you have asked me how i feel about whisky. all right, here is just how i stand on this question: if,...

You have asked me how I feel about whisky.

All right, here is just how I stand on this question: If, when you say whisky, you mean the devil's brew, the poison scourge, the bloody monster that defiles innocence, yea, literally takes the bread from the mouths of little children; if you mean the evil drink that topples the Christian man and woman from the pinnacles of righteous, gracious living into the bottomless pit of degradation and despair, shame and helplessness and hopelessness, then certainly I am against it with all of my power.

But, if when you say whisky, you mean the oil of conversation, the philosophic wine, the stuff that is consumed when good fellows get together, that puts a song in their hearts and laughter on their lips and the warm glow of contentment in their eyes; if you mean the drink that enables a man to magnify his joy, and his happiness, and to forget, if only for a little while, life's great tragedies and heartbreaks and sorrows, if you mean that drink, the sale of which pours into our treasuries untold millions of dollars, which are used to provide tender care for our little crippled children, our blind, our deaf, our dumb, our pitiful aged and infirm, to build highways, hospitals, and schools, then certainly I am in favor of it.

But, if when you say whisky, you mean the oil of conversation, the philosophic wine, the stuff that is consumed when good fellows get together, that puts a song in their hearts and laughter on their lips and the warm glow of contentment in their eyes; if you mean the drink that enables a man to magnify his joy, and his happiness, and to forget, if only for a little while, life's great tragedies and heartbreaks and sorrows, if you mean that drink, the sale of which pours into our treasuries untold millions of dollars, which are used to provide tender care for our little crippled children, our blind, our deaf, our dumb, our pitiful aged and infirm, to build highways, hospitals, and schools, then certainly I am in favor of it.

This is my stand. I will not retreat from it; I will not compromise.

On the good sideEconomic: a good that can

generate both commerce and tax revenue

Provides a stimulus and enhancement to social interaction

Can have salutary effects on moodCan have significant health

benefits

On the bad sideTotal cost to society is huge

YPLL/DALY Medical care costs Lost productivity

Strong associations with crime and a host of social problems

Interference with normal development

“to know syphilis in all its manifestations and relations, and all things clinical will be

added unto you." Sir William Osler

Like syphilis, alcohol can affect almost all bodily systemsBrain, digestive, cardiovascular,

genitourinary Both syphilis and alcohol represented

major public health problemsSyphilis was almost eradicated 50

years ago, and currently much less of a problem than alcohol

Both alcohol and syphilis associated with moral weakness and sin…stigmatized

Genetics Molecular genetics, genetic epidemiology

Pharmacology Physiology Teratology/ontogeny/morphology Unintentional and intentional injury Addiction Psychopathology Personality Social influence processes Cognitive Processes Psychological and social development

Advertising Social policy Public safety/law enforcement Economics Religion History

And produce well rounded graduates

The Greek symposium was a male aristocratic activity, a tightly choreographed social gathering where men drank together, conversed, and enjoyed themselves in a convivial atmosphere. Bedecked in garlands, participants reclined–one or two to a couch–in a room designed to hold seven to fifteen couches with cushions and low tables. Many such rooms have been identified archaeologically in domestic settings, although the best representation is perhaps the painted Tomb of the Diver at Paestum.

Fresco from the Tomb of the Diver. 475 BCE. Paestum Museum, Italy.

By the late sixth century B.C., there was an established repertoire of symposium vessels that included wine coolers, jugs, various drinking cups, and mixing vessels, many of which were decorated with scenes of drinking parties or of Dionysos and his followers. Water was mixed with wine in a large central krater to a strength determined by the symposiarch (master of ceremonies). The mixture, usually three or four parts water to one part wine, was served by slave boys who filled pitchers from the krater and poured the drink into each participant's cup.

