Monday, December 21, 2009

Will Israel Emulate the American Failure?

Perhaps.  A recent government proposal in Israel, if passed, would restrict alcohol to a greater extent than it is now.  The bill would ban off-premise alcohol sales after 11 pm, furnishing alcohol to minors, and most notably would (possibly) raise the drinking age from 18 to 21.   Other restrictions may include raising the prices for spirits, banning alcohol advertising, and requiring special licenses to sell alcohol.

Allegedly, there has been an "epidemic" of teen drinking and drunkenness in just the past few years over there.  But it is unlikely that raising the drinking age to 21 would help.  Hell, they don't even enforce the current drinking age of 18!  Perhaps if they did so, along with several of the other reforms that have been proposed, the "epidemic" drinking could be reduced, or at least contained.  Attempting to emulate America's greatest alcohol policy failure since Prohibition would likely just throw gasoline on the fire.

Monday, December 14, 2009

How Common is Extreme Binge Drinking? Now We Know

We at 21 Debunked have repeatedly voiced disapproval at those who insist on calling 5 drinks a "binge," as well as noting the dearth of longitudinal data concerning the practice of imbibing 10 or more drinks in an evening, sometimes called "extreme" drinking or "extreme binge" drinking.  The Monitoring the Future (MTF) survey of middle and high school students has not been gathering data on this truly dangerous activity, so we have been left in the dark about its true prevalence.  Until now. 

Lloyd Johnston, the overseer of the survey, has recently been asking high school seniors whether they have had 10+ drinks or more in at least one occasion in the past 2 weeks.  The most recent data say 11% have done so, and 6% have had 15+ drinks in a row.  While clearly a small minority, it is not a trivial fraction either, and is probably an underestimate.  And, most relevant to the drinking age debate, these numbers have not changed significantly since Johnston began following them, despite ever-intensifying enforcement.  So recent declines in prevalence of 5+ drinks in a row appear to be somewhat misleading, especially since underage drinkers tend to undercount their drinks.  Lying (or exaggerating or minimizing) is also fairly common in teen surveys.

For what it's worth, according to the same surveys 25% of seniors and 18% of sophomores admit to having had 5+ in a row in the past two weeks, and these numbers are leveling off after a decade-long decline.  It seems that fewer teens are drinking, but the more they do when they do.  That may explain why in emergency rooms in several cities across the country, admissions related to teen binge drinking increased in recent years in spite of surveys showing less drinking.

Tracking this dangerous behavior is long overdue.  We already know that among college freshmen, 20% of males and 8% of females have done extreme drinking (10+ males, 8+ females) in the past two weeks.  But that was a one-semester snapshot in the fall of 2003, with no other years for comparison.  The rate of "binge" drinking (using the 5/4 definition) in the past two weeks was 41% for males and 34% for females, which does jibe well with known statistics (roughly 40%) that use that definition.  But one must wonder if there is even any relationship at all between the rates of drinking, "binge" drinking, and "extreme" drinking.

Indeed, from 1993 to 2005, the percentage of college students who "binge" drank (5/4 definition) in the past two weeks has not changed a whole lot, but the percentage who do so three more times in the past two weeks ("frequent binging") has gone up significantly.  And since the aforementioned study found that extreme drinking was strongly correlated with frequent "binging," the former most likely rose as well.  Further evidence comes from another study that found that the number of alcohol poisoning deaths (a good indicator of truly dangerous drinking) among college students nearly tripled from 1998 to 2005. 

Bottom line:  when you criminalize normative drinking, you inevitably normalize truly dangerous drinking.  We saw the same thing during Prohibition.  And we all pay a heavy price for it.

Would you drive a car knowing its brakes would fail 11% of the time?  Didn't think so.

Friday, December 11, 2009

White Noise Syndrome

Has anyone ever seen the 2007 horror film White Noise 2? (Spoiler alert) A man has a near-death experience that has left him with the supernatural ability to predict exactly who will die and when.  He acts on his premonitions, and saves several lives, only to find out that exactly three days later, the people he saves start killing others upon being possessed by an evil entity.  In other words, the net effect is an increase in deaths.  He then realizes he wasn't supposed to save those people, regrets his choices, and actually considers killing those he saved in order to rectify this horrible, unforseen tragedy.  We watch such films with revulsion and assume they are mere fiction.

But what if there was a government policy, at the expense of tax dollars and civil liberties, that at best delayed deaths of young people by a few years and potentially even increased the number of premature deaths over the lifecycle?  What if there were entire orgainizations who wholeheartedly endorsed such a policy as "saving lives" or "for the children" while ignoring or minimizing its dark side?  And what if anyone who questions such a policy is subjected to a heckler's veto and even occasional censorship to chill debate? 

Well, that describes the 21 drinking age perfectly.  Fans of this blog already know about a study done by Dee and Evans (2001) which showed that raising the drinking age merely shifted deaths into the future by a few years, and perhaps even increased them.  Asch and Levy (1987 and 1990) and Mike Males (1986) were some of the first people to notice this redistribution of mortality.  And remember, the longer a drunk driver lives, the more innocent people he or she can take to his grave with him or her.  Of course, not every study agrees with Dee and Evans' conclusion, but there is some new evidence that supports this view.

Kitt Carpenter and Carlos Dobkin (2009) have a new study out that shows a discrete and significant jump in mortality at exactly age 21.  The effect is true only for external causes of death, including motor vehicle accidents, suicides, deaths labled as "alcohol related," and those labeled as "other external," but not homicides or drug-related deaths.  The effect also occurs for self reported alcohol consumption as well.  Ruling out alternative explanations, they conclude it is due to the effect of the drinking age.   But unfortunately, they also make the specious claim that such an effect is not merely a delay in deaths but a true lifesaving effect of the policy.

We at Twenty-One Debunked who have read the paper fail to see a true lifesaving effect over the lifecycle.  First of all, only deaths between one's 19th birithday and 23rd birthday are included, and the data are rather grainy, making longer range projections very difficult for what would happen in the absence of the observed drinking age effect.  Yes, the effect persists to an extent, but one can clearly see it gradually decline over time.  It would have been better if they expanded the data to include ages 18 through 24 (are 18 year olds somehow irrelevant to the debate?).  And there could be other age-related factors that give an illusion of persistence, such as a "toning down" of drinking in the few months just before turning legal as well as the fact that 22-23 year olds are more likely to have cars and live away from their parents than 19-20 year olds.  Indeed, our own crude back-of-the-envelope calculations after reading the paper (and its graphs) in which we project while excluding ages 20.5-21.5 suggest exactly that--it is most likely just a temporary effect overall.

Of course, death rates are merely the tip of a very large iceberg.  Carpenter and Dobkin (2008) also conducted another similar study, this time concerning various types of crime, with similar results overall.  Arrest rates were used as the proxy measure of crime.  They found a discrete and significant jump in the arrest rates of several offenses, such as assault, drunkenness, disorderly conduct, and especially DUI, at exactly age 21.  However, there was no noticeable effect for other crimes.  Interestingly, even rape, which has a reputation for being alcohol-related, appeared to be unaffected.  (We suspect this is due to the fact that drinking is less likely to be done "underground" after 21, and thus in environments less conducive to rape, which may outweigh the increase in drinking.  Or perhaps the supposed causal link between alcohol and rape has been overstated.)  The authors draw the same conclusions that they did in the other study, which is unfortunate for precisely the same reasons.

While our own back-of-the-envelope projection estimates suggest that the increaes in assault and disorderly conduct arrests are merely temporary and seem to wear off by age 22, the effects on DUI and drunkenness arrests do still seem to persist to at least age 23.  However, the fact that 21-23 year olds can drink in bars may make drunk drivers more likely to get caught, and also the increase in both DUI and drunkenness may be an artifact of the fact that people over 21 can no longer be charged with underage drinking, as evident in the simultaneous sharp decrease in "liquor law" (i.e. underage drinking) arrests upon turning 21.  Thus, some behaviors that would lead to underage drinking arrests before 21 would likely lead to DUI and/or drunkenness arrests instead after turning 21.

In other words, these studies show that banning young people from drinking until age 21 (when they are more likely to have cars, and family controls are much weaker) may not be the best way to introduce them to alcohol.  In fact, it appears on balance to be one of the worst ways, and is akin to setting a time bomb.  There is zero evidence that people magically become mature enough to handle alcohol upon turning 21.  Indeed, the aforementioned studies suggest quite the opposite, at least in the short term.

We all know what the road to hell is paved with.  Let's defuse this ticking time bomb and lower the drinking age to 18, legalizing alcohol for all legal adults in America.  What better time than now?

Monday, December 7, 2009

Chasing the Dragon

Doing the same thing over and over again and expecting different results is a functional definition of insanity.  So why does our government continue to pursue policies that fail?  It could be that some bad public policies, such as Prohibition, the War on (some) Drugs, and the 21 drinking age are simply addictive.  But how exactly can failure be addictive?

