Four Unsung Moments in the Genesis of the Modern Alcoholism Movement in the United States
Unpublished manuscript, 1996
University of California, San Francisco, Department of Social and Behavioral Sciences, Box 0646, Laurel Heights, San Francisco, CA 94143-0646.
This research was partly supported by U.S. National Institute on Alcohol Abuse and Alcoholism (NIAAA) grants RO1 AA07034 and RO1 AA09623.
Address correspondence to Ron@Roizen.com.
Abstract: Four significant events occurring over a five-year period from 1939-1944 marked the embracement of the disease concept of alcoholism in the U.S. “alcohol problems social arena”: (1) the October, 1939 decision by the Research Council on Problems of Alcohol (RCPA) to focus its future research on alcoholism; (2) the presentation of Dwight Anderson’s 1942 plan to give “the new scientific approach” to alcohol problems a new symbol and image with the disease concept; (3) the December, 1942 RCPA decision to open a demonstration information, referral, and treatment facility in New York City; and, finally, (4) the October, 1944 launching of the National Committee for Education on Alcoholism by Marty Mann and E.M. Jellinek. All four events reveal the rootedness of the disease-concept theme in the survival and institutional marketing preoccupations of the nascent U.S. modern alcoholism movement.
A radical transformation in the U.S.A.’s popular paradigm of alcohol-related problems commenced soon after the repeal of national prohibition. Over the course of about 15 years, what Selden Bacon (1969) called the Classic American Temperance Movement (CATM), with its paradigmatic focus on beverage alcohol, per se, became displaced by the Modern Alcoholism Movement (MAM), with its quite different focus on care, treatment, and research for alcoholism. The organizational seeds for this change were sown remarkably soon after Repeal’s passage in early December, 1933. Alcoholics Anonymous (AA) commenced from a chance meeting of its two co-founders, William Wilson and Dr. Robert Smith, in May, 1935, a mere 18 months later; the so-called “new scientific approach” to alcohol problems commenced about three years later, with the formation of a group known as the Research Council on Problems of Alcohol (RCPA) (Roizen, 1991). Within five years after Repeal, then, the two major organizational components of the MAM were already off and running. Another five or six years would be required however before the new movement and paradigm became consolidated around a single master theme, “the disease concept of alcoholism.” Such consolidation occurred in October, 1944, with the launching of the National Committee for Education on Alcoholism (NCEA) by Mrs. Marty Mann and E.M. Jellinek.
In this brief paper, I will suggest that three key historical moments preceded this fourth and consolidating event. The first, in October, 1939, saw RCPA scientists deciding to concentrate their future research program almost exclusively on alcoholism, thus also foregoing research on a variety of other researchable aspects of alcohol-related problems. The second, which occurred sometime in 1942, was the presentation of Dwight Anderson’s public relations plan to provide “the new scientific approach” to alcohol problems a new symbol and image with the disease concept of alcoholism.. The third, in December, 1942, was the RCPA’s decision to open a demonstration information, referral, and treatment facility in New York City. These three events or historical moments led to the NCEA’s formation and the promulgation of its grand disease-concept theme in the autumn of 1944, the fourth and consolidating moment. It may be noted that this 1944 consolidation was completed some eight years before the publication of Jellinek’s (1952) famous phaseology of alcoholism, which publication thereafter provided much-needed symptomatologic and scientific stiffening for the movement’s disease claim. In other words, the disease-concept promotional theme came into being well before the ostensible science on which it was based was provided. All four events were driven to a remarkable degree not by new science but by the new movement’s sustained search for financial resources. My goal in this brief paper, therefore, is to illuminate how thoroughly intertwined were the story of the new movement’s emergent ideological focus and its trying material circumstances.
