The National Council on Alcoholism and Drug Dependence fights the stigma and the disease of alcoholism and other drug addictions.

Interviews with the Experts

Former Surgeon General David Satcher, MD, PhD, on Binge Drinking

Q	Why is underage drinking such a serious public health threat?
A	Alcohol is the drug most frequently used by American teenagers. It is consumed more frequently than all other illicit drugs combined and is the drug most likely to be associated with injury or death. Alcohol is a drug that can affect judgement, coordination and long-term health. It is involved in teen automobile crashes, homicides, and suicides--the three leading causes of teen deaths.
Q	Teenagers--and many of their parents--think of drinking as a "rite of passage" and nothing to be concerned about if they don't get behind the wheel of a car. Is there anything we can do to change this attitude?
A	We must change this attitude. There was a time when alcohol use was considered a `rite of passage,' however, that `passage' was from adolescence into adulthood. Today as we see younger and younger children using alcohol, the `passage' is too frequently from childhood into adolescence. We now know that children who begin drinking alcohol before the age of 15 are four times more likely to develop alcoholism in adulthood than those children who do not begin consuming alcohol until the legal age of 21. There are other social and health consequences which make underage drinking such a serious public health problem. Adolescent drinking is associated with risky sexual behaviors that can lead to AIDS, sexually transmitted diseases and unintended pregnancies. Alcohol contributes to academic failure and dropping out of school. In addition, underage drinkers are more likely to become perpetrators or victims of rape, assault, robbery, murder and other violent crimes. This has put a major burden on our juvenile justice system which reports over 50% of their cases involve alcohol use as a contributing factor. Furthermore, deaths on college campuses due to alcohol abuse are the subject of all-too-common reports in our newspapers. Young people need to know about alcohol poisoning. Alcohol is a depressant. Consuming it rapidly in large quantities can be fatal. Alcohol's impact on developing organs, the brain, and decision making make it a particularly dangerous substance for adolescents. Preventing motor vehicle crashes is not the only reason that youth should not drink. Finally, we need to underscore to parents that they do make a difference for their children. Research tells us that the number-one reason adolescents give for choosing not to use alcohol is their parents. When parents talk with teens about drinking, those teens are less likely to use alcohol.
Q	Is the nation doing enough to combat underage drinking? Are we taking this problem seriously? What can be done?
A	We need to do much more. For too long we have looked away from the enormous social and economic toll alcoholism and alcohol abuse exact on our nation. We have failed to appreciate that the roots of alcoholism and alcohol abuse have their origins in adolescence. While alcohol is a legal product, it is not legal for children and children are especially vulnerable to its dangers. We can more aggressively enforce existing laws that prohibit alcohol sales to underage youth. We can more aggressively educate our parents, children, teachers and others involved with young people about the prevalence and the dangers of alcohol abuse, especially with respect to underage drinkers.
Q	Binge drinking typically occurs on college campuses, away from the eyes and ears of parents. Can parents do anything to protect their children?
A	First I want to stress that all too often binge drinking begins in high school. Parents must be aware of the risk and take protective steps in those critical years before their child enters college. Parents need to clearly establish an expectation that they do not want their children drinking before they are of legal age. We know that the earlier a child is exposed to alcohol, the more likely it is to lead to violence, the more likely it is to lead to other forms of drugs, and the more likely they are to have problems with it later in life. It is dangerous for parents to breathe a sigh of relief when they find out their teenager is only drinking alcohol. While it may be tempting to view alcohol as a milder drug when compared to marijuana or heroin, it is important to remember that alcohol is a powerful, mind-altering drug. The potential life threatening consequences from its misuse cannot be minimized. Parents also need to recognize that this issue impacts them even if their child is not a binge drinker. We know that students who did not binge drink but are on campuses with a large number of binge drinkers, are at greater risk for being affected by negative consequences ranging in severity from common annoyances to vandalism and assaults. Some common sense recommendations parents should follow include: Educate yourselves about the consequences of underage and binge drinking, and share this information with your children as well as your own values on the topic. Recognize that college students spend more on alcohol that they spend on soft drinks, milk, juice, coffee and books combined. Alcohol can not be treated casually. We must encourage our youth to avoid alcohol and not spend their college years drinking away their future. Investigate the college your child will attend. Find out the alcohol policies in place. Find out what non-alcoholic social activities are available to students. Visit the campus on a weekend night to see the social atmosphere first-hand. See what type of security and emergency services are available to your child if he or a peer find themselves in trouble with alcohol. Determine whether the school permits alcohol advertising and marketing on campus and at sporting events. Most importantly, stay involved with your child. Be aware of changes in grades and friends.
