Special report: Under-age drinking (U.K.)

Independent Online Edition >England is also experiencing problems with underage drinking. In England 18 year olds can purchase alcohol and 16 year olds can drink alcohol in s restaurant, if the alcohol was purchased by a parent.

Amid growing concerns over 24-hour drinking, soaring rates of liver disease and police forces unable to cope with drunken disturbances on the streets, an exclusive Independent on Sunday investigation today reveals the dramatic rise in children admitted to hospital because of alcohol-related illnesses.

The biggest increase is seen among girls under 16 years old, with a 25 per cent increase between 2002/03 and 2004/05. And the problem is getting worse: hospital admissions for under-18s are at their highest since records began, and the average amount children are drinking every week has doubled since 1990.

Professor Mark Bellis, director of the Centre for Public Health at Liverpool John Moores University and a government adviser on alcohol-related issues, said: "The numbers of underage drinkers in hospital for alcohol-related conditions are substantial but it is only the tip of the iceberg. Many more children are admitted for problems not recorded as alcohol. The admissions include everything from being involved in violence to teenage pregnancies. For every one youth admitted due to alcohol consumption there are many more whose health suffers through excessive alcohol consumption."

The ages of children admitted to hospital for alcohol-related problems are getting lower. The number of eight-year-old-boys who drink has doubled from 5 per cent in 1995 to 10 per cent in 2005. The number of 11-year-old girls who drink has increased from 15 per cent in 1995 to 25 per cent in 2005. Many experts believe country is in the grip of a hidden epidemic - one that, like alcoholics themselves, the country is in denial about.

...

Last year police introduced exclusion zones around the beaches of Polzeath and Rock after residents complained of underage drinking and fighting. Dubbed the "Costa del Sloane", the beaches are a magnet for children from public schools.

A senior policeman with Devon and Cornwall constabulary also spoke out about the underage drinking culture after a mob of 100 youths - some as young as 12 - were caught at a mass boozing session in Falmouth.

The startling rise in underage drinking is already beginning to have repercussions on public health and will continue to do so for future generations unless something is done to curb the alcohol consumption of British children, campaigners say.

Frank Soodeen of the charity Alcohol Concern said: "A recent government report on alcohol-related deaths showed that the biggest group was men and women aged 35-54 - which is far younger than ever before. Clearly it's beginning to catch up at an earlier stage, which is very worrying. Generally the highest proportion a few years ago was well above that age group."

The most serious of these health problems is liver cirrhosis. People in their 20s and 30s are now ending up with serious liver problems which, until recently, were normally seen in people twice those ages.

Professor Ian Gilmore, president of the Royal College of Physicians and a liver specialist at the Royal Liverpool Hospital, said: "Cirrhosis of the liver has increased tenfold since the 1970s. There is a big concern about the rise in deaths from cirrhosis among young people. I think we are going to see big increases in people in their 20s and 30s being diagnosed with liver cirrhosis."

David Mayer, chair of the UK Transplant Liver Advisory Group, warned that young drinkers are storing up a problem for the future and are likely to require his services in years to come. "People have more money and more opportunity to drink from an earlier age and therefore their livers are exposed to chronically high alcohol levels. We are concerned that it's becoming an epidemic. It does take many years to develop cirrhosis, but if you start drinking at an early age you are going to see problems sooner rather than later."

With such a marked increase in child drinking, campaigners are furious over the lack of provision offered to young people such as Hayley in helping to tackle their problems. There are even calls for drying-out clinics to be set up specially for young people.

But Professor Bellis argues that we need to help children long before it reaches that stage. "Waiting until children develop alcohol problems means their health, their education and ultimately their life prospects have already begun to suffer. We need a major shift in our national attitudes towards alcohol."

Caroline Flint, the public health minister, last week claimed that the Government is tackling the problem through "targeted enforcement" - reducing sales to under-18s by bars, off-licences and retailers - as well as education on substance abuse.

