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Alcoholism research paper: writing guide & topics.

Writing a research paper on alcoholism might seem like pushing a cart downhill; nevertheless, most students end up feeling frustrated. The need to bring out a new and captivating piece, in the end, remains a dream to many. But luckily, there’s a way out!

Read the sections that follow and forget about alcoholism research paper hangovers and blackouts.

How To Write an Alcoholism Research Paper Thesis

As earlier introduced, knowing the secret behind any successful paper puts you in the winning team. We need to note that such an article will majorly serve two essential purposes:

• To fight alcoholism
• To raise awareness among the people

The alcoholism outline for the research paper is as follows:

Alcoholism Research Paper Intro

An exciting introduction will hook the reader to your research paper. He/she will want to read more to feed his curiosity. Since the intro is the first paragraph that meets the reader’s eye, it should be outstanding as much as possible.

You can spice up your introduction in the following ways:

Present unexpected statistics and facts on alcoholism, Brief definitions of technical terms in your topic, if any Give the context of your research through background information Add a clear and precise thesis statement

The thesis statement serves as an anchor for your paper, determining your stance on the subject. Therefore, keep it short and sweet yet communicating the main point coherently.

It consists of all the arguments in support of your thesis statement. For a strong defense, ensure that you line up your undisputed and important ideas first as you move to the least. Some of the alcoholism research paper points to include in your body can be:

• Social effects of alcoholism on students
• How to help people struggling with alcoholism
• Symptoms of alcoholism in teenagers

Arrange the points in an orderly way so that your reader can follow through quickly. Each body paragraph should have a well-stated topic sentence, followed by an elaborate explanation and relevant examples.

Conclusion For Alcoholism Research Paper

After presenting your case on alcoholism and defending it with supporting arguments, it’s time, to sum up, your paper. The conclusion for alcoholism research paper summarizes the discussion in short, clear, and precise sentences.

You should also restate the thesis statement to emphasize your main idea of the paper. In conclusion, the general rule of thumb applies, do not add any new information. Strife to make it as short as possible yet not devoid of meaning.

When writing papers on alcoholism, be sure to use factual arguments, especially for the symptoms, effects, and other related statistics. Remember to be sensitive to the choice of words not to end up stigmatizing your reader.

Whether it’s a paper on addiction or withdrawal symptoms, do not vocabularies that may blur the reader from the article’s full picture.

Below are professionally handpicked alcoholism research paper topics for your inspiration:

Teenage Alcoholism Research Paper Topics

• Why do most teens think drinking alcohol is cool?
• Reasons why most students in college’ want to fit in.’
• Do parents who drink influence the teens also to start the habit?
• Does alcohol make teens feel more comfortable around their friends?
• Can alcohol raise the self-esteem of teens?
• Why many teens opt for alcohol when they feel pressured
• What are the withdrawal symptoms for teens addicted to alcohol?
• How teens can battle anxiety and depression without taking alcohol

Topics For Research Paper on Alcoholism and Family

• How alcohol makes parents neglect their essential duties
• Why forgetfulness as a result of alcoholism may disrupt family relationships
• Domestic violence as a result of excessive alcohol drinking
• Financial instability in families with alcohol addicts
• Can parents who drink alcohol help their children with homework?
• Why do children from families where parents drink alcohol suffer depression?
• Difficulty with intimate relationships among adults who drink alcohol
• Mental and physical health issues as a result of alcoholism in the family

Topics on Risks of Alcoholism

• Motor vehicle accidents arising from drinking and driving
• Why cases of homicide are on the rise among those who drink
• What causes alcohol poisoning?
• Risky sexual behaviors as a result of irresponsible drinking
• How mothers can experience miscarriage if they take excessive alcohol consumption
• Why do alcohol drinking people develop high blood pressure?
• Learning and memory difficulties as a result of alcoholism
• Why you risk losing your job if you continue drinking

Topics on Alcoholism as a Disease

• Can we classify alcoholism as a curable disease?
• The pre-alcoholic phase of alcoholism as a disease
• What is the relationship between increased heart rate and alcoholism?
• How effective is the Intensive Outpatient alcoholism treatment Program?
• Causes of relapse among patients recovering from alcoholism
• Aftercare support programs for patients dealing with alcoholism
• How scary is a diagnosis of alcoholism?
• Medical treatment options for people struggling with alcohol addiction

Alcohol Abuse Research Paper Topics

• The impact of alcohol abuse on relationships
• How alcohol abuse can cause harm or injury
• How alcohol abuse can harm the quality of your life
• Sexual dysfunction complications as a result of alcohol abuse
• Recommended ways of controlling alcohol abuse
• Medications to reduce the symptoms of withdrawal among addicts
• The role of support groups in reducing alcohol abuse
• Warning signs that you are abusing alcohol

Addiction Research Paper Topics

• Why is the youthful population the most affected with alcohol addiction?
• Best approaches to dealing with alcohol addiction among adults
• How drug addiction has led to increased crime rates in society
• Does counseling help to deal with the problem of drug addiction?
• Compare and contrast drug addiction between first and third world countries
• What measures can the government institute curb drug addiction?
• How drug addictions contribute to marriage breakups
• Why most drug addicts cannot have gainful employment opportunities
• How alcohol addiction impacts human health
• Why are the majority of street children drug and substance addicts?
• What are the policies legislating against drug addiction?
• Why are more men drug addicts than women?
• Rehabilitation systems of helping drug addicts
• Sociological perspectives of drug addiction
• A step by step approach to helping adolescents in drug addiction

In case the topics are not enough for you, we have professional research paper writing help for college students. Using our services will ensure that you attain that much-coveted A+.

Give it a try now!

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Alcohol’s Impact on Young People

How does alcohol affect the young?

The papers in our collection focus on the relationship between alcohol and young people from childhood to early adulthood .

Research suggests that even moderate drinking by parents may impact children. At the same time, young children’s familiarity with alcohol may put them at risk of early alcohol initiation.

Our collection goes on to explore alcohol use in adolescence , from neurobiological implications to association with sexual identity and STI risk; and considers a cohort of adolescents and young adults when analysing the relationship of drinking behaviours with social media use and risk of violence respectively.

Finally, we follow trajectories of alcohol use in early adulthood , with articles assessing predictors of Alcohol Use Disorder (AUD), considering the role of gender and age on drinking practices, and examining withdrawal-associated muscle pain hypersensitivity in healthy episodic binge drinkers.

All articles will be free to access and share until the 30th of June, with a view to disseminating scientific knowledge on the impact of alcohol on young people.

Alcohol and Children

From age 4 to 8, children become increasingly aware about normative situations for adults to consume alcohol.

Children aged 4–8 become increasingly knowledgeable about drinking norms in specific situations which implies that they know in what kind of situation alcohol consumption is a common human behavior. This knowledge may put them at risk for early alcohol initiation and frequent drinking later in life.

An Exploration of the Impact of Non-Dependent Parental Drinking on Children

Findings suggest levels of and motivations for parental drinking, as well as exposure to a parent tipsy or drunk, all influence children’s likelihood of experiencing negative outcomes.

Alcohol and Adolescents

Lifetime alcohol use influences the association between future-oriented thought and white matter microstructure in adolescents.

These findings replicate reports of reduced future orientation as a function of greater lifetime alcohol use and demonstrate an association between future orientation and white matter microstructure, in the PCR, a region containing afferent and efferent fibers connecting the cortex to the brain stem, which depends upon lifetime alcohol use.

Differential Alcohol Use Disparities by Sexual Identity and Behavior Among High School Students

Results highlight the need to incorporate multiple methods of sexual orientation measurement into substance use research.

What a Difference a Drink Makes: Determining Associations Between Alcohol-Use Patterns and Condom Utilization Among Adolescents

Results suggest significant increased risk of condomless sex among binge drinking youth. Surprisingly, no significant difference in condom utilization was identified between non-drinkers and only moderate drinkers.

Alcohol and Adolescents and Young Adults

The association between social media use and hazardous alcohol use among youths: a four-country study.

Certain social media platforms might inspire and/or attract hazardously drinking youths, contributing to the growing opportunities for social media interventions.

Change in the Relationship Between Drinking Alcohol and Risk of Violence Among Adolescents and Young Adults: A Nationally Representative Longitudinal Study

Alcohol is most strongly linked to violence among adolescents, so programmes for primary prevention of alcohol-related violence are best targeted towards this age group, particularly males who engage in heavy episodic drinking.

Alcohol and Young Adults

Predictors of alcohol use disorders among young adults: a systematic review of longitudinal studies.

This review suggests that externalizing behaviour is a strong predictor of AUD. The risk of AUD is also high when illicit drug use co-occurs with externalizing behaviour. Environmental factors were influential but changed over time.More evidence is needed to assess the roles of early internalizing behaviour, early drinking onset and other distinctive factors on the development of AUD in young adulthood

Gender-Specific Drinking Contexts Are Associated With Social Harms Resulting From Drinking Among Australian Young Adults at 30 Years

We found that experiences of social harms from drinking at 30 years differ depending on the drinker’s gender and context. Our findings suggest that risky contexts and associated harms are still significant among 30-year-old adults, indicating that a range of gender-specific drinking contexts should be represented in harm reduction campaigns. The current findings also highlight the need to consider gender to inform context-based harm reduction measures and to widen the age target for these beyond emerging adults.

The Role of Sex and Age on Pre-drinking: An Exploratory International Comparison of 27 Countries

This exploratory study aims to model the impact of sex and age on the percentage of pre-drinking in 27 countries, presenting a single model of pre-drinking behaviour for all countries and then comparing the role of sex and age on pre-drinking behaviour between countries. Using data from the Global Drug Survey, the percentages of pre-drinkers were estimated for 27 countries from 64,485 respondents. Bivariate and multivariate multilevel models were used to investigate and compare the percentage of pre-drinking by sex (male and female) and age (16–35 years) between countries.

Hyperalgesia after a Drinking Episode in Young Adult Binge Drinkers: A Cross-Sectional Study

This is the first study to show that alcohol withdrawal-associated muscle hyperalgesia may occur in healthy episodic binge drinkers with only 2–3 years of drinking history, and epinephrine may play a role in binge drinking-associated hyperalgesia.

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Reference management. Clean and simple.

How to start your research paper [step-by-step guide]

1. Choose your topic

2. find information on your topic, 3. create a thesis statement, 4. create a research paper outline, 5. organize your notes, 6. write your introduction, 7. write your first draft of the body, 9. write your conclusion, 10. revise again, edit, and proofread, frequently asked questions about starting your research paper, related articles.

Research papers can be short or in-depth, but no matter what type of research paper, they all follow pretty much the same pattern and have the same structure .

A research paper is a paper that makes an argument about a topic based on research and analysis.

There will be some basic differences, but if you can write one type of research paper, you can write another. Below is a step-by-step guide to starting and completing your research paper.

Choose a topic that interests you. Writing your research paper will be so much more pleasant with a topic that you actually want to know more about. Your interest will show in the way you write and effort you put into the paper. Consider these issues when coming up with a topic:

• make sure your topic is not too broad
• narrow it down if you're using terms that are too general

Academic search engines are a great source to find background information on your topic. Your institution's library will most likely provide access to plenty of online research databases. Take a look at our guide on how to efficiently search online databases for academic research to learn how to gather all the information needed on your topic.

Tip: If you’re struggling with finding research, consider meeting with an academic librarian to help you come up with more balanced keywords.

If you’re struggling to find a topic for your thesis, take a look at our guide on how to come up with a thesis topic .

The thesis statement is one of the most important elements of any piece of academic writing. It can be defined as a very brief statement of what the main point or central message of your paper is. Our thesis statement guide will help you write an excellent thesis statement.

In the next step, you need to create your research paper outline . The outline is the skeleton of your research paper. Simply start by writing down your thesis and the main ideas you wish to present. This will likely change as your research progresses; therefore, do not worry about being too specific in the early stages of writing your outline.

Then, fill out your outline with the following components:

• the main ideas that you want to cover in the paper
• the types of evidence that you will use to support your argument
• quotes from secondary sources that you may want to use

Organizing all the information you have gathered according to your outline will help you later on in the writing process. Analyze your notes, check for accuracy, verify the information, and make sure you understand all the information you have gathered in a way that you can communicate your findings effectively.

Start with the introduction. It will set the direction of your paper and help you a lot as you write. Waiting to write it at the end can leave you with a poorly written setup to an otherwise well-written paper.

The body of your paper argues, explains or describes your topic. Start with the first topic from your outline. Ideally, you have organized your notes in a way that you can work through your research paper outline and have all the notes ready.

After your first draft, take some time to check the paper for content errors. Rearrange ideas, make changes and check if the order of your paragraphs makes sense. At this point, it is helpful to re-read the research paper guidelines and make sure you have followed the format requirements. You can also use free grammar and proof reading checkers such as Grammarly .

Tip: Consider reading your paper from back to front when you undertake your initial revision. This will help you ensure that your argument and organization are sound.

Write your conclusion last and avoid including any new information that has not already been presented in the body of the paper. Your conclusion should wrap up your paper and show that your research question has been answered.

Allow a few days to pass after you finished writing the final draft of your research paper, and then start making your final corrections. The University of North Carolina at Chapel Hill gives some great advice here on how to revise, edit, and proofread your paper.

Tip: Take a break from your paper before you start your final revisions. Then, you’ll be able to approach your paper with fresh eyes.

As part of your final revision, be sure to check that you’ve cited everything correctly and that you have a full bibliography. Use a reference manager like Paperpile to organize your research and to create accurate citations.

The first step to start writing a research paper is to choose a topic. Make sure your topic is not too broad; narrow it down if you're using terms that are too general.

The format of your research paper will vary depending on the journal you submit to. Make sure to check first which citation style does the journal follow, in order to format your paper accordingly. Check Getting started with your research paper outline to have an idea of what a research paper looks like.

The last step of your research paper should be proofreading. Allow a few days to pass after you finished writing the final draft of your research paper, and then start making your final corrections. The University of North Carolina at Chapel Hill gives some great advice here on how to revise, edit and proofread your paper.

There are plenty of software you can use to write a research paper. We recommend our own citation software, Paperpile , as well as grammar and proof reading checkers such as Grammarly .

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Drug Abuse, Addiction, Substance Use Disorder

• Research Drug Abuse

Start Learning About Your Topic

Create research questions to focus your topic, find books in the library catalog, find articles in library databases, find web resources, cite your sources, key search words.

Use the words below to search for useful information in   books  and  articles .

• substance use disorder 
• substance abuse
• drug addiction
• substance addiction
• chemical dependency
• war on drugs
• names of specific drugs such as methamphetamine, cocaine, heroin
• opioid crisis

Background Reading:

It's important to begin your research learning something about your subject; in fact, you won't be able to create a focused, manageable thesis unless you already know something about your topic.

This step is important so that you will:

• Begin building your core knowledge about your topic
• Be able to put your topic in context
• Create research questions that drive your search for information
• Create a list of search terms that will help you find relevant information
• Know if the information you’re finding is relevant and useful

If you're working from off campus , you'll be prompted to log in just like you do for your MJC email or Canvas courses. 

All of these resources are free for MJC students, faculty, & staff. 

• Gale eBooks This link opens in a new window Use this database for preliminary reading as you start your research. Try searching these terms: addiction, substance abuse

Other eBooks from the MJC Library collection:

Use some of the questions below to help you narrow this broad topic. See "substance abuse" in our Developing Research Questions guide for an example of research questions on a focused study of drug abuse. 

• In what ways is drug abuse a serious problem? 
• What drugs are abused?
• Who abuses drugs?
• What causes people to abuse drugs?
• How do drug abusers' actions affect themselves, their families, and their communities?
• What resources and treatment are available to drug abusers?
• What are the laws pertaining to drug use?
• What are the arguments for legalizing drugs?
• What are the arguments against legalizing drugs?
• Is drug abuse best handled on a personal, local, state or federal level?
• Based on what I have learned from my research what do I think about the issue of drug abuse?

Why Use Books:

Use books to read broad overviews and detailed discussions of your topic. You can also use books to find  primary sources , which are often published together in collections.  

Where Do I Find Books?

You'll use the library catalog to search for books, ebooks, articles, and more.  

What if MJC Doesn't Have What I Need?

If you need materials (books, articles, recordings, videos, etc.) that you cannot find in the library catalog , use our  interlibrary loan service .

All of these resources are free for MJC students, faculty, & staff.

• EBSCOhost Databases This link opens in a new window Search 22 databases simultaneously that cover almost any topic you need to research at MJC. EBSCO databases include articles previously published in journals, magazines, newspapers, books, and other media outlets.
• Gale Databases This link opens in a new window Search over 35 databases simultaneously that cover almost any topic you need to research at MJC. Gale databases include articles previously published in journals, magazines, newspapers, books, and other media outlets.
• Psychology and Behavioral Sciences Collection This link opens in a new window Contains articles from nearly 560 scholarly journals, some dating as far back as 1965
• Access World News This link opens in a new window Search the full-text of editions of record for local, regional, and national U.S. newspapers as well as full-text content of key international sources. This is your source for The Modesto Bee from January 1989 to the present. Also includes in-depth special reports and hot topics from around the country. To access The Modesto Bee , limit your search to that publication. more... less... Watch this short video to learn how to find The Modesto Bee .

Use Google Scholar to find scholarly literature on the Web:

Browse Featured Web Sites:

• National Institute on Drug Abuse NIDA's mission is to lead the nation in bringing the power of science to bear on drug abuse and addiction. This charge has two critical components. The first is the strategic support and conduct of research across a broad range of disciplines. The second is ensuring the rapid and effective dissemination and use of the results of that research to significantly improve prevention and treatment and to inform policy as it relates to drug abuse and addiction.
• Drug Free America Foundation Drug Free America Foundation, Inc. is a drug prevention and policy organization committed to developing, promoting and sustaining national and international policies and laws that will reduce illegal drug use and drug addiction.
• Office of National Drug Control Policy A component of the Executive Office of the President, ONDCP was created by the Anti-Drug Abuse Act of 1988. ONDCP advises the President on drug-control issues, coordinates drug-control activities and related funding across the Federal government, and produces the annual National Drug Control Strategy, which outlines Administration efforts to reduce illicit drug use, manufacturing and trafficking, drug-related crime and violence, and drug-related health consequences.
• Drug Policy Alliance The Drug Policy Alliance (DPA) is the nation's leading organization promoting alternatives to current drug policy that are grounded in science, compassion, health and human rights.

Your instructor should tell you which citation style they want you to use. Click on the appropriate link below to learn how to format your paper and cite your sources according to a particular style.

• Chicago Style
• ASA & Other Citation Styles
• Last Updated: Feb 14, 2024 12:41 PM
• URL: https://libguides.mjc.edu/drugabuse

Except where otherwise noted, this work is licensed under CC BY-SA 4.0 and CC BY-NC 4.0 Licenses .

