Thursday, Jun. 19, 2008

Should You Drink with Your Kids?

By John Cloud/San Diego

I was 14 the first time I got falling-down drunk. I was attending summer golf camp at the University of Arkansas. It was 1985, and a preternaturally talented young golfer named John Daly was my camp counselor. This was six years before Daly won the PGA Championship as a rookie. He would also become famous for his drinking, but in 1985 he was still just a big kid, five years older than I was but not especially more mature.

One night he acquired a bottle of Canadian whiskey, and somehow we persuaded three girls from the tennis camp to join us in his dorm room. Not bothering with glassware, we passed the bottle around until it was empty. I remember eating some watermelon Daly had bought. The evening ended when I regurgitated the whiskey and melon onto one of the girls. Daly and another player on the Razorback golf team deposited me into the well of a shower, where I fell into a dead sleep.

I hadn't thought about that incident in years--I don't think I suffered any lasting damage--but then I started looking into the current state of underage drinking. What was considered by some to be a rite of passage back then would now be considered cause for grave concern. That's because the U.S. seems to be in the midst of one of its periodic alcohol panics, this one focused on adolescents. In the late 1800s and again during the first decade of the 20th century, our alcohol panics focused first on what was called "frontier drinking" and then on drinking in slums. Pulp novels and newspapers carried lurid tales of violent drunkenness. Today news stories offer grim accounts of high school parties that end in gruesome wrecks and of college kids killing themselves by consuming, say, 100 shots in as many minutes. Last year the Surgeon General issued a "call to action" to prevent underage drinking; the National Institutes of Health issued a similar one in 2002.

The calls to action make it sound as if America's high schools have become one enormous kegger, but in fact alcohol use among high school students has fallen dramatically. The Monitoring the Future surveys conducted by the University of Michigan show that in 1991, 81% of eighth-, 10th- and 12th-graders had had at least one drink in their lives; by last year, the figure was only 58%. Roughly 47% of this cohort had been drunk at least once in 1991; in 2007 only 38% had ever been drunk. On college campuses, meanwhile, the ranks of nondrinkers are rising steadily. In 1980 only 18% of college students surveyed for Monitoring the Future said they had not had a drink in the past month; by 2006 the proportion had risen to 35%.

And yet the typical college president can offer sad anecdotes about students dead from alcohol poisoning. Those deaths are still so rare that it's impossible to prove they are increasing. But according to Henry Wechsler of the Harvard School of Public Health, 26% of college kids who drink say they have forgotten where they were or what they did at least once; the figure was 18% for college men in the late 1940s, according to the seminal 1953 book Drinking in College. We think of the midcentury as a gin-soaked era, but when the Drinking in College authors asked students whether they had suffered an "accident or injury" as a result of alcohol (without defining precisely whether that meant only physical injury or also alcohol poisoning), only 6% of drinkers said they had. The figure has now more than doubled, to 13%.

So the data indicate there are fewer young drinkers, but a greater proportion of them are hard-core drinkers. Parents have helped create this paradox. Many parents seem torn between two competing impulses: officially, most say in surveys that they oppose any drinking by those under 21. But unofficially many also seem to think kids will be kids--after all, not so long ago, they were themselves drinking as teens. A few of these parents have even allowed their kids to have big drunken parties at home.

But there is a better way. At first it sounds a little nutty, but you might consider drinking with your kids. Incongruously, the way to produce fewer problem drinkers is to create more drinkers overall--that is, to begin to create a culture in which alcohol is not an alluring risk but part of quotidian family life. Of course, that's a mostly European approach to alcohol, but there's reason to think it could work here. And it may be the best way to solve the binge-drinking problem.

Ray DiCiccio is a well-tanned, mild, bespectacled 60-year-old who has served as executive director of the San Diego County Alcohol-Policy Panel since its founding in 1994. The organization is a county-funded nonprofit whose main mission is to reduce underage drinking, although in pursuit of that goal DiCiccio often fights for policies that restrict adult drinking as well. For instance, earlier this year the panel helped persuade the San Diego City Council to ban drinking on city beaches. It was already illegal for those under 21 to drink in any public place, but on a crowded day, it was difficult for police to be sure that no minors were taking beers from coolers.

DiCiccio and his top deputy, Patty Drieslein, feel that the alcohol industry has become so powerful that American culture has turned into a binge-drinking culture. "Most of our holidays have become drinking holidays," says Drieslein, 47, a brassy woman with leopard-print eyeglasses and a smoker's voice. "Halloween used to be about trick-or-treating, and now it's about Elvira with a beer." Kids notice, she says.

Like many temperance activists, going back more than a century, both DiCiccio and Drieslein have had problems controlling their own alcohol use. DiCiccio, a Vietnam vet originally from Midland, Pa., says he quit drinking in 1988 and then switched careers, from selling cars to helping others get sober. Drieslein, who grew up in San Diego, started drinking at 12 and went into recovery 18 years later, after indulging in six to 12 beers a night for many years.

