In June, 1975, I had the honor to represent Berkeley’s Alcohol Research Group (ARG), where I then worked, at the 21st International Institute on the Prevention and Treatment of Alcoholism, in Helsinki.(1) I presented a paper to the Epidemiology Section meeting (2) — a group that would later split off and become the Kettil Bruun Society following Kettil Bruun’s death in 1985.
It was my first international conference and I was pretty excited to be there. Helsinki was beautiful in its lush green setting and the conference organizers did a wonderful job hosting. At a conference dinner one evening I had the good fortune to be seated next to Dr. Max Glatt. He was the leading proponent of alcoholism treatment in Britain and as well a staunch supporter of the disease concept of alcoholism.
Glatt was friendly and open as we chatted and enjoyed a fine meal of venison with a currant sauce. At some point our conversation turned to the disease concept. In June, 1975, I was 31 and still, I hate to admit, in my piss-and-vinegar, know-it-all youth. I asked Glatt if he were familiar with Karl Popper’s notion that potential falsifiability was the true test of a genuinely empirical scientific theory or hypothesis. He said yes, he was.
“Well then,” I continued, “if the disease concept of alcoholism is a genuinely empirical assertion, what observation or observations would in your view falsify or disconfirm it? In other words, what sort of data would convince you that alcoholism was not a disease?”
Glatt thought for a long moment and then responded that he wanted to think about the question more. He’d give me his reply tomorrow at dinner, he said. The next evening, as promised, Glatt brought a response.
“None,” he said. “There’s no observation that would disconfirm that alcoholism is a disease.”
“So,” I responded, “therefore the disease concept cannot be said to be a scientific proposition in your judgment.”
“No, I guess not,” he replied, “Not entirely.”
At the time, I felt a sense of gotcha triumph at Glatt’s reply. Yet, and in due course, I came to admire his candor and his reply. It would have been good to hear his reply fully elaborated in a long discussion that evening. But Glatt said no more on the question. I don’t remember what was served for dinner that evening but I’m sure it was terrific.
(1) I published a brief account of the meeting in ARG’s house organ – see “Alcohol epidemiology: Helsinki1975,” The Drinking and Drug Practices Surveyor 11:1, 43-54, 1976.
In the first segment of this post, Ron Roizen explored the congenial relationship between the free and easy scientific method that prevailed at the Yale School during the late 1940s and Marty Mann’s message-driven National Council on Alcoholism. The second installment in his story brings in another character– Alcoholics Anonymous– and shows how they all held hands.
The A.A. Grapevine Survey
Arguably the most notable – and perhaps also the most unlikely – of these awkward interactions surrounded The A.A. Grapevine’s survey of alcoholism’s symptomatology in 1945. This survey in due course provided the data for E.M. Jellinek’s famous 1946 (8) and 1952 (9) articles describing an alcoholism syndrome.
If some speculative historical interpolation may be forgiven – because the exact origins of the Grapevine survey are not known: My hunch is that once Marty Mann embarked on marketing the disease concept to the American public she encountered questions about the concept she could not adequately address.
It’s likely, moreover, that when Mann called for backup at the Yale group its scientists had little help to offer. Mann may have also turned to her psychiatrist friend, Harry Tiebout, for help. Her request, in turn, may have prompted the writing of Tiebout’s 1945 article on the syndrome of alcohol addiction (10). Yet Mann was probably not entirely satisfied with Tiebout’s article, as its symptomatology took a psychiatric (rather than a physiologic) approach toward alcoholism. Thus, Mann may have soon come to the conclusion that she needed to collect her own scientific data on alcoholism’s symptomatology – in what would become the 1945 Grapevine survey.
Jellinek – slyly, I suggest — alluded to the homegrown origins of the Grapevine survey and a homegrown rationale for its undertaking in the introductory pages of his 1946 article. “Members of Alcoholics Anonymous,” wrote Jellinek,
see their own experience duplicated day in, day out by the many inebriates who come to them for help. Again and again they hear about those drinking incidents and behaviors which in their own cases seemed significant to them. The older members of that informal organization of recovered alcoholics, no doubt, would like to see some systematization of the knowledge derivable from the drinking history. It is, presumably, because of this that the Grapevine, now the official organ of Alcoholics Anonymous, published in its May 1945 issue a questionnaire designed for members of Alcoholics Anonymous (p. 3, emphasis added).
