Why People Drink; How People Change: A Guide to Alcohol and People’s Motivation for Drinking It

116 Pages·2022·1.398 MB·English

by  W. Miles Cox, Eric Klinger

W. Miles Cox
Eric Klinger
Why People
Drink; How
People
Change
A Guide to Alcohol and People’s
Motivation for Drinking It
Why People Drink; How People Change
W. Miles Cox • Eric Klinger
Why People Drink; How
People Change
A Guide to Alcohol and People’s Motivation
for Drinking It
W. Miles Cox Eric Klinger
School of Human and Behavioural Sciences Division of Social Sciences
Bangor University University of Minnesota, Morris
Bangor, Gwynedd, UK Morris, MN, USA
ISBN 978-3-030-93927-4 ISBN 978-3-030-93928-1 (eBook)
https://doi.org/10.1007/978-3-030-93928-1
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Preface
The 1970s were rife with consumption of psychoactive substances, including alco-
hol, America’s long-time recreational beverage. To address alcohol-related prob-
lems, the U.S. National Institute on Alcohol Abuse and Alcoholism (NIAAA) was
established. NIAAA began offering postdoctoral fellowships for training in alcohol
research and alcoholism, and W. Miles Cox was one of the first recipients of this
award. Toward the end of that decade, also responding to the apparent need, the state
of Minnesota provided statewide grants to higher-education campuses for institut-
ing drug information offices. The University of Minnesota’s Morris campus (UMM)
responded by opening one of these and proceeded to advertise a new faculty posi-
tion for someone to run it as well as to offer related coursework. Professor of
Psychology Eric Klinger, then Coordinator of the Psychology Discipline, was
involved in interviewing candidates for the position. In 1978, one of the first appli-
cants for the position was W. Miles Cox, who had a background in both motivation
and alcohol research. With Professor Klinger’s blessing, UMM hired Miles Cox.
As it happened, 3 years earlier in 1975, Klinger had published an article in the
prominent journal Psychological Review entitled “Consequences of Commitment to
and Disengagement from Incentives.” This article laid out a theory of motivation
around emotions, incentives, and goals, and the implications of the theory for alco-
hol and other drug use. Two years later, in 1977, Klinger had elaborated the theory
in a book, Meaning and Void: Inner Experience and the Incentives in People’s Lives.
Its Chap. 7, “Tampering with the Message System,” describes how this theory
explains much about the role of psychoactive substances in human life. Cox read the
article and the chapter and integrated their theoretical outlook into his own.
This was the beginning of what became a very fruitful, more than 40-year-long
research collaboration on understanding why people consume alcohol and its place
in human life. Even though Professor Cox left UMM in 1985 for a research position
with the U.S. Veterans Administration and, beginning in 1996, a professorship at
Bangor University in Wales, UK, the collaboration continued, fostering develop-
ment of promising treatment approaches to problematic drinking. It has clearly had
an impact on the field’s views regarding alcohol. In the 1990s, it inspired develop-
ment of motive-assessment approaches, as described in Chaps. 1 and 7 of this book,
v
vi Preface
which became widely used measures of alcohol-use motives. After Meaning and
Void, Cox and Klinger’s theory received its next large-scale publication in an article,
“A Motivational Model of Alcohol Use,” in the prominent Journal of Abnormal
Psychology in 1988. The theory has since received a number of subsequent updating
publications by its original authors, but by September of 2021, their 1988 article
alone had been cited, according to Google Scholar, in 1797 other publications.
The interest in this theory has continued. According to Google Scholar, a 2011
chapter on the theory had already, by September of 2021, been cited in 215 other
publications. Reception of the theory has been highly gratifying. It forms the frame-
work for this book. Previous publications about the theory were written for our
professional colleagues and their students in psychology, psychiatry, and related
fields. Many of these explanations of the theory would be overly technical and of
limited interest to many other readers. This book presents up-to-date, detailed infor-
mation about alcohol and our theory concerning people’s motivation for drinking. It
uses language that we believe will be understandable to and appropriate for readers
of all backgrounds.
Bangor, Gwynedd, UK W. Miles Cox
Morris, MN, USA Eric Klinger

