Addiction Research and TheoryAugust, 2005, 13(4): 321–331

Multicultural contexts and alcohol and druguse as symbolic behaviour

ROBIN ROOM

Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University,Sveaplan, 106 91 Stockholm, Sweden

(Received 10 January 2004; in final form 10 April 2004)

AbstractDiverse forms of cultural contact, from living together in the same society to tourism, are consideredin terms of what they mean for substance use. In a multicultural society, ethnicities are partly assignedand partly constructed, and can also be a performance in front of an audience of others. Alcoholor drug use or nonuse often becomes an ethnic marker, which helps to sustain differentiationsin patterns. Drinking and drug use patterns in immigrant communities are thus not simply a matterof acculturation to some ‘‘mainstream’’. Cultural diffusion may flow in both directions. In themodern world, mass tourism has also become a vehicle for cultural contact and transmission ofdrinking and drug use, although tourists’ behaviour is often different from their behaviour backhome. Studies of psychoactive substance use in multicultural contexts need to take account bothof the symbolism of the use, particularly in the context of the performance of ethnicity, andof the influence of power and status relations on the ethnic performance and its reception.

Keywords: Migration, ethnicity, acculturation, culture contact, tourism, drinking, substance use

Migration and ethnicity in a multicultural context

This article considers diverse forms of cultural contact, ranging from living together in thesame society to tourism, and what they mean for patterns of substance use. Our particularfocus is on use or abstention from psychoactive substances as symbolic behaviour, inthe context of the expression or assignment of ethnic difference.An important form of continuing cultural contact takes the form of living together in

a multicultural society. While there are societies where the different cultures have livedtogether for many hundreds of years, many more societies have become or are becomingmulticultural as a result of migration.

Correspondence: Robin Room, Centre for Social Research on Alcohol and Drugs (SoRAD), StockholmUniversity, Sveaplan, 10691 Stockholm, Sweden. E-mail: robin.room@sorad.su.se

ISSN 1606-6359 print: ISSN 1476-7392 online � 2005 Taylor & Francis Group LtdDOI: 10.1080/16066350500136326

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Migration has been part of the human experience since before historical records exist.The migration has taken many forms. The move can be by an individual, by a family,by a whole village, or a tribal group. It can be undertaken in a search for a better life, itcan be an escape of harsh conditions or persecution, or it can occur under compulsion.Though we usually reserve the term ‘‘migration’’ for potentially long-term moves, themigration can be seasonal, or can be intended to be short-term, even though it may turnout to be permanent. In the modern world, there is also much traveling to and fro inother forms of temporary migration, the vacation trip and business visit.Migrant groups are not a random cross-section of the culture from which they come.

Younger adults, sometimes with their children, tend to be most common in streamsof economic migration, in search of a better life. Depending on the circumstances, themigrants may be poorer or better off, skilled or unskilled, rural or urban. Partly becauseof selection by the receiving society, as a group migrants usually tend to be morevigorous and healthy than a cross-section of the society they come from, and they mayhave long-lasting health advantages in comparison also to their peers in the receivingsociety (Swallen, 1997).All the various forms of migration and travel bring people from different cultures in

contact with one another. The contacts may be brief, as when a migrating group passesthrough, or may be recurrent or seasonal, as with streams of vacation travel; but oftenthe contacts become long-term. People from the different cultures may settle down andinhabit the same or adjacent spaces, so that they are in long-term contact and interaction.Eventually people with very diverse ancestors may come to think of themselves as a single‘‘imagined community’’ (Anderson, 1983). Or their thinking about cultural identity maybe more complex than that. They may at the same time think of themselves as sharing ina national culture and also belonging to one or more ethnic groups within the nation.In the large multicultural societies that were formed primarily by migration in the lastthree or four hundred years, this has come to be expressed by identifications in hyphenatedterms: as a Ukrainian-Canadian, a Mexican-American, a Vietnamese-Australian, etc.In multicultural societies and situations, ethnic identification is to some extent assigned.

Particularly for ‘‘visible minorities’’ identifiable by skin colour or some such external sign,or for those not fluent in the local language, the identification cannot easily be escaped.But even where obvious external markers are lacking, members of an immigrant communitymay find themselves set apart in the status of the ‘‘Other’’, as for Irish in Britain(Mac an Ghaill, 2000) or Transylvanian Hungarians in Hungary (Fox, 2003). In a multi-cultural society, immigrant groups that think of themselves as very different may findthemselves grouped together by the receiving society in a common identification: thusU.S. immigrants from the Philippines, China, and Korea find themselves grouped togetheras Asian-Americans, and those from Cuba, Mexico, and Peru as Hispanic-Americans.On the other hand, for many people in multicultural societies, particularly in generations