The answer lies in the fact that several of these policies began with at least perceived success.  Prohibition, for example, coincided with a large decrease in alcohol consumption in the first year or two.  The 21 drinking age coincided with reduced drunk driving fatalities in the 1980s.  And it occurred in both cases despite little to no enforcement.  Whether or not the relationship was causal is immaterial to the government's perception of success.  For Prohibition, alcohol consumption (and its attendant social problems) began rebounding after the first two years, and by 1929 consumption reached at least 70% of pre-Prohibition levels, possibly even 100% by some estimates.  Even during the Great Depression, it continued to rise, albeit at slower rate.  Enforcement increased dramatically, but it could not duplicate or prolong the initial, temporary "success" the government was now hooked on.  Most scholars agree that Prohibition did more harm than good, and most Americans agree as well.

For the 21 drinking age, there were numerous confounding factors that likely explain the fatality decline better, especially since it occurred in Canada as well, who did not raise the drinking age to 21.  But numerous studies still claim that raising the drinking age was causally linked, and the effects occurred largely at a time during which enforcement was weak.  Miron and Tetelbaum (2009), however, find that was not the case, at least not in the long run.  By separating out states that raised it voluntarily (before 1984) from those who were coerced by the feds in 1984-1988, a striking pattern was discovered.  After controlling for numerous confounders and secular trends, it was observed that states that raised the age voluntarily did see a small lifesaving effect, but it was only temporary, lasting no more than 1-2 years. Kind of like Prohibition, though this time the rebound was masked by confounders and secular trends.  The coerced states, however, saw no lifesaving effect, and in many states it merely threw gasoline on the fire.  A similar pattern was seen for high school drinking and "binge" drinking rates as well.  And in all states, increasing enforcement over time does not appear to have any noticeable correlation.  In other words, the idea that raising the drinking age somehow saved lives and continues to do so was nothing more than a mirage.  Of course, this should come as no surprise to those who study history, or know anything about young people, but I guess we can't expect the government to do so.

In addition, another addictive aspect of these policies is actually the oldest addiction of all:  POWER.  Policies like Prohibition and the drinking age inevitably give more power to any government that enacts them.  And once they experience it, they cannot seem to get enough.  This further reinforces the pursuit of unattainable success that characterizes the various prohibitions on consensual activities throughout history.  It is also no accident that the targets of enforcement tend to be the least powerful members of society.
It's time to stop chasing the dragon.  You are never going to catch it.

Friday, November 20, 2009

Will Australia Raise the Drinking Age?

NOTE: This blog is primarily about the United States and is thus written from an American perspective.

Just as more and more Americans want the drinking age to be lowered to 18 over here, there is a growing movement to raise the Australian drinking age (currently 18) to 19 or even 21. The movement, which appears to be spearheaded by Prof. Ian Hickey, cites hackneyed and specious claims about "dain bramage" and alcohol-related violence. Interestingly, drunk driving in Australia is barely even mentioned at all since it is less of a problem over there than here (they are much tougher on DUI than America is), and we can really learn a lot from them. Fortunately, the government is not interested in raising the drinking age, and thus it probably won't happen. Because if it did, it would merely throw gasoline on the fire.

If they want to see what a failure the 21 drinking age is, they should come to America. We tried raising the drinking age to 19 in the early 1980s. Didn't work, so we raised it to 21 in the mid 1980s. Still didn't work. Then we added all these ancillary laws such as dram shop, social host, use and lose, zero tolerance, internal possession. And we toughened up enforcement. Guess what? It still doesn't work.

If Australia is worried about kids under 18 getting wasted, they should enforce the current drinking age better. And the biggest problem group over there, like in America, is people in their twenties. Raising the drinking age targets the wrong group. It would be best for them to raise the alcohol taxes (and make them proportional to alcohol content), shorten pub sales hours (currently 24/7), increase alcohol education, and have zero tolerance for drunk violence. Being drunk is no excuse for misbehavior--millions of people get drunk without ever becoming violent. And forcing drinking underground (where it can't be monitored) is unlikely to reduce violence in any sense. Even if it somehow did for 18-20 year olds, which is unproven, it would merely shift the behavior to 21-24 year olds (which already have a problem).

As for brain damage, there is no conclusive evidence that drinking at 18 is significantly worse than doing so at 21, all else being equal. Maybe for those younger than 18, but that's already illegal. So let's not confuse the issue. Again, lack of enforcement (in Australia) is the problem. And many young people would likely benefit from education about alcohol, which needs to start young since drinking starts young over there (and here as well).

Yes, Virginia, Australia DOES have a drinking problem, and a legendary one at that.  But America does too.  In fact, all predominantly Anglo-Celtic cultures do to some extent.   That's not news.  With few exceptions, the more Anglo-Celtic they are, the worse the drinking culture.  Ditto for pub/street violence--they don't call it a Glasgow kiss for nothing.

How Anglo-Celtic is each country? (Figures are approximate)

US:  30%
Canada:  50%
Australia: 70%
New Zealand: 70%+
UK: 86%
Republic of Ireland: 95%

Due to changing demographics, America is less Anglo-Celtic now than in the past.  This perhaps explains the decline in drinking since 1980 more than anything else, and it is less true for Australia and other such cultures.

The drinking age is irrelevant.  Drunken violence (and other problems) flourishes in cultures that tolerates misbehavior when drunk, such as Australia, New Zealand, the UK, and of course the USA.  Alcohol must never be considered an excuse. 

Sunday, November 1, 2009

Why Have Virtually All Prohibitions Failed?

This is a question that many people have asked, and essentially all serious scholars know the truth. Even those who admit alcohol prohibition failed, but claim the 21 drinking age (as well as the War on (some) Drugs) was a success, likely know precisely why, but are afraid to admit it. And it's more than just an inability to legislate morality or the fact that a given substance is too much a part of the social fabric. So, as Professor Charles Whitebread of USC Law School said:

Every single person who has ever written seriously about the national alcohol prohibition agrees on why it collapsed. Why? Because it violated that iron law of Prohibitions. What is the iron law of Prohibitions? Prohibitions are always enacted by US, to govern the conduct of THEM. Do you have me? Take the alcohol prohibition. Every single person who has ever written about it agrees on why it collapsed.
He further elaborates:

Large numbers of people supported the idea of prohibition who were not themselves, opposed to drinking. Want to see it? Let me give you an example, 1919. You are a Republican in upstate New York. Whether you drink, or you don't, you are for the alcohol prohibition because it will close the licensed saloons in the City of New York which you view to be the corrupt patronage and power base of the Democratic Party in New York. So almost every Republican in New York was in favor of national alcohol prohibition.
And, as soon as it passed, what do you think they said? "Well, what do you know? Success. Let's have a drink." That's what they thought, "let's have a drink." "Let's drink to this." A great success, you see.

There you have it. There is always an US and a THEM. Liberty for "just us," not all. And if you STILL don't get it by this point, he goes on to drive the point home even further:

I just want to go back to the [English] prohibition against the drinking of gin [in the 1800s]. How could a country prohibit just the drinking of gin, not the drinking of anything else for forty years? Answer: The rich people drank whiskey and the poor people drank [guess] what? -- gin. Do you see it?

He also points out that the rationale for drug prohibitions often follow the same pseudo-logic. Cannabis was banned partly due to anti-Mexican racism and competing business interests, opium banned due to racist fears of the Chinese immigrants, and cocaine was banned due to (largely fabricated) fears of superhuman, coked-up black men going on murdering sprees and raping white women. (Cocaine ironically became popular due to Southern liquor laws designed to keep whiskey out of the hands of lower-class blacks, thus driving them to a more dangerous substitute.) And the very first laws on the books against these other substances specifically targeted such groups. Even to this day, minorities are disproportionally targeted for Drug War enforcement, while the Clinton drug czar Lee Brown speciously claims that drug legalization would be "genocide" against blacks. You read that right. WE can handle it, while THEY cant.

Of course, Dr. Whitebread was not talking specifically about the 21 drinking age, but it too follows the same "iron law" as an age-based selective prohibition of sorts. In fact, it applies a fortiori in this case--the "us" group being adults over 21 and the "them" group being "minors" under 21, the latter being politically impotent at the time it was passed. Supporters of the 21 drinking age, who usually drink themselves, invariably say something to the effect of "well, WE can handle it, but THEY can't." And guess who takes that as a dare?

Nevermind that 18-20 year olds are judged capable of handling war, guns, cigarettes, questionable "dietary supplements," gambling, cars, trucks, motorcycles, chainsaws, dangerous jobs, sex, marriage, and even having kids. But not beer. This would clearly fail the Martian test (can you explain it to a Martian without sounding like an idiot?) for obvious reasons.