References
Cox, W. M., & Klinger, E. (1988). A motivational model of alcohol use. Journal of Abnormal
Psychology, 97(2), 168–180.
Klinger, E. (1975). Consequences of commitment to and disengagement from incentives.
Psychological Review, 82, 1–25.
Klinger, E. (1977). Meaning & void: Inner experience and the incentives in people’s lives.
University of Minnesota Press.
Contents
1 Alcohol Use and Abuse in Everyday Life: The Centrality of
Motivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
What Is Alcohol? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Why People Say They Drink . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Motives for Drinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
What Science Reveals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Some People Drink Too Much . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
How Much Is Too Much? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Governmental Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Legal Drinking Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Evaluating One’s Own Drinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Formal Diagnoses: Alcohol Use Disorder, Alcohol Dependence,
and Harmful Alcohol Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Theories of Alcohol Addiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2 How People Decide What They Want, Including Having
a Drink of Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
How Brains Evolved to Pursue Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
The Nature of Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
The Wide-Ranging Effects of Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Drinking Alcohol as a Goal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Heavy Alcohol Consumption: Merely a Choice or a Disease? . . . . . . . . 19
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
3 Alcohol and Its Effects on the Body . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Absorption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Alcohol in the Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Neurotransmitters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Alcohol-Induced Blackout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
vii
viii Contents
Hangover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Alcohol Withdrawal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Chronic Effects of Excessive Drinking . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Liver Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Cardiovascular Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Brain Damage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Fetal Alcohol Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
The Burden of Disease Attributable to Alcohol . . . . . . . . . . . . . . . . . . . 34
How the Brain Supports People’s Motivation to Drink . . . . . . . . . . . . . 35
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
4 Genetics of Alcoholism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Family Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Adoption Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Twin Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
What Is Inherited? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Stress-Response Dampening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Aversive Reactions to Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Low Sensitivity to Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Differentiator Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
5 Personality and Alcohol Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Important Constituents of Personality: Goals, Values,
and Emotions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Alcohol and Emotions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Addiction: Permanent Disease or Manageable Condition? . . . . . . . . . . 53
Personality Differences and Consuming Alcohol Excessively . . . . . . . . 54
Depression, Rumination, and Alcohol Use . . . . . . . . . . . . . . . . . . . . . . . 55
Depression, Protective Behavioral Strategies, and Alcohol Use . . . . . . . 57
Within-Person Affect Levels and Alcohol Use . . . . . . . . . . . . . . . . . . . . 58
Self-Control Problems and Alcohol Overuse . . . . . . . . . . . . . . . . . . . . . 60
Ways to Manage Overconsumption of Alcohol:
Implications of Personality Differences . . . . . . . . . . . . . . . . . . . . . 61
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
6 Sociocultural and Environmental Influences
on Drinking Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Global Patterns of Alcohol Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Sociocultural Variations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Religious Restrictions on Alcohol Use . . . . . . . . . . . . . . . . . . . . . . . . 68
The Mediterranean (Wet) Pattern of Drinking . . . . . . . . . . . . . . . . . . 69
The Northern European Pattern of Drinking. . . . . . . . . . . . . . . . . . . . 70
Heavy Episodic Drinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Environmental Influences on Drinking Behavior . . . . . . . . . . . . . . . . . . 71
Contents ix
Sociocultural Transmission of Drinking Habits . . . . . . . . . . . . . . . . . . . 73
Social Learning Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Collectivity of Drinking Cultures . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Drunken Comportment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
7 Why Drink Alcohol At All? Motives and Expectancies:
The Role of Expectancies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
The Role of Goals as Motives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Four Kinds of Motives for Drinking Alcohol . . . . . . . . . . . . . . . . . . . . . 82
Pre-drinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Negative Motives for Drinking Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . 84
The Role of Motivational Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
8 Ways to Control Drinking: Changing
the Motivational Nexus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
The Addiction Trap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Self-Change of Alcohol Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Principles that Govern Individuals’ Decisions and Abilities
to Control Alcohol Consumption . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Values and Expectancies in Decision-Making, Including
as Related to Drinking Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
The Role of Self-Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
The Importance of Support by Others . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Harvard Medical School’s Suggestions . . . . . . . . . . . . . . . . . . . . . . . . . 96
Organizational Resources for Supporting Control of Alcohol
Consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Systematic Motivational Counseling . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Alcohol Attention-Control Training Programme (AACTP) . . . . . . . . . . 100
Life Enhancement and Advancement Programme (LEAP) . . . . . . . . . . 101
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Final Suggestions for People Who Want to Start . . . . . . . . . . . . . . . . . . 103
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Chapter 1
Alcohol Use and Abuse in Everyday Life:
The Centrality of Motivation
Alcohol use is a widespread fact of life in much of the world. In a recent survey,
85.6% of Americans 18 years old or older reported that they had drunk alcohol at
some point in their lives, and 54.9% of them reported that they had drunk within the
past month (“Alcohol Use in the United States,” 2021, June). These rates of alcohol
use, and even higher ones, have been reported in many other countries around the
world (Ritchie & Roser, 2019).
What Is Alcohol?
The alcohol in alcoholic beverages is called ethanol, or beverage alcohol. It is a
simple chemical compound consisting of carbon, oxygen, and hydrogen atoms.
When people drink ethanol, it can induce a sense of optimism and euphoria, and it
can also reduce tension and stress. Because of these perceived benefits, beverage
alcohol is widely sold and widely drunk throughout the western world and beyond.
It is found in a variety of drinks, including beer (lager), wine, and distilled spirits.
There is a fourth category called fortified wine, which is considerably higher in
alcoholic content than ordinary table wine. In these different drinks, the alcohol
itself is colorless and odorless, and it is exactly the same in each of the drinks. It is
the other ingredients in the beverages that give each one its distinctive color, odor,
and appearance.
The concentration of alcohol in the different kinds of alcoholic drinks varies
widely. Regular beer contains about 5% alcohol; wine typically has 11–13%; and
distilled spirits (such as gin, vodka, or whiskey) often have approximately 40%
alcohol, but the percentage can be considerably higher or lower. A fortified wine,
such as sherry or port, is a wine to which enough spirits have been added to bring
the alcoholic content up to approximately 17%. (“What Is A Standard Drink?”, n.d.).
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 1
W. M. Cox, E. Klinger, Why People Drink; How People Change,
https://doi.org/10.1007/978-3-030-93928-1_1