Showing papers in "Journal of Studies on Alcohol and Drugs in 1984"

The process of recovery from alcoholism: III. Comparing functioning in families of alcoholics and matched control families.

Abstract: Families of recovered (N = 54) and relapsed (N = 51) alcoholic patients were studied 2 yr after the patients completed residential treatment and were compared with sociodemographically matched families of community controls (N = 105) on three sets of family-functioning indices--role functioning, family environment and husband-wife congruence. Families of recovered patients were functioning as well as families of controls. Families of relapsed patients showed less cohesion, expressiveness and recreational orientation, and lower agreement about their family environment than matched families of recovered patients and of community controls, and reported more family arguments than families of recovered patients. They also showed altered role functioning, the nonalcoholic spouse performing more household tasks and the alcoholic partner performing fewer. Family functioning was affected by the adequacy of the alcoholic partner's adaptation, and by life events, stressors and spouse's level of dysfunction.

Sex differences in motivations for and effects of drinking among college students.

Abstract: A sample of college students (70 men and 70 women, each group composed of equal numbers of heavy and light drinkers) completed the Beck Depression Inventory, Form V of the Sensation Seeking Scale, the S-R Inventory of General Trait Anxiousness, the Rosenberg Self-Esteem Scale, as well as seven other measures directly assessing alcohol-related attitudes and behavior. It was hypothesized that heavy drinkers would evidence strong sensation-seeking needs with a specially high need for disinhibition. It was also predicted that heavy-drinking women would display more adjustment problems than other students and would report greater anxiety than men when drinking in situations involving social evaluation or interactions with members of the opposite sex. The first hypothesis was confirmed: heavy drinkers did exhibit strong sensation-seeking needs. However, heavy-drinking women were not characterized by adjustment problems nor did they report greater anxiety in drinking situations. The results suggest that women te...

Prevention of alcohol misuse through the development of personal and social competence: a pilot study

Abstract: Seventh graders (N = 239) from two New York City junior high schools were involved in a 9-month study testing the efficacy of a broad-spectrum approach to prevention of alcohol misuse. The two schools were randomly assigned to experimental and control conditions. The seventh graders in the treatment school received a 20-session program targeted at the major cognitive, attitudinal, social and personality factors believed to promote the early stages of alcohol misuse. The program contained material on decision making, coping with anxiety, general social skills and assertiveness (including techniques for resisting peer pressure to drink) as well as information about the short- and long-term consequences of alcohol misuse. Complete pretest, posttest 1 and posttest 2 data were collected from 167 students (89 women). A significantly greater proportion of the students in the experimental group reported less frequent drinking (p less than .02), less drinking per occasion (p less than .04), and less frequent episodes of drunkenness (p less than .01) than the students in the control group.

Do alcoholics give valid self-reports?

Abstract: Self-reports on drinking among alcoholics (100 men inpatients) were compared with descriptions of their consumption given by collaterals (one friend or relative each) at 10 points during an 18-month follow-up study. The correlations between the two were only moderate; barely one-half of the variance in the alcoholics' self-reports corresponded to the collaterals' assessments. Patients underestimated collaterals' descriptions about three times as often as they overestimated them, but their over- and underestimations appeared to be of roughly equal size. The relationships between alcoholics' and collaterals' reports tended to be curvilinear. Among subjects whom the collaterals had described as abstinent or controlled drinkers, patients' and collaterals' assessments were similar but patients' descriptions grossly underestimated collaterals' reports when uncontrolled consumption was reported by the latter. The results support a moratorium on the use of patients' self-reports in follow-up studies on alcohol consumption.

Chronicity of drinking problems among men: a longitudinal study.

Abstract: Analyses demonstrate that the chronicity of alcohol problems among men is a function of age; the probable chronicity over time is greater among older than among younger men. Alcohol problems among older men show greater interrelationships; remission is higher among younger men. The data have implications for estimates of the prevalence of alcoholism in the U.S. population. If the percentage of problem drinkers in the general population is used, actual prevalence will be overestimated. If the percentage of alcoholics in treatment is used, actual prevalence will be underestimated. The ability to identify men in the general population who are at risk for becoming alcoholics has implications for prevention of alcohol-related problems and the treatment of alcoholism.

Age, drinking habits and the effects of alcohol.

