You don’t have to be a “neo-prohibitionist” to be alarmed at the serious drinking of America’s children. Alcohol is their No. 1 drug of choice. It is cheap and easily obtained. It is also regarded by many adults as a safe drug for young people, as long as they are not behind the wheel. The research is revealing a different story — and the National Academy of Sciences’ (NAS) Institute of Medicine (IOM) is calling for the nation to take drastic steps to control the epidemic of teenage drinking.

What the research says
The younger the age of the beginning drinker, the greater the chance of developing a clinically defined alcohol disorder, according to a report released by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).¹ Young people who began drinking before age 15 were four times more likely to develop alcoholism than those who began drinking at age 21. The risk for developing alcohol abuse (a drinking problem that leads to life problems and that is perhaps short of addiction) was more than doubled for persons who began drinking before age 15 compared with those who began drinking at age 21. In the total sample, more than 40 percent of the respondents who initiated drinking before age 13 were classified with alcohol dependence at some time in their lives. Overall, the risk for alcohol dependence decreased by 14 percent with each increasing year of drinking onset up to the age of 25 and older.

Teen drinking is also associated with a variety of other health problems including early and unwanted pregnancy, depression, and suicide. A central research question is whether the early alcohol use is a potentially modifiable risk factor, or whether it is simply an early indicator of inevitable development of alcohol use disorders.

“This first comprehensive analysis of the relationship between the age of drinking onset and the prevalence of lifetime alcohol abuse and dependence is one piece of a complex puzzle,” said then NIAAA director Enoch Gordis, MD. “It remains to be seen whether it is the delay in alcohol use, or possibly other associated factors that explain the inverse relationship between the age at drinking onset and lifetime risk for alcohol abuse and alcoholism .... Fortunately, this report comes at a time when NIAAA has stringently tested and proved effective several preventive interventions that can be applied in schools and communities.”

Early drinking and addiction
A study in the January 2000 issue of the American Journal of Public Health (Volume 90, Number 1) reports that approximately one in four U.S. children (19 million children!) are exposed to familial alcohol abuse or alcoholism. Since alcoholism research makes it clear that children of alcoholics are genetically and environmentally most at risk for alcohol addiction, this is the population most vulnerable to underage drinking.

According to the National Association for Children of Alcoholics (NACoA), parental alcoholism influences children’s substance abuse through several different pathways, including children’s perceptions of parental drinking quantity and circumstances, the stress of living with alcoholic parents, and decreased parental monitoring.

The connection between drinking before age 18 and later addiction is not the only effect we should be concerned about. Researchers have begun to evaluate the cognitive functioning of alcohol-dependent adolescents after the drinking has ceased, and the news is not good. Recent research evaluated matched comparisons between adolescents who had used alcohol heavily during early and middle adolescence (when important maturational changes in the nervous system are taking place) and those with no history of drinking. The two groups were similar on key educational, economic, and family factors. According to Sandra Brown, PhD, Chief of Psychology Services at the Veterans Administration Medical Center in San Diego, California, tests given to both groups revealed subtle to moderate cognitive and verbal deficits, impaired memory, as well as altered perceptions of spatial relationships in the alcohol-dependent adolescents.

Neural consequences
Here’s another way to view the problem: frontal brain systems that underpin self-control and mature judgment regarding long-term goals and consequences are being developed in adolescence. Addictive drugs work by stimulating the brain that is developing rapidly at this age, according to R. Andrew Chambers, MD, of the Yale School of Medicine in New Haven, Connecticut. In adolescent rats at least, alcohol caused “a more powerful decrease in neural activity” compared with adults.

