The International Journal of the Addictions. 27(10), 1241-1247, 1992
Research Note
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NIAAA and the New Epidemiology* Michael R. Nusbaumer’ and James D. Pierce2
‘ lndiana University-PurdueUniversity at Fort Wayne, Wayne, Indiana 46805
2101 Coliseum Boulevard East, Fort
*Park Center Inc.
ABSTRACT Utilizing data on the National Institute on Alcohol Abuse and Alcoholism’s research funding history, this inquiry assesses the level and nature of organizational support for a new epidemiology of alcohol misuse and its relationship to the Institute’s support for the disease model of alcohol problems.
Key words.
NIAAA; Epidemiology; Alcoholism
INTRODUCTION The passage of the Comprehensive Alcohol Abuse and Alcoholism Act of 1970 (P.L. 91-616) represented the first major coordinated effort by the federal government to address problems related to alcohol consumption since prohibition. The major thrust of the act was to formally establish the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Yet, more importantly in many respects, it clearly signalled federal recognition and acceptance of the disease model of alcohol problems (Wiener, 1981; Weiss, 1986). One stumbling block the NIAAA had to overcome in its support of the disease model was the widely held “skid row” stereotype of the alcohol misuser. This image typically portrayed these misusers as disaffiliated, derelict, *An earlier version of this paper was presented at the North Central Sociological Association 1990 Annual Meetings, Louisville, Kentucky. 1241
Copyright 01992 by Marcel Dekker, Inc.
Subst Use Misuse Downloaded from informahealthcare.com by UB Wuerzburg on 11/01/14 For personal use only.
1242
NUSBAUMER AND PIERCE
urban males who were unable and/or unwilling to control their drinking despite frequent encounters with the law (Cahalan, 1987; Wiseman, 1970). Such imagery tends to run counter to most disease conceptions of alcoholism however, in that diseases which have either a genetic and/or biologic etiology are unlikely to cluster in such social groupings. Rather, disease models of alcoholism tend to posit the occurrence of the disease in a very wide range of social groupings. In order to successfully gain wide acceptance of the alcoholism model, a new epidemiology with more consistent imagery had to be established and recognized (Roman, 1988; Roman and Blum, 1987). This new epidemiology reflected the view that essentially anyone from any social status or grouping could be suffering from the disease of alcoholism. The alcoholism model notwithstanding, the recognition of such a new epidemiology alone carries with it numerous implications for the management of alcohol misuse. Not only does this new epidemiology greatly expand the size of the problem population, but this in turn indicates the need to greatly expand treatment and intervention activities to service this enlarged population. Furthermore, this new epidemiology includes a large segment of people who have the financial potential to cover the costs of their own treatment. What role has the MAAA played in the development and support of this new epidemiology? Some evidence indicates that the NIAAA did play a key role in efforts to gain public acceptance of the new epidemiology, and these efforts seem closely linked to the alcoholism model. Yet empirical evidence for this role is lacking in the literature. Most attempts to substantiate the NIAAA’s role in this regard are based either upon issued policy statements, organizational structure, or public relations efforts typically focusing on a widely distributed-funded poster (Roman and Blum, 1987). While these types of activities may play a significant role in encouraging the general public to alter their drinking imagery, they are not the only bases for change. In a society where empirically based science represents the recognized source of authoritative fact, successfully altering conceptions of alcohol misuse requires reliance upon supporting empirical evidence. Given that the NIAAA has, since its inception, been the primary funding source for research dealing with alcohol consumption, what role has the MAAA played in funding empirical research that may support the new epidemiology, and what has been the relationship of this research to the disease model of alcohol misuse?
METHODS The NIAAA was not fully operational until fiscal 1972. In an attempt to ascertain some measure of the NIAAA’s funding activities related to epidemiologic concerns, this inquiry focuses upon the funding history of
Subst Use Misuse Downloaded from informahealthcare.com by UB Wuerzburg on 11/01/14 For personal use only.
