alcoholism: the nuclear bomb of the life course
This is the last post for now about The Triumphs of Experience. In today’s post, I’d like to focus on one of the book’s major findings: the extreme damage done by alcoholism. In the study, the researchers asked respondents to describe their drinking. Using the DSM criteria and respondents’ answers, people were classified as occasional social drinkers, alcoholics and former alcoholics. Abstainers were very few so they receive no attention in the book. People were classified as alcoholics if they indicated that alcohol drinking interrupted their lives in any significant way.
The big finding is that alcoholism is correlated with nearly every negative outcome in the life course: divorce, early death, bad relationships with people, and so forth. I was so taken aback by the relentless destruction that I named alcoholism the “nuclear bomb” of the life course. It destroys nearly everything and even former alcoholics suffered long term effects. The exception is employment. A colleague noted that drinking is socially ordered to occur at night, so that may be a reason people can be “functioning” alcoholics during the day.
The book also deserves praise for adding more evidence to the longstanding debate over the causes of alcoholism. This is possible because the Grant Study has very rare, and detailed, longitudinal data. They are able to test the hypotheses that development of alcoholism is correlated with addictive personality (“oral” personality in older jargon), depression, and sociopathy. The data does not support these hypotheses.By itself, this is an important contribution.
The two factors that do correlate with alcoholism are having an alcoholic family member and the culture of drinking in the family. The first is probably a marker of a genetic predisposition. The second is about education – people may not understand how to moderate if they come from families that hide alcohol or abuse it. In other words, the family that lets kids have a little alcohol here and there are probably doing them a favor by teaching moderation.
Finally, the book is to be commended for documenting the ubiquity of alcoholism. In their sample, alcoholism occurs in about 25% of the sample of men at age 20. By the mid 40s, alcoholism reaches a peak, with about half of men being classified as alcoholics. After age 50, it then declines – mainly due to death and becoming a “former alcoholic.” If there is any generalizability at all to these findings, it shows that alcoholism has probably been wrecking the lives of millions and millions of people, somewhere between a quarter and half the population. That’s a profound, and shocking, finding.
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orgtheory.net 
The question that must be asked and answered is why is alcohol used so much by humans? What is its social function? Alcohol also has health benefits which must be addressed. Alcoholism is as much a personality issue as it is a social problem. Consider how many examples of alcohol use is portrayed on television. Again, what is the use that alcohol serves in our social lives?
By analogy, what is the use that smoking serves in our social relationships? What does smoking do for us other than it’s taste and smoke effect? Many people continue to smoke even though it is a fact that smoking causes cancer. So, what is the function of smoking? These questions are never asked and it puts a mask over the entire reality of drinking and smoking.
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Fredrick Welfare
May 8, 2015 at 3:47 am
Not that I doubt the destructiveness of alcoholism, but: “People were classified as alcoholics if they indicated that alcohol drinking interrupted their lives in any significant way.”
That definition sounds like it’s selecting on the DV and stacking the deck in favor of finding: “The big finding is that alcoholism is correlated with nearly every negative outcome in the life course: divorce, early death, bad relationships with people, and so forth.”
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ceg
May 8, 2015 at 3:59 am
@ceg: A weakness of the book is how it is vague when it presents data. But I don’t think it is as bad as you suggest. For example, defining alcohol as disruptive of daily life is separate conceptually from death and divorce. Your criticism is closer to the mark on other issues though. This is a case where being folksy and wordy leads to flaws in the write up.
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fabiorojas
May 8, 2015 at 4:03 am
Great stuff, Fabio. For those without the patience to read the book, the Atlantic article on the study is very interesting: http://www.theatlantic.com/magazine/archive/2009/06/what-makes-us-happy/307439/.
On alcoholism: while I’m sure it is incredibly common and incredibly destructive, it does seem possible that mid-20th-century Harvard grads drank a bit more than the general population. So maybe things aren’t quite as bad as the study might suggest.
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epopp
May 8, 2015 at 4:12 am
@epoppp: Au contraire. The book uses data from a sample of working class men from Boston as well to supplement the Grant study.It’s bad.
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fabiorojas
May 8, 2015 at 4:15 am
I stand corrected! Not just booze-loving WASPs, then.
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epopp
May 8, 2015 at 4:16 am
I am not sure I understand this data. It is argued that alcoholism has wrecked maybe half of the lives in USA. But if divorce is one criteria for “being wrecked” – what is the base line rate? Quite a lot of people experience divorce (anyway), so based on the information above I can’t see how all bad tings can be attributed to alcohol?
And, btw., 50% of everyone in their 40s is an alcoholic?
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Carsten B
May 8, 2015 at 12:29 pm
I have not read the work, just this post, but wonder about causal order. Don’t life stresses increase the taste for mind-altering substances?
