Alcohol is classified as a class one carcinogen. I can’t recommend this article highly enough:
https://www.motherjones.com/politics/2018/04/did-drinking-give-me-breast-cancer/
Dr. Joseph LaBrie and his collaborators have conducted important research on interventions in college-age binge drinking for several decades. Many of their studies yield results that are relevant to the question of the effectiveness of similar interventions at the high-school level.
Given that some teens and preteens do drink, I think all doctors should screen for this - ASK. What to do with the information is a separate issue -but you don't even get there without asking.
But asking and talking about it is the necessary first step.
I remember being taken aback in my ancient teen times when I was a teen by knowing of a couple of peers - in a very small school - who were already alcoholics, and how that fact seemed to be invisible to adults, including teachers and parents.
Then when I had a teenage stepson, he pushed the limits on drinking - and I learned that teen drinking was widespread and accepted - enabled by adults - in the village we lived in.
Always ask. It's very likely that they will tell you.
1
I don't think you can talk a teenager out of much of anything that involves trading off short term pleasure or gain for long term well being. When I was 14, the last thing on my mind was what kind of shape I would be in at 70 pr 75, and what to do in order to make it better. When you have only been alive for 15 years, its hard to imagine four more lifespans and what your health will be then.
When I was 14, I had a hard time envisioning my life after age 35. Nor did I care much about it.
About the most effective thing that could be done is to gross a kid out with the consequences of long term abuse of their health. I remember, when I was in high school. there was a major anti-smoking campaign. They showed us a graphic movie of someone having a cancerous lung removed. Kids were nauseated, a couple of them fainted. But these days, kids are more hardened than we were back in the early 1960s.
3
I grew up in a traditional Italian family that also happened to be in the wine and spirits business. As children, from the earliest age, we were always allowed to have wine and then later liquor if we wanted it. Our parents would quiz us (for fun) about wines & liquors we sampled to help us develop an appreciation for differences and effects. I never forgot getting dizzy and nauseous from a glass and a half of champagne. Never liked that feeling. Especially interesting was sampling new liqueurs when they were released. As we got older, the only stipulation being, if we drank, we handed over the car keys. None of us ever got into liquor related problems as teens or developed bad habits as adults. It was just no big deal.
3
As a psychologist with 30+ years of experience in trying to help teens I can attest to the fact that caring adults may be able to assess an adolescent's drinking pretty well. But their ability to change that behavior is very limited. Teens will trust info from a peer much more readily than from an adult. Peer counseling is much more effective with adolescents.
1
@jeff
Well, Doctor, you grew up in a rarefied realm where kids drank everything from Boone's Farm to polio vaccine and they didn't ever puke. I congratulate you on being a member of Niedermeyer's fraternity.
I am your age. I went to a solid state school with a fine med school and law school, and witnessed a spillway of vomit from drinking.
Also, I remember a scholarship quarterback in high school regretting not holding back his girlfriend's hair matted with vomit. This ain't nothin' new.
The etiology of the drinking problem is multifold. As a psychiatrist, you'd think you would have more insight into the prolonged adolescence of American students with the attendant boredom, diffidence, lack of identity, and anxiety about grades.
There are many reasons young people drink, almost all very bad. Perhaps a real education system which valued the Arts & Sciences, as well as some sort of transcendent spirituality would be a better tack.
The Romantic poets, musicians, and artists favored excess and dissipation with various psychotropic substances. They were fleeing the rational and the industrial.
I believe that's what crapulent young people are doing with alcohol, albeit unfledged and crudely. It's a difficult assimilation into a society of rationality, money, law and order. In addition, boys want to prove their masculinity and unleash the id. Girls not so much, but they feel more comfortable with the public and privates after a few pops.
As a Brit it's kind of fascinating to see American opinions on alcohol. House parties here generally start at 16 and alcohol is often supplied by parents, it's not really seen as a big deal. There are generally healthy conversations about alcohol when the exclusivity or hype about it are taken away. Sure, there are many adolescents who will drink until they pass out or vomit, but many will learn a genuine lesson from it. Allowing them to drink in a safe space is more important than scaring them off or outlawing it.
2
@Kai
Your indifference is misinformed. Per “The Telegraph” (see article link below) alcohol is actually a big problem in Britain. Please use this information to educate yourself and anyone else who may believe alcohol is not a danger.
The Telegraph
Britain's binge drinking levels are among the highest in the world
By Laura Donnelly, and Sarah Gallagher
12:01AM BST 13 May 2014
Britain is among the worst countries in the world for binge drinking, according to a new report by the World Health Organisation. The research examined 196 countries and placed the UK 13th highest for heavy drinking - worse than countries such as Estonia, Ukraine, Belarus and Hungary.
