intoxicated across europe: in search of meaning

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Addiction Research. 2wO. Vol. 8, No. 3, pp. 233-242 Reprints available direclly fmm the publish Photocopying permitted by license only 8 UXM OPA (Ov- Publishers Association) N.V. Published by license under the Hamood Academic Publishus imprint, part of llx Gordon and Breach Publishing Group. Prinled in Malaysia INTOXICATED ACROSS EUROPE: IN SEARCH OF MEANING DOUGLAS CAMERON~*, MARK THO MAS^, SARAH MADDEP, CHRISTINE THORN TON^, ANDERS BERG MARK^, HENK GARRETSENe and MANINA TERZIDOUf ‘Department of Psychiatry, University of Leicester; Leicester Royal Infirmary, Leicester LE2 7rX, U.K., bLeicester Community Drug and Alcohol Services, Paget House, Leicester, ‘Alcohol and Health Research Centre. Edinburgh, dDepartment of Social Work, University of Stockholm, eIVO (Addiction Research Institute). Rot- terdam andfMenta1 Health Research Institute, University of Athens Strategies for prevention of alcohol problems have moved on from a preoccupation with quantities consumed per week or per annum. We are now also looking in more detail at the short-term effects of intoxication (“drunkenness”). Whilst it is relatively easy to compare rates of consumption across European countries, it is more difficult to compare rates of drunkenness because the words used to describe the state do not readily translate from one language to another, and may have very different cultural connotations. This paper describes a pilot study of a novel method of defining and quantifying the state of drunkenness in five different cities in Europe. Groups of five clinical or research workers in alcohol problems in Edinburgh, Leicester, Stockholm, Rotterdam and Athens got together and wrote down all the words they could think of in their own language which meant “drunk”. They then arranged these words on a spectrum from most positive to most negative and quantified the “top ten” words in terms of intensity of intoxication. All words were then sorted into five categories, psychological (any amount of alcohol and extreme amounts of alcohol) and behavioural (any and extreme) and post hoc: “I must have been drunk because ...( I do not know how I got home last night, cannot remember ... etc)” The results show the technique to be reliable and already to have produced interesting findings. All these drinking cultures have a rich language to describe states of intoxication and it was possible to quantify and compare them. Three groups (English, Dutch and Swed- ish) define the most severe states of intoxication predominantly in behavioural terms. The Swedish group had the largest number of words describing drunkenness as the behaviour induced by any level of ingested alcohol. The Scots and the Greeks use psychological defini- tions but the Scots also acknowledge that becoming severely intoxicated can be the conse- quence of attempting to get into a new psychological state, but overdoing it. A quarter of the Greek words describe becoming transformed into another being. The other cultures do not describe that, although the concept is known to exist in Scottish culture. Only the English, Dutch and Greek words can readily be sorted onto a positive-negative dimension, with the Dutch viewing drunkenness more negatively than the other two. * Correspondence Author. 233 Addict Res Theory Downloaded from informahealthcare.com by Northeastern University on 11/18/14 For personal use only.

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Addiction Research. 2wO. Vol. 8, No. 3, pp. 233-242 Reprints available direclly fmm the publ ish Photocopying permitted by license only

8 U X M OPA (Ov- Publishers Association) N.V. Published by license under

the Hamood Academic Publishus imprint, part of llx Gordon and Breach Publishing Group.

Prinled in Malaysia

INTOXICATED ACROSS EUROPE: IN SEARCH OF MEANING

DOUGLAS CAMERON~*, MARK THO MAS^, SARAH MADDEP, CHRISTINE THORN TON^, ANDERS BERG MARK^,

HENK GARRETSENe and MANINA TERZIDOUf

‘Department of Psychiatry, University of Leicester; Leicester Royal Infirmary, Leicester LE2 7rX, U.K., bLeicester Community Drug and Alcohol Services, Paget House, Leicester, ‘Alcohol and Health Research Centre. Edinburgh, dDepartment of Social Work, University of Stockholm, eIVO (Addiction Research Institute). Rot-

terdam andfMenta1 Health Research Institute, University of Athens

Strategies for prevention of alcohol problems have moved on from a preoccupation with quantities consumed per week or per annum. We are now also looking in more detail at the short-term effects of intoxication (“drunkenness”). Whilst it is relatively easy to compare rates of consumption across European countries, it is more difficult to compare rates of drunkenness because the words used to describe the state do not readily translate from one language to another, and may have very different cultural connotations.

