Ethnicity, alcohol, and acculturation

PERGAMON

Social Science & Medicine 48 (1999) 173±184

Ethnicity, alcohol, and acculturation M.C. Gutmann 1 Department of Anthropology, Box 1921, Brown University, Providence, RI 02912, USA Received 19 August 1997; accepted 7 July 1998

Abstract In the social and behavioral sciences there is a strong correlation alleged between alcohol abuse and ethnonational origins. Changes in drinking patterns and problem drinking among immigrants to the United States are often mistakenly attributed to acculturation, just as the etiology of alcohol abuse and alcoholism is often erroneously traced to the `ethnic origins' of these men and women. In addition, and for the same reasons, researchers and practitioners may have thus unwittingly in¯uenced the perceptions and understandings of this population with respect to the relationship between particular ethnic groups and alcohol consumption. This paper summarizes how the term acculturation has been employed recently in alcohol studies. Preliminary ®ndings are reported from ethnographic ®eldwork with Latin America-born men in the San Francisco Bay Area. # 1998 Elsevier Science Ltd. All rights reserved. Keywords: Ethnicity; Acculturation; Alcoholism; Immigration; Latinos

As utilized in contemporary alcohol studies in the United States, the term acculturation is at best not clearly de®ned and employed and at worst no longer useful in describing the cultural changes experienced by millions of immigrants to that country. The very terminology of acculturation is so mired in prosaic notions of national character traits that even if it was once helpful in drawing attention to issues of cultural diversity and con¯ict today it too often serves to create, refurbish, and emphasize ethnonational stereotypes about alcohol use and abuse. Prevalent assumptions about acculturation are based on several misconceptions, including (1) that all or most changes in alcohol consumption which are experienced following immigrants' arrival in the United States are attributable to the in¯uence of `U.S. culture'; (2) that changes simultaneously occurring in the countries of origin of these immigrants are not signi®cant and that homogeneous drinking patterns and not signi®cant intracultural diversity are characteristic of 1 Tel.: (401) 863-7732; fax: (401)

863-7588;

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these countries; (3) that ethnonational identi®cation with the country of origin uniformly decreases with time spent in the United States, and that it rarely intensi®es, for instance as a response to racism experienced in the United States; and (4) that the unilineal model of migration long posited as typical of international migration is still more valid than multilineal and circuitous models. The relationship, real and purported, between ethnicity and alcohol consumption, is of far more than passing academic interest; such stereotyping can have very harmful e€ects on clients and patients in alcohol treatment and prevention programs. 1. Practical rami®cations of scholarly discourse The impact of certain of these scholarly assumptions was evident in a counseling session run by the Addictions Counseling Center in the San Francisco Bay Area. During the session, Jimmy, a white working class man in his ®fties, told the group that he had been involved with drugs since he arrived in San Francisco in the 1960s. He had started with LSD in those days

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and then continued on through other drugs, most recently with cocaine. Quite frankly, Jimmy admitted, he had not emerged from a life of drug addiction for nearly thirty years. Jimmy's most revealing comment came, however, when he tried to explain to the others the source of his craving for alcohol and other drugs. He said, quite simply, ``I'm from German stock, so I love to drink''. His ethnonational and ancestral origins were, he believed, the primary cause of his addiction problems. That Jimmy's perception is in no way unique was made apparent by the next man to speak that night in March 1997. Also working class, though in his early thirties a good deal younger than Jimmy, Dennis told the group about his addiction to methamphetamines, the restraining order that his mother had placed against him which prevented his visiting her or her house, and his mixed admiration and jealousy of his brother's recent graduation from the University of California at Santa Cruz. On the heels of Jimmy's comment about coming from German stock, Dennis continued, ``Well, I'm part German, too. And the German side of me also likes to drink.'' He paused and then added, ``But the other side, which is Indian and Filipino, can't handle it''. In other words, the addiction problem as Dennis understood it, was related to ancestrally predetermined proclivities and intolerance for alcohol and other drugs, so much so that within the very con®nes of his body was occurring an ongoing contest for control that had international `genetic' roots, even if fought out on a far more limited terrain. Theories positing ethnic and national origins of alcoholism are therefore important not only to researchers but to many addicts and alcoholics themselves. Implications regarding a strong correlation between geopolitics and cravings deep within the bodies of alcoholics gives new and expanded meaning to Martin's (1994:263) description of ``the body as nation-state''. Here alcoholism takes on globally somatic proportions. In an age of renewed attention and identi®cation with ethnicity, race, and multiculturalism throughout the academy and more broadly in U.S. society it is worthwhile to inquire as to the impact that the social and behavioral sciences may be having with respect to 2 In addition to other sources cited in this paper on alcohol studies and Latin American migrants to the United States, see Room (1985) and Heath (1987) for general surveys of alcohol literature in anthropology, including with reference to Latin America. 3 On mixed methods approaches combining survey and ethnographic research in alcohol studies, see Delaney and Ames (1993), Janes and Ames (1992), and Ames et al. (1997).

associations alleged between speci®c health concerns like alcohol abuse and alcoholism and ethnonational origins. However unintentionally, in their e€orts to employ and promote greater sensitivity regarding ethnic and racial di€erence, many scholars may unwittingly be employing and promoting what are actually refurbished stereotypes in the mold of `national character traits'. In Europe and the United States, writes Stolcke (1995:8), we live in an age of ``cultural fundamentalism'', when ``to possess a nationality [a `national culture'] is in the nature of things''. This is similarly an age in which all kinds of ideas and behaviors (like alcohol consumption patterns, for example) are routinely associated with notions of national culture traits. When diverse disciplinary ®elds seem to have discovered culture and ethnicity it is easy to lose sight of a fundamental lesson from anthropological research on these issues in past decades. As Herzfeld (1987) cogently argues, in a certain sense the exotic ways of people around the world do not become `cultures' until they are given typological shape by Westerners (see also Das, 1995). That is, the very act of cultural labeling itself often creates as much as it purports to report about the customs, habits, ideologies, and con¯icts about, say, alcohol consumption among `Germans' or `Filipinos' or `Native Americans'. How is acculturation used to describe the cultural and behavioral changes involved in the migratory and alcohol consumption experiences of men and women presently resident in the United States who were born in Latin America?2 In addition to reviewing the literature on alcohol use and abuse among Latinos in the United States to answer this question I also draw on initial ethnographic research in the San Francisco Bay area with the Addictions Counseling Center (ACC) and more long-term and extensive ®eldwork in a colonia popular (poor neighborhood) of Mexico City on changing gender relations and identities, including those with respect to alcohol consumption. This essay is part of the author's broader interests in theoretical and empirical research concerning questions of ethnicity, migration, and health in the United States. As will be seen, one important element in this overall project is to determine better the nature, scope, and impact of stereotyping by social scientists on those whom we mean to characterize, typologize, and represent. This discussion must therefore include an examination of both conceptual and methodological frameworks, including the need to complement current epidemiological surveysÐwhich are not generally known for their ability to convey ambiguity and contradictionÐwith ®ndings from ethnographic ®eldwork. Potentially the ethnographic method is more appropriate for capturing these qualities.3

