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From Alcohol Issues Insights Update #23 July, 2007
Further Evidence Light Drinking Extends Life
A just-reported Dutch study found that "long-term, light alcohol intake of less than or equal to [1.5 drinks] per day compared to no alcohol intake was associated with a 36% lower relative risk of all-cause death and a 34% lower relative risk of cardiovascular death." Light-moderate wine drinkers experienced the greatest benefit. Their life expectancy was 3.8 years higher compared to abstainers. Key: this was a 40-year study of men born between 1900 and 1920; drinking rates were measured 7 times over the 40 years. The authors: "One can speculate that a protective effect of light alcohol intake could be due to an increase in high-density lipoprotein (HDL) cholesterol, or to a reduction in blood clotting, due to an inhibition of platelet aggregation."
From Alcohol Issues Insights. Vol. 23 No. 10, October, 2006
Another Expansion of Moderation's Benefits; Less Depression Among Young Adults
Most of moderate drinking's key beneficial effects - reduced cardiovascular disease, improved cognition, stronger bones - has shown up among middle-aged and older adults. That's one reason policymakers and practitioners shy away from broad recommendations to drink. But a new international study - covering nearly 16,000 university students in 20 countries - found that young adult (age 17-30) moderate drinkers were less likely to report symptoms of depression than non-drinkers or heavy drinkers.
The UK-based authors used two measures of moderate drinking, one based on number of drinks consumed per occasion and one based on number of drinks consumed in the 2 weeks prior to filling out the survey. To measure depression they used a "short (13 item) Beck Depression Inventory." They also controlled for several key potentially confounding factors: living arrangements (at home or at school), self-reported health and socio-economic status. Regardless of the moderation measure, the authors found that "fewer moderate drinkers than nondrinkers had depression levels above threshold, whereas nondrinkers and heavy drinkers did not differ." Nondrinkers were 20-25% more likely to be at risk for elevated depression levels than moderate drinkers.
Once again the key finding here was a potential benefit (no causal link was found) among a young (average age 20.5 years) international sample. Reviewing this finding in the context of previous research on depression and moderate consumption, the authors concluded: "The results suggest that the relationship is present across a range of cultures and in young as well as middle-aged adults."
From the Archives of Internal Medicine. Vol. 166 No. 19, October 23, 2006
Even in men already at low risk on the basis of body mass index, physical activity, smoking, and diet, moderate alcohol intake is associated with lower risk for myocardial infarction (commonly known as a heart attack).
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From the Archives of Internal Medicine. Vol. 166 No. 14, July 24, 2006
Light to moderate alcohol consumption was associated with
significantly lower rates of cardiac events and longer survival, independent of its anti-inflammatory effect.
A study of 2487 subjects, aged 70 to 79 years, found that those who consumed 1-7 drinks/week had a lower risk of death during the 5 year study.
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Initiative to lower the legal drinking age:
Minimum Age Debate Goes Very Public as Amethyst Initiative Explodes in Media
It took some time, but John McCardell's efforts to have policymakers revisit the drinking age in the US made a huge leap forward this week with his latest project: Amethyst Initiative. With a new website and a statement signed by over 100 college presidents, McCardell drew nationwide attention to the subject. Hundreds and hundreds of news stories, editorials and interviews did exactly what McCardell has been seeking since his February 2007 white paper and the formation of his Choose Responsibility organization: re-open the debate about the appropriate minimum drinking age in the US. Wisely, the Amethyst Initiative did not ask college presidents (McCardell is former president of Middlebury College) to specifically call for lowering the minimum age to 18, though some press reports suggested it did. Rather, the college presidents, from institutions as diverse as Duke and Princeton to Maine Maritime Academy and several large public universities, signed a statement that declares:
It's time to rethink the drinking age.
Twenty One is not working, given the "culture of dangerous, clandestine" drinking that has developed, use of fake id has flourished, etc.
Amethyst asks: "How many times must we relearn the lessons of Prohibition?" It calls upon elected officials to "support an informed and dispassionate public debate" over 21, consider whether the highway fund mandate "encourages or inhibits the debate" and invites "new ideas" about how to help young people "make responsible decisions about alcohol."
