In this occasional series we record the views and personal experience of people who have specially contributed to the evolution of ideas in the Journal's field of interest. Harold Holder has made many important contributions to alcohol research, particularly in relation to public health aspects. From 1986 to 2002 he was Director of the Prevention Research Centre, Berkeley, California.
EARLY YEARS (1939–1957)
Addiction (A): Where did you grow up?
Harold Holder (HH): I was born in North Carolina, and grew up in the north-west corner of Alabama. My home town was Sheffield, named after Sheffield, England, and had maybe 15 000 people. The area became famous because Huntsville is nearby, where the US space program began. Von Braun and other German rock et scientists were there when I was a kid.
A: You are a life-long student of community norms. Which ones did you grow up around in Sheffield?
HH: I wonder sometimes to what degree that heritage influenced my professional work. I grew up in the evangelical church. I was active in the church, did youth group activities and so forth. I learned to public speak in the church which prepared me for giving research lectures later.
A: Since you went to college at Samford University in Birmingham, Alabama, I assume your church was Southern Baptist?
HH: Yes. and there were many rules about drinking, card playing, dancing and even mixed gender swimming. These rules were to prevent us from being tempted. The most active I ever saw the Baptist church in politics, say in contrast to the evangelical church today, was wet–dry votes around alcohol. Because Alabama had local option (counties can vote wet or dry), alcohol elections were a regular part of church activity.
A: Dry county?
HH: Dry county, but then it was sometimes wet [chuckles]. So, yes, I grew up in that culture. I did not like small town norms and the scrutiny of behavior that I grew up with as a child, and that heritage influenced my preference to live in big cities. I never lived in small towns after that.
A: And your involvement in the Baptist Church?
HH: I left that too. What ended my church membership in 1969 was the Vietnam War. I could not align with the church's support of that war.
A: When you were a kid, were you interested in science?
HH: No, which surprises me in some ways. I was actually more interested in art and reading. But I was good at mathematics. I did not care much for physical sciences but I loved mathematics and did very well at it in high school. When I went to college, I even thought about being a math major but I could not see any future in that.
A: What was it about math that you liked?
HH: Certainly the symbology and the precision. Not just measurement precision but the precision of statement. One can express relationships mathematically with much greater clarity because of the requirement to state hypotheses or assumptions.
A: Some people would say that a guy interested in precision is going to become a physicist and not a social scientist.
HH: Well, I was intrigued with the uncertainty of human behavior. I did not understand that until 10 years ago when I had a sabbatical at the Complexity Institute in Santa Fe, New Mexico. There I discovered that physicists defined chaos as beginning a complex process at the same point each time but yielding different results. I said ‘that is human behavior’ and at that exact moment I understood what intrigued me about social science. In physics, one often has a model which yields the same result each time. In the social sciences we always know it is a stochastic or unpredictable (sometimes random) process.
‘In physics, one often has a model which yields the same result each time. In the social sciences we always know it is a stochastic or unpredictable (sometimes random) process.’
A: Wonderful. Just to close out your early years, who influenced you the most? Either an intellectual influence or a personal influence.
HH: My father influenced me in terms of work ethic. My father only had a fourth grade education. So, he liked all the education I obtained. But what I took most from him was a standard that whatever you undertook, you did to the best of your ability. So, I have often slowed things down when they could have gone faster just because of that value. My father was a very methodical craftsman as an electrician. He did everything carefully and then he moved on to the next task. If each project is done at a high standard, you do not have to look back.
A: Any teachers who had a strong impact on you?
HH: The teacher who had the most influence was my high school track coach. He was a huge man who probably weighed 300 pounds, so he could never run anything. But knowing both training and tactics, he supported my compulsivity to get it done, to work hard, and to finish whatever you’re doing.
COLLEGE AND GRADUATE SCHOOL (1957–65)
A: I am sure I am not the only person who was surprised to learn that your education was in history, journalism and communications. What drew you to those fields?
HH: I probably studied history because I was very interested in social processes and complexity. History provided challenges because I was intrigued about understanding the puzzle. I wondered why did these forces come together to yield this outcome? I did not see the connection between that interest and mathematics until graduate school. Journalism was interesting because I liked writing, and when I was an undergraduate, I believed I was going to be a newspaper reporter.
