Alcohol Use and Abuse:
The Social and Health Effects

Reports and Recommendations by The Presbyterian Church (U.S.A.)
198th General Assembly (1986)

Policy Statement and Recommendations

Alcohol use is deeply embedded in the customs and practices of our society and, consequently, the dangers of this drug are frequently overlooked or underestimated. Yet the adverse effects of alcohol abuse are universal, touching the lives of all. Alcohol consumption is a contributing factor in up to 200,000 deaths per year, and the combined social costs of alcoholic beverage purchases and the losses and damages resulting from their consumption now approach $200 billion annually in the United States alone.

As Christians, we are concerned for the health and wholeness (Shalom) of all God's people. Alcohol consumption is a leading causal factor in the impairment and destruction of life, health, relationships, and resources. The suffering associated with alcohol abuse is by no means restricted to a minority of persons diagnosable as "alcoholic" but touches the lives of all God's people.

Alcohol-related problems are complex, arising from a combination of the characteristics of (1) the drug itself, (2) the drinkers, and (3) the social context of alcohol use. All of these factors must be considered in understanding and addressing these problems, and approaches that restrict their focus to only one of these causal elements are limiting and inadequate.

The General Assembly of the Presbyterian Church (U.S.A.) does not advocate the prohibition of alcohol, a policy which would appear to attribute the entire problem to alcohol itself. Responsible and non-problematic uses of alcohol have been part of human experience and the Judeo-Christian heritage since the beginning of recorded history. The considerable risks and immense suffering that follow from excessive and unwise uses of alcohol do, however, impose upon all Christians individually and corporately, the responsibility to make and encourage judicious and well-informed choices regarding personal and social uses of alcohol.

To that end, the General Assembly encourages and supports personal decision to abstain from alcohol. For those who choose to drink and can do so without becoming dependent, the General Assembly urges a pattern of moderate and responsible drinking behavior. Finally, the General Assembly recommends and supports a comprehensive public policy approach to regulate the availability and use of alcohol in a manner consistent with its special character and the potential risk to persons and society inherent in its use and it continues to recommend and support appropriate treatment of all who are affected by alcohol-related problems.

The following general principles should guide these personal and corporate choices about the use of alcohol and the formation of public policy to regulate the use of alcohol and limit its harmful consequences.

1. Abstention in all situations should be supported and encouraged.
2. Moderate drinking in low-risk situations should not be opposed.
3. Heavy drinking in any situation should be vigorously discouraged.
4. Any drinking in high-risk situations (e.g., during pregnancy or before driving an automobile) should be vigorously discouraged as should all illegal drinking.
5. Actions to protect the general public from the effects of alcohol-related problems (e.g., alternative transportation) should be supported and encouraged.
6. Effective public policy measures designed to make alcohol less readily available and less attractive, particularly to vulnerable groups or in high-risk situations, should be encouraged and supported.
7. A combination of prevention and control measures with a variety of treatment approaches should be encouraged and supported to deal with alcohol-related problems and treat alcohol abusers and addicts.
8. All Christians, and hopefully all citizens, should model responsible choice in their own use or nonuse of alcohol, in their behavior as hosts or participants in social and business functions, and in their support of public policies that regulate the use of alcohol and limit its harmful consequences.

The position and recommendations that follow—for individual Presbyterians, for governing bodies of the church, for agencies and seminaries, and for public policy directions—are based on these principles and on the conviction that the social and health effects of alcohol use and abuse constitute a major challenge to Christian compassion and commitment and a serious threat to the vitality and character of the society.

Recommendations for Action by Individual Presbyterians

Individual Presbyterians are urged to make for themselves and to encourage in others conscious responsible choices regarding the use and nonuse of alcohol. Abstention from the use of alcohol is a healthful and responsible choice to be encouraged and supported. For those who choose to drink, moderate responsible choice means refraining from the consumption of alcohol in amounts or situations where such use would incur harm or risk of harm to the health and wholeness of themselves or others. Responsible choice requires care that one's practices and influence do not facilitate or encourage irresponsible use in others. It also requires encouragement and support for public policy efforts to regulate the use of alcohol and address alcohol-related problems. At minimum, responsible choice means:

