Department of Psychiatry, McKnight, Brain Institute, University of Florida, College of Medicine, Gainesville, FL, USA
Received date: January 16, 2014; Accepted date: January 28, 2014; Published date: February 10, 2014
Citation: Ashton JV, Blum K (2014) Everything you Need to Know about Global Alcohol Policy. “Regulating Alcohol around the World: Policy Cocktails”. J Addict Res Ther 5: 169. doi:10.4172/2155-6105.1000169
Copyright: © 2014 Ashton JV, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Alcohol; Addiction; Genetics; Neurogenetics
After reading Tiffany Bergin’s book “Regulating Alcohol around the World: Policy Cocktails”, We can’t shake the notion that human civilization will never overcome its addiction to alcohol. That is, it is clear that the pastime of drinking is not an en-vogue trend. In her book, Bergin delves into the vast history of alcohol and its effects on the societies who consume it. For the past five hundred years, governments and policymakers have been struggling to control, regulate, and harness it in response to physical and social harms, such as, violence, death, and disease. And indeed, this book identifies some of the most intriguing and contradictory policies that are put into law by nations all over the world.
The focus of the book is vast and staggeringly difficult to conceptualize, with hundreds of nations and states changing culture and regulation over hundreds of years. Even so, the book succeeds due to its detailed and intriguing accounts of some of the more unusual and lesser-known policies. In one comprehensive book, Bergin formulates a range of policies based on interesting case studies that in many instances continue today. She makes the point that some findings about alcohol policy may be widely applicable today while others depend on their historical or cultural context.
This book is indeed a well-mixed cocktail with strange foreign ingredients and includes, case studies on the religious temperance groups in Sri Lanka, Soviets cooking up bathtub moonshine in response to prohibition, and pub dwellers in Britain receiving bouts of advice or “nudges” to stop their heavy drinking encouraged by buying rounds of drinks. While we were being entertained by these case studies, Bergin focused mainly on the policies themselves. By rigorous analysis and detailed comparisons, she provides a collection where one can access a general forum of policies and their relationships to histories of alcohol use.
With such a comprehensive study, it is likely that some things might get left out. There were, for example, no instances of policies that initiate any form of education for target populations. Alcoholics Anonymous and advice-toting doctors are mentioned briefly on page 25, but the issue of alcohol addiction is much greater than that. In the United States multitudes of rehabilitation centers thrive (over 12,000), with mixed results. We are sure that there are just as many programs in other developed countries. While reading the book, We continued to wonder why there was no further detailed exploration of educational resources, such as, websites like the National Institute of Drug Abuse (NIDA) and the National Institute of Alcoholism & Alcohol Abuse (NIAA) as well other governmental global programs.
The concepts developed in this valuable book demanded intensive research, as evidenced by Bergin’s extensive use of references that helped to support her points, especially in the academic realm. However, we found that, in many cases, she depended too greatly on them, instead of clearly expanding on the detail, to clarify her points. This is not to detract from the overall positive deliberations of Bergin, but a number of times the details could have provided even greater insight for the thoughtful reader.
The issues we felt were most lacking in Bergin’s otherwise flawless collection of data and policies were the topics of addiction and genetics. She mentions addiction with reference to alcoholism on at least three separate occasions throughout her work. She even concludes that the variety of scientific opinions about addiction and alcoholism contribute to a confusing and difficult policy making environment. Yet she leaves the reader to feel something closer to contempt for the introduction of addiction into the alcohol policymaking world rather than identifying a clear way forward. This is exemplified by the fact that every time she mentions addiction she does so within quotation marks. It seems somewhat distracting to use quotations to question, the reality of, not only alcoholism but many other unwanted addictions. This is disappointing because the American Society of Addiction Medicine (ASAM) has moved from a “psychological” definition of addiction to a defining addiction as an “impairment of brain reward circuitry”, indicating that addiction is a disorder of the brain based on genetic antecedents. When on page 15 she asks herself what causes alcohol misuse she does reference genetics and its relationship to the development of harmful drinking. Then she refers to studies that refute this whole area of study. She concludes on page 16 by highlighting the “importance of environmental, sociological, and other non-genetic factors in the development of harmful drinking behaviors”. Though I’m sure these factors, which include epigenetics, (environmentally induced changes in DNA) do play a role this explanation neglects well-proven theories that should be included in her research. Although to be fair Bergin does not profess to be a scholar in the molecular neurobiology and neurogenetics of addiction.