These findings caused researchers to postulate that the brains of young humans may be more sensitive to the effects of the drug than adults, according to H. Scott Schartzwelder, PhD, a neuropsychologist at Duke University in Durham, North Carolina Even moderate consumption by young people affects the function of a variety of brain systems associated with emotion, learning, motivation, and co- ordination, according to Boris Tabakoff, PhD, Chair of the Department of Pharmacology at the University of Colorado School of Medicine in Denver.
The research also points to health and safety issues, apparent in a recent summary by NACoA. Half of all teen auto crashes involve alcohol, which also plays a key role in homicides, suicides, and fatal injuries. Underage alcohol use is associated with two-thirds of all sexual assaults and date rapes.

The response
No one knows for sure the impact of alcohol ads on minors, but voluntary standards of advertising are tightening under pressure from government agencies such as the Federal Trade Commission. The liquor industry faces risks of frontal assault comparable to that on the cigarette and the firearms industries.

The tobacco industry was sued in 1999 by the United States Department of Justice under the Racketeer Influenced and Corrupt Organizations Act (RICO). The case, which goes to trial in September 2004, centers on alleged efforts to market products to minors for the express purpose of insuring a steady supply of customers. “In a real sense they are drug pushers,” says G. Robert Blakey, a professor at the University of Notre Dame Law School in Indiana. Blakey, who helped draft RICO, argues that any product manufacturers can be sued under RICO if the seller knows that his product is being sold or used illegally.

If any industry rivals Big Tobacco as a potential source of damages, it’s the $116 billion a year alcohol industry that causes health problems for millions of Americans, and is often obtained illegally by minors who may be drawn in by many of the industry’s “party hearty” ad campaigns, according to Douglas McCollam, writing in the Fall 2003 issue of The Future of Litigation.

The IOM of the NAS is calling for action to control the epidemic of teenage drinking. The Academy in 2003 released a comprehensive review of existing alcohol prevention efforts entitled Reducing Underage Drinking — A Collective Responsibility.²

“The social cost for underage drinking is $53 billion a year, including $19 billion for traffic crashes alone,” said Richard J. Bonnie, chairman of the panel and director of the Institute of Law, Psychiatry, and Public Policy at the University of Virginia at Charlottesville. Yet, he added, “the federal government spends 25 times more on preventing illicit drugs than on preventing illicit drinking by young people.”

The scientists call for the government to deliver an annual report to Congress on the progress made against underage drinking, and urge the creation of a nonprofit organization, funded by the alcohol industry, to monitor the effectiveness of intervention programs and settle debates over which ones work best. The report called on states to strengthen statutes that hold retailers responsible if they sell alcohol to minors who get into traffic accidents or commit crimes.

The report further states that underage drinking cannot be successfully addressed by focusing on youth alone. Efforts to reduce and prevent underage drinking need to pay attention to parents and other adults. The NAS recommends multiple components be implemented that include science-based programs, research and evaluation, community organizing, coalition building, and strategic use of mass media.

“Underage drinking has been neglected too long,” said Senator Mike Dewine (R-OH) at a Senate Hearing last fall.³ Senator Christopher Dodd (D-CT) added, “To say that the numbers on underage drinking are staggering does not do it justice.” This was a step in generating debate in Congress on what can be done to end decades of neglect of childhood drinking as a serious public health and safety issue.

The Community Anti-Drug Coalitions of America recently announced its support of the NAS report to Congress that stated that it is pleased that NAS supports community coalitions, because “communities can design multi-pronged comprehensive initiatives that rely on scientifically based strategies and are responsive to the specific problems of the community.”

“The Institute of Medicine’s new report is a wake-up call to the real dangers of the underage drinking epidemic,” said Sis Wenger, Executive Director of NACoA. “We are especially concerned about the impact of early drinking on those children and youth most vulnerable to the pressure to drink — the one in four already hurt by alcohol abuse in their families and most at risk for alcohol addiction.”

