Perspectives on Alcohol Problems:

1. The Objectivist Viewpoint

This course is about problems that people experience when they or others use alcoholic beverages. Because this is a course in behavioral and social science, we will be primarily concerned with the efforts of social scientists to describe, explain, and understand alcohol problems. As seen from a sociological point of view, problems related to the use and misuse of alcohol and other drugs have a lot in common with other problems, such as crime, domestic violence, or psychiatric disorder. These are all examples of deviant behaviors that have become publically recognized and defined as social problems. So, before we deal with specific questions about the meaning and nature of alcohol problems, we should consider a broader question: What is a social problem?

Within the social sciences, there are two quite different answers to this question. On the one hand, researchers who study crime, psychiatric disorder, and other forms of deviant behavior have traditionally worked from an objectivist viewpoint, which conceptualizes social problems as harmful social conditions that can be scientifically identified and measured. On the other hand, many sociologists, political scientists, and historians have adopted an alternative conceptual strategy, the constructionist viewpoint, which analyzes social problems as a process of claimsmaking and social definition by politicians, social movements, and other interest groups. Some constructionists go on to argue that "social problems" are not necessarily based on "real world" conditions, harmful or otherwise, a contention that objectivists view as preposterous. Despite their many differences, both of these conceptual viewpoints on social problems have proven to be useful in alcohol research and theory. Let's take a look at each perspective and how it views the defining characteristics of alcohol and drug problems.

The Objectivist Viewpoint: Harmful Social Conditions

Volkow on Heroin Abuse

When most people use the term "social problem," they are referring to behaviors or conditions that are objectively harmful or threating to their own or others' well-being. For instance, people often refer to drunk driving as a serious social problem because of the thousands of deaths that result from it each year. We can also add millions of injuries, billions in economic losses, and many other forms of measurable harm that result from drunk driving in the United States. Objectivist research on the problem of drunk driving focuses on the patterning or epidemiology of this behavior and attempts to identify the basic causes of this harmful social activity.

The objectivist viewpoint is clearly illustrated in Jean Kinney's textbook, Loosening the Grip (2012, p. 42), when she presents a table in Chapter 2 showing a breakdown of the "social costs of alcohol use," such as motor vehicle crashes, reduced productivity in the workplace, treatment expenses, and other alcohol-related costs. Her 2006 estimates are actually based on the 1998 figures shown in the pie-chart to the right, which originally appeared in the 10th Special Report to the U.S. Congress on Alcohol and Health (National Institute on Alcohol Abuse and Alcoholism, 2000, p. 366). As you examine these figures, you need to keep in mind that the economic, medical, and social benefits of alcohol use are not included here. Also, critics have questioned the economic assumptions about future productivity and earnings of drinkers that underly the estimates of productivity losses, which account for nearly three-quarters of the overall cost of alcohol "abuse." Still, the billions of dollars that are spent annually on alcohol problems—not to mention the intangible human cost of alcohol-related deaths, injuries, illness, and psychological suffering—are compelling evidence of the damage that alcohol use inflicts on U.S. society. This kind of evidence is especially relevant to the goals of harm-reduction policies, such as "tipsy taxi" or "designated driver" programs, which are primarily designed to reduce the social costs and harms of alcohol misuse rather than adopting a "zero tolerance" stance toward drinking.

It is important to note that, from this objectivist perspective, "alcohol problems" or any other kind of "social problem" consist of social, medical, or economic facts that exist independently of public awareness or social concern about these conditions. These costs and harms are "out there in the real world" waiting to be discovered. This means that social scientists are potentially capable of identifying and measuring social problems even though the public or policy makers do not view these conditions as problematic. Thus, researchers might perform a valuable social function by discovering new and previously unknown problems through scientific inquiry. For example, researchers at the University of Michigan who conduct the Monitoring the Future project annually report on new or growing drug and alcohol problems that they have detected in national surveys of high school students (http://www.monitoringthefuture.org). Later in the course, we will turn to the Monitoring the Future project as a reliable source of objective, epidemiological evidence on patterns and trends in drug and alcohol use among teenagers.

Another excellent example of the objectivist approach to the study of alcohol and drug problems is the work of a team of British researchers who endeavored to develop a "rational scale to assess the harm of drugs" (Nutt et al. 2007). Nutt and his colleagues asked groups of experts on alcohol and drug problems (e.g., psychiatrists, pharmacologists, forensic scientists) to rate various drugs on nine dimensions of harm, including physical harms, risks of dependence, and social harms such as intoxication and health care costs. The experts scored each harm for each drug on a four-point scale: 0 = no risk; 1 = some risk; 2 = moderate risk; 3 = extreme risk. Thus, this study offers an objective assessment by a panel of experts of how the harms of alcohol compare to those of other psychoactive drugs.

The figure below shows the mean harm ratings by the expert panel—the overall average of scores on all nine dimensions—for 20 different substances. The colors of the bars in this graph provide additional information on the current legal status of these drugs in the United Kingdom. According to the U.K. Misuse of Drugs Act, the Class A designation (shown in red) is reserved for the most dangerous drugs whereas Class C drugs (shown in purple) are defined as the least harmful controlled substances. Legal (unclassified) substances, such as alcohol and tobacco, are shown in blue.

Heroin ranks as the most harmful drug by a clear margin, with an overall mean score of 2.78 that is near the maximum possible risk of harm. It is followed by another illegal, Class A substance, cocaine, whose overall risk rating of 2.33 places it closer to the "moderate risk" range. However, as is evident elsewhere in this graph, the legal classification of substances as dangerous does not correspond very well with their rankings in terms of objective harm. In particular, the placement of LSD and Ecstasy (MDMA) near the bottom of this list in the "some risk" range stands in sharp contrast to their legal status in the U.K. (and, similarly, in the U.S.) as Class A dangerous drugs. Equally interesting is the relatively high overall harm scores for alcohol, which is ranked even higher than another widely used legal substance, tobacco.

The Nutt et al. study shows how objectivist inquiry can potentially inform and challenge social policy in the area of alcohol and drug problems. The researchers conclude that their findings raise questions about the validity of legal definitions of dangerous drugs and indicate that the current classification system in the U.K. is "arbitrary." However, the objectivist viewpoint does not shed much light on the political, cultural, and historical processes that created these seemingly arbitrary definitions of drug problems. To understand how LSD, Ecstasy, or other substances become officially defined as more "dangerous" than the legal drug, alcohol, we need to examine how claimsmaking activity shapes the social construction of social problems.

Mean harm scores for 20 substances

Mean harm scores for 20 substances and classification under the UK Misuse of Drugs Act

Source: Nutt et al., Lancet (2007) 369:1050.
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