While psychiatric genetics is not a major part of this otherwise comprehensive book, it is poorly treated and significantly detracts from what has been well-established in the scientific literature. To potentially bias the reader to assume that the study of addiction and its relation to alcohol is a confusing and muddy science, even if it’s under the guise of an unbiased approach, is indeed a disservice to the readers of this book. A quick Google search could provide sufficient evidence that alcoholism is a malfunction of brain reward and acts as an anti –reward substance. One trip to PubMed (an online hub for over 23 million biomedical studies) a search for alcohol addiction brings up over 80,000 peer reviewed studies and a search for psychiatric genetics brings up another 13,000 studies. Most importantly, governmental policies should at least embrace our enormous display of research throughout the world that unequivocally indicates that alcohol like other psychoactive substances highjack’s our most basic need to achieve happiness via an impairment of brain reward circuitry that can in genetically prone individuals induce a need for psychoactive substances and the subsequent pain of addiction.
In total Bergin made many excellent points. In the case study on Diadema, Brazil, where through social reform; enforcing bar closures at 11: 00 PM instead of 6:00AM alcohol induced murders were significantly reduced. This example demonstrates the potential for municipal policies that can impact violence and other “bad” behaviors that can be induced by alcohol. While this may not be feasible in the United States and other industrialized nations, it does provide the impetus to consider social reforms geared towards acute alcohol intoxication. However, in the long –term we are faced with knowing that the cause of all addictions and plausible solutions to the problem are the subject of many scientific explorations geared to ‘molecularbiological and neurogenetic solutions, rather than regulation and education as weapons against alcohol’s symptomatic woes.
She surprised us with the ever-present rift between scientific study and policymaking, referred as “two communities”. A notable case in the United States occurred when the Federal minimum drinking age was changed to 21. As citizens of that found it country, we found it interesting that the legitimacy of the scientific evidence that went into the policy’s formation into law was questioned. But Bergin cited multiple references stating that there were policymakers at the time that relied too heavily on studies that were geared towards short-term impacts. Since it has become a law, research that emphasizes harm-reduction has produced vastly different results, including other more recently enacted policies that may have an effect of reducing harm. So it is interesting that, in this country, we rely on a policy that may or may not be viable when the two communities do not understand each other. Is it optimistic to hope that one day these two seemingly diverse entities will agree and when faced with similar challenges use both social and scientific knowledge to enact laws that are truly based on solid evidence?
As messy and contradictory as research evidence can be, clearly it is the most essential element of policymaking today. Bergin reminds the reader over and over throughout her case studies that even though there is a historical rift between researchers and policy developers, scientific research nonetheless appreciably influences legislators and plays a large role in court decisions. When the United States changed their minimum age requirement to consume or purchase alcohol, a group of 18 to 20 year olds came together to argue that the policy violated their Fourteenth Amendment’s equal protection clause. Yet the research evidence trumped that and convinced the court to uphold the new law. Bergin provides provocative and informative instances like this throughout her history of policymaking. These inclusions confer on the book as a whole, a certain element of real-life relevance that draws the reader in deeper.
In summary, such a comprehensive look into the world of alcohol policymaking is indeed an enormous effort and very arduous. Bergin in undertaking such a momentous and worthy task has done for the most part a splendid job. She should be congratulated for bringing together a massive amount of information in such a well-written volume. Despite some of the discrepancies pointed out in this review we highly recommend this book. Readers of the journal of Addiction Research & Therapy, and more importantly, policy makers interested in the regulation and prohibition of alcohol and other psychoactive substances, may find this book both informative and an entertaining read.