Understanding Alcohol Abuse
Underage Drinking

Further, teens raised to drink responsibly at the table are less likely to see alcohol as a badge of adulthood and rebellion. Allowing them to learn their limits in a safe space may also help ward off risky experiments in more dangerous settings later. As a result, permitting teens to drink with their parents at home and in restaurants at any age with adult supervision may make sense.

As for purchasing alcohol, Canada has adopted a legal age of 19, making alcohol illegal for high school students but allowing virtually all college kids to legally drink. This means that at least some of their drinking is supervised and that there is no incentive to binge to avoid being caught possessing alcohol.

Not surprisingly, the lower legal drinking age means that more Canadian students drink than American students; however, those who imbibe display more moderation than their U.S. counterparts. For example, 54% of American students who drank in the last week drank heavily, while only 42% of Canadian students in that group did likewise footnote icon. And despite Canada's lower drinking age, drunk driving fatality rates are virtually the same as in the U.S. (in 1999, for example, both were 40%) footnote icon.

Dealing with Excess
Though taking a pragmatic view of alcohol consumption can help reduce its use as a symbol of teen rebellion, it will not eliminate alcohol abuse or alcoholism. Those who support keeping the drinking age high cite research finding that the later one starts drinking, the lower the risk of developing dependence. For example, one large study found that those who reported starting drinking at 14 or younger are four times more likely to become alcoholics than those who said they started at 20 or older footnote icon.

Such studies define the start of drinking as the age when a person begins drinking regularly-as opposed to having just a sip or two. They do not look at the context of early drinking-so they don't offer evidence on whether drinking wine with the family at dinner would increase risk in the same way as drinking with 12-year-old friends in the schoolyard might.

The studies also cannot determine causality: there is evidence that the youngest heavy drinkers are more antisocial, more likely to have a family history of alcoholism and more troubled generally than their peers footnote icon, so it may well be that these things increase both the odds of early drinking and dependence. Rat studies do suggest that drinking at a very young age may alter brain development, however, so the causal picture is quite complex.

Whatever the case, raising the drinking age has not reduced the number of youth who drink at the earliest ages: in fact, the percentage of youth in eighth grade and lower who report drinking jumped dramatically just after the drinking age was raised to 21 (from 27% before 1984 to 36% by 1993) before returning to its previous level.

Measures that show promise in reducing youthful drinking and its consequences include:

Identifying college students who are drinking heavily
and teaching them about the effects of alcohol in a non-judgmental setting.

G. Alan Marlatt of the University of Washington has found simply educating randomly selected young heavy drinkers dramatically reduced their alcohol-related problems compared to a control group of student bingers who were not given his classes. The results were still significant four years later footnote icon.

It is critical that these classes be framed as giving students options for managing drinking-if students believe that the only choice available is quitting entirely, they simply won't turn up. Furthermore, if the classes don't recognize the pleasure young people seek from drinking and focus entirely on potential negative consequences, the material will often just be dismissed.

Teaching young people to understand what researchers call the "biphasic" effect of alcohol can be particularly helpful. Alcohol initially produces energy and excitement, but later causes tiredness and fatigue. Drinking more doesn't reproduce the early effects-but many youth don't understand this. When they do, moderation is more likely and achievable.

Helping students recognize that their peers
are not drinking as heavily as they may believe they are.

The "social norms" approach to reducing youthful drinking involves teaching people that "everybody really isn't doing it," and that most of those who are, are not indulging in the excessive amounts their peers may think they are.

Research finds that people are highly influenced by what they believe others are doing, and that they also tend to take more notice of extreme, flamboyant behavior. In combination, these factors produce teens who see a few peers vomiting in trash cans on weekends and decide that most of the campus must be getting rip-roaring drunk.

Studies have found that when youth are educated about these effects and about how much their peers are actually drinking, heavy alcohol use can be reduced by between 25-44% footnote icon (Note: while one recent study called this approach into question, it had serious methodological problems and wasn't actually designed to evaluate social norms).

Media campaigns that offer practical solutions.
The "designated driver" ad campaigns of the 1970s and 80s were some of the most effective public health ads ever broadcast. After they were introduced, the idea caught on with drinkers, while also creating a valued role for people who wanted to socialize with drinkers but did not want to drink themselves. Other ads and articles worked to make drunk driving socially unacceptable-while the designated driver offered a solution for those who wished to drink. The proportion of driving deaths attributable to drinking fell from 60% in 1982 to 40 % in 1999 .

Interestingly, ad researchers found that while commercials showing the devastating effects of drunk driving accidents had a large emotional impact and won industry awards, humorous ads teaching women how to get the car keys away from their intoxicated boyfriends were better at changing people's behavior. Media campaigns are far more effective when they offer people actions to take and not just avoid footnote icon.

A Question of Values
How to deal with youth drinking is a question that is heavily value-laden in American society. The risks associated with drinking by young people are not necessarily greater than those associated with "worthwhile" activities like sports-but we do not often offer teens the equivalent of football helmets when they participate in activities that we tend to morally condemn.

This makes evaluating the real risks extremely difficult. When people consider teen drinking, the default assumption is that it is harmful, valueless, and that anyone who would consider allowing it must have bad intentions. This often precludes rational discussion of certain options.

For example, some suburban parents secretly hold parties where they allow teens to drink, and they take their car keys and allow them to stay overnight so that driving cannot occur. In many states, this is illegal. But does it really encourage excess and condone teen drinking-or does parental supervision by its very nature reduce the odds of over-indulgence?

There have been cases where teens have died for lack of medical attention when those around them didn't seek help because they feared educational or parental consequences. In 2001, 17-year-old high school football star passed out after being punched at an unsupervised, illicit drinking party in an upscale community in Westchester, New York. He was not taken to the hospital and died, possibly as a result of the delay in care. The other teens present said they didn't get help because being caught drinking by parents or school officials would have had devastating consequences.

Yet because parentally-supervised parties are driven underground, there is little research on this subject. One study, published in the Journal of Adolescent Health in 2004 footnote icon did find that teens whose parents held parties where drinking was allowed were twice as likely to binge drink as those whose parents did not. They were also twice as likely to have had at least one drink in the month before they were surveyed.

But the same study also found that adolescents who drank at home with
their parents were half as likely to have had a drink in the last month and only one-third as likely to binge - drink as those who had not done so. And the study didn't determine whether the kids who were at parties supervised by parents had lower risks of drunk driving accidents, injuries or alcohol poisoning.

Without more research, it's impossible to figure out what this paradoxical data says about parental supervision of drinking by adolescents. And if more research were done, the measures for success would probably be disputed. Some would see failure if teen drinking were to increase due to parental license, while others would see success in fewer deaths, school dropouts and accidents.

After the Westchester case, the community soon enacted even tougher policies. Yet the media coverage never questioned whether tougher policies may have been part of the problem to begin with.

Reporters who cover teen drinking often take the values hidden in the discussion of risks related to teen alcohol use for granted. But in order to develop effective policies for dealing with underage alcohol abuse, these assumptions need to be exposed, questioned, and challenged so that parents and politicians can explore a whole range of solutions and make the best choices for their kids.

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