after the immigrant generation, ethnic identification becomes in part a matter of choice(Song, 2003), and the choices are not necessarily mutually exclusive. Someone withIrish, Welsh, and Italian grandparents can claim and feel an identity as Irish onSt. Patrick’s Day, as Welsh when singing in a choir, and as Italian when making homemadepasta. Rather than being an unchanging characteristic assigned at birth, then, ‘‘ethnicidentity, particularly in a multiethnic society, is often a definitely self-consciousconstruction or retention’’ (Room, 1985). As Eriksen (2001) remarks, ethnic identification‘‘is relational, situational and flexible, and each person carries a number of potentialidentities, only a few of which become socially significant, making a difference in everydaylife’’. On the other hand, he continues, this is not ‘‘to say that collective identities can be

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created out of thin air. They have to be connected, in credible ways, to people’s personalexperiences’’, which ‘‘in turn are flexible, . . . but not indefinitely so’’.Forgoing a ‘‘hyphenated’’ identity may also be an option in a multicultural society. Over

40% of respondents in Canada describe themselves as ‘‘Canadian’’ when asked, ‘‘Whichethnic or cultural group do you belong to?’’ (Adrian et al., 1996). Even with the muchmore pointed question, ‘‘To what ethnic or cultural group did you, or your ancestors,belong on first coming to this continent?’’, still 5% will answer only ‘‘Canadian’’ (Adlafet al., 1998:53). At the extreme, in the troubled context of Rwanda, with a recent historyof interethnic massacres, the expression of ethnic difference is outlawed as the crimeof ‘‘divisionism’’. In the words of a Rwandan interviewed in 2004, ‘‘there is no ethnicityhere. We are all Rwandan . . .. Ethnicity is bad. I want it to go away’’ (Lacey, 2004).

Psychoactive substances and the performance of ethnicity

Ethnic identification is often associated with dimensions of power and status in a society,and the assignment or adoption of an ethnic identity may be related to conflicts overpower or status (Eriksen, 2001). Whether intentionally or not, ethnic identity inmulticultural societies is also a performance in front of an audience of others, and is subjectto interpretation – whether sympathetic or negative – by the audience. Thus the children ofan ethnic community may perform the old dances in the traditional costumes not justin front of their parents, but in a community multicultural festival. In terms of interpretationby others, the behaviour of an ethnic identification may be characterized in unflattering andstereotyped terms by members of rival groups (Galasinska & Galasinski, 2003).Three characteristics of psychoactive substances make them an important part of ethnic

performances. First, psychoactive substances are valued physical goods. Their status asphysical goods renders them subject to commodification, and indeed globalization in useand trade. Given their positive valuation, possession and use is often a symbol of powerand domination (Morgan, 1983), or at least of access to resources beyond subsistence.Second, using psychoactive substances is a behaviour, and very often a social behaviour.Use of the substances socially means that the use often serves to demarcate the boundariesof inclusion and exclusion in a social grouping (Room, 1975). Third, psychoactivesubstance use is a peculiarly intimate behaviour, in that the substance is taken into thebody, and is often expected to affect behaviour – even to the extent that the substancemay be seen as possessing the user, submerging the true self (Room, 2001). This character-istic accounts for much of the moral loading that surrounds psychoactive substance usein most societies (Room, Rehm, Trotter, Paglia & Ustun, 2001).A heavy load of symbolism thus often attaches to the use or non-use of psychoactive

substances. The use may be a positive signal of power or status, or may be heavily derogatedor stigmatized, or may simply be an expression of difference without strong implicationsfor power or status. The use or non-use of psychoactive substances thus often becomesan element of the performance and the evaluation of ethnic identification.The emphasis in our discussion here is thus on symbolism and identity as factors in

drinking and drug use patterns in a multicultural situation.1 Much of the literature onmigration and substance use, however, looks in quite other directions for understanding

1Much of the discussion in the article is in terms of alcohol, because it is for alcohol that the empirical literature isbest developed. With some caveats, however, the general principles discussed may apply for other substances thatare used socially, including for instance tobacco and marijuana. The legal status of the substance in a particularsociety is, however, likely to affect what happens.

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of drinking and drug use in immigrant subcultures, emphasizing stresses prior to, duringand subsequent to migration as causes of problematic alcohol and drug use (e.g.,Gil, Wagner & Vega, 2000; O’Hare & Tran, 1998). Such relations may well be important,but they should not be presumed. Circumstances of migration, as well as cultural patternsin the migrant group and the receiving society, vary greatly, so that there is no generalrelation of migration to problematic alcohol or drug use.