This paper describes a pilot study of a novel method of defining and quantifying the state of drunkenness in five different cities in Europe. Groups of five clinical or research workers in alcohol problems in Edinburgh, Leicester, Stockholm, Rotterdam and Athens got together and wrote down all the words they could think of in their own language which meant “drunk”. They then arranged these words on a spectrum from most positive to most negative and quantified the “top ten” words in terms of intensity of intoxication. All words were then sorted into five categories, psychological (any amount of alcohol and extreme amounts of alcohol) and behavioural (any and extreme) and post hoc: “I must have been drunk because ...( I do not know how I got home last night, cannot remember ... etc)”

The results show the technique to be reliable and already to have produced interesting findings. All these drinking cultures have a rich language to describe states of intoxication and it was possible to quantify and compare them. Three groups (English, Dutch and Swed- ish) define the most severe states of intoxication predominantly in behavioural terms. The Swedish group had the largest number of words describing drunkenness as the behaviour induced by any level of ingested alcohol. The Scots and the Greeks use psychological defini- tions but the Scots also acknowledge that becoming severely intoxicated can be the conse- quence of attempting to get into a new psychological state, but overdoing it. A quarter of the Greek words describe becoming transformed into another being. The other cultures do not describe that, although the concept is known to exist in Scottish culture. Only the English, Dutch and Greek words can readily be sorted onto a positive-negative dimension, with the Dutch viewing drunkenness more negatively than the other two.

* Correspondence Author.

233

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234 DOUGLAS CAMERON et al.

INTRODUCTION

There is increasing recognition that it is not just the quantity of alcohol consumed per week that is a predictor of alcohol problems but also the amount consumed per drinking session and the psychological and behav- ioural effects of that pattern of consumption. (Rehm, J. et al 1996, Grant, M. & Litvak, J. 1997) It is not just “how much”, it is “what happens”. And what happens when people consume beverage alcohol is that they become “intoxicated” or “drunk”. There are already surveys comparing reported rates of drunkenness in young people in many European Countries (Hibbell, B. et al 1997).

But even in a single language, such as English, the words “intoxicated” and “drunk” contain a multiplicity of meanings within them. One way of trying to understand the meaning of intoxication across languages and cul- tures is to examine the words used which mean “drunk” in those different cultures and find a way of analysing and quantifying them which is not dependent on simple translation from one language to another of words and phrases that are often slang and lacking in alternative meanings. The purpose of this study was to create and examine a methodology for doing this.

To demonstrate the complexity of meanings, it is appropriate to start in one language so below are English dictionary definitions of “drunk” and “intoxicate”.

Drunk:

A) Overcome by or as by alcoholic liquor. Intoxicated.

B) 1. A drinking bout.

2. A drunken person: a case or charge of being drunk.

Intoxicate:

1. To poison.

2. To stupefy or render unconscious or delirious, madden with a drug or alcoholic liquor, to inebriate, make drunk.

3. A) To “poison”, to corrupt morally or spiritually.

B) To stupefy or excite as with a drug or alcoholic liquor.

Shorter Oxford English Dictionary 1990

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INTOXICATED ACROSS EUROPE 235

From the above definitions, it is clear that in English anyway, there are a number of different concepts involved in describing the state of intoxica- tion:

1. The simple idea of basal narcosis: as in Render Unconscious; Stupefy. 2. Almost the opposite of that: Excite; Madden; Render Delirious. 3. The idea of lack of control: Being Overcome. 4. The noun: a person who is drunk, or a drinking episode.

In an attempt to clarify what was meant by “drunk” in English, Ron McKechnie (1 980) proposed a categorisation. To this has been added what on retrospect was a clear omission from that early paper, namely a Cate- gory IV. Thus this list is expanded from the McKechnie paper.

