Paper presented at the
International Conference on Alcohol and Drug
Treatment Systems Research, Toronto,
Ontario, Canada, 18-22 October 1993.
Research for this paper was commissioned by
the Western Consortium for Public Health,
Berkeley, California. The author
thanks Sue Holtby for her patient support
and to the Addiction Research Foundation
(Toronto) and Southwest Regional Laboratory
(Los Alamitos, California) for jointing
making it possible for him to attend this
conference.
Note: I
corrected some long-lingering typos
and made a number of minor adjustments
to this text on 5/17/2019.Unfortunately,
some
infelicities in the prose remain.
An intriguing
development in the current history of the
American relationship to psychoactive
substances is the trend toward merger of the
alcohol and drug-problems social
arenas. Intimations of such a shift are by no
means new--sociologist David J.
Pittman (1967) wrote a paper titled "The Rush To
Combine: Sociological
Dissimilarities of Alcoholism and Drug Abuse"
over twenty-five years ago
criticizing what he saw as a contemporary trend
toward merger-- incidentally
citing the "Addiction Research Foundation's"
name as one example of
the drift toward combining alcohol and illicit
drug research (see Popham, de
Lint, and Schmidt, 1968, for ARF's spirited
defense). There is relatively
little scholarly literature on the merger issue
specifically (see Weisner, 1992;
Rawson, 1990-1991; Dunne et al., 1989), though a
somewhat larger literature
exists concerning the evaluation of merged
alcohol/drugs treatment modalities
(e.g., Ottenberg and Rosen, 1971; Cook, 1988;
Galanter et al., 1990).
The
extent and significance of merger are still
unclear and vary according to which
aspects of the alcohol-drug domains one has in
mind. Schmidt and Weisner
(1993:380), for example, recently called the
trend toward combined treatment
facilities "perhaps ... the most significant
organizational development
during the 1980s..." and provided impressive
treatment system data
buttressing their assertion.1
Yet most of the merging
changes so far appear to involve bureaucratic
re-organization and name
changing, as evidenced, for example: (1) in the
emergence of new federal,
state, and voluntary agencies defined around
both alcohol and illicit drugs --
notably, in the recent creation of the U.S.
national Substance Abuse and Mental
Health Administration (SAMSHA) and its two
major constituent centers, the
Center for Substance Abuse Prevention (CSAP) and
Center for Substance Abuse
Treatment (CSAT); (2) in the rising popularity
of such combinative
domain-defining terms as "substance abuse,"
"chemical
dependency," and "AOD" ("alcohol and other
drugs");
(3) in new journals and journal articles using
such terms in their titles; (4)
in the development of common protocols for the
diagnosis of drug and alcohol
dependence and problems; and (5) in the National
Council on Alcoholism's (NCA)
1990 name change to the National Council on
Alcoholism and Drug Dependence
(NCADD) [(2), (4), & (5) are cited in
Schmidt and Weisner, 1993:381-3821].
If the merging tendency continues and becomes
fully realized in substantive as
well as nominal terms, it would certainly mark a
fundamental transformation in
the American social management,
conceptualization, and moral definition of two
formerly quite separate alcohol-problems and
illicit-drug domains.
Until
very recently, alcohol- and drug-related
problems occupied quite separate
social problem domains in the U.S. -- and in
most respects I suspect they
continue to do so. The most important
20th-century historical event
shaping their separation was undoubtedly the
repeal of national alcohol
prohibition in 1933. With Repeal, alcohol
resumed its pre-Prohibition status as
a lawful commodity, and thus became legally
differentiated from illicit opiates
and, before long, from marijuana as well (made
illicit by the federal Marijuana
Tax Act in 1937 [Brecher, 1986]). Following
Repeal, alcohol's social problems
arena also saw the development of a
fundamentally different paradigm for
conceptualizing, social managing, and morally
defining alcohol-related
problems, built around the so-called "disease
concept of alcoholism"
(Johnson, 1973; Jellinek, 1960).
The
new paradigm, the brain-child and chief
preoccupation of what has come to be
called "the modern alcoholism movement," placed
the locus of
alcohol-related dependency not in alcohol itself
but instead in the faulty or
anomalous drinker, "the alcoholic."