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olderwoman
May 8, 2015 at 12:34 pm
Also, yeah, the 50% seems kind of high. Although problematic alcohol consumption is pretty high in a lot of social groups.
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olderwoman
May 8, 2015 at 12:35 pm
@olderwoman: Ideally, we’d like to interview people as children and then predict alcoholism. But we have data at age 20, and other stages, which can be used to predict later stages. It works for me.
@CarstenB: The effect of alcoholism on various life course events is done as a difference of means or correlations. The 50% number comes from a table in chapter 9 where they show, using their definition, the marked increase in alcoholism. And given what i have seen on college campuses, I am lead to believe that this is a modest over estimate.
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fabiorojas
May 8, 2015 at 12:56 pm
I still don’t understand the data. Close to 50% of american marriages end in divorce. I assume alcoholism doesn’t explain all of them – in other words, lives often get wrecked even without alcoholism. Hence my question about the baseline. Furthemore, I wonder how many american lives are categorized as “wrecked”.
About the 50% alcoholism: I don’t know anything about the actual numbers, just that sites like this one (http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics) report very (!) different numbers. Clearly based on very different definitions. 14% are abstainers according to the link given here – in contrast to the “Abstainers were very few so they receive no attention in the book”.
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Carsten B
May 9, 2015 at 8:33 am
Rates of alcohol consumption and alcoholism do vary regionally, and by religious/racial/ethnic group. A Boston/Harvard sample would not necessarily match national benchmarks.
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olderwoman
May 9, 2015 at 2:20 pm
Thanks, Fabio. Like others, I find the 50% number high, but it’s important to remember that it’s 50% of men as reported in the book, not 50% of Americans. Yes, there are a number of alcoholic women – and I’m not at all familiar with the statistics – but I doubt you would see nearly as high a number. That’s not to say that women aren’t affected by alcoholism, because everyone (the alcoholics themselves, their partners, their children, and often their parents and siblings and friends) is at risk of being affected by someone’s alcoholism. That’s why I appreciate Fabio’s nuclear bomb analogy. We often think of alcoholics on a path to self-destruction, but the deleterious effects are much more widespread and the book’s findings about alcohol illustrate that.
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jessica
May 9, 2015 at 2:43 pm
Here we go, CDC map http://www.cdc.gov/alcohol/data-stats.htm Massachusetts is, indeed, among the high-alcohol states. It is not as high as Wisconsin, but it is up there in the top tier. It is also well above the median for women’s binge drinking http://www.cdc.gov/ncbddd/fasd/monitor_table.html
So the prevalence rate is affected by the sample. This does not, of course, invalidate the point about the impact of problematic drinking on the life course.
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olderwoman
May 9, 2015 at 4:14 pm
Carsten,
This is not a random sample of all Americans but an entirely male sample with an oversample from upper-class origins from birth cohorts circa 1925, give or take five years. I’m not sure about the birth cohort effects, but alcohol consumption skews male and (at least in the US) upper SES.
As for abstainers, my understanding is they are disproportionately drawn from groups like Mormons and evangelicals who are socially distant from Harvard and working class Boston.
CEG,
It may be sampling on the DV, but it’s also standard in the literature. The DSM defines alcohol dependence (and other substance/addiction disorders) primarily based on continued behavior despite adverse consequences.
And there’s a logic to this since. For instance, I used to consume a lot of caffeine, and was even chemically dependent on it in the sense that not drinking coffee would give me headaches, but I did not have a caffeine substance abuse disorder because I did not suffer serious social, personal, or work consequences from my caffeine consumption. And one indication is about a month ago I decided to cut my caffeine intake substantially by switching from coffee to tea and I’ve been fine, no cravings, no relapses, no escalating usage — nothing — all of which is unlikely for someone who has a substance abuse disorder (or even a behavioral addiction, like gambling or sex).
In any case, it’s probably something of a semantic issue since I’d be shocked were there not a very high correlation between some measure of inputs (over 90 drinks a month) and consequence-based definitions (it has screwed up your life) like those found in the DSM and employed by addiction medicine clinical practitioners. Note though that it’s tricky to rely on “objective” measures of consumption since users radically understate their consumption — comparing excise tax data to survey data is only consistent if we assume half the booze sold in the US is poured into the sink. Since alcohol consumption follows a ZIP and heavy use is stigmatized but light use is not, it is likely that most of the underreporting is from heavy users.
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gabrielrossman
May 10, 2015 at 6:14 am
Thanks, that makes sense and makes clear that the extent of the impact is unlikely to be generalizable as epopp pointed out early on.
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Carsten B
May 10, 2015 at 11:11 am