Inventing the Alcoholic: Canadian Public Policy and the Individualization of Deviance

Greg Marquis

History and Politics Department

University of New Brunswick Saint John

A paper prepared for the Atlantic Provinces’ Political Science Association Conference, Saint John, New Brunswick, Oct. 14, 2001

NOT FOR CITATION WITHOUT AUTHOR’S PERMISSION 1

In May of 2001, New Brunswickers were urged to vote to support the retention of Video Lottery Terminals (VLTs) in bars, taverns and other licensed premises in order to assist in the proper treatment of “problem” gamblers, who are thought to be 3-5% of the population. The provincial government which authorizes and derives revenues from VLTs chose to remain “neutral,” although messages regarding a soft government revenue situation and the need to keep gambling out of the hands of organized crime leaked from state officials into the media prior to the referendum. Visitors to bars the week before the vote were met with signage declaring that the removal of VLTs would spell the doom of the bar and restaurant industry and hurt community groups and charities. Another claim was that with legal VLTs gone, the Hell’s Angels would fill the vacuum with illegal activities (Committee for Responsible and Regulated Gaming). Pro-VLT forces (the “Committee on Responsible and Regulated Gambling” and the N.B. Coin Machine Operators Association) hired a leading communications consultant who structured a publicity campaign based on notions of “responsibility”: fiscal, industry and individual. Government-regulated VLTs, much like lotteries and casinos, were promoted as fiscally responsible because they earned millions of dollars for education, health care and other services; the “industry” (manufacturers, VLT owners and leasees) supposedly promoted “responsible gaming,” and promised to work with government to do more for the third category, individual “players” who were “addicts” or “problem” gamers. With a low voter turnout, the pro-VLT forces won by a slim margin that indicated the ambivalence of New Brunswickers toward provincial gaming policy. Given that the operators announced their plan only four days before the referendum, the outcome was a significant victory.i Within academic and policy discourse, the very concept of addiction as an objective reality is under attack, and within sociology we encounter explanations of the “social construction” of various public problems (Alexander 1990, 115). Yet amongst Canada’s media, interest groups, and state bureaucracies, addiction is a “real issue” with policy implications. And public opinion reveals contrasting views on specific details of regulated gambling (Telegraph Journal, May 12 2001). Problem gambling did not exist as a medical or policy category until the last quarter of the 20th century, when Canada’s federal and provincial governments began to regulate gaming. In the 19th and early 20th century, the middle class and elite viewed various forms of gambling as a vice and made it illegal under the Criminal Code. In the 1960s, the law was changed in an attempt to keep up with social reality: the majority of Canadians either engaged in, or supported the right to take part in games of chance with a possibility of monetary gain. In recent years, governments have moved away from a “necessary vice” framework of gaming regulation to a convenience model that emphasises the player not as a threat to the public interest but as a consumer (Globe and Mail, May 4 2001; MPM Gaming Research 1998). And gaming revenues are constituting an important part of provincial government “sin taxes” (Johnson and Meier 1990). On the other hand, mental health professionals by the early 1990s were estimating that there were up to several million “pathological” gamblers in the United States (Murray 1993, 791).

i For the New Brunswick situation, see the papers by Hyson listed in the bibliography.

The concept of alcoholism has a similar genealogy. In its modern form, it appeared in the context of a liberalization of alcohol policy following American prohibition. Yet as Valverde writes in Diseases of the Will (1998, 1) “alcohol has been problematized for at least 150 years, not only at the level of individual consumption but also at the level of national populations.” During the early 1900s most Canadian provinces experimented with forms of partial prohibition. In the 1920s prohibition gave way to government monopoly of retail sale for off-premise consumption. Alcohol, especially when consumed in public, was deemed to be a dangerous commodity and the “liquor traffic” placed under strict controls. Provincial liquor commissions adopted a middle course between total liberalization and restriction, guided by public order and revenue considerations. Beginning in the 1940s, the debate on liquor was partly medicalized as a result of cultural change, scientific research and the spread of the Alcoholics Anonymous mutual support movement (Single et al. 1981) . This paper examines how the federal and provincial governments responded to problems such as “alcoholism,” “problem drinking” and “fetal alcohol effects” in the last half of the 20th century. Why bother to revisit the recent history of state responses to “alcohol problems?” Because the discourse and public policy on the nature, prevention and treatment of alcoholism may clarify certain aspects of the recent debate surrounding gambling. “Gaming” has been problematised as a social issue not on broad ethical or ideological grounds, or according to “epidemiological” evidence, but as an individualized pathology. In this paper I argue that alcohol policy, although not totally successful in destigmatizing alcohol abuse, helped pave the way for liberalization of gaming by shifting the blame for social problems from producers, purveyors and government, onto the individual drinker. An additional possible line of questioning, to test the common interpretation in the historiography of the welfare state that “when one group in society designs policy for another, the result will prove intrusive and to some degree authoritarian,” is beyond the scope of this study (Muncy, 1991, 164). The paper asks four basic questions: (1) how were 20th-century alcohol problems framed? (2) what public treatment programmes developed? (3) what types of prevention programmes were established? (4) what can the recent history of alcohol problems suggest about current and future policies on “gambling problems?”

I. Framing alcohol problems

Any “public” problem, such as tobacco use, impaired driving or crack cocaine, first must be identified through new forms of social or expert knowledge. Opium manufacturing, distribution and use were criminalized only in 1908, as a result of racially-influenced moral reform concerns. Impaired driving did not become a critical issue in terms of criminal law until the late 1960s (Marquis 2001c). For much of the 20th century, tobacco was not a public health issue and insurance companies did not even ask clients whether they smoked (Cunningham 1996, 43). The nineteenth century temperance movement, and the early twentieth century prohibition movement,

2 blamed alcohol for most social problems, from poverty and poor health to immorality and crime. Although accepting the theory that alcohol was dangerous and possibly unchristian, temperance, with its focus on voluntary action, had emphasized restraint and total abstinence by individuals. When the strategy of total abstinence and moral suasion failed to curb alcohol abuses, temperance activists rooted in Protestant evangelical churches called for legal and political action. Rather than work exclusively to curb demand, they targeted supply, notably the saloon. Prohibitionists, reflecting the concerns of social critics in the late 1800s, promoted the political theory of the “liquor traffic,” a powerful vested interest that had corrupted public life and spread ruin and misery (Marquis 2001a). Although temperance ideology stressed that the liquor traffic affected all levels of society, moral reformers tended to regard the working class and immigrants as its most vulnerable and problematic victims. In the second decade of the twentieth century, prohibitionists became better organized, and by adopting social reformist, efficiency and, during World War I, patriotic arguments, managed to garner support from moderate voters. Many provincial governments, rather than take a clear stand on liquor control, promised to follow the wishes of the electorate through plebiscites. The drys not only won most of the plebiscites, their organizations actually drafted the legislation that implemented partial prohibition in many of the following jurisdictions (Smart and Ogborne 1996, 49):

British Columbia: 1917-21 Alberta: 1916-24 Saskatchewan: 1916-25 Manitoba: 1916-24 Ontario: 1916-27 New Brunswick: 1917-27 Prince Edward Island: 1907-48 Nova Scotia: 1916-30