I see slyness here on Jellinek’s part because he attributed the Grapevine survey’s origins to a broadly diffuse alleged desire among “older members” of A.A. for a systematization of their collective drinking experience. That doesn’t quite ring true. A more candid description of the reasons behind the survey might have noted Mann’s campaign’s unmet need for more scientific stiffening for the disease concept.
Jellinek, also in the 1946 article, expressed diffidence about undertaking the analysis of data arguably collected in a more or less unscientific fashion. “After the questionnaires were returned,” he wrote,
the editors of the Grapevine requested me to prepare a statistical analysis of the data. I have undertaken this work with great interest but also with many misgivings. Statistical thinking should not begin after a survey or an experiment has been completed but should enter into the first plans for obtaining the data. In the questionnaire under consideration this requirement was neglected (p. 5).
It is well to step back and take in the irony attaching to the Grapevine survey’s story. Should the known part of this story and my guesswork prove more or less correct, then: First, Yale scientists hired a publicist to promote the disease concept. Then the concept turned out to lack good scientific legs. The publicist, in turn, launched her own survey study — in order to provide rudimentary data buttressing alcoholism’s disease character. Next, a Yale scientist reluctantly agreed to analyze the data. He published two papers stemming from the survey (1946 and 1952). In due course a chart showing alcoholism’s symptom progression (in the 1952 paper) became widely distributed within the alcoholism movement.
“This chart,” wrote Robin Room (8), “particularly as adapted by [Max] Glatt, is probably the most widely diffused artifact of the alcoholism movement’s disease concept.” Quite a story.
Players in all institutions engage in back-stage communications about how best to pursue their aims and the limits of appropriate actions. The correspondence I’ve made use of in this post sheds new light on Mann’s organization’s weak rhetorical position respecting the alcohol science it sought from Yale. O’Connor’s correspondence with Straus and with Bacon illuminated the limits of what Yale science could offer on issues that were important to NCA’s broader campaign. Mann’s correspondence with Haggard, on the other hand, showed how she sought to shape Yale science along lines that were useful – or at least not obstructive – to her campaign’s goals. The story of the Grapevine survey suggested how the role relationship between Mann’s group and the Yale group could become partly reversed. Mann, in all probability, designed and carried out the data-gathering for this study – a scientific task the Yale group might have undertaken. There are no one-way streets in this picture of interaction concerning science between NCA and Yale. Not-so-hard science could be finessed, massaged, or negotiated when the situations and the goals of the two institutions warranted.
(8) Jellinek, E.M., “Phases in the Drinking History of Alcoholics: Analysis of a Survey Conducted by the Official Organ of Alcoholics Anonymous,” Quarterly Journal of Studies on Alcohol 7:1-88, 1946.
(9) Jellinek, E.M., “Phases of Alcohol Addiction,” Quarterly Journal of Studies on Alcohol 13:673-684, 1952.
(10) Tiebout, Harry M., “The Syndrome of Alcohol Addiction,” Quarterly Journal of Studies on Alcohol 5:535-546, 1945.
(11) Yet, and interestingly, Mann cited Tiebout’s 1945 article, and not Jellinek’s 1946 and 1952 articles, as authority for the disease concept claim in her 1950 book, Primer on Alcoholism.
(12) Room, Robin G. W., Governing Images of Alcohol and Drug Problems: The Structure, Sources and Sequels of Conceptualizations of Intractable Problems, Ph.D. dissertation, University of California, Berkeley, Sociology, 1978, p. 55.
Meth and Moral Panics, Part One and Part Two led us to the question of whether and how we ought to arbitrate the real in assessing the ‘disproportionate response’ that moral panics require. In this post, we’ll look at efforts to do just this with respect to methamphetamine in the contemporary United States, and conclude with three suggestions for refashioning the relationship of moral panic studies to actual behavior.
