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6 Drinking by Young People A'' DOLESCENCE iS a very special time. We cannot treat teenagers as little children, using naive prevention strategies. We cannot treat them as adults because they are in a vulnerable period of internal stress, confusion, and irrationality. They are particularly vulnerable because of their tendency to be more loyal to their friends than to their own welfare." M. "Keith" Schuchard of the Parental Resource Institute for Drug Education in Atlanta has put her finger on a central problem of attempts to prevent alcohol abuse among young people. Adolescents are making their way through a particularly fast-moving and transitional part of their lives. Most are beginning a process that will eventually leac! to their moving away from their parents. Yet most adolescents are not yet ready to make all their own decisions, to establish an indepenclent life free of parental constraints. The conflicts of this gradual separation exacerbate what is already a difficult time. Almost all adolescents suffer from a great deal of insecurity. They worry about their bodies, their likability, the opinions of their friends, their family relation- ships. Adolescents have many problems to work out. Some they will successfully resolve, some they will forget, and some will follow them into adulthood. 70
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DRINKING BY YOUNG PEOPLE / 71 Aclolescence is also the time when many people face their first inducements to drink. (The use of the term adolescent should not disguise the fact that at least some people start drinking earlier than adolescence, when they are really still children.) Laws against selling alcohol to people under a certain age do reduce the amount that adolescents drink. But these laws fan far short of imposing absolute abstinence on this group. According to national surveys, 80 percent of high school seniors have had their first drink before they turn IS the lowest min- imum drinking age in the country. Over one-third of all high school students, including half of all 16- to 17-year-olds, report drinking within the past 30 days. The question of why adolescents drink may be even more difficult to answer than the question of why adults think. Clearly, peer pressure plays a large role in the initiation of drinking. But there are many other factors that also contribute, from family situations to availability to the intangible influence of an individual's personality. At least some of these factors can be influenced very little by prevention programs, no matter how skillfully such programs may be designed. Adolescents are also under particularly intense pressure from the mass media and popular culture. During a stage in their lives when they are particularly susceptible to such messages, adolescents are barraged by enticements to drink in television shows and advertising. Alcohol is a theme in popular music, in comic strips, and particularly in movies. (Who cannot re- member a popular film in which the protagonist was an incor- rigible, but ultimately attractive, drunk?) Schuchard particularly objects to such messages on young people's T-shirts as "Party till you puke," "Avoid hangovers, stay drunk," and "I don't have a drinking problem I drink, I get drunk, I fall down. No problem." This blitz of promotion, says Schuchard, continually antag- onizes parents and educators who are trying to teach young people about drinking. "The industry talks about responsible marketing," she says, "but I see alcoholic milk shakes in stores and I hear advertising on teen-oriented radio stations for beer, wine, and other kinds of drinks.... There are mixed-up, muddy
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72 / ALCOHOL IN AMERICA messages going to the adolescent, who is supposed to become adult and responsible in handling intoxicating chemicals that basically make him or her irresponsible." Does the Drinking Age Make a Difference? Every state in the nation has a minimum drinking age, rang- ing from 18 to 21. As of June I, 1985, 3 states set the minimum age at IS, 12 set the limit at 19, 2 set the limit at 20, and 34 (including the District of Columbia) set the limit at 21 (although several of these allowed beer sales to IS- or 19-year-olds). The primary justification for drinking ages greater than IS is concern over traffic accidents involving young people who have been drinking. Each year approximately 5,000 lives are lost in alcohol-related traffic accidents in which the driver is under 21. According to the National Highway Traffic Safety Administra- .'¢_ ~ . ~ . . ~ _ ",`1 Alcohol abuse can be a major problem on college campuses, where most students reach the minimum drinking age in an environment marked by ready access to alcohol and great personal freedom.