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Citing Your Sources

• Background Sources
• Find Articles & More
• Primary Sources
• Selected Statistics & Data

MLA (Modern Language Association) Style

Chicago style, apa (american psychological association) style.

Proper citation is an essential aspect of scholarship. Citing properly allows your reader or audience to locate the materials you have used. Most importantly, citations give credit to the authors of quoted or consulted information.

For detailed instructions on how to cite within the text of your paper, please consult a style manual listed below. 

Here are some  easy web options and more on zotero .

• MLA Formatting and Style Guide at Purdue OWL

• Purdue OWL (Online Writing Lab) Chicago Manual of Style

• Purdue OWL (Online Writing Lab) APA Style Introduction
• APA Reference examples

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• Last Updated: Aug 7, 2023 9:53 AM
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Alcoholism Research Paper

View sample alcoholism research paper. Browse research paper examples for more inspiration. If you need a health research paper written according to all the academic standards, you can always turn to our experienced writers for help. This is how your paper can get an A! Feel free to contact our writing service for professional assistance. We offer high-quality assignments for reasonable rates.

Sociology of Alcoholism

Introduction, the organization of the sociology of alcohol-related issues, the emergence of the sociology of alcohol-related issues, the first stream: sociology, alcohol abuse, and social problems, the second stream: sociology and the causes of alcoholism, the second stream: sociology and the treatment of alcoholism, the third stream: sociology and social integration.

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The status of alcohol studies within sociology is a question within the sociology of science and a more complex challenge than it might appear (Wiener 1981). This issue is not limited to alcohol studies and converges on contemporary concerns about the importance of interdisciplinary research versus the “silos” within which academic disciplines tend to operate. The central assertion in this research paper is that there is great opportunity for the application of sociological theory and methods to issues around alcohol and the problems that its use creates. The location of both past and ongoing work of this nature is not highly visible within what might be called the sociological mainstream.

In this research paper, a sampling of some of the work in this specialty is provided, together with an analysis of how this specialty has developed and been shaped over time. The discussion here is largely limited to the United States. Although there is a range of sociological activity worldwide, the patterns of scholarly interaction tend to stay within national borders, largely because of the unique policies, service delivery systems, and research support structures that guide sociological work in different nations. The worldwide sociological study of alcohol issues is of great importance but is  beyond the scope of the present discussion.

The paper opens with an overview of the historical emergence of sociological interest in alcohol issues, and three different themes are described. This is followed by several examples of research that characterize each of the three thematic areas and a discussion of possible directions that may occur in the future.

Since the early 1990s, the American Sociological Association (ASA) has had a section on the Sociology of Alcohol and Drugs, recently renamed to include research interest in tobacco use. More notable as a hub for sociological activity over the long term, the Society for the Study of Social Problems (SSSP) launched a Committee for Research on Drinking Behavior in 1955. This has since been modified to include research interest in drugs. Finally, a small but vibrant organization involving a range of international social science interests, including sociology, the Kettil Bruun Society (named in honor of the research contributions of a deceased Finnish sociologist), meets every other year at rotating venues that include the United States.

Despite these organizational structures, the actual scope of research and writing activity directed toward alcohol issues that is identifiably within sociology is relatively minimal. In a review article in an outlet central to alcohol studies, a sociological leader in the specialty (and cofounder of the ASA section), Helene R. White (1993), observes that the specialty has

a low status in the discipline of sociology. An examination of three major journals in sociology ( Social Forces, American Journal of Sociology and American Sociological Review ) revealed that out of 1,600 articles published during the 19952004 period, there were three, none and three articles, respectively, that dealt with alcohol use or alcoholism. Thus, less than one percent of all articles published in these major sociology journals in the entire decade were directly related to drinking behavior. (P. 8)

One might add more data to this observation by noting that relatively little of the underlying research activity occurs within settings that are explicitly identified with sociology. A review of the research grants funded between 1972 and 2005 by the National Institute on Alcohol Abuse and Alcoholism (NIAAA, a part of the National Institutes of Health [NIH]) reveals fewer than 20 investigators who have been based within academic departments of sociology.

Sociologists’ involvement in research and writing on alcohol issues is, however, partially masked by the organizational contexts in which it occurs. Much of the research and writing about alcohol (and drugs) takes place in interdisciplinary centers that are commonly based in medical centers or schools of public health. Notable are centers such as those at Rutgers University, University of Michigan, University of Washington, University of Texas, University of California at Los Angeles, University of Georgia, University of Kentucky, University of Connecticut, the University at Buffalo, and the University of Oklahoma. There is also a substantial amount of research activity that occurs in independent free-standing organizations, both nonprofit and for-profit, such as the Research Triangle Institute, RAND Corporation, Pacific Institutes for Research and Evaluation, and Westat, Inc.

Those with sociological backgrounds working in settings as members of interdisciplinary teams are not readily identified as sociologists, nor is their work usually published in sociological outlets. Instead, it appears in numerous specialty outlets focused on substance abuse or in journals more broadly focused on psychiatry, general medicine, public health, or health services research.

Some of these publication outlets in turn represent specialized research organizations such as the Research Society on Alcoholism, the College of Problems of Drug Dependence, the Academy of Health Services Research, the American Society of Addiction Medicine, and the American Public Health Association. Participation in these organizations keeps sociologists involved in alcohol studies in contact with peers from other disciplines, who may be studying similar issues. Such interaction is important in building and sustaining reputations and prestige, as well as providing access to new research and publishing opportunities.

These networks in turn include persons selected as peer reviewers for research grant applications by the NIAAA, the National Institute on Drug Abuse (NIDA), and other funding agencies within the NIH. Sociologists and other network members also sit on the editorial boards of the specialty journals, such as Addiction, Journal of Studies on Alcohol, American Journal of the Addictions, Journal of Substance Abuse Treatment, Substance Abuse and Misuse, and many others, publication in which is central to peer interaction and part of the expectations associated with receiving grant and contract awards. Moreover, the funding agencies, principally within the NIH, are oriented toward alcoholism and the health and social consequences of alcohol abuse and are thus unlikely to provide favorable reviews or high priority to research aimed at fundamental sociological questions.

Alcohol issues became prominent in American culture in the 1830s, with the launching of the Temperance movement, substantially predating the emergence of American sociology. The social and organizational activity swirled around alcohol issues into the first quarter of the twentieth century, culminating in national Prohibition (Clark 1976; Rumbarger 1989). While the prohibition of alcohol manufacture and distribution in the United States would seem to have offered sociologists a great opportunity for commentary and perhaps criticism of this social policy, as well as opportunity for analyzing the emergence of the policy despite popular ambivalence, an examination of the content of the American Journal of Sociology and the Journal of Social Forces, the two extant sociological journals published during the period of Prohibition (enacted in 1918, enforcement began in 1920, repeal in 1933), finds almost no interest in the topic.

The sociological study of alcohol issues in the United States had its origins in the repeal of Prohibition in 1933. The enactment of Prohibition in 1920 marked the culmination of an 80-year period of prominence for a twopronged set of efforts to remove drinking from American society, the Women’s Christian Temperance Union and the Anti-Saloon League (Gusfield 1963; Clark 1976; Rumbarger 1989). The fundamental ideology of these overlapping but separate movements was that the manufacture, distribution, and use of alcohol are destructive to both social structure and social order. Drinking was said to have especially undermining effects on the family and the workplace through adult male drinking habits, highly visible in the relatively short-lived social institution of the saloon.

The development of two streams of sociological study can be traced back to the post-Prohibition period. Each of these flowed “naturally” from other events involving changes in social policy. A third stream was launched quite deliberately several years later but has developed in a quite limited fashion and at present appears to be dormant. These three streams can also be characterized by their typical foci: (1) alcohol abuse, or behavior which produces social costs and problems; (2) alcohol dependence and alcoholism; and (3) normative drinking behavior and the roles that the use of alcohol plays in social structure and social institutions.

The first stream is easily understood for its continuity with portions of the ideology of Prohibition and the Temperance movement in its focus on the problematic consequences of alcohol use. This research includes the relationships between drinking and a variety of undesirable social outcomes such as crime, unemployment, and family instability. This stream of research also focuses on the problematic drinking patterns of certain social groups, such as college students or the elderly.

Researchers aligned with this perspective rarely advocate a return to Prohibition but are strongly identified with both supply and demand reduction in the form of preventive education about the risks associated with drinking and increased controls on the availability of alcoholic beverages. In a traditional sociological sense, this is the “social problems” perspective on alcohol. From a broad perspective, this orientation today is closely aligned with the field of public health.

The second stream flowed from fascinating social changes that began in the 1930s and continue to evolve until the present day. Temperance ideology was coupled with the notion that alcohol consumption offered the potential of unmanageable habituation to anyone who drank. The best analogy to understanding is contemporary ideas about heroin use in American culture, namely, that the drug’s effects are so potent and seductive that any user is at high risk of becoming an addict. The repeal of Prohibition occurred for a complex set of political, economic, and social reasons that did not include a social “embrace” of alcohol as the “Good Creature of God” as it had been labeled in the eighteenth century. Drinking in American society is not seen as an expectation or a right but as a privilege or a necessary evil. However, repeal effectively undermined the perspective that alcohol use created a marked risk of loss of control and addiction. Another conception was needed.

Although some changes were almost immediate, the 20 years following the repeal of Prohibition led to a greatly modified vision of the social location of the alcohol problem, namely, the rejuvenation, rearticulation, alteration, and attempted widespread diffusion of the idea of the disease of alcoholism (Levine 1978; Schneider 1978). This was the first and central ingredient of this stream of research, and it opened the way for American society to reaccept the legal presence of alcohol because alcoholism occurs among relatively few people. Specifically, this disorder, characterized by a progression to loss of control over one’s drinking, is posed to affect a relatively small proportion of alcohol users. Its definition specifically excludes the excessive use of alcohol as a cause of alcoholism and draws a distinction between this disease condition and deviant drinking behaviors. The deviant drinker has chosen to break laws and social norms and may be punished for this behavior, whereas alcoholics are driven by a compulsion that is supposedly out of their control.

The disease model could not be nurtured in a vacuum. The available organizational context was centered on the replacement of the “moral” approach to alcohol by a scientific or “rational” approach. The debate over right and wrong involving alcohol was to yield to objective and comprehensive understanding of the substance’s nature and effects. This in turn would guide social policies based on reason instead of emotion. Through happenstance or predestination, the rapid success of this transformation was greatly enhanced by the emergence of the first scientific center of studies on alcohol at one of the most distinguished and respected centers of thought in the United States, Yale University.

The Laboratory of Applied Physiology, established many years earlier, included eclectic leaders such as Dr. Howard Haggard and Dr. Yandell Henderson, the latter having authored scientific articles about the relative harmlessness of beer consumption, data that may have added impetus to the repeal movement. Following repeal, a section on Alcohol Studies appeared in the Laboratory and eventually emerged as a full-scale Center of Alcohol Studies.

The scientific orientation was attractive to a number of prominent scientists outside Yale, who had been repelled by the Prohibition experiment and its irrational features. They formed the Research Council on Problems of Alcoholism as a means of garnering interest and support for the emerging specialty of scientific alcohol studies and were closely aligned with the activities at Yale. This council enhanced its linkage with scientific imagery by becoming affiliated with the American Association for the Advancement of Science (Beauchamp 1980). This group initially received some modest support from the alcohol beverage production industry, as well as from other sources, but it did not attract governmental support for research.

Almost simultaneous with the disease model and the superceding of moralism by the scientific approach was the rise of a fascinating solution to the newly defined disease, namely, the invention, codification, and diffusion of the fellowship of Alcoholics Anonymous (AA). Originally defined as a “cure” for alcoholism (later the ideology shifted to “once an alcoholic, always an alcoholic”), AA evolved from the Oxford Group concepts popular in the 1920s and 1930s. In order to open the way for full reentry into society, AA essentially embraced the disease model of alcoholism, although its referent has always been that the loss of control is traced to an “allergy.”

While working informally and without a name for several years after its founding in 1935, AA came to national attention with an article in the then popular magazine the Saturday Evening Post. The AA program came to be articulated into a series of 12 steps. These steps include experiences of surrender to a higher power, self-examination, repentance, confession, meditation, and finally, service to others attempting to deal with their drinking problems. Membership in the fellowship requires only a sincere commitment to stop drinking. Passage through the steps, which is not mandatory and does not confer status, is reinforced by peer support, by attendance at regular meetings where members shared their “stories” of alcoholic defeat, and by sponsorship of an experienced AA member, who is available around the clock to provide advice and support.

The scientific approach, the disease concept, and AA constituted a mutually supportive and interdependent system that gave impetus to a substantial amount of research and promotional activity that brought the notion of alcoholism as a treatable illness into mainstream American culture. An illustrative capstone event of this integral process was the offer in 1954 of an honorary doctorate by Yale University to William G. Wilson, the cofounder of AA. Wilson refused the honor on the basis that it would set a precedent for individuals receiving personal recognition for the activities of AA (Hartigan 2000).

This core of the disease model of alcoholism, nested in a scientific approach, and the treatment of alcoholism with a logical, inexpensive, lay-based yet supportive of the disease concept is the home of the second stream of sociological research. It is notably interdisciplinary, and the unique contributions of sociology are not always clearly evident. This stream might be seen as a subfield of medical sociology, although it is not organized as such within sociology. The stream embodies social psychological studies, epidemiology, and health services research. It is, however, more closely aligned with medicine than with public health.

The third stream was intended to be within the sociological mainstream, but its development has become minimal and marginal to the mainstream of sociology. More than 60 years ago, a sociologist laid out a plan for using alcohol as the platform for a major endeavor in advancing sociological understanding of groups, communities, institutions, cultures, and societies (Bacon 1943). Selden Daskam Bacon was a Yale Ph.D. in sociology who studied under Albert Keller, who had been a student of William Graham Sumner. From the platform of the Yale Center and its emphasis on the scientific approach, Bacon saw distinctive roles for the social sciences assuming that the moral perspective on alcohol was relegated to the past.

In this treatise, Bacon saw both the history of alcohol in human societies and its pervasive presence in many realms of social institutional life as descriptive of its interconnections with the formation and deterioration of social norms and values. He recognized the fact that the apparent control of a potent drug flowing freely in adult society offered the potential for understanding the workings of basic processes of social control. Bacon’s call included attention to all the “normal” and integrative uses of alcohol, in addition to expected sociological concerns with alcohol-related and alcohol-fueled conflict and deviant behavior.

While Bacon’s plan never came to fruition, or is yet to be discovered by those who will develop it, he himself became a mainstream figure in the interdisciplinary research field of alcohol studies and, clearly identifying himself as a sociologist, became the first Director when Alcohol Studies achieved Center status at Yale. It should be noted that the relationship of the Center with Yale ended in 1962, when amidst a swirl of controversy,Yale president Kingman Brewster terminated the Center on the grounds that its interests were outside the University’s central stream of basic research and education (Wiener 1981). With support from the only philanthropist who has ever given substantial resources to the field of alcohol studies and practice, R. Brinkley Smithers, and with support from the National Institute of Mental Health (where the minimal federal interest in alcohol-related research was located prior to the establishment of NIAAA), the Center on Alcohol Studies was successfully relocated to Rutgers University, where it remains today.

The remainder of this research paper reviews examples of sociological ideas and research about the broad notions of alcohol abuse and alcoholism. Rather than offering an abbreviated catalog of the entire body of this work, focus is on several illustrative samples in each stream.

Beginning with what has been referred to as the first stream of sociological research, the definition of alcohol abuse is distinctively sociological, based on deviation from the norms of acceptable drinking. If one’s drinking is deviant in the eyes of another, then it may be said that an event of alcohol abuse has occurred. This becomes consequential when the defining other is more powerful than the drinker and decides to take action. Thus, a 12-year-old caught drinking a tiny amount from a bottle in her parents’ liquor cabinet would likely be defined as an alcohol abuser by an observing parent. Later in her life, when she is a college student, the same female may be observed by her peers drinking a copious amount of beer through a funnel, and the behavior is not defined as abuse.

A narrower definition emerges when social reactions are considered, for there are far more incidents of alcohol abuse than there are incidents that generate significant social reactions. These reactions may include screening for people whose drinking exceeds legal levels, such as that which occurs commonly on highways and less commonly in workplaces. Or the reactions may be triggered by social impacts, costs, and damages that are associated with the presence of alcohol abuse. In some such situations, the alcohol use is defined as abuse regardless of its level, with the consequences being the determining factors.

An illustration of this approach to analysis is a social problem that is the result of technological change, namely, the emergence of motor vehicles of all types as primary modes of human transportation. There has been a highly effective diffusion of the idea that alcohol consumption is the leading cause of highway accidents and related injuries and fatalities. In many respects, this logic is continuous with the “demonization” themes so common during the Temperance movement. Importantly, motor vehicles had not achieved prominence in the period from 1840 to 1918, when the gradual movement toward alcohol prohibition was under way. Thus, the theme of drinking’s impact on highway safety had no relevance to the Temperance and Anti-Saloon movements.

The alcohol linkage may be seen as “ecological (Roman 1981b).” Five “ingredients” are present when a drinkingdriver casualty occurs: alcohol in bloodstream + driver + automobile + highway + crash event. Testing for alcohol in the bloodstream and/or other evidence of alcohol consumption is at the forefront of the investigation. If alcohol is found to be present in an adequate amount, it is typically concluded that it was the “cause” of the event. It takes precedence over other possible causal explanations that may not be considered.

As examples, the possibility that other conditions affecting the driver could have “caused” the accident, such as lack of sleep, physical exhaustion, or emotional preoccupations, are ruled out by default. Only recently has there been awareness that “groups drive cars,” although resulting regulations about the composition of the passenger population in a given vehicle are limited to those under age 21.

Likewise, unless blatantly obvious conditions are observed, defects in the physical functioning of the automobile itself are not considered as a possible cause of the accident.

Similarly, while sometimes considered as a contributing factor, highway conditions are rarely, if ever, attributed as a primary cause of an accident when alcohol is found to be present.

Sociological studies have advanced four interrelated factors that account for the dominance of drinking-related explanations. First, there has been a well-organized social movement, Mothers Against Drunk Driving (MADD), that forcefully and effectively brought this linkage to public attention (Reinarman 1988) and led to spin-off organizations such as Students Against Drunk Driving (SADD). Rather than using scientific evidence about the linkage between drinking and vehicular accidents, MADD adopted two icons that were prominent in the Temperance movement, the innocent child and the irresponsible drunken male adult. The founders of MADD were mothers of children who had been killed or injured by a driver who had been found to be drinking. The meaning of the group’s acronym lies in maternal anger over the light penalties imposed on the drunken drivers, and the all-too-common stories that these individuals had retained their driver’s licenses. Thus, MADD pushed for heavier penalties and more extensive enforcement of drinking and driving laws, all based on the causal linkage between drinking and highway crashes.