A: Do you ever wish you had become a journalist?
HH: No. I was headed toward research. I just did not know it. My undergraduate faculty did little research. I first saw social science research during graduate studies at Syracuse University.
A: You went to college in the deep south at a time of pretty significant racial rumblings. Did that spill over at Samford? How did that affect you?
HH: I was there when the freedom riders came through Birmingham, and they were beaten in the downtown bus station. I was actually not working that day, but I was a reporter for the newspaper that took the picture of the attackers with their pipes raised in the air as they beat people. It shocked me. I did not understand this enormous violence. I had grown up in a small town that was segregated but in my family I did not learn a great deal of overt racial prejudice. I took segregation as the way things were. I developed a real friendship with an African American young man about my age who simply went to a different school. We were making the same money and doing the same job. This seemed normal. I eventually discovered how much nasty intent there was directed into racial prejudice, but that came later for me.
‘I was there when the freedom riders came through Birmingham . . . I was a reporter for the newspaper that took the picture of the attackers with their pipes raised in the air as they beat people.’
A: I have to ask you this just because you are an expert in college drinking: did you drink as a college student?
HH: No. It was a Baptist school, so there was no drinking. I had my first drink when I was 25 years old.
A: I think of Syracuse as a pretty cold, strange place for a kid from Alabama. What made you want to move?
HH: Well, part of that motivation was my desire to get out of the South. I was offended and upset by the racial tension. I love my Southern roots, a great gift, but I had to leave. I have been through that process three times actually, going back to the South, and then moving away.
Syracuse was a change in so many ways. Upstate New York was full of immigrant families, Polish and Russian and Scandinavian. It was a wonderful opening; I saw the world as much larger than I had experienced until that time. Another was the intellectual challenge. I immediately got into trouble by applying the same standards to graduate school I had used in undergraduate studies, that is, simply working hard. These professors were asking me to think. I could not simply memorize, read the assignments and write papers. That was really a shock. I loved the challenge but it was still a shock.
A: So when you first got to graduate school, were you considered a mediocre student?
HH: Yes. And Southern to boot!
A: So every stereotype a Yankee could have . . .
HH: Exactly. It fitted me perfectly. I talked funny and I did not always follow what was going on. But after, I guess about 7 months, I realized that I was as smart as the people getting PhDs, and I really liked statistics and research design and methods. That was the end of my journalism career.
A: Were there professors at Samford and Syracuse who really shaped how you think?
HH: Not so much at Samford. I had good teachers there, and as I got further along in my undergraduate program I was able to take special seminars, do guided readings. But the professor who influenced me the most was at Syracuse University.
A: Who was that?
HH: His name was William Ehling, an odd fellow in the Newhouse School of Communications, which was primarily teaching people to be journalists, writers and television producers. Professor Ehling was interested in systems, mathematical models and theory. He had a wonderful conceptual mind and he wrote very esoteric material that I found intriguing to read. He became my major professor and guided my dissertation.
A: So, you were attracted to a mentor who did not limit his interests to a narrow discipline, just as you yourself would become a discipline-spanner in your career.
HH: Yes. I was spanning disciplines even as a graduate student because there was no real field called ‘communications’. It is really not a well-defined discipline in a way you would think of sociology, psychology, or psychiatry; and even as fuzzy as the boundaries of communications were, I still did not want to keep within them. I probably did the first mathematics-based dissertation through the School of Communications at Syracuse. Most of my professors thought this was a strange dissertation, and they could not make sense of it. I had to recruit committee members from outside, including two professors in mathematical sociology.
A: What was your connection to that field?
HH: I had taken classes in sociology, primarily in theory building. However, I had no interest in the great verbal theorists. People such as Talcott Parsons did not interest me because their theories were all words. There was no precision in the theoretical statements and no way to validate them. Even though I was in my mid-twenties and most probably arrogant, intuitively this approach to complex social systems just did not make sense to me.
A: I hear two themes: ‘I want to hear the evidence’ and ‘I want to hear the practical purpose of what I am learning’.