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2. Acculturation in alcohol studies One well-known authority in the ®eld of acculturation and drinking among Mexicans in the United States has recently authored (Caetano, 1987a,b,c) or co-authored (Caetano and Mora, 1988) papers with the following titles: . Acculturation and attitudes toward appropriate drinking among U.S. Hispanics. . Acculturation and drinking patterns among U.S. Hispanics. . Acculturation, drinking and social settings among U.S. Hispanics. . Acculturation and drinking among people of Mexican descent in Mexico and the United States. As the term acculturation is not de®ned in any of these papers, it is implied that all readers share a common understanding with the author(s) as to its meaning and use. The scales used for measuring acculturation in these studies are based primarily on language use and time resident in the United States, for instance, principal language used daily to speak, read, and write, and preference for Spanish or English language television stations. Other questions asked of respondents concern the ethnicity of friends, preference for `Hispanic' music, and identi®cation of `Hispanic values' that, like acculturation itself, are taken as selfevident rather than de®ned and discussed theoretically.4 In comparison to other work on alcoholism which does not even recognize cultural di€erence and social change, any discussion of acculturation in alcohol studies can play a salutary role by emphasizing the importance of cultural diversity and di€erent cultural needs to prevention and intervention e€orts. From Jellinek's (1962) early emphasis on cross-cultural di€erences in the meaning of alcoholism to Room's (1988) 4 The term `ethnicity', too, is frequently employed in alcohol studies without being carefully de®ned. Generally investigators have in mind various cultural qualities relating to questions of race, geographical origins, shared history, and religion, but these need to be speci®ed in each research context. Further, because the concept of ethnicity is today used quite popularly in many societies, including in the United States, determining its meanings has become far more complicated than would be the case were it scholarly jargon alone. Among the recent discussions of these issues in alcohol studies, see Heath (1991) on the ``®ve garbled models of ethnicity''. 5 See, for example, Keefe (1979). If researchers persist in utilizing the concept of acculturation in alcohol studies, at a minimum they should de®ne the term in relation to others like assimilation, enculturation, syncretism, and hybridity.

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more recent remarks which seek to avoid the errors made by those who would promote an ``international league-table of alcohol consumption levels'', researchers have long grappled with how to integrate culture into alcohol studies. As it is presently utilized, however, the term acculturation may actually limit the ability of researchers and practitioners in developing culturally accountable alcohol treatment programs. Evidently acculturation means di€erent things to di€erent people. However, the term is generally used to describe the process whereby one culture group adopts the beliefs and practices of another culture group over time. Several problems inherent in the concept from an anthropological perspective will be explored shortly; as a preliminary comment we may point out that the basic premise for most discussions of acculturation in alcohol studies is that cultures can be concisely delineated within time and space. In other words, as in the case at hand, that we may reliably talk about a unique and homogenous `United States culture' and another singular and homogenous `Mexican culture', where each is clearly identi®able and distinguishable from the other. Nonetheless, Mexican immigrants to the United States who use English as their primary language do not automatically adopt any particular family organization or drinking behavior.5 How acculturation is de®ned and employed has important implications for studying the drinking patterns of migrants from Latin America who live temporarily or more permanently in the United States. Among other factors, these people are exposed in an ongoing fashion to cultural processes in two or more national and regional settings. Further, they are dramatically a€ected in the host country by geopolitical stereotypesÐalbeit frequently in the guise of `cultural di€erences'Ðabout people from other countries, e.g., ``We know what to expect from Latin men. . . '' In part as a response to such characterizations, immigrants to the United States are participants not only in the dissolution of older cultural practices and beliefs but are also constantly engaged in the creation, elaboration, and even intensi®cation of new ethnic and cultural identities. 3. Some problems with acculturation The term `acculturation' was used in the title of an article for the ®rst time by the anthropologist Richard Thurnwald (1932). Subsequently various anthropologists from the 1930 s to the 1950 s tried their best to de®ne the concept (see, for example, Red®eld et al., 1936; Firth, 1951; Beals, 1953). Whereas researchers in Britain were at the time describing changes resulting from British colonialism in Africa as `culture contact',

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in the Americas the preference was for `acculturation' to describe U.S. economic, political, military, and cultural penetration of Latin America. When they developed the concept of acculturation several decades ago anthropologists were correcting earlier notions of static (`unmodi®ed') cultures and the idea that change and time were not centrally relevant to the study of societies and cultures. So too, more recently, in the ®eld of public health generally and alcohol studies more speci®cally, researchers have sought to bring a sense of cultural comparison to previous studies that were too monochromatic and ®xed. The direction is ®ne; what is needed is greater understanding that (1) contradiction, ¯ux, diversity, and history are intrinsic to all cultures, (2) that national identity does not necessarily equate to cultural identity, and, especially, (3) that, as Stolcke (1995) among others shows, by treating culture and ethnicity as homogeneous, anti-immigrant campaigns, for example, may utilize theories of acculturation to decry the contamination of `host' countries' national identities and ``the health of the nation''.6 Brie¯y stated, following are some of the problems that anthropologists have encountered in trying to utilize the term acculturation, despite the fact that anthropologists coined the expression in the ®rst place. First, with respect to changes that may or may not occur among migrants to the United States from other countries, it is by no means certain how much change and how many changes are clearly attributable to spatial issues (i.e., being physically present in a di€erent country) and how much and how many are due to temporal changes often glossed simply as `modernity'. That is, if these same people had remained in their countries of origin, might they not have changed in the same or similar ways? Second, with respect to Mexican migration to the United States in particular, there is a growing literature grounded in political, economic, sociological, and cultural studies that shows clearly a `transnational 6

The author conducted a search of the Anthropological Literature database in July 1998. Three thousand, four hundred and twenty-three items under acculturation were listed. Notable is the fact that most authors in the list had not used the word in the titles of their articles, chapters, and books. Nonetheless, acculturation is apparently the rubric favored still by librarians. 7 For instance, on the creation of Mixtec identity among these migrants from Oaxaca, Mexico, after their arrival in rural California, see Nagengast and Kearney, 1990. 8 See the earlier e€orts of Sol Tax, Julio de la Fuente, Alfonso Villa Rojas, George Foster, Robert Red®eld and other anthropologists of Mexico and Central America who developed an Index of Acculturation as an instrument to measure culture change. In Tax, 1952:263±64.