A second contributing factor is the relative ease of generating explanatory evidence. Blood alcohol levels detected through breath or blood tests are objective indicators that are relatively easily measured and understood. By contrast, the location of other causes may involve subjectivity and set the stage for conflicting interpretations.

Third, along with much of the industrialized world, the causal linkage in the United States between drinking as a cause of vehicular accidents is an institutionalized explanation that goes without challenge. In the United States, such causal statements appear on every container of alcohol sold through a retail outlet. Another institutional marker of this causal belief is a set of “dram shop laws,” which can hold individual servers or retail outlets responsible for the material consequences of intoxication. The alcohol production and distribution industry does not challenge this explanation and in fact cooperates in campaigns to promote nondrinking “designated drivers” and to make servers of alcohol sensitive to the potential driving-related consequences of excessive alcohol consumption.

Fourth, alternative explanations that focus on defects in cars or on highway design may be seen as challenging vested interests and creating liabilities that may prove problematic for manufacturers and/or public officials who design and maintain highways. By contrast, there are no defenders of drunk drivers. Persons who desire to drink and drive or who do so routinely have not organized themselves into interest groups to promote these opportunities. To argue in today’s society that it is a person’s right to drive with a blood alcohol level of .08 or greater is patently absurd on its face.

It is of interest that this singular causal theory has not been diluted by a parallel movement to impugn illegal drug use as a significant contributor to highway accidents. Considering the elements reviewed above, there is no trace of a social movement to address drugs and driving, and it is clear that measurement of drug use in an “onsite” fashion as is done with alcohol offers considerable technical challenges. The highway and the motor vehicle are, however, part of a different drug-related drama that echoes the Prohibition era, namely, the pursuit and apprehension of “suspicious” drivers and vehicles that are found to be carrying quantities of illegal drugs.

A similar set of social constructions can be found to prevail in a very different circumstance, namely, the consumption of alcohol by pregnant women (Armstrong 2003; Golden 2005). Drinking during pregnancy is imputed as the cause of a set of psychophysiological impairments observed in childhood known as the fetal alcohol syndrome (FAS), with milder forms of the symptoms referred to as fetal alcohol effects (FAE). The linkage of maternal drinking to these outcomes is ambiguous, as are the diagnoses of the disorders. Nevertheless, warnings about the effects of drinking on developing fetuses are universally diffused in the United States, including warning labels on alcoholic beverage containers and posted warnings in retail settings where alcoholic drinks are sold. Presumably, a woman who is noticeably pregnant and observed to be drinking would be stigmatized as irresponsible, perhaps in the extreme.

There are a number of problematic implications of this emergent normative structure (Armstrong 2003). First is the fact that when cases of apparent FAS and FAE have been closely examined, there is a strong association with poverty and general disorganization in the lives of the mothers. It appears likely that the outcomes of FAS and FAE stem from combinations of behaviors resulting in malnutrition, negligence of prenatal care, and heavy drinking. By focusing exclusively on maternal drinking behavior as the etiological agent, broader social conditions and life chances of the mothers and their offspring are effectively ignored.

Second, the ambiguous association between maternal drinking and FAS/FAE is used to impose social controls on pregnant women while effectively ignoring the drinking behaviors of fathers. Fathers’drinking may lead to the conditions of negligence and poverty that are important agents in the outcomes that have been labeled FAS/FAE. Likewise, the powerful indictment of drinking as a harmful agent draws attention away from nutritional factors and maternal behaviors such as tobacco smoking.

Third, the causal linkage is a mechanism for attributing blame solely to the mother and her behavioral choices. This may be seen as another mechanism whereby women’s control over the reproductive process is curbed by the imposition of rules via simplistic interpretation of scientific data and through reasoning that easily crosses the border from science into morality.

Proscribed maternal drinking is remarkable in its simplicity in that it parallels the rules surrounding drinking and driving. Warning labels and signs are used to remind not only pregnant women of possibly damaging behavior but also bystanders of what pregnant women should and should not be doing. As with drinking and driving, there is no counteradvocacy group suggesting that pregnant women should be allowed to drink in moderation or that the research evidence about this linkage should be challenged.

That ambiguous data have been accepted as the basis for institutionalized rules that affect a significant portion of the population is another indicator of the lack of positive support for alcohol consumption in American culture and the absence of advocacy for the privilege of drinking. The overall attitude toward drinking during pregnancy, as with drinking before or during the experience of operating a motor vehicle, is “better safe than sorry,” despite the possibilities that the causes of the adverse outcomes lie in something other than drinking.

Sociologists have long been attracted to the association between alcohol and crime, a direct heritage from the Temperance and Prohibition ideologies. One of the most thorough investigations has centered on alcohol and homicide (Parker 1996). It is clear that there is no direct causal linkage between drinking and violent behavior, but that the presence of drinking can be a facilitating factor in crime (Roman 1981a). This possibility is especially underlined when it is established that the victims of crime have frequently been drinking as well as the perpetrators, or that drinking by a crime victim created a particular vulnerability to victimization by a nondrinking perpetrator. This association has recently been examined extensively surrounding the issue of “date rape,” of particular concern among college students (Abbey 2002).

There are a multitude of other social problems where data indicate an association with drinking, but where causality is difficult to discern. An example is homelessness, where drinking and alcohol abuse are complex correlates but hardly a singular cause. An emergent issue of the past decade has been “binge drinking” among college students, supposedly a set of risky and destructive behaviors affecting students who are naive about alcohol’s dangers, their nondrinking peers, and the communities in which colleges are located. The imagery of risks associated with binge drinking by college students has been painted in broad strokes (Perkins 2002a) and, in the case of one highly effective moral entrepreneur, has been escalated to be associated with frequent fatalities (Wechsler and Wuethrich 2003). On the other side of the risk model, several sociologists have been active in the effort to develop interventions that will curb these behaviors (DeJong 2002; Perkins 2002b).

Turning to the second stream of research, the overview now turns to studies that are primarily concerned with the disease of alcoholism and its treatment. Research in the twentieth century had strong suggestions of social factors in the etiology of alcohol dependence. Trice (1966) offered a theory of individually rewarding drinking experiences followed by selective and sequential associations with drinking groups within which increasingly heavy and chronic alcohol use was socially accepted. Individuals who became alcoholic were surmised to “drift” through structures of social tolerance, where they found social acceptance but eventually ended up at “the bottom,” or on skid row.

Building on the work of other researchers who had examined homeless and disaffiliated alcoholics, Wiseman (1970) uncovered social patterns and social structure in the lives and interactions within these groups rather than anomie and normlessness. Later, the same author (Wiseman 1991) documented patterns of social interaction in couples where the husband was a recovering alcoholic, strongly suggesting that social role relationships could develop around a spouse’s chronic alcoholism and can serve to prolong it; by contrast, the adjustments necessary for the couple to relate in the context of sobriety is more complex than might be assumed.

Bacon (1973) used role theory to describe how individuals used alcohol to “ease” their entry into social situations where they felt uncomfortable with their performance. This in turn was seen as creating risks of thwarted role learning when alcohol became an agent of “pampering” accompanied by a broader repertoire of alcohol use in conjunction with potentially uncomfortable social performances. This was later developed further into an explanation for why “social stars” seem at high risk for developing alcohol and drug problems (Roman and Blum 1984).

Akers (1992) developed a straightforward model based on learning theory, describing patterned rewards in social interaction wherein alcohol dependence could develop. Mulford (1984) used both data-based observations and experience as an alcoholism treatment program director to develop a theory of how the process of recovery from alcoholism actually begins during periods of one’s heaviest drinking, looking closely at responses to the reactions of one’s social audience. Norman Denzin (1987) developed a detailed and complex description of the construction of the alcoholic self, which followed an earlier monograph that described the emergence of a transformed self through the processes of alcoholism treatment and recovery (Denzin 1986). An outstanding ethnography by a sociologist provides a rich description of processes associated with the struggle for recovery within AA (Rudy 1986).

Despite considerable promise, these studies did not lead to programmatic research, largely because they did not attract research support. This lack of interest is largely explained by the intense support that came to surround the explanation of etiology within a biomedical model of causation, indicating possible variations in alcohol metabolism across individuals and often including suggestions of genetic origins of these behavior patterns.

Within the second stream of sociological research and writing, a new generation of sociologists has moved away from criticism of the disease model and attempts to supplant it with models based on social interaction and has instead implicitly embraced it through treatment and health services research. Following is an example of such sociological analysis, tracing the macroorganizational forces that affected growth and change in the alcoholism treatment industry.

Contemporary alcoholism treatment has its most direct lineage from the postrepeal social movement discussed earlier. Launched by enthusiastic members of AA, who recovered through its program during its first decade of existence, the National Council for Alcoholism Education (later the National Council on Alcoholism [NCA] and now the National Council on Alcoholism and Drug Dependence [NCADD]) was founded in 1943, its mission being to “mainstream” into the health care system the treatment of the disease of alcoholism. The fledgling organization was originally based at the alcohol studies center at Yale University, and thus attempted to build its image via a symbolic association with science and medicine.

Public treatment for inebriates has a long history, with several large-scale asylums established in the second half of the nineteenth century (Baumohl and Room 1990). These centers could accomplish little except to keep their patients away from alcohol for the duration of their stay. By the early twentieth century, they were largely abandoned and replaced by drunk farms and county poorhouses, where little in the form of treatment was attempted. NCA’s first departure from this model was the “Yale Plan Clinics” (Bacon 1947). These clinics were based on the AA approach, administered independently from the state hospital system, and their suggested design implicitly pointed toward inclusion of middle-class alcoholics, a notable departure from the caricature of drunkards at the bottom of the social class pyramid within Temperance ideology.

These clinics did not diffuse widely, and thinking shifted by the 1960s toward the idea that structured inpatient care for a brief period of time is necessary for successful treatment of alcoholism. Furthermore, inpatient care was more consistent with medicalizing alcoholism as a serious disorder. What emerged was an approach eventually referred to as “the Minnesota Model”; the inpatient treatment regimen was designed to last four weeks, and was expected to be followed by lifelong affiliation with AA. In addition to group AA experiences, patients also received individual counseling and education about the impact of alcohol on the human organism.

Parallel to these developments, NCA leadership undertook a major campaign for the decriminalization of the public inebriate. This symbolic change was seen as necessary for elevating the status of alcoholism to “a disease like any other.” The transformation of the alcoholic from “bad” to “sick” through the legislative process was viewed as highly significant at the time. NCA was successful in promoting this legislation. Inadvertently, perhaps, this accomplishment tended to reify the image of the alcoholic as a socially marginal, nonproductive public inebriate, a stereotype persisting from the Temperance movement. Thus, decriminalization was a limited and perhaps limiting organizational achievement relative to the movement’s mainstreaming goal. It was especially limiting in that it did not build either advocacy or an appropriate constituency to promote NCA’s goals.

Through the 1960s, NCA leadership slowly evolved the vision of locating alcoholism at all levels of social strata (Roman and Blum 1987). If alcoholism was a biological disorder, it should be widely dispersed within the population. Thus, the target of concern in the mainstreaming campaign moved from the highly visible, socially marginal public inebriate to the nearly invisible, socially integrated “hidden alcoholic.”

Responding to its own definitions, NCA leadership became focused on the mechanisms to most effectively reach the vast bulk of American alcoholics who were not on skid row. In retrospect, a four-pronged campaign can be inferred (Roman and Blum 1987).

First, the public must be convinced that alcoholism was pernicious and pervasive and could be found anywhere in the social structure, from which it follows that the majority of alcoholics are indeed “hidden” and not receiving treatment.

Second, mechanisms must be made available for treating these “respectable” alcoholics, facilities clearly not represented by those that had been envisioned to serve the goal of decriminalization.

Third, to make treatment for alcoholism accessible, its costs must be covered like the costs for treatment of other disorders, leading to the clear need for the extension of health insurance coverage to include alcoholism.

Fourth, means must be established to identify and motivate the vast group of hidden alcoholics in the direction of treatment. Given the contrast in the apparent level of social integration between hidden alcoholics and the public inebriates that had previously been the primary target of treatment, it was clear that the workplace had great potential for serving this purpose. Workplace interventions, ultimately refined into employee assistance programs, were visible in a small but distinguished set of American corporations and were promoted as the mechanism that would provide the patients for a new system of treatment (Roman 1981a).

These goals came to be implemented through the establishment of NIAAA (see Wiener 1981; Olson 2003 for a detailed analysis of the political processes preceding NIAAA’s emergence). As a new organization desiring to build a constituency, NIAAA worked closely with NCA. It moved on each of these four fronts to promote the idea that everyone was at risk for alcoholism, that a new system of privately based treatment should be established and supported by health insurance coverage. The NIAAA also enthusiastically embraced workplace interventions, which had been previously developed and promoted by NCA (Roman 1981a).

Entrepreneurs from many backgrounds, including AA recovery, were attracted to build a national network of private alcoholism treatment centers. These centers enjoyed growth, development, and apparently substantial income approximately from the late 1970s to the late 1980s. The centers opening during this period almost universally followed the Minnesota Model. Local, regional, and national advertising emerged to diffuse the concept of inpatient treatment, and the mass media gave considerable attention to the experiences of alcoholism and recovery among celebrated personalities.

However, during the decade of the 1980s and into the 1990s, two major and interrelated challenges to the centers’financial and organizational health emerged. First was a challenge to the relative efficacy of the residential treatment services that were the sole or central activity of most of these centers. A federally commissioned study (Saxe 1983) indicated that there was no evidence of advantages of this mode of treatment over other types. The eventual conclusion was that the residential experience was far more elaborate and expensive than was needed to produce the rate of successful client outcomes that could be inferred from research data.

The second challenge supported the first, namely, the costs of alcoholism treatment. Beginning in the early 1980s, most employers were experiencing rising costs of health insurance coverage for their employees. Employers’ concerns were also the concerns of third-party insurers, whose profits and competitive positions were adversely affected by rising costs. The combination of concerns by employers and insurers eventually spread to managers in the public sector responsible for managing public payments for eligible clients receiving private health care. All these factors accumulated toward the health care reform crisis of the early 1990s and the rise of managed care.

Residential inpatient care services provided by the relatively new set of private alcoholism treatment centers were thus under attack from two directions, and each attack was more or less bolstered by the other. On the one hand, it was argued that less expensive services (e.g., community-based outpatient care) could produce the same or better results in treating alcoholism. Furthermore, these treatment centers were especially vulnerable to strong and severe challenges to reduce the costs of services. Several features of private alcoholism treatment centers describe their weak buffers to these challenges to organizational survival.

• The costs of inpatient care for alcoholism for 28 dayswere not large relative to the costs of care in a general hospital setting. But private residential alcoholism treatment was a new arrival on the health care scene, and employers and insurers had not had these costs previously. Because of its newness, this system of treatment was far from being institutionalized within the larger culture’s expectations and norms about appropriate medical care. There is little evidence of widespread acceptance of the importance or even the propriety of this treatment within the surrounding public culture.
• Because of their newness, uniqueness, and tendencyto be freestanding, alcoholism treatment centers had not established interdependent relationships with other parts of the health care system. Such interdependencies could act as buffers in the face of environmental challenges, with other service units that either sent or received referrals from alcoholism treatment centers coming to their aid and advocating for their value. Such potential interfaces include primary care physicians and hospital emergency rooms, but partly because of the short organizational life of these centers and other aspects of the “liability of newness” (i.e., the essentially nonmedical nature of alcoholism treatment), there is very little evidence of the development of such interdependencies.
• Also related to newness, the treatment centers had notdeveloped a collective identity that was manifest in a trade association or other lobbying group that could defend its unique interests. This is in part due to the variation in organizational sponsorship from which the centers were established (i.e., general hospitals, emergent nonprofit boards, and profit-making companies).
• Most alcoholism treatment centers have little in theirregimen that can “mystify” the external observer. The apparent simplicity of their core technology, as well as the strong spiritual emphases, made them especially vulnerable to external challenges to their value. The processes that go on in residential treatment programs appear as “just talk” readily comprehensible to the external observer, bearing no resemblance to medical care. This encourages criticism by outsiders of the “unnecessary” extent of group meetings or the “luxurious” nature of recreational facilities.

A field research study focused on 126 private treatment centers initiated in 1986 (Block 1990; Roman, Blum, and Johnson 2000) revealed that within a sample of these private centers, almost perfect isomorphism could be found, following patterns of 28-day inpatient treatment, using 12step principles as the foundation for treatment design, and targeting services toward clienteles with appropriate health insurance coverage (Block 1990; Roman et al. 2000). Just as the growth of the population of these centers was spectacular, their transformation has occurred with almost equal rapidity. As the first study moved toward completion, a dramatic number of closures in the original population of centers were documented, with these organizational deaths clearly indicating environmental conditions that were failing to support the centers’ existence. There was a nearly a 20 percent fatality rate in the sample of centers between 1989 and 1991 (Roman et al. 2000).

Continuing research indicates that inpatient care and the “Minnesota Model” have become increasingly rare as treatment facilities have been forced to expand their services and modify their treatment ideologies in an effort to adapt to the turbulent environment created by managed care (Johnson and Roman 2002; Roman and Johnson 2002). What were initially separate systems for treating alcohol and drug problems have become integrated. Survival of treatment programs appears increasingly dependent on diversification and seeking new markets for care, such as providing services to special population groups and integrating treatment for co-occurring disorders such as psychiatric illness, eating disorders, and compulsive gambling.

This analysis of a portion of the treatment system for alcoholism is typical of health services research on alcohol issues conducted by sociologists. It makes use of organizational approaches to understanding the growth and development of social systems. Related studies are focused on the adoption of innovations in substance abuse treatment systems and the role of specialized occupations in treating substance abuse problems. Other research has focused on the use of the workplace for identifying employees with alcohol problems and providing them with constructive assistance via the structures available in work organizations (Roman 1990).

The third stream examines an array of “normal” drinking and considers the potentially integrative role of alcohol in multiple sectors of society. There is an extensive anthropological record of the worldwide variations in the social patterns of alcohol use (Heath 2000), much of it emphasizing the socially integrative functions served by alcohol consumption. Several sociological studies follow in this tradition, although most of them tend to include questions about alcohol abuse and alcoholism as well.

Early in this tradition was a study by Robert Freed Bales (1946) of Irish drinking behavior. Looking at drinking in rural Ireland, Bales linked the observed patterns with social and cultural organization. The rules of primogeniture resulted in the oldest son inheriting the farm, with the remaining brothers staying on as farm laborers, but without the wherewithal to marry and raise their own families. Bales argued that heavy drinking had emerged as a functional substitute for sexual outlets among these men in puritanical Irish society and that it eventually diffused as a social acceptance of heavy drinking by men.

