Science,Kids, and Alcohol The
National Institute on Alcohol Abuse and Alcoholism (NIAAA) funded the
research described in the following summary. NIAAA funds
more than 90 percent of the alcohol abuse and addiction (alcoholism)
research in the United States.
Table of Contents Suicidal Behaviors and Alcohol Use Among Adolescents: A Developmental Psychopathology Perspective Suicidal Behaviors and Alcohol Use Among Adolescents: A Developmental Psychopathology Perspective Michael Windle, Ph.D. Studies have shown that teen suicide is associated with depression, hopelessness, impulsivity, and alcohol and other drug use. This study explored the contribution of various risk factors, including alcohol use and binge drinking, to suicide attempts. Twelve hundred tenth- and eleventh-graders participated in four waves of data collection over an 18-month period. The study measured motives for drinking, percentage of friends who use alcohol, and binge drinking. Other risk factors measured included depressive symptoms, temperament (e.g., rigidity, persistence, distractibility), delinquency (e.g., destroyed public property, hit a teacher, was suspended), and stressful life events (e.g., failing one or more subjects, having an acne problem, or breaking up with a boyfriend or girlfriend). These life events may not seem particularly stressful to adults, but are often magnified in importance by adolescents’ heightened self-consciousness, acute sensitivity to rejection, and emotional fluctuations. The main results of the study were that a difficult temperament, drinking to cope, low family supports, and a higher percentage of friends who drink predicted current depression, stressful life events, and binge drinking. These three factors, in turn, predicted suicidal behavior. Of particular importance is that binge drinking was a significant predictor of an actual suicide attempt
This and other studies demonstrate that teen suicidal behaviors are influenced by a broad range of factors, with alcohol and other substance use among the prominent influences, along with depressive symptoms, psychosocial factors, and stressful events. Interventions to address these factors need to be multifaceted, from early detection and treatment of depression, to improving problem-solving and coping skills, to controlling youths’ access to firearms. Windle M. 2004. Suicidal behaviors and alcohol use among adolescents: a developmental psychopathology perspective. Alcohol Clin Exp Res 28(5) Supplement:29S-37S. Continuing Brain Ronald E. Dahl, MD Associate Professor of Psychiatry and Pediatrics University of Pittsburgh Medical Center Pittsburgh, Pennsylvania Over the past 100-200 years, the age at which puberty begins has been declining, especially among girls. For example, at the beginning of the 20th century the average age of menarche was 16-17 years—it is now occurring on average at age 12.5 years. The onset of puberty activates new drives, impulses, and emotions as well as changes in motivation. But some neurobehavioral systems—including frontal brain systems that underpin self-control and mature judgment regarding long-term goals and consequences—continue to mature well through late adolescence into early adulthood. Thus, the drives, impulses, emotions, and changes in motivation that accompany puberty arise before self control and judgment are fully developed. The complex neurobehavioral changes that occur in
adolescence interact with the social context
of
adolescence in ways that may further increase risk.
While adolescents are typically dealing with increasingly difficult
decision-making and challenges to self-control, external constraints on
behavior are falling away. For example, the biologic tendency to stay up
later that accompanies puberty often interacts with greater self-selection
of bedtimes to create severe sleep deprivation for many high school
students.
Sleep deprivation, in turn, has a negative impact on the brain
systems necessary for mature judgment. Taken together, the early onset of puberty; the
appearance of drives, impulses, and emotions before the appearance of
self-control and mature judgment; and the decrease in external constraints
that attends the beginning of adolescence increase the risk of a number of
health problems including alcohol and other drug use. Approaches to
prevention and strategies for early identification of children at risk
should consider biological, psychological, and social development as well
as the interaction between these factors in determining vulnerability to a
variety of health threats. · Over the past 100-200 years, the age at which puberty
begins has been declining, especially among girls. · The drives, impulses, and emotions as well as changes in motivation that accompany puberty arise before self-control and judgment are fully developed. · The complex neurobehavioral changes that occur in
adolescence interact with the social context
of
adolescence in ways that may further increase risk. This summary was prepared from Dr. Dahl’s presentation at the National Conference of the Leadership initiative, March 2000. Dr. Dahl is currently supported on NIAAA grant RO1AA12504—Sleep/Arousal in Adolescents: Pathways to Alcohol Abuse.
Children’s Images Mark S. Goldman, PhD Distinguished Research Professor of
Psychology University of South Florida Tampa, Florida Information stored in memory prepares people for the
circumstances they encounter. Otherwise, every moment would be an
entirely new experience requiring thought and planning. This type of
information is called “expectancies” and is believed to operate
more or less “automatically” — that is, without conscious thought. It is becoming increasingly clear that expectancies
play an important role in alcohol use and related problems. Expectancies
about the effects of alcohol are highly related to individual drinking
habits. Individuals with strong positive alcohol expectancies drink more
and are at greater risk for problem drinking patterns. Children begin to acquire alcohol expectancies at a
very young age (perhaps as young as 3 or 4 years old). In early
childhood, alcohol expectancies tend to be negative (e.g., alcohol makes
one sick, mean, and argumentative). However, by fifth and sixth grade,
these expectancies turn positive, focusing on the arousing and positive
effects of alcohol use (e.g., alcohol makes one social, happy, and
sexy).
