Needed: A License To Drink

WE BURIED MY COUSIN LAST SUMMER. HE WAS 32 when he hanged himself from a closet coat rack in the throes of alcoholism, the fourth of my blood relatives to die prematurely from this deadly disease. If America issued drinking licenses, those four men-including my father, who died at 54 of liver failure might be alive today.

Addiction to alcohol is one of the primary public-health problems in the United States. It causes more than 19,000 auto fatalities each year, it is responsible for more than a third of deaths from drowning and fire. Booze is a central factor in divorce. It can trigger incest, child and spousal abuse, suicide, homicide, assault and other crimes. it can kill by the liver, the kidneys, the heart, the pancreas, the central nervous system. The total cost, from increased jail time to workplace injuries and lost productivity, is impossible to measure, but a conservative estimate is as high as $90 billion per year. As ways to trim health-care costs are considered we must recognize that alcoholism is a big contributor to hospital admissions.

I spent two years working as a counselor in a chemical-dependency treatment center and met these "statistics" on a daily basis. I remember the bright young man who, because he passed out while smoking, lost both legs to terrible bums; the nurse with a master's degree who lost her license and became a prostitute; and there was the cheerful grandmother dying of liver failure, with only a few weeks to live. Their families cared about them but could do nothing. I've seen the helplessness in my own family.

About two thirds of adolescent and adult Americans drink alcohol. Of those, from 8 to 12 percent will become alcoholics or problem drinkers. Much is being done to confront this huge public-health crisis as judges increasingly sentence drunk drivers and other alcohol-related offenders to treatment programs and participation in Alcoholics Anonymous. I propose that a national system of licensing, with appropriate penalties, would do more.

Drivers are licensed by every state. There are licenses for fishing and for hunting-hunters are often required to attend gun-safety classes before they venture afield. These licenses are revocable; if you fail to keep to accepted norms the state suspends your right to drive, hunt or fish and imposes criminal penalties should you violate that suspension.

Although this might seem a farfetched idea, I believe drastic measures are needed. Licensing drinking would acknowledge the growing medical consensus that roughly one drinker in 10 has a genetic predisposition for addiction. In many cases, future alcoholics are dangerously unaware of their internal time bomb. They don't aspire to become drunks, but once trapped in the disease they can do enormous harm to others and themselves.

Because some potential alcoholics would not bother to apply for a drinking license, licensing would act as a screen-preventing a small percentage of the misery up-front. Those who do seek a license would follow a path similar to existing driver's licensing procedures.

Applicants would be required to study a manual containing basic information about alcohol and the law, much like the driver's manual we all memorized in high school. How many drinks will it take to intoxicate a 150-pound man? What is the penalty for drunk driving? Have any of your blood relatives been treated for alcoholism or chemical dependency? If they have, you need to know that you're at increased risk for developing addiction.

The next step would be to pass a written test. License holders would then be able to buy alcoholic beverages (including beer). A liquor store or bar caught selling to an unlicensed drinker would forfeit its license.

The 90 percent of us who do not have a problem with alcohol would simply show our licenses at the counter, bar or restaurant-in much the same way as driving to and from work each day with a driver's license.

Most of the problem 10 percent would at some point face arrest on an alcohol-related offense. Once convicted they'd lose their license. From that point on, attempting to buy or possess alcohol or being found with a detectable blood level of booze would subject them to a misdemeanor charge-with penalties comparable to those for drunk driving. Unlicensed drinkers who got drunk could be referred to treatment and to Alcoholics Anonymous.

Doctors are required to report cases of syphilis, gonorrhea, AIDS and tuberculosis as public-health hazards. They should also be required to report the medical diagnosis of alcoholism. If a patient is admitted to a chemical-dependency treatment center, his drinking license would be suspended. Physicians would report people who show signs of alcoholism after having their licenses rescinded, just as social agencies report parole violators. The objective would be treatment. If the offenders refuse to seek sobriety, they would be unable to get their licenses renewed.

A commonly accepted canon of civilized society is that when the public health is threatened, privacy rights must be compromised. Americans rarely die of typhoid, cholera or plague because we have identified their sources. Infectious carriers are quarantined when necessary and offered compassionate and lifesaving treatment.

The same criteria should apply to alcoholism, a disease that is the third leading cause of preventable death in this country. The costs inflicted by 18 million drunks, on themselves and on our social fabric, is unacceptable. Congress and the states should cooperate by instigating national drinking licenses, encouraging treatment for those afflicted and imposing firm penalties on violators. It's not such a crazy idea.