Charles Snyder (1958) completed his doctoral work at Yale with an extensive study of drinking among Orthodox Jews, attempting to understand how a culture could have a near-zero rate of abstinence and yet have few problems with alcohol. His conclusions centered on the social meanings of drinking as symbolic and supportive of family and religious life, with drinking typically present when at ceremonial events underlining the importance of family and of religion. Excessive drinking also had a negative association with non-Jewish outsiders, including memories of events when drunken anti-Semites would attack Jewish communities, particularly in Eastern Europe.

This work was revisited by Glassner and Berg (1980), who conducted research to establish the resilience of the minimal level of alcohol problems as Jewish communities moved away from Orthodox isolation and became more integrated with non-Jewish cultures. Their research revealed four factors: the continuing cultural association of alcohol abuse with non-Jews, the integration of moderate drinking into family-based rituals, tending to drink with other moderate-drinking Jewish family members and friends, and developing repertoires for avoiding the common pressures to drink heavily in social settings.

Other research that has considered the integrative effects of alcohol has suggested that drinking may be an important socialization rite of passage for youth and young adults (Maddox and McCall 1960). This conclusion is, of course, in sharp contrast to the current obsession with drinking among college students, and the symbolic association of death and injury with “binge drinking,” a term effectively invented and diffused to precipitate a degree of moral panic (Wechsler and Wuethrich 2003).

Other studies have examined the settings of drinking and have generated some fascinating ethnographies of cocktail lounges, bars, and after-hours clubs (Cavan 1966; Spradley and Mann 1975; Roebuck and Frese 1976). One such ethnography provides a rich examination of the lives of blue-collar men in one community who centered much of their social life surrounding tavern-based drinking (LeMasters 1976).

However, not only is there no sociology of drinking in the mainstream of contemporary sociology, but also it is quite clear that relatively few sociologists include the use or misuse of alcohol in their research or writing. There can be little doubt that in the United States as well as around the world, alcohol issues are marginal to mainstream sociology. Perhaps this attention will change during the twenty-first century.

Robin Room (1976), a polymath sociologist who has explored and written about nearly every aspect of alcohol social history, policy, and epidemiology, wrote a brilliant but neglected essay on American ambivalence toward alcohol and its consequences. Within the social and historical context of American society, it is easy to see how the appreciative stance on alcohol could wither away from lack of social support. The current cultural context has been characterized as a “drug panic,” and in such a setting, receptivity to discussions about the virtues and values of alcohol is likely to be low. However, in line with Room’s observations, this does not mean that drinking will disappear or even significantly diminish. What it does mean is that talking about drinking and addressing deviant drinking in families or social settings through direct confrontation will both continue as taboo topics and taboo behaviors within this culture.

Looking only at American society, there is, however, little on the horizon to suggest that change in the pattern of sociological attention and investigation will occur. Despite the potential for their development, there are few tensions or conflicts to be observed among the constituent groups surrounding alcohol, these including consumers, the specialized medical care system’s for alcohol dependence, the criminal justice system management of alcohol-related deviance, and the alcohol production and distribution industries.

Alcohol use is, however, an increasingly global phenomenon, and alcohol manufacture and distribution is an aggressively growing worldwide industry, replacing in many locations systems of indigenous alcohol production that have usually been accompanied by socially and culturally integrated customs of drinking. For example, the spread of alcohol availability is accompanied by the introduction of Western-style systems of work organization (Roman 2002). This presents two sets of potential problems. First are those where much more extensive use of alcohol develops among those with the newly acquired wherewithal to obtain it, coupled with employed persons’ responses to advertising that much more extensive drinking than was known in the past is part of the new normative order. Second are the effects of wider availability of alcohol and attractive promotions in settings where the intermingling of drinking and work has been casually tolerated for centuries. In either case, the problems are not likely to be easily tractable, and an understanding of how to effectively deal with normative and organizational change emanating from sociological research could be potentially valuable. Thus, direct sociological attention to alcohol issues could come to flourish in the twenty-first century and beyond.

Bibliography:

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How to Write a Research Paper | A Beginner's Guide

A research paper is a piece of academic writing that provides analysis, interpretation, and argument based on in-depth independent research.

Research papers are similar to academic essays , but they are usually longer and more detailed assignments, designed to assess not only your writing skills but also your skills in scholarly research. Writing a research paper requires you to demonstrate a strong knowledge of your topic, engage with a variety of sources, and make an original contribution to the debate.

This step-by-step guide takes you through the entire writing process, from understanding your assignment to proofreading your final draft.

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Table of contents

Understand the assignment, choose a research paper topic, conduct preliminary research, develop a thesis statement, create a research paper outline, write a first draft of the research paper, write the introduction, write a compelling body of text, write the conclusion, the second draft, the revision process, research paper checklist, free lecture slides.

Completing a research paper successfully means accomplishing the specific tasks set out for you. Before you start, make sure you thoroughly understanding the assignment task sheet:

• Read it carefully, looking for anything confusing you might need to clarify with your professor.
• Identify the assignment goal, deadline, length specifications, formatting, and submission method.
• Make a bulleted list of the key points, then go back and cross completed items off as you’re writing.

Carefully consider your timeframe and word limit: be realistic, and plan enough time to research, write, and edit.

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There are many ways to generate an idea for a research paper, from brainstorming with pen and paper to talking it through with a fellow student or professor.

You can try free writing, which involves taking a broad topic and writing continuously for two or three minutes to identify absolutely anything relevant that could be interesting.

You can also gain inspiration from other research. The discussion or recommendations sections of research papers often include ideas for other specific topics that require further examination.

Once you have a broad subject area, narrow it down to choose a topic that interests you, m eets the criteria of your assignment, and i s possible to research. Aim for ideas that are both original and specific:

• A paper following the chronology of World War II would not be original or specific enough.
• A paper on the experience of Danish citizens living close to the German border during World War II would be specific and could be original enough.

Note any discussions that seem important to the topic, and try to find an issue that you can focus your paper around. Use a variety of sources , including journals, books, and reliable websites, to ensure you do not miss anything glaring.

Do not only verify the ideas you have in mind, but look for sources that contradict your point of view.

• Is there anything people seem to overlook in the sources you research?
• Are there any heated debates you can address?
• Do you have a unique take on your topic?
• Have there been some recent developments that build on the extant research?

In this stage, you might find it helpful to formulate some research questions to help guide you. To write research questions, try to finish the following sentence: “I want to know how/what/why…”

A thesis statement is a statement of your central argument — it establishes the purpose and position of your paper. If you started with a research question, the thesis statement should answer it. It should also show what evidence and reasoning you’ll use to support that answer.

The thesis statement should be concise, contentious, and coherent. That means it should briefly summarize your argument in a sentence or two, make a claim that requires further evidence or analysis, and make a coherent point that relates to every part of the paper.

You will probably revise and refine the thesis statement as you do more research, but it can serve as a guide throughout the writing process. Every paragraph should aim to support and develop this central claim.

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A research paper outline is essentially a list of the key topics, arguments, and evidence you want to include, divided into sections with headings so that you know roughly what the paper will look like before you start writing.

A structure outline can help make the writing process much more efficient, so it’s worth dedicating some time to create one.

Your first draft won’t be perfect — you can polish later on. Your priorities at this stage are as follows:

• Maintaining forward momentum — write now, perfect later.
• Paying attention to clear organization and logical ordering of paragraphs and sentences, which will help when you come to the second draft.
• Expressing your ideas as clearly as possible, so you know what you were trying to say when you come back to the text.

You do not need to start by writing the introduction. Begin where it feels most natural for you — some prefer to finish the most difficult sections first, while others choose to start with the easiest part. If you created an outline, use it as a map while you work.

Do not delete large sections of text. If you begin to dislike something you have written or find it doesn’t quite fit, move it to a different document, but don’t lose it completely — you never know if it might come in useful later.

Paragraph structure

Paragraphs are the basic building blocks of research papers. Each one should focus on a single claim or idea that helps to establish the overall argument or purpose of the paper.

Example paragraph

George Orwell’s 1946 essay “Politics and the English Language” has had an enduring impact on thought about the relationship between politics and language. This impact is particularly obvious in light of the various critical review articles that have recently referenced the essay. For example, consider Mark Falcoff’s 2009 article in The National Review Online, “The Perversion of Language; or, Orwell Revisited,” in which he analyzes several common words (“activist,” “civil-rights leader,” “diversity,” and more). Falcoff’s close analysis of the ambiguity built into political language intentionally mirrors Orwell’s own point-by-point analysis of the political language of his day. Even 63 years after its publication, Orwell’s essay is emulated by contemporary thinkers.

Citing sources

It’s also important to keep track of citations at this stage to avoid accidental plagiarism . Each time you use a source, make sure to take note of where the information came from.

You can use our free citation generators to automatically create citations and save your reference list as you go.

APA Citation Generator MLA Citation Generator

The research paper introduction should address three questions: What, why, and how? After finishing the introduction, the reader should know what the paper is about, why it is worth reading, and how you’ll build your arguments.

What? Be specific about the topic of the paper, introduce the background, and define key terms or concepts.

Why? This is the most important, but also the most difficult, part of the introduction. Try to provide brief answers to the following questions: What new material or insight are you offering? What important issues does your essay help define or answer?

How? To let the reader know what to expect from the rest of the paper, the introduction should include a “map” of what will be discussed, briefly presenting the key elements of the paper in chronological order.

The major struggle faced by most writers is how to organize the information presented in the paper, which is one reason an outline is so useful. However, remember that the outline is only a guide and, when writing, you can be flexible with the order in which the information and arguments are presented.

One way to stay on track is to use your thesis statement and topic sentences . Check:

• topic sentences against the thesis statement;
• topic sentences against each other, for similarities and logical ordering;
• and each sentence against the topic sentence of that paragraph.

Be aware of paragraphs that seem to cover the same things. If two paragraphs discuss something similar, they must approach that topic in different ways. Aim to create smooth transitions between sentences, paragraphs, and sections.

The research paper conclusion is designed to help your reader out of the paper’s argument, giving them a sense of finality.

Trace the course of the paper, emphasizing how it all comes together to prove your thesis statement. Give the paper a sense of finality by making sure the reader understands how you’ve settled the issues raised in the introduction.

You might also discuss the more general consequences of the argument, outline what the paper offers to future students of the topic, and suggest any questions the paper’s argument raises but cannot or does not try to answer.

You should not :

• Offer new arguments or essential information
• Take up any more space than necessary
• Begin with stock phrases that signal you are ending the paper (e.g. “In conclusion”)

There are four main considerations when it comes to the second draft.

• Check how your vision of the paper lines up with the first draft and, more importantly, that your paper still answers the assignment.
• Identify any assumptions that might require (more substantial) justification, keeping your reader’s perspective foremost in mind. Remove these points if you cannot substantiate them further.
• Be open to rearranging your ideas. Check whether any sections feel out of place and whether your ideas could be better organized.
• If you find that old ideas do not fit as well as you anticipated, you should cut them out or condense them. You might also find that new and well-suited ideas occurred to you during the writing of the first draft — now is the time to make them part of the paper.

The goal during the revision and proofreading process is to ensure you have completed all the necessary tasks and that the paper is as well-articulated as possible. You can speed up the proofreading process by using the AI proofreader .

Global concerns

• Confirm that your paper completes every task specified in your assignment sheet.
• Check for logical organization and flow of paragraphs.
• Check paragraphs against the introduction and thesis statement.

Fine-grained details

Check the content of each paragraph, making sure that:

• each sentence helps support the topic sentence.
• no unnecessary or irrelevant information is present.
• all technical terms your audience might not know are identified.

Next, think about sentence structure , grammatical errors, and formatting . Check that you have correctly used transition words and phrases to show the connections between your ideas. Look for typos, cut unnecessary words, and check for consistency in aspects such as heading formatting and spellings .

Finally, you need to make sure your paper is correctly formatted according to the rules of the citation style you are using. For example, you might need to include an MLA heading  or create an APA title page .

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Checklist: Research paper

I have followed all instructions in the assignment sheet.

My introduction presents my topic in an engaging way and provides necessary background information.

My introduction presents a clear, focused research problem and/or thesis statement .

My paper is logically organized using paragraphs and (if relevant) section headings .

Each paragraph is clearly focused on one central idea, expressed in a clear topic sentence .

Each paragraph is relevant to my research problem or thesis statement.

I have used appropriate transitions  to clarify the connections between sections, paragraphs, and sentences.

My conclusion provides a concise answer to the research question or emphasizes how the thesis has been supported.

My conclusion shows how my research has contributed to knowledge or understanding of my topic.

My conclusion does not present any new points or information essential to my argument.

I have provided an in-text citation every time I refer to ideas or information from a source.

I have included a reference list at the end of my paper, consistently formatted according to a specific citation style .

I have thoroughly revised my paper and addressed any feedback from my professor or supervisor.

I have followed all formatting guidelines (page numbers, headers, spacing, etc.).

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How to Start a Research Paper

Beginning is always the hardest part of an assignment. The introduction should not be the first thing you begin to write when starting to work on an essay. First, tons of research should be conducted — in order for your paper to be good. Only then you will be able to extract the main points of your work, and introduce them to your readers. A good introduction will also include your personal opinion of the problem, and, therefore, will make the writing easier overall. Let's dive into the details with admission essay writing services .

What Is a Research Paper?

A research paper is a type of writing in which the author does an independent analysis of the topic and describes the findings from that investigation. Furthermore, one will have to identify the weaknesses and strengths of the subject and evaluate them accordingly.

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A good way to write an introduction for a research paper is to introduce your reader to the topic by telling them what you are writing about. Then, make sure you include an interesting fact, or some surprising statistical data, so that your reader will be hooked and will continue to read your research paper. Treat your essay introduction like an advertisement for a product you want to sell—if your advertisement is bad, the sales won’t be great. The same goes for a bad introduction; if it does not intrigue readers, they might lose interest in your paper.

The beginning is always the hardest part of an assignment. Regardless of if you are writing a small resume education section or a full-blown research paper - following the correct steps is very important . The introduction should not be the first thing you begin to write when starting to work on an essay.

You might also be interested in getting more info about HOW TO WRITE A RESEARCH PAPER

Introduction Paragraph Outline

Present Your Essay Topic

The base of every essay is its topic. What you are writing about should always be a reflection of your topic. Simply start off your introduction by telling your readers, in a simple and accessible language, what it is you are writing your research paper about. Although, we suggest you include a “trigger” when introducing the topic of your paper. A personal reference, or a story that relates to the essay topic, are options for a good way to link plain text to people’s emotions. So, feel free to write sincerely, as if you were talking to a friend.

The best strategy to start your introduction is by writing a broad topic presentation, then gradually narrow it down to what you would like to focus on exactly. It will put your topic into perspective for readers’ general understanding. When writing your research paper, make sure to include your opinion on the issue in your introduction. This will make your topic sound more personal and it will likely become more important to your audience as well.

Provide Background Information and Context

The topic you begin writing about is likely very familiar to you, as it is expected that you have done plenty of research. But what about your readers? For the most part, the amount of context is determined by what your audience already knows—though, let’s focus on a bigger assortment of readers, to make sure everyone’s needs are met. Imagine that you are part of your audience. Read the information you provided in the introduction. Is this sufficient? Does it leave gaps and unanswered questions in your research? Your job as a writer is to provide the perfect background to your topic, which gives readers just enough information to be able to grasp your topic and enjoy your research paper to the fullest. Another extreme you should avoid is giving too much context—consequently making the audience feel bored right from the introduction. Write your essay as something that you would enjoy reading yourself, like a story, but not an academic research paper.

Explain the Importance of Your Research

There is no doubt that after plenty of research you are an expert in your field. But what about your readers? In the introduction you need to showcase the extent of your research and write about the work you have completed. This will also help your readers understand that your ideas are supported by other scholars, and you share their views in your paper.

Make sure to write about all the works you have studied in order to persuade readers of your expertise. For your introduction, simply use the names you are referencing, or their most important works, so that the audience does not feel overwhelmed. It is also necessary to cite all your sources—in order to avoid academic plagiarism.

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Make Your Rationale Work

Rationale is the most important part of the beginning of your paper. Explain to readers the reasoning behind your research paper—the importance of this is a guarantee that they will keep reading and appreciate your topic. In the introduction, you need to write an explanation of how your paper fits into all the research that has already been done in that field; this shows your audience the importance of your essay and the role your research plays in the field overall.

Show the Significance of Your Research

You, and only you, understand how important your research is. The next step of your introduction is to prove to your audience how important it is. Include the basic, and the most important literature, you support your ideas with. This will show the readers your solid analytical skills, your writing capabilities, and your ability to sort out information to deliver the most important points for your paper. And the final part of the introduction is to simply explain why your research is important to the field, to society, to the whole world, and, most importantly, to the readers. When a person can relate to an idea, it is almost always a guarantee that your argument will be persuasive and have a positive outcome.

Make Sure Your Thesis Is Clear

A research paper introduction uses primary sources and data to support its thesis statement. A research paper’s thesis statement has a lot in common with a thesis for an essay, or other non-research assignment. The difference lies in the fact that in a research thesis, you gather evidence from valid sources to prove your perspective on a topic. Despite the fact that you support your thoughts by sources, the idea for your thesis in your introduction should be original and your own, as it reflects the way you think.

Here is a quick checklist for writing a thesis statement:

• Remember, the thesis is your argument. Make sure it sounds assertive.
• Write two to three versions of your thesis and choose the best one.
• Share your thesis with a neutral person—to get a different point of view.
• Discuss your thesis with others; they might have good ideas as well.
• It should appear in your introduction, and be restated in your conclusion.

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Research Paper Title Page

Mla title page.

Here are some tips from our writing team on how to format your research paper MLA title page:

• The title page is double spaced and the text needs to be centred.
• Write the name of your university or college.
• Skip about one-third of the page down and type your research paper title—include a subtitle if you have one.
• Skip several lines down and type your name, your course name and number, your instructor’s name, and your paper’s due date.

APA Title Page

• Place a running head in your page’s header:
• Use the label “Running head:” then, put your shortened title (IN UPPERCASE LETTERS), and align it all to the left.
• Place the page number in this same header, but align it to the right, and begin with page number 1.
• The header should be 1 inch from the top. Some teachers say 1/2 inch is okay as well.
• Place your paper’s title in the upper half of the page, centred. Capitalize the first letter of all of the important words in your title.
• Place your University’s name below your name, double-spaced.

Read also our research proposal example APA .

Final Thoughts

Congratulations on finishing your research paper! Answer these questions to avoid careless mistakes.

• Are all of your quotations, paraphrases, and summaries accurate?
• Are all of your references accurate?
• Is your format the proper format assigned by your instructor?
• Are all the concepts defined and easily understood by an average reader?
• Is your “hook” good enough for the reader to become interested?
• Is there a structure to your introduction that is easy to navigate for the reader?
• Does your introduction give a good idea of what your paper is about?

