Even as youth drinking rates continue to decline, usage and heavy drinking measures remain stubbornly high among some groups, decades after the legal minimum drinking age increased. Researchers and policymakers continue to try to determine effective prevention measures. A team from the Pacific Institute for Research and Evaluation, led by longtime expert James Fell, analyzed laws aimed at limiting the use of fake IDs and imposing liability on social hosts for providing alcohol to teens. Their results suggest just how difficult it will be to make further progress using new legal tools and/or ratcheting up current ones.

In this very complex analysis, researchers matched three different fake ID laws and two kinds of social host laws against measures of fatal highway crashes among youth. They found that only 1 of these laws had a significant impact on reducing crash deaths: laws aimed at punishing suppliers of fake IDs. And 24 states already have these laws. If the remaining states adopted similar laws, the authors calculated, an additional 16 lives per year would be saved, in addition to the 14 that those laws are saving right now. Recognizing perhaps the modesty of that number, the authors point out that previous research shows several "core underage drinking laws," those aimed at reducing purchase/possession and zero tolerance laws for drivers under 21, are "currently saving 732 lives annually." And "use and lose" laws save an additional 132 lives annually in the states that have adopted them. Net-net: if every state adopted each of these 5 "effective laws," the authors calculate, "states can potentially save a substantial number of lives each year": 49 more annually, from 878 now to 927.

Meanwhile, Fell's group found little life-saving impact from social host laws. Social host laws that provide civil liability - where hosts can be sued for damages - "were very close to having a significant effect on underage drinking drivers." But social host bans - where states sanction hosts - "had no effect" on youth fatalities. In any case, social host laws don't seem to be strong preventive measures, at least for crash fatalities.

A separate study of 50 cities in California, comparing municipalities that have social host (civil liability) laws of varying strictness, suggests that while these laws might not affect crash deaths or youth drinking per se, they might actually deter some drinking parties, which is what they were designed to do in the first place. Overall, the authors found "no associations…between social host policy rating and any of the three past-year drinking outcomes." Those were: alcohol use at parties, past year alcohol use and past year heavy drinking. But when the authors isolated effects among youth who had already been drinking, they found "a statistically significant inverse association…between social host policy rating and youth past-year use at parties." That suggested a "stronger Social Host policy was associated with less frequent alcohol use at parties among drinkers." The cities with the strictest social host laws showed a "20% lower incidence of drinking at parties among adolescents…compared to those in cities with no Social Host law." But again, strictness of the law had no effect on either past-year drinking or heavy drinking. All in, a pretty modest impact. Social host laws "may be most relevant and effective for deterring alcohol use in private settings for adolescents who have already begun to drink." The key takeaway from both studies: more work needs to be done to identify strategies that will continue to reduce drinking rates. Then again, perhaps the oft-maligned "education and awareness" programs might simply be tweaked and expanded. Ref 3  

Once again, the annual meeting of the American Public Health Association featured presentations by the nation's best-known public health researchers/ advocates, including the tax tool detailed above. Once again, based on abstracts, the alcohol beverage program focused on familiar pro-tax and anti-advertising research. And yet once again, none of the abstracts noted that while many underage Americans are exposed to alcohol ads, sponsorships and photos of celebrities drinking and/or brandishing alcohol-branded items, drinking rates continue to decline among youth.

While the FTC recently reported that over 99% of digital alcohol ads reached a 70%+ adult audience in 2011, CAMY found that "nearly twice as many youth (30%) reported seeing alcohol advertisements on the internet compared to adults (17%)." Youth were also more likely than adults to report having seen and "liked" images of celebrities drinking and/or with alcohol-branded items. The takeaway: self-regulation is "not protecting youth from reporting higher exposures to alcohol advertising in traditional and social media." CAMY is also "concerned" about a content analysis of popular television shows that indicated many depict alcohol use, that the proportion of females drinking alcohol has increased and that "prominent alcohol themes were relaxation, socializing and sexuality." Per usual, this study did not apparently link any actual viewing to any actual drinking.