The men conversed, often about specific topics, as in Plato's Symposium, and some recited poetry or played music. Jokes, gossip, and games of skill and balance enlivened the evening, as did professional musicians, dancers, and courtesans. The well-conducted symposium was a center for the transmission of traditional values, as well as an event that provided liberation from everyday restraints within a carefully regulated environment.

Degas

Picasso

Manet Toulouse-Lautrec

Abstention vs. Drinking Frequency of Consumption Quantity of Consumption Quantity-Frequency (Volume) Volume Variability Frequency of heavy use Frequency of heavy episodic drinking,

binge drinking, or drunkenness “Max drinks” “Hazardous” use

Alcohol-related problems (consequences, disabilities)

Alcohol dependence syndrome Alcohol use disorders

Alcohol abuseAlcohol dependence

Failure to fulfill major role obligations Recurrent use in physically hazardous

situations Recurrent alcohol-related legal problems Continued drinking despite

social/interpersonal problems that are caused/exacerbated by alcohol

Criteria for alcohol dependence not met

Tolerance Withdrawal Using in larger amounts/over a longer time

period than intended Persistent desire to cut down/control Great deal of time spent

obtaining/using/recovering Important activities given up/reduced Continued drinking despite

physical/psychological problems that are caused/exacerbated by alcohol

Polythetic criteria Diagnostic orphans Diagnostic imposters Abuse and dependence don’t behave well

psychometrically Continuum or categories

Questionnaire-based approaches Assessing alcohol daily (or more

frequently)Time-line follow-backDiary methods

Daily report EMAEvent samplingTime sampling

Transdermal ethanol sensors

2010 SUN MON TUES WED THURS FRI SA

T

1 New Year’s 2

J 3 4 5 6 7 8 9

A 10 11 12 13 14 15 16

N 17 18 M. Luther King 19 20 21 22 23

24 25 26 27 28 29 30

31 1 2 3 4 5 6

F 7 8 9 10 11 12 13

E 14 Valentine’s Day 15 President’s Day 16 17 18 19 20

B 21 22 23 24 25 26 27

28 1 2 3 4 5 6

M 7 8 9 10 11 12 13

A 14 15 16 17 St.Patrick’s Day 18 19 20

R 21 22 23 24 25 26 27

28 29 30 31 1 Passover 2 Good Friday 3

A 4 Easter 5 6 7 8 9 10

P 11 12 13 14 15 16 17

R 18 19 20 21 22 23 24

25 26 27 28 29 30 1

M 2 3 4 5 6 7 8

A 9 Mother’s Day 10 11 12 13 14 15

Y 16 17 18 19 20 21 22

23 24 Memorial Day 25 26 27 28 29

30 31

One 5 oz glass of regular (12%) wine

1 ½ oz of hard liquor (e.g. rum, vodka, whiskey)

1 mixed or straight drink with 1 ½ oz hard liquor

1 Standard Drink is Equal toOne 12 oz can/bottle of beer

Complete the FollowingStart Date (Day 1): End Date (yesterday):

MO DY YR MODY YR

Name/ID#: Date:

TIMELINE FOLLOWBACK CALENDAR: 2010

Frequency: Drinking days/year.How often did you have a drink containing

alcohol, that is beer, wine or liquor? Quantity: Drinks per Drinking Day

About how many drinks would you have on average on a typical day when you drank?

Volume: (Drinking days/year X Drinks per drinking day)/days in a year = Drinks per day

Think of all kinds of alcoholic beverages combined, that is, any combination of cans of beer, glasses of wine, or drinks containing liquor of any kind.

During the past 12 months, Start with largest amount drunk;what is the largest number ask frequency of consumingof drinks on a single day? successively lower amounts per day. • Was it 24 or more drinks on • Daily or nearly every day

a single day? • 3 or 4 times a week

• 12 to 23 drinks on a single day? • Once or twice a week

• 8-11? • 2 or 3 times a month

• 5-7? •  Once a month

• 3-4? • 1-3 times in the past year

• 1-2? • Twice in the past year

• No drinks • Once in the past year

• Never

1. On Fridays during a typical month, how often did you drink - every Friday, three Fridays, two Fridays, one Friday, or hardly ever on Fridays?

