America Is Still Drowning In The Bottle

Americans are still drowning in the bottle to this day, and paying a heavy price for it.  While the pandemic and especially the lockdowns were clearly gasoline on the fire, that fire has been burning for a very long time before that.  The ageist abomination that is 21 drinking age, and all of its illiberal ancillary laws, has clearly done NOTHING to stem that tide in the long run.  And it's truly no coincidence that alcohol (of all types, but especially hard liquor) is now the cheapest it has been in many, many decades relative to inflation and (especially) income.  That's largely because alcohol taxes have greatly lagged behind and were thus eroded by inflation in recent decades, with the tax on distilled spirits lagging the very most of all.

To quote the latest CDC report on the matter:

Average annual number of deaths from excessive alcohol use, including partially and fully alcohol-attributable conditions, increased approximately 29% from 137,927 during 2016–2017 to 178,307 during 2020–2021, and age-standardized death rates increased from approximately 38 to 48 per 100,000 population. During this time, deaths from excessive drinking among males increased approximately 27%, from 94,362 per year to 119,606, and among females increased approximately 35%, from 43,565 per year to 58,701.

Thus, as Twenty-One Debunked has long advocated, we need to raise the alcohol taxes across the board, and harmonize them all based on alcohol content.  To raise just the beer tax alone, for example, would result in drinkers simply switching to liquor, similar to how minimum unit pricing in Scotland disproportionately affected strong cider and perversely incentivized switching to liquor.  MADD (Mothers Against Drunk Driving) has long heavily beaten the drum (though not so much recently) for raising the beer tax, but has also largely been strangely silent on the distilled spirits tax.  Perhaps some alleged palm-greasing from both the liquor industry and/or foreign beer industry may be at work here?  Things that (should) make you go, hmmmm.....

We advocate raising all federal alcohol taxes to about $30 per proof-gallon, equal to the inflation-adjusted value for the distilled spirits tax in 1991 (in 2023 dollars), the last time it was raised. That would add anywhere between one and two dollars (depending on alcohol content), to the price of a six-pack of beer, a gallon of wine, or a fifth of liquor, while also incentivizing reduced-alcohol beers and wines.  And while that may not be very much of a difference to a moderate drinker, for heavy drinkers it sure adds up, as it also does for the youngest drinkers as well.  And contrary to what some believe, the price elasticity of demand for alcohol is NOT zero or trivial, and the public health benefits of higher alcohol taxes and prices are well-known and established.

To sweeten the deal, we support a relatively reduced tax rate for the smallest producers, and we also support tax incentives for producers who fortify their beverages with thiamine (vitamin B1) and perhaps other vitamins as well.  And we would also support phasing in alcohol tax hikes a bit more gradually if that is the only way to get them passed.  But raise these taxes, we certainly must.

(And, of course, we also also lower the drinking age to 18 yesterday, full stop.  We are still Twenty-One Debunked, after all.)

It is true that Thomas Jefferson once famously said, "no nation is drunken where wine is cheap".  Granted.  But the second half of that very same quote was, "and none sober when the dearness [expensiveness] of wine substitutes ardent [distilled] spirits as the common beverage.  It is, in truth, the only antidote to the bane of whiskey."  And now in 2024, it would seem that ALL categories of alcoholic beverages are too cheap for America's own good, and a fortiori for ardent (distilled) spirits today.

America Is Still Drowning In The Bottle

Americans are still drowning in the bottle to this day.  While the pandemic and especially the lockdowns were gasoline on the fire, that fire has been burning for a very long time before that.  The ageist abomination that is 21 drinking age, and all of its illiberal ancillary laws, has clearly done NOTHING to stem that tide in the long run.  And it's truly no coincidence that alcohol (of all types, but especially hard liquor) is now the cheapest it has been in many, many decades relative to inflation and (especially) income.  That's largely because alcohol taxes have greatly lagged behind and were thus eroded by inflation in recent decades, with the tax on distilled spirits lagging the most of all.