7. The psychological effects produced by any degree of alcoholisation. 11. The psychological effects produced by an extreme degree of alcoholisa- tion. 111. The behavioural effects produced by any degree of alcoholisation. IV. The behavioural effects produced by an extreme degree of alcoholisa- tion. V. A post - hoc definition: “I must have been drunk because .... (I do not know how I got home last night, I cannot remember.. .etc)

The purpose of this pilot study was to attempt to find out:

I. What words and how many of them were in common usage in five sites, in England, Scotland, The Netherlands, Sweden and Greece. 11. If the words could be fitted in to a common categorisation system.

METHOD

The method decided upon was simple. Colleagues in various alcohol research or treatment centres were asked to undertake a group exercise in which they wrote down on separate cards words which meant “drunk” and then quantifying, ranking and categorising them. The final instructions for this pilot study were as follows:

“This exercise should take less than one hour and should be undertaken very informally. Please gather a group of five colleagues (including your- self) round a table.

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236 DOUGLAS CAMERON ef al.

Stage 1: Enclosed are 50 cards. As a group, spend a maximum of 10 minutes writing on separate cards in your own language all the words or phrases that the group can think of that mean “DRUNK’. If you think of more than 50 in 10 minutes, please add extra cards - but I would be sur- prised!

“Drunk” itself can be included. Some words or phrases will be local slang; some will be more acceptable to a dictionary! Do not worry about this. Include them all. Stage 2: This will be more difficult. Please sort the cards with the words and phrases on a positive to negative dimension of drunkenness, with the highest positive score being the most positive (or pleasurable) state and the highest negative score the one that means the most negative (or unpleasurable) state. Once you have done this, number the cards in arabic numerals, from + x to - y with x and y referring to whatever numbers are appropriate for you. You can have a zero if a word or phrase is neither positive nor negative. Try to avoid equal rankings but you might find that impossible.

Stage 3: Attach red dots (enclosed) to what you -the group- think are the TEN most frequently used words or phrases meaning “drunk” in your locality. Line them up on the table in the same order as for Stage 2. You have 50 small pieces of card (counters). Arrange these counters between the 10 cards to quantify the degree or intensity of drunkenness that the words on the cards mean to the group. There is unlikely to be an even increase down the list i.e. some words will signify a much greater degree of drunkenness than others. Again try and avoid equal scoring. Once you have agreed on the scores, write the number of counters allocated onto the card with the word on it and put a ring round the number of counters allo- cated and the red dot so I can’t confuse it with the rank order from Stage 2.

Stage 4: Go through all the words and phrases and categorise them according to the expansion of McKechnie’s (1980) classification, which is written (in English) on the enclosed card. You might find it helpful to translate these definitions into your own language before starting this exer- cise. Write on the card in Roman Numerals which definition is most appropriate (I, 11,111, IV or V).

Stage 5 : Gather up the cards into the envelope provided and send them back to me! Please include a note outlining any particular difficulties that occurred during the exercise. Many thanks.”

Once the cards were returned to the lead author, they were counted, sorted, ranked and placed into McKechnie‘s categories after which simple

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INTOXICATED ACROSS EUROPE 231

numerical comparisons of the five sites were undertaken using x2. A relia- bility check was undertaken by the original Leicester group which repeated the exercise six months after first doing it.

RESULTS

The English produced 35 words and phrases, the Scots 37, the Dutch 34, the Swedes 26 and the Greeks 32. By way of examples, the “top ten” from each site are shown below, listed from the least to the most severe form of drunkenness:

Ten words reported as most frequently used Ranked from “mildest” to “most severe”

Leicester Edinburgh Rottenlam Stockholm Athens

Meny Bevvied Onder invlwd zijn

Half cut Drunk Te veel op hebben

Drunk Legless Beschonken

Sozzled Pissed Dronken

Pissed Plastered zat

Ratted Pissed as a newt Bezopen

Plastered Rat-arsed LazeNS

Legless Wasted Straalbezopen

Pissed as a fart Wrecked Strontlazerus

Rat-arsed Paralytic Ladderzat

Paverkad E X d K W d KF.@

Salongsberusad

Berusad

Dragen

Pastruken

Full

Kanon

Packad

Snorfull

Dyngrak

Except for the Greek words (see below) the non-English words do not readily translate into English. For instance, whilst the Dutch expression “Onder onvloed zyn” means “Under the Influence” and “Te veel op heb- ben” means “To have too much”, the rest “are just slang words for ’drunk‘ and do not mean anything else”.