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DRINKING BY YOUNG PEOPLE / 73 lion (NHTSA), 20 percent of all fatal highway accidents involve drivers under 2l, although this group makes up less than 10 percent of the total number of licensee! drivers. For people aged 15 to 34, automobile accidents are the single greatest cause of death. The bare statistics about young people, drinking, and acci- dental deaths do little to convey the depth of the tragedies that strike so many families each year. There are few events more shattering than the death or permanent disablement of a person on the threshold of a full, adult life. It is the emotional anguish of these families that has inspired such volunteer groups as Mothers Against Drunk Driving (MADD), Students Against Drunk Driving (SADD), and Remove Intoxicated Drivers (RID). Drawing on their own grief, these groups have inspired efforts by others to deal more effectively with the problem. Between 1970 and 1973, 24 states reduced their minimum drinking ages. The rationale for making such changes was then and still is straightforward and reasonable. State and federal laws give 18-year-olds most of the rights and responsibilities associated with adulthood among them the right to vote, seek many elective offices, enter into contractual agreements, and serve in the armed forces. It seems logically consistent to also confer the right to drink on this group. In the wake of these reductions in the minimum drinking age, a number of studies sought to assess how these changes would affect highway fatality rates among the young. These studies did not automatically anticipate that this rate would be higher; there are factors that can decrease drinking-driving ac- cidents among the young when the drinking age goes down. For instance, teenagers might be less likely to drink in their cars if bars and taverns are open to them, or they might stop driving to neighboring jurisdictions with lower minimum drink- ing ages. The studies generally found, however, that reductions in the drinking age did cause a small but consistent increase in the rate of crashes and deaths involving younger drivers. Based on such findings, NHTSA and many private organi- zations have concluded that, despite the logical consistency of an 18-year drinking age, it is better to set drinking ages at 21 and consign fewer young people to die each year on the high-
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74 / ALCOHOL IN~ERICA ways. NHTSA itself recommended to all of the states that they raise their minimum drinking ages to 21. According to NHTSA's Barry Sweedler, this recommendation received support "from across the board." In addition, a Gallup poll has shown that 77 percent of the population supports legislation that would raise the drinking age to 21. Surprisingly enough, even among IS- to 20-year-olds 58 percent support such legislation. In 1984 Congress passed a law that would reduce federal highway funds to states that have not raised their drinking ages to 21 by 1986. This is a strong incentive for states with minimum ages below 21 to raise them. But it remains the states' prerog- ative to set the minimum drinking age, and influential consti- tuencies within states have a stake in keeping the drinking age low. "Where a proposal to raise the drinking age has been voted on by a legislative body in this country, it has not lost," says Sweedler. "But in many states it has been bottler! up in com- mittee, primarily because of strong lobbying efforts by people who sell alcohol primarily to youth." What Can Schools Do? Another focus of attempts to shape drinking habits is the schools. This emphasis is definitely not new. Schools have been teaching students about drinking since the nineteenth century. Originally a product of the temperance movement, this edu- cation was for many years strongly antialcohol. Lessons painted a grim picture of alcohol's disastrous effects on character, family life, and the fabric of society. Ruin was predicted for the vast majority of people who drank at all. With the beginning of the alcoholism movement in the 1930s and 1940s, alcohol education became more health-oriented and factual. in the years that followed it grew progressively less colorful and less extensive. By the 1960s, alcohol education had shifted its focus primarily to alcoholism. Avoiding alarmist interpretations, it presented alcoholism as a disease to which every drinker had a small but real risk of succumbing. In the 1970s attention to alcohol education increased mark- eclly. At the beginning of the decade the National Institute on Alcohol Abuse and Alcoholism was founded. The NIAAA in
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DRINKING BY YOUNG PEOPLE / 75 turn set up the National Center for Alcohol Education and the National Clearinghouse for Alcohol Information, in part as sources of new educational materials. The increasing problem of drug use in the schools also strengthened alcohol education, as drug programs in general were expanded. Finally, teenage drinking came to be seen as a modern, worsening problem, although in fact research shows that drinking among teenagers has changed relatively little over the past 20 years. Despite this new attention to alcohol education, the effec- tiveness of these programs remains open to doubt. Much of today's alcohol education seeks to produce lifelong changes in a person's drinking. In effect, the goal of this education is to "inoculate" a person against future drinking problems. This goal seems unrealistic for several reasons. In the first place, drinking practices tend to change dramatically over a person's lifetime. Information absorbed about alcohol in school is not likely to have much direct effect on behavior many years later. Also, many attitudes toward drinking are learned outside