Wednesday, May 27, 2009

A New List of 39 Recommendations for the 21st Century

In 1982, President Reagan appointed a special commission to study the problem of drunk driving in America. They came up with 39 recommendations, #8 of which was to raise the drinking age to 21 in all 50 states. Of all the recommendations, that was the one that got the most attention, often at the expense of the others. Most of the other 38 were just simple common sense measures, and many of these were implemented to some extent in both the United States and Canada. Interestingly, the decline in alcohol-related traffic fatalities since 1982 occurred at about the same rate in both countries in every age group, with no evidence of divergence in the expected direction despite the fact that Canada did not raise the drinking age to 21. In fact, the decline was slightly faster in Canada (ditto for the UK and Australia as well, who remained at 18). While the problem of drunk driving has been greatly reduced in both the US and Canada, it remains persistent, and progress appears to have stalled somewhat in recent years. 
More than a quarter-century later, a new set of 39 recommendations is long overdue. We know a lot more about the problem now than we did in 1982, and have a better sense of what works in the long run and what does not. The nature of the problem has also changed, with most of the deaths caused by so-called "hardcore" DUI offenders who drive drunk repeatedly. By the time someone finally gets caught even once, they had already driven drunk an average of 88 times--often hundreds of times.  And it's an open secret that the vast majority of them are over 21, with 21-24 year olds being the worst of all.  Thus a multifaceted and wholehearted approach is essential. But what is currently being done is both over-inclusive and under-inclusive, and progress has stalled.  And as long as we keep following outdated methods, we will surely fail to see any further progress.  The updated list, devised by the TSAP, is as follows, with those in red being the highest priorities:
  1. Lower the drinking age to 18, ideally in all 50 states and DC. The more states, the better.
  2. Raise the federal beer tax to its 1951 real value and the liquor tax to its 1991 real value. That would be $2.38/gallon and $21.06/proof-gallon, respectively. Raise the alcopop tax to more than the tax on liquor as well, and make the beer tax proportional to alcohol content. Use the bulk of the revenue for education, treatment, and DUI enforcement.
  3. Lower the blood alcohol limit to 0.05 BAC generally, and maintain the Zero Tolerance law for drivers under 21. Or expand the latter to cover all drivers with less than 5 years of licensed driving.
  4. Increase the number of roving patrols for DUI enforcement, and their publicity. Sobriety checkpoints should be considered a supplement, not a substitute.
  5. Increase alcohol education programs, but make them more honest and comprehensive. An excellent model is AlcoholEdu, by Outside the Classroom. This can also be combined with social norms marketing campaigns.
  6. Toughen the penalties for driving under the influence, but have graduated penalties based on BAC. Drivers with BAC of 0.15 or higher should lose their licenses for at least 10 years, and repeat offenders of 0.08 or more should lose it forever on the second offense.
  7. Make fines for DUI proportional to the relative risk at a particular BAC. For example, 0.15 would be 50-100 times higher than 0.05.
  8. Restrict alcohol advertising to no more than what is currently allowed for tobacco. That means no TV, radio, or billboards.
  9. Increase alcohol treatment. Require all DUI offenders to undergo an alcohol assesment to determine if they have an alcohol use disorder. If so, force them into treatment via DUI court, in addition to other penalties.
  10. For those who fail a breathalyzer, a confirmatory blood test should be offered. If the latter is refused, the former alone should be considered sufficient evidence for a conviction. But no physically forced blood draws should ever be allowed, as they clearly violate the Constitution.
  11. For the eight states that currently lack it, institute administrative license suspension/revocation. The administrative penalty for refusing a breathalyzer or any other test should be greater than or equal to that for failing it.
  12. Have mandatory jail time for all DUI offenses of 0.08 or greater, including first offenses. Make driving with 0.15 BAC or higher a felony on the first offense, and 0.08 or higher a felony on the second offense, punishable by up to 5 years in prison.
  13. Those who kill or seriously injure someone else in an alcohol-related, at-fault crash should get a mandatory minimum of 10 years in prison, permanent license revocation, and forfeiture of any and all vehicles owned by that person upon conviction.
  14. Do not allow plea bargains for any DUI offense.
  15. Do not grant conditional or hardship licenses after conviction for second offenses at any BAC above 0.08.
  16. De-register any car owned (or registered) by a DUI offender, boot it, and confiscate the plates upon arrest. When (if) they get their license back, or get a conditional license, give them special "scarlet letter" DUI plates. 
  17. Require ignition interlocks for all conditional licenses, and for any DUI offender that gets their license back, forever.
  18. Make ignition interlocks standard on all newly manufactured vehicles sold in the USA, with use and maintenance of these devices voluntary for non-offenders (but see #19).
  19. Require auto insurance companies to give a deep discount (that more than covers maintenance costs) for non-offenders with an ignition interlock on their vehicles, especially for drivers under 25 (and their parents).
  20. Abolish the "assigned risk" pools for auto insurance, or at least forbid any DUI offenders from joining them. Let them pay the full market cost based on their own risk, without being subsidized by the innocent.
  21. Make it a federal crime to drive drunk across state lines. Punishable by up to 5 years hard labor in federal prison.
  22. Eliminate any rules of evidence that prohibit admission of chemical test refusals--it should be used against a DUI defendant in court.
  23. Make the road test tougher--an hour long like it is in the UK.
  24. Make licenses easier to lose for moving violations, especially during the first two years.
  25. Have driver's ed classes in every high school for free (or a nominal fee).
  26. Prohibit insurance companies from excluding alcohol-related accidents, but require all drivers involved in accidents to be tested for alcohol.
  27. Lift state-mandated smoking bans in bars, which have been shown to increase DUI fatalities.
  28. Extend bar hours to 3 am or later, but have a one-way door policy after 1 or 2 to reduce late night bar-hopping. Or let the locals decide rather than the state.
  29. Raise the gas tax by a penny each week until it is $1.00 higher than it currently is.  Call it "a penny for progress."
  30. Improve public transportation, especially very late at night. Use the alcohol and gas taxes to pay for it.
  31. Lift any "taxi tax" wherever it exists. Or better yet, subsidize taxi service or "Safe Rider" services.
  32. Limit or reduce alcohol outlet density in cities and other high-density areas, but increase it in rural areas. More rural bars within walking distance = less drunk driving deaths.
  33. Dry counties and towns should go wet, especially if their neighbors are wet.
  34. Abolish social host laws, both civil and criminal. Furnishing alcohol to minors should not include merely providing a safer location to drink.
  35. Allow parents to give their kids alcohol before 18 (within reason), and repeal all laws that prohibit it. But hold them accountable for what their under-18 kids do under the influence.
  36. Put a price floor on alcoholic beverages, especially for off-premises sales.
  37. For supermarkets, other non-alcohol-dedicated stores, and bottle shops/off-licenses, limit the quantities of alcohol sold per person per day (or transaction). Reasonable limits include 216 ounces of beer (i.e. an 18-pack), a gallon of wine, or a fifth (750 mL) of liquor.
  38. Kegs and cases should be sold only in beer distributors, which should close at 10 pm. A purchase age limit higher than 18 may be desirable for such bulk quantities, which are very unlikely to be for personal use. Ditto for very large quantities (i.e. multiple liters) of hard liquor.
  39. Forbid the sale of chilled beer or wine at gas stations, or at least to those who are purchasing gas at the same time or otherwise obviously drove there. A degree of separation is necessary. For the same reason, abolish drive-through liquor stores as well.
Recomendation #1 implies that, at the very least, we should repeal the federal highway funding penalty for doing so, and let the states use their Constitutional rights to decide for themselves. Or let them choose but additionally require that the drinking age be no higher than the age for being tried as an adult. Recommendations #3, #4, and especially #22 should take care of any potential adverse effects of unequal drinking ages across states or internationally, as well as dry counties that refuse to go wet.
To avoid collateral damage, recommendation #2 should not apply to microbrewers. Their beer is already relatively expensive anyway, and those who abuse alcohol tend to go for the mass-produced, cheap stuff.
If all 39 of these recommendations were followed, the alcohol-related fatality rates should be cut by more than half in the first few years alone. If only the ones in red were followed, or even just the first six, there would still be a dramatic drop in fatalities in both the short and long term. Some of them, such as #1, are a bit counterintuitive (the whole purpose of this blog explains in detail why #1 is actually a good thing rather than something to fear). But most are simply common-sense measures that are long overdue. And one who thinks holistically about the issues can see how it all fits together like pieces of a puzzle. It is hard to believe that even in 2009, any repeat DUI offender could still have a license at all, and that any state would refuse to do #11. By the same token, it is also baffling how Prohibition still exists in some counties in 2009.

