alcohol and culture essay

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Defining “drinking culture”: A critical review of its meaning and connotation in social research on alcohol problems

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• https://doi.org/10.3109/09687637.2016.1153602

Introduction

Summary of the critique of the understanding of the drinking culture concept in alcohol research, making sense of different cultural entities and their interactions, conclusion: ways forward, acknowledgements.

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There has been growing academic interest in “drinking cultures” as targets of investigation and intervention, driven often by policy discourse about “changing the drinking culture”. In this article, we conduct a critical review of the alcohol research literature to examine how the concept of drinking culture has been understood and employed, particularly in work that views alcohol through a problem lens. Much of the alcohol research discussion on drinking culture has focussed on national drinking cultures in which the cultural entity of concern is the nation or society as a whole (macro-level). In this respect, there has been a comparative tradition concerned with categorising drinking cultures into typologies (e.g. “wet” and “dry” cultures). Although overtly focused on patterns of drinking and problems at the macro-level, this tradition also points to a multifaceted understanding of drinking cultures. Even though norms about drinking are not uniform within and across countries there has been relatively less focus in the alcohol research literature on cultural entities below the level of the culture as a whole (micro-level). We conclude by offering a working definition, which underscores the multidimensional and interactive nature of the drinking culture concept.

• drinking culture
• public health

Policy documents increasingly refer to the need to “change the drinking culture” as a way of addressing problems associated with alcohol use (Her Majesty’s Government, Citation 2012 ; Ministerial Council on Drug Strategy, Citation 2006 ; Victorian Government, Citation 2008 ). At least in part reflecting this, interest in drinking culture has also grown in academia. As indicated in Figure 1 , the number of academic journal articles in the health and social sciences that contain the term appears to have grown steadily since the early 2000s.

Figure 1. Journal articles in the SCOPUS database containing the term “drinking culture/s” between 1967 and 2014.

Although there is considerable anthropological and sociological literature on culture and drinking (e.g. see Douglas, Citation 1987 ; Heath, Citation 1987 ; Hunt & Baker, Citation 2001 ), the issue of cultural aspects of drinking has also come to the fore in public health-oriented research that is concerned with the description, prevention and alleviation of health and social problems. This is not surprising given that public health has traditionally focussed on social determinants of health and upstream factors beyond the level of the individual. However, in much social research on alcohol, public health’s traditional focus on environmental and structural factors has been relegated to the background in favour of a focus on the individual (and individual responsibility), behaviour change and unhealthy lifestyles, of which alcohol consumption is seen as a part (Hunt & Baker, Citation 2001 ).

In the public health-oriented literature on alcohol and other issues, there has been a tendency to treat “context” and causality in over-simplistic ways (Hart, Citation 2015 ; Shoveller et al., Citation 2015 ) and to discount the pleasures of alcohol use (Hunt & Baker, Citation 2001 ). Given this tendency for oversimplification, we undertake a critical review of public health-oriented alcohol research (henceforth referred to as “alcohol research”) to trace how this body of work has understood and deployed the concept of “drinking culture”. Consistent with the critical review approach, we aim to “go beyond mere description of identified articles” deploying the drinking culture concept and “offer a degree of analysis and conceptual innovation … to ‘take stock’ and evaluate what is of value from the previous body of work” (Grant & Booth, Citation 2009 , p. 93). We do not attempt an exhaustive inventory of all the available literature on alcohol and culture, nor even all the public health-oriented literature; our concern is primarily with “the conceptual contribution of each item of included literature”, and as such this article “may provide a ‘launch pad’ for a new phase of conceptual development and subsequent ‘testing’” (Grant & Booth, Citation 2009 , pp. 93, 97). In particular, we trace the application of the drinking culture concept to different cultural entities at both macro- and micro-levels, and in so doing examine points of consensus and departure in terms of how drinking cultures have been understood in alcohol research. We utilise insights from anthropological and sociological literature to draw attention to potential oversimplifications, limitations and ways forward for alcohol research. In so doing, we encourage a nuanced and multi-dimensional understanding of drinking cultures and provide insights into how drinking cultures might be defined, investigated and monitored.

We show that the alcohol research literature offers little in terms of explicitly defining what is meant by the term “drinking culture”. Even in a recent review of drinking cultures, Gordon, Heim, & MacAskill ( Citation 2012 , p. 4) stopped short of a definition, suggesting that “the question of what constitutes drinking cultures is somewhat abstract and open to interpretation”. This conceptual ambiguity has not stopped researchers from viewing drinking culture as a target of investigation or intervention. Indeed in the very next sentence, Gordon et al. go on to state that their paper identifies “key themes influencing drinking cultures” and reviews “their nature and function” (2012, p. 4). By skipping over any detailed conceptual discourse or discussion of how the study operationalises drinking culture, the concept is enacted paradoxically as commonsense and unproblematic – something that the reader intuitively understands.

On the contrary, we suggest that the widespread and unquestioned use of “drinking culture” terminology in problem-oriented alcohol research has deepened the ambiguity surrounding it and stifled conceptual development and understanding. We argue that alcohol researchers need to more clearly articulate what they mean when they refer to drinking cultures. Prior to making this argument, however, we begin with a brief overview of anthropological and sociological understandings of culture.

More than half a century after Kroeber and Kluckhohn ( Citation 1952 ) found 164 definitions of “culture” in the anthropological literature, Taras, Rowney and Steel ( Citation 2009 ) found it still true that “there is no commonly accepted definition of the word”. Taras et al. characterise culture as a “complex multilevel construct”, with shared assumptions and values as a core, and practices, symbols and artifacts as outer layers. They also emphasise stability – that a culture is shared by members of a group that it is formed over a long period, and that it is relatively stable. Jepperson and Swidler ( Citation 1994 ) suggest that for a particular cultural form, there is an underlying code of meaning and rules, there are “customs that have emerged governing it”, and there are “ideologies of talk surrounding it”.

In an exchange specifically concerned with alcohol and culture, Lemert ( Citation 1965 ) noted that in his fieldwork he had found that “group interaction and social control are far more significant than culture values in understanding of predicting … drinking” (p. 291). In reply, Mandelbaum ( Citation 1965 ) accepted this observation, adding that “I include under the term ‘culture’ those patterns of social control and of collective behaviour which are regularly used” (p. 292).

The exchange between Lemert and Mandelbaum set a pattern that has been a regular feature of discussions of alcohol and culture, emphasising social control aspects at least as much as shared values as central to the meaning of culture. Lemert ( Citation 1962 ) and Bruun ( Citation 1971 ) made strong contributions to this tradition in their typologies of cultures in terms of differences in characteristic means of controlling and minimising harm from drinking. We will discuss below the continuation of this tradition in analyses emphasising norms concerning drinking – prescriptive norms is the term in psychology – as building blocks of culture and drinking.

Drinking culture in a society as a whole

“tolerance (hence permissiveness to drinking), disapproval of ‘wowsers’ (hence the determination not to be a kill-joy oneself), the ideal of self-control and ‘moderation in all things’ (the main social control of drinking), conformity and belief in equality and stress on the adult male role (especially the pressure on adolescents to assume this role early)” (1968, p. 150).

“drinking as a symbol of mateship and social solidarity (especially in adult male drinking); drinking for social ease (particularly in home entertaining and cocktail parties); drinking as utilitarian (hence it is acceptable to use alcohol to ‘drown one’s sorrows’); excessive drinking as socially more acceptable as an outlet for deviance than, for example, delinquent acts or schizophrenia; drinking as virile behaviour; ‘holding one’s liquor’ as also virile; adults’ opinion that adolescent drinking should as far as possible be supervised; disapproval of heavy drinking and drunkenness in women” (1968, p. 150).

At the level of “general orientations”, many of Sargent’s generalisations are still recognisable, though much has changed in Australian society, including who does how much drinking where. However, in a complex multicultural society, there will be many subdivisions of the society where the generalisations do not apply. As Sargent intimates, the drinking culture of a society may refer and “belong” to some parts of the culture much more than to others. For instance, given the male predominance everywhere in heavier drinking, it has been remarked that what are referred to as national drinking cultures seem to mostly be referring to male drinking in the society (Gmel Room, Kuendig, & Kuntsche, Citation 2007 ). This is important to keep in mind as we discuss drinking culture at the level of the culture as a whole. It is also important to note that the distinction between macro- and micro-scales of focus should not be viewed as mutually exclusive or necessarily in conflict, but are perhaps best seen as complementary perspectives.

The typological tradition

Concern with drinking norms and functions at the macro-level is evident in many early discussions of culture and drinking, in which academics used examples of drinking in different societies to develop typologies of the position of alcohol in cultures (Room & Mäkelä, Citation 2000 ). These typologies are of interest because such classifications make differentiations on various dimensions. Examining the dimensions that are chosen provides insights into thinking around what is meant by a drinking culture.

A fuller catalogue of typologies identified in the literature can be found in Table 1 . Many of the typologies in Table 1 are focussed on drinking patterns and problems. We mention a few that are particularly noteworthy here.

Table 1. Typologies of drinking cultures identified in the literature.

A strict system of legal and organisational control of accessibility of alcohol seems to be related to low alcohol consumption, but also to a high degree of public nuisance. The causal chain probably goes like this: A drinking culture with a large degree of highly visible, non-beneficial effects of alcohol consumption leads to a strict system of control, which somewhat reduces total consumption, which again influences and most often reduces the visible problems. But also, the system of control influences the visible problems – sometimes probably in the direction of increasing them … . In determining the amount of consumption and the problems created by consumption, I do not perceive the system of control as the independent variable. I view the system of control to be inter-related with the amount of consumption and especially with visible problems (Christie, Citation 1965 , p. 107).

Despite being critiqued from a number of angles (see Gordon et al., Citation 2012 ; Room & Mäkelä, Citation 2000 ), the wet–dry typology had the virtue of being one of the first to highlight systems of social controls as an important feature of drinking cultures, an aspect to which we will return.

Open and airy wine shops in Mediterranean cultures, with drinkers sitting in small groups around tables.

The huge darkened beer halls of Germany and Austria, with long parallel tables flanked by benches.

The stand-up bar of English pubs, with drinkers standing in a line.

What is most striking about this typology is not just the focus on places in which drinking might typically occur (e.g. a beer hall, wine shop, bar, etc.), but the detailed attention to how the drinking space feels, how it is organised in relation to the drinker and how drinkers relate to other drinkers. This relatively nuanced rendering of setting foregrounds a complex web of interactions that may occur between spatial arrangements and activities in drinking environments, individual drinkers, the drinking group and others in the drinking environment. Also of note is the absence of any mention of drinking behaviour, problems or drunkenness, which is a departure from most other typologies (d'Abbs, Citation 2014 ).