HH: Yes. These are my blue-collar viewpoints. I am no—this is a realization of literally just the last two or three years—true intellectual. Ideas per se do not interest me. It is the application of ideas to problem-solving that interests me and has driven my career.
‘These are my blue-collar viewpoints.’
‘Ideas per se do not interest me. It is the application of ideas to problem-solving that interests me and has driven my career.’
Syracuse was the first place that I began to experience my need for evidence. Even though mathematics and computer simulation can be esoteric, my dissertation research was actually applied (Holder & Ehling 1966, 1967). I used a Markov chain to describe the influence of various information sources on a student's decisions about going to college. So the dissertation advanced a theory, tested by the empirical data that were available. In that sense, it illustrated where my career was going to go.
EARLY CAREER (1965–76)
A: After graduate school, you joined the faculty at Baylor University, in Texas. Did you want to go back to the South or did a good position for you just happen to be there?
HH: The latter. I am convinced that one of the influences on Baylor choosing me was my Baptist heritage.
A: Did you like being an assistant professor?
HH: Well, it was a big challenge. Of course as an assistant professor I got all the classes no one wanted to teach. But I was happy because I liked students and I liked teaching. After the first year I got some credibility and started teaching graduate classes. I taught how theory could be applied in the practice of communications. I do not think the faculty thought much of what I was doing, but the students liked it.
A: Only 3 years later, you became an associate professor at North Carolina State University. Was such rapid academic promotion part of the appeal of that move?
HH: Actually, what got me to North Carolina was not so much the university, but the State Department of Mental Health. The Department of Mental Health wanted to de-institutionalize alcoholics, who were being treated in a mental hospital. The State wanted to know how to get alcoholics out of the hospital and integrated back into the community, and how to help local people adjust to the change. Well, this was a natural systems problem.
This was the early 1970s and systems approaches were new. It was bold to think of the community as a system and to view alcoholics not only as disabled individuals but also as part of a system. One of the deputy directors of the Department of Mental Health was a psychiatrist named Nicholas Stratas. He was a big thinker and we were attracted to each other right away. He had psychiatric training but also had a systems view of the world, and I had the toolkit he was looking for. So we worked together in his region of the state. This was my introduction to alcohol (Holder & Stratas 1972). Previously, I had no background in studying alcoholism or alcohol policy.
A: So there is some happenstance in your being in this field. If they had been trying to deinstitutionalize schizophrenic patients do you think you might be . . .
HH: Yes, I might be a schizophrenia researcher! What intrigued me at the time was not drinking but how does one handle deviancy in a community? Then I discovered a larger challenge: the community keeps generating alcoholics. There's no end to the supply. I thought there must be something we can do with each community to reduce alcohol abuse, not only treat alcoholics. That was the beginning of my interest in alcohol prevention in about 1972.
A: General systems theory was one of the hottest things in social science in that period and you wrote about it (Holder 1966,1969). Looking back on it, what would you say were the central insights of general systems theories for social science?
HH: Well the foundation of general systems theory is a perspective that all things are connected and that how one understands a process in one field of study can be generalized to another field of study or discipline. I now think this premise is a little bit naive but it was very powerful at the time, because it began to challenge discipline boundaries. It certainly was a rich gift for me. I became a member of the Society of General Systems Theory and studied all the writings. The disadvantage of this perspective was that it did not address practical problems. Unfortunately, this was largely a use of descriptive tools, and general systems theory eventually lost much of its early enthusiasm.
A: You were involved in the deinstitutionalization of alcoholics at the same time community mental health professionals were deinstitutionalizing seriously mentally ill people. Some people now say, ‘we’ve got all these homeless people on the streets; that was a big mistake’. Looking back, what do you think about deinstitutionalization of deviant populations in the United States?
HH: I thought it was a very good idea and still do. The re-entry of alcoholics stimulated a clinical rather than a systems response. Government basically said to the community, here are all these alcoholics and oh, by the way, please provide local alcoholism treatment. Well, de-institutionalized alcoholics need housing, they need financial resources, and somewhere they need to be socially integrated. Even though half-way houses and other rehabilitation activities existed, no community was ever asked to address this as a systems problem, only as a clinical problem. Frankly, it is because psychiatrists were the managers. They were thinking clinically such that alcoholism was only a personality or a genetic disorder; and of course the promise in the 1970s was that we could fix alcoholics best in the community. But we did not.