In the entire history of the world, there has never been a society in which adults drank but teens did not, nor has the reverse ever been true. While this is also true for other substances, it is especially true for those substances that have gained the widest acceptance in a society. And no substance in history has ever achieved this widespread status quite like ethanol. And that, my friends, is why the 21 drinking age is the greatest alcohol policy failure since Prohibition.

Mike Males observes that in the USA, youth have the least amount of freedom relative to adults. The key word here is relative. Look at other countries around the world and see if you can see a pattern. Ever notice how the less relative freedom teens have, the worse the excesses (of all kinds) are among adults in such cultures? The reason for that is very simple. Those adults feel they need not worry about being good role models, since teens will face harsh punishment for emulating their behavior. Do as I say, not as I do--farcical (and pharisaical) to say the least. Being "grown-up" apparently just means making better excuses for bad behavior rather than truly behaving better. And what passes for "education" is often little more than "just say no" and disingenuous scare tactics. Such cultural schizophrenia is clearly not the best way for teens to be socialized into the adult world. And the excess-loving adults they eventually become are living proof.

But why is America like that? How could these obvious farces still be with us? Dr. Males notes that it is more than just fear of young people in general, it is that today's youth are more racially diverse (i.e. less white) than the older generation, and this is more true in America than any other industrialized country. So the in-group-out-group thing is even more pronounced since there is more than one dimension to this fear/loathing of the Other. How did we get to be so primitive?

Monday, October 19, 2009

A Proven Method to Eliminate Underage Drinking

Fed up with underage drinking? Want to not just reduce it, but eliminate it for good? Well, we know of a scientifically proven, universally effective, but little known way to guarantee that your kids will not drink a drop before reaching the magic age of 21. It has been verified in randomized controlled trials, is truly self-evident, and costs nothing. In fact, it is not all that difficult when you think about it, despite the interesting fact that the vast majority of parents had not even considered it. How, you ask? Well, here's what you gotta do.........

(keep scrolling down)


(almost there)

(keep going)


Not only is it 100% effective against underage drinking, it also has other benefits, such as saving $250,000 per child over the first 18 years, reduced overpopulation, less urban sprawl, and a cleaner environment. The Earth will love you.

Yes, that is the only foolproof way to guarantee abstinence from alcohol (or anything else for that matter) until 21. But seriously. For those of us that live in the real world (you know, the one in which the majority will have kids and about 90% of those kids will drink before age 21), we need to admit that the 21 drinking age is a miserable failure. And admit that we do not have a "teen" drinking problem, we have an American drinking problem. Only then can real solutions be given a serious chance of working.

Tuesday, October 13, 2009

Do Zero Tolerance Laws Really Work?

This is a question to which most researchers would answer "yes," due to numerous empirical studies as well as in theory, but many have had their doubts. Enter Darren Grant, an economist at Sam Houston State University, who did a recent study that shows that there are good reasons to doubt the effectiveness of such laws.

Zero Tolerance (ZT) laws are what they sound like: laws that prohibit people (under 21 in this case) from driving with any measurable amout of alcohol in one's blood. These laws were justified by studies that found that the relative risk of a fatal crash for 16-20 year old drivers begins rising at a lower BAC, and more rapidly, than for those over 21.  By 1998, all 50 states and DC have passed such laws. Many states did so voluntarily, but the rest were forced by Congress to do so or lose highway funding (sound familiar?) and capitulated. ZT laws had to set the BAC limit for drivers under 21 at 0.02 or less in order to pass muster for Congress.  And until now, virtually every study has supported their effectiveness.

Grant's study found that ZT laws had essentially no effect on traffic fatality rates or the BAC distribution of fatalites. Data was from 1988-2000, during which time all states had a 21 drinking age. Several control variables and fixed effects were accounted for. Whether a state had a "partial" ZT law (a lower BAC limit for youth that was either >0.02 or had an age limit below 21) before adopting a "full" ZT law (satisfying the federal mandate), which several did, was also accounted for. Similar effects were observed on daytime and nighttime fatalities, despite the fact that most alcohol-related fatalities are concentrated at night. In addition, effects were compared to drivers over 21, who should not be affected by the ZT laws, but such effects were in fact similar, which suggests a spurious relationship due to unknown coincident factors. Finally, the fractions of total fatalities that were zero BAC, low BAC, and high BAC drivers were equivalent before and after a ZT law was passed, further casting doubt on its effectiveness.

What are we to make of all this? Previous studies were either pre/post studies that omitted key variables, or longitudinal studies that were otherwise less thorough than this one. This study appears to trump the rest, and it is thus very tempting to say that zero tolerance = zero intelligence.

That being said, we at 21 Debunked still recommend that if the drinking age is lowered to 18, which we strongly advocate for all 50 states, that the ZT laws generally remain as is, with an age limit of 21. Better yet, ZT laws ought to be strengthened by making the BAC limit 0.02 for the first x number of years of licensed driving for all ages, or age 21, whatever is longer. Several countries with lower drinking ages (Canada, Germany, Netherlands, etc.) interestingly set ZT age limits higher than the legal drinking age and/or base it on the number of years of licensed driving one has, with the latter making even more sense.  Puerto Rico, with a drinking age of 18, also recently adopted a 0.02 limit for those under 21. And there are good reasons for America maintaining some type of "full" ZT law even after the drinking age is lowered.
  • ZT laws send a strong message that alcohol and driving don't mix, and removing them may be seen by some as implying otherwise.
  • Inexperience in drinking as well as driving, regardless of age, can be a deadly combination.
  • If the drinking age was 18, one would have three years of legal drinking experience and up to five years of driving experience at 21.
  • ZT laws would be a good precautionary measure against the alleged adverse effects of lowering the drinking age, and would help assuage fears about such effects.
  • Federal law requires ZT laws as a condition of highway funding. It's bad enough to have to deal with that kind of coercion with the drinking age, let alone additional funding losses.
  • Some studies find positive externalities from ZT laws, such as reduced suicide rates, which may or may not be causally related. 
  • ZT laws have strong public support, and frankly, it would be politically impossible to lower the drinking age without maintaining such laws.
However, we recommend that laws that set the BAC limit to 0.00 be changed to 0.02 to prevent false positives, and violating a ZT law (but not violating the adult BAC limit) should not be a criminal offense. For those who violate adult BAC limits, there should be graduated penalties that are proportional to BAC, eliminating the current perverse incentives resulting from reduced marginal penalties for each additional drink above the 0.08 threshold. And those penalties should be tougher than the current ones as well. In addition, we also recommend lowering the adult BAC limit of 0.08 down to 0.05, like it is in many other countries, since impairment begins well before 0.08. In addition, preliminary breath testers (i.e. handheld ones) should be not be sufficient evidence; that's what evidential breath testers are for.

But most importantly, we should never lose sight of the fact that the average BAC in an alcohol-related fatality is 0.16 in general and 0.14 for drivers under 21. Moreover, only 5.8% and 5.4% of total fatalities, for all ages and ages 16-20, respectively, involve a BAC below 0.08--and most of such deaths would probably still have occurred in the absence of booze.  And drivers age 21-24 are the most overrepresented in alcohol-related fatal crashes (at all BACs) as well.  Thus, the highest priority in the fight against impaired driving should be catching and deterring those very high BAC drivers of all ages (who are responsible for the lion's share of such deaths), rather than strategize on how best to catch young drivers with BACs below 0.05 (who are responsible for only a small fraction). In other words, we need to see the forest for the trees.

Thursday, October 1, 2009

What Will South Dakota Do? (Updated)

The latest state in which there is an attempt to lower the drinking age is South Dakota. Which, as you may know, was the second to last state (followed only by Wyoming) to raise the drinking age to 21 in 1988 under federal duress and coercion. State Rep. Tim Rounds (R) currently has a proposal to let 19-20 year olds drink beer in bars if accompanied by someone over 21. Even that is rankling people like MADD, though. Rounds says he will drop the proposal if it will cost the state federal highway funding, which it likely will (it is unlikely that he found a loophole in the federal law).

Here's some advice, Mr. Rounds. You don't start out with a compromised position like this one. You will only have to compromise further. Obama learned this lesson the hard way when it came to healthcare (in 2003 he actually wanted single-payer, similar to Canada, and probably most Americans would have agreed). We know Rounds had a plan that was even more liberal than his current one last year.

If it passes, this will do good to pave the way for further changes in the drinking age, so let's cheer him on. We at 21 Debunked look forward to the day when in all 50 states, all 18-20 year olds will have the same rights as those over 21. In every way.

UPDATE:  Tim Rounds is still moving forward with the proposal as of January 2009, though he faces an uphill battle in the legislature.  Unfortunately, it appears to be too much of a compromise, and it is unclear whether even that would get around the federal highway funds coercion.  His latest plan would create special bars for 19-20 year olds to drink only beer and only on premises, though he dropped the requirement of being accompanied by someone over 21. 