When we say graduated penalties, the table below is a good guide to what they should be:

BAC ThresholdFirst offenseSubsequent offenses within 10 years
(under 21 or novice, administrative only)

1-2 drinks
$250 fine
30 day suspension
No jail
Alcohol education program
$500 fine
6 month suspension
No jail
Ignition interlock upon regaining license until 21
(administrative only)

2-3 drinks
$500 fine
Up to 90 day suspension
(6 month suspension)
No jail
Alcohol education program
$750 fine
Up to 6 month suspension
(1 year revocation or until 21, whatever is longer)
No jail
Ignition interlock 1+ year upon re-license

3-5 drinks
$1000 fine
Minimum 1 year revocation
(or until 21, whatever is longer)
Up to 6 months in jail
Ignition interlock 5+ years after re-license
$2500 fine
License revoked possibly forever
Mandatory 1+ year in jail (possible felony)
Possible vehicle forfeiture upon conviction

4-7 drinks
$5000 fine
Minimum 5 year revocation
Mandatory 6 months jail, up to 1 year
Ignition interlock forever
$7500 fine
License revoked forever
Mandatory 5 years prison (felony)
Vehicle forfeiture upon conviction

7+ drinks
$10,000 fine
Minimum 10 year revocation
Mandatory 1 year in prison, up to 5 years (felony)
Ignition interlock forever
$20,000 fine
License revoked forever
Mandatory 5+ years prison (felony)
Vehicle forfeiture upon conviction

NOTES:  1) Any alternatives in parentheses refer to drivers under 21 or novice drivers who had their licenses less than 5 years. 2) Any vehicles owned by the driver should be de-registered and the plates confiscated in the event of a license suspension/revocation, 3) "No jail" does not preclude detaining a driver overnight or up to 24 hours in the drunk tank, 4) For all of the above cases, mandatory alcohol abuse assessment and treatement (if indicated) should be done, 5) For first offenders who qualify, diversion to DUI court may be the best choice, 6) Offenses that occur during a suspension or without a license should result in permanent license revocation and/or vehicle forfeiture, as well as mandatory jail time, 7) For BAC below 0.08, penalties listed are administrative only, and there is no criminal conviction.  Above 0.08, the penalties are criminal and are additional to any administrative license suspensions. 8) Number of drinks is a very rough guide, and it assumes consumption in 2 hours, reasonably full stomach, no other drugs, and a body weight of 150 lbs.  There is much variation by individual and circumstance.

Recommended administrative license suspensions/revocations above 0.08:

Test failure, first offense:  90 day suspension (6 months if under 21 or novice)
Test failure, second offense in 5 years: 1 year revocation (or until 21, whatever is longer)
Test refusal, first offense:  1 year suspension or revocation
Test refusal, second offense in 5 years: 2 year revocation (or until 21, whatever is longer)

Conditional licenses should only be given for grave reasons, be highly restricted, and require ignition interlocks.

Driving with a  BAC above 0.08 with kids under 16 in the car should be an automatic felony, and treated like 0.15+.

In other words, though we've clearly wrestled the problem to the ground by the mid-1990s, we have unfortunately allowed ourselves to become complacent and distracted.  It's time to finish the job.

A New Dimension to the Debate--And We Debunk It Too!

Just as more and more people are questioning the wisdom of the 21 drinking age, especially its purported lifesaving effects, a new dimension to the debate was added by a recently published study. Watson and Fertig (2009) did a study on the effects of the drinking age on three measures of infant health outcomes: premature birth, birth weight, and congenital anomalies (birth defects). All data was from 1978-1988. The results were hailed as proof that a lower drinking age leads to worse infant health outcomes, presumably through unwanted pregnancies that result from drunk sex. But after reading the study, there are several apparent flaws and caveats that the media glossed over or misrepresented:

  • Only the first two measures of health outcomes (prematurity and birth weight) were statistically significant, while congenital anomalies were insignificant and even had the "wrong" sign. The latter is difficult to explain away, since alcohol is a known teratogen.
  • Effect sizes were generally very small (10% or less). Such effects are very difficult to interpret in epidemiological studies, and causality virtually impossible to determine.
  • R-squared values were very low despite controlling for numerous variables, indicating that the regressions had a bad fit. This can lead to spurious effects.
  • Missing data can lead to noisy data.
  • Curiously, the three worst years for teen pregnancy since the 1950s (1989, 1990, 1991) were not included in the data for some reason.  All of which occurred after all 50 states raised the drinking age.
  • For survey data concerning drinking before or during pregnancy, underreporting (due to changes in alcohol laws or social acceptability) could be a confounding factor.
  • While much ado has been made of the fact that the apparent effects were stronger for black women, the authors do not seem to offer an adequate explanation for why. Although it could be that white women are more likely to abort unwanted pregnancies, or even simply have better access to birth control than black women. Another possibility is differential access to good prenatal care for those who carry to term.
  • There was no effect for immigrant women.
  • Controlling for beer taxes reduced the effects by half for the 14-17 year old black women, and made the effect on 18-20 year olds less significant as well. This implies that beer taxes may have an effect. But this variable was excluded from the authors' preferred specification.
  • When 14-24 year olds as a whole were looked at, the drinking age effects interestingly had the opposite sign than when women under 21 were examined separately. That means that for 21-24 year olds, a lower drinking age was associated with better health outcomes that outweighed the purported adverse effects in 14-20 year olds, especially for black women. We speculate that, like with some studies of traffic fatalities, the pregnancies (and their poorer outcomes) were simply shifted a few years into the future. Or it could simply be that the regressions had a bad fit, putting a giant question mark over the entire study. Either way, the net effect for 14-24 year olds is the opposite of what was predicted. These possiblities were completely ignored by both the authors and the media.
  • Effects were stronger for women under 18 (the spillover group) than for women aged 18-20 (the target group). While some spillover effect is plausible, alcohol was just as illegal for women under 18 either way, so the effect should still be the strongest for 18-20 year olds. Otherwise, it is very likely a proxy for something else.
  • While the apparent effects were robust to state-specific time trends, they were not robust to age-specific time trends. In fact, the "race effect" was reversed in the case of birth weight. Even the authors concede the possibility that secular trends may affect the youngest women first, and let the reader decide.
  • As far as race goes, one potential confounder is "liquorlining," or the practice of concentrating alcohol outlet density (chiefly liquor stores) in poor minority communities. Some states probably do this more than others. This was not addressed.
  • The authors found that controlling for paternal information weakens the relationship between drinking age and infant health outcomes. And missing paternal age (thought to be a proxy for unwanted pregnancy) was significantly correlated with a lower drinking age for black women under 21 (but not for white women), leading to the assumption that drunk sex was the causal factor behind it all. But the effect was statistically insignificant in states that did not have parental notification laws for abortion. That counterfactual is telling, especially since that was true for 18-20 year olds was well (notification laws only affect those under 18). Why the latter was the case is not explained.
  • And again, for 14-24 year olds as a whole the sign was "wrong," and both "wrong" and significant for black women in notification states. This supports the idea of merely shifting unwanted pregnancies, or just a bad fit of data, but again that possibility went unaddressed.
In other words, the study makes at most a very weak case for keeping the drinking age at 21. No scratch that, it is downright anemic. Effects could not be disentangled from age-specific secular trends, so the results are inconclusive at best. Even if the purported effects were real, which is still not very clear, the effect sizes are of little practical significance since so many other things affect both teen pregnancy and infant health outcomes much more strongly. And for 14-24 year olds as a whole, a drinking age of 18 actually appears to be beneficial in terms of net effects when the data are taken at face value.

The greatest irony of all is that America tends to have some of the worst infant health outcomes relative to other industrialized countries, especially infant mortality, yet our drinking age is the highest. This apparent paradox is mainly due to less prenatal care, among other things. In addition, our teen pregnancy rate is also the highest, and other countries had generally seen more progress in reducing its rate than we did in the years following the drinking age hike. In other words, those who put too much stock into this study clearly fail to see the forest for the trees.

Furthermore, it does not follow that the results are still relevant today since only 1978-1988 were examined. First of all, the effects may just be short-term. Secondly, a lot has changed since 1988. Although they rose in the late 1980s (after raising the drinking age, oddly enough), teen pregnancies (and abortions) have plummeted since 1991, reaching lows that had not been seen for decades. Birth control (including condoms) is more available now and used more frequently than before. And as hard as it is to believe, teenagers are also less likely to have sex now than in 1990. In other words, today's younger generation is significantly more responsible (at least in terms of sex and reproduction) than the Boomers and Gen-X were when they were teenagers. But you would never hear the media say that.

This is pure mission-creep. It's time to quit punishing today's young people for the sins of their parents.

UPDATE:  It appears that in 2005, for unknown reasons, birth weights from healthy, white mothers (of all ages) were 3 ounces lower than in 1990, and the length of gestation has shortened slightly.  This is rather surprising since for the past 50-70 years, birth weights have been rising.  And trend began reversing in 1990, which was a few years after raising the drinking age.  If you recall, the Watson and Feritg study only included 1978-1988, a relatively short timeframe during which both birth weights and drinking ages rose.  This latest finding casts further doubt on a study that is already on shaky ground.

Wednesday, May 20, 2009

A Brief History of Alcohol in America

Let's face it. Our great nation was founded by drinkers. Many of whom drank enough that by today's standards they would be considered "frequent binge drinkers" or worse. The amount of alcohol consumed while the Constitution was being written was staggering (pun intended), hence all the (supposed) loopholes in the document. Hell, even the Puritans drank--they brought more beer than water with them on the Mayflower!