An abundance of published works tie the methamphetamine response to the moral panic concept, most often in studies that don’t really fit the framework (see my earlier post for more on this). Travis Linnemann’s fascinating examination of the gendered reporting of methamphetamine in the Midwest is a good example; in the end, he’s not really all that interested in arbitrating the real. Consider his observation when discussing media portraits of a masculine/feminine dichotomy of work within the methamphetamine trade: “it is not clear whether this division of labor is entirely constructed by the media or if the data depict actual differences in duties. Regardless, the mediated depictions illustrate perceived differences in duties.” (1) Likewise, the sophisticated study of Canadian media by Susan Boyd and Connie I. Carter invokes the drug panic concept, but largely confines itself to the general observation that media coverage avoids and even forecloses “discussion of the broader social, cultural, and economic factors that affect users’ lives, including lack of housing, healthcare, and meaningful employment opportunities.” (2) Jack Shafer, writing Slate‘s Press Box column, has presented some of the best journalistic accounts of error and disproportion, here and here and here—hectoring, at times even begging, his colleagues to take a more careful, evidence-based approach to their reporting of the methamphetamine problem.
The academic study that most explicitly searches for the gap between moral panic and objective reality is Robert R. Weidner’s “Methamphetamine in Three Small Midwestern Cities: Evidence of a Moral Panic,” from the September, 2009 issue of the Journal of Psychoactive Drugs. Weidner correctly observes that all of this moral panic talk would appear to demand some effort at sorting out the gap between meth panic and meth reality, and that doing so is no easy task (indeed, Weidner cites the work of several scholars who have made the case that the quest to find disproportion “is so laden with ontological and methodological difficulties as to render it virtually useless as an analytical guiding light.”). (4)
Weidner’s study “examined the existence of disproportionality” by comparing media coverage of meth relative to other illegal drugs with the prevalence of treatment admissions for meth relative to other illegal drugs in three cities (Bismarck, North Dakota; Springfield, Illinois; Topeka, Kansas). Media coverage data came from newspaper articles. Prevalence of treatment admissions came from the Treatment Episode Data Set [TEDS], “the only national-level information on the prevalence of substance abuse that is disaggregated for hundreds of MSAs.” Unfortunately, the TEDS data has one absurdly distorting quality—marijuana “treatment” cases overwhelm the data set. Nearly HALF (48%) of all treatment cases during the entire period for all three cities combined were for marijuana, mostly cases in which defendants were “diverted” from the criminal justice system into “treatment.” If coverage of marijuana was not correspondingly high in newspaper accounts (and it wasn’t), one is more inclined to praise editors for sound judgment than to attribute moral panic! By the numbers, the rest of the “real” data is similarly problematic–meth lab seizures and state-level drug self-reports. In the end, Weidner finds his moral panic with criticisms of “drug-scare” rhetoric (the use of terms like “epidemic” “plague” and “scourge”) and claims of addictiveness. A noble effort, but a dispiriting result in the quest to locate disproportion.
So, what do we do now? Discard the moral panic concept? Read More »
Over the course of the second half of the 20th century Mrs. Marty Mann and her National Council on Alcohol (NCA) became the best known public advocates of the disease concept of alcoholism in the United States. Mann’s great campaign, however, harbored a vexing rhetorical weakness.
From its outset–with NCA’s (1) launch in the autumn of 1944–Mann’s organization purported to convey ostensibly sound scientific knowledge and facts about alcoholism to the American public. Mann was a publicist, not a scientist; more to the point, scientific knowledge about alcoholism (including even whether such a phenomenon might confidently be said to exist) was scant and unreliable. This awkward behind-the-scenes circumstance created some equally awkward and unlikely back-stage interactions between NCA and the Yale Center of Alcohol Studies. Read More »
As we continue in our quest to get to the bottom of the current moment’s hysteria about “pill mills,” Points is delighted to have as a guest blogger Kenneth D. Tunnell, talking about the ways in which OxyContin abuse was portrayed in the media the first time people got all worked up over it. Professor of Criminology at Eastern Kentucky University, Tunnell is the author of Choosing Crime, Political Crime in Contemporary America, Living Off Crime, and Pissing on Demand: Workplace Drug Testing and the Rise of the Detox Industry. His forthcoming photography book, Once Upon a Place, details the vast changes occurring across rural agricultural communities in Kentucky.