Emily Robinson, deputy chief executive of charity Alcohol Concern said: “It’s a tragedy for every one of us that the UK is wallowing amongst the worst 25 countries in the world for alcohol intake. Because of this lives are being needlessly lost and even more ruined by ill health.
“Sadder still is that the Government knows what needs to be done to turn this bleak picture around, yet it continues to ignore the evidence.”
https://www.telegraph.co.uk/news/health/news/10825449/Britains-binge-drinking-levels-are-among-the-highest-in-the-world.html
7
We recently published an edited book on this exact topic which summarizes research in this area, including our own line of research successfully intervening with adolescents in the Emergency Department following an alcohol-related event such as alcohol overdose, an alcohol-related car crash, or an assault. It also includes research-based recommendations for extending this work into other settings such as foster care, youth courts, and primary care.
Monti, P. M., Colby, S. M., & Tevyaw, T. A. (2018). Brief Interventions for Adolescent Alcohol and Substance Abuse. New York: Guilford Press.
1
Missed by so many in this country is that by our puritan positions on many issues we create problems that need not exist. My California parents shared sips of wine with me when I was interested at 4 or 5 years old. I saw that the adults who drank hard liquor to excess at cocktail parties (this was in the 60s and 70s) acted foolish and did not enjoy themselves as much. As a result I have consumed modest amounts of wine since that age and have NEVER drunk enough to be even somewhat inebriated. Also this allowed me to develop an understanding of what tasted good and recognize when it started to taste less good.
I did the same with my sons. Only one son whose mother has a very low tolerance ever has been a heavy drinker from peer pressure and he now has dramatically moderated his consumption.
The two things we need to do about alcohol are to change the messages to be 1) modest amounts of wine or beer can be enjoyable and 2) drunk is NO FUN. Encouraging modest consumption at home or under adult supervision and modeling moderation are the best ways to do this with the least possibility of harm to young people and society.
4
There is a reason the drinking age is/should be 21. The brain is still developing up to then, and possibly even longer. Drenching it in poison before it's even grown up is a recipe for mental illness, behaviour disorders, criminal activity, and addiction. (It applies to drugs and tobacco, too.) You wouldn't voluntarily cut off two inches of your leg, would you? At least wait until you've given your body a chance to handle the assaults of adulthood. You ain't missin nothin.
9
Youth is wasted on the young..
5
As someone who has also gone to Medical School I can say with certainty that these “thresholds” of 4 drinks a day or 14 per week are completely made up. Literally they are committee recommendations devoid of hard research as Dr Carroll also attests.
Remember the food pyramid? It was the gospel of food nutrition until suddenly it wasn’t. Does anyone know if eggs are good for us this week?
Let’s get some funding behind actual research before we go on preaching “best guesses” as guidelines.
8
@Jason, I agree with you about the drinking recommendations. I've talked with people all over the world and they all have different cultural guidelines for alcohol...
I saw an interesting article about how the US research and information tries to become the "gold standard" on things and it doesn't really apply well to other countries, like the DSM-5 is really only applicable to Western countries or places with cultures similar to ours.
"Can Doctors Talk Teenagers Out of Risky Drinking?"
Also can parents talk teenagers out of drinking alcohol until they are 18?
And can Hollywood stop showing alcohol as the "go-to-booster/relaxer" - the cool thing for the stars to do? [Just as Hollywood eventually (much too late for a couple of generations across the world) stopped showing smoking cigarettes as the cool thing to do.]
2
People are suggestible -- young people especially. So: data or no data, suggest that they not drink. You'll be surprised how effective that can be.
1
We all know the reasons kids drink, its cool, its fun, you feel like a grown up, you like to do dangerous things, you are worried,sad, your brain is not yet developed, and so on. But this world is rapidly becoming more dangerous and less stabile. If youngsters cannot produce the self control to keep themselves out of danger, then they are facing an increasingly dangerous world. Only a few generations ago, kids had chores and worked hard on farms and in jobs. Maybe we should allow them to work earlier to give them a sense of responsibility as early as possible. Raise the wages for teens to encourage them to work when possible. They might be exploited, but they would be busy and occupied and under supervision.
@joyce, I would like to disagree with your statement that the world is rapidly becoming more dangerous and less stable. I would argue that the world has been the safest it has been in all the time humans have been around.