Contrasting customs and the symbolic arena: Migrant groupsand substance use or non-use

The contingencies of travel, migration, and coexistence affect patterns of psychoactivesubstance use in a diversity of ways. In the first place, immigrants bring with them thecustoms of their native culture, including the customs on substance use. Some of themmay be quite rigidly attached to their culture’s choices of substances, even in the face ofthe disapproval and dismay of the receiving society. Many British guest workers in SaudiArabia remain attached to alcoholic beverages, despite the rejection of this by Saudi society,just as some Somali immigrants in Canada remain attached to khat chewing, and someIranian immigrants in Sweden to opium smoking. The transnational social links thatimmigrants and their children automatically have also sometimes facilitate entrepreneurshiparound forbidden substances in the receiving society.For alcohol in particular, patterns of use or nonuse have been an important identity

marker in much of human history, and remain so today. Often the differentiations steminitially from religion, and involve whether the adherent uses alcohol at all. Islam is themajor example of a religion that absolutely forbids drinking to the believer, but in othermajor world religions – Christianity, Hinduism, Buddhism – there are denominationsor subgroups that abstain or teach the virtue of abstinence. In a multiculturalenvironment, particularly one in which drinking is widely accepted, abstention becomesalso a marker of ethnic identity. Thus, as Norway has become more multicultural andthe influence of the traditional temperance movement has declined, the social location ofabstention has changed considerably from 40 years ago, when abstention was associatedwith Christian religious involvement in the western countryside (Wallace, 1972).Nowadays the abstainers in Norway are urban – immigrants from Islamic lands andtheir children (Pedersen & Kolstad, 2000).Both religion and migration play important roles in Gusfield’s (1986) classic

interpretation of the alcohol prohibition movement in the United States at the end of the19th century as a ‘‘symbolic crusade’’. On the one hand, the core of movement could befound in a number of Protestant denominations, particularly those that had started orbeen transformed in the 19th century. On the other hand, by the late 19th century, themovement had acquired a nativist, anti-immigrant cast, reacting to large-scale immigrationfrom ‘‘wet’’ and often Roman Catholic parts of Europe such as Italy, Ireland, andGermany. Tham (1995) and Eisenbach-Stangl (2003) have argued, for Sweden andAustria respectively, that anti-drug movements and policies today often carry a codedxenophobia – that drugs are something alien to the national culture, something broughtin by immigrants. Differentiations on psychoactive substance use and attitudes thus oftenbecome expressions of ethnically based divisions in a society.

Substance use in the new land: Acculturation, economics, symbolism, and identity

It is worth keeping in mind that members of the immigrant generation bring with them thedrinking or drug use customs of their native culture at the time of immigration. These may

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be quite different from the customs in that culture a couple of generations later. Forinstance, the migration from Japan to the U.S. mainland occurred primarily early in the20th century. A study of drinking in Japan and among Japanese-Americans and otherAmericans (Clark & Hesselbrock, 1988) found that Japanese-American women weremore likely to drink infrequently or not at all than either women in Japan or WhiteAmericans. The pattern of drinking among Japanese-American women seemed to reflectold patterns in Japan, while there had been changes in postwar Japan, which meant thatwomen there were more likely to drink regularly.The effects on drinking or drug use of the migrant’s inclusion in the receiving society are

often discussed in terms of ‘‘acculturation’’, with a hypothesis, implicit or explicit, thatthe longer an immigrant group has been in a country, the closer its behaviour will be tothe ‘‘mainstream’’ (Adrian, Dini, Stoduto & MacGregor, 1996). Gutmann (1999) hasrecently re-emphasized how problematic the term ‘‘acculturation’’ can be in discussingalcohol and ethnicity. Indeed, the cultural patterns that are brought by immigrant groupsare often adapted in the context of the receiving society. But the adaptation may be fastor slow, and it is not necessarily in the direction of mainstream patterns in thereceiving society. Patterns of abstinence or very light drinking seem often to be retainedacross generations, for instance, by people of Moslem heritage, even if they are notreligiously observant (Dotinga, van den Eijnden, San Jose, Garretsen & Bosveld, 2002).Jewish-American drinking has remained lighter than that of other Americans for severalgenerations now (Glassner, 1991). In terms of the speed of adaptation, studies ofMexican migrants to the United States have found that men’s drinking changed muchmore quickly after migration – within five years – while changes in women’s drinkingwere delayed to the second generation (Caetano & Medina Mora, 1988). But the changewas not so much towards some mainstream American pattern as towards new Mexican-American patterns, constructed from the available cultural materials in the newsociocultural environment.It is also worth keeping in mind that a receiving society’s patterns may be changed by

cultural diffusion from an immigrant group. For instance, German immigration to theUnited States was important in the shift from spirits to beer as the predominant beveragein the United States (Lender & Martin, 1987:61, 97). Smoking rather than injectingof heroin among Dutch drug users diffused from Surinamese immigrants (Grund &Blanken, 1993).The changes in the regularity and pattern of drinking after an immigrant arrives in the