NIAAA AND THE NEW EPIDEMIOLOGY
1243
extramural grants which deal with epidemiologic and descriptive research questions. The focus is upon extramural grants because they represent a markedly larger portion of the NIAAA’s overall research funding as well as research specifically addressing epidemiologic questions. * In addition, the current analysis concentrates only upon those grants that are considered to be psychosocial, as opposed to biomedical, in orientation. From 1980 to 1986, grants were considered psychosocial if they were routed through the psychosocia1 peer review panel. Prior to 1980 the NIAAA did not differentiate these types of grants, therefore grants were considered to be psychosocial if the titles of the grants were judged by two independent coders to be appropriate for this category. Data regarding funded grants were acquired directly through requests made to the NIAAA. Data were obtained on some 430 differently titled grants from 1972 to 1986. The duration of each of these grants is presented in Fig. 1. For the purposes of the present inquiry, multiyear grants were considered separate grants for each year they received funding, thus resulting in a total of 1,092 grants. Specific information collected on each grant included: the years the grant received funding, the amount of funds received each year, and the
143
1 Year Grants
2 Year
Grants
3 Year Grants
4 or More Year Grants
Fig. 1. Duration of 430 differently titled NIAAA grants, 1972-1986. *The Institute’s intramural research program did include some epidemiologic research from 1976 to 1982. However, this appears LO account for a comparatively small amount of overall funds allocated to epidemiologic research during this period.
NUSBAUMER AND PIERCE
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I244
title of the grant. Content analyses of the grant titles (limited to 56 characters) were conducted in order to code two types of information: (a) the primary purpose of the research being epidemiologic in nature or not, and (b) the definition of the drinking behavior under study (alcoholism, problem drinking, “abuse,” intoxication, binge drinking, use, and no specificity). Because the current inquiry is concerned with the role the NIAAA played in the alteration of alcohol misuse epidemiology and its association with the disease definition, our analysis will focus on two definitions, alcoholism and nonalcoholism. The nonalcoholism category is composed of drinking behaviors defined as: problem drinking, alcohol “abuse,” intoxication, and binge drinking. These definitions of drinking are combined under this category because they generally do not assume the disease model.
RESULTS Analyses of the NIAAA’s support for the new epidemiology should focus upon the percentage of funds that were specifically granted to epidemiologic research. In this regard, however, caution should be used in assessing noteworthy figures in any one period, as it is possible that in any single review period the number of methodologically sound grant requests in any particular field of inquiry were limited. As a result, attention should focus on general funding patterns and trends as opposed to individual year differences. In the second column of Table 1 are the yearly percentages of the psychosocial research funds granted to epidemiologic research projects. When we recognize that the average amount of psychosocial funds spent on epidemiologic research for the entire time period under study is 17.07%,the early years clearly reflect a disproportionate emphasis upon epidemiologic concerns. Indeed, 5 of the first 6 years of full funding (1972-1977) represent a comparative overfunding of such research, and this time period reflects an overall average of 23.58%. Hence, these data clearly indicate that the NIAAA did place a comparatively greater emphasis on supporting epidemiologic research in the organization’s first few years of operation. This finding provides some support for the contention that the NIAAA played a key role in establishing the new epidemiology. However, this evidence only indicates the NIAAA’s early support of epidemiologic research, not necessarily its relationship to the disease model. An analysis of funding for epidemiologic grants focusing specifically upon alcoholism, as compared to other conceptions of drinking, should yield a better measure of the NIAAA’s support for this linkage. In the last two columns of Table 1 are listed the percentages of all epidemiologic psychosocial grants that dealt specifically with alcoholism or nonalcoholism definitions of alcohol misuse. Despite some rather dramatic year-to-
NIAAA AND THE NEW EPIDEMIOLOGY
1245
Table 1.