Colonial America

Being British, beer was the drink of choice for the early colonists and remains the number one alcoholic beverage in America to this day, though in the 1600s a new Caribbean drink made from the sugarcane byproducts (molasses and cane juice) grew in popularity. It was rum. George Washington was a big fan of it. However, the British restrictions on rum from the Caribbean led to its decline, and its being supplanted by American whiskey. Whiskey was easier and cheaper to transport than the corn from which it was made. Distilled spirits in general were considered aqua vitae, or water of life (in Latin). Indeed, alcohol was often just as important as life itself to the colonists.

But this tolerance toward alcohol was by no means universal. In many colonies, whites were often forbidden from selling alcohol to blacks, whether free or slave. And Native Americans were often hypocritically viewed as too "savage" to drink, despite the fact that white settlers often got them drunk to facilitate cheating them out of their land (failing that, brute force was used).

The Early Republic

By 1790, Americans were drinking, on average, three times what we do now per capita. In 1791, Alexander Hamilton put a tax on whiskey (and other distilled spirits, but not beer or wine) ostensibly to pay down the national debt, which led to the Whiskey Rebellion by farmers in southwest Pennsylvania. They were mad that the cheapest way to transport corn (turning it into whiskey) had now become relatively expensive, and that small producers were taxed more than larger ones. So the farmers revolted. Shots were fired, and a tax collector was even tarred and feathered. George Washington sent in 13,000 troops to quash the rebellion, but the instigators were eventually pardoned. Unlike the Boston Tea Party, it failed miserably. And that, my friends, is the real reason why alcohol (especially hard liquor) is taxed today, but not tea or coffee.

Our national anthem, the Star-Spangled Banner, was simply an 1814 poem by Francis Scott Key set to the tune of a popular British drinking song.  Why do you think it has so many octaves?  If you could sing it and stay on key, you were assumed to be sober enough for another round.

Attitudes toward alcohol varied throughout American history. Originally it was considered a gift from God, while its abuse was generally condemned. Even children drank beer and cider. But that gradually changed with the newly-created temperance movement. As alcohol problems grew in the late 1700s and early 1800s, so to did the temperance movement, who originally focused on "ardent" spirits (hard liquor) as opposed to beer and wine, and for voluntarily reducing or giving up alcohol. The mid-1800s was when the movement really gained strength, and so did social reformers of other causes. There was an alliance between the burgeoning first-wave feminist movement, temperance, abolitionism, and several other movements that lasted for decades. Industrialization helped to fuel the anti-alcohol sentiment, as did the lack of a national consensus on what constituted responsible drinking. Various churches signed on and tinkered with the established theology of the time, now speciously claiming (with zero evidence) that Jesus did not drink wine, but grape juice instead. By the end of the 19th century, the pendulum had swung toward America being alcohol-negative, meaning that the problems associated with its abuse were blamed on the substance itself rather than the abuse thereof. This view continues to this day, albeit in a slightly different form.


The first anti-alcohol laws in America were the "Black Codes," the forerunners of the Jim Crow laws. Both of these sets of laws prohibited drinking, gun ownership, and various other things specifically by black people, and even gave them a curfew. Sound familiar?

The drunkest decade in American history was from 1900-1910. Many people, mostly men, regularly went to their local saloons to get sloshed. These relatively unregulated establishments often offered other vices, like gambling, prostitution, and cockfighting (George Washington would have liked the latter one). But hey, at least they provided free food! And there was no drinking age either, except in Wisconsin. Not like America had a drinking age before, of course.

Then the most ominous five words were uttered, the ones that often open up a major can of worms: "Something has to be done!" And so, the temperance movement became the Prohibition movement, seeking to ban all alcohol period. Groups like the fanatical Anti-Saloon league led by Carrie Nation were founded (though today's MADD would probably make them blush!), and the movement grew. Prohibitionists played on the ubiquitous anti-immigrant, anti-Catholic, and even anti-Semitic prejudices of the day to attract more followers, and that tactic was successful in getting recruits who would otherwise just be sitting on the fence.  The Ku Klux Klan (KKK), having been reborn in 1915, also ardently supported the prohibition movement.


Prohibition began in Kansas and Oklahoma when they entered the Union dry from day one. From 1910-1919, several states went dry on their own as well. During World War I, the feds decided to enact "wartime Prohibition" that would take effect in 1919, but the war had ended in 1918. So the Prohibitionists went all the way this time. They passed a Constitutional amendment (the 18th Amendment) that would take effect in 1920, one year after passage. This was followed by the Volstead Act, its companion federal law, which was vetoed by President Wilson but overridden by Congress. The law prohibited the sale, manufacturing, furnishing, delivery, and transportation (but not specifically use) of "intoxicating liquor," which was defined as any beverage with 0.5% alcohol or more. Though an exception was later made for home winemaking. Other exceptions included alcohol for industrial or medical use, and wine for religious use. Advocates of Prohibition believed that crime and other social ills would disappear as a result of banning booze. Some communities even sold their jails, believing they would become obsolete. Boy, were they wrong!

The Roaring Twenties was a crazy time in history, hence the name. Though many scholars believe that alcohol consumption (along with drunk and disorderly arrests, cirrhosis deaths, and possibly even drunk driving fatalities) declined significantly during the first two years, they note that it was already declining before 1920, and after 1922 it began rising again. Moonshining became an art form. Bootleggers and speakeasies were the order of the day. In fact, they grew so much that there were eventually double the number of speakeasies than there were saloons before Prohibition! Thus, the effective "outlet density" doubled as a result of Prohibition. But unlike saloons, illegal speakeasies were decidedly co-ed, and women began drinking like never before. Speakeasies were not exactly safe either, as one was inevitably in the company of rather dodgy characters far away from the presence of any police or security. Someone could easily slip you a Mickey Finn and take full advantage of you, or simply massive amounts of booze would have had the same effect. You also had to worry about the potency and even purity of the hooch being sold, as it was often adulterated or contaminated with toxic substances. Not surprisingly, alcohol poisoning cases increased nearly fourfold from 1920 to 1925. Crime rates also skyrocketed, reaching a peak in 1933, and alcohol was controlled by organized crime. In fact, Prohibition was the main reason the Mafia got as powerful as they did. Society became corrupted as otherwise law-abiding citizens were now criminals, and even the police took kickbacks from the organized crime elements of the day.

Interestingly, teen drinking was found to have increased as well, an apparent unintended consequence of banning alcohol for everyone. Speakeasies routinely sold to minors, and obviously did not ask for ID. This was the start of a secular trend that would more or less continue unabated until 1979. Remember that before Prohibition, the majority of states had no legal drinking age at all.

In addition, use of substitutes for alcohol also increased. These included cannabis, tobacco, coffee, patent medicines, cocaine, opiates, and ether. One favorite was "paint remover," which was industrial alcohol that was required by law to be denatured with methanol, a poison that can cause blindness or even death in relatively small amounts.  Another was "ginger jake," a patent medicine that was eventually adulterated (to fool regulators) with a neurotoxic plasticizer that often caused paralysis.

Consumption patterns changed dramatically as well. Almost no one went to a speakeasy and had just one or two beers to relax. It was more like many, many shots worth of bathtub gin, moonshine, or whatever, with the intention to get completely wasted. Those who went through all that trouble to get in and pay high prices for low-quality booze wanted to make the most of it, and getting anything short of plastered was thus considered a waste of time and money. Hard liquor was more popular than beer because it was much easier to conceal. Since the illegal hooch was harsh-tasting, it was often mixed with soda, leading to the invention of the cocktail. That made it easier to stomach, and easy to drink quickly as well. Sound familiar?

At first, Prohibition was loosely enforced in most of the country, and had much popular support. But it was widely disobeyed, and thus enforcement increased dramatically from 1925 to 1932. All to no avail or course, as alcohol consumption and related problems continued to skyrocket, even during the depths of the Great Depression when people could barely afford food. Now, that really says something! More and more money was being spent on trying to enforce a largely unenforceable law that 70% of the population had turned against by 1933. It became obvious by then that Prohibition had a corrosive effect on society at large. Ironically, women (who were more likely than men to support Prohibition initially) turned against it in record numbers. The tide had turned. And so the law had to change.


In 1933, alcohol laws were first liberalized with the passage of the Cullen-Harrison Act in January, which legalized beer with less than 3.2% alcohol by weight (4% by volume). Full legalization at the federal level occurred on December 5, 1933, with the passage of the 21st Amendment. Upon legalization, crime rates plummeted. Per capita consumption increased modestly, but was already increasing before, so a causal relationship cannot possibly be drawn in this case. This amendment still allowed the states to decide for themselves how to regulate alcohol, and keep it illegal if they so desired. And 18 states continued Prohibition afterward, but all of them eventually legalized alcohol, with Mississippi (one of the first states to ban alcohol voluntarily in 1907) being the last state to do so in 1966. Most states still allow local governments to ban the sale of alcohol if they choose, and there are several dry towns and dry counties to this day (mostly rural ones in southern states).