Over the last few days, that debate has played out, often between McCardell himself and critics (like MADD's current national president) in newspapers and on television/radio stations across the nation. Nobody is making any new arguments, but that's not important. The debate is going on. Several signs suggest building momentum. The story broke on Monday, August 19. As INSIGHTS went to press, new stories continued to appear in the press, with some outlets, including the Wall St. Journal, running follow-ups to their initial coverage. Today's story in the NY Times reported that the Governors Highway Safety Association has added a workshop to its national meeting in September "to help highway safety agencies counter any effort in their states to lower the drinking age." The 21 debate will likely get another push soon, as "60 Minutes" prepares to run the segment it developed on the issue last spring, but apparently decided to postpone until this fall when schools re-open. Stay tuned.
Predictably, the media, consumer and policymaker response is all over the map. McCardell has stuck closely to his primary criticisms that 21 is ineffective, unfair and erodes respect for the law. MADD and other critics have countered with claims that the science shows 21 has saved lives (McCardell insists the science is mixed). Other key parts of MADD's talking points this week: parents should "think carefully about the safety" of students at schools where the Presidents signed the statement and charges that those officials have "waved the white flag" on underage drinking and simply want to make their lives easier. Critics also note the lack of public support for lowering the drinking age, which continues to run about 80-20% against. (But a Wall St Journal poll on its health blog this week ran 77-23 in favor of lowering the drinking age.) Not many major politicians have weighed in yet -- other than Chicago's Mayor Daley who blasted the idea. In the editorials, response varied from "a really bad idea" to "McCardell is right."
What Works, Continued: Strong Success for Social Norms Program at U VA
It's not often that university officials will put in writing that "in contrast with the national experience, the tide has turned on drinking-related consequences in this university setting." But that's the conclusion of two University of Virginia officials and an outside professor after reviewing the impressive results of a 6-year survey/evaluation of the social norms prevention program that U VA embarked upon in 1999. The results strongly counter those skeptical of social norms, like Harvard's Dr. Henry Wechsler (see below). From 2001-2006, the authors of this new study gathered data about exposure to the U VA program, which aimed to clear up misperceptions about how much students actually consumed (less drinking was the norm) and informed students about practicing protective behaviors (these behaviors were the norm). At the same time, they assessed alcohol consumption and "self- reported negative consequences of drinking," at the university in Charlottesville. The results were remarkable, especially in light of the general lack of progress in national surveys that suggest little progress reducing problems linked to risky drinking on most campuses. Here are the highlights:
For all undergraduates, the likelihood of experiencing none of 10 alcohol-related consequences more than doubled 2001 to 2006.
On a campus of 12,500 students, these findings translated into 1,972 fewer injuries in 2006 vs. 2001, 1,511 fewer students driving after drinking, and 553 fewer students engaging in unprotected sex. Also, 2,480 more students reported 0 serious alcohol-related consequences in 2006 vs. 2001. Over the 6-year period, over 9000 more students experienced none of the negative consequences than if 2001 rates held.
First-year students exposed to the social norms campaign reported a 22% reduction in the odds of experiencing multiple negative consequences.
The same first-year students reported a 24% reduction of having an estimated BAC level of .08 the last time they partied.
Among drinkers-only, the prevalence of experiencing no negative consequences increased from 33% to 51%, and the prevalence of experiencing multiple consequences fell from 44% to 26%.
Among drinkers, prevalence of 9 of 10 negative consequences tied to drinking declined 2001-2006, including: missed classes, poor test performance, unprotected sex, injury, damaged property, DUI and fights.
Importantly, the authors note that during this same period, there were "no new institutional or community wide alcohol policies or laws implemented" and no new state laws. The number of retail outlets did not change, no new taxes and no "significant retail price changes." Therefore, "we believe the evidence strongly suggests that the social norms educational intervention succeeded in a high degree of audience penetration," beginning with first-year students early on, then spreading to other student groups, including "high-risk target groups" like fraternity/sorority members and athletes.