Alcohol, in Levine's apt
term, became "the only popularly and
scientifically accepted
person-specific drug addiction" (Levine,
1978:162). Unlike the
prevailing paradigm for opiates, alcohol
addiction's source lay somewhere in
the constitution or psyche of the aberrant user
and not in the drug
itself. Alcohol's new paradigm harbored
many important implications for
research and treatment, not a few of which were
realized over the course of the
post-Repeal era. For purposes of the
present discussion perhaps the new
paradigm's most important cultural corollary was
that it tended to domesticate,
secularize, or de-vilify beverage alcohol's
symbolic definition. If a
relatively rare disease condition known as
alcoholism, rather than alcohol, caused
the great bulk of society's alcohol-related
problems, then the great
preponderance of drinkers (the non-alcoholics)
could now enjoy beverage alcohol
with impugnity (Beauchamp, 1980). In
short, the alcoholism paradigm added
to alcohol's post-Repeal commercial legitimacy a
cultural layer of symbolic
legitimacy as well.
The
alcoholism paradigm's dual capacity to enhance
the moral valence of both the
alcoholic and alcohol bears special attention,
and marks the most important
symbolic divide between the alcohol and drug
domains in the post-Repeal era.
Commentators have from time to time noted that
the drug addict is surely as
much addicted to his drug-of-choice as the
alcoholic is to alcohol.
Therefore, as this argument goes, the drug
addict should enjoy equal claim to a
"disease conception of drug addiction" and, by
extension, equal claim
to treatment rather than punishment. This
argument is true as far as it
goes, but it ignores a crucial symbolic divide
between the alcoholic and the drug
addict. There is a marked moral divide
between the user who becomes
dependent upon a tabu substance and the user who
becomes dependent upon a
substance whose use is socially sanctioned and,
for the great majority of
users, is defined as a more or less benign and
mildly enjoyable commodity.
The
difference between alcohol's and illicit drug's
legal status -- licit or
illicit -- should not be regarded as a mere
legislative incidental but as one
aspect and indicator of broad differences in our
conceptualization, mode of social
response, and symbolic definition in the social
construction of these
commodities: (1) conceptually, the alcoholism
paradigm places the locus of
alcohol-related problems in the "faulty drinker"
whereas the paradigm
for illicit drugs places it in the "dangerous
substance"; (2)
pragmatically, the alcoholism paradigm
emphasizes treatment whereas the
illicit-drug paradigm emphasizes enforcing the
tabu; (3) morally, the
alcoholism paradigm offers a measure of
exculpation whereas the illicit-drug
paradigm leaves the stigma of addiction
virtually unmitigated. As I have
noted already, the crucial social fact defining
and dividing these contrasting
social control paradigms is the moral valence
placed on the substance itself:
alcohol's post-Repeal definition as a relatively
benign and mildly enjoyable
"social condiment" (Haggard and Jellinek, 1942)
(save for the
unfortunate few) made possible the development
of a social control system very
different from that constructed for illicit
drugs. These two distinctively
different and separate social control systems,
each with its seeming coherence
and integrity, may be said broadly to represent
the initial state from which
the merging trend in alcohol and drug-related
social control recently
commenced.
I
Notions
of merger come at an historical moment when the
country also seems to be
experiencing a lessening permissiveness, or a
"new temperance," in
both attitudes and behaviors with regard to
alcohol and illicit drugs.
Alcohol consumption has been in a slow decline
for more than a decade,
following nearly two decades of increase from
1962-1980. Alcohol-related
mortality rates fell between 1979 and 1988
(Stinson and DeBakey, 1992).
Survey data indicate that the same levels of
drinking elicit considerably more
social friction in 1990 than in 1984 (Room et
al., 1991). Illicit drug
use has also been in decline since the late
1970s (Harrison, 1992), perhaps
more sharply than alcohol use. Public
notice of these new shifts began
cropping-up in the mass media in the mid-1980s
and by now -- though Heath
(1987) has expressed reservations that a
meaningful change is afoot --
impressions of a new "cultural climate" around
alcohol and illicit
drugs have become "a commonplace" (Room, 1991).
The
relationship between the "new temperance" drift
and the
alcohol/illicit drugs merging tendency is
notable. Alcohol's symbolic
definition appears to be moving toward that of
drugs. Drugs on the other
hand, seem also to be moving toward greater
proscriptiveness, and perhaps even
more markedly than alcohol. Therefore, negative
sentiment -- though it may be
increasing for both alcohol and drugs -- may not
be in fact converging.