The states that legalized alcohol varied in their methods of regulation. Some allowed it to be sold only by the state, while others allowes private enterprises to do so with a license to sell it. Some states had blue laws, others did not. Taxes varied as well. But the most salient method of regulation was by age, a fairly new concept at the time. Although all but one state (Wisconsin) had no drinking age before Prohibition, most states felt the need to have one, and it was seen as a reasonable compromise between no limit and continued total prohibition. The most commonly chosen age limit was 21, since that was the age of majority in nearly all states, but two states (New York and Louisiana) chose 18 instead in the 1930s. New York's justification for 18 was that 18-20 year olds would drink anyway, and it would be better for them not to be on the wrong side of the law. Eight other states and DC had split ages of 18 for beer and 21 for liquor (wine varied), especially in states that had major breweries. One chose 19, and two chose 20. Some states had no age limit at first, but then enacted one. (The age of majority was 21 because of a 600-year tradition in English Common Law that set that as the age of adulthood, most likely based originally on the age that a squire became a knight in the Middle Ages.)

The 1970s: Lowered Drinking Age to 18

These age limits remained fairly static until 1969, when the Vietnam War and the draft made it crystal clear that 18-20 year olds were hypocritically considered old enough to go to war, but not old enough to vote or drink in most states.  Not only that, but in 1967 there was actually a federally-funded study of possible solutions to America's notorious drinking problem that recommended that, among other things, the drinking age be lowered to 18 in those states with higher ages--an common-sense idea that would be considered heresy by today's government.  Even the National Council of Churches supported the report's recommendations.  Maine and Nebraska were the first states to lower the drinking age to 20 in 1969, and further lowered a few years later. In 1970, Alaska lowered it to 19, and the following year Tennessee and Vermont lowered it to 18.  In 1971, the 26th Amendment lowered the voting age to 18, so most states lowered their age of majority and drinking age along with the voting age. Most lowered the drinking age to 18, though a few lowered it to 19, and Delaware lowered it to 20 and no further. The same happened in Canada as well. The age lowering occurred mainly from 1972-73, a few states did so in 1974, and Alabama was the last to lower it (the ordinary way) in 1975. Oklahoma lowered it in 1976 due to a court case that equalized the drinking age for men and women. The Baby Boomers were clearly a force to be reckoned with and those in power knew it. So by 1976, 30 states lowered their drinking ages, 8 were already 18, and the remaining 12 (including all three West Coast states) kept their drinking ages at 21 throughout for some reason.

Other changes occurred as well during this period. Many formerly monopoly states had privatized alcohol sales beginning in the 1960s. In 1978, President Carter legalized home-brewing of beer, which had remained illegal since prohibition due to a clerical error. Thus America's alcohol laws were now the most liberal they had been since 1920.

However, in 1975 the war was over, and by 1976 the sentiments toward teen drinking began to change. The Insurance Institute for Highway Safety came out with a 1974 study of a small number of states that purportedly showed a modest increase in under-21 traffic fatalities as a result of lowering the drinking age. A few other studies came out around 1975-76 that used time-series data in a single state each, often with no comparison group, and appeared to reach the same conclusion, especially for "alcohol-related" fatalities. (Often with a strange love for raw numbers of fatalities rather than rates, even at a time when the youth population was exploding.) However, in at least one state that saw an increase (Michigan), the reporting methods had changed during that time. Most states, lowered age or not, saw a decrease in overall fatalities from 1970-75, with only a handful reporting an increase (including North Dakota, which remained at 21 throughout). And many of these increases were suspicious. The FARS database did not come out until 1975, so any data before that is bound to have problems. And "alcohol-involvement" was often merely subjective since few drivers were actually tested for BAC back then, so such figures are junk. Nearly all states, on the other hand, saw increases in fatalities from 1976-1980, followed by sharp decreases, including states that had kept the age at 21 throughout. Remember too that the blood alcohol limit for driving was 0.15 in most states, nearly double what it is now, and the laws against drunk driving were essentially toothless and loosely enforced. Drunk driving was more socially acceptable back then as well, even expected of you if you were the least drunk person among your friends. So too were "liquid lunches," both at school and work. And alcohol consumption, among both teens and adults, increased in all states as well (partly due to falling real alcohol prices in the 1970s) until it peaked around 1980 and then declined.

Moral Panic and MADD

Regardless of what actually happened or the causes thereof, a moral panic occurred in America over teen drinking, beginning in the late 1970s. A deviancy amplification spiral by the media only fueled the fire. Minnesota raised its drinking age to 19 in 1976, only three years after lowering it to 18, and many other states followed suit from 1977-1983. A handful raised it to 20, mostly in the New England region. And in 1978, Michigan raised it to 21, being joined by a few more states in the early 1980s, such as New Jersey in 1983. But most states did not want to raise it that high, and some wanted to keep it at 18. Thus, a patchwork quilt of different drinking ages stretched from coast to coast.

Enter MADD in 1980. Candy Lightner's 13 year old daughter was hit and killed by a 46 year old drunk driver with prior convictions, and was given a fairly lenient sentence. Lightner decided to found Mothers Against Drunk Drivers (MADD) and launch a crusade against this very real problem. To their credit, they spread awareness about it and made it less socially acceptable to drive drunk, and pushed for (and got) tougher new laws against it. However, grief turned to vengeance, and they rapidly became more and more fanatical, and took the fight far beyond drunk driving, or even driving itself. It was not enough that the drunk drivers themselves had to pay. No, America had to pay for the sins of their worst, as a society that tolerated DUI back then. Or at least start with one demographic group at a time, so as not to seem too neo-prohibitionist too soon. And they found their target demographic, one that seldom voted and had by that point become politically impotent--18-20 year olds. A group that was increasingly reviled by the media as stupid, ignorant, immature, rebellious, and violent. Nevermind the inconvenient fact that 21-24 year olds were (and still are) the worst drunk drivers in terms of fatalities, or that Lightner's daughter was killed by a 46 year old (a teenager was killed by an adult). MADD pressured states to raise their drinking ages to 21 shortly after being founded. Most were not very eager to do so. So MADD turned its sights to Washington instead.

The Drinking Age is Raised to 21

In 1982, President Reagan appointed a special commission to study the problem of drunk driving in America, and they gave 39 recommendations. Number 8 was to have a uniform drinking age of 21 across all states to eliminate "blood borders," which is similar to what happens when people from dry counties get drunk in their wet neighboring counties and drive home. (Though not every study supports the blood borders hypothesis) That was the one that really stuck the most, more than the other 38 recommendations, and that MADD latched onto. Nevermind that a uniform drinking age of 18 would do the same thing, or even beefing up patrols near the relevant state lines would likely suffice. Or make drunk driving a federal crime (punishable by federal prison time) when done across state lines as well.  But none of these alternatives were seriously considered by the feds when cajoled by MADD to implement what they wanted.  And "dry county syndrome" was not even discussed.

In 1984 (a rather ominous year), Senator Frank Lautenberg (D-NJ) wrote the National Minimum Drinking Age Act of 1984, which withheld a portion of federal highway funding from any state that did not have a law on the books by October 1986 prohibiting "purchase and public possession" of any alcoholic beverage (0.5% ABV or greater) by all people under 21. Those that did not comply would lose 5% of funds in FY 1987 and 10% in FY 1988 (it was later made permanent). While the law contained several exceptions and loopholes, it was eerily similar to the Volstead Act in both its definitions and wording. The highway funding penalty was an end-run around the Constitution since the federal government has no delegated power to set a drinking age (it is up to the states). Lautenberg wrote it partly becuase he wanted to force New York to raise its drinking age to 21 since young New Jerseyans would go there, get drunk, and drive back.  This very issue had been a bone of contention between the two states in the 1960s before NJ lowered its drinking age to 18 in 1973, and now it had returned.  Again, New Jersey could have avoided this entirely by not raising their own drinking age back to 21 when New York's was 19 (NY raised it to 19 in 1982 after being 18 since 1934, nearly half a century). They reap what they sow. But Lautenberg (and others) wanted the feds to protect them from the consequences of their own failed policy.

Lautenberg's wish was granted. By then, the moral panic had reached a crescendo. Under the influence of both MADD and junk science, Congress passed the bipartisan bill. Reagan was against it at first because it violated states' rights, but 1984 was an election year and he was easily moved by MADD's emotional anecdotes, so he signed it into law. Despite her victory, Candy Lightner quit the organization in 1986, saying that it became far too "neo-prohibitionist" for her (her words, not ours). Evidently, some members talked about criminalizing driving after drinking any amount of alcohol, for all ages, and she took exception to that relatively extreme idea. But even that would be more lenient than banning people from drinking without driving, which is precisely what she wanted for those under 21.  (More about her later)

States reacted to the law in various ways. Some complied right away, or were already 21 before. Others were less eager to change. Some went along with it and passed sunset clauses for the 21 drinking age to expire in 1989, but the highway funding penalty was made permanent (10% in any year after 1988 as well) by the feds after this was discovered (though grandfather clauses were explicity allowed). Still others fought the federal law in the U.S. Supreme Court, and lost. The case South Dakota vs. Dole (1987) challenged the constitutionality of the law, but the law was unfortunately upheld, ultimately setting a precedent for further federal coercion by funding penalties for not following other federal laws in the future. By the October 1, 1986 deadline, only seven states had drinking ages below 21. In 1988, the last two states (South Dakota and Wyoming) finally bowed down to the feds and raised their drinking ages to 21, and some states had grandfather clauses that lasted until 1989. But Puerto Rico was no sellout. They chose to keep the age at 18 despite the 10% funding penalty and put up toll booths to make up the loss of money, and that became the "new normal" for them.