Abstract: Some explanations for the common observation that older persons drink less alcohol than younger persons were tested in a sample of 41 men social drinkers aged 19-63. Subjects reported their drinking habits and performed balance beam and bead-stringing tasks under a moderate dose of alcohol (.72 ml absolute alcohol/kg). Self-reports of dose (ml absolute alcohol/kg) on a typical social occasion, and hourly dose (which controlled for individual differences in the duration of these occasions) were found to decline linearly with age. Alcohol absorption and elimination rates in the sample were not significantly related to age. The Ponderal Index (an estimate of percentage of body water in body weight) was negatively correlated with age and with peak blood alcohol levels (BALs). Older subjects had proportionately less body water (i.e., a smaller volume for distribution of alcohol) and obtained higher BALs. When individual differences in BAL were controlled for, the amount of alcohol-induced impairment in task performance was still found to increase significantly with age. This evidence was considered to suggest that a reduction in the volume of distribution for alcohol and an intensified behavioral effect of alcohol may operate jointly to cause older persons to reduce their dose of alcohol on social drinking occasions.

Neuropsychological deficits in alcoholics: etiological considerations.

Abstract: The literature on the causes of neuropsychological deficits (NDs) in alcoholics is reviewed. It is asserted that NDs are caused not simply by the neurotoxicity of alcohol but by the interrelationships of various factors. NDs might thus reflect problems antecedent to or concomitant with alcoholism and not just the consequences of alcohol use. The family histories of alcoholics have shown that a differential susceptibility to NDs might have a genetic basis. NDs might also be due to the fetal alcohol syndrome. Children who eventually become alcoholics have been shown to be more impulsive and hyperactive than other children, factors related to NDs. There seem to be multiple pathways leading to NDs--two ND syndromes, an acceleration of the normal aging process and an amnesic syndrome, seem to be a consequence of alcoholism. Depression and sociopathy are independently related to both alcoholism and NDs, so causal attributions are difficult to determine. The contribution of head injury to NDs in alcoholics might...

The risk function for liver cirrhosis from lifetime alcohol consumption.

Abstract: A hypothesis on the effects of level and duration of alcohol misuse on individual risks for liver cirrhosis is proposed. The hypothesized risk function is a generalized version of the exponential law of other researchers. Some predictions are derived and tested against two types of aggregate data--the age structure of cirrhosis mortality and time-series data for the general population. It is shown that both types of data are compatible with the proposed risk function. It is also shown that the fact that extensive alcohol misuse will result in death from cirrhosis only after a considerable number of years does not contradict the observation that changes in per capita consumption normally have an instantaneous effect on cirrhosis mortality.

Factors associated with patient dropout from an outpatient alcoholism treatment service.

Abstract: Treatment dropout was studied in 172 patients (40 women) of an outpatient alcoholism treatment program. The best predictors of dropout were the length of delay between appointments, and variables related to symptom levels such as the number of prior alcohol-related arrests, the use of illicit drugs and scores on the Michigan Alcoholism Screening Test. Of lesser importance, but in line with previous findings, were sociodemographic variables such as age, the level of social stability and the presence of dependents at home. No personality variables were found to be relevant. It is suggested that treatment programs can improve attendance by reducing the delay with which services are offered and by changing certain characteristics of treatment personnel.

Alcohol and aggression in men: a comparison of brewed and distilled beverages.

Abstract: The effects of distilled and brewed alcoholic beverages on aggressive behavior were compared in a 2 x 2 factorial design with 16 subjects per cell (N = 64 men social drinkers). One-half of the sample population was told that they would be consuming an alcohol (distilled spirits) beverage and the other half that they would be consuming beer. Within each of these conditions, one-half of the subjects received the expected drug (alcohol) and one-half was given a corresponding placebo beverage. Aggression was measured using a modified version of the Buss aggression machine. Subjects who consumed beer or believed that they were consuming beer were significantly less aggressive than subjects who consumed distilled spirits or believed that they were consuming distilled spirits. Differences between subjects receiving the drug (alcohol) and the placebo were not significant.

Work-related outcomes of the constructive-confrontation strategy in a job-based alcoholism program.

Abstract: Most job-based alcoholism policies and programs incorporate a strategy of constructive confrontation. Data from two national samples of over 600 managers in a large corporation were collected to assess the effectiveness of this strategy with both problem drinkers and other problem employees. Results showed that supervisors of problem drinkers took more actions than did supervisors of employees with other problems. Work performance of problem-drinking employees improved more than that of other problem employees. Oral discussions containing both constructive and confrontational topics were positively associated with employees accepting help and with better work performance following intervention for both samples of employees. However, more severe forms of discipline--written warnings, suspensions or discharges--were negatively associated with work performance following intervention in both samples. The results suggest that (1) the strategy is most effective when repeated discussions balance both constructive and confrontational elements, and (2) the presence of the alcoholism policy encouraged supervisors to take more actions with problem drinkers, legitimated those actions and made the threat of discipline more credible.