Thus, alcohol expectancies are largely positive by the time
experimentation with alcohol begins. · Information stored in memory prepares people for the
circumstances they encounter. This type of information is called
“expectancies.” · Individuals with strong positive alcohol expectancies
drink more and are at greater risk for problem drinking patterns. · Children begin to acquire alcohol expectancies at a
very young age. All children in our culture develop alcohol
expectancies whether or not they have had any personal experience with
consuming alcoholic beverages. When these expectancies are
strong and positive, individuals are more likely to begin drinking early
in adolescence and to get into difficulties with alcohol use. Researchers
are now studying methods to alter children’s alcohol expectancies and
thereby to decrease the risk of early onset of use and abusive
drinking. Dunn ME, Goldman MS. 1998. Age and drinking-related differences in the memory organization of alcohol expectancies in 3rd-, 6th-, 9th-, and 12th grade children. J Consult Clin Psychol 66(3): 579-85.
One in Four U.S. Bridget F. Grant, PhD Chief of Biometry Division of Biometry and Epidemiology National Institute on Alcohol Abuse and
Alcoholism Bethesda, Maryland The harmful effects of alcoholism extend far beyond those experienced by alcoholics themselves. For example, children in families affected by alcohol often live in environments that are stressful, chaotic, and frightening. Frequently they are neglected or abused and face economic hardship and social isolation as well. Studies show that children of alcoholics are vulnerable to mental illness and medical problems and are more likely than others to become alcoholic themselves. In 1992, the National Institute on Alcohol Abuse and
Alcoholism conducted the largest national survey on alcohol use ever
performed in the U.S. or elsewhere. This research revealed that almost 14
million U.S. adults meet the criteria for a diagnosis of alcoholism or
alcohol abuse.
Given the magnitude of alcohol disorders among U.S. adults and the
potential risk they pose for the children in their families,
epidemiologists sought to determine how many U.S. residents aged 17 or
younger are exposed to alcoholism or alcohol abuse by a family member. Using data from the 1992 survey, epidemiologists
recently estimated that more than 28 million U.S. children under 18
(almost 43 percent) lived in households with 1 or more adults who had been
alcoholics or alcohol abusers at some time in their lives. About 10
million of those children (approximately 15 percent) lived in households
with an adult diagnosed with alcoholism or alcohol abuse in the past
year.
Based on these two figures, it is estimated that 1 in 4 U.S.
children (19 million children), before the age of 18, lives in a family
with a member who is an alcoholic or abuses alcohol. · One in four youth, or 19 million kids, is exposed to
family alcoholism or alcohol abuse some time before the age of 18. · Children in families affected by alcohol often live
in environments that are stressful, chaotic, and frightening. · Children of alcoholics are vulnerable to mental
illness and medical problems and are more likely than others to become
alcoholic themselves. Social and health services for children of alcoholics are fragmented and often fail to address the far-reaching effects of familial alcohol exposure. The findings described here illustrate the urgent need to establish a comprehensive strategy for children at risk. Grant BF. 2000. Estimates of US children exposed to alcohol abuse and dependence in the family. Am J Public Health 90(1): 112-115.
Policy Changes Alexander C. Wagenaar, PhD Professor and Director Alcohol Epidemiology Program University of Minnesota Minneapolis, Minnesota Communities Mobilizing for Change on Alcohol (CMCA),
a 6-year trial funded by the National Institute on Alcohol Abuse and
Alcoholism, was designed to reduce drinking by young people. Rather than
using the traditional approach to preventing underage drinking — that is,
focusing on the demand for alcohol by young people — CMCA intervened in
the supply of alcohol. The study was conducted in 15 small-to-midsize
Minnesota and Wisconsin communities. Seven of the communities were randomly
selected for the intervention. These communities organized to change
local policies that affected supply of alcohol to youth and made underage
drinking less acceptable in the local culture. The remaining
eight communities served as controls. Compared with the control communities, CMCA
communities had (1) less drinking by 18- to 20-year-olds, (2) reduced sale
of alcohol to minors, (3) reduced provision of alcohol to younger
adolescents by older adolescents, and (4) more identification-checking by
alcohol merchants, who also were less likely to sell to minors. This randomized study shows that typical communities
can mobilize to significantly reduce youths’ access to alcohol. The
communities involved had paid little attention to issues surrounding youth
drinking before they were approached by the researchers. Thus, the
positive outcomes achieved in the CMCA intervention do not appear to be based on
factors that existed in the communities prior to the
trial. These findings suggest the potential for other typical communities
to achieve similar results. · Rather than focusing on the demand for alcohol by
young people, CMCA communities intervened in the supply of alcohol. · CMCA communities had
(1) less drinking by 18- to 20-year-olds, · These findings suggest the potential for other
typical communities to achieve similar results. Wagenaar AC,
Murray DM, Gehan JP, Wolfson M, Forster JL,
Toomey TL, Perry CL, Jones-Webb R. 2000. Communities mobilizing for change
on alcohol: Outcomes from
a randomized community trial.
