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Source: Beer Institute. (2011). Brewers almanac, 2011. Washington, DC: Author.
The Drinking Culture and the Alcohol Industry

As noted earlier, alcohol has a long history in the United States and an even longer history in much of the rest of the world. When we think about the tens of millions of Americans who drink at least occasionally, the ads for beer and wine and hard liquor that appear regularly in the popular media, and the thousands of bars and related venues across the country, it is certainly no exaggeration to say that we have a drinking culture.

Once upon a time, the federal and state governments tried to eliminate this culture. We are speaking, of course, about Prohibition. The passage of the Eighteenth Amendment to the US Constitution in January 1919 banned the manufacture, sale, and transportation of alcohol; the ban took effect a year later. For reasons we will discuss later, the ban was eventually deemed a failure, and the passage of the Twenty-First Amendment in 1933 repealed the Eighteenth Amendment. The manufacture, sale, and transportation of alcohol became legal once again.

Alcohol manufacturing and sales are a major industry worldwide today. Several alcohol companies rank among the largest corporations in the world as well as in the United States (Jernigan, 2009). [7] US alcohol sales amount to about $160 billion annually, and they rose by 20 percent in the 2010–2011 period during the faltering economy (Smith, 2011). [8] The amount of money the public spends on alcohol equals 12.5 percent of what it spends on food (US Department of Agriculture, 2011). [9] The alcohol industry provides about 2 million jobs annually, more than $40 billion in wages, and more than $50 billion in taxes, and it contributes more than $160 billion to the annual national economy (Distilled Spirits Council of the United States, 2011). [10] All these figures show that the alcohol industry plays a significant role in the US economy.

Despite this role, if the United States does indeed have a drinking culture, the alcohol industry bears a major share of the responsibility. As the American Medical Association (2004) [11] has stated,

Like the tobacco industry, the alcohol industry produces a legal, widely consumed drug; is dominated by relatively few producers; and utilizes a powerful combination of advertising dollars, savvy marketing, political campaign contributions, and sophisticated lobbying tactics to create and maintain an environment favorable to its economic and political interests. It requires the recruitment of new, youthful drinkers to maintain and build its customer base…As a chemical that affects our bodies, alcohol is a powerful drug resulting in more premature deaths and illnesses than all illicit drugs combined. Yet the industry has shaped public opinion and forced government to treat it not as a drug but as a cultural artifact, a valued legal commodity, almost a food, even a necessity of life.

As just one example of how the alcohol industry promotes its “powerful drug,” the headline of a recent news article declared that the “alcohol companies go online to lure young drinkers” (Gardner, 2010). [12] According to the report, alcohol companies are increasingly using Facebook and other social media to persuade young people to buy and drink their products. Not surprisingly, many of these young targets turn out to be under the legal drinking age of 21 because they are easily able to gain access to alcohol sites. This problem led a public health professor to observe, “Close to 5,000 people under the age of 21 die of alcohol overuse each year. Virtual worlds show all of the appeal and none of the consequences of alcohol use and undercut efforts to reduce the incidence of underage drinking. At this point, alcohol companies appear limited only by their imaginations and pocketbooks” (Gardner, 2010). [13]

Consequences of Alcohol Abuse

Despite alcohol’s immense popularity, the fact remains that more than 18 million Americans abuse it (Harvard School of Public Health, 2012). [14] This heavy rate of abuse means that alcohol has serious personal and social consequences. One set of consequences involves personal health. We noted earlier that alcohol abuse is responsible for about 85,000 deaths annually through the physiological damage it does. Heavy alcohol use can destroy the liver, increase blood pressure, weaken the heart and immune system, and cause sexual dysfunction. It can lead to neurological problems and also raises the risk of incurring several kinds of cancer. Binge drinking can cause serious immediate health problems because it may lead to someone overdosing on alcohol. About 800,000 adults are hospitalized every year for alcohol overdoses, and tens of thousands more are hospitalized because they have consumed alcohol along with prescription narcotic pain medications, a combination that can be deadly (National Institutes of Health, 2011). [15]

In addition to these health problems, alcohol use is responsible for more than 16,000 traffic fatalities annually, and it plays an important role in violent crime (Felson, Teasdale, & Burchfield, 2008). [16] As almost anyone with an alcoholic family member can attest, alcohol abuse can also cause many problems for families, including domestic violence and divorce and the stress that results from having to deal with someone’s alcoholism on a daily basis. (The Note 7.13 "Children and Our Future" box discusses the impact of parental alcoholism on children.) Alcohol abuse costs the United States more than $185 billion each year in medical expenses, lost earnings because of alcohol-related illness or premature death, lost earnings by victims of violent crime, and alcohol-caused traffic accidents (Harvard School of Public Health, 2012). [17]
Children and Our Future

Children of Alcoholics

As with so many social problems, one of the saddest consequences of alcohol abuse involves children. About one-fifth of children have lived with an alcoholic parent or other adult. Whether because alcoholism is partly inherited or because children tend to use their parents as role models, children of alcoholics are four times more likely than children of nonalcoholics to become alcoholics themselves by the time they reach adulthood.

