Prohibition, harm reduction, and history

You wouldn't know it from the title, "American Spirits: The Rise and Fall of Prohibition," but this exhibit at the National Constitution Center has a public health theme. Sure, it is chock full of information about the political fight for a national prohibition amendment, the criminal underworld that developed to supply spirits to thirsty Americans, and the changing culture of the 1920s spurred by the rise of the speakeasy that brought women into underground drinking establishments. But, the exhibit also has a lot to say about a core principle of public health: harm reduction.

The "drys"—a popular term for prohibition supporters—pointed to the terrible effects of alcohol abuse on the health of drinkers and, very often, their families, who suffered from abuse, poverty, and neglect when a breadwinner's wages were spent in a saloon.  Their solution was codified in the 18th Amendment to the Constitution in 1919, which prohibited the manufacture, sale, or transportation of intoxicating liquors.  The Volstead Act, the enabling legislation for the amendment, went in to effect in 1920.

Prohibition reduced alcohol consumption, which had already begun to decline because of state and local laws forbidding alcohol sales. As a result, death rates from cirrhosis and alcohol psychosis declined, as did arrest rates for drunkenness and hospital admissions related to alcohol abuse.

These health benefits had great social costs. The illegal production and sale of alcohol turned millions of ordinary Americans into criminals, led to the massive corruption of law enforcement officers and politicians, and fostered an enormous increase in organized crime. For a look at some of the people, events, and ideas surrounding prohibition, check here.

In 1933 our prohibition experiment ended with the passage of the 21st Amendment. The primary reason was money. Sales of alcoholic beverages brought in federal tax dollars as the nation confronted the Great Depression and the resulting loss of revenue from personal income and business taxes. Americans hoisted their glasses and resumed legal drinking, but at lower rates than before prohibition, demonstrating its lasting impact.

After repeal, the nation would turn to harm reduction policies designed to reduce the health, social, and economic consequences of alcohol abuse. These include education about the consequences of alcohol abuse and drunk driving, forbidding sales to those under a designated age, establishing closing hours for bars, limiting the hours and places of alcohol sales, and levying taxes on alcohol consumption.

Harm reduction is the same approach we take with tobacco--we tax it, we forbid its purchase by minors, we put warning labels on packages and we have programs to discourage smoking initiation and to assist those looking to quit.  In 1970, Congress created the National Institute on Alcohol Abuse and Alcoholism to research alcohol consumption and the prevention and treatment of alcohol abuse. The strength of these harm reduction measures is a reflection of political will in the face of interest group demands for less regulation and public health knowledge that suggests taxation and other measures should be taken to curb use or abuse.

"American Spirits" is masterful in its visual displays, provocative and informative. Visitors will enjoy the period music heard in parts of the exhibit, but may well be struck by the silence about the relevance of prohibition history to our current debates about illegal drugs.

Voters in several states have now passed laws legalizing medical marijuana or permitting its personal use, although marijuana remains illegal under federal law.  Essentially, we've begun a new discussion about harm reduction and substance abuse. The conversation includes questions about the costs of law enforcement and incarceration and the criminalization of users, as well as data regarding the health risks of marijuana and appropriate measures to help those who develop a psychological addiction.

Do we stick with prohibition, or move towards legalization and harm reduction?  A visit to "American Spirits" won't answer that question but it will provide the historical insights that we ought to bring to that debate.

Janet Golden, a Rutgers University history professor, specializes in the histories of medicine, childhood and women.

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