Data from the 60 individual themes that emerged in the initial analysis were grouped into six basic diagnostic framing categories. Several of these categories reflected themes used in major conceptual models; namely, the alcoholism or abusive drinking construct, the individual alcohol-related problems framework and the public health framework for addressing alcohol problems. As predicted, an individual responsibility/criminal sanctions framework did not emerge as a strong theme in this sample. Although respondents in the study recognized individual alcohol-related problems, they tended to view them as a reflection of life problems and/or as the social and physical effects of alcohol and not as evidence of criminality and deviance, as implied in the anti-drunk driver movement. However, many informants described alternate models, which coalesced into three additional themes: social structural problems that were found in inner city neighborhoods and were embedded in or exacerbated by alcohol problems, problems with the normative climate of alcohol use, and alcohol’s role in drug-related problems. Taken together, the six primary diagnostic frameworks used in the following analyses included individual alcohol-related problems, alcoholism and alcohol abuse, public health approaches to alcohol problems, social structural problems related to alcohol use, problems in normative contexts of alcohol use, and drug-related problems. The frameworks were used as the basis for the three phases of data analysis described in the following sections. They included analyses on the respondents’ definitions of alcohol-related problems, ranking of the relative importance of alcohol problems, and variation in how alcohol problems are ranked or defined according to activist role or community setting. Taken together, these results describe the diagnostic framing characterized by respondents in this study.
3.1. Defining Alcohol-Related Problems
Individual alcohol-related problems
As shown in Table 1
, respondents in the study provided strong support for the disaggregated alcohol-related problems framework, or the notion that drinkers can experience a wide range of problems related to alcohol use that do not stem from alcohol addiction [13
]. When defining alcohol problems, three-quarters of respondents described a range of negative consequences experienced by drinkers or their families. Almost half of the respondents (44%) described overall adverse effects of alcohol use on individual drinkers. For example, one respondent from Detroit said alcohol use becomes problematic when it “affects your ability to live life productively, to carry out your responsibilities. . . your ability to function properly, to be able to further your life and your well-being”. In addition, some of the responses described specific problems related to drinking, such as health problems (14%), problems in the workplace or with maintaining a job (13%), and driving under the influence (9%). For example, a respondent from Baltimore said that “on a personal level, if a person has a problem with alcohol. . . it could be a bad history of driving, getting into trouble. . . getting along with other folks because they’re not in their right senses. . . . [Alcohol] causes problems in the family, at the workplace. . . . Any time they drink too much, that causes these problems, then that’s bad”. Another informant from Los Angeles stated, “My personal definition of alcoholism is any kind of problem. You drinkin’ and it is related to your drinking, then you’ve got an alcohol problem. . . A parking ticket because you was drunk and forgot you parked there, whether there was an automobile accident or whether you ran into a building and hurt people and property, which constitutes felony while drinking. . . . Now, either your liver, you got bad nerves, ulcers—all the health issues that come with it are so obvious”. Some of the responses indicated that alcohol is a problem when used by drinkers for self-medication as a way to escape reality and ease psychological pain (13%), or as a way of dealing with depression or low morale (7%). For example, one informant from Detroit defined alcohol problems as hopelessness: “Just no future, no vision, no self-esteem”. She explained that “self-esteem is the way we feel about ourselves; if we feel hopeless, we need an escape or we think we need an escape. [Instead of jogging or working out] we go get a 40-ounce”. Finally, a few respondents defined alcohol problems in relation to being idle or standing around with nothing else to do.
Family and youth alcohol-related problems also were a major concern for respondents in the study. When defining alcohol problems, more than a quarter referred to the harmful effects of alcohol use on family life. The major problems included marital discord and breakups; diverting money from the needs of families and children (e.g., food, shoes, and rent) to support drinking habits; and child neglect and abuse and domestic violence. Echoing some of these themes, a respondent from Oakland stated, “In terms of the community, I see that there is a great deal of domestic violence, and so there are many divorces and many families are abandoned. And I see [as] the result of that, there is very little participation in the children’s schooling. And since there’s not enough money at home, the children often have to look for work instead of going to school. And then their mothers also have to find one or two jobs because welfare doesn’t give enough money. And so I see that alcohol causes all of the disrepair and destruction of the family”. Another respondent from this city talked about the cause-and-effect relationship of alcohol as it relates to husbands who are abusive drinkers. He focused on situations in which a man might “drink up his check”, letting his kids starve and rent go unpaid, which would the cause his spouse to get upset, and be possibly beaten by him.
