Later investigations of alcohol use, both in non-Western cultural settings (cf. Marshall, 1979) and in the
United States (Ames, 1985; Bennett, 1985; Spradley, 1970) acknowledged and attempted to explain proportions of problematic and non-problematic alcohol use within the same populations. Cultural adaptations to the presence of negative consequences of alcohol use have become legitimate topics in the study of alcohol use. Heath himself, in a later revisitation of the same cultural setting, the Camba of eastern Bolivia, allowed that under changing circumstances and community structure, alcohol use may not have the benign impact that it once had among the same people (Heath, 1994).
Acknowledgment that drug use may have different impacts under different cultural circumstances, regardless of the drug being consumed, provided an important perspective on the impact of drugs in different cultural settings. Heath (1958) and Carter (1977) concluded that problems related to alcohol consumption may have markedly different frequencies in cultural settings that restricted drinking to ritual contexts. Wilbert (1990) and Lowie (1919) made the same point about tobacco in traditional Native American cultural environments. On the other hand, in circumstances of poverty and marginaliza-tion, Singer (1986) made a convincing case for expecting increases in alcohol-related problems among Puerto Rican immigrants to the northeastern United States. Problems related to fully commercialized tobacco use, the most ruinous drug in terms of impact on the public health, have also drawn the attention of anthropologists attempting to find strategies for preventing the onset of addiction to tobacco (Nichter & Cartwright, 1991).
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