Adolescent Binge Drinking: Trends, Implications, and New Directions for Schools

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Adolescent Binge Drinking Trends, Implications,
and New Directions for Schools
Presented by Joël Phillips Community Prevention
Institute (CPI)

• Colusa County Office of EducationFebruary 16,
  2005

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Issues

• What constitutes excessive alcohol consumption?
• Is there a problem with excessive alcohol use
  among California adolescents?
• If so, to what extent?
• Are there disparities to address?
• What are the consequences of excessive alcohol
  consumption?
• What can we do?

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What is Excessive Alcohol Consumption (Binge
Drinking)?

• General
• Binge (high risk) drinking is the consumption of
  alcohol to the extent that harmful consequences
  health, academic, legal and others may be
  expected.
• Specific (Recent NIAAA definition)
• A binge is a pattern of drinking alcohol that
  brings the blood alcohol level concentration
  (BAC) to 0.08 or above. For the typical adult,
  this pattern corresponds to consuming 5 or more
  drinks (male), or 4 or more drinks (female), in
  about 2 hours.
• A drink refers to half an ounce of alcohol
  (e.g., one 12-oz. beer, one 5 oz. glass of wine,
  or one 1.5 oz. shot of distilled spirits.)

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Dimensions of the Problem
Table 1. High Risk Drug Use Excessive Alcohol
Use
91-92() 93-94 95-96 97-98 99-00 01-02 02-03
Grade 9
Excessive Alcohol Users (EAU) 18.5 21.0 23.3 19.4 16.4 17.1 14.3
High-Risk Drug Users (HRU) a 11.4 21.2 20.2 20.3 11.0 10.4 9.3
Total EAU or HRU 22.0 29.1 28.5 29.5 19.4 20.0 17.4
Grade 11
Excessive Alcohol Users (EAU) 27.5 29.2 31.3 30.8 33.9 32.4 29.9
High-Risk Drug Users (HRU) a, 17.6 26.6 26.8 26.9 20.7 21.3 17.3
Total EAU or HRU 32.5 37.8 38.4 38.6 37.6 35.7 33.6
a Refers to drug use in the past six months only.
Passive parent consent required for
participation starting in 1995, active (written)
consent was required.
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Excessive Alcohol High-Risk Drug UsersGrade 11
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Trend Data Results

• The trend data in Table 1 supports several
  conclusions
• High rate use of alcohol or drugs by California
  students increases significantly in the middle
  and high school years.
• Despite the emphasis on alcohol and drug
  prevention in schools, the percentage of students
  who report high use rates for alcohol or other
  drugs has been relatively constant over the last
  decade 2002-2003 EAU and HRU rates are nearly
  the same as the 1991-1992 rates.
• Excessive alcohol use is more prevalent than high
  risk drug use.
• A substantial percentage of California secondary
  school students report that they are high rate
  users.

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Binge Drinking
Table 2. Frequency Consumed Five or More Drinks
in a Row, Past 30 Days
  Grade 7 Grade 7 Grade 7 Grade 9 Grade 9 Grade 9 Grade 11 Grade 11 Grade 11
  1999- 2000 2001- 2002 2003- 2004 1999- 2000 2001- 2002 2003- 2004 1999- 2000 2001- 2002 2003- 2004
  () () () () () () () () ()
Never 94.2 97.2 96.3 86.7 86.6 88.5 73.8 73.7 76.7
1 days 5.8 2.8 3.7 13.3 13.4 11.5 26.2 26.3 23.3
3 days 1.7 1.0 1.3 6.1 7.2 5.1 14.2 14.0 12.2
10 days 0.9 0.6 0.6 2.5 2.4 1.9 4.5 5.1 4.2

• By the 11th grade, approximately one fourth of
  the student sample reported binge drinking at
  least once in the last 30 days.
• Approximately 12 percent of 11th graders binged 3
  or more days in the past month.

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Binge Drinkers and Problem Behavior
Table 3. Other Alcohol-use Correlates of Binge
Drinking, 11th Graders, 2003 CSS
Total Sample Binge Drank, Past 30 Days Non-binge Drinker, 30 Days No Alcohol, 30 Days
Likes to get really drunk 7.0 21.2 4.1 2.2
Was drunk 3 or more times 19.6 56.8 20.9 6.2
Drink/drive episode, 3 or more 12.5 32.4 14.6 5.8
Fight between groups, year 17.7 29.5 20.4 12.7
Used weapon to threaten, year 8.6 17.1 11.3 5.9
Been in a gang, ever 9.2 15.8 10.4 7.5
Relationship violence, year 8.2 14.9 7.9 6.4

• Binge drinkers are much more likely to put
  themselves and others in harms way through being
  intoxicated and through drinking and driving.
• Binge drinkers are more likely to be involved in
  gangs and potential violence than students who do
  not binge.
• Binge drinkers are more likely to be involved in
  relationship violence, an issue of particular
  relevance to Student Assistance Programs (SAPs).