But campaigners blame the drinks industry for promoting alcohol as "sexy" to the young. Mr Soodeen said: "The drinks industry plays a big part in the whole issue. We really need to be cutting off the supply to young people. Unfortunately, the drinks industry has been very effective in persuading the Government that a 'voluntary health' approach is the way forward. We find it odd that so much of the packaging on alcopops seems juvenile and the alcohol industry has yet to come up with a credible explanation."

[via: Alcohol and Drugs History Society]

An Honest Conversation About Alcohol

From Inside Higher Ed:

Two months after he finished up as president of Middlebury College in 2004, John M. McCardell Jr. wrote a column for The New York Times called “What Your College President Didn’t Tell You.” In the piece, he discussed how he was “as guilty as any of my colleagues [as presidents] of failing to take bold positions on public matters that merit serious debate.” Taking advantage of his new emeritus status, he proceeded to take a few such positions. Among other things, he wrote that the 21-year-old drinking age is “bad social policy and terrible law,” and that it was having a bad impact on both students and colleges....

The current law, McCardell said in an interview Thursday, is a failure that forces college freshmen to hide their drinking — while colleges must simultaneously pretend that they have fixed students’ drinking problems and that students aren’t drinking. McCardell also argued that the law, by making it impossible for a 19-year-old to enjoy two beers over pizza in a restaurant, leads those 19-year-olds to consume instead in closed dorm rooms and fraternity basements where 2 beers are more likely to turn into 10, and no responsible person may be around to offer help or to stop someone from drinking too much.

I have a few brief reactions. First, I don't have a strong opinion on the matter, other than I'd be troubled by 18 year old high-school students being able to buy alcohol.

In principle, the general idea of a less restrictive drinking law might appeal to Libertarians, but drinking licenses? That'll lose Libertarian support fast.

He makes an argument about current law criminalizing parents who try to teach their kids to drink responsibly. First, is serving alcohol necessary to do this? Second, as we saw a few weeks ago, this isn't illegal in 31 states. Third, when is the last time you heard of parents fined or arrested for allowing their teen to have a glass of wine with dinner?

Some of his arguments are a stretch -- for example, using SAMHSA's increased attention to underage drinking as an argument against the existing policy and implying that there's a relationship between the 21 year old drinking law and younger ages of first use.

The fact that we currently have problems, isn't necessarily a good argument against the status quo. Anyone who's honest with themselves will recognize that there is no such thing as a problem-free drug and alcohol policy. As I've said before in this blog, these drug policy questions are all about trade offs and, recognizing that every policy requires living with some problems, the questions you have to wrestle with are:

• Which problems are intolerable and which are you willing to tolerate?
• How do you make these decisions? (I'd suggest that even responses that purport to be value-free are value laden.)
• Which policy (or combination of policies) best balances these values?

It seems like these discussions would generate more light if people were a little more honest in acknowledging the problems inherent in their pet theory.

Teen drinking laws update

A couple of weeks ago I posted about laws that allow teens to drink with their parents and asked for info on Michigan law. Brian, a student of mine who is also a juvenile probation officer sent this:

I checked into the laws governing underage drinking related to parents here at the courthouse. There are no laws that allow for parents to let their kids drink in any circumstance. However, there are limited exceptions. One is allowed for religious purposes in a religious setting. Another is for educational purposes like in a culinary class for cooking. If a parent provides or allows a kid to drink they can be charged with contributing to the delinquency of a minor or furnishing alcohol to a minor.

Thanks Brian!

Three takes on weed

First, USA Today did it's best to create the impression that there is still a raging debate about marijuana and the gateway theory:

Most users of more addictive drugs, such as cocaine or heroin, started with marijuana, scientists say, and the earlier they started, the greater their risk of becoming addicted.

Many studies have documented a link between smoking marijuana and the later use of "harder" drugs such as heroin and cocaine, but that doesn't necessarily mean marijuana causes addiction to harder drugs.