Aside from a period of war-related federal prohibition that lasted until 1919, the Canadian form of prohibition, as a result of necessary political compromises, was rarely “bone dry.” Liquor stores and saloons did close. But breweries and distilleries continued to operate, liquor companies exported stock within and beyond Canada, customers could legally purchase mail order packaged liquor from outside their province and low- alcohol beer continued to be sold in hotels. Following World War I federal permissive legislation gave provinces the right to close the importation loophole. In 1921, for example, Ontario voters ended legal importation. The most controversial and politically worrisome exemption was medicinal. In the case where patients had a doctor’s permission, druggists who were supplied by government-appointed vendors dispensed alcoholic prescriptions (Hallowell 1972; Forbes 1989; Marquis 2001a). During prohibition referenda and elections where the issue was prominent in the 1910s and 1920s, antiprohibition forces argued that largely symbolic but unenforceable dry laws were actually increasing alcohol abuse, exposing the unwary to unhealthy and dangerous contraband (“rotgut whisky”) and enriching bootleggers and organized crime. Prohibition, the wets declared, was a sham that encouraged corruption and disrespect for the

3 law (although statistics suggest that consumption rates actually fell during prohibition). Their antidote was “moderation,” a strategy best achieved through government ownership and control of liquor stores and a partial or total ban on privately owned bars. Many who would support moderation at the polls themselves did not drink, but saw government control as socially beneficial. According to wets, alcohol problems had existed prior to dry laws, and were compounded by the hypocrisy of prohibition. Eradicating the saloons, they reasoned, would reduce the level of social harm. Upon repeal of prohibition, government would work to lesson liquor’s damage by closely regulating who could purchase alcohol and where it could be consumed. For example, in certain provinces taverns or lounges were not licensed until after World War II, women were banned from beer parlours and liquor store customers required an annual permit. (Campbell 1991, 2000; Marquis 2000; Branch 1959). The death knell for prohibition came in 1927, when Ontario, where dry support had been eroding since 1923, followed the example of the four Western provinces and repealed the “Ontario Temperance Act.” New Brunswick and Nova Scotia followed in close order. Following the defeat of prohibition, provincial governments implemented alcohol control regimes based on state revenue, public order and the promotion of moderate consumption (Campbell 1991; Marquis 2001a). Under local option laws, considerable sections of Manitoba, Ontario and Nova Scotia in the 1940s and 1960s remained without liquor stores or licensed premises. Until the late 1950s or early 1960s, the tone of provincial liquor commission annual reports was conservative and apologetic when consumption levels and profits were on the rise (Marquis 2001b). By the 1940s, public discourse on alcohol problems was moving away from traditional pronouncements against deviant “drunkards” toward a medicalized understanding that stressed not public order but public health. The most common expression of this new emphasis was the term alcoholism, which cast the subject as a victim of addiction. Despite its lack of “scientific” backing, Alcoholics Anonymous, founded in 1935, was the popular face of the new alcohol knowledge. The statute that set up the Alcoholism Research Foundation of Ontario in 1949 defined alcoholism as “any diseased condition produced by the action of alcohol upon the human system” (ARF Annual Report 1956). In contrast to traditional views of drunks as immoral, lower-class individuals, alcoholism theory purported to be nonjudgmental and clinical. The response of temperance organizations, whose membership and political influence were on the wane, was mixed. A number of temperance leaders rejected the narrow claims of alcoholism advocates, and worried that they would allow the brewers, distillers and wine producers to expand their sales, prestige and political influence. Others, for tactical reasons, were prepared, to work with the new alcohol knowledge (Campbell 1991; Marquis 2001a). The alcoholism theorists, researchers and publicists of the 1940s and 1950s were inspired by modern medical responses to tuberculosis, cancer and polio. As Fingarette (1974) points out, the term “disease” has been erratically and imprecisely used even in medical texts. According to a number of commentators, the disease construct was an “organizational metaphor” or “governing image” of the new alcohol knowledge. In the United States, the movement had three key early organizational manifestations. Beginning in 1937, the Research Council on Alcohol Problems examined medical and scientific issues relating to alcohol abuse. Yale University’s Center of

Alcohol Studies (1943-62), in addition to conducting research and promoting awareness, published the Quarterly Journal of Studies on Alcohol, the first dedicated professional journal since the turn of the century, and ran an influential summer school attended by American and Canadian public health officials, social workers, clergy and temperance workers. “Yale plan” clinics and “industrial alcoholism” programs were considered to be at the apex of professional treatment. The National Committee for Alcohol Education (part of the Yale network until 1950) was reorganized as the National Council on Alcoholism in 1954. Utilizing publications and professional and media contacts, the committee reached out to the grassroots levels and built ‘brand recognition’ for the disease concept (Roizen 1991; White 1998, 182-92). • The “classic” disease theory of alcoholism can be summed up as follows (Room 1983, 54): the older moralistic approach to alcohol problems is replaced by a newer scientific approach • alcoholism is a well-defined condition that afflicts certain individuals • alcoholics are unlike normal drinkers and should abstain from drinking • alcoholism is not a symptom, but an involuntary disease • ethics and public policy dictate humane treatment, not condemnation or prosecution • the most urgent priority is to provide treatment

Within the “disease”camp, a division of opinion existed between behavioural scientists and those who stressed biological addiction. In the field of psychiatry, psychoanalysis promoted the theory of the “alcoholic personality,” a disorder necessary for a diagnosis of alcoholism. Researchers studied the possible impact of birth order on alcohol dependency, of the relationship between alcohol abuse and aggression, and the impact of alcoholic parents on children.ii E.M. Jellinek’s influential 1960 The Disease Concept of Alcoholism, based on clinical experience, identified five types of alcoholism (Alpha, Beta, Gamma, Delta and Epsilon) of which only two were “diseases” in the sense of physiological and pharmacological addiction (Kissin 1983). Alpha alcoholism was characterized by “psychological dependence upon alcohol to relieve physical and/or emotional pain. Can develop into Gamma pattern, but generally exhibits no progression.” Gamma alcoholism was described as “alcohol-related medical complications without physical or psychological addiction. Heavy-drinking cultural norms and poor nutrition” (White 1998, 214). Although Jellinek was attempting to promote the concept of different varieties of alcoholism, in the hands of Alcoholics Anonymous and the media, his writings were distilled into three basic points: (1) all alcoholics experience craving or loss of control; (2) an alcoholic will relapse with a “first drink”; (3) the only solution to alcoholism is total abstinence (Kissin 1983, 93). Benchmarks of the institutional and policy acceptance of the disease theory included recognition by the World Health Organization and the American Medical Association in the 1950s; support by the American Hospital Association for the principle of hospitalization and the passage of American federal legislation that supported a growing treatment network in the 1960s; the creation in 1971 of National Institute on Alcoholism and Alcohol

ii Alcoholics Anonymous, as Kisson points out, has rejected personality-based theories (1983, 94).

