It seems to me that problems like this are unlikely to be addressed without facilitating some kind of culture change related to alcohol mores. That our nation's largest prevention program is the designated driver campaign says something about how much we value drinking doesn't it? We don't tell people not to get drunk. We tell them to go ahead and get drunk, just don't drive. The campaign is constructed to protect something our culture values. There's also a strong association between this and weekends. It's deserved after a week of hard work, it's how we unwind, and that it's part of the American dream to kick back with family and friends with a case of Bud, a bottle of wine, or an appletini. (In most cases this is not a drink with a meal.)
BTW - While listening to the recent suggestions that lowering the age would lead to healthier drinking on college campuses, I kept coming back to this issue of alcohol's place in our culture.
UPDATE - Of course, taxes could be an important tool for addressing underage drinking and binge drinking. However, a move in that direction would be an expression of values, and those are especially difficult to agree on in this area. Michigan has been in financial crisis for several years and proposed increases have been repeatedly killed.
This map suggests a pretty strong relationship between alcohol taxes and alcohol related problems.
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