A: And as most community systems writings would point out, helping professions have interests in their own systems and in not surrendering control of deviant populations. Despite the challenges of being charged with handling a deviant group, it does bring resources, prestige, and all that.
HH: Yes, I wrote a whole book about that (Holder 1998). My book on systems points out that there are reinforcing processes or subsystems in communities that have a vested interest in keeping heavy drinking going, and I do not mean just the ones that sell alcohol. What I call ‘the ones who clean up the streets’ also have a vested interest.
‘there are reinforcing processes or subsystems in communities that have a vested interest in keeping heavy drinking going, and I do not mean just the ones that sell alcohol’.
A: You worked at the North Carolina State Department of Mental Health and also at the City of Portsmouth, Virginia, among other governmental roles. What appealed to you about governmental work, from which some scientists shy away?
HH: I liked the time in government because it gave me a sense of the reality for people who have to make difficult decisions about health funds and programs. I was probably one of few prevention researchers in the 1970s who had actually worked in a state government office and had to negotiate with a state legislature. I have tried to help the professionals in the Federal Government understand the world of prevention professionals in, for instance, West Virginia, or Tennessee, or California. For state professionals, professional life is not just responding to the federal government and its distribution of funds but also more importantly dealing with a local legislature and its constituencies. I am currently conducting some technical work with my institute in Washington on just that issue: how to bring science to the practice of prevention with recognition of state and community governmental processes. That challenge really interests me.
A: In 1977 you began a productive period in Chapel Hill. Please tell us a bit about the 10 years you spent at the Human Ecology Institute, including being its director for seven years.
HH: There was a group of us in the Department of Mental Health at North Carolina and other state agencies who said we need a think tank . . . a place that is not governed by state government funding or rules, a place to go and explore social challenges more freely. We chartered The Human Ecology Institute (THEI) as a non-profit organization, which started to grow immediately because it met a need and occurred at a time when independent non-profits were getting grants rather than all research funding going to universities. THEI focused on substance abuse but also social problems as well. This was my first opportunity of being paid not as a state or university employee but as a professional working with federal, state and local governments on social and health problems. THEI was my first exposure to public policy as a vehicle of change.
A: And you found you liked it?
HH: I loved it! The work was political as well, and I could see a role for scientific knowledge in practice. Scientists can be effective in this type of work, if we do not delude ourselves that we are leading the public policy train but rather can support the train in directions that we might like for it to go.
A: Since you obviously spent your later career at Prevention Research Center, that type of setting must have suited you: a non-profit, interdisciplinary environment without the constraints of government or the constraints of a university.
HH: It is perfect for me. I did not fit easily in universities and by the early 1980s my teaching career eventually ended. This occurred while I was on the graduate faculty of both the University of North Carolina in Chapel Hill and Department of Sociology at North Carolina State in Raleigh. During graduate faculty meetings, I suggested that a part of our graduate training responsibility was to assist students in career opportunities. I pointed out that there was going to be increasing demand for social scientists who were interested in public policy and program evaluation and in bringing science into practice and planning. This was followed by dead silence. ‘You mean applied research?’, they said? ‘Ye-e-e-s.’ Applied science had very low academic prestige. That was the end of my graduate training career.
A: You began writing and talking about computer simulations during this period, which would seem a natural extension of your interests in mathematical models and in systems (Amatetti 1987;Holder & Blose 1987a). In terms of application, have you seen cases in your career where computer simulation did influence decision-makers as it is intended to do?
HH: I would like to say yes but the truth is no. There were many painful parts of my career, but one of the most painful was to realize that there are no reward structures for public decision makers to use evidence. It is just not there. I believed planning required evidence that any proposed prevention strategy could have a desired effect. Most of the people in the addictions area (I would expand that to include mental health) do not have the basic technical background to use this kind of complex tool. In business and military domains, many professionals utilize computer simulation.
