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.