Impact of the Minimum Legal Drinking Age Assistant Professor of Epidemiology University of Minnesota, Minneapolis, Minnesota For most of our Nation’s history, the drinking age was largely ignored as a public policy issue. During the late 1960s and early 1970s, most States lowered the drinking age in response to public pressure. When the drinking age was lowered, the number of
traffic fatalities among young people increased, prompting concern that
young people were traveling between States in order to drink legally. The legal
drinking age came to be viewed as a public health issue rather than as a
legal, ceremonial, or symbolic milestone. A limited number of States in the late 1970s and
early 1980s raised the minimum legal drinking age (MLDA) to 21. Studies in
these States showed reductions in alcohol-related traffic crashes, a
leading indicator of youth drinking. As a result of this research evidence,
the Federal Government passed legislation that would withhold funding
unless a State raised the MLDA to 21. Since the 1970s, at least 70 studies have explicitly examined the effects of either increases or decreases in the MLDA. Rigorous studies typically demonstrated increases in alcohol use among youth following a lowered MLDA. In contrast, when many States raised the MLDA, alcohol use among youth decreased. A national study also found that the lower rates of alcohol use due to a high legal drinking age continued even after individuals turned 21. Researchers have investigated whether increases in
the MLDA affect changes in alcohol-related problems other than traffic
crashes.
One study found a 16 percent decrease in rates of vandalism in
four States that raised the MLDA. Another study found lower rates of death
from suicides, pedestrian accidents, and other injuries in States with
higher MLDA.
Current research estimates suggest that the age 21 MLDA saves the
lives of over 1,000 youth each year and prevents countless traffic crashes
and injuries. · Numerous studies have demonstrated that raising the
minimum drinking age reduces alcohol consumption and related problems
among youth. · The positive effects of the age 21 minimum drinking
age on youth drinking persist even after individuals turned 21. · Consistent enforcement of the minimum drinking age
would increase the positive effects of The dramatic positive effects of the age 21 MLDA have
been realized even though these laws are poorly enforced. For example,
studies show that buyers who appear younger than 21 successfully purchase
alcohol from licensed establishments without showing age
identification in 50 percent or more of their attempts. Also,
although many youth purchase alcohol themselves, most youth indicate that
they obtain alcohol through friends, siblings, parents, coworkers,
and strangers approached outside of alcohol establishments. It is clear
that to
maximize the benefit derived from the MLDA, it must be
enforced. Toomey TL, Rosenfeld C, Wagenaar AC. 1996. Minimum legal
drinking age: History, effects, and ongoing debate. Alcohol
Health Res World 20(4): 213-218.
Why Kids Drink— William B. Hansen, PhD Social norms are standards or guides that define correct and incorrect behavior in a given situation. Norms embody sentiments that citizens within a given culture hold about what is proper and appropriate. Although there is no law that says we must shake hands when introduced to someone, most of us do because that is the norm in American culture. In other cultures this same behavior is considered rude. Norms are reflected in our beliefs about what “most
people like us do,” and these beliefs have a strong impact on our
behavior.
But what does this all have to do with alcohol use among children
and young adolescents? If you ask 6th-graders what proportion of 6th-graders
they believe drink, the average answer will be approximately “one-half” —
well above the actual figure of 20 percent. Students who overestimate the
proportion of drinkers are more likely to drink compared with those
students who have correct or low estimates of drinking levels. In other
words, students’ drinking behavior is shaped by their normative beliefs —
beliefs that are often wrong. If normative beliefs are important in shaping alcohol
use, and if these beliefs are often incorrect and exaggerated, then it
follows that we can reduce alcohol use through strategies that correct
erroneous normative beliefs. Consider a program that gathers data on actual
alcohol use rates from 7th graders. These data are then fed back to
students and used in debates and discussions about the appropriateness of
alcohol use among people their age. A study of the effects of such a
program showed significant reductions in alcohol use, drunkenness, and
alcohol-related problems, such as fights, and getting into trouble at home
or school.
Youngsters in a comparison group that received instruction in
resisting peer pressure increased their alcohol use as if there had been
no instruction.
It appears that the pressure to drink is literally inside the young
person’s head, stemming from the pressure to conform to normative beliefs
about alcohol use. · The average 6th grader believes that half of his or
her peers drink alcohol — well above the actual figure of 20 percent. · Students who overestimate the proportion of drinkers
are more likely to drink compared with those students who have correct or
low estimates of drinking levels. · The pressure to drink is literally inside the young
person’s head, stemming from the pressure to conform to normative beliefs
about alcohol use. As a society, we do a fairly poor job of shaping
children’s normative beliefs about alcohol. When we fail to make our expectations
clear, when we tolerate alcohol sales to minors, when we are indifferent
to the media messages children receive about drinking, or when we
ourselves use or serve alcohol irresponsibly, we contribute to children’s
erroneous beliefs about drinking. Current research is exploring methods
for altering normative beliefs about alcohol both in the classroom and in
the larger community. Hansen WB, Graham JW. 1991. Preventing alcohol, marijuana, and
cigarette use among adolescents: peer pressure resistance training versus
establishing conservative norms. Prev Med 20(3): 414-430. Project Northland— Program to Prevent Carolyn L. Williams, PhD Project Northland, funded by the NIAAA, was the
largest ongoing community alcohol prevention research project in the
United States during the last 10 years. The project focused on primary
prevention of alcohol-related problems using multilevel,
multicomponent interventions with both demand and supply reduction
strategies for the 6th through 12th grades. The rationale for the project derived from the
premise that underage drinking behaviors are influenced by multiple levels
of the social environment (e.g., individual, family, peer group, school,
and community).