5
In my experience, a person who will have a problem with alcohol might be able to know it from their first time drinking, especially if they've suffered from depression and/or social anxiety, or have experienced symptoms of those conditions even if not officially diagnosed. Had I understood why alcohol made me immediately feel so different, and had I understood that those different feelings were a huge warning sign, I might have been able to help myself. I might have learned that I needed therapy and AA. I haven't yet seen an article that speaks to individuals' first time using a substance: what can happen and what can be learned from that experience. My pediatricians wouldn't have been able to help me; I didn't start drinking until my sophomore year of college.
7
I respectfully disagree with those that feel only parents should be having conversations about alcohol use with their kids. What if a parent inappropriately uses alcohol, or is abusive in any way toward their child or spouse? Are teens, if old enough to comprehend health information, not entitled to be given appropriate information around alcohol by their educators or health care providers? And to have a safe place to to discuss their own issues in the privacy of their physician’s office? As a physician and father of teen and preteen boys, that’s not ever been a question in our family. I talk my kids about the the importance of risk and how behaviour can be appropriately or adversely influenced without adequate knowledge. We should support the learning of appropriate behaviours at every opportunity with our kids.
7
Human behavior is so soft and ill-defined that quantitative methods rarely establish significant results. This isn't a question for "research".
This is a task for parents, and best done by modeling good behavior. One glass of wine with a family dinner.
4
@Jonathan Katz Your colleagues at the medical campus respectfully, but emphatically, disagree.
4
no
1
I've long thought HS health classes focused in the wrong way. It's all about why the teen shouldn't drink to excess. But teens are often overconfident, sure that they can handle it. Instead, if health classes discussed what to do if a friend or acquaintance is so drunk they are at rusk of alcohol poisoining or some other adverse effect. The message would sink in and ---bonus--- they'd be better prepared to help others.
4
@SAO - That confidence in "handling it" is the fallacy. The effects of alcohol (or other drugs) are on body chemistry and structures. No amount of "toughness" or conscious resolve influences the way a brain cell interacts with a poison.
5
I don’t know what Dr. Carroll means: “There’s disagreement on the definition of unhealthy alcohol use for adults.”
The CDC guidelines (while somewhat flexible) give fair warning that no one should ever start drinking. Period.
To review:
A standard drink is equal to 14.0 grams (0.6 ounces) of pure alcohol. Generally, this amount of pure alcohol is found in
• 12 ounces of beer (5% alcohol content).
• 8 ounces of malt liquor (7% alcohol content).
• 5 ounces of wine (12% alcohol content).
• 1.5 ounces or a “shot” of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, whiskey).
According to the Dietary Guidelines for Americans, moderate alcohol consumption is defined as having up to 1 drink per day for women and up to 2 drinks per day for men.
This definition refers to the amount consumed on any single day and is not intended as an average over several days.
However, the Dietary Guidelines do NOT recommend that people who do not drink alcohol start drinking for any reason.
4
Alcohol is poison.
Your cells have these things(organelles) called Mitochondria. They're really ancient bacteria but they're the powerhouse or engine of your cell.
They take in Alcohol Dehydrogenase. It goes through cellular respiration(Krebs cycle) and is converted into Acetldehyde, which is poison.
You are damaging your cells.
I plan to live till 150 years old.
Alcohol is not going to get me there.
6
@William Smith, so many other chemicals affect your mitochondria as well and I would bet you are exposed to hundreds of them everyday.
Helping mitigate substance use in adolescents is not an event it is a process. The process starts by an interested adult having a non judgmental conversation that offers education and perhaps referral to a specialist in addiction treatment if indicated. If one operationalizes efficacy of an intervention as total eradication of a symptom after one application it is very likely that the intervention will be found to have no significant effect
7
Perhaps the rise of mental illness in our nation can be traced to a wide-ranging abuse of alcohol and drugs. I heavily abused alcohol in college, and this has contributed to a weak memory now in my 30s, and a tendency toward bipolar symptoms. I believe the alcohol abuse damaged my mind to some degree which cannot be detected on an MRI, but is nonetheless present. The brain is like a very fine and precise computer, and even small damage amongst the software of neuron connections can have long-lasting implications.
I always cringe, and even get angry, when a doctor judges the severity of a concussion on whether one lost consciousness or the severity of a drinking episode on whether one had a black-out. It is not either/or. It is not a mindless exercise of black and white.
Brain damage occurs before a loss of consciousness and before a blackout. The lack of a nuanced understanding of brain injury, drug, alcohol and concussion dangers amongst doctors and the general populace is appalling, and I truly believe contributing to the rise of mental illness in this nation: which is fundamentally one of damage to the brain. Any form of concussion, blackout or overdose from drugs and alcohol damages the brain. Period.