During the late 1990s Kentucky experienced a new drug abuse epidemic. OxyContin, a powerful analgesic for terminal disease-related pain, was over-prescribed and diverted into informal black markets. Media reports linked OxyContin use to increases in crime and overdose deaths. The OxyContin problem in Eastern Kentucky was graphically featured in a Newsweek cover story. Media rhetoric oftentimes was bigoted toward rural, mountain people (hence, “hillbilly heroin”). Media coverage of the OxyContin-crime connection was momentary (the early 2000s) as symbolic crusades about other drugs (methamphetamine and mephedrone) emerged.
OxyContin became the stuff of frequent front-page news stories that consistently increased in number. Similar to previous drug panics, the OxyContin problem was described using hyperbolic imagery and rhetoric. Its construction often relied on unverified claims. Much public discourse focused on OxyContin’s relationship to Kentucky’s increasing crime problem. Claims of increases in crime and due to one variable — OxyContin — were widely reported as fact. Although crime data are public, they were ignored by media and public officials who made sensational claims. Data simply do not support linking any crime increases (or decreases) to OxyContin’s introduction.
The realities of the crime problem are nothing like the rhetoric. Crime rates in Kentucky are declining and have been for years. The violent crime rate in 1990 was 390 per 100,000 dropping to 258 during 2001 (the year of most media attention) and increasing since then to 284 per 100,000. Property crime rates (the crime type usually associated with drug abuse) steadily decreased from 2909 per 100,000 in 1990 to 2638 in 2001 and further to 2470.
Beyond Kentucky, newspapers reported that OxyContin was fueling a national crime wave.
The fact is no such crime wave exists. For years now, crime rates in the US have steadily decreased. Property crime decreased from 5,073 per 100,000 population in 1990 to 3,658 in 2001 (the year of most media reporting) to 3,036 per 100,000 in 2009. In fact, property and violent crime has declined by 40 percent since 1990.
After a drug bust netting 201 people, a US Attorney General, justifying the arrests, claimed that OxyContin had caused 59 deaths in one year in Kentucky. Although dismissed as “inflammatory,” his claims, with no factual basis, were widely published. The actual number of OxyContin-related overdose deaths likely will never be known due to poly-drug use, most commonly OxyContin mixed with alcohol and other depressants. Data do not distinguish accidental deaths from suicides. Emergency room reports reveal that oxycodone (OxyContin’s drug category) is mentioned by fewer than one percent of patients. Oxycodone products evidently remain far less widely used than rhetoric suggests. Nonetheless, estimates — and alarming ones — have been uncritically published by the media and officials.
Like other social problems, OxyContin abuse requires social explanations. Kentucky’s history includes: OxyContin’s sales and marketing strategies, Congress’s declaration of the “decade of pain” and doctor’s treating pain differently, the DEA granting consistent increases in opiate manufacturing, and a history of pharmaceutical use. Yet Kentucky’s OxyContin-crime relationship is socially constructed. Granted, crime rates in some Kentucky counties are increasing but mainly due to decreases in population. These rate increases likely would not occur with positive population gains. But, this news further reinforces OxyContin- crime panic.
Whenever drug scares emerge, the role of the media–its focus and how the public comes to accept its stories–must be examined. During a few short years, OxyContin news stories increased, from none in 1998 to 404 stories in 2001(and then declining). In 2003, the Lexington Herald-Leader, serving nearly half the state, ran a 12-part series detailing OxyContin and its connection to crime. Such media attention contributes to the acceptance of the news as factual.
