A recent discussion on a Join Together-sponsored listserv provides a good illustration of the power of the Internet to facilitate learning as well as discussion and debate.The discussion, which began in June with a posting on a poll about the role of alcohol ads on underage drinking, soon branched off in a number of directions, with participants offering perspectives on the genetic, environmental, cultural and societal factors that contribute to alcoholism and addiction. Putting an exclamation point on the discussion was the unveiling of the Office of National Drug Control Policy's national anti-drug media campaign on July 9.
Background
On June 23, the Marin Institute posted a press release on the Subabuse online discussion list detailing a poll that found that 70 percent of Americans say they want the federal government to investigate whether TV alcohol ads impact underage drinking. The release cited a National Institute on Alcohol Abuse and Alcoholism study that found that children who begin to drink at younger ages "are at significantly higher risk of becoming alcohol dependent (as adults) than those who begin later.
"An adolescent who starts drinking by age fifteen is four times more likely to become alcohol dependent than someone who waits until age 21," according to the press release.
That promoted a question from list member Maia Szalavitz, who asked, "Isn't the reason that kids who start drinking earlier are more likely to become alcoholics likely to be that kids who start drinking earlier are more psychologically, genetically and environmentally at risk? i.e., it's not the early drinking that is causing this group to become alcoholic, but rather, the people who are likely to drink early are the predisposed ones?
She continued, "The classic example would be an abused kid, looking for some relief, who starts drinking at 11. The reason he becomes an alcoholic is not because he started drinking younger than his peers, but is related to the reasons why he did that. A 'normal' kid who tries drinking at that age due to peer pressure is likely to say 'oh yuck,' and get on with his life.
"This has obvious implications for prevention, but I find people repeating over and over again this younger drinking leads to alcoholism as if it were about causation rather than correlation," said Szalavitz. "Anyone have any data which suggest otherwise?"
Maia's question triggered a wide-ranging discussion about the root causes of alcoholism and the problems associated with underage drinking. Eris Weaver of the Marin Institute agreed with Szalavitz that the study does not prove a causal relationship, "but merely demonstrates a correlation that we would all agree fits our intuitive expectation."
"It is very important to be clear about exactly what these studies mean, and not try to imply that they prove more than they really do," said Weaver. "The mainstream media is notorious for misrepresenting research data; we need to hold ourselves to a higher standard."
Genetics
Jim Bellino, administrative services chief at the Vermont Office of Alcohol & Drug Abuse Programs, said that, "Consider the young person who is genetically predisposed to alcoholism, but who is otherwise not at risk. I don't think that we can safely assume that all of those folks will "just say yuck" and put it aside. Alcohol does have its pleasurable effects and some people like the taste. Those kids, like all the others, also want to be cool and grown up. If what they see on TV and hear on the radio, etc. is that drinking is cool and grown-up, they will continue to drink. Couple that with the fact that those very kids who are genetically predisposed probably are able to build a greater tolerance to the drug, and the fact that we as a society glorify the ability to hold one's booze, and we can see that they are sitting ducks."
Fred Rotgers, Psy.D., director of the Program for Addiction Consultation and Treatment in New Jersey, pointed out that research by Shedler and Block identified two early childhood behavior configurations that are highly associated with later problems with alcohol/other drugs: conduct disorder and abnormal levels of anxiety. "Kids with neither are the ones who try alcohol/other drugs, say 'yuck' and never move beyond casual use," said Rotgers. "It seems pretty clear that the kids who are going to say 'yuck' will do so regardless of the advertising directed at them or the messages folks presume they get from the larger society. They are the vast majority and are ones we need not worry about. It's the conduct disordered and over-anxious ones who are of concern, and they are the ones who won't get the message anyway, in most cases."
