ALCOHOL1979 1985 1991 1993 1997
Lifetime 88.5 84.9 83.6 82.6 81.9
Past Year 72.9 72.9 68.1 66.5 64.1
Past Month 63.2 60.2 52.2 50.8 51.4Percentages Reporting Lifetime, Past Year, and Past Month Use of Alcohol
in the U.S. Population Aged 12 and Older (1979–1997)Table 2
SOURCE: Substance Abuse and Mental Health Services Administration 1998.
alcoholism remains one of the most serious prob-
lems in American society. Alcohol abuse and all of
the problems related to it cause enormous person-
al, social, health, and financial costs in American
society. Cahalan et al. (1969) in a 1965 national
survey characterized 6 percent of the general adult
population and 9 percent of the drinkers as ‘‘heavy-
escape’’ drinkers, the same figures reported for a
1967 survey (Cahalan 1970). These do not seem to
have changed very much in the years since. They
are similar to findings in national surveys from
1979 to 1988 (National Institute on Alcohol Abuse
and Alcoholism 1981, 1987, 1988, 1989; Clark and
Midanik 1982), which support an estimate that 6
percent of the general population are problem
drinkers and that about 9 percent of those who are
drinkers will abuse or fail to control their intake of
alcohol. Royce (1989) and Vaillant (1983) both
estimate that 4 percent of the general population
in the United States are ‘‘true’’ alcoholics. This
estimate would mean that there are perhaps 10.5
million alcoholics in American society (see also
Liska 1997). How many alcoholics or how much
alcohol abuse there is in our society is not easily
determined because the very concept of alcohol-
ism (and therefore what gets counted in the sur-
veys and estimates) has long been and remains
controversial.
THE CONCEPT OF ALCOHOLISMThe idea of alcoholism as a sickness traces back at
least 200 years (Conrad and Schneider 1980).
There is no single, unified, disease concept, but
the prevailing concepts of alcoholism today re-
volve around the one developed by E. M. Jellinek
(1960) from 1940 to 1960. Jellinek defined alco-
holism as a disease entity that is diagnosed by the
‘‘loss of control’’ over one’s drinking and that
progresses through a series of clear-cut ‘‘phases.’’
The final phase of alcoholism means that the
person is rendered powerless by the disease to
drink in a controlled, moderate, nonproblematic way.The disease of alcoholism is viewed as a disor-
der or illness for which the individual is not per-
sonally responsible for having contracted. It is
viewed as incurable in the sense that alcoholics can
never truly control their drinking. That is, sobriety
can be achieved by total abstention, but if even one
drink is taken, the alcoholic cannot control how
much more he or she will consume. It is a ‘‘prima-
ry’’ self-contained disease that produces the prob-
lems, abuse, and ‘‘loss of control’’ over drinking by
those suffering from this disease. It can be con-
trolled through proper treatment to the point
where the alcoholic can be helped to stop drinking
so that he or she is in ‘‘remission’’ or ‘‘recovering.’’
‘‘Once an alcoholic, always an alcoholic’’ is a cen-
tral tenet of the disease concept. Thus, one can be
a sober alcoholic, still suffering from the disease
even though one is consuming no alcohol at all.
Although the person is not responsible for becom-
ing sick, he or she is viewed as responsible for
aiding in the cure by cooperating with the treat-
ment regimen or participation in groups such as
Alcoholics Anonymous.The disease concept is the predominant one
in public opinion and discourse on alcohol (ac-
cording to a 1987 Gallup Poll, 87 percent of the
public believe that alcoholism is a disease). It is the
principal concept used by the vast majority of the
treatment professionals and personnel offering
programs for alcohol problems. It receives wide-
spread support among alcohol experts and contin-
ues to be vigorously defended by many alcohol
researchers (Keller 1976; Vaillant 1983; Royce
1989). Alcoholics Anonymous, the largest single
program for alcoholics in the world, defines alco-
holism as a disease (Rudy 1986). The concept of