Alcohol intoxication isolated into a sacral corner (e.g. orthodox Jews).

Alcohol intoxication confined to clearly demarcated occasions (e.g. the Camba in Bolivia).

The Scandinavian model: vacillation between “Dionysian acceptance and ascetic condemnation of drunkenness”.

As in thinking on the wet–dry typology, social control of alcohol emerges as a key feature of drinking culture in Mäkelä’s ( Citation 1983 ) discussion.

“A common pattern, well suited to the affluence and opportunity of the industrialised workweek, is a couple of drinks every evening, just enough to feel some effects, and a drunken “blast” on the weekend” (Room & Mäkelä, Citation 2000 , p. 481).

Use-values (e.g. alcohol as nutrient, alcohol as an intoxicant, etc. (Mäkelä, Citation 1983 )).

Expectations about behaviours while drinking or intoxicated.

The cultural position of the drinker, the drinking group and the drinking occasion.

Modes of social control of drinking.

The nature of drinking-related problems and their handling.

These additional features, together with the basic features of the regularity of drinking and the extent of drunkenness, offer a range of dimensions on which a particular cultural entity can be characterised and measured.

“… homogenisation of lifestyles, urbanisation, greater female independence, globalisation of alcohol marketing (especially for beer, spirits and new beverages), and moves toward greater homogeneity of legislation and regulation (e.g., EU [European Union] alcohol policies)” (Gordon et al., Citation 2012 , p. 8).

In this light it is worth considering how globalisation has affected what have been traditionally thought of as national drinking cultures. With increased flows of people, products, information and ideas across national borders, is it possible to conceive of a national drinking culture that sits in isolation from the “global”? For instance, marketing of alcohol by multinational producers may generate flows of images and messages that are shared globally via the internet and social media (Room, Citation 2010 ). Furthermore, scholars have noted a convergence of drinking patterns between men and women living in the USA (White et al., Citation 2015 ) and in European countries (Beccaria & Guidoni, Citation 2002 ; Leifman, Citation 2001 ; Room & Mäkelä, Citation 2000 ), and trends around young people drinking less have been described in various countries (de Looze et al., Citation 2015 ; Pennay, Livingston, & MacLean, Citation 2015 ). The analysis by Gordon et al. ( Citation 2012 ) prompts us to think about the extent to which phenomena of globalisation may be implicated in these recent observations (see Leifman, Citation 2001 ; Room, Citation 2010 ).

In what seems like a jump in their argument, Gordon et al. ( Citation 2012 ) also argue that the regularity of drinking and the extent of drunkenness dimensions proposed by Room and Mäkelä ( Citation 2000 ) could be encapsulated by a single “hedonism” dimension. They suggest that a hedonism dimension could also capture the extent to which individuals’ general lifestyles with regards to alcohol can, for example, be described as hedonistic (or ascetic).

Proposing a single dimension to characterise a culture’s drinking style, with “ascetic” at one end of it, seems reminiscent of old temperance-movement framings, with an implicit assumption that drinking will lead to intoxication. The dimension’s label assumes that both drinking and drunkenness are inherently hedonistic and thus opposed to dominant social discourses of restraint and moderation (Hunt & Barker, Citation 2001 ); but alcohol’s use-values are not limited to pleasure. Alongside their “hedonism” dimension, Gordon et al. ( Citation 2012 ) propose two other dimensions to characterise “drinking cultures”: function (“inter/intrapersonal, ritual, intoxication”) and modes of social control. But the presentation of their typology does not go beyond these minimal characterisations, and the authors make no attempt to classify any societies on the dimensions.

The numerous instances where Room and Mäkelä ( Citation 2000 ) point to exceptions to general correlational patterns highlight the difficulty of pigeonholing national drinking cultures into discrete categories. For instance, drinking in Mediterranean or wine-drinking cultures is strongly associated with meals, and is associated with “less officially recognised social disruption than elsewhere” (2000, p. 478). However, the notion of this seemingly idyllic kind of drinking culture (or a singular homogeneous culture) is rendered problematic in light of other literature, for example, about men drinking in the tavernas of Greece rather than in the home (Gefou-Madianou, Citation 1992 ), or about drunkenness that also occurs among young people in wine drinking cultures (Beccaria & Guidoni, Citation 2002 ), even if to a lesser extent. What this suggests is that at a societal level drinking cultures are not homogeneous. For the society as a whole, there may be recognisable characteristics that differ from patterns elsewhere – as in Sargent’s ( Citation 1968 ) characterisation of Australian drinking culture quoted above – but there are often also divergent features in subcultures or social groups, and often also in culturally defined “time out” periods.

Although we can point to flaws in each individual typology and in the way in which typologies are developed, the typological literature produces some useful insights. First, as the more nuanced typologies suggest, the drinking culture concept is not just about patterns of drinking (e.g. rates of alcohol use, types of beverages consumed) or problems (e.g. extent of drunkenness, alcohol-related mortality or morbidity) that exist in a cultural entity, but also encompasses meanings and use-values, the settings and places in which drinking occurs, and how drinking is controlled or regulated within a society.

Normative perspectives

A perspective which encompasses both the aspect of customs and expectations about drinking and the aspect of social control and adverse responses to drinking behaviour is the concept of norms. Room ( Citation 1975 ) argued that norms are the crucial building blocks lying behind the consumption patterns that had been the primary focus of previous discussions. Defining a norm as “a cultural rule or understanding affecting behaviour, which is to a greater or lesser degree enforced by sanctions” (1975, p. 359), Room notes that a norm is cultural in the sense that it is “not a property of an individual or a private understanding between people interacting with one another, but is a relatively permanent rule shared by a class of individuals who may not ever have met each other” (1975, pp. 359–360). In this respect a norm can apply at the level of the whole culture, a well-defined subculture or a less well-defined “social world” of persons with common interests or status. In Room’s usage, a norm can be an understanding held in common by “a group of people about what is appropriate behaviour” (1975, p. 359), but it can also take the form of a law or official regulation. Including formal rules as a kind of norms potentially brings the tools of government into the fold of drinking cultures (e.g. regulation, policy, etc.).

The typological tradition’s emphasis on social control as a dimension of drinking cultures is reflected in Room’s ( Citation 1975 ) allusion to “sanctions”, which he suggests can be formal and severe (e.g. a fine, getting thrown out of a bar, being arrested and charged, etc.) or can be informal and transitory (e.g. a lifted eyebrow, a disapproving look, etc.). However, norms can act not only as mechanisms to limit behaviour, but also to encourage particular behaviours (e.g. norms about buying rounds of drinks). In contrast to the focus on “drinking” behaviour and patterns in the typological work, Room highlights that most norms are directed at behaviour during or after drinking.

A major point that Room ( Citation 1975 ) makes is that norms governing drinking and associated behaviour differ “both according to the social situation – time and place and occasion – and according to the individual status on various social differentiations” (p. 361). Examples of norms include the appropriate age to be a drinker, situations in which it is appropriate to drink (e.g. not at work), traditional expectations about women drinking less than men or older people drinking less than young people. Although drinking cultures have often been depicted implicitly as aggregates of individual actions carried out in certain prescribed ways (e.g. in wine-drinking cultures there will be less drunkenness, in dry countries there will be more drunkenness, etc.), Room directs our attention to the social, relational and emergent qualities of drinking behaviour and drinking problems, arguing that these “arise out of the interaction between the drinker’s behaviour and the various responses of others” (1975, p. 360).

Dimensions of focus in studies of drinking cultures at a macro-level

In order to obtain an indication of the dimensions of drinking culture alcohol researchers have focused on recently, we identified peer-reviewed articles in health and social science journals that included the term “drinking culture” between 2010 and 2015. This illustrated that the way in which drinking cultures have been researched at the level of the culture as a whole (the macro-level) has been similar, irrespective of the tradition in which the study might be located. Change over time analyses and cross-national comparisons have predominated. As illustrated in Table 2 , most studies tend to be quantitative, with many drawing on general population survey data.

Table 2. Recent studies on drinking culture at a macro-level, 2010–2015.

As can be seen in Table 2 , studies tend to focus on a limited number of dimensions of drinking culture. In studies examining drinking patterns, a focus on intoxication and alcohol-related problems is common (e.g. Härkönen, Törrönen, Mustonen, & Mäkelä, Citation 2013 ; Loughran, Citation 2010 ; Mäkelä, Tigerstedt, & Mustonen, Citation 2012 ; Mustonen, Mäkelä, & Lintonen, Citation 2014 ; Raitosalo et al., Citation 2011 ; Stickley, Jukkala, & Norstrom, Citation 2011 ). For instance, in their study of changes to Finnish drinking culture between 1968 and 2008 using general population survey data, Mäkelä et al. ( Citation 2012 ) note that Finland has become a “wet” drinking culture, although sporadic intoxication (primarily on weekends and evenings) still maintains an important role of the drinking culture. Many of the studies focus on young people (e.g. Beccaria & Prina, Citation 2010 ; Bye & Rossow, Citation 2010 ; Hellman & Rolando, Citation 2013 ; Loughran, Citation 2010 ; Petrilli et al., Citation 2014 ; Rolando, Citation 2014 ; Rolando, Beccaria, Tigerstedt, & Törrönen, Citation 2012 ), reflecting a conceptualisation of youth drinking as in itself a problem, and ignoring the range of other frames in which the material might be analysed. In addition, with the exception of a few studies (e.g. Härkönen et al., Citation 2013 ; Mäkelä et al., Citation 2012 ; Mustonen et al., Citation 2014 ; Raitasalo et al., Citation 2011 ), the role of place, occasions and the settings in which drinking occurs has been largely neglected in recent alcohol research. Similarly, use-values and modes of social control have been understudied.

The dominant research interest in problem-focussed dimensions of drinking culture at a macro-level might be seen as reflecting a public policy discourse about drinking culture, in which changing the drinking culture is viewed as a way of preventing and minimising harms (e.g. Victorian Government, Citation 2008 ), often presented as an alternative solution to social problems that do not require government interference in the market.

A drawback of focussing on a limited number of dimensions of drinking culture at a macro-level is that we are unable to understand how these dimensions interact in different circumstances and apply to different population groups. This may lead to an overly simplistic understanding of drinking culture as acting in predictable ways, with predictable effects, irrespective of the other forces that may be operating in any given drinking situation.