school. Students pay little attention when teachers start discussing is- sues of lifestyle patterns that were learned at home or elsewhere outside the classroom. As the National Research Council pane! on alcohol abuse concludes, ". . . [T]he ambitions of school- based alcohol education programs are too grand." It may be more practical for schools to lower their sights. Students must cope with many problems related to alcohol while they are in school: violence, traffic accidents, diminished academic performance. These problems seem the logical subject of school-based educational programs. Rather than concen- trating on lifelong drinking practices, programs could aim to achieve specific behavioral goals. Students could be taught that they are responsible for violent, reckless, or self-defeating be- havior, whether they are drunk or sober. According to the panel, "High schools and universities should adopt the objec- tive of shaping drinking practices for the student populations while they are of school age and should register success if they succeed in reducing drinking and problems associated with drinking for their current populations. This reorientation may not require much change in current approaches and materials, but it would certainly require replacing the prevailing vague
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76 / ALCOHOL IN AMERICA objectives of school-based alcohol education programs with clear behavioral goals." One program that draws on these principles, known as the Shalom program, was founded in the Philadelphia schools by Sister Madeleine Boyd. It is staffed by professional social work- ers, psychologists, and guidance counselors. In sessions during study periods and before and after school, the program lays out the possible consequences of drinking or drug use and discusses how students can avoid them. "It is a highly struc- tured discussion group from which they can learn new skills and at the same time gain new knowledge, techniques, and strategies to implement this knowledge," says Boyd. "The facts are presented in various ways: through psychodrama, maga- zines, music, videotapes, and movies." The Shalom program points toward an important component of any effort to influence drinking by the young. A number of studies have concluded that peer pressure is the major factor in the initiation of drinking, smoking, and drug use. To counter this pressure, several experimental programs have used peers to teach counterarguments against smoking or drinking. In one study in California, 16-year-olds led 12-year-olds in sessions designed to make it easier for them to resist inducements to smoke or drink. The researchers had only the students' own reports to evaluate the program's effect, but students did report significantly less smoking and drinking. Similar results were achieved in Boston in a program that used "opinion leaders" nominated by their peers to direct classroom discussion. What Can Parents Do? The question of what parents can do should perhaps begin with what they are legally bound to do. Parents are legally liable for the behavior of minors in their home and under their supervision, whether the minors are their own children or someone else' s. "If the daughter is having a slumber party and the parents are upstairs watching television, the kids get drunk from bottles out of the liquor cabinet and one of them drives off and kills someone, it is the host parents' responsibility,"
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DRINKING BY YOUNG PEOPLE / 77 says Keith Schuchard. "if they did not know it was going on, that is neglect in the supervision of minors." Reminding people of this legal liability has heightened the responsibility of all parties involved. "This is a tremendous public message," says Schuchard. "Even the kids thought it made sense.... The point made the teenagers recognize their own responsibility not to get parents in trouble." This legal liability shades gradually into the realm of parental and ethical responsibilities. As with the legal issues, at least part of the justification for these latter responsibilities is the health of the child. "Parents are responsible for their children's health and make the rules about vaccinations, measles, and everything else medical; they should make it about drugs and alcohol," Schuchard says. Health is also a relatively neutral subject on which parents can approach their children about alcohol. Adolescents are very concerned about their body images and about the changes their bodies are undergoing. Parents can take advantage of this con- cern by telling their children about the potential consequences to health of drinking. To help make this possible, researchers should learn as much as possible about the physiological effects of alcohol and other drugs on young people. Another way for parents to convey their attitudes about drinking to their children is by forming their own peer groups or networks, according to Schuchard. Within these networks, parents can form codes of behavior that apply to all of the children in the group. "Such a code does not have to cover everything, but it should cover illegal activity, the use of drugs and alcohol, getting into dangerous situations with automo- bites, etc.," Schuchard says. Parents in the network can watch over each other's children; for example, the children of working parents can check in with other parents after school. It is an idea based on a fundamental human value, a value that lies at the heart of a parent's concern over drinking by young people. "The parental instinct to protect a child's physical well-being is the strongest instinct in nature and in society," Schucharct says. "If we can tap that instinct and reinforce it with community support and legal sanctions, we can build an effective prevention movement."