"Is marijuana a gateway drug? That question has been debated since the time I was in college in the 1960s and is still being debated today," says Harvard University psychiatrist Harrison Pope, director of the Biological Psychiatry Laboratory at Boston's McLean Hospital. "There's just no way scientifically to end that argument one way or the other."

That's because it's impossible to separate marijuana from the environment in which it is smoked, short of randomly assigning people to either smoke pot or abstain — a trial that would be grossly unethical to conduct.

"I would bet you that people who start smoking marijuana earlier are more likely to get into using other drugs," Pope says. Perhaps people who are predisposed to using a variety of drugs start smoking marijuana earlier than others do, he says.

Besides alcohol, often the first drug adolescents abuse, marijuana may simply be the most accessible and least scary choice for a novice susceptible to drug addiction, says Virginia Tech psychologist Bob Stephens.

No matter which side you take in the debate over whether marijuana is a "gateway" to other illicit drugs, you can't argue with "indisputable data" showing that smoking pot affects neuropsychological functioning, such as hand-eye coordination, reaction time and memory, says H. Westley Clark, director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration.

The article ends up hedging its bets and qualifies just about everything she says. I find it hard to argue with the facts presented, but the emphasis and the selective inclusion suggest that the writer might be guilty of hype.

Next, a Canadian publication advocates legalizing and regulating marijuana:

Because of crimes that are related to the drug trade—most notably the killing of the four police officers in Mayerthorpe two years ago—many have been pushing for increased punishment for drug-related crimes recently. While a tactic such as increased jail time would theoretically make criminals think twice before becoming involved in the trade, there’s no statistical evidence that supports this claim.

The fact remains that it’s just too profitable an industry to be deterred by harsher punishment. Instead we need to end this failed experiment called prohibition and regulate most, if not all, drugs.

...The regulated sale of drugs would mean that one of the biggest dangers of drug use, drugs that are laced with more dangerous substances, would be systematically eliminated. As well, it would allow people to find a more accurate description of what they are taking, what it does to them, recommended doses and possible negative side effects. A more honest approach on the effect of these drugs would work better than just saying that drugs kill.

If there’s a demand for illicit drugs, like any other product, why should criminal elements be the ones who profit from it? Marijuana, for example, is more profitable than any other crop in Canada. Instead of letting criminals sell it, using the profits for other nefarious purposes, why doesn’t the Canadian government make it and sell it, eliminating the criminal element in the process? People are still going to buy it either way, after all.

Variations of this proposal a published frequently. At least this version eliminates profit potential. Most versions of this proposal suggest legalizing and regulating private sale, which raises the specter of a marijuana industry with the promotional and lobbying power of the alcohol and tobacco industries. While all variations of legalization models have an uphill battle, one that puts the government in the role of manufacturer and sales seems DOA.

Finally, STATS was riled by the USA Today article. They make several strong rebuttals to the points in the USA Today - if there is a gateway drug it's alcohol; alcohol causes more harm; there's lots of evidence against the gateway theory; most marijuana users experience little or no harm, etc. However, she also inserts her bias and misrepresents the USA Today article:

So, where’s the evidence that marijuana is more harmful than other substances?

The USA Today article didn't argue that marijuana is more harmful, just that it's not harmless. There were enough problems with the article that the straw man tactics we're needed.

Does marijuana contribute to psychotic illness?

Current Psychiatry on marijuana and schizophrenia:

Cannabis and psychosis: 4 clinical pearls Cannabis use increases the risk of developing psychosis and is estimated to double the risk for later schizophrenia (5 to 10 new cases per 10,000 person-years) The association is not an artifact of confounding factors such as prodromal symptoms or concurrent use of other substances (including amphetamines) The risk increases with the frequency and length of use (a dose-effect relationship) Self-medication is not the connection between cannabis use and schizophrenia, according to empiric evidence

I'll keep an eye out for responses to this. It's so hard to know what to trust on something like this. This article seems reasonable, but it feels a little reminiscent of Reefer Madness. Also, the increased risk of schizophrenia may be statistically significant but I find it difficult to get too alarmed about the risk going from 1 in 2000 to 1 in 1000. (Maybe I should be more alarmed. I suppose that you start talking about large numbers when you multiply these numbers by large numbers of users.)