It should also be noted that the majority of studies of drinking culture at the macro-level focus on European countries, with Finland and Italy being particularly prominent. Given observations of shifting drinking patterns in Finland and Italy (e.g. Allamani & Prini, Citation 2007 ; Mäkelä et al., Citation 2012 ), it is understandable that researchers would be interested in why these changes have occurred. The applicability of findings on drinking culture from Europe to other countries is unclear.

As we have illustrated thus far, there are a number of limitations in the way “drinking culture” has been understood and studied in alcohol research, and thus good reason to consider potentially novel ways of conceptualising drinking cultures. There is a well-established anthropological and sociological criticism of alcohol research understandings of drinking culture highlighted thus far (see Douglas, Citation 1987 ; Heath, Citation 1987 ; Hunt & Baker, Citation 2001 ). This has been most recently summarised by d’Abbs ( Citation 2014 ), who, like Room and Mäkelä ( Citation 2000 ), argues for a more nuanced understanding of drinking cultures, making three key points.

First, the emphasis on problems associated with drinking patterns and intoxication in discussions around drinking culture has obscured some of the meanings and practices associated with alcohol use that are culturally significant. As we have suggested, much of the research discussed on drinking cultures can be situated within a public health discourse, which views particular levels of alcohol use as “risky” and “harmful” irrespective of the context and purposes of use. As such, “drinking culture” as a determinant or mediator of alcohol use is viewed as a target for monitoring and intervention. The problem with this discourse is that it oversimplifies drinking cultures and does not take into account the benefits that alcohol use may confer (e.g. pleasure, social connection, intimacy, cultural belonging, cultural capital, etc.) and the way it is used in cultural practices (e.g. celebrations, religious occasions, etc.). Indeed there is a considerable body of sociological and anthropological work in particular that argues for the need to include pleasure in analyses of individual and collective decision-making about using alcohol and other drugs (e.g. Bancroft, Zimpfer, Murray, & Karels, Citation 2014 ; Bunton, Citation 2011 ; Duff, Citation 2008 ; Moore & Measham, Citation 2012 ; O'Malley & Valverde, Citation 2004 ; Ritter, Citation 2014 ). Without appreciation of the pleasure of alcohol use and other factors, attempts to change drinking cultures are likely to be unsuccessful.

Second, d’Abbs ( Citation 2014 ) notes that there is a tendency for the literature around drinking culture to enact drinking culture as “a stable sociological entity, anchored to a delimited geographical or social space” (p. 4). But in general thinking about cultures, this is increasingly seen as a problematic view, with cultures coming to be seen rather “as networks of meanings that are continuously being renegotiated and reconstituted rather than transmitted” (Hannerz, Citation 1992 cited in d'Abbs, Citation 2014 , p. 4). In this context, d’Abbs ( Citation 2014 ) urges us to move away from viewing drinking culture as a static entity with prescriptive norms that are “linked to sanctions and rewards designed to foster conformity and discourage deviance” (p. 4). Drinking cultures do not necessarily produce consistent and predictable behaviour, independent of the other contextual forces in which they are entangled in a given situation. Rather, there is a need to examine how drinking culture manifests in relation to other actors, use-values, practices and settings, in a given local situation. This necessitates the need for a shift in examining drinking cultures from the macro to the micro.

Third, there is another good reason for this shift, as d’Abbs ( Citation 2014 ) notes. The notion of a national drinking culture assumes that the nation is a homogeneous entity. But patterns of, and norms about, drinking as with other social behaviours, are not uniform within a single country (Fortin, Bélanger, & Moulin, Citation 2015 ). In fact, there are often great variations, which in part reflect variations in norms about drinking between different subgroups in the population. As d’Abbs ( Citation 2014 ) argues, there may be many drinking cultures within a society, necessitating a micro-level focus, below the level of the culture as a whole. We will draw on such insights in understanding drinking culture from anthropology and sociology later when we propose a working definition.

Below the culture as a whole

“Subcultures” (e.g. Hall & Jefferson, Citation 1976 ), “contracultures” (or “countercultures”; e.g. Yinger, Citation 1960 ), “subworlds”, “social worlds” (e.g. Unruh, Citation 1980 ), “scenes” (e.g. Moore, Citation 2004 ; Straw, Citation 1991 ), and “neo-tribes” (e.g. Bennett, Citation 1999 ) are among the array of terms used to describe cultural entities below the level of the culture as a whole, with each term offering a different meaning and frame of reference for “sub-entities”. In general, “subculture” (and related terms such as “contraculture” or “counterculture”) are used to refer to relatively holistic cultural entities that engross a good deal of members’ lives and times and which often provide a master identity for members. Terms like “social worlds” or “scenes” tend to indicate cultural entities more limited in their claim on participants’ lives, often referring to situations where members participate in several different “worlds” or “scenes”, and move back and forth between them as a matter of course. It should be recognised that there is no clear agreement on terminology or how best to operationalise cultural entities in terms of understanding their uniqueness, fluidity, degree of completeness or influence.

Despite the lack of agreement around terminology, sub-societal cultural groupings (e.g. subcultures, social worlds, scenes) tend to be both objects of self-conscious identification by members, and to be recognised and assigned a group identity from members of the larger society. The distinctions in norms between the cultural group and the larger society are often recognised by those outside the grouping, and are always recognised by those on the inside. For some sub-societal cultural entities, membership is considerably bounded by stable and largely assigned characteristics of the individual such as ethnicity, social class or geographic residence – ethnic subcultures or occupational subcultures, for instance. On the other hand, there are subcultures or social worlds where becoming a member is to a considerable extent a matter of choice and style – cultural entities such as rap or house music aficionados, graffiti artists, skateboarders or athletic “jocks”, to cite some social worlds which have been studied (e.g. Bennett, Citation 1999 ; Eckert, Citation 1989 ; Thornton, Citation 1995 ; Hall & Jefferson, Citation 1976 ). However, “choice” and “assigned characteristics” are often both involved: for instance in their fieldwork interviews with young people in the UK, McCulloch et al. ( Citation 2006 , p. 539) show how “young people’s subcultural styles and identities are closely bound up with social class”, which is largely assigned. In any case, rules about drinking and associated behaviour – including norms about limiting drinking or not drinking – are often a part of the normative structure of the subculture or social world, whether the entity is defined in terms of assigned characteristics or in terms of members’ shared interests.

In the field of ethnography, the cultural entity – the scene, social world, or subculture – is studied through particular sets of people in regular interaction with other as they act out their group participation. To qualify as a cultural entity, it can be argued that the group’s norms and practices must extend beyond a particular face-to-face group, so that even members of the grouping who have not met each other will be able to recognise a common set of norms.

There are various examples of face-to-face groups operating between social worlds or scenes (for example see: Chatterton & Hollands, Citation 2003 ; Grace, Moore, & Northcote, Citation 2009 ; Jayne, Holloway, & Valentine, Citation 2006 ; Measham & Brain, Citation 2005 ; Roberts, Citation 2015 ; Pennay, Beccaria, Prina, & Rolando, Citation 2012 ; Valentine, Holloway, Knell, & Jayne, Citation 2008 ; Winlow & Hall, Citation 2006 ), and of the way in which these worlds have their own style of communication and set of activities although these studies do not usually adopt a problem perspective.

This previous research has highlighted among other things the fluid nature of scenes, with individuals moving between different groups and changing their alcohol and substance use practices accordingly. It has also highlighted the different norms and drinking practices that operate across groups, settings and gender. This is also a point that Hutton, Wright and Saunders ( Citation 2013 ) make in relation to young women’s drinking cultures in New Zealand, albeit in terms of identifying risky and pleasurable places in order to inform harm reduction interventions.

“Cultures and cultural quantities like ethnicity are created anew as much as they are inherited from the past. Thus, for immigrants from Latin America, attitudes towards drinking and actual drinking behaviour do not simply reflect what people ‘left behind’ versus what they ‘find’ (and ‘move toward’) in the United States. Ethnic identity can also intensify following migration, and as part of this process alcohol use and abuse can undoubtedly change” (Gutmann, Citation 1999 , p. 182).

Often, indeed, the drinking behaviour of an ethnic group in a multicultural environment can be interpreted as an element in a performance before other elements of the society (Room, Citation 2005 ; Stivers, Citation 1976 ). What is evident in these examples is that each scene or social world has different norms, customs, sanctions and use-values associated with alcohol, and these often differ from those identified in macro-level typologies of drinking culture.

Cultural entities, whether at the whole-culture level or as subordinate groupings, should not be assumed to be unchanging and unchangeable, nor are they necessarily in conflict. With this in mind, we propose it is important to consider what the layers of influence are surrounding multiple entities and the culture as a whole and whether there is a hierarchy. Questions such as this must be considered as we untangle and make sense of complex social and cultural arrangements.

To better understand the way in which drinking cultures operate it is important to understand how subcultures or social worlds interact with the larger culture. This is a common topic in studies of contracultures, but is often neglected in studies of more integrated cultural entities. Room ( Citation 1976 ) argues that there is a loose social world of heavy drinkers in complex societies like the USA or Australia. Members of this world share an understanding of a set of norms that support and require heavy drinking in particular situations – for instance, norms about drinking etiquette and buying rounds in a pub or club. These norms may vary from the norms of the general culture, but heavy drinkers and the general population co-exist relatively peacefully. The means through which the social world of drinkers co-exists with the general population norms is through what Room calls “an implicit compromise policy of enclaving”. Enclaving the social world of heavy drinking is “an agreement that the world … will be tolerated so long as it conducts itself only within certain boundaries” (1976, p. 363). This agreement needs to be maintained by both sides (e.g. bars and their patrons keep what goes on inside the bar from being too visible to others, etc.).

Sequence problems or problems of transition – where we find ourselves intoxicated in a situation where it is no longer appropriate (e.g. wrong place at the wrong time). For instance, this can occur when a bar closes and an intoxicated person finds themselves in the street or the partygoer finds herself or himself responsible for driving home. This can be solved by changing the normative structure of one or other of the sequenced situations or allowing more time between the two situations.

Boundary problems – in which the boundary of the zone in which heavy drinking is normative is breached either accidentally or deliberately by those “outside” or “inside” the boundary. The agreement of accommodation implied by enclaving becomes unstable, and people in the social world of heavy drinking may try to extend its reach whereas those in the general culture (e.g. moral entrepreneurs, law and order advocates or public health advocates), may seek to hem the social world in (e.g. contests around public drinking). Boundary problems can be resolved through strengthening the insulation surrounding the enclaves, as well as changing the normative structures on one side (e.g. smoking outside if people object to smoking indoors, etc.).