migrant circuit' (e.g., Rouse 1991; Basch et al. 1992; Kearney 1995) whereby Mexican men and women live in both countries virtually simultaneously through rapid means of transportation, telephone contact, and salary remittances. Therefore a lineal model propounding a straight-line, unidirectional culture change on the part of Mexican migrants is unable to account for the actual migration patterns involving hundreds of thousands of Mexicans residentÐtemporarily, seasonally, and intermittentlyÐin the United States. Third, among many migrants from Latin American countries an intensi®cation and sometimes even an ad hoc invention of ethnic and national identities upon arrival and after a period of residency in the United States has been documented. Far from `melting' into some imagined national culture in this country, and contrary to predictions of `the inevitable demise of cultural localism' (see Comaro€ 1996:162), we are witnessing instead the reasserting and renaissance of ethnic and national boundaries within the borders of established nation-states, and from within and without the ethnic-national groups themselves.7 Commenting on the drinking patterns of an earlier group of immigrants to the United States, for example, Stivers (1976:129) writes, ``In Ireland, drink was largely a sign of male identity; in America it was a symbol of Irish identity'' (see also Albon, 1985). Fourth, and perhaps most importantly, even the most sympathetic discussion in academic and applied circles regarding `cultural di€erences' is frequently based on an implicit standard of `di€erences when compared with the ``normal'''. This is an inherently obfuscating manner of approaching cultural diversity. In particular it overlooks the severe problem of racism in societies like the United States. To ask how far along the path of acculturation a person or a group might be is to ask, in the context of structural inequalities and racism, how close are they to being like those of white, middle class, and dominant cultures? As Hillier and Kelleher (1996:2) note, when ocials draw attention to ethnic di€erence this can simply problematize ethnicity; it does not focus on racism, as must be done, certainly, when discussing ethnically distinguished groups like immigrants from Latin America.8 Fifth, the tremendous intracultural and regional diversity of cultural beliefs and practices mitigates against the development and utilization of national character trait lists (see discussion in Fabian, 1983). Such presumed qualities not only represent an oversimpli®cation of cultural complexities; more, they are based on an assumption of homogeneity within cultural milieus. Instead, it is today generally acknowledged in anthropology that culture is itself a source of constant contention and confusion. On the issue of acculturation, then, we agree with Heath (1989:320) who writes:

M.C. Gutmann / Social Science & Medicine 48 (1999) 173±184

[The] theoretical and methodological shortcoming of the large literature that discusses alcohol in relation to acculturation is that some authors emphasize the negative aspects and others the positive . . . This problem is especially acute in comparing studies that rely on social surveys in which one or a few key questions serve as an index of `degree of acculturation'. In her study of midwives' stereotypes regarding women who have migrated from South Asia to Britain, Bowler (1993) suggests that ``cultural awareness training'' may even contribute to the production of stereotypes about these women and, in turn, to poorer health care for them. Kelleher (1996:83) adds that, The attitudes, beliefs and behaviour of people in the wider society, including health care professionals tend to be based on limited experience and the stereotypical views of ethnic minority people conveyed in the mass media. I would argue that even in cases where health care workers may have extensive experience, and may even personally identify themselves as being the same or similar in terms of ethnic background, the same dominant, if sometimes only newly emerging stereotypes may nonetheless play an in¯uential part in the development of health care treatments.9

4. Latino drinking DeWalt (1979) and Molina et al. (1985), Gilbert (1985, 1991), Gutmann (1996), and others discuss salient di€erences in alcohol consumption patterns within regions, ethnic groups, gender groups, generations, and social classes in Mexico. Television and migration may serve to homogenize cultural outlooks and responses, as many argue, yet in practice ethnographers of Mexico have discovered not uniform and persistent cultural traits among Mexicans overall as much as a diversity of ways of reading and seeing messages presented to them by the media, government, and other ocial sources (see related evidence for this point in Alaniz and Wilkes 1995). There are thus no `typical' or `traditional' countrywide Mexican drinking patterns. Nor are there typical 9 Alaniz (1994, 1996) considers gender stereotypes and Mexican migrants. On stereotypes of Greek Americans, see Chock (1987), and on stereotypes of migrants generally inside other countries, see Herzfeld (1992 [1997]). 10 See also MeneÂndez 1987, 1991.

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`Mexican male' or `Mexican female' drinking patterns. This does not mean, however, that associations are not popularly made between drinking habits and tastes and a sense of Mexicanness (or mexicanidad). Gutmann (1996) provides ethnographic data showing the pride some working class men in the capital city express for perceived Mexican national characteristicsÐeven if these qualities are seen as negative, like alcoholism: ``More than anything we consumed tequila'', a man named CeÂsar mentioned as he was reminiscing about his early manhood exploits as a gang leader. ``We liked it, maybe because we felt more like Mexicans, more like lugarenÄos [homeboys]. You couldn't lay a ®nger on us in the colonia'' (cited in Gutmann 1996:205). Nor is such sentiment exclusive to the working classes; an entire special issue of Mexico's most re®ned arts magazine was recently devoted to the traditional art of `El Tequila' (Artes de MeÂxico 1994). Whether described in the vernacular of the working class barrios as `chupadores de cada ocho dõÂas [once-aweek boozers]' or in the greco-medical jargon of alcohol studies as dipsomania, binge drinking among Mexicans in Mexico, and indeed abstention from drinking in Mexico, are critical topics about which researchers and practitioners in the alcoholism ®eld in the United States know very little. This lack of knowledge and information seriously limits our ability to account for changes in alcohol consumption behavior that may be related to cultural factors. Caetano and Mora (1988) have laudably conducted at least some similar survey work in both countries, but their Mexico data (based on a limited cross-sectional study of respondents in Morelia, MichoacaÂn in the 1980s) do not represent a reliable summary of Mexican drinking patterns in general. There is a historical lesson here as well. In his magisterial study of the Aztecs and the Spanish Conquest, Charles Gibson (1964) advanced the notion that drinking to the point of regular intoxication was relatively unknown before the Spanish arrived in the New World. As it turns out, and as William Taylor (1979) clearly demonstrates, it is merely wishful thinking that led Gibson and others to describe the Conquest of the Aztecs as the root of all evils like alcoholism. The more we learn about historical and cultural complexity, the harder it is to utilize linear models for understanding change. Nor will recourse to multivariate analysis truly solve the dilemma, precisely because of what MeneÂndez (1990:12) calls the trivialization of the complex process of alcoholization.10 In an e€ort to document the cultural challenges facing individuals and families from Latin America after arrival in the United States, Rivas (1987:43) discusses alcohol use among this population. He also talks about the con¯icts that arise in some immigrant

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families when young women begin wearing mini-skirts. He places such events in a context of acculturation to `U.S. culture'. Yet how familiar is this researcher with clothing styles, and alcohol consumption, in some of the communities from which millions emigrate to the United States? He might ®nd that many of the trends attributed to the impact of U.S. cultural mores and customs are instead more correctly linked to modernity and its shocking ways around the world. Perhaps for all these reasons Singer (1987) changed the title of a talk from `Current knowledge on Hispanic adolescent drinking patterns' to `Current ignorance' on the same.

