July 31, 2017 – NY Times — 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.
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 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. Rates of teen use and, for most substances, rates of teen heavy use have declined 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.
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.”