Should Alcohol Education Be Taught With Drug Education?

Peter Finn, MA, MAT

During the 1960s, in response to a dramatic increase in nonalcohol drug abuse among middle-class teenagers, schools mounted a major educational campaign to educate students to the dangers of heroin, LSD, and other illicit drugs. In the past few years, however, attention in educational circles has refocused on what has always been the most widespread drug of abuse among youth, alcohol. Although this altogether welcome shift has occurred in the process the similarities and differences between alcohol and other drug abuse have rarely been clarified. As a result, in many schools alcohol education, when reintroduced or reemphasized, has been incorporated as a subordinate topic within the “larger” study of drug education. This commingling of alcohol and other drug education has in some respects been an unfortunate development, for the differences between alcohol and other drugs are profound, consisting not so much in their pharma- cological distinctions as in social, legal, attitudinal, and behavioral differentiations. These differences are so fundamental that they may require teaching about alcohol separately from other drugs.

CONTEXTUAL IMPORTANCE The issue of how alcohol education is included in the

school curriculum may seem academic-what differ- ence does it make if a teacher discusses alcohol as one of several drugs, eg, methadone, cocaine, or metha- qualone, or treats it as a separate topic in the curriculum? In fact, however, the context in which a subject is studied can have a major impact on what students learn. Context is important in at least three respects.

First, a reliable measure of society’s concern with an issue is the extent to which teachers devote attention to it in the school curriculum. As already noted, for example, when the government became alarmed by the upsurge in middle-class teenage drug abuse, schools began to develop and implement curricula devoted to addressing this critical problem. Students, in turn, infer that only those topics isolated for special study in the schools are “really” important. As a result, the

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seriousness and commitment students bring to a study of alcohol may be in direct proportion to the degree teachers single it out as a major object of study.

Second, learning can also be facilitated or hindered depending on the ways in which a teacher relates a topic to other subject matter in the curriculum. For example, treating all drugs as substances that are used or abused for similar underlying reasons may lead students to overlook the critical health, social, and legal differences between the use of alcohol and other drugs. By examining drinking in the context of drug abuse, the genuine parallels between the two tend to become over- stressed and the significant distinctions become ob- scured.

Third, the effectiveness of an educational endeavor can depend heavily on the nature of the teacher’s attitudes toward the subject matter under consideration. Teachers who view alcohol and other drug use as essentially comparable phenomena and develop instruc- tional approaches communicating this perspective may make it difficult for pupils to distinguish and explore the complex relationships and important dissimilarities between drinking and other drug taking.

Because the context in which students think about drinking is so important, it is possible to develop strong arguments both for treating alcohol separately from the study of other drugs and also for examining it in conjunction with the study of other drugs.

RATIONALE FOR INTEGRATION The “integrationist” position maintains that since it

is a drug, alcohol logically should be studied in the context of other drugs. While learning about the dangers of barbiturate dependence, heroin-associated hepatitis, and LSD psychoses, it makes educational sense to move on to discuss alcohol dependency, cirrhosis of the liver, and delirium tremens. Moreover, studying alcohol with other drugs reinforces the important concept that alcohol is a drug.

The second major rationale is predicated on the assumption that, fundamentally, education about all

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behavior where pleasure entails risks involves focusing on the same set of attitudes and feelings. The central issues in any study of alcohol, drugs, sex, tobacco, and nutrition revolve around peer pressure, controls, autonomy, maturity, rebellion, need for excitement, and curiosity. The teenager’s sneaking a drink in the park after school is similar in its psychological and interpersonal ramifications to “popping pills” at a party. Peer pressure and curiosity are as likely to be involved in one act as in the other. Since studying alcohol and other drugs makes an analysis of these issues possible, examining drug abuse helps illuminate the nature of problem drinking, and vice versa.

Deciding whether to drink or take other drugs involves an identical valuing process that can be examined regardless of the substance used. If students are helped to clarify their values-how they choose a behavior (whatever the behavior), why and how much they prize it, and how they act on it-they may learn, for example, to resist peer pressure to abuse any drug by acting on the basis of their own beliefs.

There are other reasons for combining alcohol education as part of a study of other drugs. There is a great deal of evidence that those teenagers who use drugs also drink, often (pp110-114) It therefore seems unwise to teach about alcohol use in isolation from other drug use, an approach that might create an artificial separation between drinking and drug taking not reflected in actual teenage experience. In addition, students appear to be combining the use of alcohol and other drugs, eg, smoking marijuana and drinking wine at the same time. It is therefore felt to be important that students study alcohol in conjunction with other drugs to learn about the additive and synergistic effects of multiple drug use.

Finally, some communities do not want the schools encroaching on areas of personal values, such as drinking, which they feel are the prerogatives solely of the home and church. However, these same communities often do not object when schools offer drug education. As a result, teachers can sometimes introduce a study of alcohol surreptitiously by obscuring it within a larger unit on drug education. In addition, by subsuming the study of alcohol under the general rubric of drug abuse, attention can clearly be focused primarily on those aspects of drinking-alcoholism, drunk driving-which most communities agree should be prevented.

