" In addition, many anthropologists have agreed that "cultural expectations define the ways in which drinking, both normal and abnormal, is done in a society" (Mandelbaum 1965: 288) (Wilcox, 1998). Comparisons of drinking behavior patterns across cultures suggest that, "like all other behaviors in any given cultural system, were based on cultural expectations. Who drank and when and how much they drank was determined by custom" (Wilcox, 1998). For example, in Ireland, where alcoholism is a major problem, alcohol use is frowned upon yet considered "a good man's failing." As in America, use is prohibited until age 21; most drinking occurs in bars rather than the home. In contrast, there is very little alcoholism in Italy. In that country, drinking with meals is ubiquitous and common even among children; however, intoxication is viewed negatively. (Vaillant, Hiller-Sturmhofel, & Susanne, 1996) One might argue that Italian children view alcohol no differently than any other kind of food or beverage -- it's healthy as long as it's consumed in moderation. This early introduction might result in a "comfort" with alcohol that minimizes temptations to overindulge. This leads into a very interesting phenomenon relating to alcohol abuse; one societal influence that appears to have a profound effect on rates of alcoholism is ambivalence. When ambivalence about alcohol use exists within a culture, it takes on a "naughty" feel that contributes to the "high"; it causes the user to become secretive and obsessed about its use, and leads to a potent "love-hate" relationship with the drug that is more likely to take over the life of the user. Fascinatingly, in cultures where alcohol use has no ambivalence or fear tied to its use, these cases of obsession leading to abuse are few and far between. (Chafetz & Demone, 1962) in other words, the fact that alcohol use in America is both accepted and encouraged, as well as frowned upon and feared, makes it all the more likely to become a problem. For example, in the Arctic Eskimo Aleut culture, alcohol use has been common since its introduction by Russians beginning in the eighteenth century. But alcoholism among the Aleuts was virtually nonexistent, until the 1960s. Before that, while the Aleuts had mild concerns about the effects of drinking to excess (in terms of noise and damage or injury to self or property), their general attitude was devoid of guilt or ambivalence. However, as some American teachers who chastised alcohol use became incorporated into Aleut society, attitudes began to change. (Chafetz & Demone, 1962) as one researcher stated in 1962: "This attitude, if accepted by the Aleuts, may lead to feelings of resentment, fear, and shame, ultimately creating unfavorable group attitudes of ambivalence and guilt, and thus opening one of the doors to alcoholism (Chafetz & Demone, 1962) and in fact, just a decade later, another study found "alcoholism to be the most prevalent mental disorder in all the Native groups and to have a special prominence among Athabascan Indians and Aleuts" (Spiegler, 1993). In summary, the human brain doesn't handle ambivalence well; psychologists call this phenomenon "cognitive dissonance." (Palijan, Kovacevic, Drazen, Kovac, Turcinovic, & Medak, 2007) People feel guilty and conflicted when they drink, particularly to excess; one way to numb these uncomfortable feelings is by drinking even more.

In addition, alcoholics struggle daily with a set of beliefs known as "alcoholic thinking (Wilcox, 1998)." Among AA members, these thought processes are taken very seriously and are often considered the main underlying cause of the problem. Overall, these alcoholics believe "alcoholic thinking" is what led them to view alcohol use as "desirable, then necessary, and eventually an inevitable part of their existence." (Wilcox, 1998) in very generalized terms, some beliefs, behavior patterns, and destructive thinking typical among alcoholics include: a desire to be people pleasers, a sense of hopelessness, powerlessness, fear, anger in response to fear, an inability to let go of resentments, and self-centeredness (Wilcox, 1998). Certainly these are all character traits and emotional issues that can be successfully addressed and treated through some form of therapy (like AA), or a combination of therapy and medication. Whatever genetic component exists in alcoholism, it is no match for the power of human will.

Other psychotherapeutic treatment options for alcohol abuse include family therapy, individual therapy, and professional interventions involving family and friends. Even Behavioral Couples Therapy (BCT) for alcoholism is gaining ground as an effective treatment, since many marital issues and dynamics can exascerbate and "enable" the problem. Some of the marital behaviors associated with homes having at least one alcoholic partner include "poor communication and problem solving, ineffective arguing habits, financial...

