STRANGER IN A STRANGE LAND: INSIGHTS FROM A VISIT TO NORTH AMERICA BY A BRITISH STUDENT

What a delight to be asked to read and reflect on the personal experiences of Griffith Edwards in ‘Visiting America: notes from an alcohol-focused study tour made in 1961’[1], which is printed in this issue. As an American in the next age cohort of US alcohol researchers, I found this journey to be profoundly insightful and personally interesting. I could often relate to exactly the perspectives expressed as those to which I was also exposed early in my own early career in the United States. In 1961, Edwards found North America to be a mix of contradictions and rather different from his native country in terms of the activities concerning addiction, its treatment and personal recovery. There is a useful table in which the differences (and similarities) in response by the United States and the United Kingdom are presented. As noted in the travel log, the United States (most of the visits occurred in the United States) was in a major transition from a moral agenda concerning addiction as a sin to a view of alcoholism as a disease. Most treatment was undertaken and directed by psychiatrists and based largely upon personal views, beliefs and little science, with a fair measure of moral judgement thrown in for good measure. Some US visits occurred in states where segregation was still practiced and there existed very few treatment or recovery opportunities for black Americans in these areas at that time. I found personally interesting the description of the State of North Carolina alcoholism treatment program (of course, blacks were excluded), where treatment was based totally in psychiatric facilities and reflected the self-confirming conclusions of the program directors. I began my own alcohol research career in this very state agency 10 years later. Recovery was still confined to long-term specialized residential treatment. Because I had grown up in a temperance family in the South, my work with the North Carolina alcoholism treatment program uncovered my limited scientific knowledge about drinking, problem drinking and alcoholism. Thus I began my own self-training in alcohol studies by reading the published work of Griffith Edwards and several of those interviewed by Edwards in 1961. Treatment in North Carolina, I am pleased to note, had progressed considerably by 1971, where there was increased emphasis on local recovery and the inclusion of black citizens. There is only a single sentence in the travel diary which simply notes a meeting with Mark Keller, editor of the Quarterly Journal of Studies on Alcoholism (QJSA). What were the editorial views of this editor about his journal as the only American scientific journal for alcoholism research of its time? The travel log gives no information. Perhaps the discussion was uninteresting or lost in the complexity of the journey. Any documented discussions about QJSA were left to a later meeting with E. M. Jellinek in Toronto. Edwards obviously enjoyed a delightful visit with Jellinek, including a lunch at a local French restaurant. I found particularly interesting Jellinek's views about addiction and his ideas of what QJSA would contain in 50 years (when asked by Edwards). I fear that the predictions of Jellinek reflected his particular interests, i.e. ‘psychotherapy, Antabuse and aversion’, as well as a final determination if there was a chemical foundation for addiction. The meetings with Jellinek and other scientists at the Addiction Research Foundation in Toronto reflected important differences between these Canadian scientists and their counterparts in the United States. This is especially illustrated in the Edwards' meeting with Wolff Schmidt, who was an early leader in the public health approach to alcohol-related problems. As noted by Edwards, Schmidt had already become interested in the inverse relationship of alcohol price to the population rate of alcoholism (expressed in liver cirrhosis and per capita alcohol consumption). There were no such explorations in the United States at that time. In fact, Robert Strauss in Kentucky doubted that increasing alcohol prices would have much beneficial effect. Some 20 years later, just prior to his retirement, I also enjoyed a visit with Wolff Schmidt, who had so influenced my own career through his published research. There are many important gems in this travel diary. Perhaps the most important to me was the reminder by Edwards that historical reflection is a critical means to determine how we, in alcohol studies, arrived at one place and to suggest how unknown is the next phase. This is expressed richly by the author in the abstract as ‘. . . a field such as alcohol studies which is all too easily culture bound in its horizons and assumptions. Alcohol science needs to be more reflective on its history and the mechanisms that help make it happen’ and then again in the conclusion ‘. . . it might be argued that views on substance misuse tend rather easily to have their agendas set by national and political imperatives, and by historically determined and culture bound modes of thinking’. This travel diary provides examples of just how closely linked are our perspectives to contemporaneous times and limited by our history. I always find pleasure and new insights in any writings of Griffith Edwards and this travel log of a journey undertaken almost 50 years ago has continued that experience. His descriptions of these visits were interesting and reflective of those early developmental years in North America. I recommend a reading of this travel log both for a glimpse of history from North America, but also an opportunity to recognize how those who talked with Edwards made their own unique contribution to our heritage, as he did himself. Some of those visited were to become public leaders in American alcoholism treatment and research, including at least one future director of the National Institute of Alcoholism and Alcohol Abuse. Thus, here is a great gift provided to those of us in alcohol studies and the reminder that each era contributes the foundation for the next era—for better or worse.

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