SALT LAKE CITY — The talk over how much Supreme Court nominee Brett Kavanaugh and his classmates drank in high school and college has created a moment that public health officials and substance abuse experts hope families seize: Having a conversation about youthful alcohol consumption and the risk posed by underage and binge-drinking.
Parents need to have frank discussions with their kids and set clear expectations as children and young adults face increasing pressure to engage in risky behaviors, including drinking, says Dr. George F. Koob, National Institute on Alcohol Abuse and Alcoholism director.
"Underage drinking flat out is just not good for your body, for your social interactions, for life in general," Koob says, noting a "biological basis" for laws that ban underage drinking.
Underage drinking, including binge-drinking, has declined over the past decade in terms of how many are doing it, but 1 in 6 high school students binge-drink — a hard-drinking classification that for adults includes having roughly five alcoholic beverages or more for men and four for women. It's enough to put someone above the legal limit for blood-alcohol concentration within two hours.
According to the 2016 National Survey on Drug Use and Health, 191,000 adolescents ages 12-17 were "heavy alcohol users." Ten percent of young adults ages 18-25 also fell into that category — about 3.5 million young adults. Both numbers were based on consumption within 30 days of the survey. Although alcohol consumption is illegal before age 21 nationwide, in 2016, about 7.3 million young people, 12 to 20, said they drank in the past month; including 4.5 million who binged.
Underage drinking hurts brain development and creates consequences that can burn opportunities for young people, sometimes for life. Binge-drinking pours gas on the fire.
The frontal cortex — part of the brain involved in making decisions, planning, social interactions, relationships and personality, among other things — isn't fully developed until around age 25. Before that, "the effects of alcohol change the physiology of the brain permanently and that never goes back," says Scott Smid, clinical manager for outpatient recovery service at the University Neuropsychiatric Institute at the University of Utah.
"The earlier you start drinking, the more likely you are to have an alcohol abuse problem later in life. It impairs just about every kind of function you can imagine if you're engaged in binge-drinking," says Koob, whose list of possible problem areas includes school work, deteriorating family and other relationships, increased likelihood of accidents and injuries, and more.
"They drink out of control," is how Christina Zidow describes American teens who drink. It's an observation built on experience as a licensed clinical social worker and chief operating officer of Odyssey House, which provides substance abuse treatment in Utah. Most will carry those drinking patterns with them into college and young adulthood.
Today's alcohol binge is different than those of the past, according to Joseph LaBrie, a researcher from Loyola Marymount University who studies youths and alcohol, as well as parental roles in dealing with it. When they surveyed 3,000 youths to find out why they drink alcohol, the No. 1 reason was "to pass out."
A quarter-century ago, "If we drank, we drank to have fun with friends, to hang out, be social. Now, the No. 1 identified reason is to pass out, black out, get high," LaBrie said.
Youths may even "pre-game," which means they have drinks at home before they go out to drink, he says.
For parents, delaying the age at which children start drinking and binge-drinking can head off "huge chaos in terms of development of the child into an adult."
The stakes are high. LaBrie notes 1,500 deaths a year among college-age young adults related to alcohol, as well as a half-million sexual assaults.
As is the trend nationally, underage drinking has decreased in Utah over the past decade. "But those who are drinking tend to drink more," says Susannah Burt, prevention program administrator in the state's Division of Substance Abuse and Mental Health. In fact, 60 percent of youths who drink binge-drink.
Burt says alcohol and tobacco, which are more accessible than other drugs like opioids, tend to rewire brains and lead to experimentation and other substances. Consuming alcohol young creates "much higher risk of becoming someone who's alcohol dependent." Drinking young can also create an appetite within the brain for more alcohol — and more of the chemicals and feelings that are created when one drinks.
Of those who died by suicide in Utah — not just youths, but all ages — 30 percent had alcohol in their system, according to the Office of the Medical Examiner. Burt's careful to call it a factor, not a cause; the relationship isn't clear. But it's a striking percentage.
She thinks love of children — but also love of communities — provide good reasons to set up boundaries and monitor what youths get involved with, including alcohol. "We know healthy youths become healthy citizens, proactive and engaged. The more youths are less dependent on alcohol and other substances, the more likely they are to be productive workers, the more likely to be mentally healthy and less likely to experience negative outcomes," Burt says.
Zero tolerance and tough talks
When it comes to underage alcohol or binge-drinking, zero tolerance is the only effective choice, says LaBrie. He warns against permissive or "harm-reduction" messages. Those are things like, "Don't drink, but if you do …" Stick with "Don't drink." Otherwise young people get mixed messages.
Parents are influential in setting the stage for whether and how their children drink, experts say. Zidow says kids report they pay more attention to their parents than to the media or anyone else. So parents who make clear rules and expect their kids to meet them have fewer problems than those who don't.
"When teens know parents are going to be disappointed if they're drinking and bingeing, that's effective, too," LaBrie says.
But lots of parents claim to follow a "European model" of moderation, allowing their older children to have an alcoholic beverage, like a glass of wine or other drink, with dinner. Koob rejects the notion that it teaches children to drink responsibly and exhibit self-control. European countries have their own problems with youthful binge and underage drinking, he says.
Besides that, letting a teenager have a drink or two in the backyard with 20 family members is not an experience that translates to a college drinking party. The former teaches nothing about handling the latter.
As for modeling, "If you're drinking and boozing it up in front of your kid — no offense to anyone — that's just the wrong message to send."
Zidow recommends helping young people understand what their motivations might be to drink: to deal with myself, to forget disappointments, to get over hurt feelings. "Helping people be more emotionally intelligent so they understand the function escape drinking is providing means they can find more appropriate ways to deal with those stresses."
LaBrie notes a link, as well, between anxiety and youths and young adults who drink. Managing anxiety becomes an important tool.
Communication and being a positive role model are keys to reducing youthful drinking, says Koob. Ongoing conversations are "critically important." Keeping talking, even after kids leave for college, Koob adds. "You don't want to be the pest parent … but it's a good idea to keep the lines of communication as open as possible. Every parent I know has had that phone call: 'Dad, you're not going to like this.' But at least they get the phone call."
Zidow says to start talking about alcohol and substance abuse early and then keep talking about it over time. "Talk about emotional intelligence and coping strategies and even alcohol in elementary school. Those who enter substance use disorder programs typically started young." The conversations may flow easier if you have them while you're doing something enjoyable, like going for a hike or biking. That might feel less awkward or like it's a lecture.'
And when you talk about it don't use fear, exaggerate or make things up.
"Those strategies don't work," says Zidow. Be honest. Stick with "this is more likely to happen with those who drink."
If a child asks a parent who drank as a teen, LaBrie suggests being honest but brief. "I may have drunk in high school, but looking back, I think it might have harmed me. I'm interested now in your development and what's best for you."25 comments on this story
Parents should help kids prioritize adequate sleep and a healthful lifestyle. Setting appropriate standards even helps with keeping kids from running with the "wrong crowd."
Alcohol abuse prevention also requires limiting access, says Zidow. She thinks parents need to stop modeling alcohol as a coping strategy at home. "If you had a long week and the solution is reaching for a drink, you need to pay attention. The strongest message comes from home," she says.