4
@Hierocles, I don't think there is a rise in mental illness. Mental illness is largely defined by what society thinks is acceptable or not. It wasn't that long ago that homosexuality was considered a mental illness, or a woman's menopause being labeled as "hysterics".
Two years ago I went to my high school 50th reunion.
An awful lot of men were there who were heavy partiers in high school. 20% of my class didn't make it long enough. But there was no difference that I could see between those who made it and those who didn't.
Kids see the same thing. It's not worth the effort. Concentrate on what could make a difference--drinking and then driving. Even in my high school years we could see the problems with that.
2
Looks like we aren't hearing from the kids themselves. Too bad. We might have learned something.
3
As a physician who has done college student mental health, I think we often go about warning adolescents about the dangers of drinking in the wrong way.
Obviously we need to warn them about drinking and driving or drinking to such excess that they put themselves at risk of being harmed.
However, with regard to drinking at parties or other social events, the problem is that they see others drinking without problem and wonder why they shouldn't too.
I was often asked by students who were clearly alcoholics how come they had a problem but noticed others without the same problem often drank more than they did. I usually gave the answer as something in the book "Brideshead Revisited" where Charles Ryder drinks as heavily as his friend Sebastian Flyte but noticed that while he drank to enjoy himself, Sebastian drank because he had to. I would then ask them which category they felt the were in. Most were able to honestly place themselves.
10
Doctors barely have time to treat illness much less do the parents job for them. Unfortunately teens are way more likely to listen to peers than either their doctor or parent.
1
I am a pediatrician & ophthalmologist who had to retire in 2003 after a steroid shot for rheumatoid arthritis caused permanent vision loss. In my new life, I became a meditation teacher and an addiction counselor. I taught meditation & recovery principles at a long term homeless shelter for 9 years. Along the way, I became Mindful Self Compassion teacher to help me & others deal with shame & anger, etc.
When a panel of teenagers in recovery (AA) talks to a high school audience, everyone listens. Why? Because the panel describes in their language what ran through their heads as they lost control. And they can describe how their lives are different now.
The only way doctors will become skilled at treating alcohol and other drug addictions is to get their feet wet in their local communities. Training is one thing, experience another. In the recovery world of AA, there are existing programs for teenagers with alcoholism/addiction, for children of parents with alcoholism, etc. These programs are free. Doctors can learn about their community resources through someone they know (patient, friend, family) who is active in recovery.
What does a doctor do with a positive screening question? Look up the question list for "Are you an alcoholic?" & ask a few of those questions too. If they also positive, this patient needs further evaluation & treatment for a possible lifetime disease.
10
The Gordie Foundation,housed at the University of Virginia, named after a wonderful young man who tragically died of alcohol poisoning at at the age of eighteen, has been doing groundbreaking and consequential work for well over a decade. They provide extensive outreach to high school and college students. Their materials and documentaries are used nationally by high schools and colleges, the fraternity and sorority community, and a vast variety of student organizations and groups.
I know for a fact that Gordie Bailey, his family and the Foundation have helped save many lives. They do incredible work.
Sometimes, students need to hear a variety of voices in their minds when they think about overindulging : parents, doctors, peers, educators, clergy and others. The more they hear, the more they may hesitate.
We do, however, need to do the research. There are many experieced people out there working in this area from the legal profession to dedicated parents. Let’s make use of them and begin to collect the data on what does does work.
Thank you, Dr. Carroll, for helping to lead the way.
9
I find doctors have difficulty being compassionate when it comes to self-harming behavior. The cognitive dissonance is too much for them to handle.
2
Maybe parents should actually do their jobs, or not have kids if they understand what doing so involves. Of course, the birth rate sure would drop, maybe housing costs would decline, wages would increase, crime would decline, pollution would decline... Hmmm. Yes, don't have children unless you seriously commit to being a good one.
3
When my young cousin headed off to college, we told him to avoid the lethal dose of alcohol (like in those bad traditions where they make you drink 21 drinks on your 21st birthday).
1
It's a right of passage, leave them be.
3
Can you talk adults out of it?
2
It might not help in the short term, but in the long term, I think that it is safe to assume that it helps. A pediatrician is just one of the many adults in teenagers' lives who can guide them to make good choices. There's no downside to engaging pediatricians in work that is far too often left for parents to do alone.
6
I'm a pediatrician studying the same issue. It's a good article.
Important to point out that the systematic review that is the basis for evidence looked at screening + a brief behavioral intervention. This is the SBIRT model.
There are a couple of other approaches:
1) Screening + medication (naltrexone) for those with a moderate to severe alcohol use disorder. This is the AAP guideline, but only backed up by evidence in adults, I think.