Alcoholism and alcohol abuse
Models of alcohol problems based on addictive or abusive drinking were widely discussed by informants in the study. More than half (51%) of respondents defined alcohol problems in these terms. Responses describing alcoholism or addiction (30%) emphasized symptoms such as dependence, loss of control, and tolerance. For example, one informant from Detroit stated that “alcoholics. . . are physically and psychologically dependent on alcohol” and defined alcohol as a drug because users build up a tolerance for it and require increasing amounts before they exhibit signs of intoxication. In Los Angeles, an informant defined alcohol problems as “somebody who is addicted or their life is controlled in a daily acquisition of alcoholic beverages”. An informant from Milwaukee defined alcohol problems in terms of his own experience as an alcoholic, whereby alcohol takes over a person’s life to the point he or she cannot “do anything without alcohol”. A respondent from San Antonio commented on the medical consequences of continual alcohol use and difficulties with withdrawal: “The medical problems that occur from them constantly being exposed to the alcohol is long range. . . . When this person is a alcoholic, it’s hard on detoxification, as opposed to a person who is dependent on a drug like marijuana or dependent on a drug like heroin. The withdrawal symptoms and all the things that person has to go through medically, it could tear you apart. . . . It’s very traumatic when you see somebody that you know going through the withdrawal symptoms of alcohol”.
Aside from addiction, some informants (30%) defined alcohol problems in terms of abusive or excessive drinking. Most often informants described intoxication or drinking to the point that it leads to personality changes or social disruption. An informant from Detroit defined alcohol problems as “when there’s a overindulgence which causes the person who’s consuming the alcohol behavior or mood to change. . . [which] could possibly lead to a violent individual or individual with no rationale or whatever”. A respondent from Los Angeles made a similar point: “Alcohol problems is when a person drinks on a continual basis. . . they must have that 6-pack every night or several cocktails. It can also be a problem for even just a weekend drinker. And, it just changes up the person’s whole personality”. In Milwaukee, a respondent defined alcohol problems as “any use above moderation” that impairs judgment or physical actions, or a negative change in behavior because of the abuse of alcohol.
Public health approaches to alcohol problems
A public-health-oriented model of alcohol problems also was widely reflected in responses by informants in the study. Nearly half of those interviewed (46%) discussed one or more issues related to alcohol sales and marketing. Alcohol problems were defined in terms of the overconcentration of alcohol outlets (16%); problems with selling practices and the environment in and around outlets (10%); and challenges with zoning, licensing, and regulating stores (6%). A respondent from Milwaukee focused on the problems of having a high density of alcohol outlets and the problematic selling practices of owners. He mentioned a neighborhood population composed of 63% youth, with almost 30 liquor stores in a 14-block area. He said many business owners knew welfare had been cut in Wisconsin, so they would not take a 6-pack apart and sell single beers at the beginning of the month; however, in the second through fourth weeks, “they know people are going through real hard times, they’ll set up deals and stuff. So they could still make their money and pull you in. . . . And they most definitely try to work with the minors in the neighborhood”. A community leader from Oakland also discussed the problems with outlets, which she said were intensified by the fact that her neighborhood had “five liquor stores within two blocks”. This respondent viewed “alcohol problems as a liquor outlet [includes stores where at least 30 to 40% of sales are in alcohol] and it can be people in bars”. She stated, “I have noticed that whether it’s a momma-and-poppa store on a corner, if they sell alcohol. . . people will go in and buy beverages and come out. And then they’ll stand there and [go] back and forth just getting alcoholic beverages. . . . And then when they get too intoxicated to go about their business. . . they would just either sit down there in front of the store and go to sleep or they stand there and they beg. . . . The fact there they were out there begging was. . . one thing that was bad. . . “cause most of the people in this community are working families or either seniors”. The respondent also mentioned that the families and seniors had to pass youth selling drugs out in front these establishments, litter from the numerous containers of alcohol, and/or people lying or sitting down in the street. A respondent from Los Angeles linked overconcentration with zoning and licensing issues: “Alcohol became a problem when the city planners allowed them to over-saturate it with liquor stores, when the land usage laws were ignored. The city administrators were aware that there was an overconcentration of alcohol. . . but they looked the other way. They haven’t sold any liquor license since 1965; however, liquor stores are popping up all over because the liquor licenses that were sold never expired”.