No Child Left Untested?

The ONDCP is starting a new push for random drug testing of athletes in schools. A truly awful idea. This article includes Q & A with representatives from the Drug Policy Alliance and ONDCP. It's a shame that the fringes get the spotlight.

The Michigan High School Athletic Association has weighed in against drug testing.

How kids can drink at home, legally

It was news to me that 31 states permit underage drinking with a parent:

"You can be 10 years old and drink in Virginia," said Beth Straeten, a spokeswoman for the state's Department of Alcoholic Beverage Control.

Surprised?

...Eleven states, Virginia among them, say providing alcohol to an underage son or daughter can only occur in the home. Twenty other states say parents can provide alcohol to their children anywhere.

The Virginia exception was passed during the 2006 legislature. It drew only two negative votes and won the signature of Gov. Timothy M. Kaine.

I was unable to find out what Michigan's law is. I'll post an update if anyone fills me in.

[Update: Jess found what appears to be the relevant Michigan law and there does not seem to be any language that would permit a minor to drink with a parent.]

'Drinko': Anatomy of an Advocacy Campaign

Join Together breaks down the campaign that get Target, Kohl's and Linens 'n Things to stop selling drinking games.

Study: H.S. Teenage Binge Drinking Common Link To Greater Risky Behaviors

A new report on the prevalence of teen binge drinking and the harms associated with it:

The latest study published in the January issue of "Pediatrics" based on the Centers for Disease Control (CDC) study indicates that binge drinking is common among high school students and is linked to a greater participation in several other risky behaviors.

The new study conducted by CDC scientists, Binge Drinking and Associated Health Risk Behaviors Among High School Students, found that 45 percent of high school students admittedly reported to alcohol consumption within the last month. The survey found that 64 percent of these students also reported binge drinking.

Binge drinking is defined as consuming five or more alcoholic drinks in a row within a few hours of time.

The study found that the probability of teenage binge drinkers to be tempted to get involved in other risky behaviors was much higher than that of the nondrinking teens.

These risky behaviors included sexual activity, smoking and physical fighting to name a few.

Although those students who denied any binge drinking were involved in many of the other risky behaviors, the extent to which they were involved was much lower than those students who admitted to binge drinking.

According to CDC researcher, Jacqueline Miller, MD, "Our study clearly shows that it's not just that students drink alcohol, but how much they drink that most strongly affects whether they experience other health and social problems."

The CDC researchers indicated the following comparisons between nondrinking and binge drinking teenagers from their study, with teen binge drinkers being:

• Greater than five times more likely to be sexually active with one or more partners.
• Smokers with 19 times more likelihood to smoke cigarettes.
• Almost four times as likely to engage in physical fights.
• Eleven times more likely to become a passenger in a vehicle being driven by another who has been drinking alcohol.
• Almost four times more likely to date rape or a victim of violence by the opposite sex.
• Four times more likely to attempt suicide.
• At greater risk to use drugs, such as marijuana and cocaine.

The survey also indicated that binge drinking among these teenagers was more common with boys than girls.

The binge drinkers self-admittedly reported poorer grades in school as well.

Overall, the survey included reports of both public and private school students across the entire U.S.

Assertive Continuing Care effectiveness

More evidence for the effectiveness of assertive continuing care (ACC) in adolescents. It's an important emerging recovery management approach:

ACC led to significantly greater continuing care linkage and retention and longer-term abstinence from marijuana. ACC resulted in significantly better adherence to continuing care criteria which, in turn, predicted superior early abstinence. Superior early abstinence outcomes for both conditions predicted longer-term abstinence.