5. Ethnonational origins and alcohol consumption To discuss the weaknesses and the polyvalence of the concept acculturation is not to argue that no changes take place when Mexican men and women travel from their country of origin to live in the United States for whatever periods of time. Rather, this process can result in markedly di€erent experiences and perceptions on the part of immigrants, the consequences of which cannot be subsumed within a general rubric of acculturation. Ethnographic ®eld research at the Addictions Counseling Center (ACC) in the San Francisco Bay Area, reveals certain problems which arise when attempting to integrate one-dimensional notions of acculturation with alcohol abuse treatment. Founded in 1971, ACC is located in the largely poor, Latino neighborhood. It describes itself as ``a multi-cultural/ bilingual community-based organization which provides services that educate, advocate and encourage a sober and drug-free lifestyle in a supportive environment''. Through peer-counseling in both residential and year-long out-patient recovery programs the organization seeks to provide alcoholics and addicts with ``successful role models that show they can regain the dignity and respect for themselves that is essential to recovery''.11 Spanish-speaking clients, usually remanded to the program by the court or a probation ocer, are required to attend twice-weekly counseling sessions modeled loosely on Narcotics Anonymous and Alcoholics Anonymous protocol. (There is another group for English speakers.) My knowledge of ACC is based primarily on participation at these meetings over 11

From a ¯yer distributed by the ACC (a ®ctitious name). This reached the point of true absurdity when, following an attempt to bring some levity to a point I was making, the leader complimented me, ``See, we Latinos are not the only ones who have a good sense of humor''. 12

a period of ®ve months, as well as chart review of clients in both residential and out-patient programs. I also attended intake interviews of clients for the residential program, such as when Jaime was checking into the El Chante residential rehabilitation program of ACC. According to Jaime, a 24-year-old man, ``I've been here [in the United States] maybe eight years. But I've got two little ones, two girls in MichoacaÂn [Mexico]. They're only two and three years old.'' Jaime told me that he went back to see them when he could, which meant when he had been working and earned some money, and when he had managed to avoid arrest and jail time for numerous petty crimes. On his intake form for the rehabilitation program Jaime listed `Mexican' as his nationality. If you ask him he will tell you he'd like to visit Mexico more often, but that he plans to live in Oakland. And if you examine his folder you will discover that Jaime contracted tuberculosis in the United States, possibly as a result of living in severely overcrowded conditions with a number of other Mexican day laborers. Contagious diseases are also, thus, part of the acculturative experience for certain poor immigrants to this country. In the ACC the cultural contradictions of clients like Jaime are not generally considered as questions of acculturation or in terms of the cross-cultural con¯icts that Jaime repeatedly describes. Nonetheless, ethnicity, alcohol, and migration are recurring themes in ACC discussions. 6. Institutional and governmental ascription of ethnicity ACC counselors play an instrumental role in how addicts develop their understanding about the relation between ethnoracial and ethnonationalist identities on the one hand and their drug addictions on the other. One evening in the Spanish-speaking group of Si Se Puede, a county probation ocer who moonlights as a counselor began by describing himself as a Peruvian. He was working that evening with another counselor who called herself Colombian. They were discussing the theme of `relapse triggers' with three Mexicans, one Cuban, one Nicaraguan, and me, a Spanish-speaking man from the United States. Everyone inside the room had a national identity that was to be brought into play, and throughout the session the Peruvian counselor couched the discussion in terms of `Latinos' and `what we Latinos do', and `what we Latinos are like'.12 This included speci®c reference to supposed collective memories, as when the Peruvian counselor remarked to the clients, ``You all remember what it was like to walk through the village plaza, with the shameless [sin verguÈenza] drunks asleep on the benches or in the bushes.'' This `common image' was employed both to establish a shared pastÐregardless of the actual cultural backgrounds and recollections of these

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menÐand to provide a point of comparison through which the men could share in ridicule and contempt for those left behind. The problem with this approach was that none of the men present seemed to identify with the pastoral plaza scene presented them. The lack of response to the presumed universal `Latino' theme on the part of the clients attending was striking. As two men said to me privately after the session when we headed home on the BART subway, they did not want to talk to this man at all because he was a probation ocer, and therefore not to be trusted with any information about what the men thought or did, believed or planned. Then again, although the men attending the counseling sessions did talk at length on other occasions, I never heard any of the men couch their comments in generalizations about being `Latino' or about `Mexican' drinking or any other behavior. Only the counselors initiated such connections between ethnicity and alcohol consumption. This despite the fact that, with few exceptions, the men who attend sessions at ACC do so because they are legally obliged to, generally on orders from some legal authority, less often under pressure from an employer or union, and therefore they were each under some pressure to `perform' in prescribed ways for the counselors. Guidance about how the men should categorize themselves in terms of race and ethnicity is also o€ered in documents they must ®ll out for the State of California, Health and Welfare Agency, Department of Alcohol and Drug Programs. For whatever reasons, these ocial forms attempt to get addicts to channel themselves into particular ethnoracial categories not of their own choosing. On the `Participant Record' of the California Alcohol and Drug Data System (CADDS), question six pertains to `race' and lists 16 speci®c racial categories (including separate ones for Cambodian, Chinese, Japanese, Korean, and Vietnamese); a 17th category, `other race', is clearly the one which most people from Latin America are expected to check (see Table 1). On the other hand, question seven pertains to `ethnicity': the only categories are: Not Hispanic, Mexican/Mexican American, Cuban, Puerto Rican, Other Hispanic/Latino (see Table 2). According to numerous State of California ocials13 these classi®cations represent the successful lobbying e€orts of particular groups and the lack of in¯uence of others.