Easy accessibility to alcoholic beverages through high levels of physical availability (12%), attractive pricing (5%), and aggressive sales and promotion (3%) were other important issues voiced by informants in their definitions of alcohol problems. Respondents linked high levels of alcohol availability to heavy alcohol consumption and to a variety of related problems. Echoing these concerns, one informant from Raleigh said, “The major thing is the sheer amount of alcohol that’s sold in our neighborhood is a problem . . . . The fact that more alcohol is sold than any other legal product. . . that’s a real problem because it encourages alcoholism, domestic abuse, trash, filthiness around the neighborhood”. A respondent from Los Angeles said, “Alcohol [is] usually the most available in communities that can least afford it. And when I say the most available, I mean. . . it’s not unusual on some of the main thoroughfares to find 4 or 5 liquor stores within six blocks”. In Detroit, the director of a community-based organization focused on cheap pricing and convenient packaging of alcohol, which “causes the most devastation”. He stated, “It’s the drug that’s legal, it’s the drug that’s most readily available, and the packaging is such that anybody can afford it. There was a time when those little bitty airline bottles of liquor or booze. . . there was a time when the only place you could buy that was a souvenir shop on an airplane. . . . But now they sell it in the stores all day every day, 75 cents, 50 cents. . . . They went from the fifth. . . [to] the pint. Then they went to the pocket pint, which is smaller than a pint, just large enough to slip right into the ol’ back pocket, whip it out whenever you want, to the airline size. In other words, we’re covering all areas of the market. If you got 50 cents, you could walk in here and get a little swigger to shake the hanks off of you”. In addition to expressing concerns about the high quantities and low prices of beverages available in these communities, some informants focused on characteristics of beverages (alcohol beverage type 7%) they believed to be particularly harmful, such as fortified wines, malt liquor, and 40-ounce portions.
Alcohol advertising and media images (12%) and alcohol-related billboards (5%) also were defined as alcohol problems within these communities. Informants believed the glamorization of alcohol enticed people, especially vulnerable populations, such as youth and the poor, to drink either to achieve status or popularity or to escape from problems. Advertisements from television and billboards were identified as the major vehicles through which these messages were conveyed, and informants believed their influence was enhanced by subliminal seduction. One informant from Baltimore said, “In this community, we have a lotta kids that are teenagers that are doing the 40-thing. It’s so popular because they got the commercials and they used to have the billboards. . . . And these teenagers can’t wait for somebody to buy them wine coolers or beer or whatever it is, whatever the drink of choice is, like Alize. . . . A few people used to drink it. . . but now because the advertisement has pushed it, people are drinking that more often. . . . The advertisement is what pushed these things. . . and it is so obvious, but nobody realizes it”. A respondent from San Antonio remarked that alcohol billboards were very prevalent in low-income areas and kept alcohol fresh in a user’s mind. He described a big sign that stood over a church and showed a fifth of liquor being poured into a glass over ice. To get the sign removed, activists worked for many months and met with local and state politicians. However, after being removed, it was replaced with another alcohol ad “with a pretty lady holding the bottle”. This respondent was particularly concerned about the message to children who saw billboards in a supposedly safe environment. A respondent from Milwaukee criticized the heavy promotion of alcohol on billboards throughout the community and argued that “subliminal seduction” helps entice consumers to purchase alcoholic beverages. In Oakland, one informant cited as an aspect of alcohol problems “a subliminal level that comes through advertisements or romanticism that comes with the illusions of the freedom that alcohol brings”.
Informants in the study were particularly concerned about alcohol promotion activities targeted at vulnerable populations, such as ethnic minorities, low-income groups, or youths (7%). Leaders believed targeting poor or other disadvantaged neighborhoods with excessive advertising and alcohol sale venues, while excluding more powerful and affluent communities from these tactics, was inherently unjust and led to higher rates of alcohol problems and worse social conditions in poorer areas. One respondent from Oakland said, “We’re not upper class. We’re semi lower income. That the alcohol industry targets us big time. They make it quite easy and available to buy your one can of poison. . . . You know that strong shit that they’re out of their mind with one bottle of it, you know. That malt liquor stuff. . . . What an easy target is someone that you know maybe not got a lot of education, that may not have a job, and they set them up for addiction. . . . And they’re starting younger and younger and younger and younger as the years go by”.