While each of these rationales for integrating the study of drinking into drug education has validity, the reasons for separating alcohol education on balance carry more force given the contemporary pattern of drug abuse in America and most instructors’ abilities in the area of substance abuse education.

RATIONALE FOR SEPARATION There are four major reasons why the study of

alcohol should be conducted independent of drug education.

1. Major Drug of Abuse. First, alcohol is the drug most commonly abused by students in America. Studies have shown that:

25% of all seventh-graders report getting drunk one or more times a year.”P2*’

23% of high school students report they get drunk four or more times a year; approximately 5% get drunk at least once a week-52 times a year; nearly 10% of twelfth-grade students get drunk at least 52 times a year.

18.5% of high school students report they ride in cars driven by a heavily drinking driver at least a dozen times a year; nearly 20% report driving three or more times while d r ~ n k . ~ ‘ ~ ~ ~ ’

By comparison, teenage abuse of other drugs is much less widespread.’.’’ To be sure, marijuana use is common. A recent study concluded that 29% of all junior and senior high school students had used marijuana at least once during a six month period in 1974.2 (pc68) However, most teenagers who smoke marijuana do so in social settings, in moderation, and with few, if any, documented ill effects!l-13 (p180)* 14(pp67*68)

As the National Commission on Marijuana and Drug Abuse concluded, alcohol abuse in America is a far greater problem than is marijuana abuse.”

Students’ abuse of other drugs is also relatively minor compared to their overdosing on alcohol. A national sampling of over 12,000 junior and senior high school students indicated that 3.6% had used a “hard” drug like heroin or cocaine during a six month period in 1974, while 9.3% had used hallucinogens (LSD), ampheta- mines, or barbiturates more than once during that

If a comparison is made of the 1.8% of teenagers who used hallucinogens, amphetamines, or barbiturates more than 12 times during a six month period in 1974 and the 0.5% who used “hard” drugs more than 12 times2(pC70)with the 5% who got drunk at least 52 times

it is easy to see that the prevalence during 1974, of alcohol abuse far exceeds all other forms of teenage drug abuse combined.

As the drug most widely abused by youth and adults, alcohol needs to be given attention commensurate with its pervasive role in American life. This means devoting a separate unit of study to drinking in which the magnitude of the personal and social costs associated with alcohol abuse is identified for what it is: excessive

3 (PP 27. 28.)

time,2 (ppllZ.C70)

3 ( ~ ~ 2 8 . 2 9 )

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drinking is a destructive activity recognized as the nation’s third or fourth most severe health prob- 1emI6 (px’)b ”and which, when its contribution to family disruption, impaired work performance, an overburden- ed law enforcement system, highway traffic, pedestrian, and other accidents, and soaring hospital costs is calcu- lated, may affect more Americans with greater emotional and economic impact than any other single health problem. t Only by studying alcohol as a health issue, compared to which other drug problems are secondary, will most teachers be able to encourage students to take their drinking behavior seriously and examine it closely.

2. Unique Objectives. Most Americans, while they disapprove of alcohol abuse (however they may define it), view the moderate use of alcohol as an acceptable social practice, at least for adults. The use of other drugs, however, in any amount or frequency, is not condoned unless it is for medical purposes. This difference in social attitudes toward drinking and other drug use again indicates that alcohol should be taught separately from other drugs. For alcohol education has as a goal not abstinence but responsible decision making about drinking. Whether students choose to drink as adults (or even as children) in socially acceptable and legally sanctioned circumstances is their decisi0n.A goal of drug education is to discourage students from using other drugs at all for nonmedical purposes.

The goal of drug education, too, can be seen as enabling students to make informed decisions about drugs. However, this “goal” is only a means to an end, because the ultimate goal of education about all drugs except alcohol, and the purpose behind the desire to foster intelligent decision making about drug use, is nonuse, except for medical purposes. Alcohol educa- tion, on the other hand, has as its ultimate goal nonabuse of alcohol. Combining alcohol education, with its goal of responsible decision making, with drug education, and its goal of drug avoidance, will for most teachers result in either treating both topics in terms of abstention or else confusing the very different educational objectives of the two.

3. Subcultural Involvements. Most students get alcohol from older siblings, compliant store operators, or parents’ refrigerators and liquor cabinets. Those who buy other drugs, on the other hand, often become involved with an illicit subculture, contact with which must be maintained to continue the supply. Moreover, this subculture makes available and may encourage the use of more dangerous drugs than those initially sought.

This subcultural aspect of illicit drug use, when combined with the stern legal sanctions against and the

TReferences 14(pp2-6), 16(pp30-32), 18(pp3,4) 19(ppl1-21), 20, 2 1 (pviii).