Because living with an alcoholic parent is often both chaotic and unpredictable, it is no surprise that children of alcoholics often experience a great deal of stress and other difficulties that may also account for their greater tendency to become alcoholics. Compared to other children, they are more likely to be neglected and/or abused by their parents, and they are also more likely to miss school, have lower grades, and engage in disruptive behavior. In addition, they are at great risk for eating disorders and substance abuse other than alcohol abuse. The stress they experience can also harm their neurological development and immune system and put them at greater risk for different kinds of illness and disease. Children of alcoholics are also at greater risk for several kinds of psychological and emotional problems. These include (1) guilt, because they may blame themselves for their parent’s drinking; (2) anxiety, because they worry about their parent’s health and may see their parents arguing and fighting; (3) embarrassment that leads them not to invite friends over to visit nor to ask another adult for help; (4) lack of trust in other people, because they have learned not to trust their alcoholic parent; and (5) angerconfusion, and depression.

One special problem that children of alcoholics face is that they are “forced into adulthood.” They often find themselves having to care for younger siblings and even for their alcoholic parent. By taking on such a heavy responsibility, they in effect become adults at too tender an age. This responsibility weighs on them and helps account for the psychological and emotional difficulties they often experience.

Mental health professionals strongly advise that children of alcoholics receive counseling and other kinds of support to help them deal with their family experiences. Group support programs for teenaged children may be very helpful. Perhaps the best known such program is Alateen, which also services teenagers who want help dealing with an alcoholic friend. Teenagers at Alateen meetings share their experiences, learn how to deal with the special difficulties that stem from having a relative or friend with an alcohol problem, and provide emotional support for each other. One important message they learn from Alateen is that they are in no way responsible for the alcoholism of their parent, other relative, or friend.

Alateen has helped many young people, as this testimonial from “Lizzy” attests: “Alateen has helped me a lot over the years…From the day I went to my first meeting, the door to my happiness was flung open. With the help of the Alateen Group Sponsors and my fellow teens, my life has become what I always wanted it to be. My goal for success in the program was fulfilled. I have been given a second chance at life and I have Alateen to thank for that.”

Young children and teenagers are resilient, but children of alcoholics have to be especially resilient. Programs like Alateen help give them a second chance.

Sources: Alateen, 2011; American Academy of Child and Adolescent Psychiatry, 2006; James, 2008 [18]

College Students

Alcohol abuse is also a problem on college and university campuses across the United States. Based on the SAMHSA survey evidence discussed earlier, full-time college students ages 18–22 drink more often and more heavily than their peers who are not in college (Substance Abuse and Mental Health Services Administration, 2008). [19] Among full-time college students ages 18–20, who are all too young to drink legally, about 40 percent have engaged in binge drinking in the past month, and 17 percent have engaged in heavy drinking as defined earlier. Binge drinking on and off campus is so common that binge drinkers consume 91 percent of all the alcohol that college students drink.

Binge drinking by college students has many serious consequences (Center for Science in the Public Interest, 2008; National Center on Addiction and Substance Abuse, 2007). [20] The following are consequences with approximate figures:

  • Binge drinkers are much more likely than other students to miss class, get poor grades, be injured, have unprotected sex, and to drive after drinking.

  • Six hundred thousand college students suffer alcohol-related injuries (from motor vehicle crashes and other accidents) each year, and 1,700 die from these injuries.

  • Thirty thousand college students need medical attention annually to treat alcohol overdosing.

  • Seven hundred thousand students are assaulted annually by a student who has been drinking, and three hundred students die from these assaults.

  • Students who attend colleges with high rates of binge drinking are more likely to experience sleep disruption, property damage, and physical and sexual assaults than those who attend colleges with low rates of binge drinking.