The Scots and the Swedes did not rank their words and phrases on a pos- itive-negative dimension. The Swedish commentary that was returned with the exercise stated: “Of the 26 words.. .. No one has a straightforward and unambiguous negative meaning. Perhaps one or two could, by some

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238 DOUGLAS CAMERON er al,

individuals, be considered as negative. The same is true for a positive eval- uation, no word can be seen as truly positive. The characters of the words are descriptive rather than anything else.” It would appear that in Swedish, these words and phrases lack a dimension of social approval or disap- proval. Rather, they describe states of being.

The Dutch, English and Greek respondents did, however, rank them on a positive-negative dimension. (Dutch: 4 positive, I neutral, 29 negative. English 15 positive, I neutral, 19 negative. Greek 15 positive, 17 negative. (Positive and neutral vs. Negative: x2= 6.37, 2 df, p<0.05). The Dutch seem to be less positive about drunkenness than the English or Greeks.

In terms of all words and phrases used, the categories in which they were placed were as follows:

FIGURE 1 Meanings of all words reported

There are highly significant differences between the sites: x2= 45.78, 16df p<O.OOl. Only the Scots and Greeks used the post-hoc definition. The Greeks did so with difficulty, “the group could not fully comprehend defi- nition V to allocate words in it safely: the allocation of most words to this category was done with reservation”. The Scots and Greeks also had the smallest number of words placed in Category I V behaviour caused by an extreme degree of alcoholisation. The Dutch and Swedes had fewest

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INTOXICATED ACROSS EUROPE 239

words in Category I1 (Psychological state caused by extreme degree of alcoholisation). The Swedes had less of their words in Category I, more in Category 11, more in Category I11 and most in Category IV. They had the largest Category III (the behavioural state induced by any degree of alco- holisation), of any group.

The “top ten” (reportedly ten most frequently used words) also showed significant differences by meaning across sites.

FIGURE 2 Meanings of ‘’top ten” words reported

The significant differences here are obviously smaller (x2=28.06, 16df p< 0.05). But in their “top ten” neither the English nor the Dutch had a word in Category 11, the psychological state produced by extreme levels of alcoholisation, whereas the Greeks only have words in the psychological categories and only the Scots have post-hoc words (Category V).

On the quantification exercise: which categories of drunkenness did the groups think were most severe? The results are shown in Figure 3.

There are highly significant differences: x2 =301.29, 16df p<O.OOl. In Leicester, Rotterdam and Stockholm, the most severe states of intoxication were those which entailed demonstrating the behaviour induced by extreme degrees of alcoholisation (Category IV) whereas in Edinburgh, the post-hoc definition (V) was deemed to be the most extreme state, fol-

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240 DOUGLAS CAMERON ef a!.

lowed by Category I. The Athens group, having only psychological words in their “top ten”, clearly scored highly in Categories I and 11. Again from Stockholm, there is a graduated response from psychological to behav- ioural states.

FIGURE 3 Intensity of Words by category

The repeat of the exercise by the Leicester group revealed no significant differences between time one and time two. On the second occasion, the group produced 3 1 words, 13 positive, I neutral and 17 negative, catego- rised thus: I: 511: 8,111: 5 , IV: 13, V 0. Nine of the “top ten” words were the same. At time two, the word “sozzled” (Cat I) replaced the word “smashed” (Cat IV). “Sozzled” was not mentioned at all at time one. That single change accounted for some shift in the categorisation of the inten- sity of intoxication measure, but it was well below significance. (x2 =6.88, 4df p<0.2.)