Thus, a comprehensive intervention is required. The project’s
interventions for early adolescence began during sixth grade and
continued through eighth grade. The interventions included
implementation of multiyear school-based prevention curricula, intensive
parental involvement, multiple peer leadership opportunities, and
community-level changes through the formation of task forces. The initial Project Northland intervention, Slick
Tracy, was conducted primarily with parents and young adolescents in
their homes.
The intervention was presented in four activity books featuring a
comic narrative about the adventures of teen detectives, Slick Tracy
and Breathtest Mahoney, who relayed weekly themes through an
adventure.
The program’s four booklets focused on factual information about
underage drinking, the influence of role models, peer pressure, and family
guidelines. The seventh-grade program, Amazing Alternatives!, was
a school-based intervention to develop skills for dealing with peers and
to build positive peer group influences. Amazing
Alternatives! included audiotaped stories of young teens, group
discussions, games, problem-solving exercises, and role plays, many
led by peer leaders. The eighth-grade classroom intervention, PowerLines,
emphasized influences beyond peers and families, empowering young
persons to create healthy changes in their broader communities to
discourage underage drinking, as well as reinforcing skills learned
in the previous years. Each intervention year also included a task force
working on communitywide changes. · The rationale for Project Northland derived from the
premise that underage drinking behaviors are influenced by multiple levels
of the social environment. · The project’s interventions included implementation
of multiyear school-based prevention curricula, intensive parental
involvement, multiple peer leadership opportunities, and community-level
changes through the formation of task forces. · Students who participated in the first 3 years of the
project were less likely to begin using alcohol or to have used alcohol in
the past week or past month. The effectiveness of the Project Northland
interventions was tested with a research design using school districts
randomized to intervention or control conditions. Students who
participated in the first 3 years of the project were less likely to begin
using alcohol or to have used alcohol in the past week or past month. In addition,
Project Northland appeared to be successful in increasing parent-child
communication about the consequences of drinking, increasing
students’ reasons to remain nonusers, reducing peer norms and influences
for use, and introducing skills to resist peer influence. Williams CL, Perry CL,
Farbakhsh K, Veblen-Mortenson S. 1999. Project Northland: comprehensive
alcohol use prevention for young adolescents, their parents, schools,
peers, and communities. J Stud Alcohol Suppl 13: 112-124. Effect of Heavy Sandra Brown, PhD The immediate effects of intoxication on a person’s
ability to think clearly are well known. But long- term, heavy alcohol use may
also have lasting effects on nervous system development in young
people.
Recent studies have begun to evaluate the cognitive functioning of
alcohol-dependent adolescents. In one study, cognitive functioning was examined in
adolescent subjects recruited from inpatient alcohol and drug abuse
treatment centers. These adolescents had used alcohol
heavily during early and middle adolescence when important maturational
changes in the nervous system take place. Matched comparison adolescents who had
no history of alcohol or drug disorders were recruited as controls. The
comparisons were similar to the alcohol- dependent teens on key
educational, economic, and family factors. The alcohol-dependent and comparison adolescents
completed a 2-hour test battery designed to measure verbal and
nonverbal learning and memory, perception of spatial relationships,
language skills, attention, and problem-solving skills. In order to
allow the dependent adolescents time to detoxify, testing took place in
the third week of treatment. The test results revealed subtle to moderate
cognitive deficits associated with repeated heavy alcohol use and
withdrawal during early to middle adolescence. Compared with
matched controls, alcohol-dependent teens showed impaired memory and
altered perception of spatial relationships. Verbal skill
deficits were also found in the alcohol-dependent group. These
results, taken with other studies, suggest that problems with cognitive
functioning are detectable among adolescents with histories of extensive
alcohol use.
These deficits, in turn, may put alcohol-dependent adolescents
at risk for falling farther behind in school, putting them at an even
greater disadvantage relative to nonusers. · Recent studies have begun to evaluate the cognitive functioning of alcohol-dependent adolescents. · Alcohol-dependent teens showed impaired memory,
altered perception of spatial relationships, and verbal skill
deficiencies. · The cognitive effects of alcohol may put
alcohol-dependent adolescents at risk for falling farther behind in
school. Brown SA, Tapert SF, Granholm E, Delis DC. 2000. Neurocognitive functioning of adolescents: Effects of protracted alcohol use. Alcohol Clin Exp Res 24(2): 164–171.
Early Onset of Drinking and Lifetime Alcohol Abuse
and Dependence Chief of Biometry Division of Biometry and Epidemiology National Institute on Alcohol Abuse and
Alcoholism Bethesda, Maryland Much attention has been given to delaying the onset
of drinking as a prevention strategy. Drinking has been associated with a
number of serious health problems including dependence. Other
associated problems include tobacco and other drug use, infrequent condom
use, early and unwanted pregnancy, exposure to sexually transmitted
diseases, violence, depression, and suicide. In 1992, the National Institute on Alcohol Abuse and
Alcoholism conducted the largest national survey on alcohol use ever
performed in the U.S. or elsewhere. Data from this survey have extended our
knowledge of the relation between age at onset of alcohol use and
prevalence of alcohol abuse and dependence in late adolescence and
adulthood.
This study was the first to examine effects of early onset of
drinking in a large, representative sample of the U.S. population. Lifetime alcohol dependence (blue line)
decreased steeply as a function of increasing age at onset of
drinking.