Although some may question the harm in hysteria, scare campaigns are ineffective at reducing abuse; they assign blame to individuals when explaining social problems. Drug scares have helped propagate the behaviors they aim to contain and fail at disseminating accurate information. Drug scares result in extreme reactions to perceived problems that may not correspond to reality. Drug scares, as moral panics, are symbolic crusades involving interest groups or agencies that lead the way in labeling drug as dangerous, oftentimes benefitting from such. Public officials, often aided by media outlets, embellish reports for greater crime fighting resources and social control initiatives. The OxyContin-crime panic is only the latest in the history of moral panics.
Guest blogger Eoin Cannon reported on Mickey Ward and Dick Ecklund before David O. Russell dramatized their lives last year in The Fighter. What a difference a major motion picture makes.
Despite coming a few months late to the party, I offer here some thoughts about The Fighter, because the film combines three of the specific interests that brought me into academia: addiction, sports, and cities. I acquired those interests in part through contact with the actual source materials of the film: Mickey Ward, crack cocaine recovery, and the city of Lowell.
Before going to graduate school I was a reporter for a weekly newspaper in a Boston neighborhood, from which I also branched out into freelance writing on the very small world of New England boxing.
I followed the second half of Ward’s career, and wrote a piece upon his retirement about the journey traveled by him and his brother Dick Eklund, the characters in The Fighter played by Mark Wahlberg and Christian Bale. This work informed my first academic publication, on the strategic construction of white ethnicity in the sports entertainment industry. Similarly, my scholarly interest in the cultural history of addiction began in observations about the recovery subcultures in hard-luck neighborhoods of Boston and nearby cities, including Lowell.
So I was eager to see The Fighter for a number of reasons, both the kind scholars have when a film covers their subject matter, and the kind that people have when part of their world becomes the set for a Hollywood movie. I was particularly interested in how the film would weave these different narrative threads together and what overarching frame it might invoke.
What jumped out at me in this regard was its use of the 1995 documentary High on Crack Streetto shape the story of Eklund’s crack addiction and recovery. Read More »
Guest blogger Allen Hopper ponders the impact of letters sent recently by U.S. Attorneys to officials in medical marijuana states: will they affect an ACLU lawsuit alleging 10th amendment violations in the federal government’s prosecution of a Santa Cruz medical marijuana collective? or the enforcement of medical marijuana laws more generally? Hopper is the Police Practices Director for the ACLU of Northern California and previously coordinated drug policy-related litigation as the Litigation Director for the National ACLU’s Drug Law Reform Project. A nationally recognized expert on marijuana law reform, he has been quoted extensively in the media, worked cases in state and federal courts, and testified before legislative committees on issues related to the intersection of federal and state drug laws.
U.S. Attorneys in at least seven states recently sent letters to state government officials threatening to vigorously prosecute medical marijuana distribution–regardless of individual state law protections. Patient advocates have rightly cried foul, pointing to the so-called “Ogden Memo”—an October 2009 DOJ letter instructing federal prosecutors to refocus enforcement efforts away from providers operating in accordance with state medical marijuana laws. Despite the ominous sabre rattling, however, there have been no recent raids on state-registered dispensaries in any of the states that tightly regulate medical marijuana distribution.
So, what are these threatening new letters really about? In a letter to Attorney General Holder last week, the ACLU suggested that the federal government is improperly attempting to influence the states’ legislative processes. The ACLU points out that several of these letters landed on state officials’ desks just as new state laws regulating medical marijuana were about to be enacted. The Governor of Washington, for instance, vetoed a popular medical marijuana bill after receiving a letter from U.S. Attorneys threatening to prosecute state officials who license and regulate dispensaries. If the ACLU is right about the real purpose behind these U.S. Attorney letters, the feds may be opening a can of worms they’ll wish they hadn’t. A federal lawsuit put on hold in 2009 after the DOJ issued the Ogden Memo could be reopened, with court-ordered discovery into federal enforcement practices.Read More »
Sometimes useful pieces of historical evidence may be found lying around in plain sight. A case in point concerns the relationship between Alcoholics Anonymous and the disease concept of alcoholism. In 2002, Ernest Kurtz, A.A.’s distinguished academic historian, published a well-argued article asserting that the disease concept of alcoholism was not one of A.A.’s core philosophical commitments (2). Yet – as Kurtz also noted — the disease concept has been part of A.A.’s operational vernacular for a long time. Sociologist Annette R. Smith has recently suggested that the acceptance of the disease concept is a crucial step in a new A.A. member’s conversion to an alcoholic identity (3). If both Kurtz and Smith are correct–and I believe they are–then how did an idea that is not part of the group’s core philosophy nevertheless become a central element in A.A.’s actual praxis?