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Table 1 California Alcohol and Drug Data System (CADDS) Classi®cation system for `race' 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17

White Black/African±American American Indian Alaskan Native Asian Indian Cambodian Chinese Filipino Guamanian Hawaiian Japanese Korean Laotian Samoan Vietnamese Other Asian Other Race

Ultimately, the exact reasons for developing these taxonomies are less important than the potential rami®cations for clients and practitioners in the alcohol abuse ®eld. The implications of such categorization, especially when linked to particular behavioral patterns like drug and alcohol abuse, are evidently considered so important by the State that all participants must record their personal quali®cations and/or identities within the preestablished categories. Needless to say, there is no room on the forms for self-reporting that is not accommodated by the ocial classi®cations. 7. Acculturating to the threat of deportation Clients at the ACC are not necessarily traumatized by California's classi®catory schemes. Yet questions of ethnic and racial identity may provoke serious `identity confusion' for many immigrants to the United States, especially when they are brought before legal authorities and forced to label themselves according to ocial typologies. The impact of racial and ethnic formulas and their association with particular patterns Table 2 California Alcohol and Drug Data System (CADDS) Classi®cation system for `ethnicity'

13 Phone interviews were conducted 30 April 1997, with the following State of California ocials: Calvin Freeman from the Oce of Multicultural Health, Susan Nisenbaum from the Research and Policy Analysis Branch of the Information Management Services Division, and Mary Heim of the Population Research Unit of the Department of Finances.

1 2 3 4 5

Not Hispanic Mexican/Mexican±American Cuban Puerto Rican Other Hispanic/Latino

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of alcohol use and abuse are implied to all who must answer questions six and seven on the CADDS questionnaire. Most clients in ACC do make cultural connections between their life experiences and alcohol use, and these are often intimately related to their Latin American origins, though seldom in simplistic `prefab' ways. For example, after a session one evening one man discussed his experiences as a member of the Cuban Mariel boatlift in the late 1970 s, and how he had been trying unsuccessfully since the early 1980 s to make a regular living as a ®sherman. Another older immigrant from Nayarit, Mexico, told me he had `failed' to live up to his family's expectations for him as a man with respect to earning large sums in the United States because he had been unable to send enough money back to his relatives. Several other ACC clients have not only been arrested for possession of drugs, and have not only spent time in the Santa Rita and other state prisons, but during their year-long counseling program are also under another constant threat. Theirs is a situation characterized in the ACC ®les as: `Client has a court case pending (INS). Possible deportation'.14 Dicult and complex migratory experiences are central to the lives of many men and women who live in 14

The INS is the U.S. Immigration and Naturalization Service. 15 In my research on alcohol use and abuse in the Bay Area I was able to build on my earlier work on ethnicity and gender in Mexico City (Gutmann 1996). In Mexico I have studied issues such as `youthful intemperance', that is, drinking by adolescent (male) youth; abstention from alcohol use as a highly re®ned cultural practice and, contrary to previous ®ndings, a widely accepted cultural procedure; and the gradual `degendering of alcohol'. The custom of jurarse among working class males in Mexico City, for example, takes place when men pledge to a saint not to drink for a period of time, to swear o€ alcohol use. In epidemiological research on alcohol consumption in Mexico this important practice has gone unreported. 16 For instance, Gilbert (1985:272) mentions ``the cocktail party'' being ``familiar to middle class Anglos''. Yet this certainly would not ring true for millions of middle class Anglos, nor would a sweeping characterization of Anglo families all being ``egalitarian'' seem appropriate to many. See also Gilbert, 1988; Gilbert and Cervantes, 1987b; and Trotter, 1985. 17 Further, the non-response rates in the national surveys on alcohol use for Mexican Americans (and others) is a topic worth investigating through ethnographic and other methods. The numbers seem large, albeit not for survey work (e.g., 28%). They might tell us something not only about popular sentiments regarding surveys, but also common drinking patterns not made explicit through the survey research.

the San Francisco Bay area, including those sent by the courts to the Addictions Counseling Center. The men do not drink or take illegal drugs because they are Latino. The perils and traumas of migration and living illegally in the United States would certainly be as worthwhile discussing and analyzing as any personality structuresÐ`passive', `aggressive', and `assertive' are the three recurring categories at the ACCÐthat may be inferred from periodic arrests for drunk driving, possession of illegal drugs, or work absences due to hangovers and the like. Migration is no binary a€air whereby men and women leave one ®xed culture to relocate in another, solitary U.S. culture. Without knowledge and experience with alcohol use and abuse in Mexico and Latin America it is very dicult to make accurate assessments regarding any kinds of cultural changes that might be experienced by immigrants and to trace the sources of the changes.15 Greater clarity as to what is meant by culture and acculturation might help in our discussions of alcohol use and abuse among people living in the United States and born in other countries. Gilbert (1985), for example, takes pains to discuss intracultural variety among Mexicans and (North) Americans. Nevertheless, in what seems a contradictory fashion she also relies on unnecessarily dichotomous notions like `biculturalism'. Granted, such matters are far easier to think about as binomial distributions; yet the question remains as to whether it is truly helpful to generalize about the practices of 250 million people in the United States and nearly 100 million in Mexico.16 Gilbert and Cervantes (1987a) show this quite clearly when detailing how gender roles associated with Mexicans in alcohol studies are often based more on impressionistic de®nitions than actual attempts to operationalize and measure these supposed attributes. In a similar manner, Caetano (1986±87, 1987a, b, c, 1988) and Caetano and Mora (1988) present worthwhile data regarding changing consumption patterns of Mexican-born men and women, and make clear distinctions between regional and other di€erences. Yet periodically we ®nd resort to generalizations about ``the United States' culture'' and ``the Hispanic way of life'' (Caetano and Mora 1988:462, 465). Even leaving aside the matter of whether or not we may reliably talk about a single U.S. culture, Mexican-origin men and women respond di€erently to di€erent issues like alcohol use, sexuality, and work outside the home.17 8. Unwitting stereotyping by health care workers What people believe about the origins of alcoholism has real consequences for their treatment and rehabilitation. If they attribute certain cravings and weaknesses to genetic, national, ethnic, or racial origins,

