Dec 31, 1995
It is well known that by the time they are seniors, almost all U.S. high-school students have tried alcohol, many drink with some regularity, and a substantial number drink either frequently or in quantity. However, despite its importance, alcohol misuse among adolescents has not been carefully characterized beyond simple frequency and quantity measures, particularly in youth populations that include high-school dropouts.
A recent study by Phyllis Ellickson and her colleagues in the Drug Policy Research Center provides such a characterization. The research confirms the pervasive nature of teenage drinking and indicates that alcohol misuse may be more of a problem than previously imagined. A second study demonstrates that drinking by teens, unlike their use of illicit drugs, is more strongly associated with sociability than with antisocial behavior. Together, the findings suggest that attempts to control teen alcohol consumption should focus less on prevention of initiation or any use and more on prevention of misuse.
The DPRC researchers surveyed 4390 high-school seniors and dropouts on the West Coast regarding use of alcohol and other drugs, as well as problems associated with that use. Panels of experts provided judgments that were used in developing measures of alcohol misuse. Those measures are represented in the figure. Reading from the left, the first four bars make the following points:
The second four bars are qualitatively analogous to the first, but the thresholds are relaxed. Respectively, they are one drink every third day, one occurrence of a drinking-related problem, one kind of high-risk activity on one occasion, and, again, scoring positive on at least one of those three. According to these easier-to-cross thresholds, as many as two-thirds of older U.S. teens may in some sense be misusing alcohol.
Two lessons can be inferred from the results. First, different definitions of misuse result in widely different estimates. In particular, the often-used quantity-frequency index (the first bar in each set) suggests levels of misuse lower than those of indicators of problems or activities judged by experts to be similar in seriousness.
Second, the various measures confirm that teenage alcohol misuse is a big problem. Most teenagers are misusing alcohol at least occasionally, and a substantial minority of those are doing so several times a year, or even on a regular basis. And, while boys are significantly more likely than girls to cross the higher misuse thresholds on the left of the figure, boys and girls differ little on the more inclusive set of measures. Sixty-six percent of boys engaged in at least one high-risk drinking activity over the course of a year, compared with 63 percent of girls—a statistically insignificant difference. As for racial and ethnic differences, both whites and Hispanics exhibit high levels of misuse, African Americans and Asians less so.
The pervasiveness of teenage alcohol misuse is particularly worrisome given the association of teen drinking with accidents, suicide, violent behavior, high-risk sex, and emotional problems. Parents, communities, and governments have thus been justifiably intent on controlling teen alcohol consumption along with consumption of other drugs. However, efforts in the United States to decrease drug use have focused on preventing initiation or otherwise eliminating consumption. While this strategy has yielded significant reductions in the onset of illicit drug use, it has obviously had minimal impact on teen alcohol use.
That a single strategy differently affects alcohol and illicit-drug use should not be surprising, given the different positions of these two kinds of behavior within adolescent culture. Evidence as to that difference was obtained in a second study by Ron Hays and Phyllis Ellickson, a study based on a survey of 1363 teens in tenth grade but otherwise similar to those surveyed in the first study. Hays and Ellickson used factor analysis to determine what traits, behaviors, and attitudes were associated with each other.
They found that measures of alcohol use and misuse were more strongly associated with social activities such as dating and partying than with delinquent and related behaviors such as theft, burglary, and running away from home. The opposite was true of hard-drug, cannabis, and cigarette use.
If efforts to reduce the ill effects of teen alcohol use are to be successful, they must take into account its key characteristics—its prevalence and its social context. Unfortunately, other work, some of it within the DPRC, has shown that school-based prevention programs aimed at helping younger adolescents resist peer pressures to drink have only short-lived effects or work for only a small subset of youths.
Instead of trying to stop all consumption of a drug used almost universally among teens, prevention efforts might more profitably focus on misuse of alcohol, albeit in connection with teen social life. And they should pay particular attention to the most prevalent forms of high-risk drinking behavior—binge drinking, drinking and driving, and polydrug use. To ensure long-term reductions in teenage drinking, stronger parental, community, and societal efforts to reinforce prevention messages are clearly needed. Such efforts could range from closer parental supervision of adolescents' parties to combatting media images that associate drinking with good times, popularity, and glamour.