Drug, Set, and Setting
Norman E. Zinberg, M.D.
1. Historical Perspectives on Controlled Drug Use
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Enormous variations from one historical epoch to another can also be found in the social use of intoxicants, especially alcohol, in various countries. From the perspective of alcohol use, American history can be divided into three major epochs, differing in the power of the mores to moderate the use of alcohol. In considering these epochs it is useful to bear in mind the following social prescriptions for control, summarized from cross-cultural studies of alcohol use (Lolli et al. 1958; Chafetz & Demone 1962; Lolli 1970; Wilkinson 1973; Zinberg & Fraser 1979).
1. Group drinking is clearly differentiated from drunkenness and is associated with ritualistic or religious celebrations.
2. Drinking is associated with eating or ritualistic feasting.
3. Both sexes and all generations are included in the drinking situation, whether they drink or not.
4. Drinking is divorced from the individual effort to escape personal anxiety or difficult (even intolerable) social situations. Moreover, alcohol is not considered medicinally valuable.
5. Inappropriate behavior when drinking (violence, aggression, overt sexuality) is absolutely disapproved, and protection against such behavior is exercised by the sober or the less intoxicated. This general acceptance of a concept of restraint usually indicates that drinking is only one of many activities and thus carries a low level of emotionalism.
During the first period of American history, from the 1600s to the 1770s, the colonies, though veritably steeped in alcohol, strongly and effectively prohibited drunkenness. Families ate and drank together in taverns, and drinking was associated with celebrations and rituals. Tavern-keepers had social status; preserving the peace and preventing excesses stemming from drunkenness were grave duties. Manliness and strength were not measured by the extent of consumption or by violent acts resulting from it. This pre-Revolutionary society did not, however, abide by all the prescriptions for control: "groaning beer," for example, was regarded as medicine and consumed in large quantities by pregnant and lactating women.
The second period, from the 1770s to about 1890, which included the Revolutionary War, the Industrial Revolution, and the expansion of the frontier, was marked by alcoholic excess. Men were separated from their families and in consequence began to drink together and with prostitutes. Alcohol was served without food, its consumption was not limited to special occasions, and violence resulting from drunkenness became much more common. In the face of increasing drunkenness and alcoholism, people began to believe (as is the case with regard to some illicit drugs today) that the powerful, harmful pharmaceutical properties of the intoxicant itself made controlled use remote or impossible.
Although by the beginning of the third period, which extended from 1890 to the present time, moderation in the use of alcohol had begun to increase, this trend was suddenly interrupted in the early 1900s by the Volstead Act, which ushered in another era of excess. American society has not yet fully recovered from the speakeasy ambience of Prohibition in which men again drank together and with prostitutes, food was replaced by alcohol, and the drinking experience was colored by illicitness and potential violence. Although the repeal of the prohibition act provided relief from excessive and unpopular legal control, it left society without an inherited set of clear social sanctions and rituals to control use.
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