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then in a manner similar to those who blame moral weakness for drinking problems (see Ames 1985), the stereotyped beliefs and actions based on these beliefs must be directly addressed by health care workers. The number of years an individual has lived in the United States should be seen as a dependent not an independent variable, just as alcohol use itself should be understood as a dependent variable: both are inextricably linked to other factors like class, history, gender, economics (e.g., unemployment), and political conditions (e.g., racism in the United States) and cannot by themselves provide adequate data for determining alcohol use and abuse. The issues raised here apply not only to the specialists and scientists involved in intervention, treatment, and prevention. They are just as relevant for clients as for providers. One of the implications for health promotion and disease prevention in the area of alcohol abuse and alcoholism that is highlighted by the present study is the degree to which practitioners may inadvertently contribute to social a‚iction, for instance, through inattention to the social conditions of inequality in which many live, and the concomitant subjective identi®cation of these relations by those deemed in need of public health intervention. 9. Conclusion Ultimately the issues discussed in this paper concerning acculturation are part of a larger series of questions in anthropology, epidemiology, and public health policy relating to sociocultural context, a‚iction, and risk (see Frankenberg, 1993). To what extent do Mexican immigrants and Mexican immigrant men, for instance, represent special risk groups with respect to alcohol abuse and alcoholism primarily because of alleged Mexican cultural characteristics? If the sociocultural context for their drinking problems is understood as a shift from one set of static cultural mores and preordained behaviors to another, via acculturation, then cultural stereotypes about `Mexican' or `American' drinking patterns probably represent the extent of cultural analysis involved in diagnosis and treatment of these individuals. If a‚iction from alcohol abuse is understood primarily as stemming from psychological traumas and exposure alone, then the social vulnerability of this population is distorted to individual contingency. Survey research may a€ord insights into larger populations than ethnography, yet surveys are inherently dichotomous instruments designed to emphasize binary opposites and unidirectional change. Continuous variables often prove the undoing of survey research, precisely because nuance, ambiguity, contradiction, and subtletyÐwhich are often of crucial

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importance in understanding alcohol use and its outcomesÐare not easily dichotomized. In the United States and elsewhere, in both popular and academic circles, anthropologically-inspired notions of cultural di€erence have been widely debated in the past decade. Diverse concepts of multiculturalism, for example, mark both the advent of `culture' as a critically important ingredient in descriptions and analyses of social life, and, too often, the renascence of presumptions regarding ®xed ethnonational character traits. Who stands to bene®t from the placement of individuals on a cultural continuum, for example, from Mexican to American? In public health, who bene®ts from the notion of `Mexican drinking habits' and how does such a schema contribute or hinder intervention e€orts to cope with perceived drinking problems? Cultural categorizing by government ocials, intellectuals, and the general populace has real implications for public health programs such as those devoted to treatment of alcohol abuse and alcoholism. Culture is increasingly, and perilously, linked to genetics in alcohol studies to explain the `intranecine' con¯icts that arise between urges and intolerance within individual bodies. Far from dropping culture as a factor in the study of alcohol use and abuse, there is a pressing need more carefully to explore and explain culture as a complex, ¯uid, indeterminate, contradictory, and eminently human quality. In this way alone culture should be made ever more central to public health research and policy more generally. The confusion surrounding issues of ethnicity, alcohol, and acculturation is evident among health practitioners on the front lines of service to immigrant and poor populations generally. In May 1997, I delivered a talk on alcoholism and ethnicity to the Department of Epidemiology and Biostatistics at the University of California, San Francisco. In the course of my remarks I related the comments of the two men who traced their alcohol cravings and intolerance to, variously, `German', `Filipino', and `Indian' ancestry that were recounted at the beginning of the present essay. A savvy physician involved in intervention e€orts concerning HIV and tuberculosis among the homeless in San Francisco raised his hand. He insisted that the man was undoubtedly correct who had complained that, while ``the German side'' of him likes to drink alcohol, ``the other side, which is Indian and Filipino, can't handle it''. Seeking to correct an oversight on my part, the UCSF doctor insisted, ``There is a biological basis to what he was saying because of `the Asian ¯ushing factor' ''. The implication was that because of `¯ushing'Ð vasodilation or reddening of the skinÐthat is supposedly more common among persons of Asian and Native American ancestry, patients who shared this background could not tolerate any alcohol. In other

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words, based on the existence of any genetic evidence indicating particular reactions of any kind to alcohol consumption by people of speci®c racial backgrounds, the argument was that we should view such distinctions as absolute di€erences, precisely because they are di€erences based on putative genetic characteristics impervious to `soft' causal factors like culture.18 However the scienti®c data on ¯ushing does not conclude that people of Asian or Native American ancestry should abstain from alcohol. Indeed, it is the overeagerness to accept such genetic explanations that leads to complacency in prevention and intervention programs concerning alcohol abuse, as if ancestry were all the explanation needed to explain consumption patterns. In a clear illustration of Scheper-Hughes and Lock's (1987) thesis concerning social and political bodies, patients' ethnonational origins are held within the dominant medical culture to be frozen, perhaps because they are thought to be genetically governed. The contrasting view explored here has emphasized instead that cultures and cultural qualities like ethnicity are created anew as much as they are inherited from the past. Thus, for immigrants from Latin America, attitudes toward drinking and actual drinking behavior do not simply re¯ect what people `left behind' versus what they `®nd' (and `move toward') in the United States. Ethnic identity can also intensify following migration, and as part of this process alcohol use and abuse can undoubtedly change in ways not well described by simplistic acculturation theories.

Acknowledgements My studies in alcohol use among Mexican-born men and women resident in the United States have been made possible through a training grant from the National Institute on Alcohol Abuse and Alcoholism, administered through the School of Public Health, University of California, the Prevention Research Center, and the Alcohol Studies Group in Berkeley. I wish to acknowledge the assistance of Genevieve Ames 18 On ¯ushing, see, for example, Clark 1988; Johnson and Nagoshi 1990; Ogata and Tsunoda 1988; Wol€ 1972, 1973. Wol€ (1972) calls such ¯ushing ``embarrassing'' and extrapolates that such humiliation leads to reduced drinking on the part of those so a€ected. Johnson and Nagoshi (1990:48), on the contrary, argue that no such generalizations may be made, and that, ``If a strong need to avoid losing face is present among Japanese, this need seems to vanish with a few drinks. . .'' As for pan-Asian generalizations, citing Lee (1987), the same authors note that there have been wide swings in alcohol use in China through the centuries, i.e., no one typical `Chinese' drinking pattern.

and Raul Caetano in guiding my studies on alcohol use and abuse, and express my thanks as well to Roland Moore, MarõÂ a Alaniz, Angela Gallegos, Dwight Heath, Tom Novotny and anonymous readers for Social Science and Medicine for their helpful suggestions. Portions of this paper were presented to the Dept. of Epidemiology and Biostatistics at the University of California at San Francisco in May 1997 and the Center for Alcohol and Addiction Studies at Brown University in October 1997.