Louisiana was an interesting case. As a state that had a drinking age of 18 since the 1930s, and as one of the states that fought the feds in court, they reluctantly passed a law in 1987 raising the age to 21 de jure specifically for purchase and public possession in order to not lose highway funding. It followed the precise letter of the federal law. But they kept the age 18 otherwise, and no penalty for selling alcohol to those over 18. Believe it or not, that was still compliance with the federal law since purchase by 18-20 year olds was prohibited, but that made it toothless. Nor did the feds require penalties or enforcement, just that the laws be on the books. In other words, it was 21 only on paper, and 18 de facto in Louisiana. And they lost no highway funding for doing so. This prevailed until 1995, when Louisiana closed the sale loophole, making it 21 for that as well. In 1996, this was fought in the Louisiana Supreme Court and the 21 drinking age was overturned entirely, making the age 18 across the board for three months. An uproar occurred when the feds and Slick Willie threatened to take away highway funding, and the court unfortunately reversed its decision.

Effects and Aftermath

The effects of the drinking age hike in 38 states and DC (12 were 21 throughout) have been controversial, and the jury's still out on whether any lives were really saved.  A media and political pseduo-consensus that NHTSA's specious estimate of 900 lives per year being saved is true has prevailed until very recently. First of all, out of 12 million 18-20 year olds, that amounts to 0.0075% of that population. And about 90% of those who die in alcohol-related crashes are the drunk drivers themselves (55%) and their willing passengers, while more innocent people are killed each year by trains than by drunken 18-20 year olds.  Second of all, many more than that number of lives is currently lost off the highways due to alcohol poisoning, non-traffic accidents, fights, and drowning in our neo-speakeasy atmosphere where alcohol is forced underground and made more dangerous than it has to be. Third of all, the "900 a year" figure is based on the decline in fatalities among 18-20 year olds in a few years in the 1980s, with the dual assumptions that 1) the apparent effects were due entirely to raising the drinking age and not confounding factors, and 2) the effects persisted beyond the first year or two, all else being equal.  Both assumptions are false, according to several studies (see Five Studies that Debunk the Rest for more info). So we need to be able to see the forest for the trees.

Also, some studies suggest that even if some lives were saved, it merely delayed the deaths by a few years, shifting them from 18-20 year olds to 21-24 year olds (again, see the aforementioned studies). So any claims of a net lifesaving effect are likely spurious. And here is the dirty little secret of the 21 drinking age: adding a few more years to the lives of 18 year old potential drunk drivers gives them that many more years to kill more innocent victims. Thus there may have even been a net increase in fatalities in the long run when you put it all together. The movie White Noise 2 comes to mind.

Remember too that a lot has changed since 1984. In fact, the decline in "alcohol-related" fatalities began in 1982, probably even earlier since FARS did not gather alcohol data until that year. Traffic fatalities in general for 18-20 year olds peaked in 1979-1980 and have declined fairly steadily since, and the same can be said for 15-24 year olds. These trends predate by several years the 21 drinking age in most states, and occurred in states that did not change their drinking ages as well. Save for the brief and modest increase in fatalities from 1976-1980 that occurred in nearly all states regardless of drinking age, what happened in the 1980s was part of a long-term, secular decline in 15-24 year old fatalities, and indeed for all ages, beginning in 1969. Various reasons for this trend include safer cars, improved traffic engineering, seat belt laws, tougher laws (and enforcement) against drunk driving, and public awareness and educational initiatives. And the same thing happened in Canada as well without raising the drinking age to 21, which really says something.  Ditto for Australia as well.

What about "binge" drinking, you ask? First of all, the term is being used incorrectly to refer to having 5 drinks in a night at least once in the past two weeks, regardless of how fast or slow, or of individual factors. And reducing it to a number of drinks strips away all context, and we know that context matters a great deal. That's why we put the term in scare quotes. Some definitions put the number at 4 drinks for women, but we'll use 5 for argument's sake. The media constantly alleges that it has gotten worse among teenagers. But surveys such as Monitoring the Future show "binge" drinking rates peaking for high school seniors between 1979-1981 and declining dramatically until about 1992, when it increased somewhat until 1997, and then decreased further until it recently hit a record low. This happened in nearly all states regardless of the drinking age, and was a secular trend. The same was true for 18-22 year olds who were not in college. For college students, however, it remained remarkably stable over the past few decades, hovering around 40% of students answering yes. But the devil is in the details. "Frequent binge drinking," or "binging" at least three times in the past two weeks, went up in the 1990s at a much faster rate than simple "binge" drinking. Semantics aside, that does not sound nearly as scary as when you consider the strong correlation between "extreme" drinking (10 or more drinks in a night, or 8 for a woman) and "frequent binging" found in one study. This truly dangerous behavior has not been tracked over time, so we don't know for sure, but given the correlation one can plausibly conclude that it increased over time, even when fewer people "binged" in general. In fact, from 1998-2005, alcohol poisoning deaths (a good proxy for extreme drinking) among college students tripled. This would not be surprising when you look at what happened during Prohibition, when artificial scarcity, unpredictability, forbidden fruit, and clandestinization led to truly dangerous drinking. The parallels between then and now are staggering, pun intended of course. Either way, it was the Law of Eristic Escalation in action. And that would soon goad the powers that be to get even tougher.

Remember too, that raising the drinking age may also increase underreporting of drinking and "binge" drinking in surveys, primarily due to its illegality and lessened social acceptability. Additionally, much like during Prohibition, hard liquor is now the drink of choice for teen drinkers, being much easier to conceal and more efficient in terms of getting drunk. Such concentrated beverages are easy to mismeasure, and self-poured mixed drinks made with them are usually much stronger than a can of beer, leading to underestimated reports of how many "drinks" are consumed. So survey results need to be taken with a grain of salt.

Though the National Minimum Drinking Age Act only required states to prohibit purchase and public possession in order to not lose highway funding, and had several exceptions, and did not mandate enforcement, many states took it a step further and passed various ancillary laws to prop up the failing 21 drinking age. These included dram shop, social host, keg registration, zero tolerance, use and lose, fake ID, furnishing to minors, attempt to purchase, and even prohibition of possession/consumption in private residences. Some states even prohibit parents from giving their own kids alcohol, though most still allow them to do so in private. Enforcement of some of the more wacky laws necessitates warrantless searches and/or arresting people for simply being at the wrong place at the wrong time with zero physical evidence. In a few states, cops even breathalyze pedestrians to attempt to enforce laws against underage "internal possession." Not like these ancillary laws really work either (except maybe zero tolerance for drinking and driving). But the cancer of arbitrary age discrimination has metastasized nonetheless, to the point where even colleges are expected to play "nanny" to 18-20 year old adults.

As for Candy Lightner (the same founder of MADD who quit the organization due to it becoming, in her own words, neoprohibitionist) she had the audacity to say the following in 2008 about the drinking age:

It [the brain of 18-year-olds] isn’t developed, and that’s exactly why the draft age is 18, because these kids are malleable. They will follow the leader, they don’t think for themselves and they are the last ones I want to say ‘here’s a gun, and here’s a beer.’ They are not adults; that’s why they’re in the military. They are not adults.
Apparently, she still stands by her initial support for the 21 drinking age, even if she has to implicity insult our men and women in uniform just to prove her point.  Honestly, is that really the best the pro-21 crowd can do?

And so, for 21 years now the drinking age has been 21 in all 50 states and DC. The issue has been quietly simmering on the back burner until very recently, when several states are seriously considering lowering the drinking age. Even many college presidents acknowledge that 21 is not working, despite it being enforced more stringently than ever before. That fact has been obvious from day one. Prohibition didn't work then, and it is not working now. And it's time to change our failed alcohol policy.

What better time than now?

Tuesday, May 19, 2009

Fiji Lowers Drinking Age to 18

Looks like the "21 Club" lost another member, and is now down to Palau, Sri Lanka, parts of India, a few Islamic countries, and of course the United States. The South Pacific island nation of Fiji decided on May 19, 2009 to lower the drinking age back to 18. In 2006, they rushed through a bill that raised the age from 18 to 21. Apparently, it hurt their tourism industry. Other reasons given were that an age limit of 21 was inconsistent with the age for getting married, paying taxes, being recruited in security agencies, and selling liquor. Funny how they can understand that, but not America. Really makes you wonder.

Full story can be read here.

Monday, May 18, 2009

Thus Spoke Zarathustra!

You are probably scratching your heads as we speak, asking yourselves why you should believe us? After all, we do appear to have an axe to grind about the drinking age debate. And hasn't the question of the drinking age been settled already? No, it has not been settled, despite the media and political pseudo-consensus on the matter. Since as far back as 1986, and as recently as 2007, several high-quality studies have been done that have broken any scientific consensus there may have been in the past, but those ones do not get equal time in the media. Our job at Twenty-One Debunked is simply to present the other side of the story, using those oft-forgotten studies. And when new pro-21 studies come out, we will critically review those as well. We do not claim to be prophets, but we (and anyone) can make some pretty good guesses based on the available research to date. Remember that no study is flawless, even the best ones.