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NIAAA Funding of Epidemiologic Research within the Extramural Psychosocial Area by Type of Deviant Drinking Image, 1972-1986
Fiscal year
1972 I973 I974 1975 I976 1977 1978 1979 I980 1981 1982 1983 I984 1985 I986 Fifteen year average ( 2 )
Percent of all psychosocial research monies
Alcoholism imaged grants funded (%)
Nonalcoholism imaged grants funded (%)
281,911 I,012,164 1,947,870 1,344,63 1 1,070,602 640,572 603,644 1,085,635 776,159 97I ,496 213,406 227,429 497,258 I ,221,073 4,668,880
10.52 33.50 34.93 25.03 17.31 20.19 15.06 22.94 14.52 16.25 3.70 2.67 4.34 8.26 26.77
13.29 2I .34 19.95 32.15 32.35 1 I .76 15.30 9.81 2I .49 35.20 39.40 69.98 31.79 18.99 25.64
86.71 72.14 59.25 35.60 38.86 26.78 24.67 7.19 22.57 47.30 60.60 30.02 28.65 12.43 1.61
l.lO4.182
17.07
26.56
36.96
Total epidemiologic research monies ($)
year fluctuations, the data clearly reveal that the NIAAA provided greater financial support during the 15-year period for epidemiologic research grants that dealt with nonalcoholism definitions of alcohol misuse (36.96%)than with alcoholism-based definitions (26.56%). Even more noteworthy is the discrepancy during the first 6 years when epidemiologic research grants received comparatively greater attention. During this period, the NIAAA provided more than twice the financial support for nonalcoholism-based grants (53.22%)than it did for specifically alcoholism-based grants (21.81%). Indeed, it is not until the period 1983-1986 that alcoholism specific grants received greater support than nonalcoholism grants.
DISCUSSION These findings indicate that despite the NIAAA’s apparent public relations efforts to establish a new epidemiology for alcohol misuse based upon the organization’s support for the disease conception of alcoholism, their research
Subst Use Misuse Downloaded from informahealthcare.com by UB Wuerzburg on 11/01/14 For personal use only.
1246
NUSBAUMER AND PIERCE
funding history suggests otherwise. Not only did the NIAAA provide research funds for epidemiologic research dealing specifically with alcoholism, but the organization also provided a greater amount of financial assistance to epidemiologic research utilizing nonalcoholism-based conceptions of alcohol misuse. This latter finding suggests the organization’s support for the validation of the new epidemiology of alcohol misuse was independent of the alcoholism model. When we recognize that the general public, professionals in the field, and the scientific community were not necessarily convinced of the appropriateness of either the new epidemiology or the disease conception of alcohol misuse in the late 1960s and early 1970s (Cahalan, 1987), such initial separation of the issues may have been significant. The ability to produce clear, unrefutable, scientific evidence of the new epidemiology was a simpler task than the establishment of similar evidence for the disease model. Also, recognition of the scope and extent of alcohol misuse was an essential first step in mobilizing resources to combat the problem regardless of its etiological base. For example, the NIAAA’s early efforts at employee alcoholism program proliferation utilized a marketing strategy based upon the costs to employers who ignore the problem (Cahalan, 1987; Weiss, 1986). The key to this marketing strategy was NIAAA’s “Project 95” whose goal was to identify and intervene on behalf of the 95% of alcohol misuers not on skid row (Roman, 1981). Recognition of the need for such programming is a prerequisite to questions related to what is the appropriate form of intervention. Thus, the separation of these two issues in the NIAAA’s research funding practices may have proved of particular benefit in these early years. The establishment of the new epidemiology also likely aided the slower growing acceptance of the disease model because of its epidemiologic fit. While this data set may reflect funding limitation related to the availability of grant proposals as well as other biasing factors, the current findings clearly indicate the need to more fully explore how the activities of the NIAAA have influenced public and professional thinking in the alcohol misuse field.