References Alaniz, M., 1994. Mexican farmworker women's perspectives on drinking in a migrant community. The International Journal of the Addictions 29 (3), 1173±1188. Alaniz, M., 1996. Husband's level of drinking and egalitarianism in Mexican-American families. Substance Use and Misuse 31 (6), 647±662. Alaniz, M., Wilkes, C., 1995. Reinterpreting Latino culture in the commodity form: the case of alcohol advertising in the Mexican-American community. Hispanic Journal of Behavioral Science 17 (4), 430±451. Albon, J., 1985. Irish-American Catholics in a West Coast metropolitan area. In: L.A. Bennett, G.M. Ames (Ed.). The American Experience with Alcohol: Contrasting Cultural Perspectives. Plenum, New York, pp. 395±409. Ames, G.M., 1985. Middle-class Protestants: alcohol and the family. In: L.A. Bennett, G.M. Ames (Ed.). The American Experience with Alcohol: Contrasting Cultural Perspectives. Plenum, New York, pp. 435±458. Ames, G.M., Grube, J.W., Moore, R.S., 1997. The relationship of drinking and hangovers to workplace problems: an empirical study. Journal of Studies on Alcohol 58 (1), 37±47. Anon., 1994. El tequila: Arte tradicional de MeÂxico. Artes de MeÂxico. EdicioÂn especial. Basch, L., Schiller, N.G., Szanton, Blanc C., 1992. Nations Unbound: Transnational Prospects, Postcolonial Predicaments, and Deterritorialized Nation-States. Gordon and Breach, Amsterdam. Beals, R., 1953. Acculturation. In: A.L. Kroeber (Ed.). Anthropology Today: An Encyclopedic Inventory. University of Chicago Press, Chicago, pp. 621±641. Bowler, I., 1993. They're not the same as us: midwives' stereotypes of South Asian descent maternity patients. Sociology of Health and Illness 15 (2), 157±178. Caetano, R., 1986±87. Drinking and Hispanic-American family life: the view outside the clinic walls. Alcohol Health and Research World, 11 (2), 26±33 Caetano, R. 1987a. Acculturation and attitudes toward appropriate drinking among U.S. Hispanics. Alcohol and Alcoholism 22 (4), 427±433. Caetano, R., 1987b. Acculturation and drinking patterns among U.S. Hispanics. British Journal of Addiction 82, 789±799. Caetano, R., 1987c. Acculturation, drinking and social settings among U.S. Hispanics. Drug and Alcohol Dependence 19, 215±226.

M.C. Gutmann / Social Science & Medicine 48 (1999) 173±184 Caetano, R., 1988. Alcohol use among Mexican Americans and in the U.S. population. In: M.J. Gilbert (Ed.). Alcohol Consumption among Mexicans and Mexican Americans: a Binational Perspective. Spanish Speaking Mental Health Research Center, University of California, Los Angeles, pp. 58±84. Caetano, R., Mora, M.E.M., 1988. Acculturation and drinking among people of Mexican descent in Mexico and the United States. Journal of Studies on Alcohol 49 (5), 462±471. Chock, P.P., 1987. The irony of stereotypes: toward an anthropology of ethnicity. Cultural Anthropology 2 (3), 347±368. Clark, W.B., 1988. A comparative analysis of facial ¯ushing among alcohol drinkers in Japan, Hawaii, and California. In: L.H. Towle, T.C. Harford (Ed.). Cultural In¯uences and Drinking Patterns: A Focus on Hispanic and Japanese Populations. National Institute on Alcohol Abuse and Alcoholism, Research Monograph No. 19, Rockville, MD, pp. 197±220. Comaro€, J.L., 1996. Ethnicity, nationalism, and the politics of di€erence in an age of revolution. In: E.N. Wilmsen, P. McAllister (Ed.). The Politics of Di€erence: Ethnic Premises in a World of Power. University of Chicago Press, Chicago, pp. 162±183. Das, V., 1995. National honor and practical kinship: unwanted women and children. In: F.D. Ginsburg, R. Rapp (Ed.). Conceiving the New World Order: The Global Politics of Reproduction. University of California Press, Berkeley, pp. 212±233. Delaney, W., Ames, G., 1993. Integration and exchange in multidisciplinary alcohol research. Social Science and Medicine 37 (1), 5±13. DeWalt, B., 1979. Drinking behavior, economic status, and adaptive strategies of modernization in a highland Mexican community. American Ethnologist 6 (3), 510±530. Fabian, J., 1983. Time and the Other: How Anthropology Makes Its Object. Colombia University Press, New York. Firth, R., 1951 [1963]. Elements of Social Organization. Beacon Press, Boston. Frankenberg, R., 1993. Risk: anthropological and epidemiological narratives of prevention. In: S. Lindenbaum, M. Lock (Ed.). Knowledge, Power and Practice: The Anthropology of Medicine and Everyday Life. University of California Press, Berkeley, pp. 219±242. Gibson, C., 1964. The Aztecs under Spanish Rule: A History of the Indians of the Valley of Mexico, 1519±1810. Stanford University Press, Stanford. Gilbert, M.J., 1985. Mexican-Americans in California: intracultural variation in attitudes and behavior related to alcohol. In: L.A. Bennett, G.M. Ames (Ed.). The American Experience with Alcohol: Contrasting Cultural Perspectives. Plenum, New York, pp. 255±277. Gilbert, M.J. (Ed.), 1988. Alcohol Consumption among Mexicans and Mexican Americans: a Binational Perspective. Spanish Speaking Mental Health Research Center, University of California, Los Angeles. . Gilbert, M.J., 1991. Acculturation and changes in drinking patterns among Mexican-American women: implications for prevention. Alcohol Health and Research World 15 (3), 234±238.