Tobacco and Nicotine

Nicotine, the major drug in tobacco, is another legal but very dangerous drug. As we saw earlier, its use kills four times as many people every year as those killed by alcohol use. Tobacco is a slow poison. If it were not already a legal drug used by millions, and a company had just manufactured cigarettes for the first time, the Food and Drug Administration would never approve this product. Fortunately for tobacco companies, nicotine does not distort perception the way that alcohol and many other psychoactive drugs do. Someone smoking or otherwise using tobacco can safely drive a car, operate machinery, and so forth, and someone “under the influence” of tobacco does not become violent.

If you have ever watched any number of pre-1970s movies or television shows like “Mad Men” that portray life back then, you know that the United States used to have a tobacco culture the way it now has an alcohol culture. Many, many people smoked cigarettes, and a large number smoked cigars or pipes. This particular drug culture began to abate in the 1970s after much evidence mounted about the deaths and other serious health effects of tobacco use and especially about the dangers of second-hand smoke. Whereas college students a generation ago often sat in smoke-filled classrooms and Americans generally sat in smoke-filled restaurants and other venues, today most Americans can count on being in enclosed public spaces in which smoking is banned.

Even so, we have already seen that more than one-fourth of Americans 12 and older, or some 70 million people, are still current users (past month) of tobacco. Almost one-fifth of American adults (18 and older), or 45.3 million adults, smoke cigarettes daily or occasionally (King, Dube, Kaufmann, Shaw, & Pechacek, 2011). [21] Thanks to the greater knowledge about tobacco’s health effects, public education campaigns about these effects, heavy taxes on cigarettes, and changing attitudes about tobacco, these numbers represent a significant decline from a generation ago.

Tobacco use causes more preventable death and illness in the United States than any other cause of death; if no one used tobacco, the more than 400,000 tobacco-related deaths each year would not occur. As we think about tobacco, this startling statistic needs to be kept in mind: About half of all cigarette smokers will one day die from a premature death caused by a smoking-related illness (King et al., 2011). [22] To repeat what was said just earlier, nicotine is a slow poison.

Tobacco kills in several ways. Smoking causes 80–90 percent of all lung cancers, and it greatly increases the risk of emphysema and other lung disease, coronary heart disease, and stroke. In addition to lung cancer, tobacco use also causes several other cancers, including bladder cancer, cervical cancer, esophageal cancer, stomach cancer, and throat cancer. Women who smoke are at greater risk for lower bone density and hip fracture when they get older.

The economics of tobacco use are also worth knowing. Americans spend about $90 billion annually on tobacco products, with most of this amount spent on cigarettes (Centers for Disease Control and Prevention, 2011). [23] They purchase more than 300 billion cigarettes annually, with most of the cigarettes sold by three companies. Cigarette smoking is estimated to cost almost $200 billion annually in medical expenses and lost economic productivity. This works out to a national economic loss of about $10.50 for every pack of cigarettes that is sold.

One interesting and very important fact about the economics of cigarette smoking is what happens when the cost of cigarettes is increased. Most smokers begin their deadly habit during adolescence or young adulthood. Because this is a period of their lives when they do not have much money, increases in the cost of cigarettes are particularly useful in persuading some of these young people not to buy cigarettes. Government data indicate that every 10 percent increase in the price of cigarettes reduces cigarette consumption among young people by 4 percent (Centers for Disease Control and Prevention, 2011). [24] A similar but smaller effect occurs among older smokers.

Earlier we said that the alcohol industry plays a major role in the amount of drinking that occurs in the United States. The same is true of the tobacco industry and smoking. This industry spends about $15 billion annually—or an average of $41 million daily—in advertising, sponsorship of public events, and other activities to promote its deadly product, and for many years hid or distorted data about the deadly effects of cigarette smoking (Brandt, 2009). [25]Because of funding cutbacks during the recent faltering economy, the states have reduced their media campaigns and other efforts aimed at reducing smoking. This reduction, combined with the tobacco industry’s huge promotional spending, leads one public health professor to lament, “The tobacco companies are winning the battle” (Martin, 2011). [26]

Illegal Drugs

The SAMHSA survey also gathers data from its thousands of respondents about illegal drug use. Table 7.4 "Prevalence of Illegal Drug Use, Ages 12 and Older, 2010*" presents these data for several illegal drugs and shows that use of these drugs is far from rare.

Table 7.4 Prevalence of Illegal Drug Use, Ages 12 and Older, 2010*


Past year

Past month

Any illegal drug




Illegal drug other than marijuana
























Nonmedical use of prescription-type drugs†




* Percentage using in designated time period

Includes stimulants

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