Does Social Norms Marketing Work In The Long Run? The Latest Study Says Yes

The latest study on social norms marketing for Michigan State University students over a 14 year period is highly encouraging.  From 2000 to 2014, high-risk drinking dropped significantly faster at MSU than it did for national trends:

• The percentage of MSU students who said they consumed eight or more drinks in one sitting dropped from nearly 28% to 16.5%, a 41% relative decrease.
• The percentage of MSU students who said they drove after drinking fell by 58% as well.
• Additionally, another forthcoming study found that the percentage of MSU students who said they drank on 10 or more days in the past month dropped from 24.1% to 13.4% by 2016, while it remained largely flat at the national level.

That is quite impressive.  Considering how MSU went from being consistently in The Princeton Review's list of top 20 "party schools" to no longer being on that list anymore, that really says something.

How does social norms marketing work?  Young people often falsely believe that their peers are drinking, smoking, vaping, toking, or using other substances much more than is actually the case, and they feel pressure to conform to such inaccurate norms.  This is called "pluralistic ignorance".  By simply setting the record straight about the actual numbers, it tends to reduce the use of such substances overall when the "reign of error" is corrected.  In contrast, moral panics exaggerate the levels of use, which tends to increase the use of such substances, in what is known as a "deviancy amplification spiral".

Most other studies agree on the effectiveness of the social norms approach.  The effects are quite robust and seem to occur fairly quickly in most studies.  So what about the handful of studies that seem to disagree?  It is true that poorly designed programs, unsurprisingly, do not work very well.  And for colleges and demographics in which heavy drinking is most entrenched, it stands to reason that it can take longer to show any effects, longer than the short time periods of most studies on the matter.  Attitudes generally have to change first before behavior does, as a rule.  But as we see, Michigan State is clearly an example of a formerly entrenched heavy drinking "party school" that did show massive declines in both high-risk drinking practices as well as drunk driving and the frequency of drinking.  And those declines were in fact quite long-term, continuing at least a decade and a half with still no signs of stalling.

(Looks like William DeJong was right the first time after all, even if the alcohol outlet density in college towns may moderate or confound the results in his later research on the subject.)

Social norms marketing is clearly a highly effective yet inexpensive way to reduce harmful alcohol and other substance use/abuse, and best of all, it does not violate anyone's civil rights or liberties at all.  In contrast, legalistic crackdowns and so-called "environmental management" programs like "A Matter of Degree" are expensive, authoritarian, intrusive, ageist, and can be quite difficult to implement in practice.  So what are we waiting for?

One Weird Trick Reduces Binge Drinking on College Campuses By Nearly 10%

Clickbait-y title aside, a recent study confirms what we at Twenty-One Debunked have always known.  When examining substance use trends among college students from 2008-2018, it was observed that recreational cannabis legalization was associated with nearly 10% LESS "binge" drinking by students over the age of 21.  That is of course not surprising, given that alcohol and cannabis tend to be substitutes, and the legal age limit for both substances is 21 in all such legalization states so far.  No such effect was observed for students under 21, and no other effects were observed on trends for any other substance use (including nicotine use, illicit drug use, and prescription stimulant, sedative, or opioid misuse) among students under or over 21, except for a modest increase in the (mis)use of sedatives among students under 21 (but not over 21) for whatever reason. (So much for the long-debunked "gateway" theory).

We at Twenty-One Debunked believe that if the age limit was lowered to 18 for both alcohol and cannabis, the benefits of the aforementioned reduction in "binge" drinking would extend to students under 21 as well.   In any case, cannabis legalization looks like a net public health win on balance.

So what are we waiting for?

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.

