The Shifting Boundaries of Alcohol Policy

Abstract

Prologue: Every day, it seems, the mass media report a steady stream of evidence that suggests illegal drugs are America's number one social problem. Yet alcohol, a legal drug, costs the nation far more than other drugs each year in “whatever metric applied: medical, social, economic, or public health,” stated a recent report on alcohol policy. In 1983, alcohol use and abuse cost the nation over $100 billion, according to one estimate: $71 billion in lost productivity, $18 billion in excess mortality, $14 billion in health care costs, and $12 billion in property loss and crime. These annual costs are projected to rise to $150 billion by 1995. Alcohol is implicated in as many as half of all hospital emergency room visits. So far, however, our nation has failed to formulate a comprehensive policy on alcohol abuse, ever since Prohibition was repealed in 1933. In this article, Walsh defines U.S. alcohol policy's “shifting boundaries” and sets a context for health promotion activities related to alcohol use. “The ultimate lesson for prevention from the complex alcohol case,” she writes, “is that effective policies do need to protect the innocent and foment some moral outrage while also fostering personal accountability and internalizing protective social norms. The two sets of goals are not entirely compatible.” Walsh, who holds a master of science degree in journalism and a doctorate in health policy from Boston University, is university professor and professor of public health at Boston University and is associate director of the university's Health Policy Institute. In 1986, she served as a faculty member of an international symposium on alcohol policy, convened in Salzburg, Austria, as the 248th session of the Salzburg Seminars. A summary of the consensus reached at that conference was published in the Summer 1989 issue of Health Affairs .