In addition, studies of emotional transmission between couples indicate that "distressed couples show more reciprocation of negative affect"; in other words, negative interactions between husbands and wives can become a downward spiral, with alcoholism being a major complicating factor (Larson & Almeida, 1999). Of course, there are also far-reaching effects for any children in the home. (Fals-Stewart, O'Farrell, Birchler, Cordova, & Kelley, 2005)
In many cases, alcoholism is complicated further because it coexists, or is comorbid with, other psychological or medical disorders. Examples include anxiety and mood disorders, anti-social personality disorder (ASPD), bipolar disorder, panic disorders, post-traumatic stress disorder (PTSD), and even schizophrenia. (Shivani, Goldsmith, & Anthenelli, 2002) These are often "chicken or egg" cases; doctors find it difficult to tease out which came first -- the alcohol abuse or the mental illness. Certainly, it has been proven that alcoholism can cause any of these disorders as a result of its damaging effects and nutrition depletion; and it's easy to imagine that someone suffering from mental illness will be more likely to drink to excess. The question on a case by case basis is: what needs to be treated as the primary root or underlying cause? Often, successful treatment means a combination of approached designed to address multiple causes. (Rosenthal, 2003)

In these cases, treatment with one of the many psychoactive prescription drugs available today can prove highly effective, especially if combined with other forms of interpersonal therapy or counseling. (Berkow & al, 1997) Medical treatment for alcoholism can also come in other forms. Once the disease has taken hold, a myriad of other health problems necessarily follow; yet there are many treatments available to prevent, slow, or cure these effects. Some examples include intravenous doses of vitamins (especially thiamine, which is destroyed by alcohol), nutrition counseling, and administration of drugs that affect the metabolism of alcohol in the body. One of these is Antabuse (disulfuram). This drug causes one metabolite of alcohol, acetaldehyde, to build up in the system and leads to painful headache, elevated heart rate, rapid breathing, facial flushing, sweating, nausea, and vomiting. These effects are so unpleasant that most people will not even risk drinking the small amount of alcohol found in over the counter cough syrups. (Berkow & al, 1997)

Educational and government interventions can also have an effect on attitudes toward alcohol and its abuse. Such measures might include raising the minimum legal drinking age, introducing required informational and drug abuse resistance programs to schools and workplaces, enforcing zero-tolerance laws for drinking and driving, requiring statistical warning labels on products containing alcohol, and imposing alcohol taxes. (Wilcox, 1998) (Chafetz & Demone, 1962) Interestingly, not one of these measures would be considered wise by someone supporting the idea of "ambivalence" as a major contributing factor in alcoholism. These people would argue that it's more of an "ignore it and it will go away" type issue. This approach makes a lot of sense psychologically; further experiments are required to prove its effectiveness in America. In Portugal, for example, all drugs have recently been decriminalized, and this radical change in attitude and policy has indeed resulted in a reduction in all forms of drug abuse, including alcoholism. (Szalavitz, 2009) Why should this not work in America as well?

There are countless studies and everyday examples of the ways in which alcoholism is bred by societal beliefs and behaviors. While anyone can argue that there is a genetic component, as studies on idential twins have proven (PDX, 2010), it is clear from further investigation that alcohol abuse must be treated as a contagious, curable disease if society is to have any hope of conquering this devastating epidemic. Effective treatments range from group therapies such as BCT and AA, to medicines designed to affect alcohol metabolism and make the user violently ill, to psychotropic prescription medicines that alter brain chemistry and help with comorbid mental illness and emotional issues. Above all, doctors and alcoholics themselves need to recognize that it is a highly complex, individualized disease and addiction. Making sweeping generalizations about causes and treatments will benefit no one.

Ironically, some of the most compelling arguments for successful prevention and treatment support changing societal beliefs and laws to become "neutral" to alcohol use, rather than more prohibitive. Portugal is the only modern country that…