Abuse (NIAAA); and recognition by the U.S. Department of Defence of alcoholism as an illness.iii In Canada, according to Smart and Room (1996), public support for the disease theory was less definite, but the issue noticeably affected provincial politics in the immediate postwar years. Other than the organization of Ontario’s Alcoholism Research Foundation (discussed below) the most influential policy decision prior to the 1960s was the appointment in 1954 of the Manitoba Liquor Enquiry commission, chaired by former (prohibitionist) premier and national Progressive Conservative leader John Bracken. Appointed as a nonpartisan commission, the Bracken commission was tasked with examining all aspects of the provincial liquor control act and the manufacture, distribution and consumption of beverage alcohol. Gathering a library of books and studies, consulting with experts in the field, amassing more than 150 briefs, conducting 25 public hearings and visiting nine provinces and six American states, the Bracken commission was the most ambitious Canadian alcohol ‘fact-finding’ enterprise since the 1890s Royal Commission on the Liquor Traffic (Manitoba 1955, 4-10). Knowledge-producing institutions such as the Bracken commission, provincial liquor authorities and alcoholism commissions were attempting to chart a middle way between the old-line temperance groups, associated mainly with evangelical churches, and the alcohol industry (Manitoba 1955, 81). One way in which the new knowledge on alcohol earned public recognition was through projecting the extent or impact of addiction. Based on the number of recorded deaths from cirrhosis of the liver, Jellinek devised an alcoholism estimation formula, which the ARF and other Canadian exponents of the new knowledge began to utilize in the 1950s. The Bracken Report, based on consultations with Jellinek, predicted that the number of alcoholics in Manitoba by 1960 would surpass 12,000. In 1959, the ARF estimated that 40% of Canada’s 200,000 alcoholics lived in Ontario. The foundation also pointed to large numbers of Canadians who were charged with public intoxication and impaired or drunken driving. In 1960s, following Jellinek’s repudiation of the formula, the ARF resorted to other estimates of alcoholism prevalence (Manitoba 1955, 252; ARF Annual Report, 1959-64). By the early 1970s organizations such as the ARF were utilizing a variety of methods for estimating alcoholism rates, and qualifying their statements. The “rate of alcoholism” nonetheless proved an enduring mechanism in the policy area.iv One important change in alcoholism forecasting was the increased attention in the 1970s to the alcoholic woman. At first, women were considered a small minority relative to the larger male problem population and were generally ignored in the research literature until the 1960s. During the 1970s addictions experts were estimating that up to half of all alcoholics were women (Canada 1977). According to opinion surveys, only after World War II did a majority of Canadian women admit to consuming alcohol. The alcohol industry did not begin targeting them as a separate market until the late 1960s. Prior to clinical contact with large numbers of middle-class women, the female iii Roizen (1983) notes that one line of argument within alcohol studies held that the WHO definition of alcoholism was too broad. Valverde (44) notes that in the late 1970s alcoholism was dropped as an official disease from the Diagnostic and Statistical Manual. iv ARF, The Journal 1, (1) June 1, 1972, 11. The measures included the distribution of consumption, alcoholic deaths, cirrhosis deaths and suicides.

6 alcoholic had been stereotyped as a single type: “a lower-class, promiscuous barfly who existed precariously on the margins of society.” Increased labour force participation by women, especially married women, and the feminist movement helped to broaden understanding of female addictions. Yet a new stereotype took hold: “a respectable, white, middle-aged wife who did her drinking behind the drawn curtains of the living room” (Sandmaier 1980, 76). There was an apparent relationship between real price, consumption rates and cirrhosis, as the ARF suggested on many occasions. In 1956, for example, the price of alcohol relative to real income was one-third less than in 1933 (ARF Annual Report 1960, 13). In every province, despite the perception of consumers that costs were rising, the relative price fell dramatically from the 1940s until the 1970s. Simply put, despite a century or more of temperance agitation, consumer affluence had turned Canada into a moderately “wet” society (Single et al, 1981). Roizen (1983) noted that for a period in the 1960s, as an older generation who had lived with temperance and prohibition passed away, and as society became more permissive, there was a tendency to minimize the health and social costs of alcohol beyond the small percentage of alcoholics. Then in the late 1960s, examinations began of distribution of alcohol problems across the wider society. The “distribution of consumption” model had been first proposed by the French scholar Lederman in the 1950s. His research focused on how variations in mortality rates matched trends in per capita consumption levels of alcohol (Skog 1991). Sociological inquiry, rather than examining the deviancy of individuals and the question of an alcoholic or “dependent” personality, became more concerned with the effect of aggregate levels of consumption. The ARF helped to pioneer this epidemiological approach, suggesting in the late 1960s, in the middle of a government drive towards increased liberalization, that Ontario raise alcohol prices in order to control rising levels of consumption (Pittman 1991; Marquis 2001a). Valverde (26) refers to such data-gathering activities as exercises in “mapping” the risk of social harm. Meanwhile, personality- based explanations continued to emphasize not sameness, but the uniqueness of alcoholics (Valiant and Milofsky 1991, 492). And by the early 1970s, the American Medical Association attempted to promote the concept of multiple forms of alcoholism, requiring individualized diagnosis and treatment (ARF The Journal, I (8) Aug. 1 1972). In Canada, the hearings and reports of the federal inquiry on the Non-Medical Use of Drugs (LeDain commission) attempted to put alcoholism problems into perspective in the light of newer concerns surrounding chemical dependency, which included narcotics, amphetamines, tranquillizers and painkillers (Canada 1981). In 1972, the commission reported that more than 600,000 Canadians drank “hazardous” amounts of alcohol on a daily level, and that the North American “prevalence of dependence” on alcohol was “100 times greater than dependence on narcotics.” By the early 1970s alcohol was “reclassified as a drug” (Valverde 1998, 8), which had implications for public policy, or at least policy recommendations. Despite a broader, more subtle and more complex understanding of alcohol problems within the academic community, media and public discourse continued to stress the disease theory and a minority of drinkers. One reporter in 1972 (repeating ARF ad copy) wrote that the alcoholic was society’s “forgotten addict” (Chronicle Herald, Jan. 27-28 1972). The “irreversibility” of alcoholism was a key belief of the treatment establishment, with its strong ties to AA, in the 1950s and 1960s. In the early 1960s clinical studies began to suggest that many alcoholics were capable of “controlled drinking.” The Rand

7 report of 1976, based on an evaluation of NIAAA programs, sparked a controversy that pitted the new research versus the alcoholism movement establishment. In addition to indicating that many alcoholics were capable of returning to “normal” social drinking, the Rand study suggested that current estimates of the rate of alcoholism in the general population were too high (Roizen 1977, 1983). White (1989, 284), in an overview of the history of addictions and treatment in the United States, identifies “backlash writings” in the 1980s, such as books by Fingarette (1989) and Peele (1989), as signs of an ideological and cultural reaction that devalued treatment, favoured tougher measures and supported “zero tolerance” of drug use. Fingarette described the disease theory as misleading and forty years out of date, yet recognized its social utility. According to White, the revisionists believed that alcoholism’s place in popular culture was based on a series of myths. The critics argued that there was no diagnosable disease or evidence of biological or genetic vulnerability, that research did not support the “loss of control” thesis, that many alcoholics recovered naturally, that AA was not effective with most alcoholics and that alcohol and drug treatment programs accomplished little or nothing. Per capita consumption in Canada increased during the 1960s and early 1970s, then went into a slight decline in the late 1970s. In the 1970s, there were signs in North America of a “neo temperance” movement concerned with issues such as impaired driving, underage drinking and fetal alcohol effects due to drinking by pregnant women. Addiction experts were concerned about the recently lowered legal drinking age and by the results of drug and alcohol surveys of teenagers (ARF The Journal, II Jan.-Dec. 1973). Rather than a small percentage of addicts or simply the above-mentioned risk populations, the newer concerns were directed at larger numbers of heavy drinkers, who according to surveys experienced more severe problems than moderate drinkers (Fingarette 1988, 26-27). The concept of the “problem drinker” was an example of problem amplification. By the early 1970s, public health literature enumerated not only alcoholics (each of whom influenced at least four other people) but also problem drinkers “who show no signs of dependency but cause serious personal or family problems” (New Brunswick 1972, 6-8).v In recent years, the concept of a single cause of alcoholism or a coherent pattern or uniform experience of alcohol abuse across an entire society has been undermined. In 1980, the World Health Organization explained that “there are many physical, mental and social problems that are not necessarily related to dependence. Alcohol dependence, while prevalent and itself a matter for serious concern, constitutes only a small part of the total of alcohol-related problems” (Room 1983, 62). The broadening of problems in the last quarter of the century reflected neo-temperance concerns and attempts by academics and addiction experts to place alcohol use into a larger context and the framework of preventive medicine. In Northern Spirits, Smart and Ogborne (1996, ch. 7) discuss the v For a discussion of how the NIAAA adopted the concept of problem drinking, see Gusfield, 1981, 55-60. James Gray (1982) offered an account of how alcohol consumption affected social problem in the Canadian West,