Room notes that, although efforts to control heavy drinking social worlds may reduce consumption, they may also sometimes increase the visibility of drinking-related problems, which in turn can result in resistance from members of the social worlds under observation. The concepts of “enclaving”, “sequence problems” and “boundary problems” provide useful ways of thinking about the way in which micro- and macro-level drinking cultures may interact, and how conflicts over drinking norms might be resolved.

As we have articulated throughout, much of the alcohol research on drinking cultures has focussed narrowly on alcohol consumption and alcohol problems, obscuring the multidimensional nature of drinking cultures. This has essentially isolated alcohol consumption and problems from the network of other possible interactional and cultural factors involved. However, as Duff notes, research needs to focus on the way in which alcohol consumption “is enacted, performed or ‘entrained’ within a wider network of social, material and affective forces” (Duff, Citation 2013 , p. 267) in different occasions. Similarly, we have identified a need to acknowledge the multiplicity of “drinking cultures” at different scales (macro and micro) and the way that these might interact and be configured in different circumstances.

Drinking cultures are generally described in terms of the norms around patterns, practices, use-values, settings and occasions in relation to alcohol and alcohol problems that operate and are enforced (to varying degrees) in a society (macro-level) or in a subgroup within society (micro-level). Drinking culture also refers to the modes of social control that are employed to enforce norms and practices. Drinking culture may refer to the aspects concerned with drinking of a cultural entity primarily defined in terms of other aspects, or may refer to a cultural entity primarily defined around drinking. Drinking cultures are not homogeneous or static but are multiple and moving. As part of a network of other interacting factors (e.g. gender, age, social class, social networks, individual factors, masculinity, policy, marketing, global forces, place, etc.), drinking culture is thought to influence when, where, why and how people drink, how much they drink, their expectations about the effects of different amounts of alcohol, and the behaviours they engage in before, during and after drinking. The degree and nature of the influence that drinking cultures have on individuals is not inevitable but will depend on the configuration of factors in play in any given situation, and the nature of the relationships between the culture as a whole and smaller cultural entities as they affect the individual.

We acknowledge that attempting to define “drinking cultures” is a potentially fraught exercise and that there is other sociological and anthropological work that would be useful in the conceptualisation of drinking cultures, but we offer this “working definition” as a way of stimulating further conceptual thought and discussion amongst alcohol researchers and others. We also propose this working definition as a first step in thinking about how alcohol researchers might study drinking cultures in their complexity and possible questions such studies might pose. For instance, our definition foregrounds multiple dimensions that researchers might investigate, including norms about who can drink, patterns (how frequently and how much is it acceptable to drink?), practices (what is acceptable/unacceptable practice and behaviour during and after drinking?), alcohol problems (what constitutes an alcohol-related problem and how should such a problem be handled?), settings (where is it appropriate to drink and where is it not? How are drinking spaces configured/inhabited? How should people move between spaces/places when they are drinking or have finished drinking?), occasions and times (when is it acceptable to drink or get drunk?), use-values (what does alcohol use mean? What purpose does it serve?), and modes of social control (what are the informal and formal sanctions that are in place when norms are breached?). We acknowledge that anthropologists and sociologists readily ask many of these questions, and that alcohol researchers are already asking some of these questions or are attending to one dimension of drinking culture or another. However, we suggest that it would be valuable for alcohol researchers to attend to these simultaneously if we are to investigate drinking cultures in their complexity.

As our definition attends to the multi-dimensional nature of drinking cultures and their interactions, researchers might also explore how micro- and macro-level drinking cultures relate, and how drinking culture acts in combination with a range of other factors to produce effects. For instance, we might ask what influence does drinking culture have in different circumstances, occasions, settings and groups, and why is it more or less influential in particular circumstances than others? Addressing these questions may more productively inform attempts at changing drinking cultures.

Policy makers have increasingly argued that there is a need to “change the drinking culture”, and have sought to understand the drivers or impacts of changes in the drinking culture. But, given the conceptual ambiguity surrounding the concept, it is unclear what exactly needs to be changed. This article represents an attempt to conceptualise drinking cultures with reference to the relevant alcohol research literature and in light of insights from broader sociological and anthropological work. In so doing we have highlighted the multiple and multifaceted nature of drinking cultures at both macro- and micro-levels. Engaging with such conceptual complexities will hopefully sharpen attempts at investigating and changing drinking cultures. However, further empirical work in diverse contexts is needed to better understand drinking cultures, their interactions and their entanglement with other factors. Given that the majority of alcohol research discussed focuses on drinking cultures in European and Anglophone countries, there is a particular need for research outside these countries. Furthermore, additional work is necessary to examine policy makers’ understandings of drinking culture and how these compare with academic and “lay” definitions of drinking cultures.

We would like to thank VicHealth for funding the project that was the basis for this paper. In particular, we would like to thank Emma Saleeba and Sean O’Rourke for their helpful feedback throughout the project.

Declaration of interest

M.L. and A.P. are supported by NHMRC Early Career Fellowships (1053029 and 1069907, respectively). This work was supported by a contract from the Victorian Health Promotion Foundation (VicHealth) and by a grant from the Foundation for Alcohol Research and Education (FARE).

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• Financial Cost
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Alcohol is the most commonly used drug among U.S. adults. Alcohol use is associated with a wide range of health risks and other problems for individuals. But the costs of alcohol don't just affect the person drinking. 

According to the Centers for Disease Control and Prevention (CDC), excessive alcohol use costs the U.S. almost a quarter trillion dollars a year. Economic costs are one part of the toll, but there are also other societal issues that are tied to alcohol use.

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• Family effects , including child abuse, neglect, intimate partner violence, and substance use problems in children
• Educational costs associated with worse academic performance and achievement

Such costs are often linked to those who have alcohol use disorders. According to the 2021 National Survey on Drug Use and Health (NSDUH), 29.5 million people over the age of 12 (10.6% of the population) had an alcohol use disorder in the past year. Estimates suggest that approximately 13.9% of people in the United States will meet the criteria for severe alcohol use disorder in their lifetimes.

However, it's not necessarily people with alcohol addiction having the biggest impact on these figures. It's estimated that 77% of the cost of excessive alcohol consumption in the U.S. is due to binge drinking , and most binge drinkers are not alcohol dependent.

The National Institute on Alcohol Abuse and Alcoholism states that 140,000 people die each year due to alcohol-related causes. Alcohol is the fourth leading preventable cause of death in the U.S.

Financial Costs of Alcoholism

According to the Centers for Disease Control and Prevention (CDC), the cost of excessive alcohol use in the U.S. alone reaches $249 billion annually. Around 77% of that is attributed to binge drinking , defined as four or more alcoholic beverages per occasion for women or five or more drinks per occasion for men.

The CDC estimates that 40% of the cost of binge drinking is paid by federal, state, and local governments.

The CDC suggests that the most significant economic costs of alcohol use are due to the following:

• Lost workplace productivity (72% of the total cost)
• Healthcare expenses (11% of the total cost)
• Criminal justice expenses (10% of the total cost)
• Motor vehicle crash expenses (5% of the total cost)

The CDC estimates that these figures are all underestimated because alcohol's involvement in sickness, injury, and death is not always available or reported. These figures also do not include some medical and mental health conditions that are the result of alcohol abuse.

Also not included in these figures are the work days that family members miss due to the alcohol problems of a loved one.

Healthcare Expense of Alcohol Abuse

Alcohol consumption is a risk factor in numerous chronic diseases and conditions, and alcohol plays a significant role in certain cancers, psychiatric conditions, and numerous cardiovascular and digestive diseases. Additionally, alcohol consumption can increase the risk of diabetes, stroke, and heart disease.

An estimated $28 billion is spent each year on alcohol-related health care.

Alcohol-Related Aggression and Violence

Along with unintentional injury, alcohol plays a significant role in intentional injuries as a result of aggression and violence. Alcohol has been linked to physical violence by a variety of research studies.

On top of the healthcare cost of alcohol-related intentional violence in the United States, the estimated annual cost to the criminal justice system is another $25 billion.

Impact of Alcoholism on the Family

The social impact of alcohol abuse is a separate issue from the financial costs involved, and that impact begins in the home, extends into the community, and often affects society as a whole, much like the financial impact does.

Research on the effects of alcohol abuse on families shows that alcohol abuse and addiction play a role in intimate partner violence, cause families' financial problems, impair decision-making skills, and play a role in child neglect and abuse.

Long-term alcohol use leads to changes in the brain that affect decision-making, emotional processing, and self-control, making people who drink more susceptible to aggression and violence. According to the U.S. Department of Justice, alcohol makes intimate partner violence more frequent and severe.

As with the financial costs of alcohol abuse, studies have found occasional binge drinking can also affect families. Research suggests that the risk of intimate partner violence rises not only in the context of frequent drinking but also when a partner has consumed a large volume of drinks in one sitting.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database .

Alcohol Abuse and Children

Fetal alcohol spectrum disorders (FASDs) are one of the most common direct consequences of parental alcohol use in the United States, caused by alcohol consumption by the mother during pregnancy. Children with FAS display various symptoms, many of which are lifelong and permanent.

Children who grow up in a home with a loved one dealing with alcohol addiction may be affected as well; they are at significant risk of developing alcohol use disorders themselves.

Growing up in a home where at least one parent has a severe alcohol use disorder can increase a child's chances of developing psychological and emotional problems.

The Bottom Line

Alcohol's effects go beyond it's effects on individual health and well-being; it also has steep economic and societal costs. The excess use of alcohol leads to billions in lost productivity and healthcare costs. It also has a heavy strain on families, communities, and society as a whole. Increased violence, injuries, accidents, child abuse, and intimate partner violence are all linked to alcohol use.

Centers for Disease Control and Prevention. Excessive drinking is draining the U.S. economy .

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Centers for Disease Control and Prevention. The cost of excessive alcohol use .

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Sontate KV, Rahim Kamaluddin M, Naina Mohamed I, et al. Alcohol, aggression, and violence: From public health to neuroscience .  Front Psychol . 2021;12:699726. doi:10.3389/fpsyg.2021.699726

U.S. Department of Justice, Office of Justice Programs. Who facts on: Intimate partner violence and alcohol .

Centers for Disease Control and Prevention. Basics about FASDS .

Moss HB. The impact of alcohol on society: A brief overview . Soc Work Public Health. 2013;28(3-4):175-177. doi:10.1080/19371918.2013.758987

Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. 2010 National and State Costs of Excessive Alcohol Consumption . Am J Prev Med . 2015;49(5):e73-e79. doi:10.1016/j.amepre.2015.05.031

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Social and Cultural Contexts of Alcohol Use: Influences in a Social-Ecological Framework

Affiliations.