1. To refrain from driving after alcohol consumption in any amount that would leave alcohol in the bloodstream.
2. To provide a personal model of responsible choices regarding the use and nonuse of alcohol, refraining from excessive consumption of alcohol in all situations and from any drinking in all situations where even modest consumption of alcohol is hazardous (including during pregnancy).
3. To avoid enabling hazardous drinking in others by adopting hosting practices that encourage responsible choices in the use and nonuse of alcohol.
4. To express concern about practices and attitudes that glamorize alcohol or promote alcohol abuse in the workplace, the church, social settings, media programming, and advertising, and to speak out in concern against intoxication in others.
5. To be informed about signs of emerging alcohol problems and alert to their appearance in the lives of others, and to have the courage to express concern and take action when such signs are noted.
6. To provide for young people, by teaching and example, clear and specific guidelines regarding responsible choices in the use and nonuse of alcohol.
7. To help develop and support effective public policy to prevent and address alcohol abuse, including communication with appropriate elected representatives at every level of government about social policy issues regarding alcohol.
8. To join in continuing community efforts designed to counteract alcohol abuse through organizations dedicated to the prevention and treatment of alcohol problems.
9. To be aware that drinking for the purpose of achieving alcohol's drug effects can lead to abuse and dependency.

1. Requests each congregation of the Presbyterian Church (U.S.A.) to consider implementing, preferably in the 1987-1988 program year, the program strategy model prepared for the Program Agency and the General Assembly Mission Board by a churchwide staff team. The model involves pastor, session, and congregation in a congregation-wide address to alcohol-related problems as they affect persons and the community.
2. Further requests congregations, governing bodies, agencies, and church-related institutions, as appropriate:
   1. To organize and provide educational opportunities, using study resources provided by governing bodies, denominational agencies, and others.
   2. To adopt clear policies regarding responsible beverage choices at church-related functions, including worship, meetings, and social gatherings on or off church property and adopt a clear policy regarding use and nonuse of alcohol on church property by outside groups.
   3. To develop and implement a specific educational strategy to promote conscious choice about the use or nonuse of alcohol and develop guidelines for responsible practice for those who choose to drink or serve alcoholic beverages.
   4. To adopt and implement employee assistance policies and practices to deal with alcohol-related problems among clergy and other salaried staff, and to provide adequate health care provisions to enable effective care of employees suffering from alcohol abuse or addiction.
   5. To support and collaborate in national, regional, and ecumenical efforts to prevent and address alcohol problems.
   6. To participate in the development and advocacy of public policy addressing issues of alcohol promotion, availability, and pricing as appropriate to the various jurisdictions of local, regional, state, or federal governments.
   7. To participate in ministries to victims of alcohol problems by helping them to obtain appropriate community services and by providing a larger context of support for more responsible future choices in the use and nonuse of alcohol, assisting them in seeking employment, family harmony, spiritual growth, and physical and psychological health.
   8. To designate a particular person or committee the responsibility and accountability for policy and strategies addressing alcohol use and problems.
   9. To utilize opportunities for education and interpretation concerning responsible choice and dealing with the health and social effects of alcohol in organizations, meetings, and special events.
   10. To develop specific strategies for leadership training and development for pastors and lay leaders in alcohol problem prevention and intervention efforts.
   11. To communicate and coordinate efforts with other governing bodies and agencies of the church concerned with alcohol use and problems.
   12. To encourage candidates in training for ministry to seek specific preparation and experience to deal with alcohol-related problems.
   13. To commit sufficient financial resources and staff services to develop program and strategies to address alcohol-related issues and problems in the church and the community.

Recommendations Regarding Policy on the Use of Alcoholic Beverages at Church-Related Functions

A majority of Presbyterians do use alcohol in their personal lives, and the General Assembly affirms the right of individuals in conscience to make responsible choices between abstention and moderate nonproblematic use. Each governing body and agency of the church and institutions related to the church should also make conscious decisions regarding the responsible use and nonuse of alcohol at meetings and other formal and informal functions falling within its jurisdiction.

The General Assembly recommends the following policy guidelines:

1. Alcohol should not be purchased at church expense, except when authorized by a governing body for use in the Lord's Supper. Whenever wine is used in the Lord's Supper, unfermented grape juice should always be clearly identified and served also as an alternative for those who prefer it.
2. If alcoholic beverages are to be available at church-related meetings and functions at personal expense, the sponsoring body or group should ensure that:
   1. a. The beverages containing alcohol are served in a manner and quantity that promote intentional and responsible choices regarding personal use.
   2. Attractive nonalcoholic alternative beverages are available in ample quantities to encourage their use and that food is available as an accompaniment.
   3. No person under legal age is given access to alcohol.
   4. Transportation following the event does not depend upon the operation of private vehicles by individuals who have consumed alcohol.
   5. Persons who are visibly impaired or intoxicated from alcohol or other drugs are not served alcohol and are constrained from driving.
   6. This section is not to be construed as encouraging the availability of alcoholic beverages at church-related meetings and functions.
3. Alcohol consumption should not be the explicit or implicit purpose for any gathering, including informal private gatherings of those attending the meeting or function.