8 following contemporary Canadian alcohol problems:

• hangovers • blackouts • impaired driving • traffic accidents • other accidents • overdoses and poisoning • assault, sexual assault, murder • adverse reactions with other drugs • fetal alcohol effects • alcohol dependence • liver disorders • neurological disorders • heart disease, cancer and other health problems • premature death • suicide • personal, family and employment problems

Many of these problems, if a gloss of “morality” were added, could be found in a 19th-century temperance tract. Concern over fetal alcohol effects (FAE) was first visible in the late 1960s when American public health organizations warned of neonatal drug addiction. As Valverde (179-82) notes, the rise of the FAE issue in the 1970s represented a move away from personality-based theories of pathology to biology. Most media depictions of FAE are of poor, urban, minority women, usually unwed, who give birth to addicted babies. These mentally and physically damaged children allegedly become the source for many future social problems. The “crack babies” scare was perhaps the worst example of a media-induced moral panic on this issue, yet alcohol use by pregnant women also has been problematized.vi The American campaign against FAE has been particularly alarmist, strident and universalist, Canada’s more muted. The doctrine of “zero tolerance” resulted in warning labels on all alcoholic beverage containers in the United States. When aimed at heavy drinkers, FAE awareness campaigns are somewhat narrow; when aimed at “any woman planning to become pregnant,” they cast a much wider net (Alexander 1990, 154-56, 210-12). In reviewing this section, problem definition relating to alcohol in the second half of the 20th century can be broken into two broad stages. From the 1940s until the 1960s, the classic disease theory, despite weak scientific and medical underpinnings, dominated pubic discourse and demands for changes in medical, legal and employment policies. Treatment professionals, volunteers and self-help groups (discussed in the next section) would derive not only sympathy and prestige, but also political and financial support through the theory of involuntary alcoholism

vi For moral panics, see Gouda and Ben-Yehuda (1994).

9 affecting persons from all levels of society. The media was receptive to the concept, which fit into the philosophy of the evolving welfare state and of legal reform. The research and medical communities were less receptive to the disease theory. In the late 1960s, the definition of alcohol problems was broadened out to include “problem” or heavy drinkers, and eventually other at-risk sub populations such as First Nations people or pregnant women who drank or consumed drugs. There were also claims that increased aggregate levels of consumption were unhealthy for society as a whole. Although few alcohol or addictions analysts in the late 1960s, the 1970s and the 1980s advocated abstinence as a realistic alternative to alcohol problems, many took a critical look at the issue of supply. Their approach was dubbed “neo-temperance” and overlapped with more populist concerns about alcohol advertising, youth drinking and impaired driving.

II. Treatment

In the 19th century the medical treatment of individuals who abused alcohol was principally the preserve of private physicians and the early mental health system, including “lunatic asylums” and private institutions such as the Homewood Retreat of Guelph, Ontario. Treatment varied from rest and nutritional therapy to baths and the “gold cure” (Warsh 1989; Baumohl 1993). There also existed a variety of patent medicine and homeopathic remedies. For most lower-class individuals who overindulged , however, the only treatment was jail (Warsh 1993). A scientific and professional interest in “inebriety,” meaning not simply drunkenness but loss of control, existed in North America with a professional association, and a journal, The Quarterly Journal of Inebriety, which ceased publication in 1914 (White 1998, ch. 4; Valverde, ch. 4). In terms of the community, the only organization with a consistent approach to working with “drunkards” was the Salvation Army, active in many Canadian cities by the early 20th century. Following prohibition, the first sign of the new knowledge on alcohol was the creation of Alcoholics Anonymous. The media endorsed the movement, whose members represented a long tradition of North American self-help and mutual support. AA attracted more members, prestige and public support in the late 1940s and became better known in Canada in the 1950s. In the 1950s two “auxiliary” organizations, Al-Anon, for the families of alcoholics, and Al-Ateen, for the children of alcoholics, were formed. Although AA was part of the “alcoholism lobby” and referred individuals to treatment, there is a tension in the literature as to whether AA activity constituted “treatment.” According to White, treatment, either public or private, was institutional, rooted in medicine or psychiatry, based on unequal power relationships, professional, bureaucratic and personally invasive. AA was not interested in the “causes” of addiction and generally refuted psychoanalytic or psychological approaches which focussed on heavy drinking as symptomatic of personality disorder. AA’s concern was helping members “cope“ with their condition and aside from episodic treatment such as a detox, third parties could never supplant the

10 movement’s emphasis on “mutual aid” (White 1998, 151-52, 175-76). As Roman and Blum (1991) explain, AA produced not “cured” patients but “recovering alcoholics.” But many academics and clinicians approved of the practical results of the movement, which remains less threatening and invasive for most problem drinkers than state treatment programs. Barriers remained for the treatment of alcoholics in public hospitals and sanatoria. The American experience (which had the additional factor of a large percentage of private hospitals) suggests that administrators and staff in the postwar years resisted admitting alcoholic patients because of overcrowding, nonpayment of bills, behaviour problems, recidivism and the perception that such individuals were not sick so much as willful or stubborn. The ambivalence of social agencies, general hospitals and mental health services in dealing with patients with severe alcohol problems persisted into the 1960s. The response of Alcoholics Anonymous was to provide volunteers and lobbying that created separate wards, new admission procedures and new services. AA also had an influence in terms of personnel in the emerging “lay therapy” movement in the 1960s: many counsellors and other therapists were recovering alcoholics (Gerard and Saenger 1966, 41-42; White 1998, 167-68, 184-85). In terms of numbers, out patient treatment came to dominate therapeutic responses to alcoholism. In contrast to earlier alcoholism experts such as asylum superintendents, promoters of the disease theory saw clinics, not institutionalization, as the key to therapy (Baumohl 1993, 113-14). In patient or medical responses were dedicated to short-term detox and recovery, and treating the symptoms of heavy alcohol use, which can include damage to organs and to the nervous, circulatory and digestive systems of the body. Actual medical assistance was limited and hospitalization was reserved only for cases of disorders such as delirium tremens and seizures. Often the treatment for diagnosed alcoholics was simply “a restful setting and emotional support” (Fingarette 1988, ch. 4). One policy outcome from the public health approach to alcohol in the postwar years was the creation of state and provincial alcoholism/addictions agencies, commissions or foundations. By 1954, 23 American states were funding treatment services, usually on an out patient basis, and many local and psychiatric hospitals were handling alcoholic in patients. Reflecting not only the lobbying of Alcoholic Anonymous and its supporters but also the expansion of state and federal programs and funding under the “Great Society” and “the War on Poverty,” an “alcoholism and drug abuse industrial complex” took shape in the United States. Under several pieces of legislation and news programs, the national government underwrote community mental health clinics. There was also an attempt to “mainstream” alcohol programs within the public health system (for example, through insurance coverage, an expansion of in patient treatment and workplace intervention plans). State programs mushroomed to 2400 by 1977. In keeping with the two-tier health care system, and reflecting the growth of employee assistance programs in the 1970s, and mandatory drug testing of workers in the 1980s, health corporations administered for- profit treatment programs. By the late 1980s more than $1billion (US) in taxes and private health insurance was funding outpatient and inpatient treatment each year. In 1991, the for-profit sector handled nearly two million clients (Fingarette 1988, 22; Roman and Blum 1991, 759; White 1998, 264-79). Starting in 1949, Canadian provinces set up alcoholism/addictions foundations or commissions. Public