Others on the list questioned Rotgers' focus on children with conduct disorders, with the discussion ranging from DSM-IV definitions of mental illnesses to Shedler and Block's methodology. "To label our fellow human beings in any category is not only foolish but is dangerous to society and even ourselves," wrote one list member. "Each individual human being must be dealt with in the widest manner possible. No measurement of human ability is foolproof."
Culture
Robin Robinette of the Tennessee Methadone Advocates Coalition questioned how much American culture has to do with the percentage of kids who become alcoholics. "It seems to me that in our largely "confused" culture in the US, the only clear value we place on drinking is its ability to impair one's thinking and encourage disinhibition," she wrote.
Szalavitz replied, "The cross-cultural studies which have been done suggest that wine-with-meals cultures like that of France and Italy, where drinking is done with the family and with food, have much lower rates of alcohol-related problems (including alcoholism) than cultures where drinking is done away from the home, largely by males (Ireland). Which is another reason why it makes sense to think about our policies closely and not confuse correlation with causation, I think."
Advertising
Andrea Craig of the Trauma Foundation's Alcohol-Related Injury and Violence Project stressed the role of advertising in shaping youth decision-making when it comes to alcohol. "Although I agree that the needs of at-risk youth should be addressed, I also think that it's extremely important not to minimize the impact of alcohol advertising on youth alcohol problems," she wrote. "Also, whether or not advertising causes youth to drink, there certainly appears to be an association or correlation."
Craig went on to cite a report by the Center on Alcohol Advertising that found that more children aged 9 to 11 know the phrase associated with the Budweiser Frogs than the slogans used by Smokey the Bear or Tony the Tiger (Center on Alcohol Advertising. Commercial and character slogan recall by children aged 9 to 11 years, Budweiser frogs versus Bugs Bunny, unpublished report. Berkeley, Calif., April 1996.), and another study showing that elementary school children who are more aware of television beer advertising are more knowledgeable about beer brands and slogans; have more favorable attitudes toward drinking; and report a greater intention to drink as adults. (Television beer advertising and drinking knowledge, beliefs, and intentions among schoolchildren. Joel W. Grube and Lawrence Wallack. American Journal of Public Health 84(2):254-259. 1994.)
Rotgers challenged Craig's assertions, saying, "The main problem with attitudinal and intentional research is that the relationship between those findings and actual behavior -- which, after all, is what we are truly concerned about. I might view something favorably and say I would be likely to do it, and then never do so even if the opportunity arises. There is no solid data, to the best of my knowledge, that indicates that there is any impact on actual drinking behavior of alcohol advertising aimed at kids."
Robert Schacht, Ph.D., of the American Indian Rehabilitation Research & Training Center compared Rodgers' thinking to the tobacco industry's infamous claims that smoking was never proven to be addictive, and noted that the National Institute on Alcoholism and Alcohol Abuse recently launched a study into the effect of advertising on alcohol use. "I'll bet Augie Busch and his cronies have already done this research, and their advertising campaigns are a bet that you're wrong," Schacht wrote. "But I will await with interest the results of the NIAAA study."
ONDCP Media Campaign
To top the discussion off, the Office of National Drug Control Policy launched its vaunted $2 billion national prevention media campaign in early July, prompting some list members to hold it up as an example of wasted money. "By telling kids no, you often put ideas in their mind about what symbolizes rebellion," said Szalavitz, who said the anti-drug ads could backfire.
Deacon Dzierzawski, director of the Lucas County Community Prevention Partnership, said, "[The] statement that this is a waste of money, may be true in part. I believe that more focus should be given to alcohol and tobacco and less to the illicit drugs that are less abused by the youthful population of our country.
"However, as a result of the media campaigns of the 1980s our country saw its lowest rates of alcohol and other drug use by young people," he continued. "These rates bottomed out in 1992. Ironically, these mass media messages and focus on prevention stopped at that time ... So, to say that media campaigns are a waste and have no impact is false.
"If you want to direct your energies in a positive manner, I would suggest that you advocate for a more comprehensive campaign that includes alcohol and tobacco."
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