Thus, as Twenty-One Debunked has long advocated, we need to raise the alcohol taxes across the board, and harmonize them all based on alcohol content.  To raise just the beer tax alone, for example, would result in drinkers simply switching to liquor, similar to how minimum unit pricing in Scotland disproportionately affected strong cider and perversely incentivized switching to liquor.  MADD has long heavily beaten the drum (though not so much recently) for raising the beer tax, but has also largely been strangely silent on the distilled spirits tax.  Perhaps some alleged palm-greasing from both the liquor industry and/or foreign beer industry may be at work here?  Things that (should) make you go, hmmmm.....

We advocate raising all federal alcohol taxes to about $30 per proof-gallon, equal to the inflation-adjusted value for the distilled spirits tax in 1991, the last time it was raised. That would add anywhere between one and two dollars (depending on alcohol content), to the price of a six-pack of beer, a gallon of wine, or a fifth of liquor, while also incentivizing reduced-alcohol beers and wines.  And while that may not be very much of a difference to a moderate drinker, for heavy drinkers it sure adds up, as it also does for the youngest drinkers as well.  And contrary to what some believe, the price elasticity of demand for alcohol is NOT zero or trivial, and the public health benefits of higher alcohol taxes and prices are well-known and established.

To sweeten the deal, we support a relatively reduced tax rate for the smallest producers, and we also support tax incentives for producers who fortify their beverages with thiamine (vitamin B1) and perhaps other vitamins as well.  And we would also support phasing in alcohol tax hikes a bit more gradually if that is the only way to get them passed.  But raise these taxes, we must.

(And, of course, we also also lower the drinking age to 18 yesterday, full stop.  We are still Twenty-One Debunked, after all.)

It is true that Thomas Jefferson once famously said, "no nation is drunken where wine is cheap".  Granted.  But the second half of that very same quote was, "and none sober when the dearness [expensiveness] of wine substitutes ardent [distilled] spirits as the common beverage.  It is, in truth, the only antidote to the bane of whiskey."  And now in 2024, it would seem that ALL categories of alcoholic beverages are too cheap for America's own good, and a fortiori for ardent (distilled) spirits today.

Does The Latest Brain Study Vindicate The 21 Drinking Age? Well, Not Exactly.

There is a new brain study making the headlines these days.  This study examined postmortem brains of three groups of people:  1) 11 people with alcohol use disorders (AUD) who began drinking consistently before age 21, 2) 11 people with AUD who began drinking consistently after age 21, and 3) 22 people who did not have any AUD at all, though many of them drank at least somewhat.  And among the three groups, only for the early-onset AUD group were epigenetic changes related to the expression of brain-derived neurotrophic factor (BDNF) found, particularly in the amygdala, which is responsible for regulating emotions.  These changes are thought to lead to difficulty regulating emotions, problems with anxiety, and even be part of the pathophysiology of alcoholism itself.

So what does this really mean, exactly?  First of all, the researchers seem to have arbitrarily picked 21 as the dividing line between early-onset and late-onset AUD drinkers, and made no further distinction within the early-onset group (i.e., before 15, before 18, first drink, first drunkenness, first regular drinking, etc.).  Secondly, the study looked at a small sample size of people with alcohol-use disorders (think alcohol abuse/dependence, alcoholism, truly heavy, heavy drinking for many years or decades), who at the time of death averaged well over 10 standard drinks per day and over 100 drinks per week, over 30+ years.  Males were also overrepresented (in fact there were zero women in the early-onset AUD group), and the early-onset group drank significantly heavier then the late-onset group.  It is probably safe to say that these drinkers are NOT representative of the vast majority of those who drink before 21, and given how early the onset of early-onset AUD drinkers tends to be, it would also be safe to say that this early-onset AUD group largely began drinking well before 18, if not before 15.  And even among the late-onset AUD group, the relative lack of epigenetic changes certainly did NOT stop them from becoming alcoholics in any case.

Furthermore, there is no temporality to this non-longitudinal study, so we don't know whether or not these epigenetic changes were due to pre-existing vulnerability or perhaps the early use of other substances such as that now-infamous neurotoxin, nicotine. (Most of the study subjects were smokers, apparently, and about 90% of adult regular smokers typically begin smoking before age 18).

Thus, this study tells us NOTHING about the difference between people in general who begin drinking at 18 versus 21.  NOTHING.  Nor does it vindicate the ageist abomination that is the 21 drinking age.  And anyone who claims otherwise is being, shall we say, "economical with the truth".

