Is the Binge-Drinking Glass Half Full or Half Empty?: In Reply

Abstract

In response to Dr Turner, underage drinking remains common and dangerous. Alcohol is a leading preventable cause of death among young adults and contributes to the 3 leading causes of death among adolescents.1 In addition, youth drinking and binge drinking contribute to a number of social problems, including unintended pregnancy, violence, sexually transmitted infections, altered brain development, and subsequent alcohol problems in adulthood.2,3 Although rates of underage drinking have declined slightly among male high school students during the past decade, it is hard to take solace from our study when almost half of all US high school students drank alcohol during the previous 30 days and approximately two thirds of those individuals binge drank, typically on multiple occasions.Although binge drinking is an extremely dangerous pattern of alcohol consumption, our report and other studies have shown that any alcohol consumption among youth is riskier than no consumption. For example, we found that high school students who drank but did not binge drink were 2 to 4 times more likely than nondrinkers to ride with a drinking driver, be sexually active, smoke cigarettes, and get into a fight. In addition, because respondents in adult population-based surveys tend to underreport how much they drink, it is also likely that some students who reported drinking at less-than-binge levels may have been misclassified because of potential reporting bias.4,5 Furthermore, youth generally weigh less than adults and, therefore, are more likely to attain impairment-level blood alcohol concentrations when drinking fewer than 5 drinks. Finally, underage drinkers are far more likely than adult drinkers to suffer alcohol-related harms (eg, motor vehicle crashes) at blood alcohol concentrations below 0.08%.6Dr Turner's glass-half-full paradigm reflects an approach called social norms theory, which postulates that educating adolescents or college students about normative behavior (ie, emphasizing that many people do not drink) will “pressure” them to behave in less risky ways. Although this approach has been endorsed by some educators, there are at least 3 concerns. First, according to the Guide to Community Preventive Services,7 there is insufficient evidence to determine whether social norming is effective in reducing alcohol-related outcomes among youth (eg, drinking and driving). Second, social norming programs are aimed primarily at individuals and do not address important societal determinants of youth drinking behavior, such as adult alcohol misuse and the larger alcohol-policy environment.2,8 Third, programs that have a large focus on social norming may have the unintended consequence of minimizing the public's appreciation for the problem of underage drinking, thus eroding support for other interventions that are known to be effective and that require a strong public commitment.7,9Social attitudes about the acceptability of underage drinking do need to change, but minimizing the problem will only increase our complacency about solving it. The time has come to match the scope and intensity of the underage drinking problem with robust, population-based intervention policies recommended by the Institute of Medicine, including increased alcohol excise taxes, adequate enforcement of minimum legal drinking age laws, and additional reductions in alcohol marketing to youth-oriented audiences.2 We also need to recognize the strong relationship between binge drinking by adults and binge drinking by youth and implement effective strategies (eg, limiting alcohol-outlet density) to prevent binge drinking in the general population.10 Absent such policy changes, the impact of future clinical and educational efforts to reduce underage and binge drinking and to change social attitudes regarding this behavior will be limited.