Unfortunately, he added a provision that would make it a felony DUI for anyone under 21 to drive with even the slightest amout of alcohol in one's system.  It is already illegal to do so in all 50 states for those under 21, and it seems excessive and out of proportion to make it a felony (read: life-destroying) offense to drive after a single drink.  While we at Twenty-One Debunked do not support any kind of impaired driving, however slight, we think there is a significant difference between one beer and ten, and that the law should reflect that difference.  And what about false positives?

FEB. 2010 UPDATE:  The bill has officially been killed by the legislature, unfortunately.

Thursday, September 24, 2009

Post #21--Would a Split Drinking Age Be Better?

A new study of the drinking age (Males, 2008) apparently finds that a split (or "graduated") drinking age of 18 for beer/wine and 21 for liquor would reduce combined violent deaths (traffic crash deaths plus homicides) among 18-20 year olds with similar reductions for 16-17 year olds and 21-24 year olds. It studied the effects over time of raising the age to 21 in the 1980s, based on a state's former drinking age (18 for all beverages, 18 for beer/wine only, or 19 and 20), relative to states that were 21 throughout. When they were raised to 21, the ones that were previously 18 for all beverages, as well as the former 19 and 20 states, saw a decrease in combined deaths, mainly from traffic crashes. But the 11 states that were 18 for beer and/or wine only, they saw an increase in deaths, with the lion's share of the increase being homicides. Interestingly, a few states that were 18 for all beverages saw increases or no significant change as well when the ages were raised to 21.

What are we to make of all this? Several states had split drinking ages, many of which had them for decades. When we look at the dates that the 21 law became effective, we see that all of them but Oklahoma (1983) raised them in 1985 or later. Ditto for the "18 for all beverages" states that saw increases or no significant changes. Hmmmm....what happened around that time? In 1984, the federal government coerced the states with lower drinking ages to raise them to 21 or lose 10% of annual highway funding starting in 1988. So, it could simply be that for many of the coerced states, raising their drinking ages merely threw gasoline on the fire!

This interpretation, rather than anything special about a split drinking age, appears to be more likely to be true when we consider a study by Miron and Tetelbaum (2009). In their study, which controlled for more variables than Males (2008) but looked only at traffic fatalities, they separated out the states based on the year the drinking age was raised to 21. The states that were coerced (i.e. those who raised the age after 1984) overall saw no lifesaving effect. On the other hand, the ones that raised their drinking ages voluntarily in 1983 or earlier did see a small lifesaving effect, but that only lasted a year or two and then wore off. Robustness checks were done as well. Interestingly, Miron and Tetelbaum found no clear relationship for the purchase ages of various beverage types when measured separately, but they did find an increase in fatalities among drivers under 18 when the drinking age was 19, 20, or 21 as opposed to 18.

We at 21 Debunked therefore see no reason why a split drinking age is superior to a drinking age of 18 across the board. We would support the former as a steppingstone to the latter, but ultimately favor the latter hands down. We never understood it since you can get just as drunk on one as you can on the other, and beer is grosslly overrepresented in DUI fatalities. If states feel that they must have special restrictions for 18-20 year olds, which are probably unnecessary, one or more of the following may make more sense:
  • Keep the age at 21 for kegs, cases, and other bulk quantities of alcohol; let 18 year olds buy everything else.
  • Limit the quantities 18 year olds can buy off-premise to 216 ounces of beer, 1 gallon of wine, or 1 fifth of liquor per person per day.
  • Require 18-20 year olds (or even just 18 year olds) to sign a logbook upon purchase, similar to what is done for Sudafed at all ages.
  • Have kegs and cases be sold only in beer distributors regardless of age, making the first two things easier to enforce.
  • Keep it 21 for internet alcohol orders, like some states currently do with cigarettes.
  • Have shorter trading hours (beginning later and/or ending earlier) for off-premises sales for 18 year olds than for those over 19 (or 20 or 21).
  • Allow some bars to set the limit higher than 18 if they wish (no new law needs to be made).
Also, we feel that the age limit should be the same for on- and off-premise sales, at 18. If we let 18 year olds buy cigarettes and guns for off premise use, why not a 6-pack? Their younger friends will find a way to get booze either way, and both 8th graders and 10th graders currently find alcohol easier to get than cigarettes. Furthermore, if there is a wide gap between the two (i.e. 18 for bars and 21 for stores), that may perversely encourage drunk driving for those rural 18-20 year olds whose nearest bar is 10+ miles away while a store that sells 6-packs is a mere 500 feet away. However, such perverse incentives could in theory be minimized by letting 18 year olds have the same drinking rights as 21 year olds currently enjoy, with the one exception being off-premise purchase, and having that purchase age be 19 instead of 21. We don't have any studies to back this up, but we also know of no hard evidence that it is any safer than 18 across the board.

In contrast, there is some evidence that restricting bulk alcohol sales may have benefits. A study of college students in college towns by Kuo et al. (2003) found that the availability of 6-packs was negatively associated with self-reported "binge" drinking, 12-packs showed no effect, while 24-packs (cases), 30-packs, and kegs all showed significant positive associations. In other words, the more 6-packs available, the less "binge" drinking. The more cases and kegs, the more "binge" drinking. (Liquor and wine were not studied; nor were 18-packs.) They also found that beer price was inversely related to "binge" drinking, and store advertising was directly related, just as expected. While we were unable to locate any jurisdiction in the world that has age-specific bulk-only alcohol restrictions, it stands to reason that such a thing would make more sense than splitting the age by venue or beverage type regardless of quantity.

Monday, September 21, 2009

The Truth Should Be Self-Evident--Not All "Bingers" are Created Equal

Binge drinking. We all have heard the term used incessantly in the media, who usually claim it is getting worse. Our kids are out of control, they say, and we need to get tougher. Except, of course, when the issue of the 21 drinking age comes up--then it has gone way down, and the raising of the drinking age in the 1980s gets all (or nearly all) the credit.  Predictable to say the least.

So which is it? It depends on your definition of "binge" drinking. The term originally meant a multi-day, very heavy drinking session in which the drinker neglects usual responsibilities and behaves recklessly--also known as a bender. Fortunately, very few people do this, both now and back in the day. But in 1994, Henry Wechsler of the Harvard University School of Public Health redefined the term to mean anytime someone drinks 5 or more drinks in the same evening, later modified to be 4 or more for a woman. This "5/4 definition" is the one most commonly used nowadays, with the gender-neutral 5+ definition a close second since the latter has been tracked by national surveys since 1975. And yes, it (defined this way) has gone down since its peak in 1979 for everyone except college students and non-college females. But that downward trend began several years before a significant number of states raised their drinking ages to 21, and also occurred in states that stayed 21 throughout.

But is it really an accurate index of harmful drinking? That question appears to have been answered fairly in a new study. Using self-reported alcohol-related injuries (major or minor) in the past 6 months as the dependent variable, researchers examined the effect of the number of drinks per drinking day, and the frequency of occasions having that number of drinks in the past month, among college students. This clearly makes more sense than lumping them all together, or looking only at total volume or frequency. Results were that risks increase rapidly after consuming 8+ drinks (males) or 5+ (females), on at least four days per month. Effects were further magnified among those who scored high on sensation-seeking. It was also found that the 5/4 definiton loses much of its predictive power when days of 8/5+ are removed from the equation. And remember, none of these models account for speed or context of drinking, or even distinguish drunk driving, and students often undercount their drinks as well (due in part to the ubiquitous "red party cups" and the popularity of hard liquor).  But one benefit to this study is that body weight was controlled for, since the effect of a specific number of drinks varies widely across individuals.

Another recent study found that a 7/6+ cutoff was far more predictive of alcohol-related problems (relative to non-bingers) than a 5/4+ one.  Those who met the 5/4+ cutoff but not the 7/6+ one averaged 5.4 drinks per occasion, while those who met the 7/6+ cutoff averaged a whopping 9.1 drinks.  In terms of negative consequences, those males who typically drank 5-6 drinks (and 4-5 for females) generally did not fare significantly worse than the nonbingers, but the heavier 7/6+ group clearly did.

Clearly, the 5/4 definition is an arbitrary convention with little to no scientific basis. Kind of like, well, the 21 drinking age. An ideal definition would take into account context, speed, and BAC, set at rational thresholds. However, a quick, context-neutral, numerical definition is needed for survey purposes. While for the vast majority of the college-age population a 5/4+ threshold is a good negative test for acutely dangerous drinking, a 10/8+ threshold is a better sufficient test for the same, and intermediate between the two is an 8/6+ threshold.  Thus, we at 21 Debunked propose two thresholds: 8/6+ drinks and 10/8+ drinks. It's probably best to jettison the word "binge" entirely--call the first threshold "heavy episodic drinking" or "high risk drinking," and the second one "extreme drinking." Unfortunately, these have not been measured very well over time, so to answer the first question, we don't know for sure.