Four Historical Moments:
The cultural transition advanced by the modern alcoholism movement implied two fundamental and distinguishable crucial claims: first, that alcoholism was society’s chief alcohol-related problem, and second, that alcoholism was an illness requiring medical or sympathetic handling instead of punitive responses or indifference. AA’s devotion to aiding alcoholics harbored no inconvenience regarding the first proposition, but its relationship to the disease concept was nuanced and problematic from the outset. As a lay and spiritually oriented enterprise, AA lacked the appropriate medical authority to promote the disease idea, per se, to the American public. Moreover, AA’s philosophy and modus operandi were individualistic and decentralized, and the organization noted for its aversion to corporate action and active involvement in public issues, even in relation to the alcoholism topic.
The early alcohol science movement, on the other hand, initially focused on the then-perceived social problem of faulty information about alcohol, not disease alcoholism (see, particularly, Reports, 1938). The group also initially addressed itself to an educational dilemma posed directly by Repeal's recent passage (Roizen, 1991). Repeal had reactivated state-level laws (rendered dormant by prohibition) requiring that scientific temperance be taught in public schools. The nation's bitter struggle over Repeal, however, had brought forth a confusing array of putatively scientific assertions on both the wet and the dry sides of the great debate, leaving hardly anyone sure (the RCPA argued) what exactly mainstream, authoritative science actually knew about alcohol and its effects. The RCPA's original organizers promised to bring new, objective, and disinterested science to the rescue--thus reconstituting the nation's post-Repeal alcohol pedagogy on firmer and more objective ground. Safeguarding the society's information system re alcohol, not mounting an attack on disease alcoholism, defined the RCPA's original objective.(2) However laudable this aim, it proved very difficult for the RCPA to find funding for its proposed program of new research.
How did alcohol science's initial focus on objectivity and disinterestedness become transformed into a singular preoccupation with disease alcoholism? Four key historical moments, occurring over a five-year period from 1939 to 1944, defined the transformation.
Moment One occurred when a beleaguered RCPA Executive Secretary, Karl Bowman, won approval for his plan to confine new RCPA-sponsored research to the topic of alcoholism. Bowman argued that this topical focus would allow the group to avail itself of offers of much-needed financial support from the distilling industry. His reasoning was simple and pragmatic: Bowman pointed out that industry-funded projects addressing such traditional alcohol-research questions as alcohol's relation to health, mental health, poverty, crime, etc. might generate findings favorable to beverage industry interests. Such results, coming from industry-sponsored research, would inevitably raise suspicions of bias. On the other hand, research projects focused on alcoholism, no matter how these came out, would not harbor the same daunting prospect. Hence, research on alcoholism would permit the group to make use of industry funds with relative impunity. The membership voted overwhelmingly to accept Bowman's plan and turn future research toward a focus on alcoholism in October, 1939 (Roizen, 1991). This Moment fixed research on alcoholism at the center of the nascent scientific movement's attentions.
Moment Two came when RCPA leadership, still hungry for adequate funding, asked public relations consultant Dwight Anderson to suggest new strategies for attracting support. Anderson (1942) proposed a bold new plan in which he argued that public opinion had to be fundamentally re-shaped for a scientific approach to alcohol problems to establish enduring sources of societal and financial support. Current public opinion on alcohol, Anderson contended, was in the grip of two opposing mind-sets or gestalts, dry and wet. For the scientific perspective to gain ground, he continued, science had to offer a lead idea or compelling theme that would both capture the public's imagination and convey the essence of a new scientific mind-set. Anderson proposed that alcoholism's disease character was the best candidate concept for this task. "To students of inebriety this is practically a; banality" wrote Anderson, 'but establish this fully in the consciousness of the public and the first step will have been taken toward winning it to the scientific approach to the problem (Anderson, 1941:377). This Moment turned the new scientific movement's attentions to the need to shift public opinion in its favor and highlighted the utility of disease alcoholism in fostering that shift.