At Boston University, researchers looked at 945 sponsorships from the top 75 brands consumed by underage drinkers and predictably found the most popular brands "were far more likely to engage in sponsorships and to have a higher number of sponsorships." As we've noted before, this new "brand naming" research - spearheaded by CAMY - has found that popular brands among youth, with some exceptions, are the same as popular brands among adults and often, naturally, the most advertised brands. Industry members have long argued that marketing stimulates brand choice, though not necessarily product choice. From nearby University of Connecticut, a review of over 100 peer-reviewed and unpublished "reports" found not only high levels of exposure to alcohol ads, but also that ad content has "often been found to violate relevant advertising codes…many contain elements that are attractive to youth" and "complaints about advertisements are often dismissed and action is rarely taken against" violators. Hence, research "indicates a lack of effectiveness in protecting vulnerable populations." On the same theme, 3 "public health professionals with expertise in alcohol control policy" rated a sample of 215 industry-funded responsible drinking initiatives. These experts found "only 7.5% could be considered 'evidence based' likely to have a positive impact on drinking behavior or alcohol related problems," while "39.5% were considered to have the potential to promote a brand or product." What's more, over half of the programs run in low- or lower-middle income countries "were found to have some risk of harm." Again, more grist for the familiar "self-regulation doesn't work" and "industry can't be part of prevention" public heath themes.

A group from Boston University/CAMY summed up brand research findings so far. It contradicts, they say, "commonly held notions." Among them: 1) "youth are not drinking the cheapest alcohol brands" (nor are most adults); 2) brand preferences among underage drinkers "do not simply mimic what is popular among adult drinkers" (CAMY's own research shows it's very close - see June AII); 3) youth are "not simply opportunistic" drinkers but drink a "very specific set of brands" (again, like any drinkers); 4) "evidence of alcohol advertising targeted at youth is much more likely to be found at the brand level" (likely since there's virtually no advertising that's not brand level).

There were a few counter-intuitive findings, at least from the public health perspective, presented at APHA. One study comparing high risk drinking among college and non-college young adults found that while college students engaged in more high-risk drinking, "a higher percentage of the non-college groups reported experiencing more alcohol-related problems than the college group." Indeed, the non-college students were twice as likely to report 3+ problems. Another study found that "states that permit sobriety checkpoints had significantly lower levels of alcohol-impaired driving" but "there was not a significant association between prohibition of open containers and alcohol-impaired driving." Finally, a comparison of control and non-control jurisdictions across key alcohol policies found little difference: "Control states do not appear to be more or less restrictive than privatized states on other alcohol control policies. These findings suggest that a state's alcohol distribution system is independent of its overall policy environment." Ref 2  

A handful of the most active public health advocates in the alcohol field developed a new tool to show how higher excise taxes "may lead to a small net increase in the number of jobs," not result in the kind job losses that the industry argues would follow from significant tax hikes. David Jernigan, Alexander Wagenaar, Tim Naimi and Frank Chaloupka put a lot of moving pieces into play: state-by-state drinking rates, beverage elasticities, average prices, 3 different tax scenarios, mark-up rates, employment data and adjustments for taxes going into general funds or dedicated to health care/treatment. They also adopted the notion that "excessive drinking" is any drinking over the dietary guidelines of 2 per day for men, one per day for women (see above). The result: "a new online tool estimating the impact of different alcohol tax scenarios on jobs for each of the 50 US states and Washington DC," available at www.camy.org. The scenarios include 5-, 10- and 25-cent tax hikes, plus a 5% sales tax.

Many of the methodological moves can be challenged, not the least of which is that state governments would necessarily boost employment as a result of collecting more alcohol taxes. But that's not the point. The point is that the advocates have created a new "tool" to argue in favor of higher taxes and refute the argument that higher taxes hurt jobs and the typical drinker, including responsible drinkers. And again, by defining excessive drinking as anything over the dietary guidelines, the tool suggests that "non-excessive drinkers" won't pay much of a price even for extreme tax hikes. For example, according to the tool, nearly 80% of a 25-cent per drink tax hike in California would be shouldered by excessive drinkers, who will pay about $46 more per year, compared to less than $9 for "non-excessive drinkers." Then too, the majority of the additional burden will be borne by households making over $75,000, not middle- or low-income drinkers. Not only that, but a 25-cent tax hike in California will create over 95,000 jobs there if the money goes to the general fund, about 6,000 jobs in healthcare if the funds are dedicated. Even more jobs are created with a sales tax of 5%. Presto! The creators admit that jobs may be lost in "the production or sale of alcohol," but "overall, alcohol tax increases generally result in small increases in employment under either of" the tax options, they assure.

