In reading Carlton K. Erickson, PhD's commentary “Let's Keep Up the Pressure Against Tobacco” (September/October 2007 issue), I concur with his observations. There should be no reluctance to link cigarette use with substance abuse. Their comorbidity is well-established. As far as alcohol being too woven into the fabric of American society, consider the following:
1. The decline in cigarette consumption has been precipitous. Mirroring this, trend analyses show consistent declines in use of other substances (including alcohol) since the 1980s. My colleagues and I agree that the “gateway” drug into other drug abuse is tobacco, and that these declines in use are linked.
2. Prohibition was successful when viewed in terms of substantial declines in domestic violence, accidents of all kinds, cirrhosis rates, improved productivity, and generally improved health of Americans (Ketcham K, et al. Beyond the Influence: Understanding and Defeating Alcoholism. New York: Bantam Books; 2000). The economic depression and its ensuing political era could not continue its support. The nation's current state of health awareness is at its highest ever, because of improved economics and education. A sustained effort to limit alcohol use could see it go the way of tobacco.
3. The alcohol industry years ago began a propaganda initiative to label our field and others interested in constraining alcohol use as “neoprohibitionists.” It appears that this industry wants to continue reaping profits from a small group of consumers who account for a disproportionate consumption.
4. Responsible marketing of alcohol should be encouraged. “Know when to say when” statements in alcohol advertisements are largely inadequate. Ads should responsibly reflect information regarding statistical social use. Consumers would then have a standard for comparison. There would be a clear delineation of what normal use is. Another approach would be just to indicate what the medical standard for abuse is. Factual information being portrayed accurately could be extremely instrumental in educating the public. The euphoric effect of alcohol occurs at doses of three to six standard drinks. Selling this amount is much more profitable than that of a beverage that typically sees the consumption of one to two standard drinks.
5. We would currently view the non-prescription availability of morphine, heroin, and cocaine products in unlimited quantities as absurd—however, just 100 years ago this was exactly the case. It could be possible to arrive at the same position with alcohol use 100 years in the future. We in the United States should forge ahead for the continued attrition of alcohol use through restriction of marketing to youth.
Alexander Zubenko, MAC, LCPC, Lisle, Illinois