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Binge Drinkers and School Behavior
Table 4 Binge Drinking and School Behaviors
Total Sample Binge Drank, Past 30 Days Non-binge Drinker, 30 Days No Alcohol, 30 Days
School-related Alcohol Use
Used alcohol at school, past 30 days 8.0 23.6 5.9 2.8
Drunk/high at school, 3 or more times 12.1 30.4 11.5 5.7
School Violence (Year)
Physical fight at school 20.5 32.2 30.6 14.7
Taken a weapon to school 13.0 23.1 13.6 9.2
Damaged school property 17.8 31.2 20.1 13.2
School Behavior
Skip school/cut class (ever) 60.3 82.9 54.2 50.9
Skip school/cut class (few times or more) 39.3 60.7 33.0 29.8
Low school connectedness 21.0 26.3 19.4 19.3

• Much more likely to use substances at or before
  school, and to be under the influence of
  substances at school
• Somewhat more likely to engage in violent or
  destructive behavior at school
• Much more likely to skip school or cut class and
  
• Tend to have lower connectedness to school.

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Other Behaviors that Go Hand-in-Hand with
Excessive Alcohol Consumption

• Youth with serious alcohol problems
  (approximately 9 of CA males and females ages16
  to 17)
• 11 times more likely to have serious problems
  with other drugs
• 10 times more likely to drink and drive
• 4 times more likely to be arrested
• 2 times more likely to have a C average or lower
  and are likely to miss twice as much school
• 2 times more likely to smoke
• 1.5 times more likely to require hospital
  emergency care
• 5 times more likely to commit suicide
• 4 times more likely to get into a serious fight
• 3.5 more times more likely to carry a weapon
• 3 times more likely to have a conduct disorder
• 3 times more likely to be hospitalized with a
  mental health problem
• 2 times more likely to get into an accident,
  injure another person or themselves
• Almost twice as likely to have multiple sex
  partners
• (Source George Washington University Medical
  Center)

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Other Consequences

• Binge drinking in high school, especially among
  males, is strongly predictive of binge drinking
  in college. (NIAAA)
• Young persons who begin drinking before age 13
  are four times as likely to develop alcohol
  dependence and twice as likely to develop alcohol
  abuse as those who begin drinking at age 21.
  (National Longitudinal Alcohol Epidemiologic
  Survey)

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Long-Term, Heavy Use of Alcohol

• Significant shrinking of the brain
• 50-70 show cognitive impairment
• Effects remain even after detoxification and
  abstinence
• Alcohol dementia is the 2nd leading cause of
  adult dementia

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Alcohol Hijacks the Brains Reward Circuitry

• Continued use of alcohol reduces the brains
  dopamine production.
• Because dopamine is part of the reward system,
  the brain is fooled that alcohol has survival
  value for the organism.
• The reward system responds with drug seeking
  behaviors.
• Craving occurs and, eventually, dependence.

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Adolescents with a History of Extensive Alcohol
Use

• Decrease in hippocampus by 50 (hippocampus
  converts information to memory).
• Decrease in brain activity during memory tasks.
• Increase in brain activation when shown alcohol
  images (trigger for relapse).

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Adolescents Are More Susceptible to Alcohol Than
Adults

• Reduced sensitivity to intoxication
• Increased sensitivity to social disinhibitions
• Greater adverse effects to cognitive functioning
• Medicates excitability

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Gender Discrepancies

• Underage youth saw more alcohol advertising than
  adults, on a per capita basis, in magazines in
  2002.
• Girls were even more overexposed to this
  advertising than boys (Archives of Pediatrics
  Adolescent Medicine, 2004).
• In 2002, MTF found that eighth- and 10th-grade
  girls surpassed boys for the first time as
  current drinkers.
• In 2003, CDC found that more girls consume
  alcohol than boys and they binge drink more
  often.
• An AMA poll found that the average age of a
  girls first drink is now 13.

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Why Worry About Girls?

• Girls tend to feel the impairing effects of
  alcohol much faster than males.
• Effects include liver, brain and heart damage as
  well as gender-specific complications such as
  increased chances of breast cancer, osteoporosis,
  menstrual disorders and pregnancy.
• Relationship violence.
• Sexual assault and date rape.
• Unplanned and unprotected sex.
• Fetal alcohol syndrome.

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What Can We Do?

1. Recognize there is a serious problem with binge
   drinking in our schools and communities.
2. Increase awareness/knowledge of consequences of
   underage binge drinking by sharing information
   with health care providers and educators,
   teachers, administrators, business leaders,
   public officials, community advocates, parents,
   and students. Utilize existing infrastructure of
   local coalitions if possible.
3. Examine local prevention/intervention services
   for alignment with best practice strategies.
4. Modify existing services as needed. CPI can
   provide no-cost technical assistance and
   training.