Americans Still Drinking Themselves To Death

With all the news about tobacco, vaping, opioids, and cannabis lately, Twenty-One Debunked had almost forgotten about the very substance that led us to our founding in the first place: alcohol.  And the news about alcohol these days is hardly anything rosy:  Americans are still drinking themselves to death, at an alarming and increasing rate.  And yet, such very bad news (among adults) is strangely banal and often seen as not particularly newsworthy.  As we like to say, it is our country's "pink elephant in the room".

Teen drinking specifically may be at or close to a record low now, as it is in many other countries as well, but the tragic truth is that Americans in general are currently drowning in the bottom of the bottle and paying a heavy price for it.

According to a recent article, there are indeed several proven strategies that can be implemented at federal, state, and local levels to help stem the tide and get a handle on America's drinking problem.  We KNOW how to do it, and have known for decades now.  And while they may not necessarily get at all of the deepest root causes, they are still known to work quite well in the meantime regardless:

• Raising alcohol taxes
• Restricting the number/density of alcohol outlets and/or the hours/days of sale
• Improving access to treatment
• Bolstering coping skills

And while the first two get the most "bang for the buck" in terms of cost-effectiveness, they are unfortunately a relatively tough sell in some places.  Nevertheless, all four of these strategies should be implemented yesterday--if only our "leaders" would have the intestinal fortitude to do so.

Notice also that there was no mention of the 21 drinking age in the article.  And that is probably because after maintaining such ridiculous and ageist laws in all 50 states and DC for at least three decades now, the supposed benefits of such laws are ringing more hollow than ever.  And if anything, it is becoming increasingly crystal clear now that the 21 drinking age is doing more harm than good by merely forcing young adult drinking underground and kicking the proverbial can down the road.

The Most (Cost-)Effective Ways to Reduce Alcohol-Related Harms

It has been three decades since the last state, Wyoming, raised their legal drinking age to 21 in 1988 under federal duress.  And since then, has it really led our culture to a healthier relationship with alcohol?  Hardly.  As Twenty-One Debunked has been noting for years now, the tragic truth is that Americans are drowning at the bottom of the bottle, and paying a heavy price for it.  It is the "pink elephant in the room" that no one wants to talk about, particularly for Americans over 21.  This despite the fact that alcohol continues to literally kill more people than the opioid epidemic, and yet the former has not been declared anywhere near a public health emergency the way the latter has been.  Gee, I wonder why?

And while teen drinking is currently at a record low (though not unique to the USA, so don't be so quick to give credit to the 21 drinking age), adult drinking is anything but.  What is most striking is how ageist (and cowardly) our culture's response has been to this epidemic of excessive drinking, essentially blaming young people for adult drinking problems.

As for what the most effective responses to America's drinking problem, the one that stands out as the lowest-hanging fruit of all in terms of both effectiveness and cost-effectiveness at reducing harm is raising alcohol taxes.  In fact a recent international study of 16 countries by researchers at the World Health Orgainzation (WHO) confirmed what we have basically known all along but for some reason have yet to implement fully despite reams and reams of research evidence supporting it.  Other close contenders in terms of the most "bang for the buck" include restrictions on alcohol advertising/marketing and hours of sale, but higher alcohol taxes/prices emerge as the most cost-effective measure of them all. Somewhat less cost-effective is tougher enforcement of BAC limits for DUI, but it is still highly effective as well.  And the least cost-effective, but still effective (and worth doing) albeit more expensive, measure is screening and brief intervention for alcohol problems by primary-care physicians.

And guess what was not mentioned at all?  You guessed it:  drinking age laws.   And for good reason:  the supposed "mountain" of evidence in favor of the 21 drinking age basically turned out to be a molehill all along, and a very shaky one at that.  But as an avid reader of Twenty-One Debunked, you already knew that, right?  One day we will all look at the pro-21 crowd the same way we do for flat-earthers and such.

So yes, we do need to implement these aformentioned measures, especially raising alcohol taxes.  Currently, in real dollars, alcohol is cheaper than ever in the USA.  Raising and equalizing all federal alcohol taxes to $24 per proof-gallon (i.e. the inflation-adjusted 1991 level for distilled spirits) would be a good idea, though even raising them to $16 per proof-gallon would still yield very large societal benefits as well.  That would not be much of a price hike to a moderate drinker, but to a heavy drinker it certainly would be.