Which Ancillary Laws Actually Work to Reduce Teen Drinking? (Spoiler Alert: Almost None)

The legal drinking age (at least in terms of purchase and public possession) has been 21 in all 50 states and DC since 1988 (notwithstanding the Louisiana Loophole through 1995), but states and localities have differed since then on the "ancillary" laws that are used to prop up the 21 drinking age.  These laws include, among others:

• Laws against private possession and/or consumption 
• Internal possession laws
• Laws against furnishing alcohol to people under 21
• Dram shop liability laws
• Social host liability laws (civil or criminal)
• Keg registration 
• Use alcohol and lose your license ("use and lose" laws)
• Zero-tolerance laws for DUI
• Fake ID laws and ID scanner laws
• Age limits for serving alcohol

Most if not all of these laws have been studied to some extent, with mixed results and even some serious plot twists.  Most of these studies have been conducted by MADD-affiliated researchers such as James C. Fell, Robert Voas, and Ralph Hingson, so they should probably be taken with at least a grain of salt, if not a whole pound.  But even with this potentially significant bias, most of these laws were found to have either no effect, inconsistent effects, very small effects, or even perverse effects in terms of "alcohol-related" traffic fatalities among young people.

If these laws (and by extension, the 21 drinking age itself) did work as intended, one would expect the effectiveness of these laws to show up not only in traffic fatality statistics (which are the tip of a very large iceberg), but also in surveys of teen drinking as well, especially when recent data are studied.  A 2014 study done by Vanessa H. Sacks et al. of Child Trends examined the relationship between 14 different ancillary laws (and alcohol taxes) and both current drinking (any in the past 30 days) and "binge" drinking (5+ drinks "within a couple of hours") among high school students from 2005-2011 as reported on the Youth Risk Behavior Survey (YRBS) of those years.  The 14 laws studied were the following:

• Laws against consumption of alcohol by people under 21
• Exceptions to possession laws
• Exceptions to furnishing laws
• Social host liability laws 
• BAC limits for people under 21 (i.e. zero-tolerance laws)
• Use-and-lose laws (strength measured in three different ways)
• ID scanners in retail locations
• Keg registration
• Age limits for serving alcohol 
• Beer excise taxes in 2005
• Distilled spirits excise taxes in 2005

And the results?  All but three such laws had no significant or even perceptible effect individually on either current drinking or "binge" drinking rates.  The only three that did have any statistically significant correlation were:

• Beer taxes were significantly and negatively associated with both current drinking and "binge" drinking rates.  No surprise there, as this dovetails nicely with the reams of evidence that have found similar results.  (Distilled spirits taxes showed no correlation either way, but that apparently null result is likely due to multicollinearity since beer and liquor taxes are highly correlated with each other).
• Keg registration laws were significantly and negatively correlated with current drinking, but not "binge" drinking, in one of two models.  This result should probably be interpreted with caution though, given how multiple other studies have found a positive correlation between keg registration and "alcohol-related" youth traffic fatalities.
• Use-and-lose laws (i.e. driver's license penalties for mere possession or consumption of alcohol) showed a positive correlation with current drinking, that is, such laws seemed to perversely increase teen drinking.
• And the real kicker: after controlling for drinking rates in previous years and the number of ancillary laws in previous years, states with a greater total number of such policies perversely had higher rates of both current and "binge" drinking.  But drinking rates in previous years did not predict the number of policies in place in later years, thus ruling out the possibility of reverse causation.

Thus, while the researchers caution that these results alone are not definitive enough to establish causation, it is quite clear that such results certainly cast serious doubt on the effectiveness of such laws, and by extension the 21 drinking age itself, in reducing teen drinking and related problems.  With the notable exception of alcohol taxes, the effects of such laws are most likely negligible or even perverse overall.  That, of course, dovetails rather nicely with Miron and Tetelbaum (2009), who found that raising the drinking age to 21 seems to have had "only a minor impact on teen drinking".  And we couldn't agree more.

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.