2) Screening + text message intervention. Here, a quick scan of the literature shows more evidence for effectiveness in adolescents, particularly in an emergency room setting. This type of intervention is relatively new, and is sometimes dismissed... so I wonder if USPSTF considered this when they decided not to take a position on screening.
4
I am a doctor. I just succeeded in getting two more young men (my children) through their teenage years without getting into too much trouble with alcohol. I did this by talking to them early on, knowing that they would be experimenting with alcohol.
My approach was to explain to them that drinking alcohol was like taking conscious sedation. Once the speech gets slurred, it is time to stop medicating.
I have explained to them that it is more of an accomplishment to drink responsibly then to get stumbling drunk. Also, the opposite sex does not appreciate a date vomiting all over them and passing out.
This has worked with my boys. The 24 year old survived college, and is now gainfully employed as a civil engineer. The 20 year old is an honor student in college and is an officer in his fraternity.
Honest talking to youngsters does work, if they have reasonable intelligence. And there is no reason doctors can't accomplish the same thing in their offices and clinics.
19
@doc
"Conscious sedation" is a good description but doesn't go far enough.
I've read that it takes a full 45 minutes or more for a single dose of alcohol to show its full effects, so one can easily miscalculate what constitutes an "acceptable" dose, and add to it without realizing what degree of impairment will ultimately result.
And, since intoxication itself results in impaired judgment, a drinker is not able to make a reasoned decision as to whether they've had "enough" in any given moment. They may also wrongly conclude that they're sober "enough" to drive a car, while the alcohol consumed continues make them more drunk as it's metabolized.
7
@doc Congratulations - it's always a win when you can report positive outcomes in children, especially your own. I suspect that your involvement with them as a parent is the main driver behind the outcome and not that you are a doctor (although that provides a credible information source). I've collaborated on a study where, among other things, we asked adolescents and young adults about how/where they preferred receiving information about medical (and associated) topics (it was specifically about transition readiness). They said: parents, friends, and internet. Rarely was their doctor/nurse/medical provider on their preferred list.
3
@doc
But you have to acknowledge that some of your accomplishment was due to genetics which you can't take credit for.
We know alcoholism runs in families and has a strong genetic component. You can't make somebody without that genetic predisposition to becoming an alcoholic into an alcoholic no matter how much alcohol they drink.
If there was alcoholism in your family and you convinced your sons that they put themselves at risk for the disease by drinking and they didn't, you'd have achieved something much greater.
2
Even non-binge drinking is hazardous, especially over the long term.
How many people realize that alcohol is a cellular poison, and that it will inevitably cause cellular damage even in low concentrations? It takes a while for that cellular damage to manifest to the degree that there are clinical consequences, but the cellular damage is cumulative to organs (liver, brain, etc) and is irreversible.
How many people have observed what cirrhosis does to a person who was a "moderate" drinker (one drink per day long term)? The real suffering caused by cirrhosis and other results of long term drinking?
How many family members have experienced the vicious nastiness that can be dealt by someone who's had even just one drink?
Alcohol in moderation may be "socially acceptable" but it is still a poison, literally. I've never understood why people are willing to kill off parts of themselves just "for fun"--and then expect others to care for them in their debility.
Alcohol use is exceptionally destructive to families and to society at large, whether taken in "moderate" doses or not, yet it continues to be widely represented as glamorous and joyful and socially acceptable.
Many millions of drinkers and those in contact with those drinkers have to suffer the consequences of the choices made by others to drink. I know firsthand how this can ruin the lives of even non-drinking people.
16
@kathleen
"Even non-binge drinking is hazardous, especially over the long term."
No, it is not.
6
@kathleen
Try convincing a teenager to change any of their current behavior out of fear that they may develop an illness resulting from it in 30 or 40 years.
3
@TT - Yes, it is. Drunkenness is cell damage. It just happens to be a socially acceptable form of self-harm.
3
Very important article - yet another thing we do in medicine without any evidence. Who knows if asking adolescents in the clinic about alcohol use has a similar effect as that of the well-intentioned D.A.R.E. program. More research is needed to identify high quality SBIRT interventions specifically for this at-risk age group.
1
And we’re so shocked at the opioid “crisis” propaganda. Alcohol is a much bigger problem. Why? Because it is so socially acceptable. People give you drinks spiked with alcohol without even telling you. Neither of my two kids drink, but they’ve yet to reach late adolescence. Both are brilliant, and both are generally cautious. But alcohol affects judgement. It can change personalities for the worse, and I don’t need scientific evidence; I’ve seen it happen. So I dread the prospect of my sons drinking. I think the best we can do is make it less socially acceptable. Yes, you can have fun at a party without it. Warn people before handing them a spiked drink and messing w their brains. The backlash against hazing is a good start. Let’s go further.