Recommendations Regarding Public Policy on the Pricing, Availability, and Promotion of Alcohol

One of the most effective controls on alcohol consumption and thus on its negative consequences is obtained through regulation of the price of alcoholic beverages. Social control over price is most readily accomplished through fair and equitable taxation of alcoholic beverages. With the exception of a single, modest increase on distilled spirits in 1985, federal excise taxes on alcohol have remained constant since 1951, with the effect of lowering its price relative to other beverages and increasing its availability to the general population. In addition, the alcohol in beer, wine, and distilled liquor is taxed at radically different rates: $6.44, $1.21, and $21.00 per gallon of alcohol content respectively. Effective and equitable increases in federal excise taxes on alcohol offer an immediate avenue for reducing alcohol-related problems by diminishing accessibility of alcohol, particularly to young people.

Tax Policy

1. Alcohol excise taxes should be substantially increased in phased steps over a reasonable period of time to achieve a rate of taxation at least commensurate with 1952 rates, adjusted for inflation.
2. Beer, wine, and distilled spirits should be taxed equally according to their absolute alcohol content.
3. Alcohol excise taxes should be indexed to adjust for future inflation.
4. All income tax deductions for business-related purchases of alcohol products should be ended.
5. The Department of Defense should end its discount pricing policies with regard to alcohol on military bases and terminate any connection between profits on the sale of alcohol and base recreation budgets.
6. All other tax and economic subsidies for the production and marketing of alcohol beverages should be identified and ended.

Availability Policy

The locations and conditions under which alcohol is available for sale and consumption have historically been regarded and controlled as matters for governmental jurisdiction. By making effective use of these controls, local and state jurisdictions can decrease the likelihood of excessive consumption and drinking in high-risk settings.

1. Communities, states, the federal government, and retail associations should work cooperatively to establish curriculum guidelines for model server and management training educational programs appropriate to specific community needs and specific business enterprises.
2. A thorough legislative review of Alcoholic Beverage Control (ABC) codes and the funding and operations of ABC agencies should be conducted.
3. Substantial power over the issuance, administration, and renewal of licenses to sell alcoholic beverages should be given to local governmental jurisdictions.
4. Application for a license to sell alcoholic beverages should require a special "environmental impact" review, wherein policies to reduce potential community injury and risks are proposed by the applicant.
5. Statewide provisions should be developed to promote reductions in environmental risks, including but not limited to mandatory server and manager training and elimination of drink promotions such as "happy hours."
6. The sale of alcohol through certain high-risk outlets, such as gas stations and drive-up windows, should be prohibited and should be strictly limited in other high-risk settings, such as convenience stores and mass event arenas.
7. The Model Alcoholic Beverage Retail Licensee Liability Act of 1985 (the "Dram Shop Act") should be enacted in each state.

Promotion Policy

The content and modes of promotion for the use of alcoholic beverages both reflect and influence public values and practices regarding alcohol. While billions are spent by manufacturers to promote their products, the public remains largely unaware of the well-documented risks associated with alcohol. The volume and content of alcohol promotion should be balanced by approximately equal attention to information about the risks associated with alcohol use and knowledge of the adverse consequences for personal and public health.

1. Federal legislation should be enacted requiring the electronic media to apply the equal time doctrine to alcohol advertising. This would mandate the airing of health messages, including those produced by independent health groups, on an equal time and placement basis with alcohol advertising.
2. The World Health Organization or other international body should establish a voluntary code for restraining the marketing of alcoholic beverages in developing nations, to be followed by transnational corporations and their affiliates.
3. Rotating health warnings regarding inappropriate uses of alcohol should be required on the labels of all alcohol products and in all non-electronic media alcohol advertisements.
4. Any product containing alcohol should be required to provide information on all ingredients so that those potentially allergic to alcohol will be adequately warned.
5. Federal legislation should be enacted to establish a special fund for public educational campaigns regarding alcohol, to be supported either from savings or income derived from changes in the tax laws or from a surcharge on all alcohol advertising billings.
6. The promotion of alcoholic beverages on college campuses and military bases should be prohibited.
7. Health messages designed to counteract alcohol use and abuse should depict and be addressed to a representative spectrum of individuals with regard to sex, age, and racial ethnic heritage.
8. Health messages should emphasize that alcohol is equally dangerous whether in beer, wine, or distilled spirits and that every individual is vulnerable to its harmful effects

