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NIAAA Expert Offers Solutions to Underage Drinking
July 19, 2007

According to the 2005 National Survey on Drug Use and Health, today there are 11 million underage drinkers in the United States , and nearly 7.2 million are considered binge drinkers. Earlier this year, the U.S. Surgeon General issued a call to action, urging parents, schools, and other influential individuals to do more to prevent underage drinking. To better understand the message behind the Surgeon General´s call to action, CADCA´s Coalitions Online interviewed Dr. Patricia Powell, Acting Chief of the Science Policy Branch of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Here, she discusses the importance of preventing underage drinking, and what the surgeon general believes is key to reversing this trend.

Q. Why should community, state and national leaders be concerned about underage drinking?
A. Many young people are drinking and when they drink they tend to drink a lot. Alcohol use, binge drinking and frequent binge drinking all ramp up significantly between the ages of 12 and 20, which encompass most of adolescence. Adolescence is a period of incredible changes. During this period, these “adults-under-construction” are undergoing biological changes as well as social and contextual changes that prepare them to take on adult roles. For example, we know from research that development of specific regions and functions of the brain continue into a person's 20s. That's why we're concerned about the effects of alcohol on brain development as well as its effects on other developmental changes. Using alcohol during this time can have a big impact on development of the skills and abilities needed in adulthood. For example, if you're using alcohol instead of paying attention in school that can change the opportunities you have later in life. In addition, a teen may decide he or she needs alcohol to function in certain situations, for example when socializing with the opposite sex.

Q. How can underage drinking contribute to problems later in life?
A. NIAAA's first National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) found that 40 percent of people who said they started drinking before age 15 also described their drinking patterns later in life in a way that is consistent with a diagnosis of alcohol dependence. That percentage is 4 times higher for people who start drinking before age 15 than for those who don't start before age 21. More recently, we've also learned that the highest prevalence of alcohol dependence in the entire U.S. population is among 18-20 year olds. We used to think of an alcoholic as someone who came into treatment in their late 40s, having hit bottom, but the paradigm has changed. Now, we know that there are many young people who are drinking in a hazardous way, who could benefit from but are not seeking help.

Q. What message was the surgeon general trying to get across in his call to action?
A. The main messages in the Call to Action are that underage drinking is a serious public health and safety problem because of the number of young people who drink, the way they drink and the consequences of that drinking; that underage drinking is a developmental issue; and that we all have a role in preventing and reducing the problem. The advantage of thinking of it developmentally is it really gives you a sense of why everyone needs to take responsibility in changing the culture around underage drinking. It's not about having one conversation with your child. As kids grow and develop, we need to focus on what information, programs and opportunities we need to provide so this “adult under construction” becomes a fully functioning adult at the end of the process. Everyone—from the parent or youth mentor to the physician—has a role in supporting an adolescent in this journey to adulthood.

Q. What were some of the surgeon general's key suggestions?
A. The Call to Action suggests that we need to change the culture so that alcohol use is not so central to growing up in this country. Unfortunately, being a teenager in America and alcohol seem to go hand in hand. So, until we can start to separate alcohol out, we're not going to really have an impact. To do this, we need to create opportunities for young people to participate in activities they find compelling that do not center around alcohol, such as academics, sports, the arts, or volunteering. It's also critical that there are programs for youth who are already using alcohol and are in trouble. It's about changing the entire community's attitude.

Q. How important is the role of community leaders in preventing underage drinking?
A. You have to have the community on board if you're going to make a difference. There are a number of players involved—everyone from health professionals, to parents, educators to community coalitions. The more people who are working to change the way the community views alcohol and provides opportunities for our young people, the better.

Q. What are some research initiatives that the NIAAA is undertaking to better understand underage drinking?
A. We have an initiative on the developing brain to get better idea of the consequences of early alcohol use on the brain; what preexisted before drinking and whether or not the brain recovers. We're also looking into examining the role of hormones that become active during puberty in the effects of alcohol on the developing brain. In addition, NIAAA continues to support research into college drinking and what prevention strategies are effective on campuses.

The Surgeon General's Call to Action to Prevent and Reduce Underage Drinking and his Guide to Action for Communities, developed in collaboration with the NIAAA and the Substance Abuse and Mental Health Services Administration (SAMHSA), is available at: www.surgeongeneral.gov/topics/underagedrinking/ .

Underage drinking will addressed at CADCA's Mid-Year Training Institute , July 30- Aug. 2, 2007 at the JW Marriott Starr Pass Resort & Spa in Tucson , Ariz. at a course presented by Ralph Hingson, ScD, Director of the Division of Epidemiology and Prevention Research for the NIAAA. The half-day session, entitled “The Magnitude and Prevention of Underage Drinking Problems,” will review the current statistical information on the magnitude of various problems associated with underage drinking and the types of prevention and intervention strategies commonly used to address it. The course will be presented on Tuesday, July 31, from 9 a.m. – 12 p.m. , and from 1:30 - 4:30 p.m.

Patricia Powell, Ph.D., is Acting Chief of the Science Policy Branch at the National Institute on Alcohol Abuse and Alcoholism (NIAAA). This article is part of CADCA's second editorial series featuring national experts from the NIAAA.