14
Popular culture is to a large extent determined by powerful marketing on behalf of Corporate interests which seek to sell addictive products, irrational products, products that seek to create shallow and irrational stereotypes to serve as role models, and for those that cannot live up to the stereotypes there's plenty of ways to sink into oblivion. The US is the world's largest market for illegal drugs, but revenue wise that pales in comparison to the sale of legal drugs, whether it is addiction to sugar, alcohol or related status symbols!
4
As a former teen binge drinker, I'm going to go with, No.
Final answer.
7
And that is true for you. But people are a remarkably diverse bunch with significantly different brain chemistry, backgrounds and many "unmeasurables". So it is imporant not to over generalize.
2
While people may have wished that Motivational Interviewing would reduce alcohol use, it causes people to assess pluses and minuses of a specific behavior. It appears that, in numbers great enough so as to preclude statistical significance for the outcome of reduced alcohol use, people so interviewed have decided that the benefits outweigh the risks. This could arise from Cognitive Dissonance, but it does not necessarily mean that Motivational Interviewing (if you think what it should do is cause people to think) has failed.
1
From what I have seen in my life, most of the problem comes from children seeing adults drink and yet they are rarely told that alcohol is an out and out poison that if you drink too much in one sitting, that it can kill you.
Many people think they are Protecting their kids from the dangers of alcohol and/or other drugs by not discussing them or just by giving a biased 'drugs are bad', while the kids see the parents use coffee, cigs, alcohol and prescription or over the counter drugs ALL the time.
The 'War on Drugs' has made the honest conversation about drugs and their dangers pretty much taboo with the whole Drugs are Bad, M'Kay thing, and kids see right through it all to the fact that the parents are plain doing what they say not to.
So when the kids get away and have their first keggers, whether in high school or later when they go to college, there are too many cases of alcohol poisoning, mostly because the young folks do not understand the dire dangers facing them with alcohol, they think it safe because it is Legal.
People will always put various substances into their bodies for recreation or self-medicating chronic medical conditions, but what we need are Honest, non-biased teaching for our young and then have databases online concerning the actual dangers of various substances. Religion needs to be kept out of it, the 'morality' side. People can choose for themselves, most problems are in product quality and user ignorance of possible problems. The rest is legal.
5
@B. Honest, or perhaps parents are medicating actual, diagnosed, chronic medical conditions. They do exist. And I encourage all people to take prescribed medications appropriately (under the guidance of your experienced, knowledgeable providers and pharmacists). Even, if, for example, it's needed ALL the time, like insulin or anti-seizure medications.
This is worth a try. Yet as a retired addictions counselor and treatment program manager, my experience is that few primary doctors have been trained in addiction medicine and those who have only rudimentary training. Once a teen presents as drinking too much, what will the doctor do?
I treated and supervised the treatment of thousands of alcoholics and addicts. A huge number started using/drinking even before their teen years. They also reported getting drunk the first time they drank and liked it. They were chasing that high ever since. Such children will need much more than a three question screening from their pediatrician, though that is a start.
13
Can doctors talk 300lb adults out of eating French fries?
Teens are more impulsive and think less about consequences, and are also dealing with hormone overdrive and peer pressure. Why should they be more open to a physician's advice than their parents? If you think otherwise I can refer you to studies about 'promise rings' where it was found that kids who agreed to abstain from sex were just as likely to indulge as those who didn't.
5
We know a lot about how to prevent risky drinking among adolescents. Namely policy approaches! Making alcohol harder for kids to access and having penalties for adults who provide alcohol to kids works. These types of policies have driven the remarkable decline in adolescent alcohol use that we've seen in the past few decades.
5
@Rachel
Actually, the evidence is more complicated. I recall many years ago when I was doing drug/alcohol prevention groups at a high school. There was an exchange student from Germany and he expressed bewilderment at the focus of his classmates on getting alcohol each weekend.
For him, alcohol was readily available at home, under the supervision of his parents, who could pass along their values on the appropriate and responsible use of alcohol. It held no attraction for him as part of normal adolescent individuation.
I have long advocated eliminating the drinking age for alcohol in public, on-premise locations as long as the youngster was accompanied by his/her parents, it is a thought experiment.
4
Again, the focus and direction can be, or need to be, creating not habituating. “Recreation” exemplifies just that, whatever the choice may be, and the goals beyond connecting, are always the same, regardless of skill- community and clarity.
That happens in medicine just as it happens in painting, singing, being a dj or joining a band, or participating in sports.