Q	What role can college administrators play in preventing binge drinking among students?
A	College presidents and administrators institute policies that shape the environment on college campuses. Therefore, college presidents should develop policies that will create, support, and enforce an environment which encourages responsible behavior by students on their campuses. College presidents must also work with their local communities to successfully enforce underage drinking laws and prevent binge drinking by college students on or off campus. An obvious step colleges should take is end the promotion and marketing of beer and other alcoholic beverages on campus. The level of advertising and promotion on college campuses when the majority of students are under the legal age, creates an environment that encourages underage drinking.
Q	There are reports that college and high school athletes are more likely to drink heavily than other students. Doesn't alcohol impair athletic performance? Is there anything that can be done to reach this population?
A	It should come as little surprise that members of athletic teams --both men and women--report drinking more heavily than non-athletes. There is a strong marketing association of beverage alcohol and athletic events such as football, basketball and soccer. This is particularly ironic because we know that alcohol can impair athletic performance. Alcohol interferes with the central nervous system. Balance and coordination, judgement and reaction are affected. Alcohol also causes dehydration--a condition no serious athlete would seek. Because athletes are so concerned about their performance in the pool, on the court or on the field, we need to work with coaches and athletic directors to strongly discourage alcohol use by their players. They need to educate the athlete about the effect that alcohol has on their body and by doing so, we may be able to shift the drinking culture away from the sporting culture which has tended to glamorize drinking. The beverage alcohol industry has a responsibility to discourage underage drinking and to curtail advertising and marketing that appeal to underage youth. The prevalence of alcohol advertising on television and the association of alcohol with professional and college sporting events is a matter of great concern. Secretary [of Health and Human Services] Shalala and I have called for an end of alcohol promotions on college campuses and through sponsorship agreements with college sport teams. This is an area where the industry could give parents a break and end the promotion of alcohol in college environments where a disproportionate percentage of the audience is underage.
Q	In recent years there has been great attention placed on the responsibilities of the States to curtail illegal sales of tobacco to underage youth. What needs to be done to curtail underage sales of alcohol? Will this address the problem of alcohol use by underage youth?
A	Enforcement of existing laws is critically important but it is only part of the solution. Currently there are many laws designed to curtail the sale of alcohol to anyone under the age of 21 and to make it illegal for adults to purchase alcohol for underage youth. The problem is that the existing laws are not consistently enforced. We know strategies have been successful when they use tougher State restrictions and penalties for those selling and distributing alcoholic beverages to underage youth. This includes not only retailers, but also family members, friends, and co-workers who may be contributing to the problem of allowing access to alcoholic beverages by people under 21. Another strategy that has achieved success is the passage of Administrative License Revocation (ALR) laws. ALR call for the prompt, mandatory suspension of the underage driver's license for failing an alcohol or drug test or refusing to take a test. ALR has proven to be a successful deterrent to driving while under the influence of intoxicants. While controlling access is important, we must also develop strategies to reduce the appeal of drinking for teens. We need to develop and widely disseminate campaigns that deglamorize underage drinking and change the social norm that fosters the consumption and abuse of alcohol. Until we are able to curtail the demand by young people for alcohol, increased enforcement and legal sanctions will represent only half the solution.

National Council on Alcoholism and Drug Dependence, Inc.

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