Yet a purely linear conception of changing
popular sentiment regarding either
alcohol and drugs is simplistic. The
prevailing sensibility seems roughly
that alcohol is somewhat too legal whereas
drugs, on the other hand, are
somewhat too illegal. The reasons for
these two tendencies differ.
Alcohol is being re-problematized. The
enforcement dimensions of the
"War on Drugs," on the other hand, have become
regarded as too heavy
a burden for the nation to bear.
Therefore, whereas alcohol's symbolic
definition seems to be drifting toward illicit
drugs, the drift associated with
illicit drugs -- toward the enhancement of
"demand reduction,"
"prevention," and "treatment" -- is driven by
economic and
pragmatic considerations. Yet the alcohol
side of the merging trend is
not without its economic motives as well.
For example, the flood of new
funding for drug problems that devolved from the
1986 and 1988 "War on
Drugs" legislation moved the alcohol field to
stress alcohol's
fundamentally drug character. In effect, alcohol
attempted to ride the
coattails of a boon in anti-drug funding.
Though
drug legalization has enjoyed renewed interest
in the great drug debate, the
current anti-drug drift in popular sentiment
augurs against this
likelihood. On the alcohol side, alcohol's
re-problematization has
evidenced a complex and intriguing character and
history. The fundamental
dilemmas are these: prohibition will not
return to alcohol -- the
country's recollection and image of the great
experiment are too fresh and too
negative, even despite a current, revisionist
trend in prohibition's
historiography (see Weisberger, 1990). At
the same time, alcohol's
re-problematization seems to be straining at the
symbolic boundaries of
licitness, thus giving rise to a hazy symbolic
and policy territory lying
between licit and illicit. In symbolic
terms, a new social control agenda
is asking both (1) what are the limits of
degrading alcohol's licitness while
conceding that alcohol will remain licit, and
(2) how can the social handling
of illicit drugs be pushed in a more preventive
and treatment-oriented
direction -- i.e., toward greater symbolic
benevolence -- as popular sentiment
continues in a trend toward a greater negative
valence on drugs?
II
It
may be noted that there is a big symbolic divide
between licit and illicit,
legal and illegal. The sociocultural grant
of licitness brings with it
broad and important rights, as the designation
of illicitness brings equally
broad and important controlling
potentials. Legal vs. illegal is a
fundamentally dichotomous social structural
fact: the commodity is either
legal or illegal, the prisoner is either guilty
or not guilty. A great
deal may hang on whether the plastic sandwich
bag that the police discover in
your car's trunk contains oregano or marijuana,
talcum powder or cocaine.
There is, in this formal sense, no middle ground
between a matter that is
assigned to the province of the
legal/police/criminal justice realm and one
that is not thus assigned.
The
broad symbolic significance and power of the
formal licitness is visible in a
number of ways. When, for example,
pro-beverage interests argue against
further restrictions on alcohol advertising, the
point may be made that
imposing special limits on alcohol's advertising
is incompatible with its licit
status. In U.S. House of Representatives'
hearings on alcohol and tobacco
advertising and marketing in 1990, Dan Jaffe,
representing the Association of
National Advertisers, argued that, "If a product
can be legally purchased
and used by every segment of the adult
population, then society should not
create 'second class' citizenship with regard to
commercial speech about that
product" (quoted in Alcoholism Report
18[8]:6, 1990). Similar
rhetorical motifs occur with respect to
earmarked or increased taxation,
abstinence-oriented prevention education, and so
on. In each case,
licitness symbolically lodges alcohol in a broad
class of socially sanctioned
commerical objects -- thus affording
pro-beverage interests the rhetorical
leverage of both a claim to symbolic legitimacy
by virtue of commercial
legitimacy and a claim to the right to parity or
equitable treatment with
respect to other licit commodities.
III
If
the alcohol/drug merging trend were to continue,
four merging scenarios suggest
themselves: (1) a shift toward the
"drug-ification" of alcohol
problems, (2) a shift toward the
"alcoholization" of drug problems,
(3) the emergence of some sort of
moral/pragmatic middle ground, defined by
melding the two domains' social paradigms, or
(4) the development of a new social
paradigm whose structure somehow redefined and
accommodated the requirements of
both formerly distinct problem areas.