183

Gilbert, M.J., Cervantes, R.C., 1987a. Patterns and practices of alcohol use among Mexican Americans: a comprehensive review. In: M.J. Gilbert, R.C. Cervantes (Ed.). Mexican Americans and Alcohol. Spanish Speaking Mental Health Research Center, University of California, Los Angeles, pp. 1±60. Gilbert, M.J., Cervantes, R.C., 1987b. Alcohol services for Mexican Americans: a review of utilization patterns, treatment considerations and prevention activities. In: M.J. Gilbert, R.C. Cervantes (Ed.). Mexican Americans and Alcohol. Spanish Speaking Mental Health Research Center, University of California, Los Angeles, pp. 61±93. Gutmann, M.C., 1996. The Meanings of Macho: Being a Man in Mexico City. University of California Press, Berkeley. Heath, D.B., 1987. Anthropology and alcohol studies: current issues. Annual Review of Anthropology 16, 99±120. Heath, D.B., 1989. Environmental factors in alcohol use and its outcomes. In: H.W. Goedde, D.P. Agarwal (Ed.). Alcoholism: Biomedical and Genetic Aspects. Pergamon Press, New York, pp. 312±324. Heath, D.B., 1991. Uses and misuses of the concept of ethnicity in alcohol studies: an essay in deconstruction. International Journal of the Addictions 25 (5A & 6A), 607± 628. Herzfeld, M., 1987. Anthropology Through the LookingGlass: Critical Ethnography in the Margins of Europe. Cambridge University Press, Cambridge. Herzfeld, M., 1992. La pratique des steÂreÂotypes. L'Homme 37 (1), 67±77 (Translated as The practice of stereotypes in Cultural Intimacy: Social Poetics in the Nation-State. Routledge, New York, 1997.). Hillier, S., Kelleher, D., 1996. Considering culture, ethnicity and the politics of health. In: D. Kelleher, S. Hillier (Ed.). Researching Cultural Di€erences in Health. Routledge, London, pp. 1±10. Janes, C., Ames, G., 1992. Ethnographic explanations for the clustering of attendance, injury and health problems in a heavy machinery assembly plant. Journal of Occupational Medicine 34 (10), 993±1003. Jellinek, E.M., 1962. Cultural di€erences in the meaning of alcoholism. In: D.J. Pittman, C.R. Snyder (Ed.). Society, Culture, and Drinking Patterns. John Wiley and Sons, New York, pp. 382±388. Johnson, R.C., Nagoshi, C.T., 1990. Asians, Asian± Americans and Alcohol. Journal of Psychoactive Drugs 22 (1), 45±52. Kearney, M., 1995. The local and the global: the anthropology of globalization and transnationalism. Annual Review of Anthropology 24, 547±565. Keefe, S.E., 1979. Urbanization, acculturation, and extended family ties: Mexican Americans in cities. American Ethnologist 6, 349±365. Kelleher, D., 1996. A defence of the use of the terms `ethnicity' and `culture'. In: D. Kelleher, S. Hillier (Ed.). Researching Cultural Di€erences in Health. Routledge, London, pp. 69±90. Lee, J.A., 1987. Chinese, alcohol, and ¯ushing: sociohistorical and biobehavioral conditions. Journal of Psychoactive Drugs 19 (4), 319±327.

184

M.C. Gutmann / Social Science & Medicine 48 (1999) 173±184

Martin, E., 1994. Flexible Bodies: Tracking Immunity in American CultureÐFrom the Days of Polio to the Age of AIDS. Beacon, Boston. MeneÂndez, E., 1987. Alcoholismo II: La alcoholizacioÂn, un proceso olvidado. . .patologõÇÂa, integracioÂn funcional o representacioÂn cultural. Centro de Investigaciones y Estudios Superiores en Antropologõ a Social, Mexico City. MeneÂndez, E., 1990. Morir de alcohol: Saber y hegemonõÇÂa meÂdica. Grijalbo, Mexico City. MeneÂndez, E., 1991. Alcoholismo y proceso de alcoholizacioÂn; la construccioÂn de una propuesta antropoloÂgica. Antropologõ a del alcoholismo en MeÂxico: Los lõ mites culturales de la economõÇÂa polõ tica, 1930±1979. Centro de Investigaciones y Estudios Superiores en AntropologõÇÂa Social, Mexico City. Molina, V.P., Berrucecos, V.L.A., Luis, SaÂnchez M., 1985. El alcoholismo en MeÂxico. II. Aspectos sociales, culturales, y econoÂmicos. FundacioÂn de Investigaciones Sociales, A.C., Mexico City. Nagengast, C., Kearney, M., 1990. Mixtec ethnicity: social identity, political consciousness, and political activism. Latin American Research Review 25 (2), 61±91. Ogata, M., Tsunoda, T., 1988. Flushing among the Japanese. In: L.H. Towle, T.C. Harford (Ed.). Cultural In¯uences and Drinking Patterns: A Focus on Hispanic and Japanese Populations. National Institute on Alcohol Abuse and Alcoholism, Research Monograph No. 19, Rockville, MD, pp. 179±196. Red®eld, R., Linton, R., Herskovits, M.J., 1936. Memorandum on the study of acculturation. American Anthropologist 38, 149±152. Rivas, M., 1987. Similarities and di€erences in alcohol use and abuse among Hispanic and non-Hispanic drinkers. In: M. Singer, L. Davison, F. Yalin (Ed.). Alcohol Use and Abuse among Hispanic Adolescents. Hispanic Health Center, Hartford, CT, pp. 37±43. Room, R., 1985. Foreword. In: L.A. Bennett, G.M. Ames (Ed.). The American Experience with Alcohol: Contrasting Cultural Perspectives. Plenum, New York, pp. xi±xvii.

Room, R., 1988. Cross-cultural research in alcohol studies: research traditions and analytical issues. In: L.H. Towle, T.C. Harford (Ed.). Cultural In¯uences and Drinking Patterns: A Focus on Hispanic and Japanese Populations. National Institute on Alcohol Abuse and Alcoholism, Research Monograph No. 19, Rockville, MD, pp. 9±40. Rouse, R., 1991. Mexican migration and the social space of postmodernism. Diaspora 1 (1), 8±23. Scheper-Hughes, N., Lock, M., 1987. The mindful body: a prolegomenon to future work in medical anthropology. Medical Anthropology Quarterly 1 (1), 6±41. Singer, M., 1987. Keynote talk. In: M. Singer, L. Davison, F. Yalin (Ed.). Alcohol Use and Abuse among Hispanic Adolescents. Hispanic Health Center, Hartford, CT, pp. 19±27. Stivers, R., 1976. A Hair of the Dog: Irish Drinking and American Stereotype. Pennsylvania State University Press, University Park. Stolcke, V., 1995. Talking culture: new boundaries, new rhetorics of exclusion in Europe (with commentaries). Current Anthropology 36 (1), 1±24. Tax, S., 1952. Heritage of Conquest: The Ethnology of Middle America. Free Press, Glencoe, IL. Taylor, W.B., 1979. Drinking, Homicide, and Rebellion in Colonial Mexican Villages. Stanford University Press, Stanford. Thurnwald, R., 1932. The psychology of acculturation. American Anthropologist 34, 557±569. Trotter, I.I. R.T., 1985. Mexican±American experience with alcohol: South Texas examples. In: L.A. Bennett, G.M. Ames (Ed.). The American Experience with Alcohol: Contrasting Cultural Perspectives. Plenum, New York, pp. 279±296. Wol€, P.H., 1972. Ethnic di€erences in alcohol sensitivity. Science 175, 449±450. Wol€, P.H., 1973. Vasomotor sensitivity to ethanol in diverse mongoloid populations. American Journal of Human Genetics 25, 193±199.