Mortality of treated alcoholics and drug addicts: the benefits of abstinence.

Abstract: A study of 2-yr treatment outcome and of mortality in the following 8 yr was conducted on all first admissions to Eagleville Hospital in 1970 (503 alcoholics and 221 drug addicts; 9% women). The average age of the alcoholics was 41.6 vs 23.0 for the drug addicts. Status (misusing vs not misusing) 2 yr after admission for treatment or at death was ascertained for 92% of the subjects. The 108 known deaths occurred in 18.5% of the alcoholics and 6.8% of the addicts. Death rates per 1000 person yr at risk were compared with expected general population rates, controlling for age, race and sex. Overall, mortality per 1000 person yr was 25.9 for alcoholics and 8.8 for addicts, each higher than expectancy (p less than .001). Ratios of observed to expected rates were similar (2.5 and 3.1, respectively). Excess mortality occurred only among those misusing alcohol or drugs at 2 yr; nonmisusers had expected death rates. Disease and violent deaths were excessive among alcoholics, but only violent deaths exceeded expectancy among drug addicts. Of the 108 deaths, 66 were excess deaths, attributable to substance misuse and the associated way of life. However, among the 254 who were not misusing on follow-up, 19 died rather than the 51 who would have died if their mortality had been that of the persistent misusers.

The impact of television advertising on alcohol consumption: an experiment.

Abstract: A videotaped indoor soccer game was shown to 125 men college students, ostensibly to evaluate the sport's televiewing appeal. Different versions of the videotape included zero, four or nine beer commercials. Refreshments, including beer, were available to the subjects. Half the subjects had immediate access to beer, and half had access delayed by one half hour. Exposure to the first few commercials increased consumption; however, continued exposure did not. Over the entire experiment, advertising had no significant effect on total beer consumption. Delayed access to beer led to compensatory beer consumption, notably in the third half hour. The results of the present study were interpreted as not supporting strong concern about television advertising's impact on immediate consumption of available alcohol. The results suggest that experiments on alcohol advertising are likely to produce negative results where drinking is measured over a substantial period (e.g., an hour or more), and positive results where ...

Alcohol withdrawal causes a loss of cerebellar Purkinje cells in mice.

Abstract: Mice received a liquid diet containing alcohol for 4 months, after which half of them were sacrificed and the others given a 4-month recovery period before being sacrificed. They were compared with similar mice receiving the diet with alcohol replaced isocalorically by sucrose. No damage was detected in the cerebellum during alcohol consumption, but the number of Purkinje cells was significantly reduced in the recovery period. The experiment was repeated twice with mice consuming a normal diet but exposed to alcohol vapor. The first group was exposed to alcohol vapor 24 hr/day for 3 weeks and then given alternating 1-week periods of recovery and exposure 24 hr/day until a total of 6 weeks of exposure to alcohol vapor and 4 one-week recovery periods had been experienced. They were compared with similar mice exposed to alcohol vapor 24 hr/day for 6 weeks without a recovery period. The second group was exposed to alcohol vapor 9 hr/day for 3 weeks, when part of the group was given a 3-week recovery period. I...

Alcohol consumption among Mexican American and Anglo women: results of a survey along the U.S.--Mexico border.

Abstract: A household probability survey of 1233 Mexican American women and 798 Anglo women residing along the U.S.-Mexico border was conducted. A higher proportion of abstainers was found among the Mexican Americans than among the Anglos in almost every social and demographic category examined (age, marital status, education and employment status). Because the level of alcohol consumption increased markedly with the years of education completed, almost all of the overall ethnic differences observed could be accounted for by the generally lower level of education among the Mexican Americans. However, ethnic subgroups of Mexican American women reported different levels of alcohol consumption that could not be accounted for by differences in education, suggesting that additional ethnic factors contribute to drinking patterns.