• 1 Department of Epidemiology and Biostatics and Global Health Group at the University of California, San Francisco, San Francisco, California.
• 2 School of Social Work, Boston College, Boston, Massachusetts.
• PMID: 27159810
• PMCID: PMC4872611

Alcohol use and misuse account for 3.3 million deaths every year, or 6 percent of all deaths worldwide. The harmful effects of alcohol misuse are far reaching and range from individual health risks, morbidity, and mortality to consequences for family, friends, and the larger society. This article reviews a few of the cultural and social influences on alcohol use and places individual alcohol use within the contexts and environments where people live and interact. It includes a discussion of macrolevel factors, such as advertising and marketing, immigration and discrimination factors, and how neighborhoods, families, and peers influence alcohol use. Specifically, the article describes how social and cultural contexts influence alcohol use/misuse and then explores future directions for alcohol research.

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Cultural Differences in Alcohol Consumption: The State of the Art and New Perspectives on Drinking Culture Research

• First Online: 11 May 2021

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• Giovanni Aresi 8 &
• Kim Bloomfield 9  

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This chapter describes perspectives on the study of cultural differences in alcohol consumption and reviews the relevant literature. After introducing the concept of culture and the main approaches used to study drinking cultures, we discuss various conceptualisations of such cultures. The chapter includes a systematic review of 88 articles about drinking cultures published between 1990 and 2018. Results indicate that there are problems with the definition of drinking cultures in which the dominant focus often is placed at the national level. Future research should combine macro- and micro-levels of studying sub-cultural entities and specific settings, including the relations between them and the broader cultural features at the national level.

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Aresi, G., Bloomfield, K. (2021). Cultural Differences in Alcohol Consumption: The State of the Art and New Perspectives on Drinking Culture Research. In: Cooke, R., Conroy, D., Davies, E.L., Hagger, M.S., de Visser, R.O. (eds) The Palgrave Handbook of Psychological Perspectives on Alcohol Consumption. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-66941-6_7

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Alcohol: Challenging Dangerous Cultural Norms

Revealing the hidden truths about our most publicly endorsed epidemic..

Posted April 16, 2024 | Reviewed by Michelle Quirk

• What Is Alcoholism?
• Find a therapist to overcome addiction
• We are in the midst of an alcohol epidemic, greater in scope than all other substances combined.
• Many of our social activities involve alcohol; we consume more than we realize, more often than we want to.
• Raising awareness about problems with alcohol necessitates changing the way we think about our cultural norms.

April is Alcohol Awareness Month, which feels a bit ironic, doesn’t it? Raising awareness of alcohol? We all know it's there. Instead, we should be raising awareness of alcohol normalization and the public health consequences we all suffer because of it.

As an example—we're all very aware of the opioid epidemic. It's such a key issue that it's been directly addressed in the State of the Union Address annually for the past decade. Yet, if someone used the phrase “alcohol epidemic,” eyebrows would most certainly rise, despite the fact that the magnitude of alcohol-related death in the United States is almost double that for opioids. And, similar to opioids, alcohol-related deaths spiked by nearly 30 percent over the COVID-19 pandemic. We’ve been suffering with this death toll for decades—and it's projected to increase over the next 20 years. It’s undeniably one of the greatest public health challenges facing the world today.

Destructive and Ubiquitous

Alcohol is surprisingly destructive for something so ubiquitous. It’s the seventh leading cause of preventable death globally, not to mention that in the United States alone it is involved in more than 50 percent of sexual assaults , 40 percent of domestic violence incidents , 31 percent of driving fatalities, and 21 percent of suicides. In 2021, it was calculated that 4.9 percent of all deaths in the United States could have been prevented by removing alcohol. Excessive alcohol use costs the United States $249 billion each year—to put in perspective, this is about half the cost of treating heart disease, which is the number-one cause of death for Americans.

Despite the extreme costs, both literal and figurative, alcohol remains a fixture of our culture. And not just an occasional drink— excessive drinking has been glorified and communally embraced as “normal.” Take sporting events, for example. A 2023 survey found that fans consume an average of 3.7 drinks per person while watching sports—typically more if they are attending the sporting event live (versus watching from home). On average, 51 percent of those surveyed reported regular binge drinking while watching sports. Attendees at sporting events reportedly spend, on average, $50 to $70 per person on alcohol . And championship games are windfalls for the alcohol industry. Just recently, it was reported that 325 million gallons of beer were consumed on Super Bowl Sunday alone .

Beyond sporting events, alcohol is woven into most of our social experiences: happy hours, cocktail parties, holiday gatherings, or even a casual dinner with friends. Alcohol is gifted in celebration when buying a house or getting a promotion—anytime we want to “toast” a happy occasion. And alcohol is a fixture of formal events, like weddings, galas, and fundraisers, where an “open bar” is customary.

We don’t do this with any other drugs. We don’t see heroin booths at black tie events. Cocaine is not sold in the stands at football games. Oxycodone is not available for purchase in cute little bottles on airplanes or stocked in hotel rooms. Yet alcohol is found in all these contexts—and more—despite causing more deaths and taxing our health care system more severely than all these other substances combined.

Culturally, we have a permissive attitude toward alcohol that is unlike any other substance—even tobacco. This mindset not only feeds into alcohol dependence—a condition that currently impacts more than 10 percent of the population —but also promotes the health consequences of even so-called “casual” alcohol consumption. For example, a recent study found that drinking two to three drinks per day is related to an increase in all-cause mortality. Another study found that one drink per day is enough to raise the risk of heart disease for women. Moreover, the Centers for Disease Control and Prevention links more than a dozen long-term chronic illnesses to regular alcohol consumption, including high blood pressure, heart disease, cancer, liver disease, dementia , and a weakened immune system.

We can’t afford to turn a blind eye to this compounding evidence; we must change our mentality about the normalization of alcohol use.

What We Can Do

While we can’t expect to cognitively restructure deeply embedded cultural norms overnight, there are some things that we can do to increase our awareness of the issue and small adjustments we can make that, cumulatively, can have a larger impact over time:

• Take a moment to think about your own alcohol consumption behaviors. How often do you drink? How much do you drink per occasion?
• Think about the social events you attend where you feel you are “supposed to” drink alcohol or where you would feel more comfortable, socially, having a drink. How many of these events are there? Would you otherwise choose to drink in these situations if it wasn’t socially expected of you?
• Consider the reasons why you drink alcohol (Are you celebrating? Coping? Unwinding?). Is alcohol your go-to for these situations?
• Think about how your answers would differ if they were about any other “recreational” drug. Why do you feel differently about alcohol than other substances? Does the fact that it is socially acceptable play a role?

Just these steps alone—bringing awareness to your habits and the reasons behind them—can impact your behaviors such that you’re making informed choices instead of following routines or social expectations.

This April—and all year long—“alcohol awareness” can take the form of self-reflection and changing the way we consider our cultural norms. If we don’t just accept things because “That’s the way they are” but we turn it into a question: “ Why are things the way they are?” or, more importantly, “ Should they be this way?” then we are no longer blind to the issue. And that, by itself, is a powerful step in the right direction.

Caren Chesler. More than one alcoholic drink a day raises heart disease risk for women . Washington Post. March 28, 2024.

Aaron Weiner, Ph.D., ABPP, is a board-certified psychologist and addiction specialist.

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• DOI: 10.1086/200597
• Corpus ID: 37803494

Alcohol and Culture

• D. Mandelbaum
• Published in Current Anthropology 1 June 1965

220 Citations

Culture and alcohol use in india, the intoxicated poor: alcohol, morality and power among the boatmen of banaras, more than a drink, distinctive alcohol cultural practices amongst niuean men living in auckland, new zealand, culture and alcohol use: historical and sociocultural themes from 75 years of alcohol research., patterns and practices of alcohol use among mexican americans: a comprehensive review, defining “drinking culture”: a critical review of its meaning and connotation in social research on alcohol problems, family, alcohol, and culture., critical drinking habit and its implications for alcoholics in the family premises: a case study of punjab (india), alcohol as embodied material culture, 60 references, forms and pathology of drinking in three polynesian societies1, sociocultural backgrounds of alcoholism, alcohol in italian culture, alcoholics do not drink, the wonder that was india, the greeks and the irrational, the desert people, the ancient maya, the aztecs under spanish rule, prohibition and post-repeal drinking patterns among the navaho., related papers.

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Alcohol and Culture

• David G. Mandelbaum

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The extensive literature on drinking practices raises some interesting anthropological problems. This paper is not a review of that literature or of any major part of it, but it is rather intended to bring to notice certain problems which merit further attention. The use of alcohol is generally a matter of considerable cultural interest. It may be tabooed; it is not ignored. Even a brief account of the range of drinking practices shows that cultural expectations define the ways in which drinking, both normal and abnormal, is done in a society. This is well known to anthropologists but often glossed over in the medical and behavioral studies of the subject. Cultural variations in drinking have been more often noted by anthropologists than have the cross-cultural similarities. Where drinking is culturally approved, it is typically done more by men than by women. Drinking is more often a social affair than a solitary act, and the social group in which drinking is done is usually composed of age mates and social peers. Where alcohol is used at family meals, it tends to be defined as a food rather than as a stimulant. Changes in drinking customs may offer clues to fundamental social changes. This is the case in the history of Indian civilization. The use of alcohol in Sumerian, Egyptian, and Judeo-Christian civilizations could usefully be examined from this point of view. The distribution of drinking practices is another promising field for investigation. The kind of drinking done over large parts of Africa stands in contrast to the drinking patterns used over a large part of Central and South America. Among a good many South American peoples, drinking is done at frequent intervals in prolonged bouts of drunkenness. One of the most extreme cases in this pattern is that of the Camba of Bolivia. A tentative analysis of Camba drinking suggests that it is a way of controlling interaction with others under circumstances in which such interaction is feared or mistrusted. Drinking patterns can usefully be studied as manifestations of pervasive cultural themes. Some of the earlier studies in this vein can now be supplemented with more ample data. Cultural studies of the use of alcohol have important implications for the medical problems of alcoholism.

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8 Alcohol as Embodied Material Culture: Anthropological Reflections on the Deep Entanglement of Humans and Alcohol

• Published: December 2019
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Alcohol is the most widely used psychoactive agent in the world, and it has a very deep history. Human beings have demonstrated remarkable creativity in producing alcoholic beverages from a diverse array of substances. Many varieties of alcoholic drinks have substantial nutritional value and they often form a significant component of the diet of many peoples. Like other foods, alcohol is a form of ‘embodied material culture’; that is, a substance created to be destroyed through ingestion into the human body. Hence, it has close relationship to the inculcation and symbolization of concepts of identity. Alcoholic drinks are not reducible to a chemical substance with physiological effects: they are a form of material culture with almost unlimited possibilities for cultural variation and are a versatile symbolic medium and social tool crucial to ritual, politics, and the construction of social and economic relations.