When word of this research appeared last week, DISCUS immediately dismissed it as a waste of tax dollars "on blatant anti-alcohol advocacy research." The study "wrongly presumes that the vast majority of drinkers are abusive drinkers" who impose costs on society, ignores the economic benefits of the hospitality industry as well as the health benefits of moderate consumption, and more. But, a "colossal waste of taxpayer funds" or not, the question remains whether policymakers will wield this new tool going forward.  

Two recent government published/financed studies adopt a definition of "excessive" drinking that includes all consumption over 1/day for women, 2/day for men, the current federal dietary guidelines. This definition suggests that roughly 1 in 4 American adults are "excessive drinkers," a level being used to advocate higher taxes and more restrictions.

The Centers for Disease Control's (CDC) new report on "excessive" drinking and alcohol dependence in the US got significant media coverage last week. CDC's major theme: 90% of "excessive drinkers" or "those who drink too much" are not alcoholics or alcohol dependent, showing 4 of 7 criteria for dependence. CDC seemed to be reassuring the public that not all Americans who "drink too much" need treatment for dependence. But, ac-tually, CDC's report "emphasizes the importance of taking a comprehensive approach to reducing excessive drinking." That approach, of course, includes "evidence based community strategies," along with screening, counseling and treatment if. Those strategies include "increasing alcohol taxes, regulating alcohol outlet density and holding alcohol retailers liable for harms resulting from illegal sales to minors or intoxicated patrons." And so, another advocacy document from CDC.

None of this is really new, including the notion that only a fraction of those who drink too much are dependent. But look how CDC defines "excessive" or drinking "too much." The report uses data from the annual National Survey on Drug Use and Health (NSDUH). It defines "excessive drinking" as: "binge drinking," "heavy drinking" and "any past 30-day drinking" by those 18-20 years-old or pregnant women. The NSDUH surveys and the SAMHSA federal agency that performs them define "heavy" drinking as basically 5 binge episodes per month. But the new CDC study defines "heavy drinking…as 8 or more drinks per week during the past 30 days for women or 15 or more drinks per week for men." (A separate CDC survey, the Behavioral Risk Factor Surveillance System [BRFSS], does define "heavy" drinking this way.) That's basically all consumption outside of the federal dietary guidelines, and presumably would include the first 7 drinks for female excessive drinkers and 14 for males who "drink too much."

CDC's problem inflation here is notable. First, it's including any consumption by 18-20 yr olds, adults by any other standard in most other countries, as "excessive." Similarly, a pregnant woman who has a drink or 2 per month is now an excessive drinker, as are any of her non-pregnant female friends who have that 8th drink per week. CDC's analysis of NSDUH surveys show that 70% of Americans are drinkers, about the same as other national surveys report. But CDC identifies 27% of adults, one of every 4 you pass on the street, within its "excessive" definition. That's 65 million "excessive" drinkers in the US, not to mention 4X more than the NSDUH surveys identify as "heavy" drinkers. That's not a realistic number. But it is useful to advocate allegedly "evidence-based community strategies" that most communities have so far resisted. CDC is not alone in using this tactic. As the International Center for Alcohol Policy's (ICAP) Deputy President Marjana Martinic told INSIGHTS: "There has also been a global trend towards expanding the definition of what is harmful or excessive drinking. For example, WHO now defines heavy episodic (binge) drinking as 'at least 60 grams or more of pure alcohol on at least one occasion in the past 30 days,' whereas it had previously been over the past 7 days. By this broader definition, more drinkers can now be categorized as engaging in binge drinking." Ref 1  

IARD will combine the two groups' responsible drinking, education and policy advocacy programs under a single entity. Ann Keeling will head IARD beginning January 1, bringing over 3 decades of agency experience, in developed and developing nations, working on a broad array of issues including population, diabetes and non-communicable diseases. "IARD will continue to build on last year's Commitments launch, enabling member beer, wine and spirits producers to make even more rapid, focused progress in promoting the responsible use of our products" said Chairman Rick Wilson, who is also a Sr VP at Bacardi-Martini.

Just prior to announcing IARD, the same producers announced a new set of Digital Guiding Principles as part of their commitment to reduce harmful drinking. The digital guidelines aimed to align traditional and on-line marketing standards, adopt country-specific codes to "reflect local cultures, lifestyle, traditions and national contexts." The new digital guidelines reflect the same "guiding principles" adopted in November 2011 by the ICAP companies. The Principles apply to all branded marketing communication, including advertising, marketing on social websites/blogs and mobile communications where the companies control content. User generated content (UGC) placed on sites companies do not own or control clearly can't be covered by the guidelines, but the principles include some suggestions for UGC on company-controlled sites. The principles fall into 4 buckets.

