On a recent episode of Fox’s TV series, Fringe, Agent Dunham returned home after a tough day at work. Her sister, recognizing that Dunham had been through multiple difficulties, offered a glass of wine. That same week, Drs. Karev and Stevens were considering a sexual encounter with one another on Grey’s Anatomy. Stevens proposed that Karev retrieve a bottle of tequila from another room first. On Brothers & Sisters, the entire Walker family, other than one member who is in recovery, drinks alcohol at every possible opportunity. Admittedly, they own a wine company, but given how much of their own product they consume, it’s surprising that they have any left to sell. Science fiction isn’t out of the picture: on Battlestar Galactica, the executive officer discovers that his girlfriend is pregnant. Sitting in the sick bay with his wife and physician, he mentions that now would be a good time for a drink. Alcohol not being available, the physician offers him a cigarette, whereupon both the doctor and the XO light up.

Last issue, I asked what has come over this country in light of the apparent acceptance by Americans that controlling marijuana use is no longer important. Is it simply that we’re in the midst of a sinister, though probably unplanned, campaign by media to promote substance use? I don’t recall Mr. and Mrs. Brady drinking. Major West never tossed back a shot after a long day piloting the Jupiter II. And the only time we saw Captain Kirk drink was after the transporter had split him into two — the Good Kirk and the Bad Kirk. Naturally, only Bad Kirk walked the corridors of the Enterprise with a keg of brandy. But this was back in the 1960s. Times have changed, and now, apparently, everyone drinks alcohol at the slightest provocation.

Society’s role in alcoholism

We’re in the midst of watching our children grow up more rapidly, and it isn’t unusual at all to have patients tell us that their alcohol use began prior to their teenage years. We’ve started projects designed to eliminate “underage drinking.” We’ve cried about highway deaths secondary to young people drinking and driving, and have been enthusiastic about gains in that regard secondary to raising the drinking age to 21. We also know that it takes three ingredients to construct an alcoholic: genetics, environment and a supportive society. As yet, we can do nothing about genetics; there are some people who are predisposed or susceptible as a result of their genes. Hopefully, at some point, we will be able to identify such individuals, but now our only tool is the family history. Environment is an area that we’re working on. It is here that real prevention efforts can take place, including education of parents and teachers who have contact with children under age five, as it is during this early time period that the bulk of the environmental impact upon the development of addiction takes place.

The third ingredient is just as important as the first two. A supportive society is one that has happy hours; one that has a rallying cry within the media; and one that promotes substance use through sheer opportunity. We seem to have turned the corner with tobacco use. It wasn’t too many years ago that I would tell patients in the hospital that they couldn’t smoke because they were on oxygen, despite the fact that their roommates were puffing away, or that my anatomy professor told me that it would be impossible for the hospital to make him stop smoking his pipe in his office. There were smokers in restaurants, on airplanes, and of course, in the media. Tobacco use had a considerable prevalence, but such use has dropped dramatically as the supportive society has ended. Smokers huddle in back alleys in the cold next to little industrial ashtrays outside of their workplace; there’s nothing like that to make people realize that there’s no fun in that drug use anymore.

But for alcohol, we seem to be going in the other direction. Only last year, the Amethyst Initiative launched a program, apparently supported by dozens of university and college presidents, to “weigh all the consequences of current alcohol policies and to invite new ideas on how best to prepare young adults to make responsible decisions about alcohol use.”

The Initiative was launched by a non-profit organization, Choose Responsibility, a group which states that “alcohol is a reality in the lives of young Americans [which] cannot be denied, ignored, or legislated away.” Evidently, this group appears to feel that what has been done for tobacco would be impossible to achieve for alcohol and that we may as well simply abandon impossible laws in favor of allowing our youth to drink freely. I agree with them on one point, highlighted on their website’s home page, “The time has come to address the reality of alcohol in America.” Yes, that time is clearly here, but I’d address it by dealing with the supportive nature of our society rather than by simply opening the floodgates. Fix the problem and we can effectively eliminate one of the three major ingredients to addiction with alcohol, just as we have with tobacco use.

The problem cannot be fixed unless we have cooperation from our media. It took about 40 years from the time cigarette ads were banned to reach the stage we’re at now with tobacco use. That’s a road we can’t travel with alcohol unless we decide to turn down that path. Given the number of deaths due to alcohol, the amount of illness secondary to alcohol, and the number of lives ruined secondary to addiction, wouldn’t it make sense to make that turn? There would be no prohibition because there would be no need for prohibition. The market, instead, would be eliminated just as it has been for tobacco through a concerted effort to make our society less accepting of alcohol use. But perhaps I’ve gone too far. Maybe it’s just too critical a plot device for writers to rely upon; without the bottle of tequila, Karev and Stevens wouldn’t sleep with one another, and without that, a few TV series might suddenly vanish quietly into the night.

I’m happy to hear feedback at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

his column represents his personal opinion and does not imply any position or policy taken by either the AMA or ASAM.

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