Recommended strategies and interventions
The IOM’s report (National Academies’ Institute of Medicine and National Research Council, 2003) includes recommendations for interventions, including:

• School-based approaches. Delivery through schools can reach a wide, captive audience and can ensure programs are run by trained staff members.
• Alcohol education at residential colleges and universities, including consistent policy enforcement and parental notification.
• Faith-based interventions. Family involvement in faith-based institutions and spirituality have been shown to reduce risk.
• Health system interventions. Physicians should screen and educate.
• Workplace prevention, which has the potential to reach youth that may not otherwise be reached.
• The military has increased interventions aimed at risky behavior and should target underage personnel.
• Treatment programs. Research suggests that early treatment is more effective, and that there are seven key elements to success: matching treatment to needs; comprehensive and integrated treatment; family involvement; developmental appropriateness; recognition of gender and cultural differences; continuing care; and assessment.
• A youth-focused media campaign. The research offers good evidence that young people who disapprove of heavy alcohol use and who see great harm in alcohol use are less likely to drink.

Hope for a responsible future
We now have powerful allies in our effort to reduce or eliminate underage drinking, and that should give hope to those who have given their working lives to this goal.
We appear to be in the middle of a culture shift that will deglamorize alcohol and take addiction seriously. For the sake of our children and our country’s future, we can certainly hope so.

Stephanie Abbott, MA, has 30 years of experience in the field of addiction and the family. She is currently an adjunct professor at Marymount University in Virginia, and editor of the NACoA newsletter NETWORK.

References
Brown, S.A., Tapert, S.F., Granholm, E., & Delis, D.C. (2000). Neurocognitive functioning of adolescents: effects of protracted alcohol use. Alcoholism: Clinical and Experimental Research 24(2): 164-171.
Eckardt, M.J., File, S.F., Gessa, G.L., Grant, K.A., Guerri, C., Hoffman, P.L., Kalant, H., Koob, G.F., Li, T.K., Tabakoff, B.(1998). Effects of moderate alcohol consumption on the central nervous system. Alcoholism: Clinical and Experimental Research 22(5): 998-1040.
Grant, B.F., Dawson, D.A. (1997). Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: Results from the National Longitudinal Alcohol Epidemilogic Survey. Journal of Substance Abuse, 9: 103-110.
The National Academies’ Institute of Medicine and National Research Council (2003). Reducing Underage Drinking: A Collective Responsibility. Available from: http://www.nap.edu/catalog/10729.html

Endnotes
1 The analysis by Bridget F. Grant, PhD, and Deborah A. Dawson, PhD, of NIAAA, is published in the January 1998 issue of the Journal of Substance Abuse. The national probability sample is of nearly 43,000 interviews with fieldwork conducted by the U.S. Census Bureau in 1992.
2 The report Reducing Underage Drinking: A Collective Responsibility is available from http://
www.nap.edu/catalog/10729.html. The full text is available online at www.nap.edu/books/0309089352/html.
3 A Senate Hearing on Underage Drinking was held on September 30, 2003, convened by the Substance Abuse and Mental Health Services Subcommittee of the Senate Committee on Health, Education, Labor, and Pensions, chaired by Mike Dewine (R-OH), and Christopher Dodd (D-CT). Senator Dewine made this comment in his opening statement. On the panel of five invited witnesses was: Dr. Richard J. Bonnie (who chaired the research panel that compiled the NAS report), Patricia Kempthorne (First Lady of Idaho, representing Leadership to Keep Children Alcohol Free), Jeff Becker (President of the Beer Institute), Wendy Hamilton (MADD’s National President), and David DeAngelis (High School Student, North Haven, CT).

This article is published in Counselor,The Magazine for Addiction Professionals, June 2004, v.5, n.3, pp. 52-5

---

Comments

Add New Search RSS

Write comment
Name:
Email:	do not notifynotify
Title:
UBBCode:	-color-aquablackbluefuchsiagraygreenlimemaroonnavyolivepurpleredsilvertealwhiteyellow -size-tinysmallmediumlargehuge
	Please input the anti-spam code that you can read in the image.

Powered by !JoomlaComment 3.25

3.25 Copyright (C) 2007 Alain Georgette / Copyright (C) 2006 Frantisek Hliva. All rights reserved."