• Minors - Companies "should use an age-affirmation mechanism" to assure users are over the legal drinking age in every communication that "actively engages a user to directly interact with a brand." That includes date of birth and country of residence and a notice that if there's a "remember me" option the user should consider the "appropriateness" of using it if users under the drinking age have access to the computer. Users who are denied access should be re-directed to an "appropriate message" or site and not be allowed easy return to simply change date of birth. If a digital platform does not have age affirmation, companies should consider whether the platform: has an audience that meets at least a 70% adult audience standard, reminds users not to share content with underage users and "provide a mechanism to remove or moderate inappropriate user generated content."
• Responsible Consumption - communications on company controlled platforms should include responsible drinking messages, placed on the landing page. User Generated Content on company controlled platforms should be "moderated on a regular and frequent basis" and include "community guidelines stating the UGC policy."
• Transparency - Companies should not "improperly promote a brand using marketing techniques that falsely imply they are an ordinary consumer."
• Privacy - Companies should require consumer consent before sending marketing communications, provide easy opt-outs and abide by local laws regarding use of consumer data.

These principles align with those recommended in the March 2014 report from the Federal Trade Commission on Self-Regulation in the Alcohol Industry. FTC found that in the first half of 2011, 99.5% of alcohol ads placed on digital sites had an audience that met the industry's 70% adult standard at the time, a higher percentage than the industry achieved overall. FTC recommended that alcohol beverage companies use age-gating technologies like those adopted by Twitter and You Tube, take privacy concerns into account "particularly if they collect consumer information in any form," as well as opt-in for further communications and easy opt-out procedures. Ref 3  

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References
1 Omer Hoke and Chad Cotti,"The Impact of Large Container Beer Purchases on Alcohol-Related Fatal Vehicle Accidents," Contemporary Economic Policy, Online Advance, doi:10.1111/coep.12089, October, 2014.
2 Wayne Hall, "What has research over the past two decades revealed about the adverse health effects of recreational cannabis use?," Addiction Monograph, doi:10.1111/add.12703, October, 2014.
3 Beer, Wine and Spirits Producers' Commitments to Reduce Harmful Drinking, "Digital Guiding Principles, Self-Regulation of Marketing Communications for Beverage Alcohol," September, 2014.

legalization of medical marijuana in 10 big US markets "if anything…had a positive impact on beer volume." Per capita beer consumption in those states fell more slowly after legalization than before, Stirling found. Medical marijuana is not recreational, Trevor admits. But look at the biggest alcohol beverage market in the US: California. Consensus is that medical marijuana regulation is a "joke" there, as advocate Michele Simon said at the CAP meeting we reported on in the last issue of AII; access to pot is quite easy. Since 1996 when medical pot was legalized there, per capita beer consumption in California dipped 4.7%, vs a 6.5% drop across the US. During the same period per capita wine consumption increased by 1/4 and per capita spirits consumption rose by over 20%. Point is: the jury is still out on how recreational use in Colorado and Washington impacts drinking. But in the biggest alcohol beverage market where medical pot has been widely available for almost 2 decades, there's been no drinking disaster.

A recent review of 20 years of pot research in the journal Addiction accentuated the negative aspects of mostly "regular, typically daily, cannabis smoking" and ill effects. But the review also pointed out that car crash risk is significantly higher among drinkers than pot smokers. "Cannabis users who drive while intoxicated increase their risk of motor vehicle crashes 2-3 times as against 6-15 times for comparable intoxicating doses of alcohol," research suggests. And while cannabis is "estimated to account for 2.5% of traffic deaths in France," for example, alcohol accounts for 29% of traffic deaths there. The author also pointed out that that "adverse health and social consequences of cannabis use" reported by users seeking treatment "appear to be less severe than those reported by alcohol…dependent people." Ref 2

