When Teenagers Drink, Avoiding the Risks From Driving

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The Checkup

My youngest child was starting sixth grade when we moved to New York City and, naturally, I worried about what challenges the big city might have in store. But when it comes to adolescence, there is at least one major advantage to being a parent in Manhattan: Kids don’t have access to cars.

This is not parental paranoia. The mix of drinking and driving is as dangerous to adolescents as you think it is, dangerous when the adolescents are driving, and also when they are passengers. Dr. Scott Hadland, an adolescent and addiction medicine specialist at Boston Medical Center, said that alcohol is a factor in half of the deaths of people under 21 from motor vehicle crashes. Those deaths are about an equal mix of drivers and passengers, and in many of the passenger deaths, the driver was 21 or older.

“The vast majority of people under the age of 21 dying in car crashes are dying in evenings, on weekends,” he said. “It’s a high risk time to be out on the road.”

A study published in February in the journal Pediatrics that looked at deaths among people under 21 years old in motor vehicle crashes involving alcohol found that, as a whole, more restrictive policies about drinking were associated with fewer deaths. The policies included a wide array of rules and regulations. Some specifically targeted youth drinking or youth driving, like graduated licensing laws. Others were aimed at the general population, including such measures as excise taxes on alcohol, or restrictions on locations where alcohol can be sold, on advertising, or on the permissible density of liquor establishments.

For each state, they looked at the proportion of motor vehicle deaths associated with alcohol in at least one driver. This was a way of correcting for underlying disparities, since some states have longer distances, more driving and other factors that can affect the absolute number of highway deaths.

Dr. Hadland, who was the first author on the study, said that he was initially drawn to the question because he was thinking about the states that are legalizing marijuana for recreational purposes and wanted to understand what has been shown to be effective as far as policies that reduce the risks of drinking and driving.

Previous studies have often looked at individual policies in isolation, trying to measure what happened before and after a particular law was put in place, “but we wanted to know what’s the overall effect of multiple policies acting at once,” he said. The result: “It’s really the collection of them all that seems to be effective.”

Dr. Tim Naimi, a physician and alcohol researcher at Boston Medical Center and senior author of the recent paper, said, “What parents do — the way they drink and whether they drink at all — is more important than what they might say about alcohol.” Genetic factors in alcoholism, he said, have been emphasized too strongly, and even when there is a strong family history of alcohol problems, parents can model good and sensible behavior in the home: “A lot more than genetics runs in families.”

There is also a relationship between the way that kids drink and the way that their peers drink, though it’s hard to argue cause and effect; adolescents may be influenced by the practices of their peers, but they may also choose to associate with those whose habits most appeal to them.

Every parent of every adolescent, I would bet, at some point lies awake and worries about the mixing of alcohol and driving, whether you’re worrying about your own child drinking, or about someone else who’s driving, or even about the danger of someone in another car altogether. We know this is a toxic and often fatal mixture, even when the driver is over 21.

We also know that it’s one of the places where you come across the basic necessities of parental guidance: you have to tell your children what not to do (go to parties where alcohol is illegally served to minors, binge drink or hang out with binge drinkers) and then you have to tell them what to do when they have broken the rules you set.

That’s not new, that essential often-to-be-repeated-until-your-child-is-sick-of-hearing-it-but-has-it-irreversibly-stamped-on-the-neurons advice: Don’t drink, don’t hang out with people who drink, but if you do, call me and I’ll come pick you up, no questions asked. Nowadays, of course, depending on where you live, you can offer the easier and more anonymous safety valve of Uber, or some other ride service; parents who can afford it might consider paying for an account through high school and college so there is always a ride home available.

It’s a useful, if difficult, form of advice to learn how to give: Don’t under any circumstances do this, but if you do, stay safe. But yes, Dr. Hadland said, you can highlight both messages. “The data that have come out in the time since this generation’s parents were teenagers really demonstrates the harm of drinking at a young age,” he said, from the increased risk of long-term problems with alcohol to the changes in brain structure and function that we see in people who drink heavily during adolescence.

But when someone does drink — your child or your child’s friends — finding a safe way home comes first. And adolescents need to have that safe way home planned, and they need to know that if it comes down to contacting a parent, the parent would rather be contacted than not.

Dr. Hadland said that when he talks about drinking with his teenage patients, “we strategize around safe ride approaches,” including using ride share services. He frames it, he said, as a concerned doctor: “I’m very worried about the risk to their health and well-being when they get into a car with someone who’s been drinking or they operate a car when they themselves have been drinking,” he said.

Parents — and pediatricians — need to negotiate those complex double messages of don’t do this and stay safe even if you do. Adults need to model responsible, law-abiding behavior. And around all that, cities and states need policies and protections that cumulatively make the world safer for everyone, especially those who are growing up and learning to navigate.