July 31, 2017
American adolescents are binge drinking less than they used to, according to a new report.
“It’s good news,” said Bohyun Joy Jang, a researcher at the Institute for Social Research at the University of Michigan, and the first author of a study that appeared in the May issue of the journal Pediatrics. The bad news, Dr. Jang said, is that frequent binge drinking is not decreasing as rapidly among members of lower socioeconomic groups, African-Americans and girls.
The study showed that “frequent binge drinking” — at least two occasions of drinking five or more drinks in a row over the past two weeks — decreased among American adolescents over the period from 1991 to 2015. The study found, however, that drinking rates are decreasing faster among the economically better-off, and among boys.
“Maybe some policy or some other intervention or prevention has worked,” Dr. Jang said. But it is “not equally effective across all these populations.” The study was funded by the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism.
The kinds of policies that are aimed at reducing underage alcohol consumption include stronger laws about ID checks, minimum ages for alcohol sellers, servers and bartenders, and keg registration requirements. And of course, there have been numerous efforts made to educate adolescents about the risks of heavy alcohol use.
Dr. Jang said that adolescent drinking and binge drinking have been decreasing since the early 2000s, but that this study shows a decrease specifically in the pattern of frequent binge drinking.
“The overall declines in frequent binge drinking indicate that national and state-level policies and programs targeted at underage drinking may have been effective, although I’m not sure to what extent each of the policies specifically contributes to the declines,” Dr. Jang said.
The differential effects on different populations, however, are worrying. “One of the crucial messages from our study is that the public efforts may not be reaching all adolescents equally,” Dr. Jang said. So the researchers would like to see more attention — from parents, from health care providers and from researchers — to the populations that are not being reached as successfully: black adolescents, young women and people from lower socioeconomic backgrounds.
“I think this is a real public health success that hasn’t actually been really celebrated,” said Dr. Scott Hadland, a pediatrician and adolescent addiction specialist at the Grayken Center for Addiction Medicine at Boston Medical Center, who was a co-author of a commentary on the study. And it’s not just alcohol use that has declined. “Rates of teen use and, for most substances, rates of teen heavy use have declined,” he said, steadily since about the 1990s. The exception, he said, is marijuana; daily use and near-daily use of that drug have increased, while perceptions of harm have decreased.
In the late ’90s, he said, about one in two high school seniors reported having used alcohol in the last 30 days, whereas in 2016, it was down to one in three.
Binge drinking, he said, has declined notably among all age groups. “More teens than ever are expressing disapproval around binge drinking, fewer teens than ever are reporting that alcohol is readily available, easy to get,” he said. But he agreed with other experts’ concerns about the ways that the improvements were more significant in some groups than in others. “The public health successes are not being equally shared by everybody.”
This is one of the first papers to really look carefully at drinking in this kind of detail, he said. And it’s important, even while we celebrate the public health success we think is connected to effective messaging and good preventive care, to think about whether there are adolescents cut off from the potential benefits of anti-drinking programs.
“Not all youth have the same access to high quality care and to high-quality screening and referral services,” Dr. Hadland said. “We need to think about whether our school systems have equal access to high-quality preventive messaging, whether our schools are managing this problem equally and across the board for all youth.”
How can parents best help their teenagers navigate this issue and keep an eye out for trouble?
“I’m also a parent, and I have been asked a lot of those kinds of questions by my friends and my co-workers,” Dr. Jang said. She pointed to the important role of screening at health care visits.
“We have to talk with the practitioners at the regular checkup because there are these short checkup guidelines so practitioners can see whether the child has any problems or not,” she said. The National Institute on Alcohol Abuse and Alcoholism publishes a guide for practitioners on how to screen young people relatively quickly for alcohol problems and intervene when necessary.
Dr. Hadland acknowledged that parents can feel that they are being asked to give contradictory messages.
“What I say to teens and what I recommend that parents reinforce with teens,” he said, “is first and foremost, for your health it’s best not to drink or to use any substances. We have data underlying that.” But then there has to be a second message, particularly for young people who are drinking: “I say, for your health, I recommend that you reduce the amount that you drink and you drink less often to reduce the harms of drinking.”
In addition, of course, there are other essential messages about how to take care of yourself if you are drinking, especially regarding safe rides home, protected sex practices and mental health.
“I do think it is really important in these conversations with teens to help reset their understanding of what is excessive drinking,” he said. Adolescents may not be measuring their alcohol intake by the same standards as researchers.
“Many of the teens I care for are not measuring alcohol as we would,” Dr. Hadland said. “They’ll tell me oh, just one or two drinks, but if you drill down you realize each of those may have four or five ounces of hard liquor.” Researchers define a drink as containing 12 ounces of beer, five ounces of wine or one-and-a-half ounces of hard liquor.
Dr. Hadland also uses hist conversations with young patients to talk about the consequences of heavy drinking. The top three causes of death in adolescence are motor vehicle crashes, homicide and suicide, and he said alcohol can be a contributing factor in all three.
The long-term dangers of heavy drinking may be harder for adolescents to grasp, he said, though starting to drink young puts you at risk for long-term addiction. Over the long haul, heavy drinking is linked to many other kinds of illness, from liver disease and heart disease to cancer.
“I say, I’m really having this conversation because I’m worried about you and I want to keep you safe with this drinking.”