CAHALAN, D. (1987). Understanding America’s Drinking Problem. San Francisco: Jossey-Bass. ROMAN, P. M. (1981). From employee alcoholism to employee assistance: Deernphasis on prevention and alcohol problems in work-based programs. J . Srud. Alcohol 42: 244-272. ROMAN, P. M. (1988). Growth and transformation in workplace programming. In M. Galanter (ed.) Recent Developmenis Alcoholism, Vol. 6. New York: Plenum, pp. 131-159. ROMAN, P. M., and BLUM, T. C. (1987). Notes on the new epidemiology of alcoholism in the U.S.A. J . Drug Issues 17: 321-332. WIENER, C . (1981). 711e Politics of Alcoholism. New Hrunswick, New Jersey: Transaction Books.
1247
NIAAA AND THE NEW EPIDEMIOLOGY
WEISS, R. M . (1986). Managerial Ideology and the Control of Deviance in Organizations. New York: Praeger. WISEMAN, J . (1970). Sfarions of the Lost: The Treatment of Skid-Row Alcoholics. E n g l e w d Cliffs, New Jersey: Prentice-Hall.
Subst Use Misuse Downloaded from informahealthcare.com by UB Wuerzburg on 11/01/14 For personal use only.
THE AUTHORS Michael R. Nusbaumer is currently an Associate Professor of Sociology at Indiana University-Purdue University at Fort Wayne. He received a B.S. in Education from Indiana University, an M.A. in Sociology from Ball State University, and a Ph.D. in Sociology from Western Michigan University. He also completed the Specialty Program in Alcohol and Drug Addiction at Western Michigan University and spent a year at Washington State University as an NIAAA Post-Doctoral Fellow. He has worked in the addictions field as a teacher, researcher, and consultant. His main area of interest deals with formal policy efforts to control alcohol intoxication. James D. Pierce received his B.A. in Psychology from Indiana UniversityPurdue University at Fort Wayne. He was employed as a Counselor at Park Center Inc. and is now in the Doctoral Program in School Psychology at Indiana University. His major area of interest is adolescent behavioral disorders.
Research Note
Subst Use Misuse Downloaded from informahealthcare.com by UB Wuerzburg on 11/01/14 For personal use only.
NIAAA and the New Epidemiology* Michael R. Nusbaumer’ and James D. Pierce2
‘ lndiana University-PurdueUniversity at Fort Wayne, Wayne, Indiana 46805
2101 Coliseum Boulevard East, Fort
*Park Center Inc.
ABSTRACT Utilizing data on the National Institute on Alcohol Abuse and Alcoholism’s research funding history, this inquiry assesses the level and nature of organizational support for a new epidemiology of alcohol misuse and its relationship to the Institute’s support for the disease model of alcohol problems.
Key words.
NIAAA; Epidemiology; Alcoholism
INTRODUCTION The passage of the Comprehensive Alcohol Abuse and Alcoholism Act of 1970 (P.L. 91-616) represented the first major coordinated effort by the federal government to address problems related to alcohol consumption since prohibition. The major thrust of the act was to formally establish the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Yet, more importantly in many respects, it clearly signalled federal recognition and acceptance of the disease model of alcohol problems (Wiener, 1981; Weiss, 1986). One stumbling block the NIAAA had to overcome in its support of the disease model was the widely held “skid row” stereotype of the alcohol misuser. This image typically portrayed these misusers as disaffiliated, derelict, *An earlier version of this paper was presented at the North Central Sociological Association 1990 Annual Meetings, Louisville, Kentucky. 1241
Copyright 01992 by Marcel Dekker, Inc.
Subst Use Misuse Downloaded from informahealthcare.com by UB Wuerzburg on 11/01/14 For personal use only.
