Further Reading

Addiction Research & Theory 2007, 15: 227-229

Editorial

The Bizarre Effort to Eliminate Underage Drinking in the U.S.:
A Harm Reduction Approach to Youthful Drinking

Stanton Peele

The article in this issue, Perceived Availability and Alcohol Cue Reactivity, by James MacKillop and Stephen A. Lisman, presents an interesting – perhaps critical – result. Telling underage drinkers they won’t have access to alcohol only increases their motivation to drink, whether they are exposed to alcohol cues or not.

This result presents a paradigm for why the American prohibitionist model of alcohol education and control for young people is doomed to fail. To start, keep in mind that the United States is the only Western nation to make drinking illegal until people turn 21. Yet efforts to restrict access to alcohol for youthful drinkers, according to the current study, are only likely to exacerbate their urge to drink.

According to the government’s National Survey on Drug Use and Health, “In 2005, about 10.8 million persons aged 12 to 20 (28 percent of this age group) reported drinking alcohol in the past month. And nearly 7.2 million (19 percent of all youths and 70 percent of those who drink) were binge drinkers” – that is, having five or more drinks at least once a month. Beyond this, 2.3 million (6 percent of all youths and 20 percent of youths who drink) were “heavy drinkers” (frequent binge drinkers).

These are quite startling figures – but they don’t capture the extent and resulting peril of unhealthy drinking by Americans as they approach and then achieve the age of 21, when they can drink legally. More than half of those 18 to 20 had at least one drink in the last month, as have more than two-thirds of those between the ages of 21 and 25.

Young drinkers don’t drink well. More than a third of all young people between 18 and 20 (36 percent) binge drink, as do 46 percent among those aged 21 to 25. Thus bingeing gets even worse when young people can drink legally – at age 21, half of all Americans binge! When intoxicated, young Americans do dangerous things – 20 percent of 18 to 20 year olds, and 28 percent of 21 to 25 year olds, report having driven under the influence of alcohol in the past year.

To believe MacKillop and Lisman’s finding is to believe that American prohibitionism contributes to the massive bingeing characteristic of American drinkers, particularly the young. Yet, our failure to curtail this bingeing seemingly only fuels our futile, counterproductive efforts to stop young people from drinking entirely.

In 2006, the U.S. House of Representatives passed The Sober Truth on Preventing Underage Drinking (STOP) by a vote of 373-23, which the Senate then promptly endorsed unanimously. According to Rep. Tom Osborne (R-Neb.), one of the bill’s cosponsors, the legislation is necessary because "the Centers for Disease Control and Prevention estimated the number of underage deaths due to excessive alcohol use at 4,554 a year.” Whereas 23 senators voted against the resolution that authorized the invasion of Iraq, none dared oppose this jihad. The bill was supported by a wide range of government agencies, alcohol producers and sellers, and public interest groups.

Yet the bill is redundant, since underage drinking is by definition already illegal. The legislation’s supporters are not daunted that we have been fighting underage drinking for decades, since the drinking age was raised nationally to 21. Although there is evidence that raising the age limit reduced traffic fatalities (cf. Wagenaar & Toomey, 2002), drunk driving has been increasing since the late 1990s among both high school and college students (Hingson et al., 2005; Teens Today, 2006).

Moreover, the offsetting drawbacks of America’s singular age restrictions on drinking have not been remedied, as the current legislation once again attempts to do.

One reason every other comparable country permits what Americans consider to be “underage” drinking (including drinking by Americans over 18 who are capable of volunteering to face death fighting in Iraq) is that they want to keep such drinking public, to reduce resulting harms.

If our goal is to eliminate all underage drinking, we certainly have our work cut out for us. As the American data make clear, underage drinking and bingeing is commonplace, and by their late teens, typical of Americans (the U.S. shares this characteristic with many countries, although other countries, primarily around the Mediterranean, have less adolescent bingeing; see Currie et al., 2004). Striving to eliminate something that has reached this critical mass is quixotic.

And what if we could eliminate such underage drinking? What would happen when all those abstinent youths can suddenly drink legally? Would they drink any better than young adults currently do? After all, how would they have learned to drink moderately and sensibly? A sister study to the U.S. National Survey, the Monitoring the Future survey, finds that more high school seniors disapprove of regular moderate drinking than disapprove of periodic bingeing. Somehow, the alcohol education they receive leads them to prefer bingeing!

Even recognizing the high levels of underage drinking that will undoubtedly continue to occur, could we nonetheless discourage bingeing? Instead of stressing the elimination of all youthful drinking, we could use education and public service announcements to distinguish “sensible” from excessive and dangerous drinking, including not only safe levels of drinking but taking steps to reduce harms from drunkenness, such as arranging safe rides. My book – Addiction-Proof Your Child – describes these and other healthful policies towards youthful substance use.

Students can be taught the different consequences of binge drinking and regular moderate drinking. For instance, the government’s Dietary Guidelines for Americans recommends 1-2 drinks daily for adult Americans who drink, since this level of consumption is associated with reduced heart disease. Binge drinking, on the other hand, is particularly damaging neurologically to young brains (Townshend and Duka, 2005).

Saying that alcohol consumption is inevitably negative – that it leads only to risky behavior and alcoholism – is a temperance message that causes youth to reject all messages about safe drinking, the same way they reject inaccurate messages about illicit drugs such as marijuana.

References

Currie C., Robert, C., Morgan, A., Smith, R., Settertobulte, W., Samdal, O., et al. (Eds.). (2004). Young People’s Health in Context. Copenhagen: World Health Organization.

Hingson, R., Heeren, T., Winter, M., & Wechsler, H. (2005). Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 1824: Changes from 1998 to 2001. Annual Review of Public Health, 26, 259-279.

Peele, S. (2007). Addiction-Proof Your Child. New York: Random House/Three Rivers Press.

Teens Today (September, 2006). 2006 Survey Results. Liberty Mutual and Students Against Destructive Decisions. Available at http://www.sadd.org/teenstoday.htm.

Townshend, J.M,.and Duka, T. (2005). Binge drinking, cognitive performance and mood in a population of young social drinkers. Alcoholism: Clinical and Experimental Research, 29, 317-325.

Wagenaar, A.C., & Toomey, T.L. (2002). Effects of minimum drinking age laws: Review and analyses of the literature from 1960 to 2000. Journal of Studies on Alcohol Supplement, 14, 206-225.