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Research Paper Introduction Example

Now that you have a solid idea about the introduction of a research paper, let’s take a look at some examples from our writers. They will help you see how all of the rules we presented above work in practice. ‍

Research Paper Introduction Example: Should Parents Be Held Accountable for the Criminal Acts of Their Children? Recently, youth gang connected attacks have been occurring in an increasing prevalence, with some even causing deaths, such as the killing of a college student at Suburbs East. Such occurrences have made a lot of people to wonder about the origin of those violent actions, with much of the extent of guilt being put on the parents of such adolescents. In any event, one has to question whether the parents should be penalized for the offenses of their kids. Some people believe that parents should be held responsible for the criminal acts of their offspring because parents are mostly accountable for the education and upbringing of their kids, and frequently impact the actions and behavior of their children until they become mature and independent. This is because they are almost always the ones that raise their kids after birth. As such, it is believed that parents start to influence the ethical range of their children from a young age, and one’s ethics are critically impacted by the way parents act and their personalities (Gratz, 169). This logic can make parents responsible for their children if they do wrong later on — because they are understood to not have raised their child in the right way. Furthermore, there is an argument that children are virtually completely controlled by their parents, as they are apt to want to make their parents happy, and they would, therefore, listen to whatever they are told to do or how they are told to behave (Michael, Andrew and Michael, 4). This, in turn, makes many people think that parents should always be the ones to be blamed for the criminal acts of their children, as they believe that they have the power to warn and control them.

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How To Write Your Best Alcoholism Essay?

Table of Contents

To start off, alcoholism is a physical and psychological disease characterized by regular consumption of high qualities of alcohol and troubles with giving up drinking.

It is a well-known fact that alcoholism is quite an issue nowadays. It breaks the lives of people, their families, and the whole society. According to WHO (World Health Organization), excessive use of alcohol causes 5.3% of deaths yearly, which makes a total of 3 million deaths.

The topic is quite vast, so it won’t be hard to find a thrilling aspect to cover in your essay.

6 facts for your alcoholism essay

The main goal of writing an essay on alcoholism is to highlight the problem, it’s causes, reasons, and outcomes.

Keep things simple, precise and informative. Use only credible sources in references. Try visiting official websites of WHO, Medical News Today (website specialized on medical information), ASAM (American Society of Addiction Medicine, on different addictions), etc.

Also, here are several facts for you to start off somewhere.

• Alcoholism is not only a disease but also an addiction. This may seem obvious. Therapists state that it can be as dangerous as drug addiction since a person gets used to it not only on a mental level but also on a physical. As a result, there are loads of difficulties when giving up.
• Alcoholism shouldn’t be regarded as a personal choice. Like any other addiction, it differs from person to person. Usually, people can’t notice that something is wrong before they actually try to stop drinking.
• Except for being a disease itself, alcoholism leads to health and social issues. Doctors claim that alcoholism results in liver disease, pancreatitis, cancers, brain damages, and others. Moreover, it leads to socialization problems as alcoholics can be depressed, aggressive and struggle from a negative attitude of society.
• Alcoholism has a genetic complex. It is stated that children of alcoholics are 4 times more predisposed to alcoholism. Scientists claim that alcohol and drug addiction usually starts with families.
• There are more men alcoholics than women. The research shows that men are more likely to become alcoholics than women. Investigation can’t actually explain this fact, but the main reason is considered to be the fact that men drink more alcohol overall.
• Alcohol makes people feel worse. Some may say that they drink to “drown sorrows,” but it doesn’t work in a long-term perspective. Actually, alcohol is a depressant.

How to structure the essay on alcoholism?

A good structure is essential for any writing. As a rule, the essay is divided into three parts: introduction, main body, and conclusion.

You might also want to write an outline for your work. Here are some easy instructions to follow:

Outline. Basically, it is a table of contents. You briefly plan your essay and organize your thoughts. Write down the statement you are about to use in the introduction, note several arguments supporting your statement and think of how to summarize these thoughts in conclusion .

Introduction. Here you need to provide the reader with some basic information on the topic. It may include the definition of alcoholism, statistics, and rates of how many alcoholics are out there, the yearly amount of deaths, age statistics, and so on. Include a thesis explaining the main idea of your essay and your standpoint. It shouldn’t be longer than 1 sentence.

The Main Body. Explain your standpoint step by step. Add arguments gradually. Each supporting statement takes 1 paragraph and is accompanied by a brief explanation . Put them in a logical order.

Conclusion. Sum up everything you said before and confirm the thesis. Do not add new ideas , statements, or facts. Here, in the alcoholism essay conclusion, you may express your own vision of the problem.

Causes and effects of alcoholism essay: what to cover?

Each case of alcoholism is unique and has its own set of reasons and consequences. Thus, you may need to know some general statistics and information on the causes and effects of alcoholism. Here are several prompts.

Causes of alcoholism essay:

• A stressful environment that enforces the person to seek consolation.
• Drinking at an early age.
• Mental issues (like depression, apathy, etc.).
• Genetics and family history.
• Mixing alcohol with medicine: possible outcomes.
• The experience of trauma.
• Bad influence of the company.
• Lack of family care.
• Power of the mass media.
• No awareness of the possible psychological problems.

Effects of alcoholism essay:

• Health problems, like heart and liver diseases, brain damage, low immunity, cancer, etc.
• Depression, apathy, suicidal thoughts.
• Slurred speech, confusion, trouble remembering things.
• Concentration issues.
• Bad academic performance.
• Increased chance of committing a crime.
• Domestic violence.
• Adverse effect on children.
• Loss of job and financial troubles.
• Mood swings.

Alcoholism is quite an issue in modern society. Essays, exploring this topic, are needed to spread the awareness of the risks we all encounter.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Introduction.

Alcohol is part of our society. People use it to celebrate, socialize, relax, and enhance the enjoyment of meals. Nearly 90 percent of adults in the United States report that they drank alcohol at some point in their lifetime, and more than half report drinking in the last month. 1  Although most people drink in moderation, nearly 40 percent of U.S. adults drink in excess of the low-risk guidelines established by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). 2  (See “ Drinking Patterns and Their Definitions .”)

Alcohol misuse has wide-ranging adverse consequences. In the United States, nearly 88,000 people per year die from alcohol-related causes; 3  globally, alcohol accounts for 3.3 million deaths—5.9 percent of all deaths—each year. 4  Alcohol misuse also contributes to poor performance at school and work; family problems; unprotected sex and sexually transmitted diseases; violence; memory blackouts; unintentional injuries, accidents, and overdoses; and organ damage and disease. It can lead to alcohol use disorder (AUD), a serious chronic condition that affects nearly 16 million people in the United States. 5  (See “ What Is Alcohol Use Disorder? ”) The Centers for Disease Control and Prevention estimates that alcohol misuse, including AUD, costs the United States $249 billion per year due to health care expenses, lost workplace productivity, crime, property damage, and other outcomes. 6

NIAAA, a component of the National Institutes of Health (NIH), is the largest funder of alcohol research in the world. For nearly five decades, NIAAA’s extramural research program has supported a diverse portfolio of innovative investigator-initiated research to elucidate the effects of alcohol on health and reduce the burden of alcohol misuse for individuals at all stages of life. This work is complemented by a robust intramural research program that leverages the state-of-the-art resources available at NIH to advance high-risk, high-reward studies in key areas of alcohol science. In addition, through the Collaborative Research on Addiction at NIH (CRAN) initiative, NIAAA is partnering with the National Institute on Drug Abuse and the National Cancer Institute to integrate resources and expertise across NIH to develop a comprehensive, well integrated understanding of substance use, misuse, and addiction that considers the common and distinctive features of addictive substances and substance use disorders (SUDs).

Research supported by NIAAA has spurred tremendous progress in identifying the factors that contribute to alcohol-related problems and the fundamental biological and behavioral mechanisms by which they develop, and it has paved the way for innovative preventive and treatment interventions. Once viewed as a moral failing or character flaw, AUD is now widely regarded as a chronic but treatable brain disease that develops through complex, dynamic interactions among biological, environmental, and developmental factors. This shift in perspective, bolstered by decades of research on the neurobiology of addiction, has helped reduce the stigma associated with AUD and has underscored the need for a multipronged approach to preventing and treating alcohol-related problems, with interventions designed for individuals, families, communities, and society at large.

This strategic plan serves as a roadmap for catalyzing continued progress across the spectrum of alcohol research and translating these advances for the benefit of the public. It highlights NIAAA’s research goals in five key areas:

• Goal 1: Identify Mechanisms of Alcohol Action, Alcohol-Related Pathology, and Recovery  
• Goal 2: Improve Diagnosis and Tracking of Alcohol Misuse, Alcohol Use Disorder, and Alcohol-Related Consequences  
• Goal 3: Develop and Improve Strategies To Prevent Alcohol Misuse, Alcohol Use Disorder, and Alcohol-Related Consequences  
• Goal 4: Develop and Improve Treatments for Alcohol Misuse, Alcohol Use Disorder, Co-Occurring Conditions, and Alcohol-Related Consequences  
• Goal 5: Enhance the Public Health Impact of NIAAA-Supported Research

Along with the goals outlined above, NIAAA has identified several cross-cutting research themes, which are woven throughout this strategic plan.

Address Alcohol Misuse Across the Lifespan

Human biology and behavior change throughout life; these changes affect drinking patterns and risks for alcohol-related injury and disease. NIAAA has adopted a “lifespan approach” to alcohol research that considers how the emergence and progression of drinking behavior and related outcomes interact with developmental changes and environmental inputs across the lifespan, from the embryonic and fetal stages of development into older adulthood. This perspective guides the identification of life-stage–appropriate strategies for preventing, treating, and facilitating recovery from alcohol problems, as well as tailoring resources to the needs of individuals of all ages.

Address Co-Occurring Conditions

AUD frequently co-occurs with other SUDs and mental health conditions, including major depressive disorder, anxiety disorders, bipolar disorder, antisocial and borderline personality disorders, and post-traumatic stress disorder (PTSD). Individuals suffering from psychiatric comorbidity tend to have a poorer prognosis, higher risk for treatment dropout, less support for sobriety from their families and in the workplace, and a higher risk for suicide. Alcohol misuse also contributes to more than 200 diseases and injury-related health conditions, 9  including alcoholic liver disease. In fact, alcohol is involved in nearly half of all liver disease deaths in the United States each year. 10  Alcohol misuse frequently co-occurs with human immunodeficiency virus (HIV), contributes to HIV transmission, reduces HIV screening, makes it difficult to follow complex HIV medication regimens, and contributes to or exacerbates other health conditions in HIV-infected individuals. NIAAA will continue to support research to investigate the relationships between AUD and co-occurring conditions and to develop interventions to prevent and treat them.

Reduce Health Disparities

Some groups of people may be more vulnerable to alcohol problems than others. For example, although Native Americans are less likely to drink than white Americans, those who do drink are more likely to binge drink, 11  have a higher rate of past-year AUD compared with other racial and ethnic groups, 12  and are approximately twice as likely to die from alcohol-related causes than the general American public. 13  In addition, Hispanics and blacks who drink are more likely to binge drink than whites who drink, 11  but Hispanics with AUD are less likely than whites with AUD to receive alcohol treatment at a specialty facility. 14  The lesbian, gay, bisexual, and transgender communities are also important subpopulations to consider. Lesbian and bisexual women are about seven times more likely than heterosexual women to meet criteria for AUD. 15  Although rates of alcohol use and AUD among men who have sex with men (MSM) are comparable to rates in the general population, alcohol misuse among MSM is an important public health problem. Alcohol misuse is a known risk factor for HIV, and MSM account for more than half of all new HIV infections each year in the United States. 16  NIAAA is committed to ensuring that all people benefit from alcohol research advances and will support studies to better understand health disparities and develop interventions for at-risk groups.

Advance Precision Medicine

Studies investigating how individual variability in genes, environment, and lifestyle contribute to disease are bringing us closer to developing individually tailored interventions for alcohol-related conditions. NIAAA will continue to support research on the factors that contribute to individual variation in alcohol misuse, AUD, and alcohol-related outcomes. The Institute will use that information to guide the development and validation of prognostic and diagnostic biomarkers and personalized interventions for these conditions. These efforts will be aided by the recent expansion of electronic medical records and the development of mobile health technologies, which have the potential to improve the quality and collection of patient data and to provide comprehensive, personalized health care services where and when patients need them.

Strengthen the Biomedical Workforce

Cultivating a talented and diverse research workforce is essential to advancing the frontiers of scientific knowledge and to translating research findings into practice. NIAAA promotes alcohol research training through individual pre- and postdoctoral fellowships, institutional training grants, and career development awards that span the breadth of NIAAA’s research portfolio. Diverse research teams broaden the scope of scientific inquiry, bring creative solutions to bear on complex scientific problems, and encourage research relevant to the health care needs of underserved populations. Programs to identify, recruit, and train scientists from diverse populations, especially those underrepresented in health research, are an important component of NIAAA’s training portfolio.

Serve as a Responsible Steward of Our Nation’s Research Resources

Underpinning NIAAA’s ability to advance innovative science is an unwavering commitment to responsible research stewardship. NIAAA supports efforts to enhance the rigor and reproducibility of research, including ensuring that sex is incorporated as a biological variable into the design, analysis, and scientific reporting of the studies it funds. This is a critical step toward ensuring that everyone, regardless of sex or gender, benefits from alcohol research advances. NIAAA maximizes the use of research resources by forging strategic partnerships with other NIH Institutes, Centers, and Offices; other Federal agencies; academia; industry; and not-for-profit organizations. Such partnerships provide opportunities to share resources and expertise, and to broaden the dissemination of alcohol research findings. Moreover, by encouraging the use of common research metrics and protocols, as well as the sharing, aggregation, and secondary analysis of data, NIAAA hopes to improve the efficiency of alcohol research and stimulate new insight into preventing and treating alcohol-related conditions.

Drinking Patterns and Their Definitions  

What Is a Standard Drink?

Many people are surprised to learn what counts as a drink. The amount of liquid in your glass, can, or bottle does not necessarily match how much alcohol is in your drink. Different types of beer, wine, or malt liquor can have very different amounts of alcohol. For example, many light beers have almost as much alcohol as regular beer—about 85 percent as much.

Moderate Alcohol Consumption

According to the Dietary Guidelines for Americans, 7  which are intended to help individuals improve and maintain overall health and reduce the risk of chronic disease, moderate drinking is up to one drink per day for women and up to two drinks per day for men.

Low-Risk Drinking for Developing Alcohol Use Disorder

As defined by NIAAA, for women, low-risk drinking is no more than three drinks on any single day and no more than seven drinks per week. For men, it is defined as no more than 4 drinks on any single day and no more than 14 drinks per week. NIAAA research shows that only about 2 in 100 people who drink within these limits have alcohol use disorder. Even within these limits, you can have problems if you drink too quickly or have other health issues.

Alcohol Misuse

Alcohol misuse refers to drinking in a manner, situation, amount, or frequency that could cause harm to the users or to those around them. For individuals younger than the legal drinking age of 21, or for pregnant women, any alcohol use constitutes misuse.

Binge Drinking

NIAAA defines binge drinking as a pattern of drinking that brings blood alcohol concentration levels to 0.08 g/dL (0.08 percent) or higher. This typically occurs after a woman consumes four drinks or a man consumes five drinks in a 2-hour time frame.

The Substance Abuse and Mental Health Services Administration (SAMHSA), which conducts the annual National Survey on Drug Use and Health (NSDUH), defines binge drinking for men as drinking five or more alcoholic drinks on the same occasion on at least 1 day in the past 30 days. SAMHSA defines binge drinking for women as drinking four or more alcoholic drinks on the same occasion on at least 1 day in the past 30 days.

Extreme Binge Drinking

Extreme binge drinking, also known as high-intensity drinking, refers to drinking at levels far beyond the binge threshold, resulting in high peak blood alcohol concentrations. Though definitions vary, some studies define extreme binge drinking as 2 or more times the gender-specific binge drinking thresholds (i.e., 10 or more standard drinks for men; 8 or more for women); other studies use a higher threshold that may or may not be gender specific.

Heavy Drinking

SAMHSA defines heavy drinking as binge drinking (based on the SAMHSA binge drinking thresholds described above for men and women) on 5 or more days in the past 30 days.

Certain people should avoid alcohol completely, including those who:

• Are younger than the minimum legal drinking age of 21.
• Are pregnant or trying to become pregnant.
• Have a medical condition that alcohol can aggravate.
• Take medications that interact with alcohol.
• Are driving a vehicle or operating machinery (or plan to do so shortly after drinking).

What Is Alcohol Use Disorder?  

Alcohol use disorder (AUD) is a medical condition that doctors diagnose when a patient’s drinking causes distress or harm. It ranges from mild to severe and is characterized by clinically significant impairments in health and social function. To be diagnosed with AUD, a person must meet certain diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM).8 The current DSM (DSM-5) integrates the two DSM–IV disorders, alcohol abuse and alcohol dependence, into a single disorder called AUD. Under DSM-5, anyone meeting any 2 of the 11 criteria during the same 12-month period is diagnosed with AUD. The severity of AUD is based on the number of criteria a person meets—mild (2–3), moderate (4–5), or severe (6 or more).

To assess whether someone has AUD, a health care provider may ask him or her some questions. For example, in the past year, have you:

• Had times when you ended up drinking more, or longer, than you intended?
• More than once wanted to cut down or stop drinking, or tried to, but couldn’t
• Spent a lot of time drinking? Or being sick or getting over the aftereffects?
• Experienced craving—a strong need, or urge, to drink?
• Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
• Continued to drink even though it was causing trouble with your family or friends?
• Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
• More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
• Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout (i.e., forgetting, after drinking, where you were or what you did while drinking)?
• Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
• Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, dysphoria, depression, restlessness, nausea, or sweating? Or sensed things that were not there?

Any of these symptoms may be a cause for concern. The more symptoms one has, the more urgent the need for change.

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Sandee Lamotte what too Much Alcohol Can do to your Health Summary

This essay about Sandee Lamotte’s investigation into alcohol’s impact on health illuminates the complex web of physiological and societal consequences wrought by excessive drinking. Through meticulous research and compelling narrative, Lamotte underscores the dire toll alcohol takes on the brain, mental health, and vital organs like the liver and heart. With a focus on prevention, intervention, and holistic support systems, Lamotte’s work serves as a clarion call for greater awareness and action to address the pervasive challenges of alcoholism in society.

How it works

Sandee Lamotte’s meticulous investigation into the ravages of alcohol consumption on health unveils a tapestry of physiological and societal consequences. Through her meticulous research and compelling narrative, Lamotte underscores the multifaceted impact of excessive alcohol intake on the human body and beyond, serving as a clarion call for greater awareness and intervention.