Recommendations Regarding Public Policy on Alcohol Research and Treatment

Research

Public awareness of and knowledge about alcohol abuse has been limited and often inaccurate. Both public and professional knowledge are best advanced through the conduct and communication of well-conceived and designed research into the causes, prevention, and treatment of alcohol problems. According to 1982 statistics, $200 per cancer patient is spent on cancer research; $88 per heart patient is spent on research on cardiovascular disease; while only $2 per alcoholic is spent for research on alcohol-related problems.

1. Research regarding alcohol use and problems should be greatly increased and expanded, with a high priority given to appropriately designed studies of the impact of specific prevention and treatment strategies.
2. The research budget of the National Institute on Alcohol Abuse and Alcoholism should be doubled as soon as possible and steadily increased thereafter to promote and coordinate the conduct of critically needed research.
3. Grants in aid from denominational agencies and funds should be made available for the exploration of appropriate strategies to prevent and address alcohol abuse, and all funded studies should include explicit plans for how such strategies will be evaluated to determine their impact.
4. Provision should be made for the clear and rapid dissemination of relevant and applicable findings of past, current, and future research.

Treatment

Effective and compassionate care is the right of every person whose health has been impaired by alcohol. The extent and nature of such care should be guided by the best research knowledge available regarding the effective treatment of alcohol-related problems. A diversity of well-substantiated alternatives is most likely to serve the needs of the largest number of affected individuals.

1. State and local governments should ensure adequate funds to provide detoxification and treatment services for victims of alcohol problems who are unable to pay for such services.
2. In the interest of cost containment, the 1986 determination of a Diagnosis-Related Group (DRG) reimbursement policy for alcohol abuse treatment should reflect current research findings by providing at least equal reimbursement for nonresidential as for residential treatment, and insurance companies should be encouraged to adopt similar practices.
3. In the long-range planning of treatment services for a geographic region, priority consideration should be given to the provision of a range of different types of effective interventions rather than to duplication of similar programs in multiple settings.
4. The provision of all treatment services should include respect for and attention to the spiritual dimensions and needs of the individual.
5. Appropriate treatment should be made available within the criminal justice system to individuals suffering from alcohol problems. Efforts should be made to avoid overuse of the criminal justice system for public intoxicants when treatment would be the more appropriate option.
6. The special circumstances of women, older adults, and racial ethnic minority populations should be taken into account in the planning and provision of treatment services, to ensure that such services are accessible, acceptable, appropriate, and sensitive to their diverse needs.
7. Rehabilitation should be understood as concerned with more than the treatment of alcohol problems, since recovery and the prevention of relapse frequently require a larger stabilization of employment, relationships, psychological, spiritual, and physical health.
8. The needs and involvement of family members of those in treatment for alcohol problems should be recognized and addressed in the rehabilitation process.

General Assembly Actions

The Advisory Council on Church and Society submits the following report on The Social and Health Effects of Alcohol Use and Abuse and recommends that the 198th General Assembly (1986):

1. Adopt the policy statement and recommendations and commend the report, with background sections, appendixes, and related documents, for study and action in the church.
2. Direct the Office of the General Assembly and all agencies and councils of the General Assembly to implement the policies regarding the use of alcoholic beverages at church-related functions in the planning and conduct of all meetings and activities, including committees, task forces, and program events; and urge other governing bodies and congregations also to adopt these policies.
3. Direct the Stated Clerk of the General Assembly to transmit the policy statement and recommendations to members of Congress and appropriate officials of the Departments of Defense, Health and Human Services, and Treasury as well as the Internal Revenue Service, drawing attention to the recommendations relevant to these agencies.
4. Direct the Stated Clerk of the General Assembly also to transmit the report and recommendations to the governor of each state, drawing attention to sections relevant to the legislative and administrative authority of the states.
5. Request agencies and councils of the General Assembly as well as schools and institutions related to the General Assembly to review the report and its recommendations together with the implementation plan submitted by the Program Agency and General Assembly Mission Board in order to plan, implement, and fund an effective strategy for a churchwide response to the social and health effects of alcohol.

The full report, Alcohol Use and Abuse: The Social and Health Effects—Reports and Recommendations by the Presbyterian Church (U.S.A.), may be ordered from PDS, 500-87-001, $3.00.