Reducing Harms from Youth Drinking - Collegiate Binge-Drinking

Written by Stanton Peele

Moreover, the collegiate binge-drinking figure remained the same from 1993 to 2001, despite a host of efforts to cut the rate.[6] A funded program to reduce such intensive drinking did show higher rates of abstainers (19 percent in 1999 compared with 15 percent in 1993), but also an increase in frequent bingers (from 19 percent in 1993 to 23 percent in 1999).[29] Other research combining several data bases has shown that collegiate risk-drinking persists; indeed, driving under the influence of alcohol increased from 26 to 31 percent between 1998 and 2001.[7]

Data also show that recent age cohorts are more likely to become and remain alcohol dependent. Examining the National Longitudinal Alcohol Epidemiologic Survey (NLAES) conducted in 1992, Grant found the youngest cohort (those born between 1968 and 1974) was most likely to become, and persist in, alcohol dependence, even though this cohort overall was less likely as a group to drink than the cohort just before it.[30] The follow-up National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), conducted in 2001-2002, found that alcohol dependence (median age of incidence = 21) was slower to show remission than in the 1992 NLAES study.[31]

Finally, "medical epidemiology has generally accepted as established . . . . the protective effects of light drinking for general mortality." [32] These results have been acknowledged in the Dietary Guidelines for Americans.[33] And binge drinking, as this paper has shown, is associated with more adverse consequences. Yet young people do not believe regular moderate drinking is better than binge drinking. MTF finds that more high school seniors disapprove of people 18 and older having "one or two drinks nearly every day" (78%) than disapprove of having "five or more drink once or twice each weekend" (69%) (Table 10).[1]

Is a Reorientation of American Alcohol Policy and Education Advisable?

The data we have reviewed show that the current (and, in terms of the Surgeon General's initiative, intensifying) efforts to encourage abstinence have not reduced binge drinking and alcohol dependence. Indeed, major American surveys have shown clinical problems from drinking, for young people and beyond, to be increasing, even though overall drinking rates have declined. The combination of high abstinence and high binge drinking is typical in many contexts, as this paper has shown.

Comparisons of two primary cultural patterns of drinking - one in which alcohol is consumed regularly and moderately versus one in which alcohol is consumed sporadically but drinking occasions often involve high levels of consumption - show that the regular, moderate style leads to fewer adverse social consequences. Cultures where moderate drinking is socially accepted and supported also have less youthful binge drinking and drunkenness.

Conveying the advantages of one cultural style to those in other cultures, however, remains problematic. It is possible that drinking styles are so rooted in a given cultural upbringing that it is impossible to extirpate the binge drinking style in cultures where it is indigenous in order to teach moderate drinking on a broad cultural level. Nonetheless, there may still be benefits to educating youth to drink moderately in cultures where binge drinking is commonplace.

The approach propagated by many international policy groups (and many epidemiologists and other researchers) favors reducing overall drinking in a society and zero-tolerance (no-drinking) policies for the young. Yet, as indicated by variations in legal drinking ages, most Western nations continue to follow a different model. For example, the United States is the only Western country that restricts drinking to those 21 years of age or older. The typical age of majority for drinking in Europe is 18; but some Southern countries have lower age limits. Age limits may also be lower (for example, in the UK) when drinking occurs in a restaurant when a youth is accompanied by adults.

The United States, by restricting drinking to those 21 years of age and older, has adopted a model of alcohol problems that assumes drinking per se raises the risk of problems. Evidence supports that raising the drinking age lowers drinking rates and accidents among the young - primarily in precollegiate populations.[34] Nonetheless, most Western nations continue to accept the concept that encouraging youthful drinking in socially governed public environments is a positive societal goal. By learning to drink in such settings, it is hoped, youth will develop moderate drinking patterns from an early age.

Indeed, the policy of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) when it was initially created in 1970 under its first director, Morris Chafetz, included the creation of moderate drinking contexts for young people.[35] But this approach was never widely adopted in the United States and declined in popularity when youthful drinking accelerated in the late 1970s. One contemporary alternative to a zero-tolerance or decreased-overall-consumption model is the "social norms" model. The social norms approach informs students that many more students abstain, or drink moderately, than they are aware, assuming this will lead students to drink less themselves. However, CAS investigators found that colleges adopting the social norms approach showed no reduction in drinking levels and harms.[36]

A New Paradigm - Harm Reduction

At this point, it is obviously easier to point to failures in alcohol education and prevention programs for youths than to identify successes. As a result, leading researchers continue to uncover a growth in risk drinking among college students and to advocate stricter enforcement of zero-tolerance:

Among college students ages 18-24 from 1998 to 2001, alcohol-related unintentional injury deaths increased from nearly 1600 to more than 1700, an increase of 6% per college population. The proportion of 18-24-year-old college students who reported driving under the influence of alcohol increased from 26.5% to 31.4%, an increase from 2.3 million students to 2.8 million. During both years more than 500,000 students were unintentionally injured because of drinking and more than 600,000 were hit/assaulted by another drinking student. Greater enforcement of the legal drinking age of 21 and zero tolerance laws, increases in alcohol taxes, and wider implementation of screening and counseling programs and comprehensive community interventions can reduce college drinking and associated harm to students and others.[7] (p259) [emphasis added]

However, Hingson et al. in their recommendations also adumbrate a newer approach to youthful alcohol-related problems (and other substance abuse). Called "harm reduction," this approach does not insist on abstinence and instead focuses on reducing identifiable harms that result from overimbibing. Two examples of harm reduction in the substance abuse field are clean needle programs for injecting drug users and safe driver programs for drinking youths (like those encouraged by MADD). Teaching moderate drinking is another example of harm reduction. Any policy that recognizes drug use and underage drinking occur, while seeking to reduce their negative consequences, represents harm reduction.

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