Constitutional amendments aren’t always the answer

The Providence Journal

The 18th amendment of the U.S. Constitution was ratified in 1919. The American public tolerated it, in a manner of speaking, for about 14 years and then repealed it — the first and, thus far, only amendment of the Constitution to have been rescinded.

This 14-year interval, during which consumable alcoholic products were prohibited, is viewed by many as a singularly bizarre, crime-ridden interlude in American history _ a kinky eccentricity in that flawed ambiguity called the American ethos. It was an interval when bootlegged liquor and speakeasies replaced the corner saloons _ when the American transatlantic-cruise industry was destroyed, because it could not compete with the European vessels, which served liquor. And it was a time when many communities, such as Miami, flouted the law, with bootlegging’s becoming a major industry.

It has thus been assumed by many that this was a short-lived post-World War I period of legislative madness, and that it had no immediate or enduring effect on alcohol-related diseases in the United States. Both assumptions are wrong.

Fermentation of barley, mead, grapes, and other plants has been known since antiquity. But it was not until the technical process of distillation yielded far higher concentrations of alcohol, by then called spirits, that alcohol consumption assumed a major threat to societal integrity.

Early New England clerics, such as the Mathers, father and son, decried the use of spirits. The preachings of John Wesley (1703-91), in both England and colonial Georgia, to "the multitudes living in heathen darkness" initiated a movement advocating abstinence from all alcoholic beverages. Wesley’s evangelical Methodism declared that drinking was a morally destructive activity.

The 19th century witnessed the coordinated, religion-based temperance movement, extending beyond the Wesleyan efforts. Much of this national movement was directed by women who had seen how liquor consumption by working-class husbands and fathers had sapped the meager physical and emotional resources of their families. This led to formation of the Women’s Christian Temperance Union, in 1873.

Some in the organization condemned all alcoholic beverages, while others exempted such non-distilled drinks as sacramental wines and beer. After all, they said, the word temperance was derived from the Latin for "moderation," not "exclusion." And so temperance took on many meanings in 19th Century America. The following words, from an old hymnal, were among many rallying cries of the movement:

Temper my spirit, 0 Lord, keep it long in the fire; / Make it one with the flame; let it share that upreaching desire.

For much of the 19th century, persuasion, both written and oral, and appeals to religious faith were the primary weapons deployed against alcoholism. But a more aggressive approach was adopted by those who believed that alcohol’s addictive influence was mightier than words. And so the Anti-Saloon League gradually assumed the leadership in the war on alcoholism.

The league is often portrayed as a small group of grim, hatchet-wielding women, intent on destroying neighborhood saloons. Yet their effect on American history, and American legislative bodies, was far greater than the destruction of a scattering of bars. The recruitment of immense numbers of middle-class women in the fight against alcoholism represented the Anti-Saloon League’s greatest achievement.

Temperance infiltrated the sermons of thousands of ministers, and many newspapers and magazines refused to carry advertisements for spirits. Even the American Medical Association went on record opposing spirits used for therapy. Alcoholism thus transformed from a moral into a public-health problem.

The first tangible effect of the temperance movement was the passing of laws in the "dry" states restricting the making, transporting, and selling of alcoholic beverages. By 1909, six states forbade consumable alcohol. And in 1913 Congress passed the Webb-Kenyon Act, which made importing liquor to dry states a federal crime.

Nevertheless, the decade between 1910 and 1920 saw a notable increase in consumption of intoxicating beverages in the United States. Beer production rose from 1.2 billion gallons a year to over 2 billion gallons, while production of whiskey and other high-alcohol beverages rose from 97 million gallons a year to 147 million..

The efforts of those opposed to alcohol consumption finally culminated in the ratification of the 18th Amendment, on Jan. 16, 1919, which prohibited the sale, manufacture, transportation, importation, and exportation of intoxicating liquors "for beverage purposes" within the United States and its territories. The amendment did not specify what concentration of alcohol constituted an intoxicating beverage, so Andrew Volstead, a Minnesota congressman, offered a bill (the Volstead Act, of 1919) declaring any beverage with 5 percent or more of alcohol as intoxicating. Thus, the 18th amendment also prohibited beer and wine.

The provisions of the amendment were poorly enforced, yet the data demonstrate that the frequency of deaths due to acute alcoholic intoxication, cirrhosis of the liver (a complication of alcoholism), and brain diseases caused by alcoholism had appreciably diminished during the 14 years of Prohibition. (A sharp drop in alcohol-related deaths had similarly been seen in France and Britain during World War I, when resources for alcohol production were diverted to the munitions factories.)

Then, on Dec. 5, 1933, the 21st Amendment was ratified. It declared, "The 18th article of amendment to the Constitution of the United States is hereby repealed."

Many have proclaimed the Prohibition era (1920-33) an interval of utter folly _ a madness that defied the principles of civil liberty and individual human responsibility. Nevertheless, some lives were saved during this interval. "What is madness," said the poet Roethke, "but nobility of soul at odds with circumstance?"

(Stanley M. Aronson, M.D. is dean of medicine emeritus at Brown University. E-mail smamd(at) This column is adapted from one in the current issue of Medicine & Health/Rhode Island, the monthly publication of the Rhode Island Medical Society.)