2. How many drinks would you usually have on a Friday?

3. Repeat for Saturday, Sunday, and weekdays.4. Were there days when you had more than

your usual in the past 12 months?5. If yes, what did you typically drink and how

often.?6. Proportion of time you drank with a meal,

while snacking, or without eating anything.7. Did you ever drink enough to get drunk or very

high, that is, your speech was slurred or you were unsteady on your feet?

8. If yes, how often did you drink enough to get drunk or very high?

During the last 12 months, how often did you usually have any kind of drink containing alcohol? By a drink we mean half an ounce of absolute alcohol (e.g. a 12 ounce can or glass of beer or cooler, a 5 ounce glass of wine, or a drink containing 1 shot of liquor). Choose only one.

During the last 12 months, how many alcoholic drinks did you have on a typical day when you drank alcohol?

During the last 12 months, how often did you have 5 or more (males) or 4 or more (females) drinks containing any kind of alcohol in within a two-hour period? [That would be the equivalent of at least 5 (4) 12-ounce cans or bottles of beer, 5 (4) five ounce glasses of wine, 5 (4) drinks each containing one shot of liquor or spirits - to be provided by interviewer if asked.] Choose only one.

During the last 12 months, how often did you usually have any kind of drink containing alcohol? By a drink we mean half an ounce of absolute alcohol (e.g. a 12 ounce can or glass of beer or cooler, a 5 ounce glass of wine, or a drink containing 1 shot of liquor). Choose only one.

During the last 12 months, how many alcoholic drinks did you have on a typical day when you drank alcohol?

During the last 12 months, what is the largest number of drinks containing alcohol that you drank within a 24-hour period?

During the last 12 months, how often did you have 5 or more (males) or 4 or more (females) drinks containing any kind of alcohol in within a two-hour period? [That would be the equivalent of at least 5 (4) 12-ounce cans or bottles of beer, 5 (4) five ounce glasses of wine, 5 (4) drinks each containing one shot of liquor or spirits - to be provided by interviewer if asked.] Choose only one.

0

10

20

30

40

50

60

70

80

18-24 25-44 45-64 > 64

Drank past yearLifetime abstainerPast yr. abstainer

P

erce

nt

1.0

2.0

3.0

4.0

5.0

6.0

7.0

Gallo

ns of

etha

nol

Measure Dates Change

Cirrhosis mortality 1911–1929 29.5 to 10.7 per100,000

Admissions foralcoholic psychosis

1919–1928 10.1 to 4.7

Arrests for drunk &disorderly

1916–1922 50% decline

Source: Moore & Gerstein, 1981

1.0

1.21.4

1.61.8

2.02.2

2.42.6

2.8

Gallons

of et

hano

l

U.S. Per Capita Beer, Spirits and Wine Salesand Total Alcohol Sales (Savitzky-Golay Smooth)

Source: Williams et al. (1996) and Adams Wine Handbook 1997 (for 1996)

1960 1970 1980 1990 2000Year

0

0.4

0.8

1.2

1.6

2

2.4

2.8

Gal

lons

Eth

anol

Wine

Spirits

Beer

Total

1.00

2.00

3.00

4.00

5.00

AlcoholicBeverages

Consumer PriceIndex

Non-AlcoholicBeverages

Sources: Mosher, 1997; Mosher & Cowan, 1985; Bureau of Labor Statistics, 1996

Relative Price, 1970 $

1.99 or below

2.00 to 2.24

2.25 to 2.49

2.50 or over

U.S. total = 2.18

DC

3.99 or below

4.00 to 4.49

4.50 to 4.99

5.00 or over

DC

0

10

20

30

40

50

60

70

80

90

100

2.5 5 10 20 30 40 50 60 70 80 90 100

Highest Volume Percentile of Drinkers Lowest Volume

Perc

ent of

Tot

al

60+

50-59

40-49

30-39

18-29

Greenfield TK & Rogers JD.J Stud Alcohol 60:78 (1999)