In the total sample, more than 40 percent of respondents who
initiated drinking before age 13 were classified with alcohol dependence
at some time in their lives. · Age at first use of alcohol is a powerful predictor of lifetime alcohol abuse and dependence. · Age at first use is associated with a variety of
other health problems including early and unwanted pregnancy, depression,
and suicide. By contrast, rates
of alcohol dependence among those who started drinking at ages 17 and 18
were 24.5 percent and 16.6 percent, respectively. The results
for lifetime alcohol abuse (red line) were similar to those for
dependence, although the decrease with age was less dramatic. These results suggest that preventive efforts should
be targeted toward the delay of alcohol use onset. The weakness
of such a preventive strategy is the lack of complete understanding as to
why onset of alcohol use is related to the development of alcohol abuse
and dependence. Grant BF,
Dawson DA.
1997.
Age at onset of alcohol use and its association with DSM-IV alcohol
abuse and dependence: Results from the National Longitudinal Alcohol
Epidemiologic Survey. J Subst Abuse 9: 103-110.
Effects of Moderate Boris Tabakoff, PhD Heavy alcohol consumption is associated with a number
of neurological and behavioral problems in adolescents and adults. Here we
consider the effects of moderate consumption. Moderate consumption of alcohol affects the function
of a variety of brain systems associated with emotion, learning,
motivation, and coordination. These effects can change significantly
as blood alcohol content rises and falls during a given drinking
episode. Moderate alcohol intake can produce effects that
are pleasurable or motivating. But people differ in their reactions to
alcohol.
The same amount of alcohol can produce positive feelings, increased
energy, and reduction of anxiety in some people, but can have an aversive,
sedative, incoordinating, or no effect in others. Decreases in the performance of complex cognitive
tasks generally occur at blood alcohol levels in the range of those
affecting moods and feelings. Alcohol’s short-term effects on memory
occur at higher blood alcohol levels than do effects on performance. It
appears that increasing blood alcohol levels first affect mood states,
then performance, and then memory. A number of studies have noted impaired
cognitive functioning in people who regularly drink moderate amounts of
alcohol.
However, other studies have not found such effects. Moderate
consumption of alcohol by pregnant women can have significant
negative effects on the developing nervous system of the fetus. Multiple
factors play important roles in determining the effect of alcohol on the
developing central nervous system, and different factors may be important
in different fetal alcohol effects. These factors may include
gestational period, total alcohol consumption at a particular point during
pregnancy, genetic factors, and so on. · Moderate consumption of alcohol affects the function
of a variety of brain systems associated with · emotion, learning, motivation, and coordination. · The same amount of alcohol can produce positive
feelings, increased energy, and reduction of anxiety in some people, but
can have an aversive, sedative, uncoordinating, or no effect in
others. · It appears that increasing blood alcohol levels first
affect mood states, then affect performance, and then affect memory. · A number of studies have noted impaired
cognitive functioning in people who regularly drink moderate amounts of
alcohol.
However, other studies have not found such effects. · Moderate consumption of alcohol by pregnant
women can have significant negative effects on the developing nervous
system of the fetus. Eckardt MJ, File SE, Gessa GL, Grant KA, Guerri C,
Hoffman PL, Kalant H, Koob GF, Li TK, Tabakoff B. 1998. Effects of
moderate alcohol consumption on the central nervous system. Alcohol Clin
Exp Res 22(5): 998-1040. This document was supported by the National Highway Traffic Safety Administration, under the Department of Transportation. NHTSA provides a number of resources for the prevention of underage drinking, including the Community How To Guides On Underage Drinking Prevention. Age of Drinking
Onset, Driving After Drinking, and Involvement in Alcohol-Related Motor
Vehicle Crashes Ralph
Hingson, Sc.D.*, T. Heeren, Ph.D.*, S. Levenson, M.Ed., M.P.H.*, A. Jamanka,
M.P.H*., and R. Voas, Ph.D.** *Social
and Behavioral Sciences Department Boston University
School of Public Health Boston, MA **Pacific
Institute for Research and Evaluation Calverton,
MD There is growing evidence that early onset of
drinking is a powerful predictor of lifetime alcohol abuse and dependence (see
Science, Kids, and Alcohol: Early Onset
of Drinking and Lifetime Alcohol Abuse and Dependence). The study described here assessed the
relationship of early onset of drinking to driving after drinking and
involvement in motor vehicle crashes among individuals aged 18 and older. Data for the study came from the 1992 National
Longitudinal Epidemiologic Survey conducted by the National Institute on
Alcohol Abuse and Alcoholism.