It is up to you to decide which side you want to believe. But please, base your decision on the facts, not the messenger.

Neither the True Spirit of America Party (TSAP) nor Twenty-One Debunked have any affiliation with or connection to the alcohol industry, DISCUS, or Prof. David J. Hanson. Nor do we have any connection with Choose Responsibility or the Amethyst Intitiative. And it goes without saying that, while we detest drunk driving, we have no connection to MADD or similar groups. But that does not mean we do not agree with the aforementioned organizations on some things.

For best results, please read the intro before proceeding.

Saturday, May 16, 2009

The Truth About New Zealand

New Zealand. An island country of 4.3 million people in the southwest Pacific, 1250 miles from Australia. With more sheep than people, they say. What could this tiny, halfway-around-the-world country possibly have to do with the American drinking age debate? Everything, at least according to the pro-21 crowd.

It turns out that New Zealand was the only country in the past decade that has lowered its drinking age, and it did so from 20 to 18 in December 1999. With disastrous results, according to the pro-21 crowd. The same folks that otherwise insist that we can't compare America to other countries with lower drinking ages imply that we would experience disaster as well. Only a few studies have been done to determine the effects of the drinking age change, most notably Kypri et al. (2005) which was co-authored by MADD member Robert Voas from the USA.  When the study came out, leading to news sound bites alleging a dramatic increase in 15-19 year old fatalities resulting from the change, the pro-21 crowd ate it right up without questioning a word of it. But several astute observers did precisely that--they questioned. When the Progressive Party of NZ tried to raise the age back to 20 in 2006 as a result of the moral panic, it fortunately got defeated by a conscience vote after much protest against it. Today in 2009, the drinking age issue is back on the front burner again, in both NZ and the USA. And over here, when the pro-21 crowd is pressed and refuted by those in the movement to lower the drinking age, they like to pull the New Zealand card. And here is where it gets debunked.

Traffic Crashes

The study by Kypri et al. (2005) allegedly found an increase in traffic crashes that involved injuries (not fatalities as is often claimed) among 15-19 year olds since the drinking age was lowered, comparing the four years before to the four years after December 1999. What the media don't mention is that the "increase" was relative to 20-24 year olds, not an absolute increase. There was actually a decrease in all three age groups studied (ages 15-17, 18-19, 20-24), but the 15-19 year old crashes decreased at a slower rate than 20-24 year olds. The original claim that an additional 12 deaths per year resulted from lowering the drinking age was left out of the final paper, probably for good reason. The study also does not control for potential confounders (other than the population of each age group), and we know that such confounders existed during the study period (e.g. increased outlet density, falling alcohol prices, increasingly aggressive advertising/marketing, rise of alcopops). And yes, it is possible for different age groups to be differentially affected by things other than the drinking age, especially the last three things. So one could not really tease out the effect of the law change. The authors assume that teen crashes would have probably dropped even more had the age not been lowered, but that assumption is far from obvious.  Also, according to the International Traffic Safety Data and Analysis Group, the reporting of nonfatal injury crashes by police had improved since 2001.  Teen fatalities fluctuated a great deal due to their small numbers, but the rates generally remained below their 1999 values from 2000-2008.

Indeed, using 20-24 year olds as a control group is a poor choice. We know that several American studies found that drinking age changes merely shift deaths from one age group to another (see Five Studies that Debunk the Rest for more info), so that could be a reason for the faster decline among 20-24 year olds when those who were 18-19 when the age was lowered turned 20 in 2001-2002. Also, Brownsfield et al. (2003) found that college students already over 20 when the age was lowered drank less immediately after the age-lowering than immediately before. That could be due to not wanting to go to the bar as much due to the resulting influx of younger people, or simply because it would be more crowded. Or they may have felt that their thunder was stolen, so to speak. This (drinking less and staying home more) could also plausibly lead to fewer crashes among those 20 and over. A better choice would have been to use 25-29 year olds as a control group as they would be distant enough to not be affected by the drinking age, but still close enough to be "in the loop" of the latest social trends.

What about the apparent spillover effect on 15-17 year olds, you ask? Interestingly, the "increase" in crashes was even higher for them than for 18-19 year olds, and females were affected more than males in both groups. In America, this would make no sense since crashes involving female drivers are less likely to involve alcohol, and the same is true for 16-17 year olds. So other factors had to be involved. And there is a much more plausible explanation as well.

A little background about New Zealand is necessary to understand all this. First of all, they never really had a true drinking age like we do in America, just a purchase age (we will use the term "drinking age" anyway). They also allow moonshining and drinking in the street. When the age limit was 20, it was poorly enforced, and there were numerous exceptions to the law as well. IDs were not consistently checked, if at all. Back then, it was fairly easy even for 15 and 16 year olds to get into bars and be served. Nod nod wink wink, as long as you behaved yourself we'll let you drink. When the age limit was lowered to 18, however, they really cracked down on bars and restaurants who served to anyone under the new drinking age, but for off-licenses (liquor stores, supermarkets, convenience stores) the enforcement was just as lax as before, which was very lax indeed. Youth under 18 ironically found it harder to get into bars when the age was lowered. So those 15-17 year olds who could no longer go to bars simply went to the stores instead. What they couldn't buy themselves they often got strangers outside to buy for them (furnishing to minors was and remains effectively legal, unless it can be proven who bought it, but even then the penalty is modest). Premixed spirit-based drinks (ready-to-drink, or RTDs), like our alcopops only stronger, were often the drink of choice, as well as cheap liquor. And the already low prices were effectively falling due to the practice of "loss leading," to the point where one could easily get completely wasted for only a few dollars, as RTDs were cheaper than soda or even water. And wasted they got, without the moderating influence of the pub and with little incentive to behave. 

The seeds appear to have been planted in 1989, a full ten years before the drinking age change.  That was the year the Sale of Liquor Act was enacted, which liberalized licensing laws and allowed for 24-hour opening hours.  The number of licensed outlets skyrocketed since then.  Also, NZ began to allow the sale of beer in supermarkets, and legalized Sunday sales of alcohol, on the very same day that the drinking age was lowered.  This further increased the number and density of outlets as well as the resulting availability of booze.

The prexisting trend of increasing binge drinking (which was always worse than in America), combined with the converging trends of falling real alcohol prices, increasing outlet density, 24-hour sales, aggressive marketing and advertising, and the rise of alcopops/RTDs, was a powder keg. Non-alcohol factors, such as faster cars and increasing illegal street racing, may have also played a role in the car crashes as well. If the law (and enforcement) change did anything, it was merely a spark, and rather ironically so at that.

Other effects

Alleged effects of the drinking age change were not limited to motor vehicle crashes. Putative increases in binge drinking, alcohol overdoses, unsafe sex, teen pregnancy, and violent crime have all allegedly been linked to the age-lowering by those who seek to raise the drinking age, using mostly anecdotal evidence. But most of these were either continuations of preexisting secular trends and/or things that could also be explained by other factors (falling alcohol prices relative to income, increasing outlet density, 24-hour sales, aggressive marketing and advertising, and the rise of alcopops/RTDs). These variables are seldom controlled for in the studies. For crime, there were changes in how some crimes were reported and collated since the age was lowered as well, further muddying the waters. Also, many of these effects (such as higher pregnancy rates) were also found for those over 20 as well, and there is a strong correlation between the behavior of adults and that of teens. Indeed, the alleged "effect sizes" of some of these things, though practically small in most cases, are implausibly large given the minimal enforcement of the previous drinking age, and so such effects are likely spurious. The same can be said about the alleged effects on traffic crashes.

Contrary to popular opinion, there was little evidence that 18-19 year olds were a significant source of alcohol for younger teens. But the number one source of alcohol, as it had always been, was parents. Parents were, and still are, the elephant in the room than no one wants to talk about. A pink elephant in this case. Not only do they drink quite a bit themselves, they would also buy large quantities of beer, RTDs, and liquor for 15 year olds, and those 15 year olds would often share it with their younger friends as well. Often unsupervised, in God knows where. Remember that 15 is the driving age in NZ. That means the parents essentially handed them whiskey and car keys. Have fun, don't kill nobody! Look, you simply can't legislate common sense, and raising the drinking age back to 20 would do nothing for this issue.