US Drinking Rate Remarkably Stable; Under Reporting Rampant; Policy Implications
The annual Gallup Poll on Americans' drinking habits provides support for policy positions from both industry and public health points of view. The percentage of American adults (Gallup continues to poll those 18 and older) who say they have occasion to drink remained at 62% in July 2008, basically unchanged over the last decade. At the same time, that 62% was exactly the same as in 1960 and only 1 point lower than it was 60 years earlier. And that's despite billions in annual marketing spend by industry members (at least in recent years) and vastly expanded availability over the long term. These trends counter two bedrock themes of public health advocates. First, that broader availability is linked to a higher percentage of drinkers in any given population. Second, that marketing efforts increase consumption rates. (Drinking rates may not have changed much since the late 1940's; brand preferences surely have.)
A more problematic constant from the Gallup Poll: the data suggests severe under reporting of consumption. The 2008 poll shows that only 7% of adults say they drink every day and another 13% say they drink a few times per week. What's more, average consumption among drinkers is only 3.8 drinks per week, according to Gallup. And that's down sharply from over 5 drinks/week as recently as 2003, ostensibly a 25% decline. Those figures don't come close to matching recent sales data. Indeed, using population figures, Gallup's 62% drinking rate and reported volumes of beer, wine and spirits, the average drinker in the US actually consumes over 2 drinks per day. And if you exclude the 29% of those who say they only drink on "special occasions," average daily consumption exceeds 3 drinks/day. This suggests most drinkers already exceed recommended levels (2/day men, 1/day women) and offers some support for those who advocate measures to reduce average consumption.
Wechsler Weighs in on CAS
Longtime public health advocate Dr. Henry Wechsler recently reviewed the key findings and lessons from The Harvard Public School for Health College Alcohol Study (CAS). CAS began in 1992 and included four national surveys of over 50,000 college students over 14 yrs. "CAS research has raised awareness about the extent of college binge drinking and associated harms," wrote Dr. Wechsler. Results from CAS surveys "point to the need for a broad approach that goes beyond individual students and targets the alcohol environment at the college and the surrounding community." Going forward, "it may be more feasible for prevention practitioners in college to incrementally shift the drinking behavior of the majority than to dramatically change the behavior of the heaviest drinker," he noted, fully embracing a broad environmental approach vs. harm reduction. Prevention efforts on campus should "be directed toward limiting" student exposure to marketing efforts of alcohol companies or "increasing counter-advertising" efforts as well as reducing access to low-priced alcohol and "limiting the high density of alcohol outlets."
Dr. Wechsler notes the term "binge drinking," and the 4/5 measure, while "controversial," has since been "widely adopted" by researchers. The major criticism of the binge measurement "is that it overstates the problem of heavy drinking…by adopting a low threshold that includes too many students who do not experience alcohol-related problems." He dismisses that notion however and contends CAS studies found "most alcohol-related harms experienced by college students" are captured by the 4/5 binge definition.
CAS studies 1993-2001 found "few changes" in binge drinking rates. Approximately 44%, or 2 in 5 college students report drinking alcohol binge levels. But while the rate of binge drinking has remained relatively constant, CAS has found a "polarization of drinking behavior, with simultaneous increases in the number of abstainers and in the number of students who engage in frequent binge drinking." He cites high percentages of excessive drinking: 48% report "drinking to get drunk." Another 23% drink alcohol 10 or more occasions per month and 29% report being intoxicated 3 or more times per month. CAS studies found binge drinkers account for 91% of all alcohol consumed by students; 68% is consumed by frequent bingers. In addition: "Less than one quarter of frequent binge drinkers thought they ever had a problem with alcohol, and only 13% of this group thought they were heavy or problem drinkers."
Influence of college environment Though half of college binge drinkers engaged in the drinking behavior before entering college, "an equal number pick up" binge drinking after they arrive on campuses, found CAS. Joining a fraternity or sorority, drinking "to fit in" with others, low-price alcohol and attending a college with a high percentage of binge drinkers "were all independently associated with first-year students taking up binge drinking." Colleges with a diverse racial and ethnic student body, as well as those with larger percentages of female students, were found to have lower binge drinking rates.