Respondents in this national probability survey were asked whether they
had ever driven after having too much to drink, whether they had ever had
a motor vehicle accident after having too much to drink, and whether either
of these events happened in the last 12 months. They were also asked how old they were when they first started
drinking. The study revealed that adults who started
drinking at age 14 were three times more likely to report driving after
drinking too much ever in their lives than those who began drinking after age
21. Crashes were four times more likely
for those who began drinking at age 14 when compared to those who began
drinking after age 21 (see figure). Even among
persons who never became alcohol dependent – i.e., alcoholics – those
who began drinking by age 14 were significantly more likely than those who
began drinking at age 21 or older to report being in a motor vehicle crash
after drinking. This study suggests that delaying the onset of
alcohol use may result in lower rates of driving after drinking and fewer
alcohol-related crashes. The study
highlights another reason to step up enforcement of the minimum 21-year-old
purchase age and to expand educational and community efforts to delay the onset
of drinking. Hingson, R,
Heeren, T., Levenson, S.,
Jamanka, A, and Voas, R. Age of
Drinking Onset, Driving After Drinking, and Involvement in Alcohol-Related
Motor Vehicle Crashes. DOT HS 809. Springfield, VA: National Technical Information Service, 2001
This document was supported by the Office of Juvenile Justice and Delinquency Prevention, in conjunction with its Enforcing Underage Drinking Laws program. The opinions in this document do not necessarily reflect the official position of the US Department of Justice. Using Alcohol Policy
to Reduce Underage Drinking:
Strategies The Underage Drinking Enforcement
Center Pacific Institute for Research and
Evaluation Calverton, Maryland To a large extent, community environments determine whether and how much young
people drink.1 This environment consists of
the community’s alcohol-related norms and regulations and the availability of
alcohol to young people (see figure).
Policymakers and concerned citizens can help to shape their community
environment to support healthy choices about alcohol use.
Controlling Alcohol Availability to Young People • Enforcement
of laws against underage drinking – Underage drinking laws are
among our most important tools to reduce underage drinking, and the better the enforcement, the better the results. Enforcement efforts are most efficient and
effective when they focus on adults (retailers, parents, older friends) who
provide alcohol to underage drinkers.
Nevertheless, enforcement aimed at young people themselves can send a
message about community norms and may deter them from attempting to buy
alcohol. • Reducing
overall availability – Reducing the overall availability of
alcohol makes alcohol less convenient for young people to obtain. It also sends
a message to young people that alcohol does not have to be the central feature
of social life. One important way to
reduce the overall availability is to reduce the number of alcohol outlets
relative to community size and population.
Communities can also prohibit alcohol
outlets in areas that are frequented by young people, for example, near
schools. Finally, communities can restrict alcohol availability at public
events, such as fairs and festivals or in other public places, such as
beaches and parks. Controlling the Ways in Which Alcohol Is Advertised and Promoted
1 Regulatory Strategies for Preventing
Youth Access to Alcohol: Best
Practices, Washington, D.C.: OJJDP, USDOJ. Presented at OJJDP National
Leadership Conference, 7/11-14/99.
This document was supported by the National Highway Traffic Safety Administration, under the
Department of Transportation. NHTSA provides a number of resources for the prevention of underage
drinking, including the Community How To Guides On Underage Drinking Prevention.
The Effects of Lowered Legal Blood Alcohol Limits for Young Drivers Alexander
Wagenaar, Ph.D.*, Patrick O’Malley, Ph.D.**, and Colette LaFond, J.D.* *School of Public Health University of Minnesota Minneapolis, MN **Institute for Social Research University of Michigan Ann Arbor, Michigan Rates of alcohol-related traffic crashes in the United States have declined significantly in the past 2 decades, among both adults and teenagers. In addition to efforts aimed at controlling driving while intoxicated among all drivers, several initiatives have specifically targeted teenaged drivers. The most successful of these was raising the legal drinking age to 21. Another important effort to reduce traffic crashes among young people was the enactment of laws that reduced the allowable blood alcohol concentration (BAC) for teenaged drivers to very low limits. These laws are often referred to as “zero BAC” or “zero tolerance laws.” In 1995, Congress passed legislation providing that any state not enacting a BAC limit of 0.02 or less for young drivers would lose 5% of its federal highway funds for that year and 10% each subsequent year. The study described here examined the effects of zero BAC laws in 30 states. The study was based on data collected from high school seniors across the United States as part of the Monitoring the Future project.1The results are shown in the figure. Enactment of the zero BAC laws resulted in significant reductions in driving after drinking among young people. The number of incidents of driving after any drinking in the two weeks before the survey dropped by more than 400 incidents (19%), and driving after five or more drinks dropped by more than 300 incidents (23%). Although zero
tolerance laws are clearly effective in reducing impaired driving among young
people, these laws are generally not well enforced, and many young people are
not even aware of them. Research shows
that a public information campaign can increase the deterrent effect of zero BAC
laws. In short, improved enforcement and
education efforts could substantially increase the beneficial effects of the
laws. Wagenaar, A, O’Malley, P, and
LaFond, C. Effects of lowered legal blood alcohol limits for young
drivers: Effects on drinking, driving,
and driving after drinking behaviors in 30 states. American Journal of Public Health 91(5):801-804, 2001. 1 Monitoring the Future has been collecting nationally representative data on each high school senior class since 1975. The sample size for the study was approximately 5,000 students surveyed before the zero BAC laws and 5,000 students surveyed after the laws took effect. – See Johnson, L.D., O’Malley, P.M., and Bachman, J.G. Monitoring the Future: National Survey Results on Drug Use, 1975-2000. Bethesda, MD: National Institute on Drug Abuse, 2001.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) funded the research described in the following summary. NIAAA funds more than 90 percent of the alcohol abuse and addiction (alcoholism) research in the United States. Parental Supervision
And Teen Drinking
1 Kenneth
Beck1, Teresa Shattuck1, Denise Haynie2, Aria Davis Crump1, and Bruce Simmons-Morton2 1Department of Public and Community Health Education, University of
Maryland, College Park 2 Prevention Research Branch, Division of Epidemiology Statistics
and Prevention Research, National Institute of Child Health and Human
Development It is widely suggested that close
parental supervision may reduce adolescent alcohol use. The current study assessed associations
between parent’s monitoring strategies and self-reported drinking behaviors of
their adolescent children. Interviews
were conducted in a random sample of households in Maryland. Households were eligible if a parent and at
least one adolescent aged 14 to 19 resided in the home 2 weeks or more per
month. A total of 454 matched
parent-adolescent pairs provided data for the survey, with a response rate of
about 60 percent. Monitoring was measured by six questions that
asked how often the parent: 1) monitors
with whom their teen spends free time, 2) monitors how the teen spends free
time, 3) sets a time when the teen is expected home, 4) monitors when the teen
comes home, 5) determines if other parents are present at teen parties, and 6)
supervises teen parties given in their homes.