A key part of the answer lies in the promotional campaign of Mrs. Marty Mann. In 1944, Mann was employed by Howard W. Haggard and E.M. Jellinek at the Yale Center of Alcohol Studies to promote the disease concept to the American public. The Yale group’s ultimate aim for Mann’s campaign was the establishment of a single-disease advocacy organization for alcoholism treatment and research enterprises – an organization not unlike the American Cancer Society or the American Lung Association. This advocacy group, Yale leadership hoped, would in due course provide a stream of donations for the support of their own alcohol-related research. The Yale group’s plan for Mann doubtless sprang in large part from a report prepared by Dwight Anderson for the Research Council on Problems of Alcohol, later published in a 1942 article titled “Alcohol and Public Opinion” (4). Anderson argued that the new scientific approach to alcohol-related problems proffered by the Research Council (and, by extension, the Yale group) needed a new symbol to differentiate itself unmistakably from the old vying “dry” and “wet” camps of the previous era. The idea that the alcoholic was “a sick man,” Anderson contended, would perform very nicely as that new symbol.Yet Mann’s campaign was dogged by a crucial ambiguity. Read More »
Today’s installment of the Points Interview is the ninth of the series and, as ever, we’re grateful to find so many authors willing to discuss their work in this forum. That’s certainly true of entry #9–Burton Peretti, talking about his book Nightclub City: Politics and Amusement in Manhattan (paperback edition, University of Pennsylvania Press, 2011). Interested readers can see the table of contents and an excerpt of the book here.
Describe your book in terms your mother (or the average mother-in-the-street) could understand.
Manhattan nightclubs in the 1920s were places your mother wouldn’t want you to go. They were frightfully expensive. Prostitutes and gangsters often worked in them. If you bought liquor in the clubs, you were breaking the law. If you were there during a Prohibition raid, you would be arrested. Governments at the city, state, and local level tried to stop the spread of nightclubs, and then they tried to regulate them in various ways. Do-gooder reform groups got into the act, too. Only the Great Depression killed off most Manhattan nightclubs, though. When the clubs revived later in the 1930s, they were tamer places. Liquor was now legal again and carefully regulated, and clubs catered to the middle class and conventioneer clientele. The new clubs paved the way for the mostly innocuous family entertainment found in the suburbs after World War II.Read More »
Hopping on the Ron Paul bandwagon as it pulls out for Campaign 2012, guest blogger Eoin Cannon speculates on why Libertarians don’t show more love for Alcoholics Anonymous.
In the book manuscript I’m currently revising, I look at the founding of Alcoholics Anonymous in relation to its political moment in the mid-to-late 1930s, building a case that AA belongs, in quite specific ways, to the culture of New Deal liberalism–despite the FDR-derangement-syndrome of its co-founders. In developing this idea, I have become attuned not only to ideological analyses of AA and its founding, but also to what one might call the political flavors of the popular critiques of the recovery movement. I find myself oddly fascinated with superficial contempt for AA and twelve-step culture, in part because it is so common, but moreso because it seems to spring from that hard-to-pin-down nexus of identity and sensibility that underlies more formal beliefs. That is, people who express this contempt tend to do so in the same terms that inform their political orientations. Sometimes this connection is explicit, but just as often it comes in signs of cultural identity and social attitude.
Leftish and rightish anti-AA attitudes are fairly predictable. Read More »