1242
NUSBAUMER AND PIERCE
urban males who were unable and/or unwilling to control their drinking despite frequent encounters with the law (Cahalan, 1987; Wiseman, 1970). Such imagery tends to run counter to most disease conceptions of alcoholism however, in that diseases which have either a genetic and/or biologic etiology are unlikely to cluster in such social groupings. Rather, disease models of alcoholism tend to posit the occurrence of the disease in a very wide range of social groupings. In order to successfully gain wide acceptance of the alcoholism model, a new epidemiology with more consistent imagery had to be established and recognized (Roman, 1988; Roman and Blum, 1987). This new epidemiology reflected the view that essentially anyone from any social status or grouping could be suffering from the disease of alcoholism. The alcoholism model notwithstanding, the recognition of such a new epidemiology alone carries with it numerous implications for the management of alcohol misuse. Not only does this new epidemiology greatly expand the size of the problem population, but this in turn indicates the need to greatly expand treatment and intervention activities to service this enlarged population. Furthermore, this new epidemiology includes a large segment of people who have the financial potential to cover the costs of their own treatment. What role has the MAAA played in the development and support of this new epidemiology? Some evidence indicates that the NIAAA did play a key role in efforts to gain public acceptance of the new epidemiology, and these efforts seem closely linked to the alcoholism model. Yet empirical evidence for this role is lacking in the literature. Most attempts to substantiate the NIAAA’s role in this regard are based either upon issued policy statements, organizational structure, or public relations efforts typically focusing on a widely distributed-funded poster (Roman and Blum, 1987). While these types of activities may play a significant role in encouraging the general public to alter their drinking imagery, they are not the only bases for change. In a society where empirically based science represents the recognized source of authoritative fact, successfully altering conceptions of alcohol misuse requires reliance upon supporting empirical evidence. Given that the NIAAA has, since its inception, been the primary funding source for research dealing with alcohol consumption, what role has the MAAA played in funding empirical research that may support the new epidemiology, and what has been the relationship of this research to the disease model of alcohol misuse?
METHODS The NIAAA was not fully operational until fiscal 1972. In an attempt to ascertain some measure of the NIAAA’s funding activities related to epidemiologic concerns, this inquiry focuses upon the funding history of
Subst Use Misuse Downloaded from informahealthcare.com by UB Wuerzburg on 11/01/14 For personal use only.
NIAAA AND THE NEW EPIDEMIOLOGY
1243
extramural grants which deal with epidemiologic and descriptive research questions. The focus is upon extramural grants because they represent a markedly larger portion of the NIAAA’s overall research funding as well as research specifically addressing epidemiologic questions. * In addition, the current analysis concentrates only upon those grants that are considered to be psychosocial, as opposed to biomedical, in orientation. From 1980 to 1986, grants were considered psychosocial if they were routed through the psychosocia1 peer review panel. Prior to 1980 the NIAAA did not differentiate these types of grants, therefore grants were considered to be psychosocial if the titles of the grants were judged by two independent coders to be appropriate for this category. Data regarding funded grants were acquired directly through requests made to the NIAAA. Data were obtained on some 430 differently titled grants from 1972 to 1986. The duration of each of these grants is presented in Fig. 1. For the purposes of the present inquiry, multiyear grants were considered separate grants for each year they received funding, thus resulting in a total of 1,092 grants. Specific information collected on each grant included: the years the grant received funding, the amount of funds received each year, and the
143
1 Year Grants
2 Year
Grants
3 Year Grants
4 or More Year Grants
Fig. 1. Duration of 430 differently titled NIAAA grants, 1972-1986. *The Institute’s intramural research program did include some epidemiologic research from 1976 to 1982. However, this appears LO account for a comparatively small amount of overall funds allocated to epidemiologic research during this period.
NUSBAUMER AND PIERCE
Subst Use Misuse Downloaded from informahealthcare.com by UB Wuerzburg on 11/01/14 For personal use only.
I244
title of the grant. Content analyses of the grant titles (limited to 56 characters) were conducted in order to code two types of information: (a) the primary purpose of the research being epidemiologic in nature or not, and (b) the definition of the drinking behavior under study (alcoholism, problem drinking, “abuse,” intoxication, binge drinking, use, and no specificity). Because the current inquiry is concerned with the role the NIAAA played in the alteration of alcohol misuse epidemiology and its association with the disease definition, our analysis will focus on two definitions, alcoholism and nonalcoholism. The nonalcoholism category is composed of drinking behaviors defined as: problem drinking, alcohol “abuse,” intoxication, and binge drinking. These definitions of drinking are combined under this category because they generally do not assume the disease model.