The "new paradigm" option has come forward in
the broad idiom of a
"public health" model or approach. The
significance and prospects
of this paradigm are difficult to assess at this
point (see Beauchamp, 1990;
Erickson, 1990; and Mason et al., 1992 for good
articulations of this new
perspective). One reason is that it has
been presented in several
different and even incompatible forms: as
a classic
agent-host-environment model, as a risk-factor
model, as a demand-reduction
model, as a "problem-minimization" model, as a
single-distributionist
model, as a community organization model,
etc. This sort of multiplicity
of conception is not surprising, coming at a
time of seeming ferment and change
in the field. Moreover, as Christie and
Bruun (1969) sagely pointed out
many years ago, multiple and fuzzy meanings may
well be one of the assets and
even requirements of viable social problems
paradigms, given that such
paradigms must serve to integrate thought,
feeling, and action across many
institutional planes, diverse interest groups,
and changing historical
circumstances.
Yet, and despite this new paradigm's legitimate
claim to offering a (several?)
new conceptual frameworks for understanding and
responding to society's
substance-abuse problems, the public health
paradigm's major pragmatic
implications seem to date merely to devolve back
to the drug-alcohol merging
options (1)-(3) (see above) -- i.e., by
"drug-ifying" alcohol,
alcoholizing drugs, or somehow averaging the two
domains. So far, at
least, the public health idiom has been employed
primarily (a) to promote a
re-problematization of alcohol and alcohol use,
(b) to de-emphasize punitive
approaches to drug problems (favoring instead
preventive and treatment
efforts), and (c) to promote a general emphasis
on primary prevention with
respect to both alcohol and drug problems,
particularly focusing on
youth. It follows, therefore, that even
from within the new conceptual
offerings of a public health approach, the
current merging trend can rely on
little more than a melding or averaging of the
alcohol and drug domains in
defining policy design.
IV
Can
the alcohol and drug arenas truly be merged or
melded given their formerly
sharply different symbolic definitions, or can a
socially meaningful
"average" be defined between them? Or does
the symbolic plane
not lend itself to averaging? More than one sort
of response is possible.
Advocates of the new public health idiom have,
for example, tended to downplay
or reject the moral/symbolic dimension.
This disposition is nicely
reflected in the often heard public-health
argument that (licit) alcohol and
tobacco impose far greater tolls of death,
sickness, and disruption for society
than do (illicit) heroin, cocaine, and
marijuana. The central rhetorical
value of this contrast is that it frames and
advocates an ostensibly more
"rational" and objectivist approach to setting
society's "substance
abuse" problem priorities. Society
misjudges the comparative
suffering and social costs of licit and illicit
substances, the argument
suggests, because it is mislead by irrational
factors. That heroin, say,
may have acquired a symbolic definition -- for
whatever reasons -- that makes
its use and users more threatening and loathsome
than the three-pack-a-day
cigarette consumer is utterly disregarded in
this formulation. So also is
the symbolic significance of the licit/illicit
divide. Indeed, the
licit/illicit divide seems reduced the status of
an arbitrary and archaic
holdover from a bygone mentality.
Nothing
seemingly stops society from shortening the
symbolic distance between illicit
drugs and licit alcohol by simply making it
tougher to produce, sell, buy,
consume alcohol. These approaches are
evidenced nowadays in a great
variety of strategies that both promote and
devolve from alcohol's
re-problematization: for example, limiting
or reducing the number alcohol
sales outlets, reducing days/hours of sale,
restricting advertising, increasing
tax levels, raising minimum age, imposing
warning labels, and even monitoring
the use of alcohol in entertainment media such
as television. The irony
of these control measures is that though they
may be justified and explained in
terms of an abstract, statistical relationship
between (say) per capita alcohol
consumption and society's burden of
alcohol-related problems, they are more
likely to be embraced because they provide
valuable and ostensibly authoritative
ammunition in the symbolic redefinition of
alcohol, alcohol producers, alcohol
sellers, and even alcohol users. What is
offered as a technical
contribution is embraced for its symbolic
utility.