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78 / ALCOHOL IN ~ERICA Prevention at the College Level When teenagers go away to college, the situation changes. For many of them it is the first time they have lived away from home. Parental oversight diminishes, the range of opportunity increases, the world can seem a much larger and freer place. For some students this is a dangerous combination. Many students, faculty, administrators, and community members associated with universities have expressed concern over the amount and consequences of the drinking that goes on in college. One university that sought to channel that con- cern in constructive directions is the University of Massachu- setts at Amherst. For 10 years beginning in 1973, this campus of 22,000 students, over half of whom live in university housing, was the site of a comprehensive program to prevent alcohol- related problems among its students, the Demonstration Al- cohof Education Project (DAEP). Problems associated with drinking were widespread on cam- pus during DAEP. Over the years 1975-80, an average of 29 percent of students surveyed reported driving while intoxi- cated, 23 percent reported academic problems related to drink- ing, 17 percent reported minor physical problems associated with drinking, 16 percent reported alcohol-related abusive be- havior, and 14 percent had trouble with their jobs because of alcohol. Smaller percentages reported property damage caused by drunkenness or dependence on alcohol. DAEP sought to reduce these problems using posters, news- paper advertisements and articles, radio advertisements and interviews, and special displays in the student center. Each year about lL0 percent of the students in the university also received intensive face-to-face instruction about dunking. Generally, these sessions involved small groups of students taught by other, trained students and were held in dormitories or classrooms. About half of ~ percent of all students participated in more than one discussion group or in formal courses dealing with alcohol. DAEP also trained about 5 percent of the university's staff and faculty each year, and it sought to study and modify various regulations involving alcohol. Over the course of the program, several special projects were initiated that involved the broader university community as
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DRINKING BY YOUNG PEOPLE / 79 well as students. In many cases these projects evolved within the broader program as specific problems became apparent. "The needs often could not be adequately addressed until rel- evant individuals or groups in the community became suffi- ciently concerned to help effect necessary changes," says David Kraft of the university's Health Services Department. One of these special projects was a comprehensive party- planning policy implemented in 1978 by a joint student-staff task force. This policy defined the responsibilities and training required of party planners, bartenders, security personnel, and staff supervisors for parties of different sizes. In 1981 four young people who had been drinking were in- volved in a fatal accident in Amherst. This led to the Safety Action Program, a cooperative effort of the town and university. According to Kraft, this program "included both education about drinking and driving in the secondary schools and on college campuses, and stricter, highly visible enforcement of drunk driving laws with subsequent convictions." In 1982 questions by off-campus bar owners about their lia- bility for accidents led to an expansion of the on-campus bar- tender training to off-campus establishments. Also in 1982 a special educational effort called the Student Opportunity Pro- gram began working with students who had disciplinary prob- lems related to alcohol. DAEP was evaluated through an annual questionnaire, sur- veys of university staff members, archival data, and controlled studies of the educational efforts. These evaluations showed that most students did learn about alcohol problems and agreed about the need to control them. However, the questionnaires uncovered no significant decrease in either drinking or alcohol- related problems over the years of DAEP. Only among the students who were taught to train other students did alcohol problems significantly diminish. As in other programs of this type, it is possible to give people new knowledge without nec- essarily changing their behavior. Despite the lack of a change in drinking practices, there were many indications of ways in which DAEP did have a positive effect. University faculty and staff recognized alcohol-related problems much earlier and acted to deal with them. Students were also more likely to confront their peers in an attempt to
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80 / ALCOHOL IN AMERICA make them drink more safely. Specific environmental factors changed, such as more parties offering food and nonalcoholic beverages. When DAEP came to an end, many of its educational efforts were integrated into the ongoing activities of the groups that had been involved in the program. According to Kraft, DAEP brought to the fore a number of observations that should be taken into account in designing similar programs. First of all, a university-based program should decide which alcohol-related problems concern university and community members the most. At the beginning of DAEP, campus and community leaders were most concerned about what seemed to be an increasing number of student alcoholics. But they soon saw the need to expand the program to include many other people. "Very quickly, key community members began to realize that the highest proportion of alcohol problems occurred among both regular and occasional heavy consumers of alcohol, only some of whom would be defined as 'alcoholic' by any stanciard criteria," says Kraft. "The focus of community alcohol program efforts rapidly shifted to preventing certain problems by a variety of strategies, only some of which focused on heavy drinkers, including alcoholics." Once the problem is defined, programs like DAEP should enlist aid from as many groups and individuals as possible. Programs too often overlook such obvious partners as distri- bution centers (bars, restaurants, liquor stores, etc.), servers, police and medical personnel, and community leaders. These organizations and individuals may initially resist some of the changes a program seeks, but they can be valuable parts of a comprehensive approach to prevention. Finally, programs like DAEP should be evaluated continu- ously and refined if necessary. "The evaluation methods used need not be highly advanced or complicated, but should be systematic and honest," says Kraft. "Systematic evaluation can also help ensure ongoing community funding and support even if efforts are only moderately successful." In general, Kraft believes that community-based approaches to preventing alcohol problems work best by combining edu- cation with regulation. Neither alone is practical. To be effec- tive, education alone would be too expensive, and regulation
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DRONING BY YOUNG PEOPLE / S] by itself can polarize community members around unpopular laws. But together they can complement each other by rein- forc~ng and drawing attention to each other's messages. "A combination of education and regulation proved to be the most effective way to produce community-level changes at the Uni- versity of Massachusetts," Kraft concludes. .
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