Central to Lamotte’s exposé is the insidious assault alcohol launches on the brain. Delving into neuroscientific research and expert insights, Lamotte meticulously illustrates how alcohol disrupts neurotransmitter function, impairs cognitive abilities, and erodes memory retention.

Her narrative vividly portrays the toll alcoholism exacts on neural pathways, underscoring the dire need for strategies to mitigate cognitive decline and promote brain health in those grappling with addiction.

Moreover, Lamotte explores the intricate nexus between alcohol abuse and mental health disorders, unearthing the profound toll of addiction on psychological well-being. Through poignant anecdotes and clinical analysis, Lamotte elucidates the synergistic relationship between alcoholism and conditions such as depression, anxiety, and trauma. Her narrative underscores the urgency of integrated treatment approaches that address both substance use disorders and co-occurring mental health challenges, fostering holistic healing and recovery.

In addition to its neurological and psychological repercussions, Lamotte sheds light on the devastating toll alcoholism exacts on the body’s vital organs, particularly the liver. Drawing upon medical expertise and epidemiological data, Lamotte unveils the intricate cascade of damage wrought by chronic alcohol abuse, from fatty liver disease to cirrhosis and hepatocellular carcinoma. Her narrative underscores the urgent need for preventative measures, early intervention, and comprehensive support systems to mitigate the burgeoning burden of alcohol-related liver diseases.

Furthermore, Lamotte delves into the cardiovascular sequelae of alcoholism, interrogating its role in precipitating hypertension, arrhythmias, and cardiomyopathy. Through meticulous analysis of clinical studies and expert testimonies, Lamotte challenges prevailing assumptions about the cardiovascular benefits of moderate alcohol consumption, highlighting the nuanced interplay between drinking patterns and heart health. Her narrative underscores the imperative of personalized risk assessment and targeted interventions to mitigate alcohol-related cardiovascular morbidity and mortality.

Beyond its physiological ramifications, Lamotte elucidates the profound societal and economic repercussions of alcoholism, unraveling its impact on families, communities, and healthcare systems. Through poignant vignettes and data-driven analysis, Lamotte exposes the ripple effects of addiction, from interpersonal strife and domestic violence to soaring healthcare expenditures and productivity losses. Her narrative underscores the imperative of comprehensive public health strategies that address the social determinants of alcohol misuse while fostering resilience and community cohesion.

In conclusion, Sandee Lamotte’s incisive exploration of alcohol’s toll on health and society serves as a catalyst for action and compassion. Through her blend of rigorous inquiry and empathic storytelling, Lamotte amplifies the voices of those affected by addiction while illuminating pathways to prevention, treatment, and recovery. As we heed Lamotte’s call to confront the scourge of alcoholism with urgency and empathy, we embark on a collective journey toward a healthier, more resilient future for individuals, families, and communities alike.

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The effects of alcohol use on academic achievement in high school

Ana i. balsa.

a Research Professor, Center for Applied Research on Poverty, Family, and Education, Department of Economics, Universidad de Montevideo; Prudencio de Pena 2440, Montevideo, 11600, Uruguay; Phone: (+598 2) 707 4461 ext 300; Fax: (+598 2) 707 4461 ext 325; yu.ude.mu@aslaba

Laura M. Giuliano

b Assistant Professor, Department of Economics, University of Miami, Coral Gables, FL 33124, United States; [email protected]

Michael T. French

c Professor of Health Economics, Health Economics Research Group, Department of Sociology, Department of Economics, and Department of Epidemiology and Public Health, University of Miami, Coral Gables, FL 33124, United States; ude.imaim@hcnerfm

This paper examines the effects of alcohol use on high school students’ quality of learning. We estimate fixed-effects models using data from the National Longitudinal Study of Adolescent Health. Our primary measure of academic achievement is the student’s GPA abstracted from official school transcripts. We find that increases in alcohol consumption result in small yet statistically significant reductions in GPA for male students and in statistically non-significant changes for females. For females, however, higher levels of drinking result in self-reported academic difficulty. The fixed-effects results are substantially smaller than OLS estimates, underscoring the importance of addressing unobserved individual heterogeneity.

1. Introduction

In the United States, one in four individuals between the ages of 12 and 20 drinks alcohol on a monthly basis, and a similar proportion of 12 th graders consumes five or more drinks in a row at least once every two weeks ( Newes-Adeyi, Chen, Williams, & Faden, 2007 ). Several studies have reported that alcohol use during adolescence affects educational attainment by decreasing the number of years of schooling and the likelihood of completing school ( Chatterji & De Simone, 2005 ; Cook & Moore, 1993 ; Gil-Lacruz & Molina, 2007 ; Koch & McGeary, 2005 ; McCluskey, Krohn, Lizotte, & Rodriguez, 2002 ; NIDA, 1998 ; Renna, 2007 ; Yamada, Kendrix, & Yamada, 1996 ) Other research using alternative estimation techniques suggests that the effects of teen drinking on years of education and schooling completion are very small and/or non-significant ( Chatterji, 2006 ; Dee & Evans, 2003 ; Koch & Ribar, 2001 ).

Despite a growing literature in this area, no study has convincingly answered the question of whether alcohol consumption inhibits high school students’ learning. Alcohol consumption could be an important determinant of how much a high school student learns without having a strong impact on his or her decision to stay in school or attend college. This question is fundamental and timely, given recent research showing that underage drinkers are susceptible to the immediate consequences of alcohol use, including blackouts, hangovers, and alcohol poisoning, and are at elevated risk of neurodegeneration (particularly in regions of the brain responsible for learning and memory), impairments in functional brain activity, and neurocognitive defects ( Zeigler et al., 2004 ).

A common and comprehensive measure of high school students’ learning is Grade Point Average (GPA). GPA is an important outcome because it is a key determinant of college admissions decisions and of job quality for those who do not attend college. Only a few studies have explored the association between alcohol use and GPA. Wolaver (2002) and Williams, Powell, and Wechsler (2003) have studied this association among college students, while DeSimone and Wolaver (2005) have investigated the effects of underage drinking on GPA during high school. The latter study found a negative association between high school drinking and grades, although it is not clear whether the effects are causal or the result of unobserved heterogeneity.

Understanding the relationship between teenage drinking and high school grades is pertinent given the high prevalence of alcohol use among this age cohort and recent research on adolescent brain development suggesting that early heavy alcohol use may have negative effects on the physical development of brain structure ( Brown, Tapert, Granholm, & Delis, 2000 ; Tapert & Brown, 1999 ). By affecting the quality of learning, underage drinking could have an impact on both college admissions and job quality independent of its effects on years of schooling or school completion.

In this paper, we estimate the effects of drinking in high school on the quality of learning as captured by high school GPA. The analysis employs data from Waves 1 and 2 of the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative study that captures health-related behaviors of adolescents in grades 7 through 12 and their outcomes in young adulthood. Our analysis contributes to the literature in several ways. First, we focus on the effect of drinking on academic achievement during high school. To date, and to the best of our knowledge, only one other study in the literature has analyzed the consequences of underage drinking on high school GPA. Second, rather than rely on self-reported GPA, we use objective GPA data from academic transcripts, reducing the potential for systematic biases in the estimation results. Third, we take advantage of the longitudinal nature of the Add Health data and use fixed-effects models to purge the analysis of time invariant unobserved heterogeneity. Fixed-effects techniques are superior to instrumental variables (IV) estimation when the strength and reliability of the instruments are suspect ( French & Popovici, 2009 ). Finally, we explore a variety of mechanisms that could underlie a detrimental effect of alcohol use on grades. In addition to analyzing mediators related to exposure to education (days of school skipped), we investigate the effect of drinking on students’ ability to focus on and adhere to academic objectives.

2. Background and significance

Behavioral research has found that educational performance is highly correlated with substance abuse (e.g., Bukstein, Cornelius, Trunzo, Kelly, & Wood, 2005 ; Hawkins, Catalano, & Miller, 1992 ). Economic studies that look at the link between alcohol use and educational outcomes have customarily focused on measures of educational attainment such as graduation (from high school or college), college matriculation, and years of school completed (e.g., Bray, Zarkin, Ringwalt, & Qi, 2000 ; Chatterji, 2006 ; Cook & Moore, 1993 ; Dee & Evans 2003 ; Koch & Ribar, 2001 ; Mullahy & Sindelar, 1994 ; Renna, 2008 ; Yamada et al., 1996 ). Consistent with the behavioral research, early economic studies found that drinking reduced educational attainment. But the most rigorous behavioral studies and the early economic studies of attainment both faced the same limitation: they were cross-sectional and subject to potential omitted variables bias. Some of these cross-sectional economic studies attempted to improve estimation by using instrumental variables (IV). Cook and Moore (1993) and Yamada et al. (1996) found that heavy or frequent drinking in high school adversely affects high school and college completion. Nevertheless, the validity and reliability of the instruments in these studies are open to debate ( Chatterji, 2006 ; Dee & Evans, 2003 ; French & Popovici, 2009 ).

By contrast, more recent economic studies that arguably use better estimation methods have found that drinking has modest or negligible effects on educational attainment. Dee and Evans (2003) studied the effects of teen drinking on high school completion, college entrance, and college persistence. Employing changes in the legal drinking age across states over time as an instrument, they found no significant effect of teen drinking on educational attainment. Koch and Ribar (2001) reached a similar conclusion applying family fixed effects and instrumental variables to NLSY data. Though they found that drinking had a significant negative effect on the amount of schooling completed among men, the effect was small. Finally, Chatterji (2006) used a bivariate probit model of alcohol use and educational attainment to gauge the sensitivity of the estimates to various assumptions about the correlation of unobservable determinants of these variables. She concluded that there is no evidence of a causal relationship between alcohol use and educational attainment when the correlation coefficient is fixed at plausible levels.

Alcohol use could conceivably affect a student’s quality of learning and academic performance regardless of its impact on school completion. This possibility is suggested by Renna (2008) , who uses a research design similar to that used by Dee and Evans (2003) and finds that although binge drinking does not affect high school completion rates, it does significantly increase the probability that a student graduates with a GED rather than a high school diploma. Drinking could affect learning through a variety of mechanisms. Recent neurological research suggests that underage drinking can impair learning directly by causing alterations in the structure and function of the developing brain with consequences reaching far beyond adolescence ( Brown et al., 2000 ; White & Swartzwelder, 2004 ). Negative effects of alcohol use can emerge in areas such as planning and executive functioning, memory, spatial operations, and attention ( Brown et al., 2000 ; Giancola & Mezzich, 2000 ; Tapert & Brown, 1999 ). Alcohol use could also affect performance by reducing the number of hours committed to studying, completing homework assignments, and attending school.

We are aware of five economic studies that have examined whether drinking affects learning per se. Bray (2005) analyzed this issue indirectly by studying the effect of high school students’ drinking on subsequent wages, as mediated through human capital accumulation. He found that moderate high school drinking had a positive effect on returns to education and therefore on human capital accumulation. Heavier drinking reduced this gain slightly, but net effects were still positive. The other four studies approached the question directly by focusing on the association between drinking and GPA. Three of the GPA studies used data from the Harvard College Alcohol Study. Analyzing data from the study’s 1993 wave, both Wolaver (2002) and Williams et al. (2003) estimated the impact of college drinking on the quality of human capital acquisition as captured by study hours and GPA. Both studies found that drinking had a direct negative effect on GPA and an indirect negative effect through reduced study hours. Wolaver (2007) used data from the 1993 and 1997 waves and found that both high school and college binge drinking were associated with lower college GPA for males and females. For females, however, study time in college was negatively correlated with high school drinking but positively associated with college drinking.

To our knowledge, only one study has looked specifically at adolescent drinking and high school GPA. Analyzing data from the Youth Risk Behavior Survey, DeSimone and Wolaver (2005) used standard regression analysis to estimate whether drinking affected high school GPA. Even after controlling for many covariates, they found that drinking had a significant negative effect. Their results showed that the GPAs of binge drinkers were 0.4 points lower on average for both males and females. They also found that the effect of drinking on GPA peaked for ninth graders and declined thereafter and that drinking affected GPA more by reducing the likelihood of high grades than by increasing the likelihood of low grades.

All four GPA studies found that drinking has negative effects on GPA, but they each faced two limitations. First, they relied on self-reported GPA, which can produce biased results due to recall mistakes and intentional misreporting ( Zimmerman, Caldwell, & Bernat, 2006 ). Second, they used cross-sectional data. Despite these studies’ serious efforts to address unobserved individual heterogeneity, it remains questionable whether they identified a causal link between drinking and GPA.

In sum, early cross-sectional studies of educational attainment and GPA suggest that drinking can have a sizeable negative effect on both outcomes. By contrast, more recent studies of educational attainment that use improved estimation methods to address the endogeneity of alcohol use have found that drinking has negligible effects. The present paper is the first study of GPA that controls for individual heterogeneity in a fixed-effects framework, and our findings are consistent with the more recent studies of attainment that find small or negligible effects of alcohol consumption.

Add Health is a nationally representative study that catalogues health-related behaviors of adolescents in grades 7 through 12 and associated outcomes in young adulthood. An initial in-school survey was administered to 90,118 students attending 175 schools during the 1994/1995 school year. From the initial in-school sample, 20,745 students (and their parents) were administered an additional in-home interview in 1994–1995 and were re-interviewed one year later. In 2001–2002, Add Health respondents (aged 18 to 26) were re-interviewed in a third wave to investigate the influence of health-related behaviors during adolescence on individuals when they are young adults. During the Wave 3 data collection, Add Health respondents were asked to sign a Transcript Release Form (TRF) that authorized Add Health to identify schools last attended by study participants and request official transcripts from the schools. TRFs were signed by approximately 92% of Wave 3 respondents (about 70% of Wave 1 respondents).

The main outcome of interest, GPA, was abstracted from school transcripts and linked to respondents at each wave. Because most of the in-home interviews during Waves 1 and 2 were conducted during the Spring or Summer (at the end of the school year) and alcohol use questions referred to the past 12 months, we linked the in-home questionnaires with GPA data corresponding to the school year in which the respondent was enrolled or had just completed at the time of the interview.

The in-home questionnaires in Waves 1 and 2 offer extensive information on the student’s background, risk-taking behaviors, and other personal and family characteristics. These instruments were administered by computer assisted personal interview (CAPI) and computer assisted self-interview (CASI) techniques for more sensitive questions such as those on alcohol, drug, and tobacco use. Studies show that the mode of data collection can affect the level of reporting of sensitive behaviors. Both traditional self-administration and computer assisted self-administered interviews have been shown to increase reports of substance use or other risky behaviors relative to interviewer-administered approaches ( Azevedo, Bastos, Moreira, Lynch, & Metzger, 2006 ; Tourangeau & Smith, 1996 ; Wright, Aquilino, & Supple, 1998 ). Several measures of alcohol use were constructed on the basis of the CAPI/CASI questions: (1) whether the student drank alcohol at least once per week in the past 12 months, (2) whether the student binged (drank five or more drinks in a row) at least once per month in the past 12 months, (3) the average number of days per month on which the student drank in the past 12 months, (4) the average number of drinks consumed on any drinking day in the past 12 months, and (5) the total number of drinks per month consumed by the student in the past year.

Individual characteristics obtained from the in-home interviews included age, race, gender, grade in school, interview date, body mass index, religious beliefs and practices, employment status, health status, tobacco use, and illegal drug use. To capture environmental changes for respondents who changed schools, we constructed indicators for whether the respondent attended an Add Health sample school or sister school (e.g. the high school’s main feeder school) in each wave. We also considered family characteristics such as family structure, whether English was spoken at home, the number of children in the household, whether the resident mother and resident father worked, whether parents worked in blue- or white-collar jobs, and whether the family was on welfare. Finally, we took into account a number of variables describing interview and household characteristics as assessed by the interviewer: whether a parent(s) or other adults were present during the interview; whether the home was poorly kept; whether the home was in a rural, suburban, or commercial area; whether the home environment raised any safety concerns; and whether there was evidence of alcohol use in the household.

Respondents to the in-home surveys were also asked several questions about how they were doing in school. We constructed measures of how often the respondents skipped school, whether they had been suspended, and whether they were having difficulties paying attention in school, getting along with teachers, or doing their homework. We analyzed these secondary outcomes as possible mediators of an effect of alcohol use on GPA.

Our fixed-effects methodology required high school GPA data for Waves 1 and 2. For this reason, we restricted the sample to students in grades 9, 10, or 11 in Wave 1 (N=22,792) who were re-interviewed in Waves 2 and 3 (N=14,390), not mentally disabled (N=13,632), and for whom transcript data were available at Wave 3 (N=10,430). In addition, we excluded 1,846 observations that had missing values on at least one of the explanatory or control variables. 1 The final sample had 8,584 observations, which corresponded to Wave 1 and Wave 2 responses for 4,292 students with no missing information on high school GPA or other covariates across both waves. Male respondents accounted for 48% of the sample.

Table 1 shows summary statistics for the analysis sample by wave and gender. Abstracted GPA averages 2.5 for male students and 2.8 for female students, 2 with similar values in Waves 1 and 2. Approximately 9% of males and 6% of females reported drinking alcohol at least one time per week in Wave 1. The prevalence of binge drinking (consuming five or more drinks in a single episode) at least once a month is slightly higher: 11% among males and 7% among females. On average, the frequency of drinking in Wave 1 is 1.34 days per month for male respondents and 0.94 days per month for female respondents, while drinking intensity averages 2.8 drinks per episode for males and 2.2 drinks per episode for females. By Wave 2, alcohol consumption increases in all areas for both males and females. The increases for males are larger, ranging from an 18% increase in the average number of drinks per episode to a 55% increase in the fraction who binge monthly.

Summary Statistics

Note : Based on responses to survey questions regarding most recently completed school year.

Of the Wave 1 respondents, 87% of males and 90% of females had skipped school at least once in the past year, with males averaging 1.47 days skipped and females averaging 1.37 days. Further, 11% of males and 7% of females had been suspended at least once. Regarding the school difficulty measures, 50% of male respondents in Wave 1 reported at least one type of regular difficulty with school: 32% had difficulty paying attention, 15% did not get along with their teachers, and 35% had problems doing their homework. Among females, 40% had at least one difficulty: 25% with paying attention, 11% with teachers, and 26% with homework.

Table 2 tabulates changes in dichotomous measures of problem drinking by gender. Among males, 82.6% did not drink weekly in either wave; 8.1% became weekly drinkers in Wave 2; 4.8% stopped drinking weekly in Wave 2; and the remaining 4.5% drank weekly in both waves. Among females, 88.5% did not drink weekly in either wave; 5.3% became weekly drinkers in Wave 2; 3.7% stopped drinking weekly in Wave 2; and 2.5% drank weekly in both waves. The trends in monthly binging were similar, with the number of students who became monthly bingers exceeding that of students who stopped bingeing monthly in Wave 2. The proportion of respondents reporting binge-drinking monthly in both waves (6.6% and 3.4% for men and women, respectively) was higher than the fraction of students who reported drinking weekly in both waves.