I think my personal holy grail was to build a rigorously tested science-based computer model which states or local communities could use. I called it ‘SimCom’ for simulated community. Therefore, I developed demonstration state computer models of California, North Carolina and South Carolina, and local models of San Diego, California and Raleigh, North Carolina. These models could all replicate up to 20 years of known local history as a standard to increase confidence in forecasts from this model. Because every US state is required to complete an annual prevention plan, states could utilize results from SimCom to investigate if certain prevention strategies have the potential to reduce alcohol-related problems. This never happened. Professional practitioners enjoyed training seminars using SimCom but never applied it to their actual planning. I had to accept that as there is no requirement to demonstrate the potential effectiveness of a prevention plan, there is just no need for computer models and thus no culture for undertaking simulations. My dream never came true. The model and its documentation just sits there [gestures to about 8 feet of shelf filled with binders]. That is 20 years of my career right on that shelf]. I was a very naive guy.
‘The model and its documentation just sits there[gestures to about 8 feet of shelf filled with binders]. That is 20 years of my career right on that shelf.’
A: Many scientists start with that naive view, the rational model of political decision making, and quit policy work after reality disabuses them of their fantasy. But you did not quit. What kept you going after such a big disappointment?
HH: Well, I went lateral. I discovered SimCom was not going to save the world. But at that time I learned from the increase in the US minimum drinking age, that science with good politics makes a difference. So I began studies of alcohol policy in the 1980s and then built a whole part of my career around such research. I enjoyed undertaking research to evaluate effective policies and to advance them.
A: Toward the end of your years in North Carolina, you start writing about health insurance and cost offsets. Was it the potential policy impact of those fields what drew you to them? After all, you are not an economist . . .
HH: In the world of politics, I found that money was pretty powerful and that one does not have to be an economist to do cost studies. Money is just another metric. Because I knew about treatment systems, I began to study the health service costs and benefits of alcoholism treatment. Under research support from NIAAA, we performed a series of cost studies (Holder & Blose 1986, 1987b, 1992).
A: I perceive the impact of that work to be large. Is that how you perceive it?
HH: I think so, but not immediately. We were the first ones to test the hypotheses that alcoholism treatment was cost beneficial and that it affected not only alcoholics but could also affect their family members. The metric we used was medical costs, which everyone could understand. When we first performed those studies, everybody yawned. There was so much money for alcoholism treatment in the US during those years. Who cared whether treatment was cost beneficial? It was not until later in the 1980s that this research received public attention, although I had been doing it for 10 years by that time.
CALIFORNIA YEARS (1987–present)
A: Who or what led you to come to Berkeley in 1987?
HH: Well, on the personal side, all my children were gone. My youngest child, Alicia, was about to graduate, so it was a good time to move. Also, the Prevention Research Center, as I perceived it, was in difficulty. I was even talking to people in North Carolina, including the Research Triangle Institute, about developing a competing center. I was concerned that the science standard of this prevention center was not as high as it should be. Coincidentally, the current director of this center decided he wanted to leave to take a tenured university position and began recruiting me to become director.
Remember, I had deep desire for the alcohol prevention field to have a strong science base. Since the early 1970s I had realized that treatment alone was not the answer and prevention was essential. At this time, no one in the United States was talking about methods of prevention, other than school education and helping kids identify alcoholic parents. Then I read the ‘Purple Book’ (the color of its cover) about taking a public health approach to alcohol prevention (Bruun et al. 1975). The world of alcohol prevention opened up to me through the Purple Book. It changed my professional career. It demonstrated that there was a public health approach to prevention that was more than alcoholism treatment or identifying high-risk drinkers. I might not have seen the full possibility for a systems approach to prevention without that book.
An outcome was my first book (Holder 1987), a sort of American answer to the Purple Book. It was very educational for me to review the scientific evidence concerning alcohol regulation and where science and public policy could be connected.
A: And you wanted to bring that here to Prevention Research Center.
HH: I wanted to bring that perspective to the Prevention Research Center (PRC). I wanted this center to be a true flagship for US alcohol prevention research. I wanted the very best prevention science to be undertaken here: and as far as I am concerned, this center, as a collectivity, has established a high standard for prevention science in the United States. I think this standard is pretty well recognized within the United States, but also researchers from other countries who visit report that Prevention Research Center is well known internationally for conducting good science.
