Alcohol and harm reduction, then and now

Abstract

The liquor control school of thought of the 1890s–1930s offered a clear alternative to alcohol prohibition, much as today some strands of harm-reduction thinking are an alternative to drug prohibition. Liquor control studies were an elite concern, often unusually international in perspective. Characteristics of the thinking included a focus on the harms from drinking, whether or not drinking per se was affected; a pragmatic approach to structuring the market, to taxation policies, and to controls on the individual drinker, emphasizing the question ‘what works?’; and an orientation to patterns in the whole population, rather than a focus just on the drunkard or alcoholic. The new public health approach to alcohol policy, which began to emerge in the 1970s, to some extent is a revival of the concerns and approaches of liquor control thinking, although without the emphasis on individual controls. A striking difference between both liquor control and the new public health approach to alcohol policy, on the one hand, and the modern drug harm-reduction movement, on the other, has been the latter's emphasis on treatment and social handling of heavy users. This partly reflects the impetus the HIV epidemic gave to drug harm reduction, and partly the political hegemony of drug prohibition, which did not invite alternative perspectives that looked beyond providing services to the already thoroughly marginalized and stigmatized.

Acknowledgements

This paper has been developed from a paper presentation at the 15th International Conference on the Reduction of Drug Related Harm, Melbourne, Victoria, Australia, 20–24 April 2004; and at the International Conference on Drugs and Alcohol in History, London, Ontario, Canada, 13–16 May 2004. Thanks to Harry G. Levine for his stimulating comments.

Notes

 In this spirit, when the present author used the term ‘harm minimization’ concerning alcohol policy in 1974 (see below), a politically-attuned California official suggested verbally that perhaps ‘harm reduction’ would be a less radical and more politically acceptable term.

 Catlin's other types are misery drinking (in poverty); industrial drinking (in the workplace); emergency drinking (calming situational nervousness); and finally convivial drinking.