Tabulation of Changes in Dichotomous Measures of Alcohol Use By Gender

4. Empirical methods and estimation issues

We examined the impact of adolescent drinking on GPA using fixed-effects estimation techniques. The following equation captures the relationship of interest:

where GPA it is grade point average of individual i during the Wave t school year, A it is a measure of alcohol consumption, X it is a set of other explanatory variables, c i are unobserved individual effects that are constant over time, ε it is an error term uncorrelated with A it and X it , and α, β a , and β x are parameters to estimate.

The coefficient of interest is β a , the effect of alcohol consumption on GPA. The key statistical problem in the estimation of β a is that alcohol consumption is likely to be correlated with individual-specific unobservable characteristics that also affect GPA. For instance, an adolescent with a difficult family background may react by shirking responsibilities at school and may, at the same time, be more likely to participate in risky activities. For this reason, OLS estimation of Equation (1) used with cross-sectional or pooled longitudinal data is likely to produce biased estimates of β a . In this paper, we took advantage of the two high school-administered waves in Add Health and estimated β a using fixed-effects techniques. Because Waves 1 and 2 were only one year apart, it is likely that most unobserved individual characteristics that are correlated with both GPA and alcohol use are constant over this short period. Subtracting the mean values of each variable over time, Equation (1) can be rewritten as:

Equation (2) eliminates time invariant individual heterogeneity ( c i ) and the corresponding bias associated with OLS estimation of Equation (1) .

We estimated Equation (2) using different sets of time-varying controls ( X it ). 3 We began by controlling only for unambiguously exogenous variables and progressively added variables that were increasingly likely to be affected by alcohol consumption. The first set of controls included only the respondent’s grade level, indicators for attending the sample school or sister school, and the date of the interview. In a second specification, we added household characteristics and interviewer remarks about the household and the interview. This specification includes indicators for the presence of parents and others during the interview and thus controls for a potentially important source of measurement error in the alcohol consumption variables. 4 The third specification added to the second specification those variables more likely to be endogenous such as BMI, religious beliefs/practices, employment, and health status. A fourth specification included tobacco and illegal drug use. By adding these behavioral controls, which could either be mediators or independent correlates of the drinking-GPA association, we examined whether the fixed-effects estimates were influenced by unmeasured time variant individual characteristics.

The fifth and sixth specifications were aimed at assessing possible mechanisms flowing from changes in alcohol use to changes in GPA. Previous research has found that part of the association between alcohol consumption and grades can be explained by a reduction in study hours. Add Health did not directly ask respondents about study effort. It did, however, ask about suspensions and days skipped from school. These school attendance variables were added to the set of controls to test whether an effect of alcohol use on human capital accumulation worked extensively through the quantity of, or exposure to, schooling. Alternatively, an effect of alcohol use on grades could be explained by temporary or permanent alterations in the structure and functioning of an adolescent’s developing brain with resulting changes in levels of concentration and understanding (an intensive mechanism). To test for the mediating role of this pathway, we added a set of dichotomous variables measuring whether the student reported having trouble at least once a week with each of the following: (i) paying attention in school, (ii) getting along with teachers, and (iii) doing homework.

Finally, we considered the number of days the student skipped school and the likelihood of having difficulties with school as two alternative outcomes and estimated the association between these variables and alcohol use, applying the same fixed-effects methodology as in Equation (2) . To analyze difficulties with school as an outcome, we constructed a dichotomous variable that is equal to one if the student faced at least one of the three difficulties listed above. We estimated the effect of alcohol use on this variable using a fixed-effects logit technique.

Separate regressions were run for male and female respondents. The literature shows that males and females behave differently both in terms of alcohol use ( Ham & Hope, 2003 ; Johnston, O’Malley, Bachman, & Schulenberg, 2007 ; Schulenberg, O’Malley, Bachman, Wadsworth, & Johnston, 1996 ; Wechsler, Davenport, Dowdall, Moeykens, & Castillo, 1994 ) and school achievement ( Dwyer & Johnson, 1997 ; Jacob, 2002 ; Kleinfeld, 1998 ). These gender differences are clearly evident in the summary statistics presented in Table 1 . Furthermore, the medical literature suggests that there may be gender differences in the impact of alcohol consumption on cognitive abilities (e.g. Hommer, 2003 ).

In addition to examining differential effects by gender, we tested for differential effects of alcohol use along three other dimensions: age, the direction of change in alcohol use (increases vs. decreases), and initial GPA. These tests, as well as other extensions and robustness checks, are described in Section 6.

Table 3 shows the fixed-effects estimates for β a from Equation (2) . Each cell depicts a different model specification defined by a particular measure of alcohol use and a distinctive set of control variables. Rows (a)-(d) denote the alcohol use variable(s) in each specification, and Columns (1)-(6) correspond to the different sets of covariates. Control variables are added hierarchically from (1) to (3). We first adjusted only by grade level, sample school and sister school indicators, and interview date (Column (1)). We then added time-varying household characteristics and interviewer assessments (Column (2)), followed by other individual time-varying controls (Column (3)). Column (4) adds controls for the use of other substances, which could either be correlates or consequences of alcohol use. Columns (5) and (6) consider other potential mediators of the effects found in (1)-(3) such as days skipped, suspensions from school, and academic difficulties.

Fixed effects Estimates; Dependent Variable = GPA

Notes : See Table 1 for list of control variables in each model specification. Robust standard errors in parentheses;

The results for males provide evidence of a negative yet small effect of alcohol use on GPA. No major changes were observed in the estimates across the different specifications that incrementally added more controls, suggesting that the results are probably robust to unmeasured time-varying characteristics. In what follows, therefore, we describe the results in Column (3), which controls for the greatest number of individual time-varying factors (with the exception of tobacco and illicit drug use). Weekly drinking and monthly binge drinking are both negatively associated with GPA, but neither of these coefficients is statistically significant (Rows (a) and (b)). The continuous measure of alcohol consumption has a statistically significant coefficient (Row (c)), suggesting that increasing one’s alcohol intake by 100 drinks per month reduces GPA by 0.07 points, or 2.8% relative to the mean. The results in Row (d) suggest that variation in both the frequency and the intensity of alcohol use contributes to the estimated effect on grades. An increase of one day per month in drinking frequency reduces GPA by 0.005 points, and consumption of one additional drink per episode reduces GPA by 0.004 points.

Columns (4)-(6) report the estimates of interest after controlling for use of other substances, days skipped or suspended from school, and difficulties with school. Relative to the effects identified in Column (3), controlling for tobacco and illegal drug use reduces the negative effect of total number of drinks on GPA by 9% or 0.006 GPA points (see row (c), Column (4)). Adding the school attendance variables to the set of controls in Column (3) results in a point estimate of −0.06 or 0.01 GPA points below the coefficient in Column (3) (see Column (5)). Adding the school difficulty variables results in a reduction in GPA of 0.007 GPA points or a 10% decrease relative to the estimate in Column (3). While not shown in the table, the inclusion of both school difficulty and attendance variables as controls explains approximately 20% of the effect of alcohol use on grades, with the alcohol use estimates remaining statistically significant at the 10% level.

For females, the estimated coefficients are much smaller than those for males, and for two measures (binge-drinking and drinking frequency), the estimates are actually positive. However, none of the coefficients are statistically significant at conventional levels. 5 Interestingly, after controlling for substance use, difficulties with school, and school attendance, the estimates become less negative or more positive. But they remain statistically non significant.

Table 4 shows the effect of alcohol use on the number of school days skipped during the past year. These results are qualitatively similar to the findings for GPA, suggesting some small and statistically significant effects for males but no significant effects for females. For males, increasing the number of drinks per month by 100 leads to an additional 0.72 days skipped (p<0.10) when controlling for household features, interviewer comments, and individual characteristics such as body mass index, religiosity, employment, and health status (see Column (3), Row (c)). Controlling for tobacco and illegal drug use reduces the coefficient slightly to 0.69 days. The results in Row (d) suggest that this effect is driven mainly by variation in drinking intensity, with an additional drink per episode resulting in an increase of 0.06 days skipped.

Fixed-effects Estimates; Dependent Variable = School Days Skipped

Notes : Robust standard errors in parentheses;

Table 5 contains estimates of the relationship between alcohol use and our dichotomous measure of having difficulty in school. For males, we found one small but statistically significant effect: consumption of an additional 100 drinks per month is associated with a 4% increase in the probability of having trouble in school. For females, the estimated coefficients are all positive and larger than those found for males, and four out of five are statistically significant. The probability of having trouble in school is roughly 11% higher for females who drink weekly relative to those who do not, and there is a similar effect for monthly binge drinking (Rows (a) and (b)). Furthermore, the likelihood of difficulties increases by 7% with an additional 100 drinks per month (Row (c)). These findings suggest that female students suffer adverse consequences from alcohol consumption, even if these effects do not translate into lower grades. Finally, in Row (d), we see that these adverse effects are driven by increases in drinking frequency rather than drinking intensity.

Fixed-effects Logit Estimates; Dependent Variable = Difficulty with School

Notes : Dependent variable is a dummy variable equal to one if respondent had trouble at least once a week with one or more of the following: (1) paying attention in school, (2) getting along with teachers, or (3) doing homework. Robust standard errors in parentheses;

Our main results thus far point to two basic conclusions. After controlling for individual fixed effects, alcohol use in high school has a relatively minor influence on GPA. But there are also some interesting gender differences in these effects. For males, we find small negative effects on GPA that are partially mediated by increased school absences and difficulties with school-related tasks. For females, on the other hand, we find that alcohol use does not significantly affect GPA, but female drinkers encounter a higher probability of having difficulties at school.

Our basic estimates of the effects of drinking on GPA complement those of Koch and Ribar (2001) , who find small effects of drinking on school completion for males and non-significant effects for females. However, our analysis of school-related difficulties suggests that females are not immune to the consequences of drinking. Namely, females are able to compensate for the negative effects of drinking (e.g., by working harder or studying more) so that their grades are unaffected. This interpretation is consistent with Wolaver’s (2007) finding that binge drinking in college is associated with increased study hours for women but with reduced study hours for men. It is also reminiscent of findings in the educational psychology and sociology literatures that girls get better grades than boys, and some of this difference can be explained by gender differences in classroom behavior ( Downey & Vogt Yuan, 2005 ) or by greater levels of self-discipline among girls ( Duckworth & Seligman, 2006 ).

When interpreting our results, there are some important caveats to keep in mind. First, we must emphasize that they reflect the contemporaneous effects of alcohol use. As such, they say nothing about the possible cumulative effects that several years of drinking might have on academic performance. Second, we can only examine the effect of alcohol use on GPA for those students who remain in school. Unfortunately, we cannot address potential selection bias due to high school dropouts because of the high rate of missing GPA data for those students who dropped out after Wave 1. 6 Third, we acknowledge that our fixed-effects results could still be biased if we failed to account for important time-varying individual characteristics that are associated with GPA differentials across waves. It is reassuring, however, that our results are generally insensitive to the subsequent inclusion of additional time-varying (and likely endogenous) characteristics, such as health status, employment, religiosity, tobacco use, and illicit drug use. Finally, we cannot rule out possible reverse causality whereby academic achievement affects alcohol use. Future research using new waves of the data may provide further insight on this issue. In the next section, we discuss some additional issues that we are able to explore via robustness checks and extensions.

6. Robustness checks and extensions

6.1. ols versus fixed effects.

In addition to running fixed-effects models, we estimated β a using OLS. Separate regressions were run by gender and by wave. We first regressed GPA on measures of alcohol use and the full set of time-varying controls used in the fixed-effects estimation (see Column (3), Table 3 ). Next, we added other time-invariant measures such as demographics, household characteristics, and school characteristics. Finally, we controlled for tobacco and illegal drug use. The comparison between fixed-effects and OLS estimates (Appendix Table A1 ) sheds light on the extent of the bias in β ^ a OLS . For males, OLS estimates for Wave 1 were 3 to 6 times larger (more negative) than fixed-effects estimates (depending on the measure of alcohol use), and OLS estimates in Wave 2 were 3 to 4 times larger than those from the fixed-effects estimation. The bias was even more pronounced for females. Contrary to the results in Table 3 , OLS estimates for females were statistically significant, quantitatively large, and usually more negative than the estimates for males.

OLS Cross-sectional Estimates; Dependent Variable = GPA

6.2. Outlier analysis

Concerns about misreporting at the extreme tails of the alcohol use distributions led us to re-estimate the fixed-effects model after addressing these outliers. A common method for addressing extreme outliers without deleting observations is to “winsorize” ( Dixon, 1960 ). This technique reassigns all outlier values to the closest value at the beginning of the user-defined tail (e.g., 1%, 5%, or 10% tails). For the present analysis, we used both 1% and 5% tails. As a more conventional outlier approach, we also re-estimated the models after dropping those observations in the 1% tails. In both cases we winsorized or dropped the tails using the full Wave 1 and Wave 2 distribution (in levels) and then estimated differential effects.

After making these outlier corrections, the estimates for males became larger in absolute value and more significant, but the estimates for females remained statistically non-significant with no consistent pattern of change. 7 For males, dropping the 1% tails increased the effect of 100 drinks per month on GPA to −0.15 points (from −0.07 points when analyzing the full sample). Winsorizing the 5% tails further increased the estimated effect size to −0.31 points.

We offer two possible interpretations of these results for males. First, measurement error is probably more substantial among heavier drinkers and among respondents with the biggest changes in alcohol consumption across waves, which could cause attenuation bias at the top end. 8 Second, the effect of drinks per month on GPA could be smaller among male heavier drinkers, suggesting non-linear effects. Interestingly, neither of these concerns appears to be important for the analysis of females.

6.3. Differential effects

Thus far we have reported the differential effects of alcohol use on GPA for males and females. Here, we consider differential effects along three other dimensions: age, direction of change in alcohol use (increases vs. decreases), and initial GPA. To examine the first two of these effects, we added to Equation (2) interactions of the alcohol use measure with dichotomous variables indicating (i) that the student was 16 or older, and (ii) that alcohol use had decreased between Waves 1 and 2. 9 For males, the negative effects of drinking on GPA were consistently larger among respondents who were younger than 16 years old. None of the interaction terms, however, were statistically significant. We found no consistent or significant differences in the effect of alcohol consumption between respondents whose consumption increased and those whose consumption decreased between Waves 1 and 2. All results were non-significant and smaller in magnitude for females. It should be noted, however, that the lack of significant effects could be attributed, at least in part, to low statistical power as some of the disaggregated groups had less than 450 observations per wave.

To examine whether drinking is more likely to affect low achievers (those with initial low GPA) than high achievers (higher initial GPA), we estimated two fixed-effects linear probability regressions. The first regression estimated the impact of alcohol use on the likelihood of having an average GPA of C or less, and the second regression explored the effect of drinking on the likelihood of having a GPA of B- or better. For males, we found that monthly binging was negatively associated with the probability of obtaining a B- or higher average and that increases in number of drinks per month led to a higher likelihood of having a GPA of C or worse. Frequency of drinking, rather than intensity, was the trigger for having a GPA of C or worse. For females, most coefficient estimates were not significant, although the frequency of drinking was negatively associated with the probability of having a GPA of C or worse.

6.4 Self-reported versus abstracted GPA

One of the key advantages of using Add Health data is the availability of abstracted high school grades. Because most educational studies do not have such objective data, we repeated the fixed-effects estimation of Equation (2) using self-reported GPA rather than transcript-abstracted GPA. To facilitate comparison, the estimation sample was restricted to observations with both abstracted and self-reported GPA (N=2,164 for males and 2,418 for females).

The results reveal another interesting contrast between males and females. For males, the results based on self-reported grades were fairly consistent with the results based on abstracted grades, although the estimated effects of binging and drinking intensity were somewhat larger (i.e., more negative) when based on self-reported grades. But for females, the results based on self-reported grades showed positive effects of alcohol consumption that were statistically significant at the 10% level for three out of five consumption measures (monthly binging, total drinks per month, and drinks per episode). Furthermore, with the exception of the frequency measure (drinking days per month), the estimated effects were all substantially larger (i.e., more positive) when based on self-reported GPA. This suggests that females who drink more intensively tend to inflate their academic performance in school, even though their actual performance is not significantly different from that of those who drink less. Males who drink more intensely, on the other hand, may tend to deflate their academic accomplishments.

6.5. Analysis of dropouts

In Table 3 , we estimated the effects of alcohol consumption on GPA conditional on being enrolled in school during the two observation years. While increased drinking could lead an adolescent to drop out of school, reduced drinking could lead a dropout to re-enroll. Our GPA results do not address either of these possible effects. Of those who were in 9 th grade in Wave 1, roughly 2.3% dropped out before Wave 2. Of those who were in 10 th and 11 th grades in Wave 1, the dropout rates were 3.7% and 5.0%, respectively. Our core estimates would be biased if the effect of alcohol use on GPA for non-dropouts differed systematically from the unobserved effect of alcohol use on GPA for dropouts and re-enrollers in the event that these students had stayed in school continuously.

To determine whether dropouts differed significantly from non-dropouts, we compared GPA and drinking patterns across the two groups. Unfortunately, dropouts were much more likely to have missing GPA data for the years they were in school, 10 so the comparison itself has some inherent bias. Nevertheless, for those who were not missing Wave 1 GPA data, we found that mean GPA was significantly lower for dropouts (1.11) than for those students who stayed in school at least another year (2.66). Dropouts were also older in Wave 1 (16.9 vs. 15.9 years old) and more likely to be male (54% vs. 48%). They also consumed alcohol more often and with greater intensity in the first wave. While there is evidence of differences across the two groups in Wave 1, it is unclear whether dropouts would have differed systematically with respect to changes in GPA and in drinking behavior over time if they had stayed in school. Due to the small number of dropout observations with Wave 1 GPA data, we could not reliably estimate a selection correction model.

6.6. Attrition and missing data

As described in the data section, a large fraction of the Add Health respondents who were in 9th, 10th, or 11th grade in Wave 1 were excluded from our analysis either because they did not participate in Waves 2 or 3, did not have transcript data, or had missing data for one or more variables used in the analysis. (The excluded sample consisted of 7,104 individuals out of a total of 11,396 potentially eligible.) Mean characteristics were compared for individuals in the sample under analysis (N=4,292) and excluded respondents (N=7,104) in Wave 1. Those in the analysis sample had higher GPAs (both self-reported and abstracted, when available) and were less likely to have difficulties at school, to have been suspended from school, or to have skipped school. They were less likely to drink or to drink intensively if they drank. They were more likely to be female and White, speak English at home, have highly educated parents, have a resident mother or father at home, and be in good health. They were less likely to have parents on welfare, live in commercial areas or poorly kept buildings, and smoke and use drugs.