receiving society reflect several influences beyond a straightforward adaptation to localcustoms. One such factor is the different economic and social circumstances of theimmigrant. For instance, Mexican immigrants to the United States are often movingfrom a rural subsistence economy into an urban cash economy, and will often have comewithout their families. Whereas their drinking may have been confined to occasionalcommunal festivals in rural Mexico, in the new circumstance of a cash economy and asocial life predominantly of male camaraderie, every weekend can become a fiesta. Thenorms about how much to drink in different contexts have not necessarily changed; it justbecomes possible, in the new circumstances, to apply the norms more frequently, in‘‘an extra night or two of drinking’’ each week (Caetano & Medina Mora, 1988).Another factor is the symbolic meanings surrounding abstention or drinking in the

new circumstances, particularly to the extent they have a special significance for the immi-grant group. Herd (1985a) has tracked what happened to cirrhosis death rates amongAfrican-Americans in the great internal migration northward in the United States in thefirst half of the 20th century. While the anti-alcohol movement in the U.S. had originally

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been closely related with the movement for Black emancipation (Herd, 1985b), by the timethe great migration begun it had become associated with the most reactionary aspects ofSouthern white racism. In the urban Northern environments, drinking and heavydrinking acquired positive associations, for instance with the Harlem Renaissance ofAfrican-American musicians, writers, and artists of the 1920s. Herd (1985a) shows thatcirrhosis mortality rates, reflecting rates of heavy drinking, marched inexorably upwardsin successive cohorts of 20th-century African-Americans, particularly in the North, passingand exceeding white rates in the 1950s.Related to this factor is the role the immigrant group is assigned and eventually takes on

in the receiving society. A stereotype in terms of alcohol intoxication has often been used asa derogation of ethnic groups in societies where they have low status and power. In anunpromising situation, members of the ethnic group may end up making use of thestereotype as an instrument of at least expressive power. The most detailed analyses ofthis in terms of the performance of an ethnic group to an audience of the largersociety are again for the United States, although there is also an analysis along this lineof Finnish immigrants to Sweden (Falk, 1983). Lurie (1971) has interpreted the heavyand ostensive drinking of many Native Americans as ‘‘the world’s oldest on-going protestdemonstration’’, with a historically ‘‘gradually expanding function of communication andprotest in order to maintain the Indian-white boundary’’.In the same vein is the extended interpretation by Stivers (2000) of Irish-American

drinking. Levels of drinking in Ireland in the 1800s, Stivers argues, were actually quitelow by international standards. In part they were kept low by poverty, but there is verylittle evidence that drinking customs varied greatly at the time between Britain andIreland. However, in the context of British rule over Ireland, there was an English stereo-type of the Irish as drunkards, which was taken into mainstream American culture withthe great Irish immigration of the mid-19th century. Stivers argues that Irish-Americanstook on many aspects of the stereotype, with heavy drinking rapidly becoming institutional-ized. ‘‘To drink excessively symbolized one’s Irishness, created a community amongco-drinkers, . . . and was a bond of acceptance into American society’’ (p. 179). Drinkingbecame an intrinsic part of the performance of ethnicity in a multicultural society: it‘‘made one more Irish; it distinguished one from other ethnic groups’’ (p. 136).The use of a particular beverage often serves as an ethnic marker. Thus, Fiskesjo (2000)

describes how for the Wa, on the China-Burma frontier, despite the incursions ofcommodified distilled liquor, the Wa home-brewed rice beer remains ‘‘the sine qua nonof Wa social life and, . . . indeed, indispensable to Wa-ness as such’’, with ‘‘social drinkingas a key arena for establishing who is who in Wa lands’’. In a multicultural society, anethnoreligious group’s alcohol use often takes on institutional forms, such as social clubsand taverns. The ‘‘neighborhood taverns’’ in U.S. studies from the 1940s and 1950swere often, in fact, ethnic taverns: ‘‘there were taverns for Old Poles, New Poles (recentimmigrants), Germans, hillbillys [from the Appalachian South], and Italians. In six of thelocal taverns respondents identified along ethnic lines the patrons of taverns in otherparts of the city, and their accuracy was confirmed in later research’’ (Gottlieb, 1957).Style of drinking can also become a marker of ethnoreligious identity. Glassner (1991)

has argued that a restrained drinking style is a part of Jewish-American self-identity;in the context of this identity, ‘‘Jews define alcohol-related problems as non-Jewish’’.Drinking patterns may become a consideration in affiliation with or rejection of anethnoreligious identification. Thus Mullen, Williams and Hunt (1996) suggest thatin the West of Scotland heavy drinkers and smokers are differentially associated withIrish-ancestry Catholics compared with Protestants because Protestants who drink heavily