There
are, it seems to me, at least two drawbacks to
this alcohol-re-problematizing
approach. First, the various control
measures themselves afford society
no clear sense of their theoretical
limits. If public health
considerations were absolutely to govern the
degree, manner, and subsequent enforcement
of these control measures, would hours of sale
go to zero, or taxes go to
infinity, or outlets to nil, etc.? If
alcohol is a "risk
factor" with respect to a great many illnesses,
injuries, and causes of
death, is the best level of alcohol consumption
no alcohol consumption at
all? And if alcohol in the hands of
television actors legitimizes and
glamorizes alcohol to youth, should alcohol be
flatly prohibited from appearing
on television? Public health advocates
might readily concede that these
objectives go too far. My point, however,
is that the logic of such
advocacy does not convey what the theoretical
limits to control should
be. One byproduct of the absence of
theoretical limitation is that such
measures are readily equated with a
temperance-like or prohibitionist objective
for public policy.
The
second drawback is that the symbolic character
and symbolic consequences of
alcohol's re-problematization are in effect
dismissed or rendered nil.
Who hears anymore of the competing (and
antagonistic) "cultural
integrationist model" in the explanation of
aggregate level
alcohol-related problems? If, for example,
re-problematizing alcohol were
to undercut alcoholism treatment's symbolic
legitimacy, would anybody
care? Is such a concern a "technical"
matter that belongs in
the discussion when hours of sale or taxation
levels are up for debate?
The champions of the modern alcoholism movement
regarded themselves as having
fought a long and important cultural battle on
behalf of improving alcoholic's
social standing and moral definition. If
their advocacy and social
accomplishment (Schneider, 1978) is in effect
degraded by the current public
health paradigm, does that sort of symbolic
"correlation" belong in
the political forum? A prevention
enterprise aimed at alcohol-related
problems cannot be regarded in quite the same
terms as, say, a prevention
enterprise aimed at reducing heart
disease. An HMO's (say) new heart
prevention effort may simply be regarded as a
welcome addition to heart-related
services -- save in minor ways, the promotion of
prevention would not
equivalently imply the symbolic degrading of
direct treatment. Not so
regarding alcohol-problems prevention: if
society's duty to proffer
alcoholism treatment is linked to the prevailing
moral valence on alcohol, per
se, then re-problematizing alcohol implies also
marginally reducing society's
duty to provide alcoholism treatment.
V
The
general territory defined by alcohol-related or
drug-related problems
comprehends a great host of included problems --
call these
"subproblems" -- thus allowing advocates and
researchers in a social
problems arena the flexibility to shift their
gaze from one subproblem to
another as circumstances may warrant. Such
"subproblem shifts" may
involve new attention to new problem categories,
to new circumstances, or to
new categories of victims. As it happens, the
recent trend toward
re-problematization of alcohol has involved a
number of subproblem shifts.
These, to the extent they have lessened the
symbolic distance between alcohol
and illicit drugs, have figured in the current
tendency toward merger. In other
words, one of the mediums through which the
symbolic distance between the
alcohol- and drug-problems domains have been
reduced is a shifting gaze with
respect particularly to alcohol-related
subproblems.
Four
subproblem shifts particularly have
characterized recent history: (1) to drunk
driving, (2) to fetal alcohol syndrome (FAS),
(3) to youth, and (4) to criminal
justice populations. All four cases
involve a re-emphasis on alcohol, per
se, (not alcoholism); all four also reflect
problem areas where the alcoholism
paradigm's utility is limited; drunk driving and
FAS define victims other than
the drinker him/herself, thus evoking social
responses on behalf of the victim's
protection; all four may also be said to involve
statuses in which abstinence
from both alcohol and illicit drugs is the ideal
norm. To the extent that
the alcohol problems domain has becomes
preoccupied with these four subproblems
particularly, the wider alcohol arena is
commensurately better suited to nudge
alcohol's symbolic definition in the direction
of illicit drugs.
VI
The
modern alcoholism movement sought the
improvement of the alcoholic's social
standing -- which, perhaps inadvertently, also
helped redefine alcohol
itself. Now -- and for the past decade or
so -- alcohol has been
undergoing a process of re-problematization. Why
did the domesticating
inclination of the modern alcoholism movement in
turn give way to the
re-problematizing drift of a "new temperance"
shift in
sentiment? Has a new linkage of alcohol
with drugs served as a symbolic
medium and instrumentality for the alcohol
re-problematizing tendency?