The above comparisons suggest that our estimates are representative of the sample of adolescents who participated in Waves 2 and 3 but not necessarily of the full 9 th , 10 th , and 11 th grade sample interviewed at baseline. To assess the magnitude and sign of the potential attrition bias in our estimates, we considered comparing fixed-effects estimates for these two samples using self-reported GPA as the dependent variable. But self-reported GPA also presented a considerable number of missing values, especially for those in the excluded sample at Wave 2. Complete measures of self-reported GPA in Waves 1 and 2 were available for 60% of the individuals in the analysis sample and for less than 30% of individuals in the excluded sample.

As an alternative check, we used OLS to estimate the effects of alcohol use on self-reported GPA in Wave 1 for the excluded sample, and compared these to OLS coefficients for our analysis sample in Wave 1. The effects of alcohol use on self-reported grades were smaller for individuals excluded from our core analysis. Because the excluded individuals tend to consume more alcohol, the finding of smaller effects for these individuals is consistent with either of the two explanations discussed in Section 6.2 above. First, the effect of consuming alcohol on GPA could be smaller for those who drink more. And second, measurement error is probably more serious among heavier drinkers, potentially causing more attenuation bias in this sample.

To summarize, the analysis described above suggests that some caution should be exercised when extrapolating the results in this paper to other populations. Due to missing data, our analysis excludes many of the more extreme cases (in terms of grades, substance use, and socioeconomic status). However, our analysis suggests that the effects of alcohol use on grades are, if anything, smaller for these excluded individuals. It therefore supports our main conclusions that the effects of alcohol use on GPA tend to be small and that failure to account for unobserved individual heterogeneity is responsible for some of the large negative estimates identified in previous research.

7. Conclusion

Though a number of investigations have studied the associations between alcohol use and years of schooling, less is known about the impact of adolescent drinking on the process and quality of learning for those who remain in school. Moreover, studies that have examined the impact of drinking on learning have faced two important limitations. First, they have relied on self-reported grades as the key measure of learning and are therefore subject to potential biases that result from self-reporting. Second, they have relied on cross-sectional data and suffer from potential biases due either to unobserved individual heterogeneity or to weak or questionable instrumental variables.

In the present study, we contribute to the existing literature by exploiting several unique features of the nationally representative Add Health survey. First, we measure learning with grade point averages obtained from the respondents’ official school transcripts. Second, we exploit Add Health’s longitudinal design to estimate models with individual fixed effects. This technique eliminates the bias that results from time-invariant unobserved individual heterogeneity in the determinants of alcohol use and GPA. Finally, we explore a variety of pathways that could explain the association between alcohol use and grades. In particular, we examine the effects of alcohol consumption on both the quantity of schooling—as measured by days of school skipped—and the quality—as measured by difficulties with concentrating in school, getting along with teachers, or completing homework.

The main results show that, in general, increases in alcohol consumption result in statistically significant but quantitatively small reductions in GPA for male students and in statistically non-significant changes for females. For both males and females, comparisons of the fixed-effects models with standard cross-sectional models suggest that large biases can result from the failure to adequately control for unobserved individual heterogeneity. Our findings are thus closely aligned with those of Koch and Ribar (2001) and Dee and Evans (2003) , who reach a similar conclusion regarding the effects of drinking on school completion.

Our analysis also reveals some interesting gender differences in how alcohol consumption affects learning in high school. Our results suggest that for males, alcohol consumption has a small negative effect on GPA and this effect is partially mediated by increased school absences and by difficulties with school-related tasks. For females, however, we find that alcohol use does not significantly affect GPA, even though it significantly increases the probability of encountering difficulties at school. Gender differences in high school performance are well documented in the educational psychology and sociology literatures, yet no previous studies have estimated gender differences in high school learning that are directly associated with alcohol use. Our study is therefore unique in that regard.

Finally, our study also highlights the potential pitfalls of using self-reported grades to measure academic performance. Not only do we find evidence that use of self-reports leads to bias; we also find that the bias differs by gender, as drinking is associated with grade inflation among females and grade deflation among males. Hence, the conceptual discoveries uncovered in this research may be as important for future investigations as the empirical results are for current educational programs and policies.

Acknowledgements

Financial assistance for this study was provided by research grants from the National Institute on Alcohol Abuse and Alcoholism (R01 AA15695, R01 AA13167, and R03 AA016371) and the National Institute on Drug Abuse (RO1 DA018645). This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website ( http://www.cpc.unc.edu/addhealth ). No direct support was received from grant P01-HD31921 for this analysis. We gratefully acknowledge the input of several colleagues at the University of Miami. We are also indebted to Allison Johnson, William Russell, and Carmen Martinez for editorial and administrative assistance. The authors are entirely responsible for the research and results reported in this paper, and their position or opinions do not necessarily represent those of the University of Miami, the National Institute on Alcohol Abuse and Alcoholism, or the National Institute on Drug Abuse.

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1 Due to a significant fraction of missing responses, we imputed household income and household welfare status using both predicted values on the basis of other covariates and the sample mean for households that were also missing some of the predicting covariates. We added dummy variables to indicate when an observation was imputed.

2 Grades and numerical grade-point equivalents have been established for varying levels of a student’s academic performance. These grade-point equivalents are used to determine a student’s grade-point average. Grades of A, A-, and B+ with respective grade-point equivalents of 4.00, 3.67, and 3.33 represent an “excellent” quality of performance. Grades of B, B−, and C+ with grade-point equivalents of 3.00, 2.67, and 2.33 represent a “good” quality of performance. A grade of C with grade-point equivalent of 2.00 represents a “satisfactory” level of performance, a grade of D with grade-point equivalent of 1.00 represents a “poor” quality of performance, and a grade of F with grade-point equivalent of 0.00 represents failure.

3 Note that some demographics (e.g., race, ethnicity) and other variables that are constant over time do not appear in Equation (2) because they present no variation across waves.

4 Of particular concern is the possibility that measurement error due to misreporting varies across waves—either because of random recall errors or because of changes in the interview conditions. (For example, the proportion of interviews in which others were present declined from roughly 42% to 25% between Wave 1 and Wave 2.) Such measurement error could lead to attenuation bias in our fixed-effects model. On the other hand, reporting biases that are similar and stable over time are eliminated by the fixed-effects specification.

5 We tested the significance of these differences by pooling males and females and including an interaction of a gender dummy with the alcohol consumption measure in each model. We found statistically significant differences in the effects of monthly bingeing, drinks per month, and drinking days per month.

6 If alcohol use has small or negligible effects on school completion - as found by Chatterji (2006) , Dee and Evans (2003) , and Koch and Ribar (2001) - then such selection bias will also be small.

7 These results are not presented in the tables but are available from the authors upon request.

8 Examination of the outliers showed that only 15% of those who reported a total number of drinks above the 95th percentile of the distribution did so in both waves.

9 These fixed-effects regressions were adjusted by the same set of controls as in Table (3) , Column (3).

10 More than two-thirds of those who dropped out between Waves 1 and 2 were missing Wave 1 GPA data

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How can I plan what to eat or drink when I have diabetes?

How can physical activity help manage my diabetes, what can i do to reach or maintain a healthy weight, should i quit smoking, how can i take care of my mental health, clinical trials for healthy living with diabetes.

Healthy living is a way to manage diabetes . To have a healthy lifestyle, take steps now to plan healthy meals and snacks, do physical activities, get enough sleep, and quit smoking or using tobacco products.

Healthy living may help keep your body’s blood pressure , cholesterol , and blood glucose level, also called blood sugar level, in the range your primary health care professional recommends. Your primary health care professional may be a doctor, a physician assistant, or a nurse practitioner. Healthy living may also help prevent or delay health problems  from diabetes that can affect your heart, kidneys, eyes, brain, and other parts of your body.

Making lifestyle changes can be hard, but starting with small changes and building from there may benefit your health. You may want to get help from family, loved ones, friends, and other trusted people in your community. You can also get information from your health care professionals.

What you choose to eat, how much you eat, and when you eat are parts of a meal plan. Having healthy foods and drinks can help keep your blood glucose, blood pressure, and cholesterol levels in the ranges your health care professional recommends. If you have overweight or obesity, a healthy meal plan—along with regular physical activity, getting enough sleep, and other healthy behaviors—may help you reach and maintain a healthy weight. In some cases, health care professionals may also recommend diabetes medicines that may help you lose weight, or weight-loss surgery, also called metabolic and bariatric surgery.

Choose healthy foods and drinks

There is no right or wrong way to choose healthy foods and drinks that may help manage your diabetes. Healthy meal plans for people who have diabetes may include

• dairy or plant-based dairy products
• nonstarchy vegetables
• protein foods
• whole grains

Try to choose foods that include nutrients such as vitamins, calcium , fiber , and healthy fats . Also try to choose drinks with little or no added sugar , such as tap or bottled water, low-fat or non-fat milk, and unsweetened tea, coffee, or sparkling water.

Try to plan meals and snacks that have fewer

• foods high in saturated fat
• foods high in sodium, a mineral found in salt
• sugary foods , such as cookies and cakes, and sweet drinks, such as soda, juice, flavored coffee, and sports drinks

Your body turns carbohydrates , or carbs, from food into glucose, which can raise your blood glucose level. Some fruits, beans, and starchy vegetables—such as potatoes and corn—have more carbs than other foods. Keep carbs in mind when planning your meals.

You should also limit how much alcohol you drink. If you take insulin  or certain diabetes medicines , drinking alcohol can make your blood glucose level drop too low, which is called hypoglycemia . If you do drink alcohol, be sure to eat food when you drink and remember to check your blood glucose level after drinking. Talk with your health care team about your alcohol-drinking habits.

Find the best times to eat or drink

Talk with your health care professional or health care team about when you should eat or drink. The best time to have meals and snacks may depend on

• what medicines you take for diabetes
• what your level of physical activity or your work schedule is
• whether you have other health conditions or diseases

Ask your health care team if you should eat before, during, or after physical activity. Some diabetes medicines, such as sulfonylureas  or insulin, may make your blood glucose level drop too low during exercise or if you skip or delay a meal.

Plan how much to eat or drink

You may worry that having diabetes means giving up foods and drinks you enjoy. The good news is you can still have your favorite foods and drinks, but you might need to have them in smaller portions  or enjoy them less often.

For people who have diabetes, carb counting and the plate method are two common ways to plan how much to eat or drink. Talk with your health care professional or health care team to find a method that works for you.

Carb counting

Carbohydrate counting , or carb counting, means planning and keeping track of the amount of carbs you eat and drink in each meal or snack. Not all people with diabetes need to count carbs. However, if you take insulin, counting carbs can help you know how much insulin to take.

Plate method

The plate method helps you control portion sizes  without counting and measuring. This method divides a 9-inch plate into the following three sections to help you choose the types and amounts of foods to eat for each meal.

• Nonstarchy vegetables—such as leafy greens, peppers, carrots, or green beans—should make up half of your plate.
• Carb foods that are high in fiber—such as brown rice, whole grains, beans, or fruits—should make up one-quarter of your plate.
• Protein foods—such as lean meats, fish, dairy, or tofu or other soy products—should make up one quarter of your plate.

If you are not taking insulin, you may not need to count carbs when using the plate method.

Work with your health care team to create a meal plan that works for you. You may want to have a diabetes educator  or a registered dietitian  on your team. A registered dietitian can provide medical nutrition therapy , which includes counseling to help you create and follow a meal plan. Your health care team may be able to recommend other resources, such as a healthy lifestyle coach, to help you with making changes. Ask your health care team or your insurance company if your benefits include medical nutrition therapy or other diabetes care resources.

Talk with your health care professional before taking dietary supplements

There is no clear proof that specific foods, herbs, spices, or dietary supplements —such as vitamins or minerals—can help manage diabetes. Your health care professional may ask you to take vitamins or minerals if you can’t get enough from foods. Talk with your health care professional before you take any supplements, because some may cause side effects or affect how well your diabetes medicines work.

Research shows that regular physical activity helps people manage their diabetes and stay healthy. Benefits of physical activity may include

• lower blood glucose, blood pressure, and cholesterol levels
• better heart health
• healthier weight
• better mood and sleep
• better balance and memory

Talk with your health care professional before starting a new physical activity or changing how much physical activity you do. They may suggest types of activities based on your ability, schedule, meal plan, interests, and diabetes medicines. Your health care professional may also tell you the best times of day to be active or what to do if your blood glucose level goes out of the range recommended for you.

Do different types of physical activity

People with diabetes can be active, even if they take insulin or use technology such as insulin pumps .

Try to do different kinds of activities . While being more active may have more health benefits, any physical activity is better than none. Start slowly with activities you enjoy. You may be able to change your level of effort and try other activities over time. Having a friend or family member join you may help you stick to your routine.

The physical activities you do may need to be different if you are age 65 or older , are pregnant , or have a disability or health condition . Physical activities may also need to be different for children and teens . Ask your health care professional or health care team about activities that are safe for you.

Aerobic activities

Aerobic activities make you breathe harder and make your heart beat faster. You can try walking, dancing, wheelchair rolling, or swimming. Most adults should try to get at least 150 minutes of moderate-intensity physical activity each week. Aim to do 30 minutes a day on most days of the week. You don’t have to do all 30 minutes at one time. You can break up physical activity into small amounts during your day and still get the benefit. 1

Strength training or resistance training

Strength training or resistance training may make your muscles and bones stronger. You can try lifting weights or doing other exercises such as wall pushups or arm raises. Try to do this kind of training two times a week. 1

Balance and stretching activities

Balance and stretching activities may help you move better and have stronger muscles and bones. You may want to try standing on one leg or stretching your legs when sitting on the floor. Try to do these kinds of activities two or three times a week. 1

Some activities that need balance may be unsafe for people with nerve damage or vision problems caused by diabetes. Ask your health care professional or health care team about activities that are safe for you.

Stay safe during physical activity

Staying safe during physical activity is important. Here are some tips to keep in mind.

Drink liquids

Drinking liquids helps prevent dehydration , or the loss of too much water in your body. Drinking water is a way to stay hydrated. Sports drinks often have a lot of sugar and calories , and you don’t need them for most moderate physical activities.

Avoid low blood glucose

Check your blood glucose level before, during, and right after physical activity. Physical activity often lowers the level of glucose in your blood. Low blood glucose levels may last for hours or days after physical activity. You are most likely to have low blood glucose if you take insulin or some other diabetes medicines, such as sulfonylureas.

Ask your health care professional if you should take less insulin or eat carbs before, during, or after physical activity. Low blood glucose can be a serious medical emergency that must be treated right away. Take steps to protect yourself. You can learn how to treat low blood glucose , let other people know what to do if you need help, and use a medical alert bracelet.

Avoid high blood glucose and ketoacidosis

Taking less insulin before physical activity may help prevent low blood glucose, but it may also make you more likely to have high blood glucose. If your body does not have enough insulin, it can’t use glucose as a source of energy and will use fat instead. When your body uses fat for energy, your body makes chemicals called ketones .

High levels of ketones in your blood can lead to a condition called diabetic ketoacidosis (DKA) . DKA is a medical emergency that should be treated right away. DKA is most common in people with type 1 diabetes . Occasionally, DKA may affect people with type 2 diabetes  who have lost their ability to produce insulin. Ask your health care professional how much insulin you should take before physical activity, whether you need to test your urine for ketones, and what level of ketones is dangerous for you.

Take care of your feet

People with diabetes may have problems with their feet because high blood glucose levels can damage blood vessels and nerves. To help prevent foot problems, wear comfortable and supportive shoes and take care of your feet  before, during, and after physical activity.

If you have diabetes, managing your weight  may bring you several health benefits. Ask your health care professional or health care team if you are at a healthy weight  or if you should try to lose weight.

If you are an adult with overweight or obesity, work with your health care team to create a weight-loss plan. Losing 5% to 7% of your current weight may help you prevent or improve some health problems  and manage your blood glucose, cholesterol, and blood pressure levels. 2 If you are worried about your child’s weight  and they have diabetes, talk with their health care professional before your child starts a new weight-loss plan.

You may be able to reach and maintain a healthy weight by

• following a healthy meal plan
• consuming fewer calories
• being physically active
• getting 7 to 8 hours of sleep each night 3

If you have type 2 diabetes, your health care professional may recommend diabetes medicines that may help you lose weight.

Online tools such as the Body Weight Planner  may help you create eating and physical activity plans. You may want to talk with your health care professional about other options for managing your weight, including joining a weight-loss program  that can provide helpful information, support, and behavioral or lifestyle counseling. These options may have a cost, so make sure to check the details of the programs.

Your health care professional may recommend weight-loss surgery  if you aren’t able to reach a healthy weight with meal planning, physical activity, and taking diabetes medicines that help with weight loss.

If you are pregnant , trying to lose weight may not be healthy. However, you should ask your health care professional whether it makes sense to monitor or limit your weight gain during pregnancy.

Both diabetes and smoking —including using tobacco products and e-cigarettes—cause your blood vessels to narrow. Both diabetes and smoking increase your risk of having a heart attack or stroke , nerve damage , kidney disease , eye disease , or amputation . Secondhand smoke can also affect the health of your family or others who live with you.

If you smoke or use other tobacco products, stop. Ask for help . You don’t have to do it alone.

Feeling stressed, sad, or angry can be common for people with diabetes. Managing diabetes or learning to cope with new information about your health can be hard. People with chronic illnesses such as diabetes may develop anxiety or other mental health conditions .

Learn healthy ways to lower your stress , and ask for help from your health care team or a mental health professional. While it may be uncomfortable to talk about your feelings, finding a health care professional whom you trust and want to talk with may help you

• lower your feelings of stress, depression, or anxiety
• manage problems sleeping or remembering things
• see how diabetes affects your family, school, work, or financial situation

Ask your health care team for mental health resources for people with diabetes.

Sleeping too much or too little may raise your blood glucose levels. Your sleep habits may also affect your mental health and vice versa. People with diabetes and overweight or obesity can also have other health conditions that affect sleep, such as sleep apnea , which can raise your blood pressure and risk of heart disease.

NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for healthy living with diabetes?

Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of healthy living for people with diabetes, such as

• how changing when you eat may affect body weight and metabolism
• how less access to healthy foods may affect diabetes management, other health problems, and risk of dying
• whether low-carbohydrate meal plans can help lower blood glucose levels
• which diabetes medicines are more likely to help people lose weight

Find out if clinical trials are right for you .

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical trials for healthy living with diabetes are looking for participants?

You can view a filtered list of clinical studies on healthy living with diabetes that are federally funded, open, and recruiting at www.ClinicalTrials.gov . You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe for you. Always talk with your primary health care professional before you participate in a clinical study.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

NIDDK would like to thank: Elizabeth M. Venditti, Ph.D., University of Pittsburgh School of Medicine.