11 health, social welfare and legal reform accelerated this institution building, as did the existence of AA chapters and municipal and provincial councils on alcoholism. The commissions, usually funded out of public health budgets, performed a combination of research, treatment and education functions surrounding this “new” social problem. The general trend was to fund state efforts from consolidated revenue, although a number of jurisdictions (Connecticut starting in 1947 and Prince Edward Island in the late 1960s) used fees from state or provincial liquor profits to support programs, a fiscal tool the beverage industries generally opposed (White 1998 191; Marquis 2001b). In Slaying the Dragon (ch. 24), William White summarizes the principal forms of physical treatment of alcoholism in the 1950s and 1960s. For the most part they were based on diet or the use of drugs, including antidipsotropics:

• nutrition theory • alcohol therapy • vitamin therapy • tranquillizers • Antidepressant • mood stabilizers • sedatives • amphetamines • aversion therapy • LSD • multiple drug therapy

Canada’s contribution to aversion therapy was considerable. In 1949, the private Bell Clinic had been the first in North America to use Antabuse in treatment. In addition to drugs administered through treatment programs, antidepressants and tranquillizers were heavily prescribed by family doctors who believed that substance abuse was a reflection of depression or other negative psychiatric conditions. Canada’s leading alcohol research/treatment institution, Ontario’s ARF, was typical of 1950s and 1960s treatment in that most clients were male. Table 3 indicates the sources of referral for all new patients to ARF services from 1954 to 1960. Branch offices were opened in London, Hamilton, Kingston, Ottawa and other communities. The ARF stressed that it was more of a research institution than a treatment service, and in the late 1950s it was fortunate to have E.M. Jellinek on staff. Yet treatment was an active area, starting with the original clinic in an Erindale hospital in 1950. In the 1950s, the ARF was selective, taking in mainly low-risk, relatively- stable patients who came voluntarily. Starting in 1959-60, partly for research reasons and partly because of a shortage of hospital beds, ARF clinics began to handle chronic cases. Out patient services included sessions with physicians, a psychiatrist, a psychologist and a social worker. By 1960 the ARF claimed to have provided treatment for 7,500 individuals and to have supported more than 100 research projects. One of them involved studying chronic drunkenness offenders who passed through a specific Toronto police court (ARF Annual Report, 1950-60; Popham

12 and Schmidt 1961). By the late 1960s, most American states and Canadian provinces had established alcoholism programs. The American trend, until the 1970s and 1980s, was for alcoholism and drug problems to be handled by separate agencies which viewed their clients as distinct groups (White 1998, 267-68). The ARF, which in 1961 was given an additional mandate and a new name, the Alcoholism and Drug Addiction Research Foundation, was an early example of convergence, and anticipated a broadening mandate and a further name change to the Addiction Research Foundation. By the 1970s, the new emphasis was on (professional) psychotherapy and (lay) counselling, despite the apparent clash with AA philosophy and practice. Behaviour modification approaches played on fears of loss of employment and family stresses. The increased emphasis on psychotherapy may have been an attempt to improve the professional image of treatment programs; it also represented an attempt by psychotherapists to “colonize” the overall addictions field (Roman and Blum 1991, 759-65). In this period, the self-help and lay therapy movement organized around other compulsive behaviours, such as over eating, over working and excessive gambling. According to Stearns, dieting, exercising and keeping slim, although promoted as health issues, functioned as methods of “demonstrating character or self control” (Stearns 1999, 117). AA continued to enjoy considerable public prestige, and informal links with the treatment establishment, the corrections sector and social services, despite the fact that the effectiveness of its approach did not hold up to scientific evaluation. But in this regard AA was no worse than most public or for-profit programs. One point worth mentioning is a lag effect between alcohol knowledge on the one hand and treatment and prevention programmes on the other. As section I of this paper indicates, by the 1970s the disease theory had been rejected or seriously modified by the medical and psychiatric communities and sociologists and not supported by clinical studies. Yet the 1970s and 1980s were the heyday of clinic openings in the United States and in the Maritime provinces and other parts of Canada in the 1970s treatment professionals, lobby organizations, the media and supportive politicians employed the concept of alcoholism as a “progressive, chronic and often fatal illness” in order to build public support and attract resources (Canada 1977, 27). Despite its early action in establishing the ARF, Ontario did not start funding a network of detox centres until the early 1970s.vii Another example is the “Jellinek formula” for estimating alcoholism prevalence rates. As noted above, Jellinek soon rejected the formula, yet public officials and media commentators would continue to use it for many years (Roizen 1983). One noticeable change in the 1970s alcohol programs was increased attention to female clients. In keeping with the general pattern of the new feminism, demands arose for gender-specific mutual support, treatment and prevention. Alcoholics Anonymous in the United States was still 78% male in composition as late as 1968, although women had been attending meetings since the 1940s and 1950s. As “invisible” alcoholics, women with drinking problems faced stigmas peculiar to dominant gender ideology, which valued women primarily as wives and mothers. In the 1950s and 1960s, women’s alcoholism often was framed not as an individual physical or mental health vii In July of 1972, the Ontario government announced a plan to fund 16 detox centres in 11 communities where public intoxication arrests surpassed 1,000 per year: ARF The Journal, July 1, 1972.

13 problem, but a threat to the family. One of the new American organizations that reflected the impact of feminism was Women for Sobriety, which modified AA practice and highlighted personal self esteem (Sandameir 1980; White 1998, 278). Specialized clinics and other services for women began to appear in Canada in the 1970s and Health Canada launched initiatives on women and chemical dependency (Marquis 2000; Canada 1977). In 1972, the LeDain commission reviewed many of the acknowledged limitations of treatment: low success rates, lack of modern detoxification centres, continued reliance upon the “drunk tank,” insufficient follow- up or aftercare for individuals released from detox, lack of medical attention to primary alcohol dependence, exclusionary hospital admissions’ policies, lack of insurance coverage of alcoholics, the failure of AA to reach many problem drinkers because of its total abstinence policy, the middle-class focus of clinics, restrictive AA-methods in halfway houses, the abandonment of the “skid row” alcoholic and lack of good clinical research on the effectiveness of treatment (Halifax Chronicle Herald, Jan. 27 1972). The commission paid tribute to a notable exception, Toronto’s Donwood Institute, a new, 50-bed centre where alcoholics from Canada and the United States agreed to a minimum of 12 months of treatment Three years afer its opening, the centre claimed a 75% success rate (ARF The Journal, I (8) Aug. 1 1972). With the scientific consensus on whether alcoholism was a treatable illness in doubt, the effectiveness of therapeutic methods was impossible to prove. The “controlled drinking” evidence suggested that a large minority of heavy drinkers and diagnosed alcoholics “matured out” or became more stable as they aged. The “maturing out” pattern was even more noticeable for drinkers with high education and incomes. On the other hand, follow-up studies in the United States suggested that most problem drinkers who went through treatment did not remain abstinent (Fingarette 1988, ch. 4). Alcoholism services furthermore, like mental health services, were often a reflection of social class. By the 1970s, AA had been criticized in the academic literature and treatment community, if not in the political realm, for not being more open to women and people of colour and for perpetuating methods that bordered on “brainwashing” or “infantilization” (White 1998, 151-57). During the 1970s, there was an attempt to promote “community-based “ social and public health services. This reflected late 1960s discussions of participatory democracy and community consultation and a new health administration philosophy of allowing “clients” to help design the system. The Nova Scotia Drug Dependency Commission, for example, whose mandate included alcohol dependency, attempted to serve clients and their families though regional committees and services in Halifax and Cape Breton (Marquis 2001c). The ARF and other agencies provided grants and contracts with private agencies and community groups to run clinics, halfway houses and drug and alcohol counselling services. And the behavioural sciences and mental health practitioners continued to support multi disciplinary approaches, involving medical staff, para-professional and social services. A “symptom-related” medical model of treatment, according to the Canadian Psychological Association, was insufficient (ARF The Journal, I (9) Sept. 1 1972). By the 1980s, despite a network of provincial and federal referral and treatment programs, many of them community based, the continued activity of Alcoholics Anonymous, and support by the media, treatment, at least as

14 measured through “scientific” experimental design, had not proven to be effective. Another criticism, noted by the LeDain commission in 1972, was the “low proportion of cases that come to treatment in relation to their presumed presence in the population.” A final failing of both public and private treatment networks by the late 20th century, was the “lateness” or chronicity of those who did enter treatment (Roman and Blum 1991, 756-57). Criticisms and shortcomings aside, programs would continue to grow, until by the mid 1990s publically funded treatment agencies in Canada totalled roughly one thousand (Smart and Ogborne 1996, 198). Given that academic and professional definitions of ”addiction” by the 1980s were unravelling, there was less certainty of the efficacy of treatment. Yet political reality meant that treatment programs would stay. By the late 20th century, alcoholism treatment was “an explicitly hybrid project,” involving psychiatry, medicine, mutual support, self-help and “New Age spirituality” (Valverde 1998, 11).