DISCUSSION

The purpose of this pilot study was to explore a method of increasing our understanding of the meaning of drunkenness across cultures by quantify-

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INTOXICATED ACROSS EUROPE 24 1

ing and categorising words meaning “drunk” in five sites, in England, Scotland, The Netherlands, Sweden and Greece. The simple card-sort exercise undertaken by non-random groups of workers in alcohol treat- ment or research did highlight differences in the meaning of drunkenness and intoxication across sites. It is interesting to speculate upon similarities and differences.

First, all these groups can produce a rich language describing various states of intoxication and the words used can be categorised.

Second, the English, Dutch and Swedish groups define the most severe states of intoxication predominantly in behavioural terms. The Scottish group describes these as either psychological states created by any level of intoxication or as post-hoc states, as if they are aiming for a psychological state but make occasional errors of dosage leading to unintended conse- quences, either psychological or behavioural. This might reflect ambiva- lence in the Scots culture, both relishing and regretting the effects of strong drink.

The dimension of positive to negative alcohol effects was more broadly problematic. It has to be acknowledged that in the construction of the methodology, the principal author’s own beliefs and prejudices may have been imposed. These beliefs may be meaningful to the Dutch, English and Greeks, but not to the others. The English and Greeks reported less nega- tive words than the Dutch.

Third, the responses from Sweden were declared neutral and descriptive of states of being. But they also contain the largest number of words describing the behaviour induced by any level of alcoholisation. It is possi- ble that this is evidence of an abstinence oriented culture whose social pol- icies have been directed predominantly towards suppression of consumption as a public health measure, a culture quite sensitised to the visible effects of any drinking: all levels of intoxication are seen as the same.

Fourth, because of the notable bias of Greek words to psychological states, further exploration of the words from Athens was necessary. The Greeks include words such as “village drunk” as descriptions of negative states of drunkenness. That is, they shift from what in the English diction- ary definitions of Drunk are A, the adjective to B, the noun. There may be something important underlying this. Many Greek words are quite differ- ent from the other languages in that they often use phrases containing the word E$VE (become) which, if translated literally, mean such things as

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242 DOUGLAS CAMERON et al.

“become a cauliflower”, or “become a cardinal”. This seems to be more than simile: as in “pissed as a newt”. We may be talking here of transfor- mations. This is qualitatively different from the regularly used suffix pvoo, which means a state of being, as in nlopvoo and ~ e h a p v o o . Those words do not translate beyond of meaning “drunk”, or “very drunk”. That “state of being” notion occurred in words in other languages in this study but transformations did not. However, in a song by Will Fyffe (1885 - 1947), the Scottish comedian is the verse, “I’m only a common auld working chap, as anyone here can see, but after a couple of drinks on a Saturday, Glasgow belongs to me! ”. That might be a Scottish example of transformation. Further work will need to find a way of tapping in to this concept for it accounted for 8 (25%) of the Greek words.

All the usual caveats should be applied to a pilot study of this sort: the groups were small, not necessarily homogeneous or representative of the cultures in which they work, being researchers or practitioners who were alcohol knowledgeable. Also, there could be institutional biases built in: what are the views of the agency or its funders about drunkenness. Young people and old people were underrepresented. However, we propose that there does here seem to be the beginnings of a simple, easily administered methodology which demonstrates the differences in what it may mean to be intoxicated in different parts of Europe.

With special thanks to Ron McKechnie.

References Grant, M. & Litvak, J. [eds] (1997) Drinking Patterns and their consequences. Washington

DC. Taylor and Francis. Hibell, B., Andersson, B., Bjamason, T., Kokkevi, A., Morgan, M. & Narusak, A. (1997) The

1995 ESPAD Report. Stockholm. The Swedish Council for Information on Alcohol and Other Drugs.

McKechnie, R.J. (1980) The question of Drunkenness: Who’s Drunk or Whose Drunk? In Aspects of Alcohol and Drug Dependence. Eds Madden, J.S., Walker, R. & Kenyon, W. Tunbridge Wells. Pitman Medical.

Rehm, J., Ashley, M.J. Room, R. Single, E. Bondy, S. Ferrence, R. & Giesbrecht, N. (1996) On the emerging paradigm of drinking patterns and their social and health conse- quences. Addicrion 91: 1615 - 1622.

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