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Home — Essay Samples — Nursing & Health — Alcohol Abuse — America’s Drinking Problem: the Impact of Alcohol Consumption

America's Drinking Problem: The Impact of Alcohol Consumption

• Categories: Alcohol Abuse Alcoholism

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Published: Sep 5, 2023

Words: 639 | Page: 1 | 4 min read

Table of contents

The prevalence of alcohol use, health and social consequences, economic and social burdens, addressing the issue, changing cultural norms, conclusion: striving for balance.

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Military service and alcohol use: a systematic narrative review

A k osborne.

Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK

G Wilson-Menzfeld

M d kiernan.

Despite research highlighting the role of alcohol in military life, specifically in relation to mental health and certain combat experiences, there is no synthesised evidence looking at the relationship between military service and alcohol use.

To synthesize and examine evidence exploring the relationship between military service and alcohol use.

Six databases were examined across a 10-year period. Papers were included if they involved a military population and focused on alcohol use. From 4046 papers identified, 29 papers were included in the review.

Military characteristics and experience were linked to high levels of alcohol use across military populations. Societal and cultural factors also played a role in alcohol use in military populations. Predatory behaviour of alcohol establishments, pressures to conform, an acceptance of alcohol use, and the role of religious services and military affiliated social networks were all considered. Excessive drinking impacted physical and mental health. Those diagnosed with PTSD and associated symptoms appeared to have greater alcohol use.

Conclusions

This review identified certain characteristics and experiences of military service that are associated with higher levels of alcohol use. It is important to identify risk factors for alcohol misuse to develop appropriate policy, targeting prevention.

Key learning points

What is already known about this subject

• Historically alcohol has had an integral role in military life and has been seen as an acceptable behaviour in social bonding and comradeship.
• Alcohol misuse in military populations has been associated with a negative impact on social, physical, and psychological health.
• Literature reviews to date have focussed on comorbidity of PTSD and alcohol misuse, wider mental health and Gulf and Iraq/Afghanistan war veterans, no systematic reviews of literature have considered the wider experiences of alcohol use and military service.

What this study adds

• Military-specific traits and experiences such as, service type, rank and deployment status are linked to higher levels of alcohol use in military populations across multiple countries.
• There appears to be an over-reliance on self-report questionnaires for the assessment of alcohol use in a military population focussing on symptom severity, with a paucity of research considering personal experiences and meanings ascribed to alcohol use.
• The systematic narrative review has brought together a body of knowledge on alcohol use in a military population and the synthesis of this literature provides an evidence base to help inform future policy.

What impact this may have on practice, policy or procedure

• There are specific characteristics strongly associated with military service that impact alcohol use, it is important to identify these ‘risk factors’ to mitigate the impact on operational effectiveness and workplace cohesion by developing appropriate and targeted prevention policies.
• Mental ill health and harmful levels of alcohol use in military personnel co-exist and more specifically, this creates internal stigma making this population particularly reticent to seek help for both alcohol and mental health problems and therefore harder to identify.
• The systematic narrative review has highlighted a lack of consistency in the tools and measures used to assess alcohol use in a military population and suggests a need for a consensus of assessment measures in practice and wider research.

Introduction

Alcohol has played a prevalent, historic role in military life, where, internationally, it has been used as a means of mediating stress, both in theatre and in the aftermath of battle [ 1 ]. Used in social bonding and comradeship [ 1 ], drinking has become a common and accepted behaviour in military culture, surpassing alcohol use in the general population [ 2 , 3 ]. Beliefs on acceptable drinking norms can be influenced and reinforced when exposed to the military social environment [ 4 ].

The Motivational Model of Alcohol Use indicates consumption of alcohol may be used to cope, and to ‘regulate the quality of their emotional experience’ [ 5 p. 990]. These reasons for alcohol misuse have also been evidenced in serving military and veteran populations [ 4 ]. However, regardless of the potential advantages of alcohol consumption socially, especially in enhancing positive emotional experiences, problems develop when alcohol is misused. For military service members, exposed to highly stressful situations, behaviour around long-term alcohol use can be affected by the accepted social norms around higher levels of alcohol use for recreation and coping [ 4 ].

Research has suggested that alcohol may serve as a coping mechanism after traumatic events, where deployment has been associated with increased rates of alcohol use or problem drinking [ 6 ]. Drinking to excess may have a negative impact on mental and physical health [ 7 ], functional impairment [ 8 ], troop readiness [ 9 ], suicidal ideation [ 10 ] and the perpetrator in military sexual assaults [ 11 ]. Furthermore, the UK Armed Forces have expressed concerns that ‘excessive drinking can undermine operational effectiveness, leave soldiers unfit for duty, and damage trust and respect within the team’ [12 p. 12 ].

Alcohol use and military service are of great importance and a public health issue. However, there are no systematic reviews of literature that focuses on the wider, overall experiences of alcohol use and military service. Existing systematic review evidence stresses the important role of alcohol in military life, particularly focussing on the comorbidity of PTSD and alcohol misuse [ 13 ], Gulf and Iraq/Afghanistan war veterans [ 14 ], or as part of systematic reviews with a wider mental health focus [ 15 ]. Therefore, this study employs a systematic narrative review that aims to explore the relationship between military service and alcohol use.

To appraise evidence from multiple sources including qualitative and quantitative research, and to ensure an inclusive systematic search without bias, a systematic narrative review strategy was employed [ 16 ]. Suitable databases were searched, identifying published peer-reviewed evidence ( Table 1 ).

Systematic search strategy

Research papers on alcohol use with a military sample published prior to March 2021 were considered. Since the Global War on Terrorism began in 2001, there has been an increase in combat deployments of military service personnel from many nations across the globe. During this period, warfare has evolved, and the world has seen a more complex form of modern warfare, adapting and modernising to become more technologically advanced. This has also resulted in a change in the nature of deployments, impacting the role of military service in the lives of serving personnel. Deployments are dangerous and stressful for military personnel and combat stress, specifically experienced in Iraq and Afghanistan, has been associated with alcohol misuse [ 14 ]. Consequently, only papers published after 2001 have been considered in this review to ensure an accurate representation of the role military service has on alcohol misuse.

The exclusion criteria included papers that were unavailable in English, focussed on treatments or interventions for alcohol problems, or the sample included veterans. Papers on substance use were included, only if they reported alcohol use. The PICO framework was used to develop the search terms ( Table 2 ). Truncation and wildcard search strategies were utilised.

PICO framework to develop search terms

Veterans and ex-service were included as search terms to ensure the maximum number of papers were returned. However, only papers with a serving military population were included in the review. The ex-service military population was excluded because of additional, non-military specific, factors that exist that may impact alcohol use such as their experience of transition out of the military. Following the search of the databases, 4046 papers were returned ( Figure 1 ).

PRISMA diagram of papers returned during systematic search.

A full-text search was carried out on 83 papers to determine the suitability for inclusion in the review. To appraise the quality of papers included in the review, the Critical Appraisal Skill Programme [ 17 ] tool was consulted. Fifty-four papers were excluded due to their focus on a veteran population or alcohol use not specific to military service. No further papers were identified through reference and citation searches. Consequently, 29 papers were included in this review.

Thematic analysis was used to analyse the papers and generate themes. The six steps of Braun and Clarke [ 18 ] were followed: familiarization with the data, generation of initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report.

Twenty-nine papers were included in this review ( Table 3 ). There were 22 studies represented across all 29 papers. Studies with multiple papers in this review included: the Health and Wellbeing of the UK Armed Forces Cohort Study [ 2 , 8 , 39 ]; Ohio National Guard (OHARNG) Mental Health Initiative [ 34 , 36 ]; Department of Defence Health Related Behaviours study [ 28 , 35 ] and the Prevalence, Incidence and Determinant of PTSD and Other Mental Disorders (PID-PTSD +3 ) study [ 40–42 ].

Characteristics of papers in review ( N = 29)

AUDIT, Alcohol Use Disorder Identification Test; PTSD, Post Traumatic Stress Disorder; N/S, not specified.

Seventeen papers had samples from the US [ 6 , 20 , 21 , 23 , 25 , 26 , 28 , 31–38 , 43 , 44 ], six from the UK [ 2 , 8 , 19 , 27 , 29 , 39 ], three from Germany [ 40–42 ], one from Norway [ 24 ], one from Nigeria [ 30 ] and one from Angola [ 22 ]. Six papers looked at alcohol in the military for male personnel only [ 19 , 26 , 27 , 41–43 ], whereas 21 papers considered male and female personnel [ 2 , 6 , 8 , 20 , 23–25 , 28–40 , 44 ]. Two papers did not specify the gender of their sample [ 21 , 22 ].

Eleven papers considered Active Duty/Regular personnel [ 2 , 6 , 8 , 19 , 24 , 28 , 30 , 35 , 39 ] including two looking at special operations [ 23 , 38 ]. Ten papers considered National Guard/Reserve personnel [ 21 , 25 , 26 , 31 , 32 , 34 , 36 , 37 , 43 ] and four papers considered all serving personnel [ 33 , 40–42 ]. Five papers did not specify the enlistment type of the military personnel in their sample [ 20 , 22 , 27 , 29 , 44 ]

Of the 29 papers, 28 were quantitative [ 2 , 8 , 19–44 ] and one paper was qualitative [ 6 ].

Four themes were identified in the literature: Military Characteristics and Alcohol Use, Consequences of Deployment on Alcohol Use, Implication of Mental Health on Alcohol Use and The Role of Cultural and Social Factors on Alcohol Use.

Fifteen papers considered military characteristics associated with alcohol use in their military samples [ 2 , 19 , 20 , 22–25 , 27 , 29 , 30 , 33–35 , 40 , 41 ]. Hooper et al. [ 29 ] surveyed 1382 military personnel and reported they had a higher number of units of alcohol consumed per week than the suggested ‘low risk’ drinking threshold. In comparison to the general population, Fear, Iversen [ 2 ] identified a greater percentage of hazardous drinkers in a military population than in the general population.

Only two papers considered the potential differences in alcohol consumption between men and women. Fear et al. [ 2 ] suggested a gender difference in hazardous drinking where there were a greater number of male hazardous drinkers (67% military, 38% general population) than female hazardous drinkers (49% military, 16% general population). However Fadum et al. [ 24 ] noted that high alcohol consumption did not differ much between military women and men. Furthermore, no significant difference in high alcohol consumption between military and civilian women was found [ 24 ].