III. Prevention

In terms of public dollars dedicated to dealing with alcohol problems, prevention has always trailed far behind criminalization (arrests, prosecution, corrections) and treatment, which are costly, labour intensive, “bricks and mortar” responses. Logically, once a social problem has been identified, it makes greater sense to lessen the chances of its replication, which is exactly why the Nazis sterilized up to 30,000 alcoholics prior to World War II (White 1998). In their social history of alcohol in Canada, Smart and Ogborne (1996, 171) write:

Prevention has usually been a poor stepsister to treatment when it comes to alcohol problems. Virtually all cities and towns in Canada have some treatment for alcohol problems, including specialized treatment programs, Alcoholics Anonymous or general hospitals. However, few have any sustained prevention programs in the community.

Similarly, in the late 1980s, Calahan (cited in Roman and Blum 1991, 755) concluded that the failure of prevention meant that alcohol-related problems in the United States had not been addressed in any meaningful way. Reflecting the larger public health literature, Ogborne and Smart discuss three levels of alcohol prevention: (1) primary prevention of new problem drinkers and new alcohol problems; (2) secondary prevention or early detection of problem drinkers and intervention to limit damage; (3) tertiary prevention: the treatment of diagnosed alcoholics. In Canada, alcohol education and awareness prior to the 1940s fell largely to the temperance movement. The federal government and its agencies, aside from some World War II restrictions on the retailing of beer, spirits and wine, rarely pronounced against alcohol until Health and Welfare adopted the “alcohol and other drugs” approach in the late 1960s and early 1970s. The classic temperance tactic for the prevention of alcohol problems was the total abstinence pledge. At first, pledges enjoined drinkers to moderate their consumption, for example, by

15 swearing off distilled spirits and keeping to beer and cider. The next stage was to encourage drinkers to take the “teetotal” or cold water pledge. The final voluntary effort was to encourage children and youth to avoid starting to drink in the first place. Hundreds of thousands of Canadians, Protestant and Catholic, had taken the pledge in the 19th century through church meetings and temperance revivals. As in the United States, most pledges were made by politically powerless women and children, yet these personal commitments were an important part of the overall dry assault on the political system in the late 19th century (Noel 1995). Canada’s largest Protestant denomination in the 20th century, the United Church, maintained a voluntary abstinence pledge for its members as late as the late 1950s. The Ontario synod of the Church of England, which had been lukewarm on prohibition, in 1947 identified temperance as “a bounden duty for Christians.” The decidedly anti-prohibition Roman Catholic hierarchy in 1952 attempted to enforce a “no liquor” policy in parish halls. The United Church pledge of 1948 is worth reproducing because of its appeal to not only Christian stewardship, but also social responsibility, including an ethical investment rule (Manitoba 1955, 93):

I promise to support my church by: (a) abstaining completely from all personal use of alcoholic beverages. (b) refraining from offering them to my family or my guests on any occasion. (c) refraining from investing money directly or indirectly in any company which manufactures or sells such beverages. (d) using my influence to encourage others to support my church on this issue (e) using my vote on behalf of all social legislation which makes a constructive contribution to a Christian society.

Prior to prohibition, groups such as the Woman’s Christian Temperance Union (WCTU) lobbied to have “scientific” temperance instruction inserted into teacher training and the public school curriculum, either as distinct courses or within science and health lessons. Formal temperance instruction enjoyed mixed success, largely because politicians and school officials saw it as propaganda. Yet the WCTU and organizations such as the Sons of Temperance were given access to the schools and they organized children’s and youth wings, sent lecturers to the schools and ran essay and poster contests for students. In Nova Scotia, the major temperance organization for young people, the Allied Youth, enrolled only a fraction of the province’s teenagers in the 1950s and 1960s. By the mid 20th century, temperance organizations in Manitoba and New Brunswick received small provincial grants and limited access to the schools, and Nova Scotia employed a full-time director of temperance education, but the impact of “scientific” temperance was far weaker than it had been in the 1890s and early 1900s (Cook 1995, Marquis 2001a). The 1955 Bracken Report was highly symbolic of the changes underway in official thinking on alcohol. Bracken, a former prohibitionist, came out in favour of “liquor control,” not liquor “expansion,” but his suggestions

16 on adult education were revealing. He recommended the nonpartisan use of “the facts of science” and “the truth about liquor” rather than myth, folklore and “the unfounded propaganda on both sides of the liquor problem,” in order to maintain an informed pubic opinion. Another commissioner, Dr. P. L’Heureux, wrote: “It would appear that history and experience dictate a middle course to be followed if we are, on the one hand, to satisfy the reasonable demands of a free people and on the other, to avoid as much as possible the terrible consequences of frequent and widespread abuse” (Manitoba 1955, 348-49, 721). In 1970, British Columbia’s Morrow Report repeated the consensus message that all parties “agreed that excessive consumption is totally unacceptable to modern society” (British Columbia, 1970, 11). In the 1950s and 1960s the new provincial alcoholism commissions usually adopted education and awareness strategies. The ARF concentrated both on educating “other professionals” on alcohol issues and on public awareness. In addition to operating a resource library and distributing literature, by 1960 the ARF had produced educational films, including three shorts for the Canadian Broadcasting Corporation’s television network. One film, “Hospitality,” encouraged hosts to provide non-alcoholic beverages for recovering alcoholics and other problem drinkers. Public service ads aimed at youth were produced with the aid of a social psychologist who was taken on staff in 1959 and a teacher’s guide and other materials were prepared for Ontario high schools. In the area of corporate or industrial alcoholism campaigns, the alcoholic employee was the target. In keeping with the new alcohol knowledge, the ARF stressed that education and awareness messages reflected public health, not morality. In 1960, Executive Director David Archibald expressed both the confidence and the naivete of Canada’s emerging treatment network by predicting that “ultimately” treatment would bring the problem of addiction under control and that “future generations” of drinkers could be prevented from becoming alcoholics (ARF Annual Reports, 1950-60). The alcohol industry’s contributions to education and awareness of alcohol abuse were (and are ) minimal, and limited to “drink responsibly” slogans. The classic alcoholism theory suited the industry’s strategy of liberalization in the post World War II period (Burnham 1993, ch. 3), yet it is possible to see its response to alcohol problems as “haphazard” rather than “conspiratorial” (White 1998, 195). Sam Bronfman’s Seagram’s distilling empire, for example, in 1934 hired a New York advertising agency that developed a series of cautionary public service messages that ran up until the 1960s. Slogans included “Drink Moderately,“ ”Drinking and Driving do not Mix,” and (interestingly from the point of view of the theory alcoholism) “Some People Should Not Drink” (Marrus 1991, 197-98).viii In 1972, an interesting debate occurred at Ottawa between an academic and a senior vice president of the House of Seagram, Ltd. The question was whether alcohol caused alcoholism. Citing authorities such as the ARF, the Rutgers University Center of Alcohol Studies and the United States Department of Health, Education and Welfare, the Seagram’s executive blamed “the person, not the bottle.” The professor admitted that psychological and biological research had failed to find a “cause” of alcoholism, but suggested that liberalization of access was a

viii As Marrus points out (ch. 8), by the 1950s, most of Seagrams’ sales were outside of Canada.