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tend to drift away from that identity. Conversely, an ethnoreligious group with a heavy-drinking reputation can gather around it others of like mind. Among San Francisco menin 1969, Irish-Americans and Scandinavian-Americans stood out as reporting high ratesof social problems due to drinking, and Jewish-Americans as having especially low rates(Cahalan & Room, 1974:203). But the rates were almost as high among those who werenot themselves Irish-American or Scandinavian-American, but who reported that morethan half their friends were Irish-American or Scandinavian-American (Cahalan & Room,1974:205). On the other hand, rates of social problems were not especially low amongthose with Jewish-Americans as more than half of their friends.The complicated nature of the interactions of substance use and ethnic identification

are suggested by findings in a study by Marsiglia, Kulis and Hecht (2001) of alcohol,tobacco and drug use among 7th grade students (mostly aged 12 or 13) in a southwesternU.S. city. There were few significant differences between Mexican-American (a majority inthe sample), African-American, and Anglo-American (non-Hispanic white) students infrequency of use of tobacco, alcohol, or illicit drugs in the last month (African-Americanswere significantly more likely to have used drugs other than marijuana). But there wereinteresting variations in the relations of substance use to a measure of ethnic pride anda measure of whether the respondent felt him/herself to have the behaviour, speech, andlooks of the respondent’s ethnicity (though only some of these relations were significant,in a total sample of 408). Among Mexican-Americans and African-Americans, frequencyof use was generally negatively associated with pride in one’s ethnicity, while the associationwas positive for Anglo-Americans. Considering oneself to have the behaviour, speech, andlooks associated with one’s ethnicity, on the other hand, was generally negatively associatedwith frequency of use among Anglo-Americans, but positively associated among African-Americans. The divergence in results between looking and acting one’s ethnicity andpride in it suggests a need to acknowledge the complexity not only of ethnic identificationbut also of the potential role of substance use in the performance of ethnicity.

Substance use in tourism and other brief cultural contact

Migration is not what it used to be. European families setting out for Australia in the 19thcentury might never return, and contacts were limited to letters, which could take monthsin each direction. Now, living in Sweden, I can visit family members in California orAustralia in the course of a short vacation, and can communicate back and forth instanta-neously. Mexican migration to the United States now often takes the form of a ‘‘trans-national migrant circuit’’, in which ‘‘Mexican men and women live in both countriesvirtually simultaneously through rapid means of transportation, telephone contact, andsalary remittances’’ (Gutmann, 1999).The shrinking of psychological distances has effects both on immigrant communities and

on their countries of origin. Ways of thinking and behaving in metropolitan France aremuch more visible and notable to French Canadians than they would have been a centuryago. In recent decades, in tune with the increased identification with French cultureassociated with Quebec’s ‘‘quiet revolution’’, consumption of wine (particularly Frenchwine) increased in Quebec even when overall alcohol consumption decreased (Trolldal,2005). On the other hand, those who have gone off to a new land as an immigrant labourernow often retain much closer links in the old country, and can return if they choose to liveout their old age as a local notable.The advent of mass tourism has also transformed the nature and extent of cultural

contacts. In some parts of the world, tourism has become the dominant industry; in the

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Caribbean, for instance, it was estimated that 24.7% of all formal employment in theCaribbean region in 1996 was in the tourist industry, with probably as many again engagedin informal activities connected to tourism (Kempadoo, 1999). Cultural contact in thecontext of tourism may be as sustained as in the context of migration: the tourists maychange every week, but the next week’s group has the same nationality. But the conditionsof contact are very different from those most common for migration: unlike most immi-grants, tourists have the money and the power in the situation, and the receiving cultureis expected to accommodate to their desires. What tourists are presumed to demandbecomes a powerful argument to loosen alcohol controls or lower alcohol taxes (Roomet al., 2002:204). The drinking patterns of tourists on holiday, for that matter, oftendiffer considerably from their patterns at home; tourists are often living by ‘‘time-out’’ holi-day norms (Bellis, Hale, Bennett, Chaudry & Kilfoyle, 2000). Thus Kuhlhorn, Hibell,Larsson, Ramstedt and Zetterberg (1999) report that Swedes consume more than threetimes their normal daily levels of alcoholic beverages when they are on holiday.In the context of tourism, young people in the host society become involved in

performances for which the script comes primarily from the tourist imagination.Interactions with sex workers serving tourists, for instance, provide ‘‘a stage for FirstWorld gendered performances – for European and North American men to reenacttraditional masculine roles and to reassure themselves of their dominance over women, forEuropean and North American women to experiment with, confirm, or expand theirgender repertoires’’ (Kempadoo, 1999:26). While there has been little study specificallyon the impact of tourism on drinking or drug use in host countries (Lee, 2001), it is clearthat workers in the tourist trade are particularly likely to be involved in heavy drinkingand drug use.