But if we are to go with anecdotal data and statistical proxies for extreme drinking, we can probably safely that say such drinking has been on the rise, at least for college students. For example, another study found that between 1998 to 2005, there was a significant increase in alcohol-related nontraffic deaths among students, driven by a near tripling of alcohol poisoning deaths. (The actual statistics were simply those for 18-24 year olds multiplied by 30%, so this actually includes many non-students as well) That being said, we should note that the majority of college drinkers still drink responsibly, whether legally or illegally, and only a small minority drinks to these ludicrously high levels. However, the latter appears to be where the real problems lie, and where our efforts are best concentrated.  But we still keep on barking up the wrong tree time and again.

It's also worth noting that in the first study mentioned, participants from 3 out of the 4 American universities surveyed had higher rates of alcohol-related injury than those from the one Canadian university, though the difference was not statistically significant.  It is quite plausible that the 21 drinking age, by forcing drinking underground, exacerbates such problems. (Canada's drinking age is 18 or 19, depending on the province)

We at Twenty-One Debunked do not endorse any kind of drinking, underage or otherwise, and we do not mean to imply that drinking below a specific threshold is safe for everyone. To our knowledge, no such absolute threshold exists. But we do think that we need to get our priorities straight as a society when it comes to drinking.  America's young people--our future--deserve nothing less.

Latest Bit of Scarelore--Is it True?

In a desperate attempt to hang on for dear life, knowing its days are numbered, the pro-21 crowd is recycling an old fear: that alcoholism rates would increase dramatically if the drinking age is lowered below 21. And they now have a study to "prove" it, or so they say.

The study pools data from both a 1992 survey and a 2002 survey, and finds that those who were exposed to a drinking age of less than 21 when they were ages 18-20 were about 1.3 times more likely to have an alcohol use disorder, and about 1.7 times more likely to have a substance use disorder other than alcohol, in the past year. Even (scratch that, especially) when the respondents were in their 40s and 50s. The researchers attempted to control for confounders, but we all know there can always be some that were missed. And we know that if you torture the data enough, it will confess to anything.

We at 21 Debunked think that the relationship between MLDA and later alcohol problems is likely spurious for the following reasons:

  • At least part of the relationship seems to be mediated by self-selective cross-state migration (i.e. budding alcohol abusers moving to states with more lenient laws). But there was no data on state of residence at age 18, only birth state and current state.
  • The relationship was apparently NOT mediated by earlier age of drinking onset, as would be expected if the relationship was truly causal. Also, there was no significant effect on drinking before 18, so we can rule out the often claimed "spillover effect" on younger kids.
  • Drug addiction (especially hard drugs) was affected more strongly than alcohol addiction for whatever reason, the opposite of what would be expected assuming causality.
  • No distinction was made between a drinking age of 18, 19, or 20, which may have a misleading impact on the results.  Though this could bias the results in either direction.
  • The effect on past-year alcohol use disorders was strongest among respondents in their 40s and 50s, and weakest (and statistically insignificant) among those in their 20s, the opposite of what would be expected from a causal relationship. Both drinking age exposed groups start out fairly close, disorders decline at the same rate at first, and divergence does not occur until around age 35.
  • Regressions did not control for state-specific trends, religion, or completely for ethnicity. Whites were treated as a monolithic group (despite wide variation in drinking cultures), and no distinction was made for Native Americans (who tend to have higher alcoholism rates).
  • Unemployment and education were controlled for, but not poverty.
  • The odds ratio for the relationship between MLDA <21 and later alcohol use disorders was an anemic 1.33. In epidemiology, odds ratios and (relative risks) below 2.0 are difficult to interpret and are often due to residual or unmeasured confounding, bias, or even chance. This caveat is especially true for retrospective and non-longitudinal survey studies such as this one. For example, the New England Journal of Medicine would likely consider this association "weak" and thus unfit for publication in most circumstances.
  • And there's always the usual recall bias, as well as good old-fashioned denial. They don't call it a "pink elephant in the room" for nothing.
In other words, the results are preliminary at best. And there's plenty of counter-evidence as well. According to NIAAA data from 1981, courtesy of Mike Males (1986), states with a drinking age of 21 back then actually had higher rates of alcoholism than states with lower drinking ages, and much higher rates of alcohol-related diseases despite both lower teen and adult drinking rates. North Dakota, who nonetheless remained at a constant 21 since the 1930s, is currently the worst state in terms of alcoholism. The worst city is Reno, Nevada, whose state had not seen a drinking age less than 21 for 75 years.

And why does Canada (MLDA 18 or 19 depending on province) not have a higher alcoholism rate than America? Demographically, they probably should! Ditto for most other countries with lower drinking ages, even the notoriously binge-drinking British and Australians? Some may say culture, but Canada's culture is not radically different than ours, and Britain's should, if anything, be more conducive to alcoholism than ours.

Another new study, this one done in Australia (with a legal drinking age of 18), explores the "age at first drink" effect on alcohol dependence from a new angle. Studying numerous twins, they find that there appears to be a gene-environment interaction among those who begin drinking before 15, especially before 13. Such very early drinking, or some environmental factor closely linked to it, appears to activate the bad genes. Though this could simply be a common vulnerability from other differences in environment rather than a truly causal effect of age. Or perhaps the context of drinking matters. The older one starts drinking, the more the environment matters, and the less genes do. But interestingly, and most importantly for the purposes of this discussion, the effect of age at first drink levels off after 18, with no significant difference between those who begin drinking at 18, 19, 20, or even 23. (Funny how this "leveling" effect occurs precisely at the age that corresponds to the MLDA. Coincidence? Hmmm.....)

This jibes well with a Canadian study done in 2000 that found that, while those who begin drinking between 11-14 have the highest risk for later alcohol dependence, even when taking time since first drink into account, there was no significant difference (in the long run) between those who began at 17-18 and those who began at 19 or later.  For the latter group, the onset of dependence was merely delayed.  Again, no conclusive proof of causation, but the authors concluded that prevention programs that succeed in delaying drinking to even 15-16 would likely produce substantial benefits.  This is probably a better idea than trying to make the perfect the enemy of the good, like those who support the 21 drinking age never cease to do.

In other words, we need to see the forest for the trees.  Something we as a society fail to do time and again.

Friday, September 18, 2009

Blast from the Past

One of the fears about lowering the drinking age is that traffic fatalities will rise. Usually, the pro-21 crowd either points to studies of the 1980s, when drinking ages were raised, or the 1970s, when drinking ages were lowered. Having already debunked the studies of the post-1976 period, using studies such as Miron and Tetelbaum (2009), here we look at a period with relatively scant data: 1970-1975, when 30 states lowered the drinking age.

Claim: There was an immediate and persistent increase in (presumably alcohol-related) fatalities among 18-20 year olds when the drinking ages were lowered (generally to 18).

First of all, we don't really know if that statement is even true to begin with, and we probably never will. Only a few decent-quality studies examined the years 1970-1975, the years in which the drinking ages were lowered. The Fatality Analysis Reporting System (FARS), which gives detailed reports about traffic fatalities, was not even created until 1975, and state-level data were not available through that system until 1976. So any conclusions drawn from state-level data for 18-20 year olds before 1976 is questionable at best.  For studies of nonfatal crashes, this caveat applies a fortiori. And any "alcohol-related fatality" data before 1982 is unreliable since FARS did not make this distinction until that year, which is understandable since a state that tested even 50% of fatal crash drivers for alcohol was considered stellar back then. Garbage in, garbage out.

From 1970-1975, any alleged increase in fatalities was imperceptible in the aggregate data. Using data from the National Safety Council, Miron and Tetelbaum (2009) showed that national 15-24 year old fatalities peaked in 1969, then declined sharply until 1975. From 1976-1980, fatalities rose somwhat, and declined from then on. The same was true for 18-20 year olds after 1976, when that group was separated out by FARS and the two groups have been highly correlated since. But the increase in the late 70s also occurred in states like California, which kept their drinking age at 21 throughout, so the 1976-1980 increase was unlikely to be a result of lowering the drinking age a few years prior.