Predicting undergraduates' intentions to drink

Abstract: Sex-linked differences in motivation to drink were studied with Fishbein's model of the relationship between attitudes and behavior. Fishbein's model was revised so that personal normative beliefs were seen as measuring ideal behavioral intentions (what the person intended given real-world constraints) rather than personal norms. A total of 101 college students (53 women) completed a questionnaire. Also, 10 additional students (five women) were interviewed to determine referents whose expectations were salient for the present sample. Both attitudes and social normative beliefs (SNB) correlated significantly with ideal behavioral intentions (IBI); IBI was able to be predicted from the weighted sum of attitudes and SNB. IBI correlated significantly with actual behavioral intentions and accounted for the majority of the variance in actual intentions to drink. Support for the revision of Fishbein's model was shown by the direct effect of attitude on women's intentions to drink. The lack of mediation of attitudes by IBI showed that IBI function differently from actual intentions. The revised model was shown to be very successful in predicting intentions to drink, and in exploring gender and cultural differences therein. Language: en

The flushing response to alcohol use among Koreans and Taiwanese.

Abstract: Alcohol use, the existence of a flushing response to alcohol and the amount of alcohol required to evoke flushing were studied by questionnaire in 87 homeland Korean and 101 Taiwan Chinese families SFs (slow flushers--flush after two or more drinks) and FFs (fast flushers--flush after one drink or less) were compared Despite the similarity in the proportions of subjects who reported flushing, Koreans reported very heavy and Taiwanese very light alcohol use The two groups differed substantially in the proportions of SFs and FFs Five ethnic groups in Hawaii were compared with the Koreans and Taiwanese It appears that fast flushing, but not slow flushing, leads to substantial decreases in alcohol use among all seven groups The association of flushing type with the extent and duration of flushing and with the frequency of other alcohol-related symptoms may be dose-dependent For both Koreans and Taiwanese, family resemblances in flushing are substantial but not supportive of the belief that flushing is

Measuring the success of occupational alcoholism programs

Abstract: The research on the success of occupational alcoholism programs (OAPs) was reviewed. One measure of the success of OAPs has been a change in drinking behavior. This may seem like the most relevant measure but there are questions about its reliability because researchers usually depend on subjects' self-reports and do not define their criteria for successful outcome well. In addition, attempts by employers to dictate the drinking habits of their employees may be difficult to justify. Varying rates of success on this measure have been reported. Subjects have generally been able to control drinking in the long term, but it is suggested that their control erodes over time. A second measure of the success of OAPs has been work performance, as revealed by absenteeism, disciplinary actions, accidents, sick and injured days taken, turnover rate and job efficiency. Studies of this measure have been hindered by employers' poor record keeping and by the difficulty of developing standard measures of outcome success. In general, studies with weaker research designs have shown more improvement on this measure. A third measure has been the cost efficiency of OAPs, as revealed by direct savings for employers resulting from OAPs such as decreases in absenteeism and indirect savings such as increased accuracy of work. This measure seems to be the one most relevant to employers' profit motives. Studies of cost efficiency have had ambiguous findings. A fourth measure has been the penetration rate--the extent to which an OAP reaches its target population. This measure has never been studied successfully. A problem with all the studies reviewed has been their poor design (a lack of control groups, follow-up periods that were too brief and problems with selection of subjects), which raises serious questions about their validity. The obstacles to measuring outcome success were also discussed--poor documentation by employers, lack of access to subjects and reluctance on the part of employers and treatment staff to allow studies.

A discriminant-function analysis of screening tests for excessive drinking and alcoholism.

Abstract: Because a previous study among 385 psychiatric admissions had shown each of three rapid interviews to be far superior to each of nine laboratory tests in screening for excessive drinking and alcoholism, the separation of patients with these drinking patterns from normal drinkers was reexamined by the more sophisticated technique of discriminant analysis. It was thus possible to determine where there was overlap in the information provided by some tests in contrast to "new information" provided by others and whether the arbitrary cut-off points of the normal ranges of the laboratory tests were contributing to their poor sensitivity. Discriminant analysis again confirmed the good performance of the rapid interviews, particularly the Brief Michigan Alcoholism Screening Test and the Reich interview, but it also identified glutamate dehydrogenase (GDH) as the best of the laboratory tests and of comparable efficacy to the rapid interview for the group of excessive drinkers. By comparison, gamma-glutamyl transpe...

Relationship between reasons for drinking and customary drinking behavior

Abstract: In 80 subjects (28 women), a factor-analytic investigation of the relationship between the reasons for drinking and customary drinking behavior revealed that solitary drinking is associated with drinking in order to forget personal shortcomings, drinking to forget problems and disappointments, and drinking to be less concerned with what others think. Positive skewness proved to be a valid index of deviant drinking practices and motives. Some incidental findings indicated that heavy beer consumption occurs most among young men.