Heck, why shouldn’t an MD be regarded and respected as a source for making that choice?
3
If a child wants to drink it is usually supported by his peers and the parent is outside the loop. The peers have it, not the parent(s).
3
@DENOTE MORDANT You’re totally right. Our society over emphasizes the role parents have with their adolescent children. It would be smarter for a parent to steer their children to hang out with friends who are responsible and are on the right track. Teenagers listen to their peers.
4
Very cool article, not just because of its content but primarily because of the comments.Two words among the comments seemed paradoxically to resonate- “engagement” and “boredom”.
Likewise, owning the consequences of one’s actions and just walking away from any dysfunction share a peculiar association.
In nearly thirty years of healthcare, I’ve never seen anything as beneficial or durable as a form of recreation, prescribed or otherwise, solitary or communal, whereby a participant’s field of influence is encouraged to grow and become more inclusive. Invariably recreation that has this source and continuum of interconnectedness and of facing and breaking down walls, whether it’s singing or throwing or kicking a ball, affords the cheapest and potentially indomitable source of self-esteem, as well as a meaningful invitation to others.
It’s not just a matter of “kids will be kids”, because adults face not just this dysfunction but this dilemma with equal or greater onus to the very end.
5
@Orbis Deo
Yes! A negative command is much less effective than a positive command. 'Let's go play ball' is a whole lot better for kids, adults, men, women, and dogs.
1
By all means, lets spend a million dollars on a study to demonstrate something that is obvious. Better to train parents to interact with their children.
4
@Kent Kraus
It is not at all clear that current practice is actually effective. Perhaps a more careful reading of the article would help?
If doctors simply worked on what seems “obvious”, we’d still be doing bloodletting. It seemed to work at the time, after all.
5
@Pundette
It killed George Washington.
It did not "seem to work". It was done on the basis of a "theory" about "humors" that we now know to be nonsense.
@Jonathan Katz
Yes, I know about the theory of humors, but it was supported by confirmation bias in that it “seemed to work”. I think we are on the same page and simply referencing two aspects of the same thing. Washington wasn’t the only one it killed either.
1
Doctors have an uphill road to travel if they're trying to dissuade teenagers from drinking. Our society extolls alcohol. Lethal fraternity 'hazing' involving alcohol gets a nod and a wink. High level politicians and judges wax poetic about their college drinking stunts. Fratboy kavanaugh came right out and said it , "I like beer". And there are many other examples.
The fact is that until this society gets real about the toxicity of alcohol, any attempt to stop underage drinking will fail.
43
Engagement is crucial with kids . Keep on talking!
12
Quite honestly I think the best thing that happened to my child as far as drinking goes. My wife filled a water bottle with vodka to take on a trip
(Sneaking it) my very young daughter took a sip. It was the worst tasting water she ever had! Horrible stuff!
And that thought has stayed with her.
She has had no interest into alcohol to this day.
And my wife stopped that behavior also.
1
@John
This is, unfortunately, an example of one. Similar experiences have not stopped many an experimenter.
I hated my first taste of coffee, wine, and spirits, but went on to enjoy them all (thankfully) in moderation. (Beer I loved from the first sip, but only abused a bit in my 20’s, but that didn’t ever include any “binge drinking”.)
4
As a family doc, I often counseled 10 to 16 year old kids.
I would start with the idea of the girl or boy friend:
"Don't go out with someone who is drinking or drugging. they learn to lie and you don't want to be with someone who lies. Don't go out with someone whose family drinks or drugs: lying becomes part of their family and the kids will lie too. Drinkers and druggies are not good partners and not good parens for your kids."
I started early because you have to get them when they still have hope that they will grow up to be good. I have no idea whether it worked. But I thought they needed to hear it in a simplified way: because the physical problems of addiction are abstract but kids know about lying.
Read "The Deepest Well" by Jamala Burke Harris MD. A pediatrician who clearly explains the effects of ACEs on kids and adults. ACEs are "Adverse Childhood Events" and they cause illness and dysfunction lifelong. She lists them in the back of the book.
7
A little chat from a doctor will not get young people to stop binge drinking. It just won’t. All you can do is wait for them to grow out of it. As mammals we are wired for risky behaviour in search of new experiences when we are young. It is common throughout the animal kingdom. You can try to reduce the instances of harm that come from young people taking risks, but that’s about it. Their risk taking, on the whole, is GOOD for the species.
On a separate note, is binge drinking when young really a problem? Sure, a minority of people suffer bad outcomes (even death), but the same is true of riding a bike, driving a car, eating chicken, or any number of other activities most of us do every day without much thought.