Community factors To advance the notion that student access to low-priced alcohol should be limited, Dr. Wechsler cites research that determined "students who pay a higher price for alcohol are less likely to transition" from abstainer to binge drinker. Outright bans on drinking by colleges did not reduce heavy drinking. Students who attended colleges that banned alcohol "were less likely" to binge and "more likely to abstain" from drinking alcohol. However it was also determined that students, "drank just was heavily as students at non-ban schools," he noted.
No Impact from Social Norms CAS found 49% of colleges used social norms programs to publicize healthy drinking patterns on campus as a way of reducing binge drinking. "Overall, the evidence on the efficacy of social-norms marketing programs is mixed," said Dr. Wechsler. "No significant decreases in any measure of drinking were observed at colleges that employed a social-norms approach compared with schools that did not, regardless of the length or intensity of the program." Further study is needed on social norms, he added. Some of that research has been done, as noted above. Ref 3 Go To Top
Beyond Binge Drinking; ICAP Considers "Extreme Drinking"
"We argue that there is a need for a new term to describe young people's drinking that encapsulates a specific behavior and its outcomes. It is our hope that extreme drinking captures its essence, shifting the focus to what really matters from a public health, criminological and policy perspective." So conclude the authors of a new book, "Swimming with Crocodiles: The Culture of Extreme Drinking," commissioned by the International Center for Alcohol Policies (ICAP) a non-profit group funded by global alcohol producers. Editors Marjana Martinic and Fiona Measham explain that despite growing global concern about heavy drinking by youth, commonly-used terms like "binge drinking" don't "fully capture" the behaviors, motivations or outcomes of the activity and "hinder public discourse" due to disagreements about definitions.
The term "binge drinking" is "problematic," the editors point out, for at least 4 reasons. First, it centers on a simple quantity measure - usually 4 or 5 drinks -- without specifying a time requirement. Second, these definitions "neither address nor specifically require intoxication as an outcome." Third, different cultures define a "drink" in very different ways. Fourth, simple drink counts don't take into account differences in height, weight, alcohol tolerance and experience. They also "disregard the social and cultural contexts of consumption." Then too, there's the shift from associating a "binge" with an extended "bender" to the new focus on a single-setting. "As a result" of these issues, "the term binge has all but lost its currency."
Martinic and Measham suggest a new, broader term -- extreme drinking -- that goes beyond quantity, frequency or even intoxication to include cultural and other factors. Most important, they suggest that while extreme drinking involves "excessive consumption," the real key is the motivation for the behavior. They identify 5 "key criteria" for extreme drinking:
Intoxication - excessive or heavy drinking and its physiological effects
Motivation - intention or directed quest for a degree of altered state of consciousness or loss of control, though not limitless
Process - a social and positive process in which pursuit of pleasure goes beyond norms or typical social drinking within a culture
Outcomes - attention to both positive and negative outcomes
Alcohol experience - the capacity for a "controlled loss of control" balanced with the development of "alcohol maturity"
Importantly, extreme drinkers, are aware of the negative outcomes, yet adopt the risky behavior in any case. In this way they're much like folks who engage in extreme sports which also involve serious risks, the editors point out. Extreme drinkers try to "walk the fine line" between enjoying the risk-taking behavior, but also "end the evening safely." That's the "controlled loss of control."
Like other ICAP projects, Swimming with Crocodiles takes a very international approach, using focus groups in 7 countries to describe extreme drinking in their societies. The title hails from a South African participant who says: "When I get drunk I want to go swimming… This is a stupid thing to do because there are crocodiles and hippos in the river, but you feel like you are invincible when you are drunk, so you do it." How should societies address extreme drinking? ICAP calls for "multi-sector collaboration," that involves government, criminal justice, the industry, public health and "civil society," i.e. groups that may not have a specific stake in the business or the behaviors, but rather other civic groups with an interest in public safety. The authors also called for prevention tactics more targeted to extreme drinking than drinking per se. These include:
A proper regulatory framework, appropriate enforcement, adequate healthcare and social service and consumer information
Focused policy measures, tailored to specific cultures and "flexible enough to respond to the immediacy of concerns and priorities"
Alcohol education and life skills training
Social norms marketing
Brief interventions
Media campaigns, responsible hospitality programs and efforts aimed at specific outcomes (i.e. car crashes)
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