A: Of your achievements as director, would that be the one you would cite as the greatest?
A: Another way we achieve is through whom we hire. Of the people you brought in, who has brought you joy, personally, intellectually?
HH: When I first arrived, Genevieve Ames and Robert Saltz were already at the center. They were conducting good research but were not yet well known in the alcohol research field. Joel Grube, who is now the center director, was a postdoctoral student here, and after seeing his capacity I knew we absolutely had to hire him. After I had been here maybe 6 months, a fellow named Paul Grunewald, who is now scientific director for the center, showed up and said, ‘If you hire me, I want to be an apprentice. It is not a field I know.’ Those were the perfect words for me to hear. Paul had a great research background but he did not know the substance use area. So, he and I worked together for almost 2 years on a single project (Gruenwald, Ponicki & Holder 1993).
All four of them have become superstars. They are all individually well known now for their own research areas: Genevieve for family and work place studies; Bob for responsible alcohol service practices (he is Mr Responsible Alcohol Service because he carried out the earliest work in that field), and for college drinking research; Joel for adolescent drinking studies and factors which influence adolescent drinking; and Paul for alcohol policy studies and also for complex modeling. They all made PRC a strong scientific center.
A: What is it that makes some alcohol research centers great and others merely good?
HH: Well, I do not know for certain but can tell you what I think, what I advise others. First, if you are a director, it is very important that you do not get your ego attached to a certain hierarchy or structure. I certainly had my own ego attachments, but I was particularly taken with the success of the folks working with me. Not all center directors or leaders see it that way. If their name is not the first author on the paper, they think they have lost something.
Second would be find good people and stick with them. Do not tolerate mediocrity; and then the third element for success is to have very high standards.
This is not just about science, it is also about values and ethics. At PRC, we have pressure from two sides. The alcohol industry advances the notion that alcoholism is a disease so nothing you do in prevention is going to work. But the other group that puts tremendous pressure on us is the public health community. They want us to advance their perspectives and recommendations with our science. We have said, look, we feel with you, but we are not taking a position, only publishing our findings.
‘the other group that puts tremendous pressure on us is the public health community . . . We have said, look, we feel with you, but we are not taking a position, only publishing our findings.’
I think there was sometimes more pressure from the public health community than the alcohol industry, even though the alcohol industry dislikes our research findings. Over time, in fairness, the public health community has embraced us. At first, they wanted us to leap over the barricades with them.
A: Turning to one of the best-known PRC projects, you conducted a 5-year community trial with alcohol problem prevention (Holder et al. 2000), which was a success in an area where the normative result is failure. What made your program different from all those other noble efforts that did not succeed?
HH: What is the old saying: ‘just lucky I guess’?. I actually honor those other failures because I learned from them. I found that most community prevention trials lacked sufficient strength of intervention or dosage for a long enough time. I have not found a better word than the language of drug trials, which measures amount of medication as ‘dosage’. The past failures in community prevention were almost always program-based with inadequate dosage to have a significant effect. Most previous prevention efforts designed and implemented a program, and undertook pre–post-evaluation. There may be early effects but few, if any, community level effects or sustained effects. To succeed in community-based prevention, one must honor both the complexity and dynamics of a local system and undertake highly visible, politically salient and scientifically based strategies. If these three ingredients are not present, you are unlikely to have much prevention effect at the community level.
A: So you are actually avoiding two things. One is ignoring the community as those who parachute a program in would do, but you are also not romanticizing the community's ability to solve a challenging problem with no help.
HH: This is where I have very strong disagreements with some in the alcohol field who have very romantic ideas about what communities are and what the community actually knows. I am a community member and if my community has a problem with clean water, sewage or safe streets, I want my community to find the best engineering and technology needed to address such problems.
Therefore, I have written about what I call a respectful partnership or marriage (Holder & Reynolds 1998). One puts science and communities together with each bringing what they uniquely have to offer. I dislike the silly debate about whether prevention is top-down or bottom-up. I find this distinction to be without much value. The key to success is whether both scientists and community members can work in a true partnership to stimulate system changes. This is neither top-down nor bottom-up. As a prevention scientist, why would I hold back my knowledge from the community and why should I not learn about community values and needs from the community itself? Both groups need each other for effective community prevention.