Conclusion

Cultural contact, whether it is a matter of brief encounters or living side-by-side, bringsboth possibilities and problems. In a multicultural environment, the drinking or druguse – or abstaining from drinking or drug use – often becomes part of an ethnic perfor-mance, an expression of cultural identity and belonging. The drinking or drug use canthus be a demarcation of ethnic boundaries. Alternatively, for those wishing to reachacross the boundaries, using together can become a powerful enactment of being at one.There is also a potential demonstration effect from drinking or drug use, which

can happen even if the observer is excluded from the particular occasion of use. Serviceworkers at tourist hotels can pick up practices from the guests. Tourists may bring backnot only the tax-free bottle or sachet of pills from their vacation, but also a commitment todoing something different on home territory. The innovation may be beneficial, but,transferred to new circumstances, the behaviours may also carry with them new problems.The world has been shrinking psychologically, but cultural differences have not

necessarily been shrinking along with this. In fact, in some ways close contacts betweencultures can reemphasize the existing cultural differences, and may prompt new differentia-tions. Despite such indications of diffusion as the gradual homogenization of preferences foralcohol beverages in Europe, some aspects of drinking customs seem to be lodged quitedeeply in the culture, and are resistant to change (Simpura, 2001). As multiculturalsituations become increasingly common, ways of using drugs and alcohol will remainmarkers of ethnic identity.The main frame for the existing research on ethnicity or cultural contact and alcohol

and drug use has been the study of patterns among immigrant groups in

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multicultural societies. In these studies, the primary governing image used has beenof acculturation. In general anthropology, this conceptualization has long been seen asproblematic as a master image, and its problems have now been discussed also in thespecific context of substance use (Gutman, 1999). On a specific behaviour, such as alcoholor drug use, acculturation in an immigrant group is always a possibility, but so are a numberof other trajectories, including the construction of a new synthesis distinct from patterns inboth the immigrant culture and the receiving society, or the alternative of divergence anddifferentiation as a marker of an ethnic identity. Where a pattern becomes a marker ofethnic identity, as Glassner (1991) argues is so for Jewish-Americans, the differentiationin pattern may be quite stable. Thus Jewish-American drinking patterns remaindifferentiated from general U.S. drinking patterns, four generations after the main Jewishimmigration to the U.S.Research on psychoactive substance use in multicultural contexts, this article has argued,

needs to take explicit account of two characteristics of the context, particularly if we havethe ambition to develop models which explain rather than just describe how patternsdevelop and change. In the first place, ethnic identity in such a context is in part assignedby an audience of others and in part assumed and constructed by those identified withthe ethnicity. In a multicultural context, ethnic identity is a performance; a performancein which, we have argued, alcohol or drug use and problems are often importantconstituents. The performance is defined with reference to and often in contrast to theperformance of other ethnicities in the context. In the second place, dimensions of statusand power lie in the background, and often in the foreground, of cultural contacts.These dimensions affect who has the greater power to define the ethnic identificationand its characteristics, and they affect access to psychoactive substances and the definitionand evaluation of substance use behaviour as problematic.

Acknowledgements

This article is revised from a paper prepared for presentation at a workshop, ‘‘Substance usein ethnic minority communities: prevention, treatment and policy’’ at the SeventhInternational Metropolis Conference, ‘‘Togetherness in Difference’’, Oslo, 9–13September 2002. Thanks are due to the organizers of the workshop for suggesting thetopic and to Ingeborg Rossow and an anonymous reviewer for Addiction Research andTheory for helpful suggestions.

References

Adlaf, E. M., Ivis, F., Ialomiteanu, A., Bondy, S., Rehm, J., Room, R., et al. (1998). Ontario drug monitor, 1997:Technical guide. Toronto: Addiction Research Foundation (Research Document No. 140).

Adrian, M., Dini, C., Stoduto, G., & MacGregor, L. J. (1996). Multicultural influences on women’s use of alcohol,toabcco and drugs, In M. Adrian, C. Lundy & M. Eliany (Eds), Women’s use of alcohol, tobacco and other drugsin Canada (pp. 104–128). Toronto: Addiction Research Foundation.

Anderson, B. (1983). Imagined communities: Reflections on the origin and spread of Nationalism. London: Verso.Bellis, M. A., Hale, G., Bennett, A., Chaudry, M., & Kilfoyle, M. (2000). Ibiza uncovered: Changes in substance

use and sexual behaviour among young people visiting an international night-life resort. International Journalof Drug Policy, 11, 235–244.