Social structural problems related to alcohol use
Although few contemporary studies have focused on community and neighborhood problems related to alcohol use, respondents in this study were keenly aware of these problems. More than two-thirds discussed alcohol problems in terms of the impact of alcohol use on broader community life. Within this category, the largest proportion of respondents (28%) suggested alcohol use or related issues (e.g., sales and marketing) were problematic because they had negative effects on the community as a whole and/or could be considered a social problem. For example, one of the activists in Los Angeles stated, “We look at alcohol problems like any other social problem. It has social groups, and we would say that there is a number of different social conditions that create the substance abuse problem; specifically, the alcohol problem in the communities that we work in, which are mostly Latino. So we don’t look at it as an individual issue. We see a tremendous social problem in that it involves thousands and tens of thousands of people, and I’m not just talking about people that abuse, but the people that are victims of domestic violence or economic [problems]”. A number of the informants also defined alcohol problems in terms of the nuisances (e.g., loitering, litter, harassment, and noise; 25%) and anti-social behaviors (e.g., belligerence; 10%) associated with public drinking and its effects on community life. Many of these themes were stated by a respondent from Milwaukee who said, “I define an alcohol problem with people who are either walking up and down the streets, in clearly intoxicated stages; carrying bottles of alcohol. . . whistling or being loud and rude to people; urinating; defecating in public, which happens around here; leaving their bottles; being passed out on your steps. Some drunk drivings you’ll see up and down the street here. Accidents, people vomiting, that’s the outward appearances of an alcohol problem here in this immediate neighborhood”.
A number of activists (14%) defined alcohol problems in terms of the impact of alcohol use on crime in their communities. The most common crimes attributed to alcohol were robbery or stealing; crimes associated with lack of inhibition, such as bar fights and violent confrontations; and prostitution. One informant, a police officer from Los Angeles, described some of these issues: “Ninety percent of the females we arrested were involved with alcohol at the time of arrest, where they’re either inebriated or involved with consuming. . . . And then the people. . . trying to make dates with these girls—most of ‘em are under the influence, so it lowered their inhibitions to go after things like that. . . . Most of the fights that occurred at the bars was abuse of alcohol. People just lose their tempers and [are] out of control and then. . . we have an apparent homicide. All related to this alcohol situation”. An informant from Raleigh focused on neighborhood theft as an issue: “I define it when I see people that are intoxicated hanging around on the streets, not working. At the day care, people break in cars the minute they park ‘em out there. . . . We’ve had several break-ins in the mornings when parents drop children off. I consider that a problem because they have to support their habits and they are not working, so they go out to do whatever they need to do. We’ve had several break-ins in the day care, too”.
Some leaders interviewed (10%) expressed concerns about the impact of alcohol use on local community economies, especially those related to depressed housing values and the lack of economic development in poorer communities. For example, one interviewee from Raleigh stated he was focused on the family “trying to climb out of poverty” who lives on the same block and sees their property value “go to hell” and “who have a 8- or 10-year-old kid that they don’t think they can let play in his own neighborhood”. A respondent from Los Angeles suggested that alcohol consumption, sales, and distribution create environmental problems, such as the focus on alcohol outlets to the exclusion of other types of businesses: “I think a lot of that [lack of commercial development] has to do with people saying, ‘Oh, there’s a lot of liquor stores in the two-block radius. I’m not putting my Starbuck[s] or my Borders Books [there].’” From a related perspective, some informants (8%) described how questionable alcohol marketing and sales tactics or problematic drinking styles were concentrated in poorer or ethnic minority communities, as compared with those in middle-class or suburban environments. Other structural problems (e.g., the presence of blight, racism, educational problems, problems with housing, and lack of alcohol treatment or prevention services) were mentioned, but with less frequency. A somewhat higher percentage of respondents (6%) voiced concerns about the exposure of youth to adverse social conditions in communities as a result of alcohol use or sales and marketing.
Problems in normative contexts of alcohol use
Another major issue raised by respondents defining alcohol-related problems was the interrelationship between alcohol use and the social environment (23%). Some leaders interviewed believed permissive social norms (8%), the tendency to ignore or rationalize problems associated with drinking (7%), and the belief that drinking is necessary for recreation or fun (3%) contribute to drinking problems. One respondent from Oakland said, “I can’t speak for other cultures. . . but I can tell you about Latino culture. If you’re going to have a party for a child, if you want everyone to have a good time, the children, the adults. . . many times you would include liquor. You would bring alcohol to the party, and for me, that––well, some years back––that would be very normal. . . . I would see that there would be a birthday or a baptism, and you’d have the piñata for the child, but there would always be liquor. I think that is something that we have to educate our community about. . . because I think that [at] a party for children, there doesn’t necessarily have to [be] liquor there. Although the children won’t drink the alcohol. . . from the time they see this, they grow up seeing it as something normal”. An informant from San Antonio said he does not define alcohol problems from the standpoint of being an alcoholic, but in terms of people overdrinking for recreational purposes: “I just think people use alcohol to an excess. . . . It’s just that people think that alcohol is a way to have fun. And that’s where the misconception is, and the misuse starts”. In addition to these issues, a few respondents defined alcohol problems in terms of the disrespectful behavior of drinkers (2%), as a reflection of spiritual problems (2%), and as a potential danger to the broader social fabric (1%).