitations.
Such limitations can be of two sorts. One simplifying strategy is to focus on a limited set of effects. Thus, one can focus on adverse health effects and promote policies to reduce cirrhosis and accidental injuries associated with alcohol, taking everything else as secondary in importance. Alternatively, one might be primarily concerned with the social degradation accompanying chronic alcohol dependency and concentrate on policies to locate and rehabilitate (or at least provide humane care to) alcoholics. Or one might consider the appearance of public sobriety to be of overriding importance and choose policy instruments that will simply but effectively keep drunkenness out of public view. In short, by choosing a limited range of effects to be the dominant objective of alcohol policy—effects that are the largest, or most important, or the only ones that are conceived to be an appropriate concern of government—the problem can be simplified sufficiently to gain confidence in designing and recommending alcohol policy.
A different simplifying approach is to decide which causal variables are most important in generating the effects of drinking, then to choose policy instruments that operate most directly on these causes. Thus, one might judge (on the basis of available evidence) that the quantity of alcohol drunk is itself the major causal variable determining the observed pattern of effects and try to develop policies that will ration the amount of individual access to it. Alternatively, one might conclude that the aggressiveness with which alcohol is marketed and the kinds of settings in which drinking occurs are capable of making otherwise moderate and sensible people into dangerous, risky drinkers. This judgment might lead to efforts to “take the profit out of selling alcohol” or to carefully shape the times, places, and settings in which drinking takes place. Then again, one might determine that whenever there are alcohol problems, they are due to a relatively small number of unusually reckless or vulnerable drinkers and consequently tailor alcohol policy to prevent such people from drinking or to “treat” them so that they are more resistant to it. In short, by limiting one”s attention to a small set of causal variables, one can find a comfortable basis for supporting a given policy.
The most successful simplifications of the alcohol problem have involved both kinds of limitations simultaneously: the major objective of the policy and the judgment about what causes this particular effect are sewn together into a neat conceptual bundle. A few such bundles have had widespread and durable appeal in U.S. society, because they have proven compatible with common social views, individual experiences, and the interests and purposes of organized groups concerned with alcohol. We refer to these cognitive bundles as governing ideas. A few other such bundles have considerable intellectual appeal and have at times claimed the interest and loyalty of “experts” who influence alcohol policy, but they have not succeeded in capturing the imagination of the broad population or in shaping their actions. We will refer to these as minority conceptions. Before looking at the kinds of policy choices that our analysis suggests are available, it is well worth understanding the basic structure of the three ideas that have succeeded in profoundly shaping alcohol policy as well as two others that are interesting and have appeared historically but have made lesser claims on credibility.