RESULTS Analyses of the NIAAA’s support for the new epidemiology should focus upon the percentage of funds that were specifically granted to epidemiologic research. In this regard, however, caution should be used in assessing noteworthy figures in any one period, as it is possible that in any single review period the number of methodologically sound grant requests in any particular field of inquiry were limited. As a result, attention should focus on general funding patterns and trends as opposed to individual year differences. In the second column of Table 1 are the yearly percentages of the psychosocial research funds granted to epidemiologic research projects. When we recognize that the average amount of psychosocial funds spent on epidemiologic research for the entire time period under study is 17.07%,the early years clearly reflect a disproportionate emphasis upon epidemiologic concerns. Indeed, 5 of the first 6 years of full funding (1972-1977) represent a comparative overfunding of such research, and this time period reflects an overall average of 23.58%. Hence, these data clearly indicate that the NIAAA did place a comparatively greater emphasis on supporting epidemiologic research in the organization’s first few years of operation. This finding provides some support for the contention that the NIAAA played a key role in establishing the new epidemiology. However, this evidence only indicates the NIAAA’s early support of epidemiologic research, not necessarily its relationship to the disease model. An analysis of funding for epidemiologic grants focusing specifically upon alcoholism, as compared to other conceptions of drinking, should yield a better measure of the NIAAA’s support for this linkage. In the last two columns of Table 1 are listed the percentages of all epidemiologic psychosocial grants that dealt specifically with alcoholism or nonalcoholism definitions of alcohol misuse. Despite some rather dramatic year-to-
NIAAA AND THE NEW EPIDEMIOLOGY
1245
Table 1.
Subst Use Misuse Downloaded from informahealthcare.com by UB Wuerzburg on 11/01/14 For personal use only.
NIAAA Funding of Epidemiologic Research within the Extramural Psychosocial Area by Type of Deviant Drinking Image, 1972-1986
Fiscal year
1972 I973 I974 1975 I976 1977 1978 1979 I980 1981 1982 1983 I984 1985 I986 Fifteen year average ( 2 )
Percent of all psychosocial research monies
Alcoholism imaged grants funded (%)
Nonalcoholism imaged grants funded (%)
281,911 I,012,164 1,947,870 1,344,63 1 1,070,602 640,572 603,644 1,085,635 776,159 97I ,496 213,406 227,429 497,258 I ,221,073 4,668,880
10.52 33.50 34.93 25.03 17.31 20.19 15.06 22.94 14.52 16.25 3.70 2.67 4.34 8.26 26.77
13.29 2I .34 19.95 32.15 32.35 1 I .76 15.30 9.81 2I .49 35.20 39.40 69.98 31.79 18.99 25.64
86.71 72.14 59.25 35.60 38.86 26.78 24.67 7.19 22.57 47.30 60.60 30.02 28.65 12.43 1.61
l.lO4.182
17.07
26.56
36.96
Total epidemiologic research monies ($)
year fluctuations, the data clearly reveal that the NIAAA provided greater financial support during the 15-year period for epidemiologic research grants that dealt with nonalcoholism definitions of alcohol misuse (36.96%)than with alcoholism-based definitions (26.56%). Even more noteworthy is the discrepancy during the first 6 years when epidemiologic research grants received comparatively greater attention. During this period, the NIAAA provided more than twice the financial support for nonalcoholism-based grants (53.22%)than it did for specifically alcoholism-based grants (21.81%). Indeed, it is not until the period 1983-1986 that alcoholism specific grants received greater support than nonalcoholism grants.
DISCUSSION These findings indicate that despite the NIAAA’s apparent public relations efforts to establish a new epidemiology for alcohol misuse based upon the organization’s support for the disease conception of alcoholism, their research
Subst Use Misuse Downloaded from informahealthcare.com by UB Wuerzburg on 11/01/14 For personal use only.
