The public response to excessive drinking has been a mix of two general approaches:
- Directly reduce drinking + restrict availability/raise prices
- Indirectly reduce drinking + increase availability
- Directly reduce drinking + lower price
- None of the above
- The “neo-prohibitionists”:
- Are comprised of economists, epidemiologists, and other scientists doing research on the causal effects of alcohol-control measures on drinking, abuse, and consequences
- Present the case that the price and availability of alcohol affect the amount of alcohol-related harm to society
- Both a and b
- Neither a or b
- During the 1930’s a new scientific understanding of alcoholism shifted the focus to:
- Alcohol itself
- Morality
- The small fraction of the population vulnerable to alcoholism
- None of the above
- Just like tobacco:
- A small increase in tax would have a small effect on the public health
- A large increase in tax would have a large effect on the public health
- Both a and b
- Neither a or b
- Prohibition or the 18th Amendment:
- Promoted a substantial reduction in drinking
- Was a political failure
- Was repealed by Constitutional Amendment
- All of the above
- Today, the American public is mostly drinking:
- Liquor
- Beer
- Wine
- All of the above equally
- The first internal revenue measure instituted by the 1st United States Congress was a tax on:
- Wages
- Liquor
- Land
- Tea
- The most politically effective organization working for Prohibition was:
- Alcoholics Anonymous
- Anti-Saloon League
- League of Women Voters
- Al-Anon
- The Volstead Act banned the ________________ of alcohol.
- Purchase
- Possession
- Consumption
- Manufacture and sale
- The economist Clark Warburton claimed that during Prohibition there was a reduction in he overall consumption of ethanol coupled with a substitution of liquor for beer based on :
- Agricultural sources
- Death rates from alcohol related causes of production
- Arrests for drunkenness
- All of the above
- Under the 21st amendment the states took the lead in regulating alcohol:
- Excise taxes
- Tax collection
- Distribution and sales
- Both a and b
- The co-founders of Alcoholics Anonymous were:
- Bill Wilson and Dr. Bob Smith
- Carl Jung and William James
- John D. Rockefeller Jr. and Pierre S. DuPont
- None of the above
- Jellinek reserved the disease label for those alcoholics:
- Who evidenced dependence by an inability to stop drinking once started
- Who had an inability to refrain from starting to drink
- Who practiced controlled drinking
- Both a and b
- A procedure reserved for those that require medical help to mitigate severe withdrawal symptoms is:
- Relapse prevention
- Detoxification
- Liver transplant
- None of the above
- Inpatient rehabilitation programs
- Are the most costly and highly structured
- Traditionally last 28 days
- Include group therapy, individual therapy, and education
- All of the above
- The alcoholism movement engendered a research program that:
- Seeks to identify individual characteristics that create susceptibility to alcohol problems
- Develop effective treatments
- Obtain federal funding
- Both a and b
- Quantification is essential to:
- Assessing the scope, pattern, and trends of drinking
- Evaluating particular interventions intended to reduce problematic drinking
- Both a and b
- Neither a or b
- 80 proof whiskey is:
- 8% alcohol
- 80% alcohol
- 40% alcohol
- 100% alcohol
- Problems with using tax records as the basis for estimating alcohol consumption include:
- No account of wastage
- Illicit production for sale (moonshine)
- Tourists
- All of the above
- Prudent users of survey data:
- Check data with other surveys, sales data, and other benchmarks
- Trust but verify
- Proceed with certainty in their data alone
- Both a and b
- People in _______ health are more likely to drink:
- Poor
- Fair
- Good
- All of the above
- The public health perspective attempts to:
- Distribute specific benefits to identified individuals
- Improve the level or rates of health among the entire population or specific groups
- Both a and b
- Neither a or b
- The sale of cold beer to drivers generates a ________ externality to the extent that it increases the chance that people who share the road with the beer buyer ( and drinker while driving) will collide with the buyer:
- Neutral
- Positive
- Negative
- Zero
- Self-control is a matter of:
- Willpower
- Experience
- Technique
- All of the above
- _____________ measures are aimed at reducing the harmful consequences of some unhealthy or unsafe activity
- Government regulation
- Harm reduction
- Public policy
- Abstinence
- The Cost of Illness (COI) method:
- Is the norm in government reports
- Distinguishes between direct costs and indirect costs resulting from loss of productivity
- Is implicitly based on the maximization of society’s present and future production
- All of the above
- Among the causes of death and disability associated with drinking, __________ disproportionally young adults
- Heart disease
- Cirrhosis of the liver
- Traffic accidents
- Brain damage
- The brewing industry actively supports a rollback of the 1990 excise tax increase to:
- Provide relief for the lower and middle classes
- Allow brewers and wholesalers to expand and hire more workers
- Boost the American economy
- All of the above
- An example of a harmful consequence of alcohol misuse beyond the reach of a targeted consequence oriented approach is:
- Organ damage from chronic excess drinking
- Drinking while driving
- Domestic violence
- Child abuse
- America is predominately a __________ drinking country.