17 factor. The executive, Michael McCormick, stated that there was no proven link between consumption and alcoholism, and objected to the term “alcoholic beverages” because it misleadingly suggested that the industry’s products caused alcoholism. ”Beverage alcohol products” was a less “archaic” term. When asked why the distilling or alcohol industry did little to raise awareness of drinking problems, McCormick replied that 96% of the adult population drank responsibly, and that the 3-4% who were alcoholics would not pay attention to “moralizing” campaigns. On both accounts, industry support of education and awareness would be a waste of money. He admitted that the distillers contributed “nothing” to treatment beyond normal taxes and opined that the industry would resent health warning labels on bottles (ARF, The Journal, I (6) July 1 1972).ix There are suggestions that the neo-temperance movement in the 1980s and 1990s, which at the grassroots level was symbolized by organizations such as Mothers Against Drunk Driving (MADD), pressured the alcohol industry into spending more on public service advertisements. The most common type of public service announcement was directed at impaired driving. At present, the Brewers Association of Canada funds a program, designed by an independent third party, that indoctrinates 13 and 14-year olds in New Brunswick on “the responsible and appropriate use” of alcohol (Evening Times Globe, Oct. 1 2001). As studies indicated that rates of per capita consumption and alcoholism were on the rise in the late 1960s, more attention was paid to prevention (Alcoholism Foundation of British Columbia 1972). Consumption rates were affected by a larger proportion of young adults in the population, greater consumer purchasing power, a more liberal social climate, fewer restrictions on sale, and a lowered legal drinking age. An increased alcoholism prevalence rate underlined “the importance of the untreated alcoholic in public policy” (Roizen 1983). The chief obstacle to awakening public concern was overall support for liberalization. Public opinion polls indicated that a majority of adult Canadians used alcoholic beverages (ARF Annual Report, 1964, 89). And in the late 1960s and early 1970s, provincial governments were reviewing alcohol control policies with a few to further liberalization (ARF The Journal, II (1) Jan. 1 1973, (3) March 1 1973). Yet, as noted above, the distribution-of- consumption model encouraged researchers to make a case that price controls were a powerful health prevention tool. In 1972, ARF researchers suggested that socially-harmful drinking levels could be controlled if the provincial liquor commission doubled the price of cheap wine, raised the price of beer by half, and also examined the price of distilled spirits (ARF, The Journal, I (6) July 1 1972). One prevention issue that received some attention at the provincial level was alcohol advertising. In the 1940s and 1950s, temperance groups had fought a rearguard battle against the wishes of the “liquor traffic” to “seduce” the youth of the United States and Canada through glamorous advertising. In the 1950s, Quebec allowed advertising except where it depicted scenes with drinking, women or religious imagery, and Ontario allowed no product advertising (Manitoba 1955, 311-18). Breweries most common use of institutional advertising was through the ownership of professional sports teams and community charities. By the mid 1970s New Brunswick and PEI still

ix The executive argued that even if alcohol did not exist, certain individuals would still be addicted.

18 banned internal alcohol advertising (and PEI attempted to screen out-of-province ads). British Columbia disallowed internal radio and television commercials in 1971-72 and Manitoba in 1974 banned in-province print and electronic media beer advertisements. In 1973 the Ontario Liberal and New Democratic parties called for the end of alcohol advertising in order to combat youth drinking. In Ontario and other provinces, liquor licensing authorities regulated institutional and brand advertising, and electronic media advertising was regulated by the federal government, which banned radio and television ads for spirits until the 1990s (Scoffield 1976). As part of the neo-temperance wave of the 1970s and 1980s in the United States, parents’ organizations, consumer groups such as Ralph Nader’s Center for Science in the Public Interest and health organizations called for mandatory health warning messages on alcohol containers and limits on advertising (Pittman 1991, 779). Mandatory warning labels, introduced in the United States in 1989 but not in Canada, were a sign that the classic disease theory, which focussed on demand (the alcoholic) was being altered by the distribution model which examined supply. Public health and addictions experts regarded public awareness campaigns not as a form of prohibition, but harm reduction (Courtwright 2001, 203-04). As Pittman (1991, 777) notes, the disease concept could not be stretched to include all types of problematic behaviours, such as impaired driving. Starting in the 1970s, the victims and families of victims of pedestrians, passengers and drivers killed or injured by impaired drivers began to organize on the grassroots level. In addition to punitive responses to drinking and driving, and the raising of the legal drinking age back to 21, these organizations also pressed for education and awareness campaigns that accepted social drinking, but targeted driving while impaired as not only illegal, but morally and socially unacceptable. MADD and Students Against Drunk Driving (SADD), having risen to prominence in the American “war on drugs,” began to organize in Canada in the 1980s (Gusfield 1981; Marquis 2001c). Although not directly involved in alcoholism services, except in specific jurisdictions such as Status Indians or military veterans, the federal government became more active in helping to fund various provincial and nonprofit programs, in supporting research and in providing information on addiction and dependency. The Non- Medical Use of Drugs (NMUD) Directorate of National Health and Welfare was organized in the early 1970s. On the one hand, federal intrusions into public health and social services were threats to provincial jurisdiction, but as temperance advocates had long pointed out, the federal government derived substantial sums each year from excise and other taxes on the liquor industry (particularly in the case of distilled spirits). In 1973, the head of the NMUD Directorate justified Ottawa’s new interest in alcohol prevention and treatment on the grounds that alcohol abuse was a national issue and that the federal government was already involved in programs such as hospital and health insurance. The American government had only recently set up the NIAAA. During the 1972 election campaign, Prime Minister Trudeau had made reference to alcohol as Canada’s leading drug problem, and of his government’s determination to address the issue. In 1973, the NMUD Directorate, which had ignored alcohol, set up a task force to look at research on treatment and prevention (ARF The Journal II (1) Jan. 1 1973).

IV. Some People Should Not Gamble

The title of this paper is not meant to suggest that the category of the alcoholic literally was “invented” by government, the alcohol industry or the media in order to legitimize the increasing liberalization of alcohol policy. Similarly, I am not implying that alcohol problems do not exist or that treatment programmes are not needed. Much of the pressure for services for alcoholics came not from professional, economic or political elites but problem drinkers, their families and organizations such as Alcoholics Anonymous, which had no formal legal or political status. Civic and industry organizations, municipal governments, service clubs, organized labour, the helping professions and a sympathetic media were responsible for pushing provincial governments in the 1950s, 1960s and 1970s to provide treatment and counselling services. E.M. Jellinek, often credited as the chief exponent of the disease theory, believed that the response to alcoholism would be dictated more by “social values than scientific evidence” (White 1998, 185). True to Jellinek’s predictions , alcoholism has played a utilitarian role in “setting therapeutic goals” (Kisson 1983, 119). It also served the interests of other groups in society. In retrospect, who benefited from the problematization of alcoholism, problem drinking and fetal alcohol effects?

1. The subjects of the reform gaze, with important exceptions, benefited from medicalized approaches to alcohol problems. The exceptions were individuals who were subjected to involuntary treatment or legal sanction. Increasingly, responses were within a medical, counselling, mutual aid or social service framework. And compared to attitudes towards drug addicts, the response of society was relatively benign.

