By Joseph A. Califano, Jr., Julius B. Richmond, Louis W. Sullivan, M.D. and David Satcher
The study published this week in the JAMA (Journal of the American Medical Association) which finds that underage drinkers and adult excessive drinking account for half of the alcohol consumed in the U.S. has profound ramifications for public policy, parents and the alcohol industry.
The peer-reviewed analysis reveals that in 1999 (the last year for which necessary data was available) children and underage drinkers consumed 19.7% and excessive adult drinking accounted for 30.4% of the beer, wine and liquor consumed in the U.S.. And that estimate of misuse and abuse of alcohol is probably conservative. Researchers used the federal government’s health standard for men—in excess of 2 drinks a day--to calculate the amount of adult excessive drinking for both men and women, when the health standard for women is in excess of 1 drink a day because of differences in body water and the way in which women metabolize alcohol.
Drinking is a fatal attraction for America’s children and underage drinkers. Alcohol is a major contributor to the 3 leading causes of teen death: accidents, homicide and suicide. Individuals who begin drinking before age 21 are likelier to become adult excessive drinkers. They are more than twice as likely to develop alcohol related problems. Biomedical research had found that alcohol alters the developing brain and may cause irreversible brain damage.
Moreover, for young Americans there is a correlation between alcohol use and illegal drug use. The Directors of the National Institutes of Drug Abuse and Alcoholism and Alcohol Abuse point out that “12 to 17 year old youth who consumed alcohol in the past month were 7.6 times more likely to use illicit drugs than those who did not.”
Although a recent study by the Harvard School of Public Health suggests that moderate drinking may have some beneficial impact on the heart, there is resounding evidence that excessive drinking is linked to serious health problems such as liver disease, high blood pressure, stroke and many cancers. Alcohol is the number one drug involved in crimes such as rape, assault and murder and in child abuse, domestic violence, family breakup and accidents. In the population 12 and older, heavy binge drinkers (5 drinks at one sitting at least 5 times a month) are 11 times more likely to use illicit drugs like marijuana, cocaine and heroin.
Of Americans who drink, 76% are adult moderate drinkers who consume 34% of the alcohol. 9% are adult excessive drinkers who consume 46.3% of the alcohol. The remaining 15% are underage drinkers who consume 19.7% of the alcohol.
With these revelations about underage and adult excessive drinking, the beer, wine and hard liquor companies face a choice. They must now decide whether they are prepared to cooperate with the public health community to curb such drinking, or whether they intend to walk the walk of the cigarette companies, undermining legislative public health initiatives and fighting lawsuits that claim their marketing activities have encouraged such drinking.
One marker of good faith would be for the alcohol industry to endow a truly independent foundation to mount an aggressive campaign to combat underage and adult excessive drinking. We do not expect an industry that gets half its sales from such drinking to mount a credible campaign against it with institutions like the Century Council, which it controls.
The industry should also voluntarily label its products, detailing all the ingredients and specifying the caloric content. In a survey of girls and young women, The National Center on Addiction and Substance Abuse at Columbia University found that only 56% knew alcohol is high in calories and contributes to weight gain. Another 5.7% thought that drinking alcohol makes one lose weight (not surprisingly, these young women drank more than the others). Every beer container and bottle of wine and hard liquor should bear a label warning against underage and excessive adult drinking and listing the consumption standards established by the U.S. Departments of Health and Human Services and Agriculture—e.g., “More than 2 drinks a day for men and more than 1 drink a day for women is hazardous to your health.”
Federal, state and local governments can promote the public health and ease their budgetary problems by increasing taxes on beer, wine and liquor. Increasing the cost of alcoholic beverages offers a triple win to hard pressed governments: it will discourage underage and adult excessive drinking and decrease the related health care and criminal justice costs, it will lower their deficits, and it will reduce illegal drug use.
Alcohol is the number 1 drug of abuse for young Americans. Revealing the widespread extent of underage drinking and the often related adult excessive drinking triggers a loud alarm for parents and schools: Underage drinking can no longer be winked at as an inevitable rite of passage; it must be recognized as the grim game of Russian roulette it is, a game far too dangerous to ignore or accept among our youngsters.
February 27, 2003
Joseph A. Califano, Jr. was Secretary of Health, Education and Welfare and Dr. Julius B. Richmond was U.S. Surgeon General in the Carter Administration; Dr. Louis W. Sullivan was Secretary of Health and Human Services in the George H.W. Bush Administration; Dr. David Satcher was U.S. Surgeon General in the Clinton and George W. Bush Administrations.