So all state-level data for 18-20 year olds before 1976 must be gleaned from sources other than FARS, and some states had data problems for this period. And here's the grain of truth of it all. It is true that some states that lowered their drinking ages (and some that did not) saw increases in reported 18-20 year old fatalities from 1970-1975. But other states that lowered their drinking ages saw either no significant change or sharp decreases in such deaths in the table below:

StateDrinking Age Change (1970-1975)% Change in 18-20 total auto fatalities per capita (1970-1975)
Lowered, 21 to 19, 1975
Alaska*Lowered, 21 to 19, 1970no data
Arizona*Lowered, 21 to 19, 1972-29%
Arkansas21 (no change)-22%
California21 (no change)-14%
Colorado18 (no change)-10%
Connecticut*Lowered, 21 to 18, 1972+11%
Delaware*Lowered, 21 to 20, 1972+2.3%
DC18 (no change)no data
Florida*Lowered, 21 to 18, 1973-28%
Georgia*Lowered, 21 to 18, 1972-26%
Hawaii*Lowered, 20 to 18, 1972no data
Idaho*Lowered, 20 to 19, 1972-29%
Illinois*Lowered, 21 to 19, 1973-18%
Indiana21 (no change)-19%
Iowa*Lowered, 21 to 19, 1972, then 18, 1973-31%
Kansas18 (no change)-49%
Kentucky21 (no change)-31%
Louisiana18 (no change)-26%
Maine*Lowered, 20 to 18, 1972-14%
Maryland*Lowered, 21 to 18, 1974-8.6%
Massachusetts*Lowered, 21 to 18, 19730%
Michigan*Lowered, 21 to 18, 1972-6.4%
Minnesota*Lowered, 21 to 18, 19730%
Missouri21 (no change)-20%
Mississippi18 (no change)-46%
Montana*Lowered, 21 to 19, 1971, then 18, 1972+19%
North Carolina18 (no change)-10%
North Dakota21 (no change)+5.2%
Nebraska*Lowered, 20 to 19, 1972+7.8%
Nevada21 (no change)-61%
New Hampshire*Lowered, 21 to 18, 1973-59%
New Jersey*Lowered, 21 to 18, 1973+2.9%
New Mexico21 (no change)-14%
New York18 (no change)-9.7%
Ohio18 (no change)-35%
Oklahoma21 (not lowered to 18 until 1976)-14%
Oregon21 (no change)-13%
Pennsylvania21 (no change)-7.1%
Rhode Island*Lowered, 21 to 18, 1972+67%
South Carolina18 (no change)-25%
South Dakota*Lowered, 19 to 18, 1972-31%
Tennessee*Lowered, 21 to 18, 1971-1.6%
Texas*Lowered, 21 to 18, 1973+2.0%
Utah21 (no change)-49%
Vermont*Lowered, 21 to 18, 1971+161%
Virginia*Lowered, 21 to 18, 1974-17%
Washington21 (no change)-7.1%
Wisconsin**18 (no change for on-premise beer)**-7.1%
West Virginia18 (no change for beer)+1.9%
Wyoming*Lowered, 21 to 19, 1973+1.0%
(Taken from Cook and Tauchen (1984), Appendix A. Calculations ours. All data involves purchase age for beer unless otherwise noted. Dates taken from Wikipedia)

Thus, the state-level data are completely patternless, at least in terms of drinking age. Clearly, other factors were involved, such as gas prices (now known to have an effect), the economy, or even the weather. Only a handful of states (mostly with relatively small populations and hence much volatility in the numbers) in the table show significant increases, including one (North Dakota) that kept a constant 21 MLDA since the 1930s. The rest either saw sharp decreases or no significant change. This was in spite of the fact that, nationwide, the average driver in 1975 traveled more vehicle miles than in 1970. And before the advent of FARS, any increases are not clear as to whether they reflect true fatality increases or simply changes in how fatal crashes were reported. Nor does this table tell us whether those increases were contemporaneous with the age-lowering (done mostly in 1972-1973) since only two years, 1970 and 1975, were compared due to data availability. For example, Vermont's rather large increase, apparently, was not contemporaneous (See Douglass and Filkins, 1974).

A quick, albeit imperfect, way to estimate the effect of a policy change ceteris paribus is a method called "difference-in-differences," or DD for short. Here, we do a DD analysis comparing change vs. no change states:

Median difference, "change" states (1975 vs. 1970): -6.8%
Median difference, "no-change" states: -16.5%
Net difference-in-differences: +9.75%

This implies that, while both groups declined overall, the no-change states declined at a significantly faster rate than the states that lowered their drinking ages. And the latter group can be said to have more deaths at first glance. However, there are two radical outliers (VT and RI) that dramatically skew the results. Furthermore, Delaware is the only state that lowered the age from 21 to 20 and no further, and Wisconsin would better be included with the no-change states since 18 year olds were allowed to drink beer in bars both before and after. Thus, we omit the two outliers and Delaware entirely, and instead place WI with the no-change in our adjusted DD analysis:

Adjusted median difference, "change" states: -11.3%
Adjusted median difference, "no-change" states: -14.0%
Net difference-in-differences: +2.7%

Wow, that really makes a difference in the results. The net DD drops from nearly +10% to less than +3%. The latter "effect size" is small enough to be due to chance alone. Indeed, we also observe in the table that several of the states with significant increases are also states with some of the smallest 18-20 year old populations. Such states are prone to spurious shocks due to the volatility of smaller numbers of fatalities. Thus, we see that when we eliminate all the states with populations less than or equal to that of Montana, along with making the aforementioned adjustments, the drinking age effect disappears entirely:

Adjusted median difference, "change" states: -14.0%
Adjusted median difference, "no change" states: -14.0%
Net difference-in-differences: 0%

Regardless of what happened (or didn't happen) in the 1970s, it is essentially irrelevant today. Back then, drinking ages were lowered against a backdrop of falling real alcohol prices, higher adult per capita alcohol consumption than today, permissive and toothless DUI laws, social acceptability of drunk driving, no seat belt laws, ignorance about the risks of alcohol, and a generally cavalier attitude toward safety. The term "air bag" meant a person who talked too much. The term "designated driver" was not even in our vocabulary until the 1980s. Drunk driving was not just tolerated back then, it was expected of you if you were the least drunk person in the group (to drive everyone else home). Needless to say, things are very different today. So it's comparing apples and oranges. And any fear relating to the 1970s is therefore academic. Consider it debunked.

Claim:  There was a major increase in high school drinking (and related problems) when the drinking age was lowered, as 18 year olds bought for their younger friends.

Again, correlation does not equal causation.  It was true that in the 1970s, teen drinking increased, but that was a national trend that occurred in essentially every state, including those like California that kept the drinking age at 21.  In fact, the secular trend predated the 1970s by many decades, and ironically enough began during Prohibition in the 1920s.  It lasted until about 1979, then the trend reversed and teen drinking declined through the 1980s until the early 1990s.  And the downward trend predated the raising of the drinking age, and again occurred in essentially every state.

The average age at first drink did decline nationwide, but that began in 1965 (or earlier), and continued to decline long after the drinking age was raised in the 1980s. And California, who had a 21 drinking age since 1933, saw the same trend overall as the rest of the country. So clearly other factors are at work, and the trends cannot be traced to changes in the drinking age.

Part of the increase in teen drinking could be that parents stuck their heads in the sand about alcohol, being relieved that "at least my kid isn't smoking pot."  Or it could have resulted from a moral panic and a consequent deviancy amplification spiral.  Or perhaps a bit of both, with the former preceding the latter.

Interestingly, a 1977 study found that high school seniors in states with a drinking age of 18 actually drank less and had fewer alcohol-related problems than those in states with a drinking age of 20 or 21.  Why this is is not entirely clear, but the researchers hypothesize that "forbidden fruit" may very well entice those in the more restrictive states to drink.  Or perhaps those seniors that are still 17 are more likely to wait until 18 to be legal since this is more realistic than waiting until 20 or 21.

Again, much of the fears from the 1970s are now academic, and are unlikely to be a problem if the drinking age was lowered today.  The notion of teenagers having "liquid lunches" in high school is no longer socially acceptable--it is now considered a sign of a drinking problem.  Those who are caught bringing booze to school are dealt with much more harshly than they were back then, campuses are often closed, and students are essentially defanged and declawed.  And today's tough enforcement requires IDs to be shown when purchasing alcohol, reducing the chances of a 15-17 year old "passing" for 18.  About the last remaining fear is high school keggers (which still occur even with a 21 drinking age), but any possible increase in these parties can (by definition) be prevented by keeping the purchase age at 21 (or 20) for bulk quantities like kegs and cases while lowering it to 18 for everything else. 

One thing, however, is for sure:  teenagers will get their hands on booze one way or another, and whether the drinking age is 18 or 21 is of little consequence to this fact.  Where there's a will, there's a way.  And where there's a swill, there's a sway.  So consider this one debunked as well.


Thursday, September 17, 2009

Daredevil Behavior and the Teenage Brain

Teenagers are often assumed to be risk-takers who engage in dangerous and idiotic activities. And that is often true. But compared to American adults, they are really not that bad.