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Paradigm Shift Away from Blaming Youth

• Youth are not the primary producers, promoters,
  distributors, sellers, or users of alcohol
• ...ADULTS AND ADULT BUSINESSES ARE
• adult drinkers / brewers, distillers wine
  producers / bars, taverns, restaurants / mass
  media / advertising / merchants / etc.

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Journal of Adolescent Health (Oct. 2004)

• Reports on a study that concludes parents
  strongly influence their childrens drinking
  behavior.
• Teens were twice as likely to binge drink and use
  alcohol within a 30-day period if their parents
  or friends parents provided alcohol at their
  homes for a party.
• Parents who set strict consequences for breaking
  the house rules regarding drinking can help
  prevent underage drinking.

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Student Assistance Programs

• A recognized, school-based approach to providing
  focused services to students needing
  interventions for substance abuse or other
  problems.
• Few studies, but with promising results.
• SAPs are uniquely tailored to local needs.
• Selective participation.
• Collaboration.
• Screening and assessment.
• Multiple services.

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Potential SAP Services

• Academic support
• Counseling services
• After-school activities
• Substance use education
• Violence prevention and conflict mediation
• Peer support and mentoring programs
• Career services

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Common Characteristics

• Support groups
• Individual counseling
• Community involvement
• Supportive environments

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Collaboration

• Facilitate accessibility
• Avoid duplication
• Support groups
• Health clinics
• Health care providers
• Cessation programs
• Law enforcement agencies
• Social service organizations

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Identification

• Teachers
• Counselors
• Administrators
• Other school personnel
• Law enforcement
• Disciplinary referrals
• Parents
• Peers
• Self

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Common Challenges

• Funding
• Staffing
• Program awareness
• Buy-in

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Complementary Model ProgrammingProject Toward
No Drug Abuse

• Recommended for indicated and selective high
  school youth.
• Originally developed to work with youth in
  alternative high schools with higher risk youth,
  but has since been adopted by many traditional
  high schools.
• Targets ATOD by encouraging youth to participate
  in lower-risk activities, to appreciate the risks
  of drugs on the body, and to develop positive
  decision-making skills.
• 40- to 50-minute interactive curriculum designed
  to be presented in 12 lessons.
• Good fit for a pullout group format.

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Complementary Model ProgrammingToo Good For
Drugs

• Recommended for selective middle and high school
  youth.
• Middle school curriculum is grade-specific high
  school is not.
• Designed to reduce the intention to use ATOD
  during the middle and high school years.
• Relies on small group activities, role play and
  group discussions regarding appropriate attitudes
  toward ATOD use, knowledge of ATODs negative
  consequences, the benefits of a drug-free
  lifestyle, and positive peer norms.
• Also meets the needs of sites seeking to prevent
  conflict and violence on their campuses.
• Pullout structure okay as long as the same
  students are served throughout the program.
• 10-lesson curriculum once a week for 14 lessons.
• Optional home workouts for parents and infusion
  lessons are included

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Complementary Model Programming LifeSkills
Training

• Recommended for indicated and selective middle
  school youth.
• Flexibility to be used with a universal or
  elevated risk middle school population, and to be
  used in a classroom or support group setting.
• Drug Resistance Skills.
• Personal Self-Management Skills.
• General Social Skills.
• Interactive skills-based curriculum with
  follow-up boosters.

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CPI Services

• Prevention Extension Workshop
• Community Action to Reduce Binge Drinking
• Profile population needs, resources, and
  readiness to address the problems and gaps in
  service delivery.
• Mobilize and/or build capacity to address needs.
• Develop a comprehensive strategic plan.
• Implement evidence-based prevention programs and
  infrastructure development activities.
• Monitor process, evaluate effectiveness, sustain
  effective programs/activities, and improve or
  replace those that fail.

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On-Line Resources

• www.ca-cpi.org
• www.jointogether.org
• www.marininstitute.org
• www.saddonline.com
• www.westcapt.org
• www.camy.org
• http//modelprograms.samhsa.gov

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Local and State Data Sources

• California Healthy Kids Survey (CHK)
• ASIPS/GIS mapping
• Place of Last Drink (POLD)
• SWITRSCalifornia Highway Patrol
• Police Department
• Emergency Medical Services
• Hospital Discharge Data

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National Data Sources

• Monitoring the Future
• National Survey on Drug Use and Health
• NIAAACollege Drinking Prevention
• Harvard School of Public Health, College Alcohol
  Study
• SAMHSAClearinghouse

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www.ca-cpi.org 771 Oak Avenue Parkway, Suite
3 Folsom, CA 95630 916-983-8929-MAIN 916-983-5738
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