For each item, parents were classified as either
those who always monitor or those who monitor less than always. Teens were categorized as “drinkers” if they
reported any alcohol use in the past 12 months. The figure presents the relationship
between parents’ supervision strategies and their teens’ drinking
behaviors. In all cases, drinking teens
are more likely to have parents who do not always supervise
them. The strategy, “determines if
other parents are present at parties,” significantly discriminated between
drinkers and non-drinkers. Because the study was conducted at a
single point in time, it is not
possible to determine whether parental supervision and youth drinking are
causally related. In addition, the low
response rate indicates that truly dysfunctional families or parents reluctant
to reveal their parenting practices may have been missed. Nevertheless, the study strongly suggests
that improving parental monitoring through parent education, support groups, and
communication networks can reduce teen drinking. 1 Beck, K., Shattuck, T., Haynie, D., Crump, A., and
Simmons-Morton, B. Associations between
parent awareness, monitoring, enforcement and adolescent involvement with
alcohol. Health Education and Research: Theory and Practice, 14(6):765-775,
1999.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) funded the research described in the following summary. NIAAA funds more than 90 percent of the alcohol abuse and addiction (alcoholism) research in the United States. Drinking and Related Problems: Sex and Race/Ethnicity Eleanor Z.
Hanna1, Hsiao-ye Yi2, Mary Dufour1, and Christine Whitmore2 1National Institutes of Health, National Institute on Alcohol Abuse
and Alcoholism Division
of Biometry and Epidemiology 2Alcohol Epidemiology Data System, CSR Inc. It is commonly assumed that, like their adult
counterparts, boys drink more than girls and white adolescents drink more than
members of other racial/ethnic groups.
This study examined sex and racial/ethnic differences in drinking and
related problems using data from the 1997 Youth Risk Behavior Survey (YRBS), a
nationally representative survey of ninth grade girls and boys attending
schools in the United States. Blacks
and Hispanics are oversampled in order to allow analysis by race. The study found similar rates of current
drinking for boys and girls. The study
also compared the actual number of drinkers in each racial/ethnic group with
the expected numbers given each group’s proportion in the general population. As seen in the table, fewer Blacks, more
Hispanic girls, and more boys in the “other” category are current drinkers
compared to their proportions in the general population. The study also related current drinking to a variety of risk behaviors (e.g., driving after drinking, fighting). Among current drinkers, Blacks, Hispanics, and members of “other” non-white racial/ethnic groups report higher rates of drinking-related risky behavior than do whites. Higher socioeconomic status (indexed by mother’s education level) is associated with reductions in risk behavior. The results suggest that prevention planners
should not assume that girls and non-white adolescents are at lower risk for
drinking and related problems. The
drinking patterns of Hispanic girls, in particular, contradict this
assumption. The study also supports
the hypothesis that Blacks and Hispanics, because they tend to be concentrated
in areas associated with risk factors for drinking (e.g., poverty, billboard
advertising, greater numbers of off-premise sales establishments) may
experience a greater number of alcohol-related problems than whites.1 Hanna, E., Hsiao-ye, Y.,
DuFour, M., and Whitmore, C. Risky
Behavior by Sex and Race Among Currently Drinking Ninth Graders in the United
States: Results from the 1997 Youth
Risk Behavior Survey (YRBS). Poster
presented at the 23rd Annual Scientific Meeting of the Research Society on
Alcoholism, June 24-29, 2000, Denver, Co. 1 Wallace JM. The social ecology of addiction: race, risk,
and resilience. Pediatrics, 103:1122-1127, 1999
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) funded the research described in the following summary. NIAAA funds more than 90 percent of the alcohol abuse and addiction (alcoholism) research in the United States. Changes in Brain Activity in Alcohol-Dependent Young Women Susan F.
Tapert, Gregory G. Brown, Sandra S. Kinderman, Eric H. Cheung, Lawrence R.