More Alcohol-Pot Parallels; What's Responsible Use? While alcohol-pot parallels and relative "safety" arguments played a key role in the Colorado legalization debate (and is part of the initiative in Alaska and Maine), that was not the case in Washington state. And in Washington DC, the debate is apparently centering around "racial justice" issues, according to AP. Many advocates point to the disproportionate number of black residents arrested for pot offenses. But the DC debate also shows how fast all this is moving. DC decriminalized small amounts of pot in July of this yr. That did not stop advocates from pursuing legalization just a few months later. Another sign of the fast-changing times: "300 attendees paid $500 each to attend the Cannabis Business Expo" in NYC recently, reports Reuters. And a lengthy USA Today article on October 4 detailed large and small businesses that are "eyeing the emerging marijuana markets." Interestingly, pot regulators will likely face the same challenge that their alcohol counterparts encounter as the businesses develop: tracing cross ownerships and investor backgrounds. One Colorado policymaker said "If you have outside investment, can you track where those dollars are coming from? You want to make sure that none of the criminal element is infiltrating the marijuana industry."

And here's yet another alcohol-pot parallel. Just as some public health advocates over the years have suggested "all drinking is risky" and questioned the very notion of "responsible drinking," the same issue is emerging with marijuana. Reacting to the edible challenge, pro-pot activists in Colorado have launched their first "consume responsibly" ad campaign, including the slogan "don't let a candy bar ruin your vacation. With edibles, start low and go slow," the New York Times reports. But a recovery expert told the paper: "The legislature in Colorado put greed before safety and failed to set any real standard. How do you gauge what qualifies as responsible use? Based on what measures?"

Can States "Get it Right"? Back at CAP, and elsewhere, anti-legalization observers have stressed difficulties with: 1) measuring THC content in users, especially in drivers, significantly complicating enforcement; 2) properly taxing THC; 3) regulating edibles; and more. The Colorado Department of Public Health recently advised, then backtracked on a proposal to ban many forms of marijuana edibles, AP reported. There will be further regulation of that format coming. Despite these issues, a recent Bloomberg article stressed that "states can get it right." The conclusion reflects a very common consensus: "If you accept the evidence that alcohol is worse than marijuana or that the drug war didn't work or simply that legalization is inevitable, it doesn't take much to see the trend. The public is clamoring for a more up-to-date and realistic approach to recreational pot, and government is figuring it out." We'll see.  

a 10% increase in total beer purchases of containers greater than 12 oz increases alcohol related fatal accidents by 1.95%." Given the annual number of accidents in these DMAs, that translates to "an overall increase [of] approximately 3.6 more alcohol related fatal accidents in a year for the average DMA."

The authors acknowledge that the data is limited by the fact that they were not measuring any on-premise consumption. And they did not provide any pricing data. But they did point out that other studies have linked larger container sizes with increased consumption (for example, popcorn in movie theaters). And they speculated that "the combination of the lower unit price associated with larger container size and short consumption window after opening" specifically shorter than for wine/spirits, they note elsewhere, "may cause people to consume alcohol more quickly, or in greater quantity." (Our emphasis.) That in turn "may lead to greater average levels of intoxication" (ditto) and therefore fatal accidents.

And again, despite no information on who was actually drinking what or from what size container in the accidents, the same results, in their view, "suggest that individuals prone to dangerous levels of drunk driving are the same people who most prefer large container size consumption." What's more, the findings, they claim, are "consistent with the idea that binge drinkers and beer drinkers are much more likely to drive while legally intoxicated." (Recall, they measured crashes with any alcohol, not with BACs over the legal limit.) In a final leap to policy, the authors advise that "policy makers should consider a beer tax based on the size of the containers" since that "should" reduce alcohol-related crashes. This is not the first time that policy changes have been advocated based on statistical correlations. But it is an especially wide leap given this data's limits. Ref 1  

Some interesting media takes emerged in recent weeks on drinking patterns, as outside observers explored what's "normal" and what isn't when it comes to imbibing alcohol. The Washington Post kicked it off with a "Wonkblog" post in late September that resurrected a calculation from advocate/researcher Phil Cook's book back in 2007 titled "Paying the Tab." Cook calculated that the heaviest drinking group in the US population consumed, on average, 10 drinks per day. Every day. That's not only too much alcohol, but it's a ton of calories, no matter what you're drinking.