Papers in this review also considered the consequences of heavy drinking whilst serving in the military. For personnel that had deployed on operational service, a greater volume of drinking was linked to difficulties at home during and post-operational deployment [ 19 , 41 ]. In addition to demonstrating a high incidence of alcohol use in the military, the papers reported evidence of associations between alcohol use and factors such as age, service type, active deployment, combat exposure, mental health, and relationship status. In UK, US and German military populations, heavy drinking has been associated with holding a lower rank, being younger, being single, being in the Naval service or Army, being deployed to Iraq, not having children, being a smoker, having a combat role and having a parent with a drink or drug problem [ 2 , 19 , 23 , 25 , 35 , 41 ]. Most papers examined such risk factors in soldiers from US or UK military populations, potentially providing limited applicability to military populations in developing nations [ 22 ]. Interestingly, in contrast to US and UK findings, Cheng et al. [ 22 ] identified older age rather than younger age as a significant risk factor for alcohol use in Angola.

Literature suggests that, in the UK, levels of drinking are higher in the Army than other branches of the military [ 2 ]. Different subcultures of drinking within individual branches have been attributed to these variations across the military, especially under circumstances that involve personnel taking part in team activities where there may be pressure from peers to drink alcohol to relax and debrief [ 2 ]. These situations that involve socialising and alcohol use are a common feature of Armed Forces life and particularly in the Royal Navy. In this regard, Henderson, Langston [ 27 ] reported significant degrees of harmful drinking among personnel serving in the Royal Navy in comparison to the civilian population.

In addition to heavy and hazardous drinking, substantial levels of binge drinking have also been found in military populations across UK, US, German, Angolan and Nigerian military populations [ 2 , 20 , 22 , 25 , 30 , 33 , 40 ]. Binge drinking in the UK, has been associated with being younger, being in the Army, being single and being a smoker [ 2 ]. Furthermore, there appears to be a difference in the prevalence of binge drinking between Active Duty/Regular soldiers and National Guard/Reserves. Larson, Adams [ 33 ] identified that there was a marked difference between those personnel in Active Duty who reported frequent binge patterns of alcohol use than those in the National Guard/Reserves.

The issue of problematic alcohol use among the Armed Forces population, related to active service, was considered by 19 papers [ 6 , 19–21 , 23 , 29–31 , 33 , 34 , 36–44 ], including a focus on adverse combat experiences [ 19 , 21 , 29 , 37 , 38 , 44 ], pre-deployment preparedness [ 36 ] and differences between Active Duty/Regular soldiers and the National Guard/Reserves [ 31 , 33 ].

Rates of alcohol use have been perceived as the highest for those with combat specific jobs or those with a greater number and higher intensity deployments [ 6 ]. Furthermore, despite Special Operations Forces experiencing greater exposure to combat deployments than conventional forces, Dretsch et al. [ 23 ] determined that the prevalence of alcohol misuse in 16 284 Special Operations Forces soldiers was comparable or lower than reported by the wider military. This paper had the largest sample of the papers included in this review.

Research has indicated that heavy alcohol use often occurs during pre- and post- deployment with a significant association to the deployment period itself [ 6 , 20 , 30 , 37 , 43 ]. Most of the research primarily focuses on personnel with military service during the Iraq War (2003–2011), with and without deployment experience. More recent papers have begun to consider the impact of the War in Afghanistan (2001–2014).

Adverse combat experiences during deployment have been associated with heavy drinking in military personnel [ 19 , 21 , 38 ]. Hooper et al [ 29 ] discussed how the active involvement in theatre of war had strong links to problematic drinking habits among serving personnel who feared for their own mortality and who ‘experienced hostility from civilians’. Wilk, Bliese [ 44 ] also found that soldiers who had higher rates of exposure to the threat of death or injury were significantly more likely to screen positive for alcohol misuse. Exposure to atrocities similarly predicted misuse of alcohol with alcohol-related behavioural problems.

Although in Russell [ 37 ] all combat experiences were also positively correlated, only the combat experience of killing was significantly related to post-deployment alcohol use. Interestingly, alcohol use decreased amongst those who experienced killing during combat. The authors’ explanation for this was based on the suggestion that the ‘killing experience may activate the soldiers’ mortality salience and trigger a self-preservation focus that manifests itself in reduced risky alcohol consumption’ [ 37 ]. No other paper in the review considered this.

Alongside the available evidence that suggests that fighting the enemy in battle and witnessing the horrors of war predisposes serving personnel to the risk of problematic alcohol use, Skipper et al. [ 38 ] suggested that serving personnel who are part of ‘special forces’ are at an even higher risk of providing a positive alcohol test result due to problematic drinking if they are involved in hostile warfare. In line with adverse combat experiences, Browne, et al. [ 19 ] also argued that personnel who deployed with their parent unit, whose role in theatre was outside, above or below their training or experience and who experienced poor in-theatre unit leadership were more likely to be heavy drinkers.

Despite several papers in this review ( n = 13) identifying a significant link between deployment and subsequent alcohol use, regardless of country, Thandi et al. [ 39 ] demonstrated that levels of drinking were not related to deployment status. Marshall et al. [ 34 ] also found no effect of deployment on alcohol use, although this was for those who reported pre-deployment depression or PTSD. Three German papers support the suggestion that deployment has no effect on alcohol use [ 40–42 ]. Interestingly, the correlates of increased average daily alcohol use across two time points in these papers, were limited social support, greater sleeping difficulties and increased negative post-event cognitions following deployment [ 41 ]. Lower PTSD symptom severity pre-deployment and less childhood emotional neglect, predicted a decrease in average daily alcohol consumption [ 41 ]. It is possible to suggest that specific deployment experiences impact alcohol use in a military population rather than deployment in general. However, these German papers were all from the same Prevalence, Incidence and Determinant of PTSD and Other Mental Disorders (PID-PTSD +3 ) study. Additionally, Orr et al. [ 36 ] identified that only pre-deployment preparedness was associated with incident alcohol misuse when controlling for demographics, deployment related factors (e.g. exposure to warzone stressors), and the presence of psychopathology.

US research has identified further differences within a military population. Around 13–14% of National Guard/Reserve personnel exhibited high levels of drinking in association with deployment [ 31 , 33 ]. Whereas Larson et al. [ 33 ] discovered that an increase in alcohol use as a result of deployment was actually greater in Active-Duty personnel compared to the National Guard/Reserves. Regardless, alcohol use following deployment is thought to be uniquely predicted by higher levels of PTSD symptom severity, higher levels of avoidance-specific PTSD symptoms and lower levels of positive emotionality [ 31 ]. It is worth noting that although there appears to be an indication of differences in alcohol use with engagement type following deployment, more research is needed to further explore this.

Although not a focus of this review, eight papers focussing on alcohol use in a military population reported on the implication of mental health [ 8 , 25 , 28 , 31 , 32 , 34 , 39 , 40 ]. This included five papers looking at the role and impact of PTSD [ 25 , 31 , 32 , 34 , 39 ], one on wider mental health [ 40 ], one on suicide [ 28 ] and one on functional impairment [ 8 ].

Previous research has suggested military personnel with PTSD may use alcohol for self-medication as a coping mechanism for distress related to psychological symptoms [ 31 , 34 ]. Five papers indicated a significant association between PTSD symptom severity, heavy drinking behaviours and new-onset Alcohol Use Disorder [ 25 , 31 , 32 , 34 , 39 ]. However, once the influence of personality variables were accounted for, Ferrier-Auerbach et al. [ 25 ] found that mental ill health was not associated with any drinking variable.

Although baseline PTSD symptoms significantly increased the risk of screening positive for new onset alcohol dependence, Kline et al. [ 32 ] identified no effect of pre-deployment alcohol use on subsequent PTSD diagnoses post-deployment. Such findings indicate that it is possible that the specific psychological consequence of military deployment (e.g. PTSD) significantly impacts military personnel’s alcohol use rather than being in the military in general.

In support of the specific psychological impact of deployment on military personnel’s alcohol use, further differences have been identified between deployed and non-deployed military personnel. Trautmann et al. [ 40 ] identified among recently deployed soldiers, that heavy drinking was related to a higher risk of anxiety, affective and sleep disorders. Among soldiers never deployed, heavy drinking was linked with any mental disorders other than substance use disorder and was further associated with somatoform disorders. For those recently deployed, associations between heavy drinking and the presence of any mental disorder as well as anxiety disorders were significantly greater than those that had never deployed.

Beyond PTSD, Herberman et al. [ 28 ] identified that US soldiers who reported high levels of alcohol use were more likely to have seriously considered and/or attempted suicide. After adjusting for level of alcohol use, PTSD, and depression, drinking to avoid rejection/’fit in’ was associated with suicidality.

One paper considered the impact of alcohol use on functional impairment. Rona et al. [ 8 ] identified that a score on the Alcohol Use Disorder Identification Test (AUDIT) denoting potential alcohol dependence was consistently associated with functional impairment, whereas binge drinking was not. Interestingly, despite a known impairment, participants with hazardous drinking perceived their functioning to be better than those with lower AUDIT scores. The implications of this perception should be explored further. Furthermore, half of the participants presenting with potential alcohol dependence also had psychological comorbidities.

Five papers identified the role of social support and communities in the alcohol consumption of military personnel [ 6 , 22 , 26 , 30 , 39 ]. The communities within which military personnel reside can have a prominent role in their alcohol use. Besse et al. [ 6 ] conducted interviews and focus groups with 29 US Active-Duty soldiers to understand the context of alcohol establishments in communities near military installations in relation to alcohol use. Participants identified predatory behaviour by local alcohol establishments to encourage excessive drinking, placing the profit as a higher priority over the safety of the soldiers. Free or reduced admission fees and drink specials were often specifically designed with soldiers in mind, with some participants reporting that alcohol establishments gave soldiers ‘heavier pours’ or mixed drinks with a higher proportion of alcohol. These findings indicate that there is a perception that military personnel drink more, thus increasing the availability of alcohol and subsequent use.

Unsurprisingly, Besse et al. [ 6 ] also ascertained that drinking has been described as an accepted way to relax and cope with stress brought on by the daily stressors of military life. Drinking alcohol was perceived to be an accepted part of military culture. Pressure to engage in heavy drinking often came from peers as an obligation to prove oneself to the group. This was particularly common among young military personnel or those new to a unit. Socialising appears to play a role in military personnel’s alcohol use. Besse et al. [ 6 ] conducted the only qualitative paper in this review. The findings allow further insight into the reciprocal relationship between alcohol and military personnel by using interviews and focus groups to explore the reasons behind the relationship. Qualitative methods are highly appropriate for this paper, where the purpose was to learn how military personnel experiences the community within which they reside.

