Teen drinking

Are Australians seeing a skewed picture when it comes to teen alcohol consumption? Rada Rouse reports.

DEBATE around the alcopop tax and current affairs reports on badly behaved partygoers have made “teenage binge drinking” a well-worn phrase in the media. But what is the evidence of increased consumption, and increased harm?

At the Public Health Association of Australia (PHAA) conference in Brisbane last month, results from a population-based cohort study provided some new evidence of clinical harm from teen drinking.

The study followed 1000 teens for 10 years, finding a prevalence of alcohol use disorder in the mid-20s of 17% for men and 9% for women.

Researcher Dr Elya Moore (PhD), from the Murdoch Childrens Research Institute, Melbourne, collected data from the cohort in eight waves from the age of 15 years, allowing estimation of the relative risk of developing a disorder based on risky drinking, compared to no drinking, at each successive wave.

Those continuing to drink at risky levels had double the risk of a disorder after two waves and three times the risk after three waves if they were male, suggesting a “dose response relationship”, although the risk for females was less clear in this study, she said.

Researchers working with young people in a bid to reduce sexually transmitted infections (STIs) also report risk-taking behaviour associated with heavy drinking.

In an innovative attempt to bring messages about safer sex to young people, a Victorian group based at the Burnet Institute has mounted a chlamydia testing outreach program at sporting clubs in rural Victoria.

Young people in the Loddon Mallee region aged 16 to 25 years who filled in a questionnaire gave some insights into drinking habits and their consequences, researcher Associate Professor Margaret Hellard told the PHAA conference.

Around 700 young people participated in the study, which found that 60% of males and 20% of females consumed alcohol at risky levels at least weekly.

STI knowledge was generally poor and, significantly, only 25% used a condom the last time they had sex, Professor Hellard said.

NHMRC draft guidelines for low-risk drinking of alcohol cite several studies evidencing increased risky sexual behaviour associated with alcohol, including increased likelihood of sexual coercion.

The measure of risky drinking is not merely increased likelihood of disease such as liver cirrhosis and cancer – with alcohol accounting for 2.2% of Australia’s total disease burden – but violence, unwanted sex, injury and suicide, the NHMRC document points out.

National statistics show that 3430 young adults lose their lives annually in alcohol-related road crashes, accidents, assaults and suicides, says leading public health researcher Professor Wayne Hall from the University of Queensland.

YOUNG LIVES DEVASTATED

Drug educator Paul Dillon regularly sees young lives being devastated by alcohol abuse.

“Over the last 15 years, I’ve been to 13 schools where young people have died because of alcohol,” he says.

“These are students who are just starting to muck around with alcohol but don’t have the life experience to back them up when things go wrong.”

Mr Dillon, who runs a consultancy called Drug and Alcohol Research and Training Australia, at the same time believes Australians are on the receiving end of a skewed picture when it comes to teen alcohol consumption.

While the focus has been on the excesses of the hard-drinking minority, at least one in five late school students does not drink at all and most drink moderately, he points out.

Teetotal teens are rarely acknowledged or rewarded, making them feel even more alienated among their peers and contributing to a belief that hard drinking is the norm.

It’s also wrong to attack young people as if they were growing up in a vacuum, he says.

“They learn from what they see, and we have to change the whole culture of drinking, not saying ‘don’t do it’, but we have to stop drinking to the point of intoxication,” he says.

Alcohol consumption demo­graphics have changed, Mr Dillon says, and marketing has a lot to do with it.

Media coverage that suggests ready-to-drink beverages (RTDs) “are based on dark spirits, which are more regularly consumed by blokes with utes rather than bright young things in bars” is just plain wrong, he says.

A Jack Daniels bourbon marketing strategy document cited by Mr Dillon boasts that “nearly 40% of bourbon RTD drinkers are female. They also contribute to one-third of the volume.”

Millions of dollars are spent annually in marketing, and it is “ludicrous” for the industry to claim this is about market share rather than encouraging drinking per se, he says.

“The alcohol industry... has done an incredible job in making spirits become a young person’s drink,” he adds.

FIGHTING FIRE WITH FIRE

Alcohol industry representatives like to quote the latest National Drug Strategy Household Survey, which does not show an increase in alcohol consumption and, if anything, depicts a slight decline.

The proportion of Australians aged 14 years or older that has never had a full serve of alcohol has been on the rise over the past decade, increasing significantly between 2004 and 2007, from 9.3% to 10.1 per cent.

However, the usefulness of the Household Survey has recently been questioned by policy analysts.

In an editorial in the Medical Journal of Australia, Professor Hall comments that with a response rate to the survey of less than 50%, its representativeness is questionable.

However, the statistic that underscores the concern of researchers such as those presenting at the recent PHAA conference is the rate of risky drinking among young women.

The Household Survey showed that more than a quarter of all 14 to 19 year olds had put themselves at risk of alcohol-related harm in the short term at least once a month during the previous 12 months, but it’s significantly higher among females of this age (28.3%) than males (24.5 per cent).

Even the alcohol industry acknowledges the problem, with the Distilled Spirits Industry Council of Australia conceding recently that “too many Australians drink to excess”.

After decades of focusing on illicit drugs, health policy makers now have alcohol firmly in their sights with imminent NHMRC guidelines, a wealth of new research projects, and the government-appointed Preventative Health Taskforce developing advice to be released later this year on how to combat associated chronic disease.

What GPs can do

The RACGP recommends raising the issue of alcohol and drugs with adolescents.

All patients aged 14 years or older should be questioned every three years about the quantity and frequency of alcohol intake, the Red Book recommends.

“As some patients may be sensitive to your question, it is important to be non-judgmental,” it advises.

In a guide for GPs, the NSW Centre for the Advancement of Adolescent Health suggests kicking off such a conversation with: “Many young people at your age are starting to experiment with [alcohol]... have any of your friends tried [alcohol], have you?”

References

1. Draft revised Australian alcohol guidelines for low-risk drinking 2008 (NHMRC).
2. Roy Morgan MAT June 2005.
3. Australian Institute of Health and Welfare, The burden of disease and injury in Australia 2003.
4. Australian Institute of Health and Welfare, 2007 National Drug Strategy Household Survey.
5. Medical Journal of Australia 2008; 189:188-89.