Alcohol consumption and escalatory aggression in intoxicated and sober dyads.

Abstract: It has been suggested that alcohol ingestion facilitates escalatory processes in aggressive interactions. The present study examined interaction patterns in intoxicated, sober and mixed dyads. Thirty pairs of men college students were randomly assigned to these conditions. Subjects who received alcohol received .964 g of absolute alcohol per kg of body weight. At the beginning of each trial in a reaction-time competition, each member of the dyad selected the shock level that he wanted his opponent to receive if the opponent was slower on the trial. Further, each member was informed by feedback lights of the shock level that his opponent had selected for him. The results indicated that the intoxicated dyads selected higher shock levels than did the sober dyads. Mixed dyads tended to select lower shock levels than intoxicated dyads but higher shock levels than sober dyads. However, these differences were not statistically significant. Additionally, intoxicated dyads escalated in aggression over the first block of six trials, whereas neither sober nor mixed dyads evidenced such an escalation. One interpretation of these findings is that the cognitive disruption caused by the alcohol interfered with the subjects' ability to evaluate the consequences of their behavior and to interpret the behavior of their opponents. A second interpretation is that, because of the expectancy effects associated with alcohol consumption, intoxicated dyads did not feel constrained to a nonaggressive stance. Finally, the value of the dyadic-interaction paradigm in the study of alcohol-related violence was discussed.

"Serious drinking," "white man's drinking" and "teetotaling": drinking levels and styles in an urban American Indian population.

Abstract: The differences between abstainers, moderate drinkers and heavy drinkers were examined in American Indians living in Los Angeles, California. Equal numbers of these three groups (total N = 155) were selected from four tribal groups: Siouan-speaking, Navaho, Five Civilized Tribes (of eastern Oklahoma origin) and indigenous California tribes. The relative predictive powers of sociostructural, cultural and psychological variables in accounting for current drinking levels were then assessed. The results indicated that, much as for non-Indian populations, heavy drinkers were more likely to have had heavy-drinking models in the family of origin, to be men and to score high on psychophysiological stress indices. Socioeconomic status and traditionalism were found to be weaker predictors of drinking level. Differences in drinking styles over individuals' lifetimes and between tribes were also studied. Ethnographic observations, case vignettes and statistical summaries of the sample by tribe and by drinking level showed that tribal origins, age and socioeconomic status influenced drinking style and attitudes toward alcohol, even if they did not predict the current drinking level of the subjects.

Impaired memory for treatment-relevant information in inpatient men alcoholics.

Abstract: Inpatient alcoholics (N = 54 men), nonhospitalized members of an Alcoholics Anonymous group (N = 15 men) and nonalcoholic inpatients (N = 10 men) were shown a 55-min film on alcoholism and were subsequently given memory tests for recall and recognition of information from the film. The performance of the inpatient alcoholics was impaired relative to that of the controls. Alcoholics who were tested earlier in treatment performed worse than those tested 3 or more weeks after their last drink. These results suggest that treatment-relevant information may not be well remembered by alcholics until they have been in treatment for at least 2-3 weeks.

Drunken Drivers in Longitudinal Perspective

Abstract: The lives of men convicted for driving while intoxicated (DWI) were compared with those of other men who spent their childhoods in the same neighborhoods. The comparisons were based on interviews, questionnaires and agency records. Although not distinguishable by their age at first conviction, the men convicted for DWI were more likely to have been convicted for serious crimes. They were also more likely to be alcoholics. As children, they were less likely to have appeared to be insecure or dependent. During adolescence, those who would later be convicted for DWI were more likely to have parents who were inconsiderate and aggressive, and who fought with one another. The men convicted for drunken driving seemed independent and relatively self-confident, both during early childhood and in middle age. Their history of antisocial behavior belies a view that these men have inadvertently risked the safety of others during an unaccustomed lapse in self-control.

Relationship of neuropsychological performance to primary alcoholism and self-reported symptoms of childhood minimal brain dysfunction.