It is often assumed that it is due to their "underdeveloped brains," which apparently continue to develop until at least age 25. This factoid is heard so often that it is taken as gospel. Indeed, numerous studies have revealed changes in the adolescent and young adult brain. So one must lead to the other, right?

But what if the supposed causation is not just inaccurate, but in fact is 100% wrong? Apparently, a new study of brain imaging suggests just that. They found that the more mature and "adult" the white matter of teen brains was, the more risk-taking behavior reported, the opposite of what was expected. Of course, the direction of causality is uncertain, but doesn't this blow a hole in the conventional wisdom?

Another study finds that, among 10-16 year olds, shortsightedness is not caused by impulsivity (lack of self-control), but rather by sensation-seeking. While 10-16 year olds did tend to think about the future less than adults do, and thus prefer immediate rewards to delayed ones, there was little change in shortsightedness after 16 (the study looked at 10-30 year olds). This is interesting since the parts of the brain that are related to sensation do not continue maturing after 16, but the parts responsible for self-control do. Still, shortsightedness changes little between the ages of 16 and 30.

The results of another study imply that, at least in terms of resistance to peer influences, 18 year olds are essentially just as competent as 23-30 year olds.  This echoes older studies that found that results on tests that measure competence to stand trial seem to level off after age 16, similar to the way IQ typically does.

Another study found that the likely explanation of the relationship between age at first drink and subsequent drinking problems has to do with the quality of the parent-child relationship. In other words, the better the quality, the later drinking begins and the fewer drinking problems. Age at first drink may simply be a marker for later problems or lack thereof, since it appears to be a marker for the relationship quality. Still another study finds that child maltreatment is independently linked to adolescent "binge" drinking (5+ drinks/occasion), as was the pink elephant in the room (parental alcoholism).

What does all this have to do with the 21 drinking age? Plenty. Arguments supporting a drinking age higher than the age of majority do not appear to hold water upon closer examination.

Monday, August 31, 2009

The Tide is Turning

According to the latest Rasmussen poll, 30% of American adults believe that the drinking age should be lowered to 18, and 5% believe it should be lowered to 16. This combination, 35%, is a record high, and this is one of the few times in decades that we broke the 30% barrier. And only 51% believe it should remain at 21, a record low. Adults under 40 were fairly even on whether the drinking age should be 18 or 21 (last year it was about half of men and about a quarter of women under 40 who wanted the age to be 18), another sign of progress. (Now, if only we could get young people to vote more!)

Also, 50% of adults believe that drunk driving laws are too lenient, while only 8% think they're too tough. That's one thing we at 21 Debunked do agree with the majority on.

It appears we are fast approaching a critical mass, if we have not achieved one already. Remember that it does not always take a majority to prevail, as Samuel Adams so eloquently noted.

Forty years ago, it was 1969. Lots of great things happened in that fateful year (Woodstock, the moon landing, the first Earth Day, etc.), but most relevant to the debate is the fact that the first two states to lower the drinking age (the first time around) did so that year. From 1970-1976, 30 states would lower their drinking ages, chiefly in 1972-1973, after decades of it being 21 in most states (some were 18 since the 1930s or remained 21 throughout). This occurred because the voting age and age of majority were lowered, due to the hypocrisy that 18-20 year olds were dying in Vietnam but were not allowed to have full adult rights, leading to much protest from that age group. Sound familiar? There was a huge mass of young people at the time, whose numbers would decline to political impotence in the 1980s (when the drinking age was raised to 21) and rise again in the late 1990s and especially the 2000s. Forty years later, the children of the Baby Boomers have come of age. There are now at least as many young Millennials as there were young Boomers in 1969, and they are a force to be reckoned with as there is strength in numbers.

If the current groundswell continues, perhaps we can consider 2009 to be like the new 1969, and so on. Only now Vietnam is spelled "Iraq" (or perhaps "Afghanistan"). Thus, we may lay the events on a timeline and make a prediction that the first state or two to lower the drinking age will do so in 2009-2011. Those will be the "guinea pigs," and how the feds handle it in 2011 will be crucial to the movement's success--that will be the wild card. If a large number of states follow suit, that will likely occur in 2012-2013. If so, a few more may do so in 2014-2016, and hopefully the Millennials won't sell out like the Boomers did back in the day.

Of course, this is all just speculation, but it can happen. What better time than now?

Monday, August 24, 2009

Our Modest Proposal

While the first post outlines our purpose and views, and should be read, some folks may still be confused about details. Here is precisely what we at Twenty-One Debunked (a subsidiary of the True Spirit of America Party) propose, in concrete terms, to further the cause of justice and help reduce America's drinking problem:

  1. Lower the drinking age to 18, period. No compromises, except perhaps to have the age for kegs/cases/other very large quantities be 20 or 21.
  2. Raise the beer tax and liquor tax to its 1951 and 1991 inflation-adjusted values, respectively, and make the beer tax proportional to alcohol content. (No tax hike for microbrews.) Use the funds to pay for education, treatment, and DUI enforcement.
  3. Crack down hard on DUI, increase penalties, lower BAC limit to 0.05%. Have graduated (but stiff) penalties based on BAC, with serious jail time for high BAC offenders. Lose license forever on second offense above 0.08, regardless of age. No more excuses.
  4. Keep Zero Tolerance age at 21, and/or make it for anyone who has had a license for less than 5 years, regardless of age.
  5. Increase honest alcohol education, which should begin long before 18.
Lower-priority measures that we support include the following:
  • Restrict alcohol advertising to no more than what is allowed for tobacco.
  • Regulation of alcohol outlet density.
  • Price floors on off-premises sales.
  • Free or low-cost taxi service to and from bars and/or improved late night public transportation.
  • Increased alcohol treatment.
  • Make driver licenses tougher to get and easier to lose, and the road test much tougher.
  • Make it a federal crime to drive drunk across state lines, punishable by many years in federal prison.
What we do NOT support:
  1. Special restrictions on 18-20 year olds that do not apply to those over 21 (except perhaps on bulk quantities of alcohol) or any kind of strings attached, including "drinking licenses".
  2. Dram shop and social host laws of any kind.
  3. Loopholes that allow DUI offenders to get off easily (e.g. plea bargain for "reckless driving").
  4. Harsh criminal penalties for underage drinkers of any age.
  5. Blue laws.
  6. Public drunkenness laws based solely on BAC or the mere fact of drinking.*
  7. Laws that completely prohibit parents from giving their own children alcohol.
  8. Any laws that require that the Constitution be violated in order to adequately enforce them.**
*We do support laws against drunk violence and disorderly conduct, and tougher enforcement thereof.
**We do not consider implied consent laws to be against the constitution, and have no problem with stiff penalties for test refusals for drivers (but no one else).

Friday, August 14, 2009

Latest Brain Studies Demonstrate The Same Old Flaws

Potentially adding fuel to the fire of the drinking age debate is a new study of 18-20 year old first-year university students in Spain, that looked at the effects of so-called "binge" drinking on the brain. In this study, 95 students (42 "bingers", 53 controls) were given tests of attention and working memory, and their specific brain waves were monitored with electrodes. No statistically significant differences were observed between the two groups in terms of actual performance, but the electrophysiological test suggested that more attention was expended to complete a given task among the "binge" group, as well as other electrophysiological differences. This is a lot more nuanced and less certain than the media are implying, and hardly represents "dain bramage."

The biggest flaw in this study was the fact that there was no over-21 comparison group. So we simply cannot infer anything at all about age from this piece of research. Absolutely zilch. A better method would have been to have three groups: 15-17, 18-20, and 21-24 years of age. But no study that we know of meets this standard. This would help to settle the nagging question of whether or not it actually is worse to drink at 18 rather than 21. Or perhaps some people are afraid of the possibility that their rationale for keeping the drinking age at 21 would be debunked if such a comparison was done. As yet, there is essentially ZERO hard evidence that drinking at 18 is significantly worse than doing so at 21, ceteris paribus, but a plethora of evidence showing that excessive drinking is unhealthy at any age. To be fair, however, the purpose of the study was not to test the rationale for the drinking age, but rather the effects of alcohol on a particular segment of the population.

Other flaws included small sample size, and not enough information to determine whether the results are of any practical significance. The lack of behavioral performance differences between the two groups suggests that the answer is not very much, but still warrants more study before jumping to any conclusion either way. Subjects were only required to refrain from using alcohol or drugs for at least 12 hours, so acute and transient effects (such as hangover, which can last for up to 36 hours) cannot be ruled out. Also, this was a cross-sectional study, so we do not know whether or not the purported effects were acutally innate characteristics that predated (or even predisposed for) the "binge" drinking. Tobacco smoking was also not controlled for. In other words, this study is preliminary at best.

It is also interesting to note that the average age of onset of drinking in the "binge" group was 14, and 15 in the nonbinge group.