- Beer
- Wine
- Liquor
- None of the above
- A surprising feature of government in the liquor trade is:
- 18 states continue to control wholesale distribution as a public monopoly
- 5 states monopolize the retail sale of package spirits
- Both a and b
- Neither a or b
- In recent years the U.S. Congress has set alcohol taxes:
- Far lower than previously
- Far higher than previously
- About the same as previously
- None of the above
- Unintended consequences of increased taxes and price include:
- Substitution from alcohol to other drugs
- Creation of a black market for alcohol
- Both a and b
- Neither a or b
- In youths the use of one illegal substance results in greater interest and opportunity to try other substances and is known as __________ phenomena:
- Co-op
- Either –Or
- Gateway
- Challenge
- In the public health framework an increase in alcohol taxes is justified by:
- A reduction in morbidity and mortality
- No decrease in overall employment
- Impact on alcohol industry products
- None of the above
- Alcohol control is:
- All or nothing
- A continuum of possibilities
- Both a and b
- Neither a or b
- Time, place, and circumstances:
- Include efforts to motivate people to refrain from drinking when it is likely to cause damage
- Matters are largely dealt with through counseling and private authority
- May require government authority for intervention in some areas
- All of the above
- In public opinion surveys, a large majority of the public indicate support for increasing alcohol taxes provided:
- The revenues be used for targeted and preventive programs or some other good use
- The revenues are a preventative measure in themselves
- The revenues go into the general fund for all to use
- None of the above
True or False Questions – 2 points each
- Mothers Against Drunk Drivers (MADD) has been an ineffective influence on policy change referencing drunk drivers.
- Throughout U.S. history there has been one standard in response to alcohol related issues.
- Prohibition proved to be a considerable disappointment to the public and the business community.
- In the U.S., public attention referencing alcohol related problems is primarily focused on drunk driving.
- A sizeable share of drinking deaths involves innocent bystanders.
- The evidence supporting the public health benefits of increased alcohol taxes is every bit as strong as for cigarette taxes.
- Drinkers as a group are less politically influential since they are less educated, poorer, and ambivalent.
- Prohibition was ended by the 22nd
- Alcohol taxes are imposed to generate revenue.
- Home production of wine and hard cider for personal use was allowed during Prohibition.
- The reformers and moralists were pleased with the results of Prohibition.
- The best measure of alcohol consumption is tax paid sales.
- After Repeal the federal government was more motivated and more successful in enforcing the tax law than enforcing the previous prohibition law.
- The alcoholism movement insisted that only a small is vulnerable.
- Heavy drinking is not enough evidence to make the diagnosis of an illness.
- The natural history of alcoholism was best documented by George Vaillant.
- Jellinek proposed that the interaction of individual susceptibility and the alcohol “wetness” of the environment determine the likelihood of individual alcoholism.
- Twin studies proved that a single gene shapes alcoholism risk.
- Alcoholism is the result of both individual and environmental determinants.
- Outpatient treatment services last 28 successive days and are highly structured.
- Motivational enhancement therapy seeks to strengthen the patient’s intrinsic motivation to change.
- There is no doubt about the efficacy of psychotherapy alone in helping alcoholics give up drinking.
- Brief counseling by a family physician has demonstrated to be effective in promoting more moderate drinking in patients.
- All treatment requires voluntary compliance by the drinker.
- Wines are fermented from the sugars in fruit, berries, and other sources.
- The distinctive ingredient in wine, beer, and distilled spirits is ethyl alcohol, also known as ethanol.
- Proof is simply twice the percentage of alcohol content by volume.
- Aggregate data for study is usually derived from tax records.
- The only practical means of obtaining information on individual consumption, and on drinking patterns within a group is by direct observation.
- Per the 2001 – 2002 NESARC, in the U.S. the top decile of the population consumes well over half the alcohol in any one year.
- Survey data indicates no differences in drinking patterns among population groups.
- Married people are more likely to binge drink than singles.
- Women attending school are associated with lower rates of drinking.
- Men drink more than women.
- The population distribution of consumption among those who drink follows a particular shape with a high concentration of total consumption at the upper tail.
- Government agencies are quick to intervene when a pregnant woman drinks too much and places her unborn baby at risk of being born with severe defects.
- In the public health view, the community interest is not just the sum of self-regarding individual interests.
- The effects on bystanders are called externalities.
- Self-control is not just a matter of willpower, but also experience and technique.
- Harm reduction measures benefit the drinkers themselves.
- Information provision is a coercive approach.
- Economists assume that the market cannot provide an accurate indication of the publics tradeoff between safety and money.
- For a life saved or a disability averted the community is viewed as paying without gain.
- Interventions that save younger lives tend to have a positive effect on the collective standard of living.
- The states have been in the business of taxing and regulating alcoholic beverages since repeal.
- The notion of drinking as a privilege rather than a right would be a hard sell to voters in the U.S.
- Enforcing DUI and criminal laws is a profitable enterprise.
- The revenue motive has remained paramount in federal and state tax policy.
- Higher prices and restrictive availability of alcoholic beverages reduce per capita consumption of ethanol.
Essay Questions – 50 points each
- Describe in detail the 6 assessment dimensions of the ASAM patient placement criteria. Discuss their impact on proper placement and treatment planning.
- Describe Al-Anon, its origins, history, foundations, and development. Detail the Al-Anon program of recovery, philosophy, how it works, and spin-off programs.
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- Describe in detail group therapy. Include a discussion of its curative factors, history, and processes. Note the various types of therapy groups and how they work.
- Describe in detail the Stages of Change denoting each stage and describing the paths and processes associated with this model and each stage.
- Compare Individual Counseling to Group Counseling treatment from a Motivational Interviewing standpoint. Note the implications and resultant effects after each form of treatment.