A: What have you learned about how people in communities think about alcohol problems as opposed to how most professionals in the field think about them?
HH: Community people, unless they have had a personal experience, are not concerned about alcoholics. They are concerned about car crashes, about youth drinking and about injuries, whether from domestic violence or street violence around drinking. We carried out many community surveys, but they confirmed what we already learned from just hanging out on the street corner. I have gone to Australia, New Zealand, Finland, Italy and Brazil and found that communities most often have similar concerns. Clinical professionals in particular have a recognized focus with the patients they see; and I honor that. But alcoholics are a selected group of people, and the community as a whole is unconcerned about them.
A: I just want to ask one other question about the work on this period. You conducted several studies showing that ending state-controlled liquor monopolies increased alcohol consumption and problems (Holder 1993). For most commodities we accept the idea that if you expand availability more people will buy them, but some people had a great deal of trouble believing this was true for alcohol. Why do you think your work drew criticism of this sort?
HH: These findings ran counter to the professional belief that alcohol programs must focus on alcohol dependency. Thus one need not be concerned about alcohol supply, it all has to do with alcoholics. Unfortunately for this belief, most community alcohol problems are not caused by alcoholics; policies which restrict alcohol supply can reduce community-level alcohol problems (Blose & Holder 1987).
HOLDER AS INTERNATIONALIST
A: You outstrip even most successful academics in your frequent flyer miles. What accounts for your long-term involvement over many years in so many international projects?
HH: Probably because I was a blue-collar kid who never got to go to Europe.
A: Beats a bus trip to Biloxi.
HH: You betcha. At first that was why I traveled. I did not really start doing extensive international travel until the 1980s. Then I realized that Americans knew very little about alcohol policy, but there were three countries that knew a great deal: Finland, Sweden and Norway. I did not want to teach them anything, I wanted them to teach me. That was the beginning of a long pattern of going regularly to Europe and especially to the Nordic Countries. At the time, Gabriel Romanus was the head of the Swedish retail monopoly, Systembolaget. He was very interested in science and public policy. He encouraged my visits, and we are still friends. The other value for me was learning that often Europeans think differently about policy than Americans do.
‘often Europeans think differently about policy than Americans do’.
HH: Well, they are often willing to be more dispassionate in the policy areas than Americans. I was surprised by that. In Scandinavia and even in England there's a certain dispassionate approach to public policy. We Americans tend to be yellers and head shakers around our policy. Scandinavians have a tradition of dialogue and an examination of the best evidence. I remember being in Stockholm 10 years ago and having a civil conversation with the head of the Swedish brewers. To be treated respectfully by an alcohol industry representative even while he disagreed with me was quite different than my American experience.
‘they are often willing to be more dispassionate in the policy areas than Americans’.
‘We Americans tend to be yellers and head shakers around our policy’.
Also, I respect other countries as our early teachers in community prevention trials, such as the Finnish heart disease study. Sally Casswell in New Zealand did the earliest studies of community advocacy and how to mobilize communities to undertake local alcohol policy. I went overseas to learn. Only in recent years have I had something to teach or share from my own experiences, especially around our community prevention trials.
A: You have worked so much with European scientists, I wonder if you feel you now understand better what it means to be a US scientist?
HH: For better or for worse, the US National Institute of Health stimulates science that is the best in the world because it is so competitive. Not because we are smarter. We are just more willing to go through the rigors of thorough peer review and the requirement to be cutting edge. That does not mean the United States. has the best system, but it works well. European scientists are only occasionally asked to write proposals to get supplemental funds. I have grown to value the US health research system, even though I hated it when I was being reviewed. The other difference I observed is that US addiction scientists have more experience working with colleagues in related fields than do European scientists.
‘The other difference I observed is that US addiction scientists have more experience working with colleagues in related fields than do European scientists.’
