American alcohol education and prevention efforts for youth emphasize abstinence. In support of this approach, epidemiologists conclude that early drinking by adolescents increases the lifetime likelihood of alcohol dependence and that overall drinking levels in a society are directly linked to drinking problems. At the same time, cultural, ethnic, and social differences in drinking indicate that drinking styles are socialized and that those groups that encourage regular but controlled drinking yield lower rates of binge drinking and alcohol-related problems. Recent international epidemiologic research has found that societies in which men and women consume their alcohol in bursts have more drinking problems. The same cultures with high binge drinking rates for adults have high rates of adolescent drunkenness. It has, however, proven difficult to impose a moderate-drinking template on cultures, including notably American adolescent and college cultures. Nonetheless, approaches that focus on preventing problems rather than on abstinence per se – called harm reduction – may have value in reversing problems created by youthful drinking. The question is whether the socialization of moderate drinking can be incorporated as a harm reduction technique for young people, at least for college students.

Journal of Alcohol and Drug Education, Vol. 50(4), Dec. 2006, pp. 67-87

Introduction

Youthful drinking is of tremendous concern in the United States and elsewhere. Alcohol is the psychoactive substance used the most often by adolescents and college students and is associated with more youthful dysfunction and morbidity than any other drug. [1], [2], [3], [4] Alcohol use by youth contributes significantly to academic and social problems, risky sexual behavior, and traffic and other accidents, and is a risk factor for the development of alcohol-related problems during adulthood. As a result, youthful drinking – and particularly binge drinking – has been a target for public health interventions. It is thus highly troubling that these efforts have produced few benefits; high-risk drinking by both adolescents [5] and college students [6], [7] has not declined over the past decade. According to the Monitoring the Future (MTF) survey, the percentage of high seniors who have been drunk in the past month has gone below 30 percent one year in the last decade and a half (in 1993 the figure was 29%; in 2005 it was 30%; Table 1). Some data show startling increases in binge drinking by young people: the National Survey on Drug Use and Health (NSDUH) reported for 1997 that 27 percent of Americans aged 18 to 25 had consumed five or more drinks at one time in the prior month (Table 7.7) [8]; in 2004, the figure was 41 percent (Table 2.3B). [9]

Although research has found that American adolescents who begin drinking earlier in life are more likely to display adult alcohol dependence [10], another body of research has found that drinking varies tremendously among religious, ethnic, and national groups. [11], [12], [13] In particular, those groups that are less proscriptive towards alcohol and in fact permit and even teach drinking in childhood, and in which drinking is a regular integrated part of social life, display fewer alcohol problems. This work has usually been the province of sociology and anthropology. As such, it has not had a firm status in epidemiology and public health. The thrust in the public health field has been towards labeling alcohol an addictive drug and towards reducing and even eliminating youthful drinking. [14], [15]

Recently, however, several large international epidemiologic surveys have supported principal components of the sociocultural model of drinking patterns and alcohol problems. Among these studies are the European Comparative Alcohol Study (ECAS)12; the World Health Organization’s ongoing Health Behaviour in School-aged Children (HBSC) survey tracking drinking and other behavior by young adolescents in 35 nations in Europe and (in the survey completed in 2001-2002) the U.S., Canada, and Israel)13; and the European School Survey Project on Alcohol and Other Drugs (ESPAD) surveying 15-16 year olds in 35 European countries (but not the United States and Canada), last completed in 2003. [16]

Religious/Ethnic Differences in Drinking Styles and Problems

Differences in drinking have frequently been noted among religious groups in the U.S. and elsewhere, including among youth and college students. Drinking by Jews has been one special object of attention due to their apparently low level of drinking problems. Weiss indicated that, although drinking problems in Israel have increased in recent decades, absolute rates of problem drinking and alcoholism in Israel remain low compared with Western and Eastern European countries, North America, and Australia. [17] The HBSC study found that Israel, among 35 Western nations, had the second lowest rates of drunkenness among 15-year-olds: 5% of girls and 10% of boys have been drunk two or more times, compared with 23% and 30% for the U.S. (Figure 3.12).[13]

Studies of drinking by Jews compared with other groups have included a study of male Jewish and Christian students at an American university by Monteiro and Schuckit, in which Jewish students were less likely to have 2 or more alcohol problems (13% v. 22%), or to have more than five drinks on a single occasion (36% v. 47%). Weiss compared drinking by Jewish and Arab youths, and found Arab drinking is far more frequently excessive, despite the Moslem prohibition on drinking. [19] Weiss explained such differences as follows: “The early socialization of Jewish children to a ritual, ceremonial and family use of alcoholic beverages provides a comprehensive orientation to the when, where, and how of drinking” (p111).[17]

The nonproscriptive approach to alcohol characterizes not only Jewish drinking. Some American Protestant sects are highly proscriptive towards alcohol (e.g., Baptists); others (e.g., Unitarians) not at all. Kutter and McDermott studied drinking by adolescents of various Protestant affiliations. [20] More proscriptive denominations were more likely to produce abstinent youth, but at the same time to produce youth who binged, and who binged frequently. That is, while 90 percent of youth in nonproscriptive sects had consumed alcohol, only 7 percent overall (or 8% of drinkers) had binged 5 or more times in their lives, compared with 66 percent of those in proscriptive sects who had ever consumed alcohol, while 22 percent overall in these sects (33% of drinkers) had binged 5 or more times.

At the same time that youth in proscriptive groups have less exposure to controlled drinking, these groups set up a “forbidden fruit” scenario. According to Weiss, “Forbidding drinking and conveying negative attitudes toward alcohol may prevent some members from experimenting with alcohol, but when members violate that prohibition by using alcohol, they have no guidelines by which to control their behavior and are at increased risk of heavy use” (p116).[17]

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