Moment Three came in December 1942 when a still money-starved RCPA leadership hit on the idea that the group should market itself not merely on behalf of the need for more research on alcoholism but also as a means for doing something directly about the problem (see Anderson,1950:203). A special committee -- including both Karl Bowman and E.M. Jellinek in its seven-person membership -- crafted a detailed new plan in which New York City would become the demonstration site for an ambitious program of information dissemination, referral, treatment, and clinical research -- with a "John Brown Institute" at the enterprise's capstone.(3) A six-point outline of this new, action-oriented emphasis was announced in the June, 1943 number of the Quarterly Journal of Studies on Alcohol ("The Research," 1943:149-150). The RCPA's planned university-based clinic in New York City prefigured the famous Yale Plan Clinics, which commenced operations in March, 1944. This Moment marked the scientific movement's transition from the world of ideas and research on alcoholism to the everyday world of addressing alcoholism via newly established community institutions.
Finally, Moment Four came In October, 1944 when Mrs. Marty Mann and E.M. Jellinek launched the National Committee for Education on Alcoholism (NCEA--later renamed and better known as the National Council on Alcoholism [NCA]) . The NCEA began its organizational life as an integral element of the Yale University-based Section on (later, Center of) Alcohol Studies in Howard W. Haggard's Laboratory of Applied Physiology. The Yale-based alcohol science enterprise displaced the RCPA as the most important locus of scientific activity on alcohol in the country in the 1940s. The NCEA's manifest goal was to bring the disease idea to a nationwide public audience though a far-flung network of local voluntary organizations. The NCEA's Yale-based backers, however, also saw the network as affording means to establish grassroots support, both moral and financial, for their own program of alcohol science.
Mann borrowed the substance of her four-point public relations campaign -- i.e., (1) that alcoholism is an illness, (2) that alcoholism can be treated, (3) that the alcoholic deserves treatment, and (4) that alcoholism is a public health problem -- directly from Anderson's (1942) plan, but she contributed a crucial new spin: if Anderson recommended the alcoholism-as-a-disease theme because it conveyed the spirit of a new scientific approach, Mann saw it offering symbolic rescue to alcoholics themselves. Mann campaigned to make alcoholism respectable by emphasizing its involuntary, disease-driven character. Neither AA philosophy nor contemporary alcohol science could readily supply Mann with direct justification or authority for the radically mechanistic disease process that her exculpatory vision of alcoholism required. (The publication of E.M Jellinek's famous symptom progression for disease alcoholism was still eight years in the future [Jellinek, 1952].) In fact, Mann had reached outside the orbit of the nascent alcoholism movement for her imagery -- drawing the inspiration for it instead from the story of Dorothea Dix's campaign to reform public attitudes toward mental illness (Johnson, 1973). This Moment brought a new moral agenda to the disease-alcoholism idea by defining the alcoholic as the unwitting victim of society's ignorance.
Obviously, all four Moments were driven by the new movement's marketing and survival preoccupations. And yet it would be unfair to take too cynical a view of this behind-the-scenes aspect of the movement's choices. Movement advocates sought to realize a fond dream. They envisioned a future society with a scientifically enlightened approach to alcohol-related problems. They searched for symbolic packaging of that dream that would bring forth from society the sort of financial support that would allow them to try to realize it.
(1) Repeal was ratified by the final state (Utah) on 5 December 1933. Alcoholics Anonymous (AA), which the late Selden D. Bacon called the movement's "wheelhorse," commenced with a famous meeting between Bill W. and Dr. Bob in Akron, Ohio in May, 1935. The Research Council on Problems of Alcohol, the chrysalis for the "new scientific approach" to alcohol problems, commenced in 1936 or 1937 (Keller, 1990; Roizen, 1994).
(2) See "Reports"  for an excellent contemporary expression of the RCPA's information-safeguarding scientific orientation.
(3) A confidential RCPA memorandum in the author's possession described the name as a temporary placeholder for that of “a public spirited citizen, or a famous doctor of medicine, or a respected ex-alcoholic" to be selected at a later date.
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