Unexpectedly, Cheng et al. [ 22 ] indicated that socialising with family and friends two to four times, but not five or more times, per month increased the risk for problematic drinking in military personnel. More specifically, Thandi et al. [ 39 ] identified that entering into a new relationship resulted in a decrease in alcohol use.

Only two papers considered the role of religion in alcohol consumption [ 22 , 30 ]. Cheng et al. [ 22 ] ascertained that attending religious services more than once a week appeared to protect against problematic drinking in Angolan soldiers. It is possible that the effect of religion on alcohol consumption is dependent on the soldiers’ culture as another paper determined that religion had no role in drinking in Nigerian soldiers [ 30 ].

The social networks of military members appear to be crucial in the likelihood of alcohol use. For Reserve and National Guard soldiers, one paper indicated that drinking-related social network characteristics such as drinking buddies were associated with increased alcohol problems [ 26 ]. However, for those deployed, military-affiliated social networks were a protective factor against alcohol problems [ 26 ].

This systematic narrative review explored the relationship between military service and alcohol use. From the 29 papers examined in this review, it is evident that there are military-specific traits and experiences which impact alcohol use, namely military characteristics, such as service type and rank, and military deployment. Mental health, cultural and social factors also play a role in alcohol use in a military population.

Throughout this review, there are associations drawn between military characteristics and alcohol use such as service type, rank and deployment status [ 2 , 19 , 23 , 25 , 35 , 41 ], that have been associated with higher levels of alcohol consumption in military populations in a number of countries [ 2 , 20 , 22 , 25 , 30 , 33 , 40 ]. Additionally, studies have pointed towards a difference between alcohol use in a military population and the civilian population [ 2 , 27 ]. Although, Fadum et al. [ 24 ] indicated no difference between military women and civilian women.

Most papers indicated that alcohol use was greatest in those with deployment experience, especially those with adverse combat experiences [ 6 , 19 , 21 , 38 ]. This is unsurprising, at least in a UK military population, where policy allows the continuation of alcohol use during military ‘decompression’, where those returning from combat receive a short duration of absence together with psychological support [ 45 ]. There was a suggestion that these findings were a result of using alcohol as a coping mechanism after traumatic events, however, further work is needed to explore this. Specific combat experiences were significantly related to screening positive for alcohol misuse for elite and non-elite military personnel including personal threats, fighting and atrocities [ 38 ]. Interestingly, an increase in alcohol use following deployment was greater for Active-Duty personnel compared to the National Guard and Reserves in a US cohort [ 33 ]. It is important to note that not all research found a significant link between deployment and subsequent alcohol use, regardless of country, a few papers argued that deployment had no effect on alcohol use in military populations [ 34 , 39–42 ].

Evidence in this review suggests that mental ill health and harmful levels of alcohol use in military personnel co-exist. But, more importantly, the evidence suggests that internal stigma makes this population particularly reticent to seek help for both alcohol and mental health problems. Kiernan et al. [ 46 ] identified that many veterans only present for help when they can no longer cope with the situation, they find themselves in. This study found that seeking help for alcohol misuse issues late, when problems have escalated significantly, invariably led to a co-morbid presentation, a significant decline in mental health and excessive drinking, usually exacerbated by a collapse of the individuals social support network. Once more, this strengthens existing evidence that excess drinking negatively affects physical, social, and mental health [ 7 , 46 ]. Specifically, PTSD symptom severity was significantly associated with greater alcohol use [ 25 , 31 , 32 , 34 , 39 ]. Heavy drinking was also related to a higher risk of anxiety, affective and sleep disorders, functional impairment, and suicide [ 8 , 28 , 40 ].

This review also suggests that culture and social factors can influence alcohol use in a military population. An interdependent relationship was identified between military personnel and local alcohol establishments near military installations [ 6 ]. It was suggested that establishments tailor their business, often in a predatory way that is perceived as detrimental to military personnel’s health, well-being, and career. The behaviour of alcohol establishments near military installations was felt to exacerbate this alcohol acceptance. However, only one US paper considered this, more international research should be conducted to consider if this is a common experience in a military population. Interestingly, there was a suggestion that attending religious services [ 22 ] and that having military affiliated social networks when deployed [ 26 ], protected against problematic drinking.

Drinking alcohol was noted as an accepted way to relax and cope with stress in the military with some feeling pressure to conform to drinking [ 6 ]. This acceptance of alcohol use and the social norms surrounding its use can have life-long, post-military service implications, as military veterans who normalise or excuse their drinking, delay their engagement in substance misuse services [ 46 ]. The historic social and cultural norms within the military [ 1 ], and even the ‘romanticising’ of this culture [ 12 ] are now being recognised, and the UK’s Ministry of Defence is trying to combat and encourage a sensible approach to alcohol use with initiatives to identify individuals’ alcohol use during regular oral examinations [ 47 ].

In almost all studies considered for this review, the Alcohol Use Disorder Identification Test (AUDIT) or the modified brief version, AUDIT-C was utilised. The AUDIT and AUDIT-C have been acknowledged as valid instruments for identifying alcohol misuse or dependence among US and Australian military populations [ 48 , 49 ]. However, the validity of such tests in other military populations does not appear to have been completed, despite the variability in populations. Regardless of the validity of such instruments, research has relied heavily on self-report questionnaires for assessment in a Military population. This can result in ascertaining large volumes of data; however, this can also give rise to participants answering in a more socially desirable way, rendering results inaccurate [ 50 ].

This focus on quantitative research methods has made it difficult to draw any conclusions as to what the resulting impact of military service on alcohol use may have on the ability of service personnel to carry out their jobs. To mitigate this, future research must also consider a qualitative approach, considering personal experiences and meanings ascribed to alcohol use, rather than only symptom severity, to draw any conclusions.

This review has synthesised findings from existing literature, highlighting potential gaps in current research. Despite being a comprehensive, international systematic narrative literature review, it is important to acknowledge there are limitations. First, only papers written in English were considered for review and may have excluded inclusion of international findings. Only the relationship between military service and alcohol use of serving personnel was considered, with papers including veterans in their sample being excluded as it was outside of the aims of this review. Finally, only peer-reviewed research was included in this review and, whilst this was a purposeful decision, it is acknowledged that evidence from grey literature may illuminate further understanding of this issue.

This systematic narrative review aimed to critically evaluate existing literature to explore the relationship between military service and alcohol use. Findings indicated that there are specific characteristics strongly associated with military service that appear to have an impact on alcohol use. The subsequent effects of alcohol use in a military occupational context reinforces the validity of exploring the casual links in more depth. Further research is needed to identify specific ‘risk factors’ associated with serving in the military and problematic alcohol consumption. Exploring the attributable burden will be a crucial building block to developing appropriate and targeted prevention policies.

Contributor Information

A K Osborne, Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK.

G Wilson-Menzfeld, Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK.

G McGill, Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK.

M D Kiernan, Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK.

Essay on Alcoholism

Students are often asked to write an essay on Alcoholism in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

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100 Words Essay on Alcoholism

Understanding alcoholism.

Alcoholism is a serious issue. It is a disease where a person cannot control their desire to drink alcohol. They keep drinking even when it causes harm.

Alcoholism can be caused by genetics, environment, and mental health. Some people are more prone to it because of their family history. Others might start drinking due to stress or depression.

The Effects

Alcoholism can lead to health problems like liver disease. It can also cause problems at work, school, or with relationships. It’s important to seek help if you or someone you know is struggling.

250 Words Essay on Alcoholism

Introduction.

Alcoholism, also known as alcohol use disorder (AUD), is a chronic disease characterized by an inability to control or abstain from alcohol use despite its negative consequences. It is a pervasive global issue with significant health, social, and economic implications.

Causes and Risk Factors

Impacts and consequences.

The impacts of alcoholism are far-reaching. Physiologically, it can lead to liver disease, cardiovascular problems, and neurological damage. Psychologically, it can result in depression, anxiety, and increased risk of suicide. Socially, it can disrupt relationships, lead to job loss, and contribute to social isolation.

Treatment and Prevention

Treatment for alcoholism typically involves a combination of medication, therapy, and support groups. Prevention strategies include education about the risks of excessive alcohol consumption, early intervention for at-risk individuals, and policies to limit alcohol availability.

Alcoholism is a complex disease with a multitude of contributing factors and consequences. Understanding its causes, impacts, and treatment options is key to addressing this pervasive issue. As future leaders, we must advocate for effective prevention strategies and accessible treatment services to combat alcoholism.

500 Words Essay on Alcoholism

Alcoholism, also known as Alcohol Use Disorder (AUD), is a chronic disease characterized by an inability to control or abstain from alcohol use despite its negative repercussions. It is a multifaceted disease, with complex interactions between genetic, environmental, and psychological factors.

Genetic Underpinnings of Alcoholism

Scientific research has established a strong genetic component to alcoholism. Certain genes can make individuals more susceptible to alcohol addiction, demonstrating that alcoholism is not merely a result of personal weakness or lack of willpower. It is estimated that genetics accounts for about 50% of the risk for AUD. However, having a genetic predisposition does not guarantee the development of alcoholism, indicating the significant role of environmental factors.

Environmental Factors and Alcoholism

The psychological impact of alcoholism.

Alcoholism inflicts significant psychological damage. It can lead to a range of mental health disorders, including depression, anxiety, and increased risk of suicide. Furthermore, alcoholism can negatively impact cognitive functions, impair judgment, and lead to behavioral changes. It is also closely linked to social problems, such as domestic violence, child abuse, and other forms of crime.

Treatment and Recovery

Alcoholism is a treatable disease, with various therapeutic strategies available. These include behavioral treatments, medications, and mutual-support groups. Behavioral treatments aim to change drinking behavior through counseling, while medications can help to manage withdrawal symptoms and prevent relapse. Mutual-support groups like Alcoholics Anonymous provide a supportive community for individuals recovering from alcoholism.

Prevention is Better than Cure

Alcoholism is a complex, multifaceted disease that requires a comprehensive approach for its prevention and treatment. Understanding its genetic, environmental, and psychological dimensions can inform effective strategies to combat this pervasive public health issue. While alcoholism is a serious disease, recovery is possible with the right support and treatment. Therefore, it is essential to foster a supportive environment for those struggling with this disorder, free from stigma and judgment.

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