1246
NUSBAUMER AND PIERCE
funding history suggests otherwise. Not only did the NIAAA provide research funds for epidemiologic research dealing specifically with alcoholism, but the organization also provided a greater amount of financial assistance to epidemiologic research utilizing nonalcoholism-based conceptions of alcohol misuse. This latter finding suggests the organization’s support for the validation of the new epidemiology of alcohol misuse was independent of the alcoholism model. When we recognize that the general public, professionals in the field, and the scientific community were not necessarily convinced of the appropriateness of either the new epidemiology or the disease conception of alcohol misuse in the late 1960s and early 1970s (Cahalan, 1987), such initial separation of the issues may have been significant. The ability to produce clear, unrefutable, scientific evidence of the new epidemiology was a simpler task than the establishment of similar evidence for the disease model. Also, recognition of the scope and extent of alcohol misuse was an essential first step in mobilizing resources to combat the problem regardless of its etiological base. For example, the NIAAA’s early efforts at employee alcoholism program proliferation utilized a marketing strategy based upon the costs to employers who ignore the problem (Cahalan, 1987; Weiss, 1986). The key to this marketing strategy was NIAAA’s “Project 95” whose goal was to identify and intervene on behalf of the 95% of alcohol misuers not on skid row (Roman, 1981). Recognition of the need for such programming is a prerequisite to questions related to what is the appropriate form of intervention. Thus, the separation of these two issues in the NIAAA’s research funding practices may have proved of particular benefit in these early years. The establishment of the new epidemiology also likely aided the slower growing acceptance of the disease model because of its epidemiologic fit. While this data set may reflect funding limitation related to the availability of grant proposals as well as other biasing factors, the current findings clearly indicate the need to more fully explore how the activities of the NIAAA have influenced public and professional thinking in the alcohol misuse field.
CAHALAN, D. (1987). Understanding America’s Drinking Problem. San Francisco: Jossey-Bass. ROMAN, P. M. (1981). From employee alcoholism to employee assistance: Deernphasis on prevention and alcohol problems in work-based programs. J . Srud. Alcohol 42: 244-272. ROMAN, P. M. (1988). Growth and transformation in workplace programming. In M. Galanter (ed.) Recent Developmenis Alcoholism, Vol. 6. New York: Plenum, pp. 131-159. ROMAN, P. M., and BLUM, T. C. (1987). Notes on the new epidemiology of alcoholism in the U.S.A. J . Drug Issues 17: 321-332. WIENER, C . (1981). 711e Politics of Alcoholism. New Hrunswick, New Jersey: Transaction Books.
1247
NIAAA AND THE NEW EPIDEMIOLOGY
WEISS, R. M . (1986). Managerial Ideology and the Control of Deviance in Organizations. New York: Praeger. WISEMAN, J . (1970). Sfarions of the Lost: The Treatment of Skid-Row Alcoholics. E n g l e w d Cliffs, New Jersey: Prentice-Hall.
Subst Use Misuse Downloaded from informahealthcare.com by UB Wuerzburg on 11/01/14 For personal use only.
THE AUTHORS Michael R. Nusbaumer is currently an Associate Professor of Sociology at Indiana University-Purdue University at Fort Wayne. He received a B.S. in Education from Indiana University, an M.A. in Sociology from Ball State University, and a Ph.D. in Sociology from Western Michigan University. He also completed the Specialty Program in Alcohol and Drug Addiction at Western Michigan University and spent a year at Washington State University as an NIAAA Post-Doctoral Fellow. He has worked in the addictions field as a teacher, researcher, and consultant. His main area of interest deals with formal policy efforts to control alcohol intoxication. James D. Pierce received his B.A. in Psychology from Indiana UniversityPurdue University at Fort Wayne. He was employed as a Counselor at Park Center Inc. and is now in the Doctoral Program in School Psychology at Indiana University. His major area of interest is adolescent behavioral disorders.