High school drug use predicts job-related outcomes at age 29

A new study finds a relationship between adolescent drug use and job status 10 years later:

Overall, the results suggest that adolescent drug use is linked with poorer occupational and job quality outcomes as much as 10 years after high school. Interestingly, which job-related outcomes are affected by early hard drug use varies by gender. Females who use hard drugs as adolescents end up in lower skill, lower status jobs while males who use hard drugs as adolescents are more likely to end up in jobs with fewer benefits (e.g., health, retirement).

Youngest Drinkers Likelier To Use Alcohol For Stress Relief As Adults

A new study reports on the impact of one risk factor for problem substance use:

The younger someone starts drinking alcoholic beverages, the more likely he or she is to reach for a drink to relieve stress when older, a large new study suggests.

...

Respondents were asked whether they had experienced 12 different types of stressful events in the previous year, such as death of a family member or close friend, unemployment for more than a month, financial crises, legal problems or disruption of a marriage or romantic relationship.

Average daily consumption of alcohol increased by 19 percent with each additional stressful event experienced among those who started drinking at 14 or younger compared with 3 percent among those who took their first drink at 18 or older.

After adjusting for other factors that might be related to the amount of alcohol consumed, the researchers said "the association between stress and volume of consumption was significant only for early initiators."

This Is Your Brain on Drugs, Dad

In an Op-Ed in the New York Times, Mike Males calls for an end to "the obsession with hyping teenage drug use." I have the same reaction every time I read something from him. He always does a good job arguing that we while our attention is on drugs, sex and violence among youth, the biggest problems in these area are adults.

Among Americans in their 40s and 50s, deaths from illicit-drug overdoses have risen by 800 percent since 1980, including 300 percent in the last decade. In 2004, American hospital emergency rooms treated 400,000 patients between the ages 35 and 64 for abusing heroin, cocaine, methamphetamine, marijuana, hallucinogens and “club drugs” like ecstasy.

Equally surprising, graying baby boomers have become America’s fastest-growing crime scourge. The F.B.I. reports that last year the number of Americans over the age of 40 arrested for violent and property felonies rose to 420,000, up from 170,000 in 1980. Arrests for drug offenses among those over 40 rose to 360,000 last year, up from 22,000 in 1980. The Bureau of Justice Statistics found that 440,000 Americans ages 40 and older were incarcerated in 2005, triple the number in 1990.

...

In 1972, the University of Michigan researchers who carry out Monitoring the Future found that just 22 percent of high school seniors had ever used illegal drugs, compared to 48 percent of the class of 2005. Yet as that generation has aged, it has been afflicted by drug abuse and its related ills — overdoses, hospitalizations, drug-related crime — at far higher rates than those experienced by later generations at the same ages.

However, I get the sense that his intention is for the reader to be more alarmed about adult behavior and less alarmed about youth behaviors. I tend to be more alarmed about both young people and adults. He also (unintentionally?) makes the case that the problem is worse than we realize:

When releasing last week’s Monitoring the Future survey on drug use, John P. Walters, the director of the Office of National Drug Control Policy, boasted that “broad” declines in teenage drug use promise “enormous beneficial consequences not only for our children now, but for the rest of their lives.” Actually, anybody who has looked carefully at the report and other recent federal studies would see a dramatically different picture: skyrocketing illicit drug abuse and related deaths among teenagers and adults alike.

While Monitoring the Future, an annual study that depends on teenagers to self-report on their behavior, showed that drug use dropped sharply in the last decade, the National Center for Health Statistics has reported that teenage deaths from illicit drug abuse have tripled over the same period [emphasis added]. This reverses 25 years of declining overdose fatalities among youths, suggesting that teenagers are now joining older generations in increased drug use.