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rigid social disapproval of most drug use, also makes taking drugs for many a very different emotional experience from drinking. Drinking among students is a ubiquitous phenomenon that is pursued relatively openly, with little fear of the law or stiff parental censure, with little need for covert activity and no contact with drug pushers, and which, as a result, is carried on without the associated mystique connected with clandestine activity. Combining alcohol with other drug education consequently has the confusing effect of equating two aspects of teenagers’ lives, which to many of them are dramatically differnt experiences.

4. Special Problems. Alcohol’s accepted social use by two thirds of the population presents personal, as well as educational, problems for instructors. For example, the attitudes of most teachers toward teenage drinking are likely to be ambivalent or confused. While society sanctions adult use of alcohol, it frowns upon regular social use by teenagers when unsupervised by an adult. Teachers usually opt, as a result of these social attitudes, to indicate that adult use of alcohol is acceptable, but its regular use by minors is hazardous and often illegal. This dichotomous view is seen by teenagers as a double standard-more so since they know that many of their peers have at least tried alcohol without visible harm and with what appear to be very tangible rewards. When treating other drugs, however, most teachers face no such dilemmas unless they smoke marijuana or take other drugs. Taking barbiturates for nonmedical purposes, they feel, is dangerous for people at any age. Therefore, the teacher can with a clear conscience and without provoking student accusations of hypocrisy discuss the risks of barbiturate use irrespective the age of the user.

Not only is there disagreement about whether, how much, and in what circumstances teenagers should drink, there is also no consensus regarding what constitutes acceptable adult use of alcohol. In teaching about drinking, therefore, the instructor is faced with making a difficult decision to: (1) express no opinions about what constitutes acceptable drinking behavior, (2) express his or her personal views, or (3) express the views prevailing in the students’ own particular community, if such a consensus exists.

Teaching about drinking creates issues and problems for many, if not most, teachers, which education about other drugs does not. If teachers are to examine their feelings about drinking and teaching about alcohol, they may need to segregate alcohol education from the study of other drugs. Otherwise, combining the two may either lull them into thinking they have no problems related to teaching about drinking or else lead them to assume incorrectly that the problems they do have stem from concerns about drugs in general, not about alcohol in particular.

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PROVISIONAL ENDORSEMENT The case for integrating alcohol with the study of

other drugs is, as noted initially, a compelling one. It is clear, for example, that some educators are able to combine the study of alcohol with other drugs and still effectively point out both the similar underlying motivations that lead to alcohol abuse and other drug abuse and also the significant differences between drinking irresponsibly and abusing other drugs. It is also possible that if attitudes and legislation continue to shift toward widespread sanctioning of marijuana as an acceptable drug for social use and if opinions change regarding the dangers and uses of other drugs, the time may come when a separate curriculum unit may be warranted which focuses exclusively on drugs whose unique characteristic is that they lend themselves both to responsible social use and frequent individual abuse.

However, at the present time and for most teachers, the soundest instructional approach from an educational standpoint is to separate alcohol from drug education. Most teachers will find it easier to help students clarify their feelings, attitudes, and behaviors related to drinking and abstaining if alcohol education is divested of its subordinate role as a component of drug education and given the prominence it deserves as by far the most extensively abused drug in America.

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Adolescent Drinking Behavior. Attitudes and Correlates. Prepared for the National Institute on Alcohol Abuse and Alcoholism. US National Technical Information Service, Springfield, Va, April 1975.

3. Alcoholand Health: New Knowledge. Second Special Report to the US Congress from the US Department of Health, Education, and Welfare, June 1974.

4. Communications Strategies on AIcohol and Highway Safety. Volume 11 - High School Youth. Prepared for the US Department of Transportation. US National Technical Information Service, Spring- field, Va, February 1975.

5 . Wechsler H, McFadden M: Sex differences in adolescent alcohol and drug use. J Stud Alcohol 37:1291-1301, 1976.

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15. US National Commission on Marijuana and Drug Abuse: Drug Use in America: Problem in Perspective. Second Report of the National Commission on Marijuana and Drug Abuse. US Government Printing Office, 1973.

16. Cahalan D, Room R: Problem Drinking among American Men. New Brunswick, NJ, Rutgers Center of Alcohol Studies, 1974.

17. Noble ER quoted in Lewis J: Washington report. JStudAlcohol 37:1383-1392. 1976.

18. The President’s Commission on Law Enforcement and Administration of Justice: Task Force Report: Drunkenness. US Government Printing Office, 1967.

19. Alcoholand Highway Safety. A Report to the Congress from the Secretary of Transportation, US Department of Transportation, 1968. 20. Waller JA: Alcohol and unintentional injury, in Kissin B,

Begleiter H (eds): The Biology of Alcoholism. Vol 4: Social Aspects of Alcoholism. New York, Plenum Press, 1976. 21. Alcohol and Health. First Special Report to the US Congress

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ACKNOWLEJXMENT

The author would like to thank Dr. Robert Russell for his thoughtful comments on a draft of this paper.

Peter Finn, MA, MAT, is Senior Education and Training Analyst, A bt Associates Inc., 55 Wheeler Street, Cambridge, Massachusetts 02138.

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