Abstract: The relationship between neuropsychological performance and a childhood history of the hyperkinetic and minimal brain dysfunction syndrome (Hk-MBD) was studied in 60 men alcoholic patients at an alcoholism treatment center. Primary (N = 28) an secondary (N = 32) alcoholics and a matched group of 60 nonalcoholic controls were administered a checklist on the presence of childhood symptoms associated with Hk-MBD. The primary alcoholics reported a significantly higher number of Hk-MBD symptoms than the secondary alcoholics and controls; they also performed significantly more poorly than the other groups on several neuropsychological tests. The secondary alcoholics did not differ significantly from the controls in the number of Hk-MBD symptoms reported or in neuropsychological functioning. Neuropsychological performance did not differ significantly between those with high and low numbers of Hk-MBD symptoms, but in almost all comparisons the direction of differences favored those with low numbers of Hk-MBD symp...

Alcohol consumption patterns among women in Baltimore.

Abstract: A telephone survey of women aged 18 + (N = 1084) in Baltimore during 1980 showed that 8.1% had a heavy alcohol intake (2 + drinks per day) and that 22.4% engaged in escape drinking. Age, race, marital status, maternal status, income, education, employment and degree of urbanization were examined for their relationships with the amount of alcohol consumption and the prevalence of escape drinking. Multivariate analysis showed that being married or widowed, lower educational attainment and less egalitarian sex-role attitudes were associated with lower alcohol consumption.

Relationship between the Course of Primary Alcoholism in Men and Family History

Abstract: Structured interviews were conducted with 453 men primary alcoholics and with up to two resource persons for each patient to investigate the association between the sex of an alcoholic parent and the course of alcoholism in the subject. Earlier and more severe alcohol-related and antisocial problems were found among subjects with any alcoholic parent than among those without an alcoholic parent. The highest level of problems was noted for subjects with both parents alcoholics. There were few differences between the sons of alcoholic fathers and the sons of alcoholic mothers but the latter demonstrated significantly more drug misuse.

Locus of control and treatment outcome in alcoholics

Abstract: Alcoholism is no longer regarded as a unitary disorder, but conventional measures of cognition and personality have yet to be shown capable of consistently predicting clinical outcomes. The present study evaluated the ability of two measures of locus of control--a generalized measure (IE) and a drinking-related one (DRIE)--to predict therapy involvement during, and treatment outcome following, an abstinence-oriented inpatient program for alcoholics. Both measures were administered to 106 patients (32 women) once near the beginning and once near the end of treatment. A range of other sociodemographic and psychological data was also recorded. Significant and independent shifts in the internal direction were found on both measures from the first to second testing. Relationship between locus of control and treatment participation was weak. DRIE fared better than IE in predicting treatment outcome. Ability to predict outcome was enhanced when interactions between locus of control and cognitive dysfunction were considered and when analyses included nonlinear relationships between these measures and treatment outcome.

Alcoholic denial: a biopsychological interpretation.

Abstract: A theory of the origins and mechanisms of denial, which is frequently characteristic of alcoholics, is proposed on the basis of a biopsychological rather than a psychodynamic model of emotion. The biopsychological approach views denial as a consequence of a developmental defect in the apperception of interoceptive stimuli and in the appraisal of the significance of environmental events. Three hypotheses must be substantiated in order to support this theory: (1) alcoholics were physiologically unstable in arousal regulation; (2) alcoholics cannot cognitively discriminate interoceptive cues and physiological states; and (3) alcoholics cognitively underestimate emotion-laden events in their lives. Research which demonstrates the validity of these hypotheses is reviewed and implications for future research and treatment strategies are discussed.

A "reverence for strong drink": the lost generation and the elevation of alcohol in American culture

Abstract: Over one-half of famous American authors with reputations for drunkenness were born between 1888 and 1900. Although college students of their generation seem to have been "drier" than earlier or later cohorts, many of the writers were already drinking heavily in college. Several reasons are suggested. After World War I, many fledgling authors spent time in Paris, becoming known as the "lost generation" and adding French and other drinking styles to their existing drinking patterns. Bohemian Americans during Prohibition found a resonance with the residual political symbolism of drinking in France as a statement of autonomy against the state. The community of expatriate writers provided a supportive environment for heavy drinking. In turn, the lost generation became a transmitter of new values concerning drinking to American culture in general. Their writings inadvertently promoted mass middle-class tourism to Paris in the late 1920s. Their lives and works strengthened the association between writing and drinking as a model for later literary generations. Both in written form and as films, their works conveyed an attractive image of drinking and often of drunkenness to the wider public. The decisive shift in drinking patterns among middle-class youth in the late 1920s ushered in a lasting change in the cultural position of drinking, as it became a cosmopolitan, progressive and eventually respectable behavior. At a minimum, the writers of the lost generation served as harbingers, carriers and catalysts of this change.