0

2

4

6

8

10

12

14

16

18-24 25-44 45-64 > 64

Heavy Use

Women: > 1 drink / day Men: > 2 drinks / day

Per

cen

t

0

1

2

3

4

1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997

Rate

per

100

million VM

T

All fatalities

Alcohol-related fatalities

0

5

10

15

20

25

18-29 30-44 45-64 65+ 18-29 30-44 56-64 65+

Per

cen

t

Abuse Dependence

Men Women

12-mo. Prevalence of DSM-IV AUD Diagnoses

0

1

2

3

4

1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997

Rate

per

100

million VM

T

All fatalities

Alcohol-related fatalities

Alcohol Policy Issues

Jurisdictional Level Federal, state, county, municipal (or local community)

Type Taxation/pricing, access, advertising, transportation,

etc. Legally based policies, enforcement, and justice

system Institutional policies (e.g., schools, workplace, military) Health services and public health measures Science priorities and research policies

Issues Studies of policy making, policy analysis Evidentiary basis of policies and the role of science

Period• Up to 1906• 1907–1913 • 1914–1918 • 1917• January 1918• January 1919

Status• 3 Prohibition States• 23 Prohibition States (17 by referenda)

• 48 Prohibition States (25 new referenda; 16 < war)

• 18th Amendment introduced• Ratified by Congress• U.S. Prohibition Effective

Source: Moore & Gerstein, 1981

1932: Roosevelt campaigns for repeal of 18th Amendment December 1933: 21st Amendment (Repeal) ratified by 35

states Alcohol Control becomes “a pivotal idea” in post-Repeal era

Federal regulate production of spirits, wine & beer (curb illegal production) manage product purity and labeling; impose excise taxes Authority with Department of Justice (ATF since 1972)

State Devolved Powers including dry option, retail monopolies, taxation Alcoholic Beverage Control (ABC Laws)

Sources: Levine 1980; Moore & Gerstein, 1981

Federal law required health warning on container labels• Government warning from credible source: Surgeon General• Pregnant women should not drink : risk of birth defects• Impairs ability to drive a car or operate machinery and may

cause health problemsMajor Results

• By 1994, 60% drinkers reported exposure to label–curve flattening

• Messages reach many but not all target groups, heavier drinkers; e.g., > 50% males 18-20 (drunk driving); > 65% drinkers 18-29 (pregnancy); may miss less educated and ethnic groups

• Modest associations with precautionary behavior, conversations

Sources: Greenfield & Kaskutas, 1998; Greenfield et al, 1999; Hankin et al, 1993

After Prohibition, nearly all states has minimum legal drinking age (MLDA) at 21

Between 1970 and 1975, 29 states lowered the MLDA to 18, 19, or 20. Corresponded to changes for minimum age for other

activities, such as voting, also were being lowered 1976-1983, 16 states of these states raised it

to 21 1984, Uniform Drinking Age Act Movement to decrease MLDA again

What do you think???

1.00

2.00

3.00

4.00

5.00

AlcoholicBeverages

Consumer PriceIndex

Non-AlcoholicBeverages

Sources: Mosher, 1997; Mosher & Cowan, 1985; Bureau of Labor Statistics, 1996

Relative Price, 1970 $

Learning about various aspects of alcohol use, consequences, and dependence Epidemiology Assessment Ethics and protection of human subjects Neurobiology Genetics Treatment Prevention

Working in the labs of researchers at WUSM and MU conducting alcohol research

Tremendous variability in the kinds of experiences interns will have Data analysis Scheduling and “running” subjects Brain imaging Manuscript and presentation preparation Library research