And lowering the drinking age to 18 while implementing better and more honest alcohol education would most likely, at least over time, lead to a culturally healthier relationship with alcohol as well since it would no longer be a fetishized "forbidden fruit" that fosters a "go big or go home" attitude to drinking.  The status quo certainly hasn't helped America's drinking culture one bit.

Let America be America Again, and lower the drinking age to 18.  If you're old enough to go to war, you're old enough to go ot the bar.  'Nuff said.

Is Alcoholism on the Rise for Women?

A recent article in Prevention discusses a recent study by NIAAA, that finds that alcoholism (or clinically speaking, "alcohol use disorder") among women has apparently been on the rise lately, having nearly doubled since 2002.  And while at least some of what the NIAAA has to say (especially their rather low definition of "binge" drinking) should be taken with at least a grain of salt (if not a whole pound), there does unfortunately seem to be at least some truth here.

So why is this happening now?  The article does speculate that deteriorating work-life balance, increased stress and anxiety, and increasingly aggressive alcohol marketing towards women should take at least some of the blame.  And all of that is certainly true to one degree or another.  But truly the pinkest elephant in the room is that excessive drinking (and related consequences) has been increasing overall for both women and men during that timeframe, and while the gender gap has indeed narrowed, men continue to greatly exceed women in terms of alcoholism and alcohol-related problems, as they always have (despite some improvement in decades past until very recently).

Americans of all ages and genders are literally drinking themselves to death as we speak.  About 88,000 per year, in fact, die from alcohol-related causes (vs. 65,000 per year for opioid and all other drug overdoses combined), a number that has been increasing in recent years.  And that number, though staggering in itself, is merely the tip of a very large iceberg of injury, illness, crime, violence, motor vehicle crashes, family breakdown, addiction, and other social costs linked to this deadly yet ubiquitous substance.  Meanwhile, the powers that be are unfortunately--no, shamefully, responding to this epidemic with a collective shrug for the most part.

Fortunately, we know now after decades of reams of research evidence that there is in fact a very simple solution for reducing the death rates and other harms of excessive drinking.  And that solution is raising alcohol taxes.  The higher the price of alcoholic beverages, the fewer deaths and other alcohol-related problems occur, all else being equal.  Even modest increases seem to have a significant impact.   We know this, yet not only have the powers that be generally let the alcohol taxes lag behind inflation, but have actually moved to lower such taxes as a lesser-known part of the recent Republican tax bill.  This at a time when the relative price of alcohol is at an all-time record low already and still falling, while alcohol-related casualties continue to rise.

Also, we really need to legalize the safer choice, yesterday.  Cannabis is overall safer than alcohol, and generally tends to substitute for it.  Many studies strongly suggest that when one advances, the other retreats, albeit with some nuance of course.  Cannabis may even take a major bite out our nation's deadly and devastating opioid epidemic as well, according to some studies.  There's really no good reason to keep it illegal.  Zip. Zilch. Nada.

One thing is for sure.  Raising the drinking age to 21 in the 1980s, and increasing enforcement from the 1990s onward, appears to have done NOTHING to stem this tide, at least not for this most recent increase in alcohol-related problems, particularly among women.  Yet you can bet that the powers that be will predictably double down on this very ageist abomination and greatest alcohol policy failure since Prohibition.  Because reasons.  Or something.

Of Death And Taxes, Part Deux

While the opioid epidemic has recently been declared a public health emergency, what if we were to tell you that there is another drug epidemic that kills even more people (a whopping 88,000 per year vs. 65,000 per year for opioid and all other drug overdoses combined), a number that has actually been increasing in recent years?  And that number, though staggering in itself, is merely the tip of a very large iceberg of injury, illness, crime, violence, motor vehicle crashes, family breakdown, addiction, and other social costs linked to this deadly yet ubiquitous substance.  Meanwhile, the powers that be are responding to this epidemic with a collective shrug for the most part.  I think the reader would figure out by now that we are talking about alcohol.