Wonkblog's author Christopher Ingraham checked the number with Cook himself, who of course defended it and said: "I agree that it's hard to imagine consuming 10 drinks a day," but added "there are a remarkable number of people who drink a couple of six packs a day, or a pint of whiskey." Indeed, there are 24 million of them, Cook calculates. Ingraham went on to suggest, naturally, that the industry is "heavily dependent" on these heavy drinkers. Cook had used the findings (among others), of course, to advocate that "alcoholic beverages are too cheap for our own good. The obvious solution is to raise excise taxes."

Cooking the Consumption Figures At Forbes, columnist Trevor Butterworth, who has called out some other alcohol researchers in the past, pointed out that Cook had noted that the national survey he'd used to determine American drinking habits had under estimated known sales of alcohol by about half. (Indeed, drinking surveys always significantly underreport known sales. As Butterworth points out about diet studies in general: "We misremember what we ate; we misjudge by how much; we lie.") In response, "Cook corrected" the survey data "for under-reporting by multiplying the number of drinks each respondent claimed they had drunk by 1.97 in order to comport with the previous year's sales data for alcohol in the US." There are at least 4 problems with Cook using an "aggregate multiplier to plug the sales data gap," in Butterworth's view: 1) while the multiplier may make sense for light drinkers, it's a "stretch" to think "that everyone who drank, say, four to eight drinks per week systematically [forgot] that they actually had eight or sixteen: " 2) the national survey included no underage consumption; 3) a certain volume of alcohol is "wasted" (not consumed -- and some is stockpiled, especially wine and spirits); 4) Cook's data doesn't square with other national surveys, like Gallup, NHANES or NSDUH, none of which "come remotely close to Cook's estimate." That estimate, Butterworth observes, "makes it easier to advocate for taxation as an intervention," which is exactly what Cook does. Butterworth goes on to make some broader claims about the problem of statistics abuse in the blogosphere and elsewhere in the media. It is certainly common in the alcohol policy field.

What's Normal; What's Up with Ledermann? Meanwhile, over at online magazine Slate, Daniel Engber used the same Cook data to explore his own drinking levels, ask "How normal is your drinking?" and ultimately defend Sully Ledermann's theorized "single distribution consumption curve" that's been much debated and oft-challenged in alcohol studies over the decades. Engber cites the Wonkblog's "shocking chart" that shows the heaviest drinkers average an "incomprehensible" 74 drinks per week. He expresses "relief" that his 11-drink/week habit makes him a "temperate fellow," but then alarm when he realizes, that according to Cook, he's "dosing himself with 10 times more alcohol than the typical American."

Engber's personal response is mostly interesting as yet another form of American ambivalence about drinking, but he spends most of his post defending Sully Ledermann's single distribution theory linking average consumption to the number of abusive drinkers in any given culture. Engber comments, not quite accurately, that the Ledermann theory has been "tweaked but never fully contradicted." Clearly, he missed John Duffy's and Christopher Snowdon's total dismantling of Ledermann, from the perspectives of math, logic and real world experience, earlier this year (see June AII). Engber concludes that the single distribution curve "isn't as precise as Ledermann claimed" and that the argument that "any change in mean consumption will change the alcoholism rate …doesn't always hold." Yet, "when it comes to assessing public policy, it's not a bad rule of thumb," Engber decides, without actually exploring any "public policy" implications.

Nice Knows it's Best to Drink Less Finally, the National Institute for Health and Clinical Excellence (Nice) in the UK recently announced a plan to offer hundreds of thousands of consumers a "first ever drug to help reduce alcohol consumption," according to The Daily Telegraph and several other press reports. Nalmefene, which costs almost $5 per pill, apparently reduces the urge to drink, will not be prescribed for alcoholics. Rather, it is aimed at men who, after two weeks, cannot reduce their drinking levels below 3 pints of beer/day and at women who can't cut back below 2 glasses of wine/day -- levels often associated with heart health and other benefits. In effect, Nice wants to prescribe a drug to turn responsible drinkers into light drinkers. Nice estimates the program will cost about $460 million per year, save 1,854 lives over 5 years and prevent 43,074 alcohol related diseases, strangely precise figures for a new drug, reported the Telegraph.

Reactions ranged embracing an "alternative step" to complete abstinence by "helping people to cut down drinking to less harmful levels" (a professor) to resistance to the nanny state "medicalizing perfectly normal and harmless human behavior" (an observer from Scottish Express) and questions about cost when "relatively simple population interventions, such as reducing advertising and minimum unit price, could quite easily reduce alcohol consumption to safer levels" (a public health advocate in the Telegraph). Look back to a comment from the Duffy critique of Ledermann. Interventions such as nalmefene mostly hurt "those who experience alcohol problems" because they lose out on necessary "specialist alcohol treatment" when the focus turns to broader based interventions.  

