Learning from drunk monkeys

This dissertation examines how alcohol and drug problems came to be seen as complex and chronic problems in the United States between 1870 and 2000. The dissertation focuses on seven expert-led organizations that were influential at different times: the American Association for the Study and Cure of Inebriety, the Committee of Fifty, the Center of Alcohol Studies, the Addiction Research Center, the National Institute on Alcohol Abuse and Alcoholism, the Special Action Office for Drug Abuse Prevention and the National Institute on Drug Abuse. These organizations supported experts who articulated distinctive and historically specific "problem frames": conceptual and practical orientations that accounted for the manifold causes and consequences of alcohol and drug problems, and recommended complimentary managerial techniques. Some problem frames were bounded by the diagnostic categories of addictive diseases, such as "inebriety," "alcoholism" and "substance dependence"; others framed alcohol and drug problems as social or public health problems that afflicted particular populations of at-risk individuals. Expert-led organizations were an invaluable asset for alcohol and drug experts who wanted to speak credibly about a tangled set of politically volatile issues. Organizations set programmatic goals for the alcohol and drug fields, they courted patrons, they financially supported alcohol and drug experts, and they communicated expert findings to general and professional audiences. In fact, organizations and their preferred problem frames were codependent and mutually constitutive: they emerged, stabilized, transformed and disappeared together, and together they structured interdisciplinary relationships between different types of experts, while aligning the interests of experts and their patrons. The federal government created agencies for alcohol and drug experts in the early 1970s, and these agencies adopted three problem frames before the end of the twentieth century. The processes that underwrote strategic change in federal agencies are best understood in terms of the "politics of instrumentalism"--these processes revolved around questions about how to reach mutually agreed-upon ends; experts possessed considerable discretion over the design and implementation of new problem frames, but policymakers and private sector advocates were highly attuned to policy details, and experts developed accountability and support systems to legitimate the expenditure of public funds.