Like many other people in recovery, DiCiccio and Drieslein--and by extension the county organization they run--take an all-or-nothing approach to alcohol. The policy panel and many groups like it around the country now maintain that all kids should wait until they turn 21 before having their first drink. That may sound uncontroversial; after all, isn't underage drinking illegal? Actually, no. When Congress passed the National Minimum Drinking Age Act in 1984, it explicitly allowed kids to drink at home or in "private clubs or establishments." Similarly, under most state laws, it's legal for those under 21 to consume alcohol under certain conditions. Only six states, mostly rural ones, ban underage alcohol consumption completely.

Most alcohol laws were enacted before we began trying to construct a zero-tolerance, total-abstinence culture for our teenagers--a phenomenon of the post-Columbine, post--Bill Clinton years. Two decades ago, prevention efforts aimed at kids focused on school programs that taught the dangers of excessive drinking. The trouble was, the programs didn't work very well. Teen drinking rose during the 1980s, the heyday for well-meaning, not especially effective programs like Drug Abuse Resistance Education. "The research kept coming over and over again that you can do this education stuff, but then you put these kids back in this culture, and it really doesn't make much difference," says DiCiccio, who has a master's in social work.

So in the '90s, DiCiccio and other alcohol officials around the country began to shift their focus from education to what is known as environmental prevention--banning alcohol in public places, for instance, or restricting alcohol licenses near schools. Prevention officials began working less with teachers and more with cops. In a way, the new strategy worked: fewer kids drink now because it's harder for them to obtain alcohol. But as psychologist Stanton Peele writes in his 2007 book Addiction-Proof Your Child (one of his 10 books on addiction), "When alcohol is presented as impossibly dangerous, it becomes alluring as a 'forbidden fruit' ... The choice between abstinence and excess is not a good one to force on children."

By the early part of the current decade, alcohol officials had noticed the numbers on binge-drinking, and they embarked on a new kind of prohibitionist strategy to discourage it: the "social host" law, the most sweeping change in American alcohol-enforcement since Prohibition. Social-host laws make residents over 21 responsible for any underage drinking that occurs at their home. The laws vary, but those who break them can be fined, forced to pay for police costs that result from underage drinking or even jailed. Twenty-four states and more than 100 local jurisdictions have passed such laws, the majority of them in the past five years. Many of the laws make no allowance even for parents to drink with their own kids; of the 55 social-host laws passed by California jurisdictions, for instance, only 25 make exceptions for parents.

That matters because there's evidence that drinking with your kids--not buying them alcohol for a party but actually drinking with them at home--is a good way to teach responsible drinking behavior.

A few years ago, a team of North Carolina researchers, led by public-health professor Kristie Long Foley, examined whether adults' approval or disapproval mattered when adolescents were deciding whether and how much to drink. Foley's team analyzed surveys of more than 6,000 people ages 16 to 20 in 242 U.S. communities. One predictable finding: kids whose parents gave them alcohol for parties were more likely to binge-drink. That discovery underscored years of research showing that the earlier people start to drink, the more likely they are to become alcoholics.

But another result was surprising: if kids actually drank with their parents, they were about half as likely to say they had drunk alcohol in the past month and about one-third as likely to say they had had five or more drinks in a row in the previous two weeks. As Foley and her colleagues wrote in a 2004 Journal of Adolescent Health paper, "Drinking with parents appears to have a protective effect on general drinking trends."

How this approach would work in any individual case depends, obviously, on the kid and the parent. Peele, the addiction expert, raised his own daughter (who is 20 and will be a junior at New York University) to drink a "few sips" of alcohol at family meals until she was about 16, when she could have a full glass of whatever the adults were drinking. "You give them sips as smaller kids, and you don't make a big deal about it," says Peele, 62. "Around 16, give them a glass of wine. A second glass probably doesn't make sense, but making hard-and-fast rules creates the sense that alcohol is some magical potion."

I was still curious to see how drinking with your kid might work in practice. Peele referred me to Tom Horvath, a past president of the American Psychological Association's division on addictions and the father of a 17-year-old, Greg. Through his work treating at least 2,000 people with substance-abuse problems, Horvath has come to believe that the best way to teach your kids about alcohol is to demystify it. Horvath, 54, was never forbidden alcohol; he recalls that his grandmother gave him his first sip of wine at age 4 or 5. He spat it out, but he absorbed the lesson that alcohol was part of family life. Growing up, he occasionally drank with his parents, and he now drinks a glass or two of wine or beer with Greg once or twice a month. (Tom and Greg's mother are divorced.)

I met Greg and his dad at a restaurant in La Jolla, Calif., where Tom runs a for-profit treatment center. After we were seated, I ordered a bottle of cabernet sauvignon, and the server asked for Greg's ID. "He's 17," Tom immediately said. He then asked the waiter if it would be O.K. if Greg drank with his approval. The waiter said no.

Greg seems like a typical teenager, which is to say he's enamored of green causes and a bit cocky. He also seems to have learned some lessons from drinking with his dad. "I went to a party as a freshman with all juniors," he recalls. "And there was one guy who was drinking, and he was chugging a bottle of Skyy. And they tried, 'Let's get the freshie drunk,' all that sort of stuff, and it just didn't seem that hard to me to say I wasn't going to drink."