What to do about it

New Zealand has always had a drinking problem worse than America. There is much debate on what to do about it. But raising the drinking age would likely be fighting fire with gasoline. It would at best be a distraction from the worst drinkers of all--20-29 year olds. Here is what we, the TSAP, recommend instead:

  • Raise the tax on all alcoholic beverages, especially RTDs, hard liquor, and cheap beer.
  • Set a price floor for alcohol, especially at off-licenses, and ban the practice of "loss leading".
  • Restrict alcohol advertising, especially on TV.
  • Increase the penalties for drunk driving, and step up enforcement.
  • Lower the general blood alcohol limit for driving to 0.05, and the under-20 limit to 0.02 or less (the limits are currently 0.08 and 0.03, respectively).
  • Hold parents more accountable for what their kids (under 18) do, especially if the parents supplied them with alcohol beforehand. Duh!
  • Put more cops on the street, and get tough on real crime, including drunk violence.  Penalties and enforcement for violent crimes appear to be far too lax in New Zealand.
  • Ban drinking in the street by all ages, or allow very limited designated areas to do so.
  • Restrict the number and density of alcohol outlets.
  • End 24-hour bar-hopping and have a pub closing time of 2 am, and/or a one-way door policy after 1 am. That's evidently when the crazies come out, and the crazy stuff happens.
  • Increase alcohol education and public awareness campaigns.
  • Do NOT touch the drinking age!  Just enforce it better at off-licenses to increase compliance, and close the existing loopholes on furnishing alcohol to minors. 
These common-sense measures would work wonders, and would affect all ages. Which is exactly what a lot of adults who would rather scapegoat teenagers don't want. Those who insist on raising the drinking age in NZ are so fixated on age that they fail to see the forest for the trees. Gee, who does that sound like? If they are really that concerned about age, than raising the driving age (currently 15) to 16 or 17 is probably the best place to start (along with making the road test harder).

Interestingly, the New Zealand Medical Association agreed in 2006 that the drinking age should remain 18, since there was no clinical evidence that alcohol was more harmful to an 18 year old than a 20 year old.  But they did say that the current drinking age needs to be enforced better, and also called for tighter advertising restrictions on alcohol.

Relevance to America, or Lack Thereof

It goes without saying that while America is not Europe, we are not New Zealand either. As mentioned before, there are several significant differences between the two countries that the pro-21 crowd likes to gloss over. And even there, the effects of the drinking age are likely spurious. So consider this one debunked as well.


Saturday, May 9, 2009

Five Studies that Debunk the Rest

Over a hundred studies have been done on the effects of the drinking age, mainly on traffic fatalities. The pro-21 crowd claims that "science" is entirely on their side. However, about half of the studies done suggest otherwise. The best they can honestly say is that the jury is still out. The majority of drinking age studies are either cross-sectional in design or look at time-series data in only one state (or province). Not all studies control for potentially confounding variables or even have a comparison group. A few good ones do, and some of those still find a lifesaving effect for a higher drinking age, but no study is perfect, and there are always unmeasurable variables that are left out due to lack of data. Other problems include the definition of "alcohol-related," poor and widely varying alcohol testing rates, the non-existence of the FARS database before 1975, and policy endogeneity. Even the relatively good studies in favor of a high drinking age can be readily debunked with no more than five other studies, the ones that the pro-21 crowd doesn't want you to see. Consider these studies to be pieces of a puzzle; while they (like all studies) each have their own strengths and weaknesses, they fit together quite well as the strengths of some compensate for the weaknesses of others.

The Furious Five

The five studies that debunk the rest, in chronological order, are:

Males (1986)
Asch and Levy (1987)
Asch and Levy (1990)
Dee and Evans (2001)
Miron and Tetelbaum (2009)

1) Asch and Levy found in their first study that the drinking age had no significant (or even perceptible) effect on either 18-20 year old traffic fatalities or all-ages fatalities, even when single-vehicle nighttime crashes (a proxy for alcohol-involvement) were studied.  It also found no evidence of endogeneity in a state choosing on a lower drinking age. The strengths of this study were that it controlled for several variables, used an error term in the regression, and is one of the few studies that controlled for adult per capita alcohol consumption. The one weakness was that this study was cross-sectional in design and looked only at the year 1978. However, this year was chosen on purpose because all of the drinking age lowering from the early 1970s had occurred years ago, and only a few states had recently raised the drinking age.  In short: the Asch and Levy study was designed to check for long-term effects of the drinking age. It found none.

Interestingly, a 1984 study by Israel Colon did a similar cross-sectional study for the year 1976, and found a positive correlation between the number of single-vehicle fatalities and the drinking age (higher drinking age = more deaths).  The author attributed it to border effects from neighboring states with lower drinking ages (similar to the case of dry counties adjacent to wet ones), but the Asch and Levy study (which controlled for more variables than the Colon one) found no difference in their own results when they eliminated all states for which border effects were potentially important from their regressions.

2) Their second study, longitudinal from 1975-1984, did not show a very conclusive relationship between drinking age and fatality rates. The drinking age oddly enough had opposite effects on single-vehicle (SV) versus single vehicle nighttime fatalities (SVNT). Effects on former had the expected sign, while the latter the effects were statistically insignificant and even had the "wrong" sign. It did, however, show significant effects for experience drinking legally, independent of the drinking age, which greatly diminished the drinking age effect on SV fatalities (often to nonsignificance) and strengthened the wrong-signed effect SVNT fatalites even more in the opposite direction. The more experience, the fewer traffic deaths. Thus, if the drinking age did have any effect, which was still left uncertain, it was mainly to postpone fatalities by 1-3 years rather than cause a net reduction. Strengths were its longitudinal design and inclusion of both state and year "fixed effects," which controlled for state-specific characteristics that did not change significantly with time, and national trends, respectively. The only weakness was the very small number of other control variables in the regressions, but additional ones that were tested (such as the 25-29 year old fatality rate) did not substantively affect the results and were thus dropped for the sake of parsimony.

3) Dee and Evans, using data from 1977-1992, found that, after controlling for several confounders and fixed effects, a drinking age of 21 did reduce fatalities slightly for 18-19 year olds, but increased them for 22-24 year olds, merely shifting the deaths a few years into the future. In other words, no net lifesaving effect, and possibly even a net increase in fatalities. Effects on 16-17 year olds were less clear; a drinking age of 18 (relative to 21) apparently reduced fatalities in this group while a drinking age of 19 increased them. Strengths were its longitudinal design, state and year fixed effects, a few control variables, and the fact that 16-17 year olds and 22-24 year olds were included. The time lag for the effect on 22-24 year olds was taken into account, unlike most other studies that looked at this age group. The only major weakness was not including data for 20 and 21 year olds, especially the latter, which makes the net effect on fatalities less clear (since some other studies suggest a spurt in traffic fatalities at age 21). However, if anything, this omission would attenuate the fatality increase for 21-24 year olds.

4) Mike Males got similar results more than a decade prior, using different methodology and data from 1976-1983, finding that there is not only a "seesaw effect" between age groups regardless of what the drinking age is, but a higher age generally leads to a net increase in fatalities overall. The TSAP speculates that the longer the drunk drivers live, the more of a chance of killing others in a crash. The study compared the changes in the fatal crash ratio (relative to 21-24 year olds) of 18, 19, 20, and 21 year olds in several "change" and "no-change" states that were matched based on various similarities. His methodology has been sharply criticized by many in the pro-21 crowd, but it was not radically different from that used in a pro-21 study by the Insurance Institute for Highway Safety, and actually used more statistically reliable measurements.

5) But the final nail in the coffin comes from a study done in 2007 (and published in 2009). Miron and Tetelbaum (2009) found that, after controlling for numerous confounders and fixed effects, as well as state-specific trends, only the first few states to raise the drinking age to 21 voluntarily saw any statistically significant reduction in 18-20 year old fatalities, while many of the coerced adopters saw no change or even increases. And even for the early adopters, there was an apparent rebound effect after the first two years of the higher drinking age. Again, no net lifesaving effect in the long run. They found no statistically significant effects on those over 21, but that could be due to an unaccounted for time lag (when the first 18-19 year olds exposed to a drinking age of 21 turned 21 2-3 years later).

But what about high school kids? Contrary to popular opinion, Miron and Tetelbaum also found little to no effect of the drinking age on reported high school drinking (in Monitoring the Future survey data) as well after controlling for several confounders, and such effects are consistent with underreporting. Even these weak effects were not robust to a change in model specification that restricted the sample to states that raised the drinking age in response to federal coercion. It appears that they are willing to drink regardless, and that the drinking age is irrelevant or even counterproductive. In fact, they found that the higher the drinking age, the more 17 year old (and under) driver fatalities there were! That "negative spillover" effect was also somewhat consistent with Dee and Evans (2001), though it was less clear in the latter.

Most of Miron's statistical models were slightly modified versions of a model used by Dee (1999), in which lifesaving effects were found for the 21 drinking age, but no lifesaving effects were found for the beer tax (in fact they had the "wrong" sign). This is important because Dee (1999) was (until recently) the virtual gold standard for the pro-21 studies as it was a longitudinal study that controlled for several potential confounders, fixed effects, and even state-specific trends. Miron simply took Dee's best model from 1999 and a) added Alaska, Hawaii, and DC to the data, b) added vehicle miles traveled (VMT) and BAC limit variables to the regressions, and c) compared the effects of including or omitting the first few states that raised the age to 21. The drinking age effects were somewhat diminished with the second change and not at all robust to the third change.

Interestingly, the mere addition of Alaska and Hawaii (two of the highest beer tax states) and DC to Dee's best 1999 model made the beer tax suddenly become significant (at the 10% level) and have the correct sign, a drastic change from Dee's results. That is probably because the lower 48 states (except Alabama) and DC have much lower beer taxes (often an order of magnitude lower). It was also worth noting that, in the model that was identical to Dee's except for including AK, HI, and DC, the effect of doubling the beer tax had about twice the apparent effect that raising the drinking age from 18 to 21 did. And that was before the model was changed further in ways to which the drinking age effects were not robust.