Frank, and Sandra A. Brown. VA San
Diego Health System and the Imaging studies of alcohol dependent
adults have revealed a number of brain abnormalities. However, it has been unclear when in the course of alcohol
dependence or at what age such abnormalities appear. The study reported here sought to reveal possible changes in the
brains of alcohol dependent young women that might underlie the deficits in
cognitive functioning observed in other studies of young drinkers.1
Young women were chosen for this study
because other research has suggested heightened sensitivity of the female brain
to alcohol effects. Participants were 10 women with
histories of alcohol dependence and 10 healthy controls, all between the ages
of 18 and 25. In the 3 months before
data collection, the alcohol dependent women were primarily weekend binge
drinkers. Seven of the ten met DSM-IV
criteria for current alcohol dependence, and three had been abstinent for 6
months or longer. After a minimum of 72 hours of abstinence from alcohol, functional magnetic resonance imaging (fMRI) data were collected while participants engaged in a spatial working memory task (memory for the position of objects in space). Compared to controls, the alcohol-dependent young women showed decreased activity in the areas of the brain associated with memory. These decreases were most pronounced in young women who had experienced alcohol withdrawal symptoms at some time in the past. This study suggests alcohol
dependency in young women is associated with decreases in brain activity. The study also suggests that heavy drinking
leading to withdrawal poses particular threats to brain functioning. The researchers stress the need for similar
studies with younger adolescents in order to determine how early
drinking-related brain consequences can be detected. Tapert, S., Brown, G., Kinderman,
S., Cheung, E., Frank, L., and Brown., S.
fMRI measurement of brain dysfunction in alcohol-dependent young
women. Alcoholism: Clinical and Experimental
Research, 25(2):236-245, 2001. 1 See Science, Kids, And Alcohol - Heavy
Alcohol Use and Nervous System Development.
This document was supported by
the Office of Juvenile Justice and Delinquency Prevention, in conjunction with
its Enforcing Underage Drinking Laws program.
The opinions in this document do not necessarily reflect the official position
of the US Department of Justice. Enforcement of Underage Drinking Laws: Strategies that Work The Underage Drinking Enforcement
Center Pacific Institute for Research and
Evaluation Calverton, Maryland Laws establishing 21 as the minimum purchase age for alcohol (adopted in all states by 1988) have been shown to be extremely effective in reducing underage alcohol consumption and its consequences1. National Highway Safety Trafic Association (NHTSA). 2007. Traffic Safety Facts 2006— Young Drivers. Washington, DC: NHTSA, National Center for Statistics and Analysis. 2 ,3 Despite
the effectiveness of 21-year-old purchase age laws, more vigorous enforcement
would further reduce underage drinking and save even more young lives. Evaluations have shown repeatedly that when
the following techniques are applied, rates of sales to minors drop dramatically: Enforcement
aimed at retailers
Enforcement
aimed at other sources of alcohol those kegs. Enforcement
aimed at young people 1 O’Malley,
P., and Wagenaar, A. Effects of minimum drinking age laws on alcohol use,
related behaviors, and traffic crash involvement among American youth
1976-1987. Journal of Studies on Alcohol, 4:807-818, 1991 2 3 Parker,
M., and Rebhun, L. Alcohol and Homicide: A Deadly combination of Two
American Traditions. Albany, NY: State University of New York Press, 1995. 4 Mosher, J. The
merchants, not the customers: Resisting the alcohol and tobacco industries’
strategy to blame young people for illegal alcohol and tobacco sales. Journal
of Public Health Policy, 16(4):412-432, 1995.
Abstracted for the Leadership to Keep Children Alcohol Free Drinking and Domestic Violence Nationally representative surveys indicate that one in six couples experiences an incident of partner-to-partner violence each year. Thus, domestic violence constitutes a significant public health concern. Researchers have long noted a relationship between heavy alcohol consumption and domestic violence. Some have suggested that problem alcohol use and domestic violence often occur together because the same personality characteristics put people at risk for both behaviors.Others have suggested that heavy alcohol consumption contributes to unhappy and conflict-ridden domestic environments, which in turn lead to violence. However, recent studies suggest that the relationship between problem drinking and domestic violence is causal and direct – that is, alcohol consumption directly contributes to the frequency and severity of domestic violence. The first study 1 examined the day-to-day occurrence of drinking and partner violence among couples who had experienced at least one episode of male-to-female aggression in the previous year. Data on drinking and aggression were gathered over a 15-month period through the use of diaries kept by both partners and quarterly interviews with each partner. The odds of male-to-female violence increased 8- to 11-fold on drinking days. The second study 2 followed 366 newlywed couples over a 1-year period. Assessments at the time of marriage measured factors associated with marital violence. Interviews conducted at the 1-year anniversary revealed strong associations between husbands who drank and episodes of physical violence (although not verbal aggression). In conclusion, the results of the present study strongly support an association between husband drinking and the occurrence of marital aggression, but not between wife drinking and the occurrence of aggression. In both studies, the results were sustained even when other factors that might cause both drinking and violence were statistically controlled. Thus, both studies suggest a direct, causal relationship between male drinking and male-to-female partner violence. These findings suggest that strategies that reduce the alcohol consumption of male partners (including both prevention and treatment) can directly contribute to reductions in domestic violence.
2 Leonard, K., and Quigley, B.Drinking and marital aggression in newlyweds: An event-based analysis and the occurrence of husband marital aggression. Journal of Studies on Alcohol, 60:537-535, 1999. 3 Grant BF. Estimates of US children exposed to alcohol abuse and dependence in the family. American Journal of Public Health 90(1): 112-115, 2000. 4 U.S. Department of Justice. Bureau of Justice Statistics. National Crime Victimization Survey 2002. http://www.ojp.usdoj.gov/bjs/cvict_c.htm (accessed online August 28, 2003).
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