The reason this blog uses scare quotes on the word "binge" is by convention: we do not feel that the definiton used (6+ standard drinks on at least one occasion in the past month, at a pace of 3+ drinks per hour) was an adequate one. That was equivalent to about 4+ American drinks, and undercounting and underreporting can also confound the results as well. Given the small sample size, there could be a few students that drank much more than the others, and more than they led on, and skewed the results. Some could have been dishonest about alcohol use disorders, which were an exclusion criterion, and could also have skewed the results.

Another recent study, done on college students in Belgium, also found similar electrophysiological differences, but again no behavioral differences for some reason. In this study, there were no differences in alcohol consumption or electrophysiological results at baseline, but both changed significantly in the "binge" group when measured 9 months later, but not in the control group. However, we should keep in mind that the binge group averaged 12.5 units (about 9 American drinks) per binge session, and two such binge sessions per week, which is quite extreme. Number of (American) drinks per week averaged a whopping 35 units (25 American drinks) in the binge group, while the control group drank about one drink per week. And some participants drank as recently as three days before the tests as well, potentially conflating short and long term effects, though this was ostensibly controlled for. One good thing about this study, however, was that the sample size was significantly larger than the aforementioned one, and there was both a before test and and after test.

Still another study in 2007, this time of 21-25 year olds (you know, folks who are legally allowed to imbibe) who were self-identified heavy drinkers (more than 25 drinks per week), found that subtle brain changes are not exclusive to those under the magic age of 21.  The heavy drinkers did not exhibit significant neuropsychological test differences, but PET scans showed subtle differences.  Of course, this study did not gain nearly as much attention as the others previously mentioned.

Drinking ludicrous amounts of alcohol is dangerous, period.  Regardless of age.  That, if anything, should be the moral of the story. Keeping the drinking age at 21 only encourages such extremes, especially for college students.

We at 21 Debunked provide this for informational purposes only and do not in any way advocate drinking of any kind, underage or otherwise.

Tuesday, August 4, 2009

Looks promising for South Carolina (Updated)

Two recent lower (county level) court rulings have declared South Carolina's drinking age of 21 unconstitutional. The state's constitution says that “Every citizen who is eighteen years of age or older ... shall be ... endowed with full legal rights and responsibilities, provided that the General Assembly may restrict the sale of alcoholic beverages to persons until age twenty-one.” (emphasis added). Also cited was a SC Supreme Court decision in May 2008 that struck down a law banning handgun possession by 18-20 year olds. If these rulings are upheld on appeal, then the age for possession and consumption of alcohol would automatically revert to 18, like it was 25 years ago. But the age for sale would remain 21, unless the legislature decides to lower it. And the results of the court cases would only be binding in the affected counties unless the SC Supreme Court upholds the appeal as well.

However, the legislature could always change the state constitution, but only with voter approval.

While limited, this is clearly a step in the right direction. Domino effect you say? One can only hope.

UPDATE: We may have spoken too soon. On August 26, 2009, a circuit court upheld the drinking age of 21, unfortunately. The judge said it would create an "absurd result" to allow possession and consumption, but not sale, to 18-20 year olds. (But the SC constitution clearly says "sale" and nothing about possession or consumption). Honestly, the real absurdity is the fact that 18-20 year old legal adults are allowed to go to war, vote, get married, raise kids, and even (as of 2008) carry handguns in SC, but not drink--period. And we (the USA) stand alone among the developed world in maintaining this absurdity.

However, the latest ruling can still be appealed further if so desired, possibly all the way to the Supreme Court. It is too early to throw in the towel just yet.

The drinking age must be lowered, in the interest of justice. What better time than now?

Saturday, August 1, 2009

About-Face, About Time!

You know the 21 drinking age is on its last legs when one of its former supporters, substance abuse expert Dr. Morris Chafetz, has a sudden change of heart a quarter-century later. Remember that presidential commission in 1982? The one that gave 39 recommendations, #8 of which was to raise the drinking age to 21? Well, Dr. Chafetz was on that commission, and he now calls his decision to support Legal Age 21 "the single most regrettable decision" in his career.

Now THAT really says something! Especially given the length of his career. And he's no hippy-dippy or wild party animal either. Dr. Chafetz was the founding director of the NIAAA (pronounced "nee-ahh") beginning in 1970, a psychiatrist, and a renowned expert on alcohol.

He also notes, as 21 Debunked has, that the alcohol-related traffic fatality decline in the US was virtually identical to that in Canada, a country that did not raise the drinking age to 21. Even NHTSA admits this, and it is pretty tough to explain away. This fact alone puts a huge question mark over the specious claim the Legal Age 21 saves any lives at all. Additionally, he echoes the view that the 21 drinking age created unintended negative consequences, such as more deaths and injuries off the roads from clandestine, underground binge drinking (not unlike Prohibition).

As a result, we at 21 Debunked propose an honor for anyone who once fervently supported Legal Age 21 but has finally seen the light. Three cheers for the first ever recipient of the Chafetz award!

The tide, my friends, is turning as we speak. What better time than now?

Thursday, July 2, 2009

The Shell Game

A recent study found that "binge drinking"* has declined overall from 1979 to 2006 among young people, with one notable exception--college students. Oh yeah, and young females also.

During this period of nearly three decades, men and women experienced converging trends in reported "binge" drinking:


Age 15-17: -50%
Age 18-20: -20%
Age 21-23: -10%


Age 15-17: unchanged
Age 18-20: unchanged
Age 21-23: +40%

while college students and nonstudents the same age experienced diverging trends:


Age 18-20, males: unchanged
Age 18-20, females: unchanged
Age 21-23, males: unchanged
Age 21-23, females: +40%


Age 18-20, males: -30%
Age 18-20, females: unchanged
Age 21-23, males: -10%
Age 21-23, females: +20%

The authors took this as evidence that raising the drinking age to 21 was successful. But there are two problems with that theory. One is that they are assuming that correlation was causal without controlling for other variables, while in reality the downward trend predated the raising of the drinking age to 21. It was a secular trend, albeit one with some groups bucking it. And a higher drinking age may also increase underreporting as well. The other flaw is that it even if it were partly due to the drinking age being raised, it appears to have been a rather hollow victory upon closer examination. Females seeing no change or even an increase? Ditto for 21-23 year olds? Zero progress among collegians? If that's success, I'd hate to see what failure looks like.

Using an overly broad definition of "binge" drinking, like the one used above (5 drinks in an evening at least once in the past month)* may mask trends in truly dangerous drinking. Another study found that between 1998 to 2005, there was an increase in alcohol-related deaths, self-reported "binge" drinking, and self-reported driving after drinking among college-age 18-24 year olds (but in most cases a peak was reached in 2001-2002). Deaths were driven by a near tripling in the number of alcohol poisoning fatalities. That's a good index of extreme drinking, well above the 5 drinks threshold. But because the increase in self-reported "binge" drinking and driving after drinking was primarily among 21-24 year olds, while 18-20 year olds stayed roughly the same, some people have taken that as a sign of success. Again, this is specious reasoning. It seems that the 21 drinking age (and increased enforcement thereof) simply shifted such behavior a few years into the future, not at all unlike the drunk driving studies mentioned on this blog.

And remember, from 1993-2001 when "binge" drinking was (modestly) increasing for all age groups, 18-20 year olds ironically saw the largest increase of all (+56% in the number of "binge" episodes per person per year) before ostensibly declining again. So part of the increase in 21-24 year old binge drinking could in fact be a cohort effect a few years later. But for 18-20 year olds, it remains elevated in spite of (or perhaps even because of) tougher 21 law enforcement over time. It is also worth noting that the number of episodes per person per year increased faster than the proportion of "binge" drinkers in the population.

Further evidence of failure is that, according to MADD, about half (48%) of the of the alcohol consumed by college students (at four-year schools) is consumed by students under 21. This is even more striking when you consider that only 37% of four-year collegians are under 21.

In other words, at best, a drinking age of 21 appears to merely delay binge drinking, drunk driving, and alcohol-related injuries and deaths. At worst, it may even prolong such behavior. In other words, a shell game.

*A convention on this blog is to always use scare quotes when referring to "binge drinking" defined as an arbitrary number of drinks in an evening. Definitions very as there is no international consensus on what qualifies as a "binge," but the most common definition is 5 or more drinks in the same occasion (evening), or 4 for a woman in some definitions, regardless of drinking speed, weight, etc. When no scare quotes are used, we are talking about truly heavy, rapid, high-intensity drinking--often involving serious chugging or slamming many shots in a short period of time--which involves an unacceptably high risk of harm for anyone of any age. Our definition implies very high intoxication, at least 0.15 BAC if not 0.20+. That is where the lion's share of real problems occur. Fortunately, the vast majority of Americans, even college students, do not do this, regardless of what the media says.