Post-Miron Studies

The aforementioned studies do an excellent job of debunking all the pro-21 studies done prior to 2007. A few more studies have been done since then, and it is now up to us to debunk them:

1) Even in some of the studies that do suggest lifesaving effects of a high drinking age, we also learn that the beer tax potentially has a lifesaving effect as well. For example, Ponicki et al. (2007) even found that, while the drinking age does have a small effect, there is a negative "interaction" between the drinking age and the beer tax: the higher one is, the less effective the other is in reducing fatalities. Their model suggested that if the beer tax is high enough, the drinking age becomes irrelevant or even counterproductive. While the study controlled for more variables than most, as well as state and year fixed effects, it did not control for state-specific trends like Miron and Tetelbaum (2009) did. It is also important to note that this study did not adequately test the conclusions made by Miron and Tetelbaum (2009) or Dee and Evans (2001).

2) Lovenheim and Slemrod (2010) also came out with a recent study that looked at the effects of the drinking age itself, as well as "blood borders" (effects of unequal drinking ages across neighboring states). They apparently found small but statistically significant lifesaving effects of a higher drinking age, but the opposite was true in counties within 25 miles of a lower drinking age jurisdiction, for obvious reasons. They imply that if some states were to lower the drinking age, they would hurt others due to drunk driving across borders. That was one excuse the feds gave for their power grab in 1984. Nevermind that the exact same thing happens in dry counties among those 21+, as verified by some studies (Baughman et al., 2001), and yet we do not say that wet counties "hurt" their dry neighbors. Rather, we say that the dry counties are hurting themselves with their provincial and unenforceable policies, and we let them take the consequences of those policies. Futhermore not every study agrees with their conclusion about border effects, such as Kreft and Epling (2007), who found no robust border effects in Michigan counties that bordered on areas with lower drinking ages (Wisconsin, Ohio, and Ontario) back in the 1980s.

The authors were familiar with Miron and Teltelbaum (2009), and even reference that groundbreaking study. Lovenheim and Slemrod's study was very different from the latter, however. Not only was it one of the few studies that looked at border effects in great depth, it also had different methodology. Their fatality measure was the ratio of 18, 19, and 20 year old driver fatalities, analyzed separately, relative to those of 21-25 year olds in one model, and 26+ in another. Two models were done for each, one including border effects, and the other neglecting it. Border effects were localized to those counties 25 miles from the border of a lower drinking age jurisdiction, and were essentially exclusive to the higher drinking age side (similar to what happens dry counties when the drinker drives out sober but drives back home drunk).

However, there are several flaws and caveats. The authors imply that Miron was refuted since Lovenheim still found effects post-1984, but they only restricted the time period studied, not which states were included like Miron did. In fact, they strangely did not even look at what separating out early-adopting (i.e. non-coerced) states would do to the results, even though the gist of Miron was to do exactly that. While Lovenheim and Slemrod point out that most states had drinking ages of 19 or higher by 1984, and that lumping 18-20 year olds together may therefore distort the data, they fail to mention that Miron tests the specific effects of MLDA19, MLDA20, and MLDA21 relative to MLDA18, and there were still some states that were 18 until 1987. So this is essentially a non-issue. Effects of the drinking age were robust to neglecting border effects, and in fact roughly identical in both models, so Miron's neglect of border effects was also not substantive.

Most importantly, Lovenheim's models using 21-25 and 26+ control groups differed in terms of drinking age effects, and the differences are very telling indeed. The effect of drinking age on fatality rates of 18-19 year olds was twice as strong in magnitude when the 21-25 control group was used compared with using 26+. For 20 year olds, the difference was smaller but still visible. could that be? Though glossed over, a stronger relative effect with respect to 21-25 year olds than with 26+ year olds implies that some (if not all) of the reduced 18-20 year old traffic deaths were likely just postponed by a few years, Dee and Evans (or Asch and Levy) style. A true net reduction should not have such differential effects. This possibility was unfortunately ignored by the authors, so the net effect is still unclear in this study. Thus Lovenheim and Slemrod fail to knock down the aforementioned studies.

Finally, it is rather interesting that border effects involving the Canadian border were found to have the opposite sign compared with those of state borders. This led the authors to admit (in a roundabout way) that the counties in upstate New York and Vermont, which were known to beef up roving patrols and sobriety checkpoints close to the Canadian border at a time when the border was not much more protected than state borders, found a way to more than counteract the apparent border effects. Put another way, this actually pulls the rug out from under the strongest argument for states being coerced to have a uniform drinking age of 21. States who refuse to recognize 18-20 year olds as full adults, but whose neighbors are intent on doing just that, take note. It just might save some lives.

3) Fell et al. (2008) also came out with a recent pro-21 study, and it has been hailed by some as the one study that was finally able to tease out the effect of the drinking age alone, and settle the debate once and for all. Red flag statements aside, this study by MADD member James Fell still suffered from some serious issues. The study was divided into two parts. The first part looked at the effect of the drinking age from 1982-1990, using the ratio of alcohol-positive to alcohol-negative fatal-crash under-21 drivers as the fatality variable. States with a drinking age of 21 since before 1982 were compared with states that did not. While modest but statistically significant effects were found, even when numerous variables were controlled for, there are some caveats that were glossed over. First, the apparent convergence of the fatality ratios in the two groups did not occur until 1988, with the gap persisting even in 1987, even though most of the age-raising occurred in 1984-1986, and only a handful of states changed ages in 1987-1988. Until 1988, the ratios declined at roughly the same rate, albeit a gap between them that persisted until then. The gap should have begun narrowing since 1984 if the drinking age effects were real. In fact, in 1990, re-divergence began despite no change in drinking age after 1988, and the percent change from 1982-1990 was not dramatically different between groups.  Secondly, the effects of a 0.08 BAC limit and automatic license revocation laws had much stronger magnitudes than those of the 21 drinking age. Thirdly, alcohol testing rates were abysmal and erratic before 1990, which could bias the results in either direction. Remember too that "alcohol-positive" means any alcohol (even 0.01 BAC) was present in the driver's body, not necessarily that the crash was alcohol-caused. Fourthly, beer taxes and seat belt laws were not controlled for. And finally, it goes without saying that since it did not compare the post 1984 change states to the early MLDA 21 adopters between 1982-1984, it does not successfuly refute (or even address) Miron and Tetelbaum's findings. Also, it does not even broach the issue of shifting deaths to 21-24 year olds, so it does not refute Males, Asch and Levy, or Dee and Evans.

The second part of Fell's study is sometimes hailed as a strong point in that it includes "modern" data, but upon closer examination it actually contains the study's deepest weakness. It looks at the same under-21 alcohol-related fatality ratio as above, only this time as a percentage of all-ages fatalities, over the period 1998-2004. The effects of the two "core" drinking age laws (purchase and possession under 21) and 14 ancillary laws (anti-fake ID, keg registration, furnishing to minors, social host laws, graduated driver licensing with nighttime restrictions, zero tolerance, use and lose, and others), and the relative "strengths" of those laws, on fatalities was examined. The only one that had any significant and negative effect on under-21 fatalities, relative to over-21 fatalities, was the anti-fake ID law, a law that all 50 states have had since before 1998 but varied in strength from state to state. All of the other laws, even the two core laws, were either insignificant or even perverse, calling into question whether these or even the 21 drinking age itself is still useful or relevant today. Since drivers under 18 were included in the under 21 group, the fake ID law's small effect could very well have been driven by such youth since they would be just as affected by this kind of law if not more so. Or it could simply be a proxy for something else that was not observable (the same could also be said for the drinking age itself, by the way). The authors try to explain away the apparently null or perverse effects of the other laws by the way the "strengths" were coded as well as the fact that this part of the study was cross-sectional due to data problems for enactment dates, but one can just as easily make the exact same argument about the fake ID laws as well. Far from settling the issue, this study acutally opens up a huge can of worms. So consider this one debunked as well. The bigger they are, the harder they Fell.

UPDATE:  Fell et al. (2009) also did another, more recent study that looked this time at both the 21 drinking age as well as a few ancillary laws (zero tolerance, use and lose, graduated driver license night restrictions, and keg registration) that were evaluated longitudinally, in contrast to their 2008 largely cross-sectional evaluation of ancillary laws that found no significant effects for laws other than anti-fake ID laws.  Their longitudinal study did find a significant downward effect of the "core" 21 drinking age laws and smaller but statistically significant effects of use and lose laws and zero tolerance laws on the ratio of alcohol-related to non-alcohol traffic fatalities among 16-20 year olds, but keg registration unexpectedly had the opposite effect, acutally increasing this ratio.  That result is surprising since outdoor keggers frequently involve at least someone driving when they shouldn't be on the road.  Thus, if one believes the study's conclusion that the 21 drinking age and use and lose laws both save hundreds of lives each year, you'd also have to believe that keg laws kill people as well, and that their proponents have blood on their hands.  In addition, though the model was somewhat improved, the study still suffers from many of the same shortcomings as the authors' previous study, and cannot be said to truly refute Miron and Tetelbaum and the other Furious Five studes.