HH: Well, I was involved because this remarkable man in England, Griffith Edwards, invited me. I got to know Griffith through the first project, Alcohol Policy and the Public Good. I thought, this is someone I want to sit beside, to learn from. I remember it so clearly because my 90-year-old father made his first European trip with me for our first project meeting in London. I took my father to Griffith's home for an opening reception for the working group and Griffith and Sue were so kind to him. What I also appreciate about Griffith, who had a huge influence on me whether he realizes it or not, is his openness to different ideas. He is always interested in fresh perspectives and bright people. His openness taught me a great deal. And, he demonstrated that if you were interested in or committed to a certain cause that you could have an effect if you were persistent enough. I believe Griffith has had marked effects on British substance abuse policy because he is persistent and informed.
A: That leads naturally to a question about Alcohol Policy and the Public Good. It aspired to public policy relevance. Do you feel it had such an impact?
HH: I was pleasantly surprised by that book. I was somewhat skeptical—as all scientists should be—that anybody would ever read a book written by a bunch of scientists. But Griffith set two standards. First, all our statements must be correct and scientifically accurate. If we do not know, say so. Secondly, the writing must be readable, and I think those two qualities made it a best seller. This book has been translated into many different languages and often cited. The earlier, Purple Book (Bruun et al. 1976) was the precursor but had a more limited readership. What we needed in the 1990s was a readable book marketed by a reputable publisher, and that is what increased the book's impact: it contained readable summaries of the best evidence concerning public policy and prevention of alcohol problems.
A: Being as candid as possible, what do you think of the alcohol beverage industry?
HH: They have a real problem and they know it. Most of their product is consumed by people who are dependent and/or do heavy, often high-risk drinking. That is their business reality. They have not been honest about that knowledge and have tried to cover it up, so we are left wondering whether we can trust them or not. They have not been honest about the risk of their products in a way that encourages honest partnerships with the public health community. The alcohol industry helped create this tension through an ‘us versus them’ perspective and by using the label ‘neo-prohibitionist’ to refer to those of us who held a public health perspective. The alcohol industry could have stimulated good public relations by being collaborative, but they have not.
‘They have not been honest about the risk of their products in a way that encourages honest partnerships with the public health community. The alcohol industry helped create this tension through an “us versus them” perspective . . .’
I do not feel personally offended by the industry because alcohol is a legal product. I enjoy their product myself. I do feel they probably could have reached out more instead of leaving the public health community, particularly the research community, with no basis for discussion. They want to force their way into our meetings but close their meetings to us. If you look at the Swedish, Finnish and Norwegian cases, the production monopoly was owned by the government until 1995. So there was opportunity for dialogue because these were all government enterprises. As soon as they went private, dialogue largely ended.
A: So, if politics were no object, would you have the United States go back to having liquor stores be state operated?
HH: I would in a minute if I had the choice. Alcohol is enough of a toxic product that creating some inconvenience is worth it in terms of the safety that is involved. I have no problem with people drinking, but I do have a problem because alcohol can be a dangerous product, meaning it is psychoactive, it reduces performance levels and increases the risk of injuries and death. It is not good for children or adolescents. State retail stores in the United States have notable effects on consumption and problems (Holder 1993).
A: Anything other alcohol policy changes you would make, again assuming politics are no object and you are king for a day?
HH: Well certainly I would increase alcohol prices.
A: I want to close with a personal observation about you. Some people have a hard time retiring. But you seem extremely happy to be fully retired. Am I misreading that?
HH: No, you are reading it perfectly! I think some people saw me as intensely attached to my work because I spent so many hours in research. However, I take my full identity from where ever I am in the moment, maybe because I was a blue-collar kid. I mean, I learned to work at a farm; I learned how to handle tools and build things. Now that I do not come into the office but once every 6 weeks or so, I have time to work in my garden (especially my roses); I build stone walls, I do sculpture. It is all perfectly satisfying.
A: And anyway, isn’t paid retirement the dream of a blue-collar kid?
HH: That is true! Every day, I go, Wow! I do not have to go to work today. What am I going to do? I think I willl read a book. I still get invited to great conferences and have opportunities to help. People still give me airline tickets to provide consultation in the United States and Europe.
A: We will consider that an advertisement . . .
HH:[Laughs]‘’Retiree. Has passport, will travel!