Caetano, R., & Medina Mora, M.-E. (1988). Acculturation and drinking among people of Mexican descentin Mexico and the United States. Journal of Studies on Alcohol, 49, 462–471.

Cahalan, D., & Room, R. (1974). Problem drinking among American men. New Brunswick, NJ: Rutgers Centerof Alcohol Studies (Monograph No. 7).

Multicultural contexts 329

Add

ict R

es T

heor

y D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y Fr

eie

Uni

vers

itaet

Ber

lin o

n 11

/26/

14Fo

r pe

rson

al u

se o

nly.

Clark, W. B., & Hesselbrock, M. (1988). A comparative analysis of U.S. and Japanese drinking patterns,In L. H. Towle & T. C. Harford (Eds), Cultural influences and drinking patterns: A focus on hispanic andJapanese populations (pp. 79–98). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism(Research Monograph 19).

Dotinga, A., van den Eijnden, R., San Jose, B., Garretsen, H., & Bosveld, W. (2002). Alcohol y emigracion:Los problemas de medicion en la investigacion sobre el consumo de alcohol entre immigrantes Morroquiesy Turcos (Alcohol and emigration: Problems in the measurement of alcohol consumption in Turkish andMoroccan immigrants). Adicciones, 14(Suppl. 1), 261–278.

Eisenbach-Stangl, I. (2003). Drug policy as policy with foreigners: The Austrian case in times of Europeanintegration. Contemporary Drug Problems, 30, 563–594.

Eriksen, T. H. (2001). Ethnic identity, national identity and intergroup conflict: The significance of personalexperiences. In R. D. Ashmore, L. Jussim & D. Wilder (Eds), Social identity, intergroup conflict, and conflictreduction (pp. 42–70). Oxford & New York: Oxford University Press. http://folk.uio.no/geirthe/Identity_politics.html

Falk, P. (1983). Ruotsinsuomalainen humala (Drunkenness among Finnish immigrants in Sweden).Alkoholipolitiikka, 48, 141–145.

Fiskesjo, M. (2000). The infusion of sameness, or, you are what you drink: Wa rice beer vs. Chinese liquor.Presented at the annual meetings of the Association for Asian Studies, San Diego, CA, March 9–12.Abstract at: http://www.aasianst.org/absts/2000abst/Inter/I-38.htm

Fox, J. E. (2003). National identities on the move: Transylvanian Hungarian labour migrants in Hungary.Journal of Ethnic and Migration Studies, 29, 449–466.

Galasinska, A., & Galasinski, D. (2003). Discursive strategies for coping with sensitive topics of the Other.Journal of Ethnic and Migration Studies, 29, 849–863.

Gil, A. G., Wagner, E. F., & Vega, W. A. (2000). Acculturation, familism, and alcohol use among Latino adoles-cent males: Longitudinal relations. Journal of Community Psychology, 28, 443–458.

Glassner, B. (1991). Jewish sobriety, In D. J. Pittman & H. Raskin White (Eds), Culture, society and drinking patternsreexamined (pp. 310–326). New Brunswick, NJ: Rutgers Center of Alcohol Studies.

Gottlieb, D. (1957). The neighborhood tavern and the cocktail lounge: A study of class differences.American Journal of Sociology, 62, 559–562.

Grund, J. P., & Blanken, P. (1993). From chasing the dragon to Chinezen. Rotterdam, the Netherlands: IVO.http://www.drugtext.org/books/grund/CHASDRAG.html

Gusfield, J. R. (1986). Symbolic crusade: Status politics and the American temperance movement (Revised edition).Urbana, IL: University of Illinois Press.

Gutmann, M. C. (1999). Ethnicity, alcohol and acculturation. Social Science and Medicine, 48, 173–184.Herd, D. (1985a). Migration, cultural transformation and the rise of Black liver cirrhosis mortality. British Journal

of Addiction, 80, 397–410.Herd, D. (1985b). ‘‘We cannot stagger to freedom’’: A history of Blacks and alcohol in American politics.

In L. Brill & C. Winick (Eds), Yearbook of substance use and abuse (Vol. 3, pp. 141–186). New York:Human Sciences Press.

Kempadoo, K. (1999). Continuities and change: Five centuries of prostitution in the Caribbean, pp. 3–33.In K. Kempadoo (Ed.), Sun, sex and gold: Tourism and sex work in the Caribbean. Lanham, Md., Boulder,New York & Oxford: Rowman and Littlefield.