2. The alcohol industry (distilleries, breweries and wine and cider producersx), the hospitality sector (bars, hotels, motels and restaurants), and the advertising industry (initially the newspapers and magazines, then radio and television).

3. The public sector partners, the federal and provincial governments who derive excise and other taxes and revenues from production, distribution and sale of beverage alcohol.xi

4. The citizen-consumer, the majority of the adult population who could be described as moderate or social x Employing c. 20,000 people in the early 1990s: Smart and Ogborne 1996, 157. xi According to Ogborne and Smart, in the early 1990s, alcohol was responsible for 2.7% of all taxation (156).

20 drinkers. In addition to being cast as “normal” under the popular conception of alcoholism, the majority of citizens were assuaged in their guilt because tax dollars supported programs treating the addicted minority .

5. The treatment and prevention sector, which became an important part of community health, and developed a vested interest in claims making and responding to alcohol-related problems. In the United States it includes a large for-profit sector.

We now turn briefly to the “pathological,” “compulsive” or “problem” gambler. The gaming issue, in contrast to the evolving understanding of alcohol issues since World War II (with the possible exception of the 1960s and early 1970s), at present is characterized by problem minimization. Like the alcoholic, the problem gambler is a casualty of liberal modernity, of the drift to a more permissive society in terms of consumer choice and personal freedom. A focus on problem gambling as a mental disorder affecting a small percentage of players has individualized and medicalized what might otherwise be treated as a larger social or political problem. The current discourse on problem gaming, like that on alcoholism in the 1950s and 1960s, is based on an assumption that most citizens are responsible gamblers. The irresponsible minority of gamblers, unlike the classic alcoholic, does not injure its physical health and hence does not require treatment for detoxification or acute withdrawal. It is unlikely to require clinic or hospital beds. But it is more likely to experience serious financial problems. Gamblers Anonymous was founded in the 1950s in the United States, and adopted much of the approach of AA, including abstinence. Like alcohol addiction, gambling addiction can only be controlled, not cured. The first centre to professionally treat pathological gamblers opened more than two decades later (Murray 1993). Three competing explanations of gambling problems were listed by the ARF in a 1996 survey of Ontario attitudes. Two, the South Oaks Gambling Screen and the Diagnostic and Statistical Manual of the American Psychiatric Association, are based on the “gambling addiction as a disease” philosophy. The third framework, a “life-areas problems measure” that focussed more on gambling’s social consequences, reflects the approach of Health Canada to measuring drug and alcohol problems in the 1980s and 1990s (Ferris 1996, 4). As of the early 1990s, psychological research on gambling (echoing earlier accepted wisdom on drinking) was based on the premise that “most people maintain self-control and can stop whenever they wish, but a few fall into a pattern of pathological gambling.” By 1993, “no one personality profile definitive of pathological gamblers” had been identified in a literature review by Murray (792, 803). In the anti-gaming camp, mental health and social responsibility are strongly linked, with suggestions that individuals who gamble away savings and property often succumb to personal and family crises, depression and even suicide. That VLTs, casinos and lotteries represent a form of poverty tax is patently obvious to all students of the subject, especially neoliberal opinion as represented by the Fraser Institute, which privileges consumption taxes over income and corporate taxes. Another common “personal” story in the media is the addict who steals or commits fraud in order to find money for his or her compulsion. The courts have accepted gambling addiction as a factor

21 when determining sentences in cases of crime against property. Government, the gaming industry and the media have moved away from “gambling addicts” to “problem gamblers” but for the most part the change in terminology means little to the general public, which envisions low-income binge gamblers squandering pay checks (or welfare checks) in drinking establishments equipped with VLTs, which in 1999 produced 27% of government gambling revenues in Canada (Globe and Mail, May 4 2001). Visions of cross-addiction enter into popular discourse, with problem gamblers also portrayed as heavy smokers and drinkers, a triple public health threat. For largely tactical reasons, the need to develop public awareness of a new but complex social “problem,” anti-VLT groups are focussing on addicts or problem gamblers, a useful image for mobilizing opinion, much like the drunk driver or the cancer-diagnosed nicotine addict. In terms of policy, the logic of addiction in light of alcohol regulation leads not to the removal of VLTs or closure of casinos, but screening, harm reduction and possibly selective incapacitation. It means that the problem gambler has to be identified, treated and even prevented from gambling, either totally or beyond a certain limit, through the use of medical interventions, surveillance and technology. Such proposed remedies raise a host of troubling civil liberties and legal questions. And compared to the gaming industry, beverage alcohol producers and purveyors historically have adopted a low profile when it comes to suggesting how alcohol problems should be prevented or treated. In the New Brunswick case, the pro- gaming forces openly speak of addiction, research and treatment, and gave an as yet-to-be-fulfilled promise that they would help devise a “solution” to the problem. A spokesperson for gambling lobby has compared possible solutions to the approach of MADD, which does not condemn drinking, only irresponsible drinking (Telegraph Journal, May 26 2001; Evening Times Globe, Sept. 28 2001). In conclusion, the recent history of how the concepts of alcoholism, problem drinking, heavy drinking and fetal alcohol effects relate to the convenience model of alcohol control is instructive for discussions of regulated gaming. The academic opinion that “addiction” is “an ambiguous term with various meanings in different situations” (Canada 1971, 429) does little to weaken its salience as a public issue. The slogan “some people should not gamble,“ much like “some people should not drink,” can be supported by all sides in the debate, from anti-VLT and anti-casino groups to revenue-addicted governments to the gambling industry itself. Based on an examination of the recent history of Canadian alcohol policy, it seems logical to conclude that once anti-gambling groups choose addiction as their battleground, they have already lost the war.

APPENDIX

Table 1: Creation of Alcohol/Drug Commissionsxii

ONT 1949

QUE 1959

BC 1973

MAN 1958

ALTA

SASK

PEI

NB 1974

NS 1959

NFLD

Table 2: Estimates of Prevalence of Alcoholism, 1962xiii

Total alcoholics Alcoholics/100,000 pop. aged 20 or over NFLD 2290 1010

PEI 800 1370

NS 5600 1330

NB 3625 1130

QUE 69940 2340

ONT 92170 2410

MAN 11355 2040

SASK 7040 1310

ALTA 11355 1455

BC 23940 2350

xii Author’s files. xiii Addiction Research Foundation (ARF) Annual Report, 1964, 93.

CANADA 228115 2125

Table 3: ARF New Patients: Sources of Referralxiv

1954 1955 1956 1957 1958 1959 1960

Physicians 167 148 129 134 139 120 128

AA 109 73 63 78 58 53 63

Family/friends 105 91 75 98 93 83 79

Social agencies 31 34 35 37 25 43 52

Justice system 23 26 26 8 25 19 22

Self referral 51 39 48 69 83 77 67

Other medical 48 61 68 39 60 43 37

Clergy 10 9 16 24 16 12 13

Employers 14 16 11 15 20 22 24

Other patients 57 50 43 23 23 28 25

Other sources 17 14 10 9 3 4 3

Not recorded 4 2 6

ARF branches 21 12 8

xiv ARF, Annual Report, 1959-60, Table VII, VIII. Toronto services only.

Chart 1xv

ARF Clinic Clients Toronto, 1956-64 3500 3000 2500 2000 1500 1000 500 0 1956 1957 1958 1959 1960 1961 1962 1963 1964 Inpatients Outpatients

xv ARF, Annual Report, 1960-64. The out patient statistics refer only to the ARF’s Central Clinic, not the East Toronto alcoholism clinic or the narcotic clinic. The in patient statistics do not include referrals to general hospitals or the ARF acute treatment service.

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Notes