It's a familiar refrain, but one worth returning to. As public health advocate-researchers like Jim Mosher and CAMY's David Jernigan raised alarms recently about alcohol ads appealing to youth, the latest data from the national Monitoring the Future surveys shows yet another significant decline in teen drinking rates. Last month, Mosher had a "case study" published about the marketing of the Smirnoff brands titled "Joe Camel in a Bottle." At the same time, CAMY put out a new brochure this week that points out that television "exposure" to alcohol ads increased by 71% from 2001-2009. CAMY also warned about the widespread popularity on Facebook of alcohol and risks to youth who are "plugged in 24/7." Meanwhile, the 2011 MTF data shows another year of across the board declines in key drinking measures among 8th, 10th and 12th graders, most of which have fallen to "historic lows."

The table below highlights how much 10-year trends in current drinking and being drunk (in the past 30 days), heavy drinking (5+ at least once in past 2 weeks) have plummeted among teens. During the same period, "disapproval rates" of both experimentation and heavy drinking increased though not quite as dramatically as drinking rates have fallen. Some of the 10-year trends show truly remarkable progress: the current drinking rate among 8th graders fell by over 40%; it fell by over 30% among 10th graders. Rates of having been drunk and so called-binge drinking also declined in the 35-45% range among 8th and 10th graders. Declines among high school seniors were not as sharp, but still in the 20% range. Flavored alcohol beverages, viewed by public health advocates as a particular threat to teens (i.e. Mosher's comments about Smirnoff Ice), lost a great deal of popularity among them over the last 5 years, again especially among the youngest teens. As noted, anti-drinking attitudes moved in the right direction, with over ¾ of 8th and 10th graders disapproving or strongly disapproving of weekend heavy drinking.

Compare other long term trends. Daily drinking measures have always been very low. Only 0.4% of 8th graders, 0.8% of 10th graders and 2.1% of 12th graders admit to the habit. But that's down from 0.5%, 1.3% and 3.6% respectively compared to 20 years ago in 1991. During the same 20-year period, daily pot smoking increased significantly among each age group and now far exceeds daily drinking.

Among 12th graders, 6.6% smoke pot every day, more than 3X the daily drinking rate, and up from just 2% 20 years ago when it was less popular than daily drinking among high school seniors. Daily smoking has also declined significantly among teens during the last 2 decades, but still remains more popular than pot or drinking. Over 10% of high school seniors still smoke every day and over 4% still smoke at least a half-pack daily. Ref 1

Drinking alcohol mixed with energy drinks (AmEd) "had a greater likelihood of experiencing negative alcohol-related consequences and reaching thresholds for harmful/hazardous alcohol use," a study of 620 college students over a 2-year period (from sophomore to senior year) found. Over the study period, approximately 26% of the students who participated mixed alcohol and energy drinks in past 30 days. So, while pre-mixed alcohol and caffeine drinks have disappeared, a significant minority of students continue to mix (or order) the drinks on their own. Higher risks were associated with both infrequent (1-3x a month) and frequent (1 or more times per week) AmEd consumption. The authors also found that frequent AmEd users "were also more likely to report serious alcohol problems and alcohol-related accidents" two years later. The study found "no differences" for consequences based on gender, race, age or sorority/fraternity involvement.

Alcohol "may alter the subjective rewards experienced by the drinker," the authors suggested, which leads to "increasing alcohol use both in the moment and across time." Other research has shown AmEd use "is associated with consuming higher quantities" over longer periods of time, they also pointed out, "which may also directly increase the likelihood of alcohol tolerance and dependence." Adolescents, students, parents, teachers, doctors and others need "basic information" about dangers of AmEd use, noted the authors, adding that educational efforts "although rarely sufficient" to change behavior, could be boosted by "improved labeling regarding caffeine content of beverages, as is required for over-the-counter products containing caffeine." Ref 1  

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References
1 Patrick, M, et al, "Use of Alcohol Mixed with Energy Drinks as a Predictor of Alcohol-Related Consequences Two Years Later" Journal of Studies on Alcohol and Drugs, Vol 75, No 5, September , 2014, 753-757.