Kuhlhorn, E., Hibell, B., Larsson, S., Ramstedt, M., & Zetterberg, H. L. (1999). Alkoholkonsumtionen i sverigeunder 1900-talet (Alcohol consumption in Sweden in the 1990s). Stockholm: Oberoende Alkoholsamarbet.

Lacey, M. (2004). A decade after massacres Rwanda outlaws ethnicity. New York Times, 9 April.Lee, V. (2001). Tourism and alcohol in the developing world: Potential effects on alcohol policies and local

drinking problems. Report to the World Health Organization. Stockholm: Centre for Social Research onAlcohol and Drugs.

Lender, M. E., & Martin, J. K. (1987). Drinking in America: A history (Revised and expanded edition). New York:Free Press & London: Collier Macmillan.

Lurie, N. O. (1971). The world’s oldest on-going protest demonstration: North American Indian drinkingpatterns. Pacific Historical Review, 40, 311–332.

Mac an Ghaill, M. (2000). The Irish in Britain: The invisibility of ethnicity and anti-Irish racism. Journal of Ethnicand Migration Studies, 26, 137–147.

Marsiglia, F. F., Kulis, S., & Hecht, M. L. (2001). Ethnic labels and ethnic identity as predictors of drug useamong middle school students in the Southwest. Journal of Research on Adolescence, 11, 21–48.

Morgan, P. (1983). Alcohol, disinhibition, and domination: A conceptual analysis. In R. Room & G. Collins (Eds),Alcohol and disinhibition: Nature and meaning of the link (pp. 405–420). Rockville, MD: National Institute onAlcohol Abuse and Alcoholism (Research Monograph No. 12, DHHS Publication No. (ADM) 83-1246).

Mullen, K., Williams, R., & Hunt, K. (1996). Irish descent, religion and alcohol and tobacco use. Addiction,91, 243–254.

O’Hare, T., & Tran, T. V. (1998). Substance abuse among Southeast Asians in the U.S.: Implications for practiceand research. Social Work in Health Care, 26, 69–80.

Pedersen, W., & Kolstad, A. (2000). Adolescent alcohol abstainers: Traditional patterns in new groups.Acta Sociologica, 43, 219–233.

330 R. Room

Add

ict R

es T

heor

y D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y Fr

eie

Uni

vers

itaet

Ber

lin o

n 11

/26/

14Fo

r pe

rson

al u

se o

nly.

Room, R. (1975). Normative perspectives on alcohol use and problems. Journal of Drug Issues, 5, 358–368.Room, R. (1985). Foreword. In L. Bennett & G. Ames (Eds), The American experience with alcohol: Contrasting

cultural perspectives (pp. xi–xvii). New York & London: Plenum Press.Room, R. (2001). Intoxication and bad behaviour: Understanding cultural differences in the link. Social Science and

Medicine, 53, 189–198.Room, R., Rehm, J., Trotter, R. T., Paglia, A., & Ustun, T. B. (2001). Cross-cultural views on stigma, valuation,

parity and social values towards disability. In T. B. Ustun, S. Chatterji, J. E. Bickenbach, R. T. Trotter,R. Room, J. Rehm & S. Saxena (Eds), Disability and culture: Universalism and diversity (pp. 247–291).Seattle, Toronto, Bern & Gottingen: Hogrefe & Huber.

Room, R., Jernigan, D., Carlini Marlatt, B., Gureje, O., Makela, K., Marshall, M., et al. (2002). Alcohol indeveloping societies: A public health approach. Helsinki: Finnish Foundation for Alcohol Studies.

Simpura, J. (2001). Trends in alcohol consumption and drinking patterns: Sociological and economic explanationsand alcohol policies. Nordic Studies on Alcohol and Drugs, 18(English supplement), 3–13.

Song, M. (2003). Choosing ethnic identity. London: Polity.Stivers, R. (2000). Hair of the dog: Irish drinking and its American stereotype (Revised edition). New York & London:

Continuum.Swallen, K. C. (1997). Do health selection effects last? A comparison of morbidity rates for elderly adult

immigrants and US-born elderly persons. Journal of Cross-Cultural Gerontology, 12, 317–339.Tham, H. (1995). Drug control as a national project: The case of Sweden. Journal of Drug Issues, 25, 113–128.Trolldal, B. (2005). The privatization of wine sales in Quebec in 1978 and 1983 to 1984. Alcoholism: Clinical and

Experimental Research, 29, 410–416.Wallace, J. (1972). Drinkers and abstainers in Norway: A national survey. Quarterly Journal of Studies on Alcohol,

6(Supplement), 129–151.

Multicultural contexts 331

Add

ict R

es T

heor

y D

ownl

oade

d fr

om in

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ahea

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re.c

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y Fr

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Uni

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itaet

Ber

lin o

n 11

/26/

14Fo

r pe

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al u

se o

nly.