Everything I've read by Males is thought provoking and worth reading. I just always feel that he's successful in making his case about adults but fails to persuade me that we're overly concerned about young people.

Fight the stupor: Teen Care takes sobriety to school

A horrible headline but it's interesting that Hawaii has treatment in every high school:

All public high schools and some middle schools in Hawaii have alcohol and drug treatment programs, and the 2005 Legislature provided $1.8 million to expand services to 21 middle schools on Oahu, four on the Big Island and three in Maui County.

...

Keith Yamamoto, chief of the state Health Department's Alcohol and Drug Abuse Division, said funding for adolescent alcohol and drug treatment programs in schools this fiscal year totals $6.5 million, including the new appropriation. Schools receive $10,000 to $90,000 for the program, depending on their size, he said.

Overall Youth Drug Use Down in 2006, But Survey Sees Trouble Brewing with Inhalants, Prescription Drugs, Smoking

The latest Monitoring the Future drug use survey numbers are out and much of the news is good:

The survey of 50,000 8th-, 10th- and 12th-graders found that the overall percentage of U.S. youths using alcohol or other drugs declined modestly in 2006, continuing a decade-long trend. Since the mid-1990s, past-year use of marijuana has fallen 36 percent among 8th-graders, 28 percent among 10th-graders, and 18 percent among 12th-graders. That led Bush administration drug czar John Walters to cite a "substance-abuse sea change among American teens."

"They are getting the message that dangerous drugs damage their lives and limit their futures," said Walters, director of the Office of National Drug Control Policy (ONDCP).

...

Use of marijuana, the nation's most commonly used illicit drug, has been the main focus of the ONDCP's antidrug media campaign. Not surprisingly, federal officials this week celebrated the fact that past-month use of marijuana reported by MTF survey participants has fallen 26 percent since 2001, from 16.6 percent of teens in 2001 to 12.5 percent in 2006. NIDA Director Nora Volkow called this finding "great news."

Some of the researchers are expressing concern about some of the findings:

The University of Michigan, which produced the report, took a more nuanced view, noting that while there was little evidence of increased drug use, reported overall declines in adolescent drug use were relatively small, and that use of many drugs -- including inhalants, LSD, powder cocaine, crystal methamphetamine, heroin, and club drugs like Ketamine, Rohypnol, and GHB -- did not decline at all.

Lloyd Johnson, Ph.D., principal investigator of the study, expressed particular concern about a decline in perceived risk of using inhalants. Use of inhalants did not increase in 2006, according to the study, but inhalant use has been rising among American youth in recent years. "Perceived risk is often a leading indicator of changes in actual use," said Johnston. "So when we see a change like this, we take it as an early warning of trouble ahead."

Misuse of prescription drugs, which also has risen sharply in recent years, did not increase in 2006, but remained at "unacceptably high levels,"... About 9 percent of 2006 survey respondents said they had used prescription narcotic drugs like OxyContin and Vicodin within the past year, and between 4 and 7 percent of 8th- to 12th-graders said they had used over-the-counter cold medicines -- typically containing dextromethorphan -- to get high.
...

University of Michigan researchers also sounded an alarm about youth smoking, saying the MTF findings indicate that the trend toward lower smoking rates among children in their early and middle teens has ended. While current daily smoking has fallen by half among 12th-graders and more than half among 8th- and 10th-graders since the mid-1990s, no further declines were reported in the 2006 survey among 8th- and 10th-graders (daily smoking declined slightly among 12th-graders, from 13.6 percent in 2005 to 12.2 percent in 2006).

Perceived risk of smoking also has leveled off, which researchers said could be due to slackening public attention and publicity about the dangers of smoking. On the other hand, lifetime use of cigarettes has declined by about half among 8th-graders, by 40 percent among 10th-graders, and by 30 percent among 12th-graders since the mid-1990s. Overall smoking rates among all three grades are at an all-time low, and disapproval of smoking among teens is still rising among teens.