Personally, binge drinking among the youth does not worry me in the slightest. I don’t ‘like it’, obviously....but there is a stark difference between not liking something and labelling it a serious problem to be addressed.
Or maybe we should bubble-wrap our children even more....you know, since that seems to be working out so well!
10
How about sexual assault? A huge percentage of college sexual assault charges involve drunk participants. Whether it’s a young woman becoming extra vulnerable through intoxication or a young man drunkenly reading consent wrong and subsequently being charged with rape, reliance on alcohol as a substitute for emotional connection is dangerously common now among adolescents.
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@Lesley "How about sexual assault?"
Sexual assault happens in countless different circumstances. Yes, alcohol can play a part in sexual assaults, you're exactly right. However, let's not blame alcohol for sexual violence (I thought we had advanced beyond it). The perpetrators are to blame....every time.
Perpetrators have a responsibility to not commit sexual assault. Potential victims have a responsibility to manage their risk of being victmised. This is true for pretty much all crimes, and is totally independent of the presence of alcohol.
6
Well, a little chat from any one person may not stop kids from excess drinking but an additive or ideally timed talk or talks DO seem to help some kids some of the time, to those of is who do this every day. I have had kids get back to me with "that thing you said? It helped me so,thanks". We are "hard wired" for many things with many different individual results. So the cynical view not so valid or helpful. Want something to be cynical about? "Social Norms Marketing" "research" funded by the alcohol industry.
15
I am a psychiatrist. I doubt that any conversation is going to convince a teen to opt out of participation in most social functions. Over the 30 years of my practice drugs and alcohol have become more omnipresent in the social atmosphere of teenagers and young adults. I blame (along with the pressures and profound boredom of living in wealth suburbs) the 21 year old drinking age. Making alcohol forbidden fruit for a 16 year old who can barely imagine being a college senior has turned alcohol into "a thing" that one must "score". When I arrived at college in 1973 there was a beer pub in the basement of the freshman dorm at my state university (sponsored by student activity funds). It was no big deal. People partied but nobody threw up! Throwing up meant you were a baby who did not know when to stop. Now there are pop songs with romantic lyrics about holding your partner's hair back so they can vomit cleanly. Clearly this policy has been harmful. If you are 16 waiting to drink nat 18 was no big deal and although 16 year olds snuck some here and there it never became a big deal. The kitten does not care about the string until you yank it away from them when it becomes fascinating.
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@jeff
Legal drinking has always been 21 in my life (I grew up in Washington State) so I don’t think your theory holds much water. As a doctor (?) you should know better than to form such a hypothesis and then accept it without any evidence.
There are myriad cultural influences that may contribute to the scenario you describe other than legal drinking age--which has varied over the years and in different states.
9
@jeff
Maybe things were different at your college but I went to college about the same time as you and sure do remember classmates drinking so much that they vomited. I even lost a classmate who was killed when being driven by a classmate who had been drinking.
4
@jeff
Well, Doctor, you grew up in a rarefied realm where kids drank everything from Boone's Farm to polio vaccine and they didn't ever puke. I congratulate you on being a member of Niedermeyer's fraternity.
I am your age. I went to a solid state school with a fine med school and law school, and witnessed a spillway of vomit from drinking.
Also, I remember a scholarship quarterback in high school regretting not holding back his girlfriend's hair matted with vomit. This ain't nothin' new.
The etiology of the drinking problem is multifold. As a psychiatrist, you'd think you would have more insight into the prolonged adolescence of American students with the attendant boredom, diffidence, lack of identity, and anxiety about grades.
There are many reasons young people drink, almost all very bad. Perhaps a real education system which valued the Arts & Sciences, as well as some sort of transcendent spirituality would be a better tact.
The Romantic poets, musicians, and artists favored excess and dissipation with various psychotropic substances. They were fleeing the rational and the industrial.
I believe that's what crapulent young people are doing with alcohol, albeit unfledged and crudely. It's a difficult assimilation into a society of rationality, money, law and order. In addition, boys want to prove their masculinity and unleash the id. Girls not so much, but they feel more comfortable with public and privates after a few pops.
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I did not realize that young people aged 12-17 still were patients of pediatricians at age 12-17. If so, I guess questions about sexual habits and knowledge of contraception also might be included as part of routine pediatric examination for that age group.
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@Penseur Pediatricians see patients 0-17. Most will tell the patient at 18 they need to find a new MD, but not always. Sometimes they will allow the patient to continue seeing them since they have such a knowledge of their medical history. Yes, I agree there needs to be lots of education going on but we also can't rely on a MD to do all that in one appointment. It needs to be on the parents, schools, and community as a whole :)
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