How will the historians and sociologists of the
future explain this remarkable,
and unexpected, shift of American sentiment and
conceptualization? The
literature on the new temperance has cited a
number of factors: the growth of
healthism, consumerism, the new conservatism of
the 1980s, the seemingly
self-destructive tendencies of the modern
alcoholism paradigm (Roman, 1991),
the emergence of polydrug abusers, the emergence
of the parents movement, the
growth of criminal justice alcoholism treatment
clients, the development of the
public health perspective, the development of a
federal preoccupation with
prevention, and more. I should like to note two
background factors that have
undoubtedly contributed to the current
shift: the freestanding character
of the alcohol problems field after over the
post-Repeal period and the remarkable
persistence of a substantial abstaining and very
infrequently drinking segment
of the U.S. population over the same period.
Although
the rhetoric of the modern alcoholism movement
was ostensibly committed to
integrating the treatment of alcoholism into the
mainstream of American
medicine -- a rhetorical corollary of the
"disease conception" -- in
fact the treatment system that emerged in the
nation was instead freestanding
and primarily nonmedical in character.
What first evolved in the nation
was a treatment system divided between a
voluntary, self-help wing and a
parallel, publicly financed wing employing the
same basic conceptual paradigm
and treatment approach but applying these to
alcoholics who had one way or
another disdained, avoided, or failed AA's
program in the past. The
freestanding character of the alcohol arena, in
turn, implied that a resurgence
of dry sentiment across the country -- whether
in the form of a grassroots
movement or a campaign urged on by public health
professionals -- would find a
social arena in which to articulate their
perspective and advance their action
agenda.
Although
the modern alcoholism movement's paradigm
provided the rhetorical/conceptual
basis for de-problematizing or domesticating
beverage alcohol, in fact the
nation's population subgroups of abstainers and
infrequent or light drinkers
remained remarkably unchanged in the years and
decades following Repeal.
When Riley and his colleagues conducted the
first survey of drinking patterns
in the national population in 1946 (Riley and
Marden, 1947), they found that
35% of the adult population abstained and
another 13% drank less often than
once a month -- a total of 48% either abstained
or drank less than
monthly. When Cahalan et al. (1969)
conducted their national survey in
the mid-1960s, their findings were virtually
identical to Riley's: 32%
abstained and 15% drank less than monthly -- or
47% either abstained or drank
less than monthly. Much the same pattern
were observed in the several
surveys conducted in national population over
the course of the 1970s and 1980s
(see Hilton, 1991:126-128). In 1990, the
most recent year for which
national survey data are available, 35%
abstained and 17% drank less than
monthly (Bocian, 1993) -- or 52% either
abstained or drank less than monthly.
In
short, the long sweep of such findings suggests
a national population divided
roughly equally between abstainers and
infrequent drinkers, on the one hand,
and a broad array of more frequent drinkers, on
the other. Though the
nation's apparent per capita consumption of
alcohol has enjoyed periods of
unchanged constancy (1946-1961), gone up
(1962-1980), and gone down (1981-1990)
over the historical period covered by modern
national surveys, changes in
consumption are due primarily to variations in
the consumption practices of
more frequent drinkers and not due to either
great expansions or great
contractions in the nation's proportions of
abstainers and infrequent
drinkers. The country has never become
"wettened" in either
popular sentiment or behavior in the sense that
more frequent drinking -- here,
defined very broadly to include drinking "at
least once a month" and
more frequently -- has expanded greatly beyond
roughly half the national adult
population. Aside from its significance as
a measure of the remarkable
stability of the nation's abstaining and
infrequently drinking population
segment, these findings suggest that about half
of the U.S. adult population
would be inconvenience little or not at all were
alcohol controls greatly
increased. It remains to be seen how a
newly re-politicized
alcohol-and-drugs-limiting campaign would play
out in this semi-arid clime.
1"National Drug
and Alcohol Treatment Utilization Survey"
(NDATUS) data show remarkable
growth in combined alcohol/drug treatment
facilities between 1982 and 1992:
combined alcohol/drug facilities rose from 26%
of all facilities (i.e., 74% of
all facilities offered either alcohol-specific
or drug-specific treatment but
not combined treatment) in 1982 to 76% of all
facilities in 1990; combined
facilities saw a six-fold increase in absolute
numbers of clients seen
1982-1992 (from 83,677 to 508,789) whereas
alcohol-only facilities underwent a
significant decline in clients (from 199,492 to
132,493) over the same period
(from Schmidt and Weisner, 1993:Table III, p.
381).
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