And aside from its overall banality, what is particularly notable about the alcohol epidemic is how ageist our response has been.  While the epidemic clearly affects all ages, the powers that be have been focusing in laser-like fashion on people under 21 while largely ignoring people over 21, despite the fact that people over 21 make up the vast majority of this epidemic.  Not only does this scapegoat young people for largely adult problems, but it also hinders any real solutions to such problems as well.  It's basically the "pink elephant in the room".

Fortunately, we know now after decades of reams of research evidence that there is in fact a very simple solution for reducing the death rates and other harms of excessive drinking.  And that solution is raising alcohol taxes.   The higher the price of alcoholic beverages, the fewer deaths and other alcohol-related problems occur, all else being equal.  Even modest increases seem to have a significant impact.   We know this, yet not only have the powers that be generally let the alcohol taxes lag behind inflation, but have actually moved to lower such taxes as a lesser-known part of the new Republican tax bill.  

So what should the ideal alcohol tax be?  According to researchers, the externality costs of alcohol are estimated to be around $45-58 per proof-gallon, yet the federal tax on distilled spirits is $13.50 per proof-gallon, and for wine and beer it varies but tends to hover between $4 and $5 per proof-gallon.  And while state and local alcohol taxes vary, they are also generally very modest in most states, especially for beer.  So there is a very wide range by which such taxes can be raised while still being socially efficient.

Of course, those figures are now effectively even lower now that the Republican tax bill has lowered such rates even further for roughly the first 100,000 proof-gallons of all alcoholic beverage categories across the board.  But the aforementioned rates still remain the top rates above the respective thresholds in the now-tiered system.  Beer was always tiered with a reduced rate for the first 60,000 barrels, but now that reduced rate is even lower still, and for the first time ever distilled spirits now enjoy a reduced rate for the first 100,000 proof-gallons.  The rate structure is not inherently bad in itself, of course, but both the new and old rates are simply too low.

Twenty-One Debunked believes that, along with lowering the drinking age to 18, that alcohol taxes should be raised significantly.  Specifically, we support raising and equalizing the federal tax on all alcoholic beverages to the inflation-adjusted 1991 level for distilled spirits, which would be $24 per proof-gallon in 2016 dollars.  It should also be simplified by getting rid of all credits and lower tax rates, with perhaps the exception of ones for the first X number of proof-gallons produced by very small domestic producers.  At the state level, it would also be good to equalize alcohol taxes across all beverage types, while allowing localities to levy their own alcohol taxes (including sales and gross excise taxes) as they see fit.  The latter is especially important for college towns.

Even a smaller hike, such as to $16 per proof-gallon across the board, would likely save thousands of lives per year according to researchers.  And of course it would also raise more revenue.  As for job losses, the best research suggests that the net effect is actually neutral or even positive with respect to jobs overall.  So it should be a no-brainer.  A win-win-win situation for everyone but the alcohol industry, basically.

Oh, and by the way:  craft breweries (both macro and micro) not only exist in high-tax Canada, but actually appear to be thriving over there.  Ditto for even higher-tax Iceland as well.   Keep in mind that the tax hikes we propose would still leave American beverages cheaper than Canadian beverages.  So even if we raise such taxes dramatically without reduced rates or credits for small producers, they will likely continue to thrive here as well (at least if such tax hikes are phased in somewhat gradually).

Don't get us wrong, Twenty-One Debunked does not believe that alcohol is inherently evil or anything like that.   We are certainly not in league with the neo-dry lobby!  But when we as a society fail to appreciate that alcohol has a very real dark side for all ages, there are very serious consequences to doing so.  History speaks for itself.  So what are we waiting for?

Latest Bit of Scarelore--Is it True?

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

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

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

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

In other words, the results are preliminary at best. And there's plenty of counter-evidence as well. According to NIAAA data from 1981, courtesy of Mike Males (1986), states with a drinking age of 21 back then actually had higher rates of alcoholism than states with lower drinking ages, and much higher rates of alcohol-related diseases despite both lower teen and adult drinking rates. North Dakota, who nonetheless remained at a constant 21 since the 1930s, is currently the worst state in terms of alcoholism. The worst city is Reno, Nevada, whose state had not seen a drinking age less than 21 for 75 years.

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

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

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

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