Later in the meal, Tom raised the issue of how culture influences consumption. Kids from the Southern European countries of the Romance languages--France, Romania, Italy, Spain and Portugal--get drunk at about the same rate as American teens (or slightly less often) even though a typical kid in these countries can buy wine or beer in any shop from early adolescence. The Southern European model of moderate, supervised drinking within families seems to be the most promising approach, on the basis of the North Carolina study. Italy and Spain report very low rates of alcohol dependence or abuse (less than 1% and 2.8%, respectively) compared with the U.S., where the rate is 7.8%, slightly lower than France's 8.7%. (All the figures are from the World Health Organization.)

The spread of social-host laws makes it harder to teach a European model here. True, it's unlikely that police are going to raid private homes when only parents and their kids are together. But social-host prosecutions can be quite aggressive; in 2002 a Virginia mom and stepfather were sentenced to eight years behind bars for serving their son and his friends for the boy's 16th birthday. The couple had collected car keys in advance, and no one was hurt. But after years of failed appeals, the mom and stepdad, now divorced, had to report to jail last year. (In the end, they had to serve only five months, not eight years.)

Most social-host laws give police expansive powers. According to data compiled by the Pacific Institute for Research and Evaluation, an organization based in Calverton, Md., that studies alcohol policy, only eight of 67 U.S. jurisdictions with social-host laws require that the homeowner have "actual knowledge" of underage drinking at the house to be charged with a crime. In other words, you can violate most social-host laws even if you are in another country when your kid decides to party. And under many social-host laws, a meal with wine served at a dinner table is treated no differently from a kegger if neighbors are present with their kids. In short, we are encouraging kids to leave their homes (presumably by car) and drink in parks or abandoned warehouses or anywhere else they think they won't get caught and their parents won't get arrested.

It's not surprising that social-host laws don't seem to work as intended. In 2003, San Diego became one of the first big jurisdictions to adopt a social-host ordinance (both the city and county of San Diego passed a social-host law that year). After some legal wrangling, a tougher version of the city's law was enacted in 2006. Yet according to the San Diego Police Department, patrol-car responses to parties in the city increased from 7,265 in 2002 to 9,383 last year. (This figure includes parties with both underage and of-age drinkers, since it's impractical for cops to ID everyone once they arrive. But it is teen parties that get the loudest.)

The period since the city's social-host law was first enacted has also seen an enormous increase in the number of kids going to hospitals with alcohol-related problems. According to data from San Diego County's health department, the number of minors presenting alcohol and substance-abuse problems at health-care facilities in the jurisdiction rose from 473 in 2002 to 892 last year. At one of the city's biggest hospitals, Sharp Memorial, 7.3% of underage trauma admissions involved alcohol in 2002; by 2005 the figure was 13.4%.

In other words, the social-host law appears to have broken up big house parties into many smaller ones. Possibly because fewer adults are present, the parties are less supervised, and more kids are getting so drunk they end up in the ER.

When I mentioned some of the arguments against social-host laws at the San Diego County Alcohol-Policy Panel, DiCiccio offered another reason that kids shouldn't drink with adults: alcohol could hurt their developing brains.

It is accepted as an article of faith in the prevention community that "the teen brain" should not be exposed to any alcohol. But the research on alcohol and the young brain is actually quite murky. It has mainly shown that very high doses of alcohol given to adolescent rats (those roughly 40 days old) affect those animals differently from the way alcohol affects adult rats. In typical studies, the rats are injected with 5 g of alcohol per 1,000 g of their body weight, often after the rodents have been deprived of food for 12 hours. Rats metabolize alcohol about 10 times as fast as humans, but in a typical rat, this 5 g/kg dose on an empty stomach still results in a monumentally high blood-alcohol concentration. "It's difficult to compare to humans, but it's about a case of beer," says Aaron White, an alcohol researcher at the Duke University Medical Center--that's a case of beer ingested all at once.

What these rat studies tell us is that exposure to very large amounts of alcohol (particularly repeated exposure) probably inhibits normal brain development. And yet there are signs that in certain ways the adolescent brain is better equipped to handle alcohol than the adult brain. Adolescent rats show less vulnerability than adult rats to alcohol's sedating effects (which is one reason kids can party so much longer than adults). Other studies have found that, as White writes, "adolescents may be less sensitive than adults to the effects of alcohol on motor coordination." None of this means you should let your kids get drunk with their friends. But there's little reason to think small amounts of alcohol consumed at family meals will be as harmful.

Because alcohol is harder to obtain now than in the '70s and '80s, more kids are delaying their first drink. But most people will drink before 21, and it's a reasonable goal for parents to be there when it happens. "What if a kid has never had alcohol and drinks for the first time at 21?" asks Peele, the author of Addiction-Proof Your Child. "If they haven't developed a capacity to regulate themselves with alcohol at all, you can be headed for trouble."