A Simple, Yet Overlooked Solution to College (Town) Drinking Problems

With all of the perennial hand-wringing about binge drinking and related problems on college campuses and in college towns, one would think that actual solutions would have been implemented long ago.  But it appears that not only are the chattering classes NOT naming and defining the actual problem correctly (spoiler alert:  it is NOT peculiar to college students or limited to a specific age group), but they do NOT seem to be interested in solutions that really work.  They just keep on repeating the same tired, old nostrums that are either feel-good pseudo-solutions or worse, neoprohibitionist measures (usually involving propping up the ageist abomination that is the 21 drinking age) that tend to do more harm than good overall.  Or they jump on the anti-student bandwagon and vilify college students as a group that is somehow unworthy of full adult rights and/or somehow parasitic to the surrounding community.

But there is in fact a very simple solution to reduce such alcohol-related problems, improve town and gown relations, correct for Pigouvian externalities, and raise revenue at the same time:  raise alcohol taxes locally in college towns.  The town of State College, PA, home to my own alma mater, Penn State University, is the latest to float the idea of levying their own local alcohol taxes (though the state would have to grant them permission to do so).  We have known for decades that alcohol taxes work well in general to significantly reduce alcohol-related harms without actually violating anyone's rights, discriminating against students or young people in general, or forcing non-drinkers to foot the bill for the externalities of excessive drinking.  And the state of Pennsylvania (and any other state, for that matter), would do well to grant local governments the right to levy their own alcohol taxes as they see fit, for both on- and off-premise sales.

If the price of alcohol were to go up significantly, even if only modestly, excessive drinking and related consequences (such as traffic casualties, violence, vandalism, overdoses, and public nuisances) would go down, all else being equal.  Moderate drinkers would barely even notice the price difference.  And the revenue it would raise could be used to further reduce (or at least deal with) whatever problems that remain in the community.  A win-win-win situation for everyone but the alcohol industry, basically.

So what are we waiting for?

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?

What do the "Hookup Culture" and "Binge Drinking" have in common?

Turns out, they both have an awful lot in common indeed:

• Both terms are rather nebulously-defined concepts that can mean anything you want it to mean
• Both are fueled by the lamestream media's sensationalism, creating a "deviancy amplification spiral"
• Both are fueled by "pluralistic ignorance", i.e. people falsely believing that everyone else is doing it more than they are and more than is actually the case
• Both are fueled by a kind of androcentrism that persists in spite of the patriarchy's overall decline (i.e. women are expected to behave more like men rather than vice-versa, and men write the rules)
• Both are fueled by a sort of "tyranny of the structurelessness" and the persistent belief that they are the "only game in town" on college campuses (spoiler alert: that is NOT actually true)
• Both are fueled by our schizophrenic culture's ambivalence about both sex and alcohol
• Both, statistically speaking, tend to go together (albeit not always, though)
• Both are used as virtual bogeymen of sorts to advance regressive and illiberal agendas, often in the guise of "protecting" young people and especially women
• Both are often falsely blamed on feminism, when the reality is that, among individual women, there seems to be a somewhat inverse correlation between feminist beliefs and those behaviors.
• The existence and prevalence of both are heavy on anecdotal evidence, and very light on actual data.
• And both defining behaviors are actually less common now than in the past, with Millennials being less likely to drink and tend to have fewer sex partners than their Baby Boomer parents.  Even Jean Twenge of all people concedes this.

But don't expect the lamestream media to tell you any of that, though.  Why let mere facts interfere with a good story that can boost their ratings?

The Kids Are (Mostly) Alright

The results of the annual Monitoring the Future survey of middle and high school students for 2014 were primarily good news overall.  Alcohol and tobacco use both dropped to record 40-year lows, and cannabis use saw the first decrease in years after steadily increasing since 2007.  Other drugs, both illicit and prescription, saw either decreases or no significant change in 2014, and most of those remained well below their most recent peaks.  Dangerous quasi-legal synthetic "designer drugs", such as "K2" (synthetic cannabis) and "bath salts", have plummeted to the lowest levels since they have first been measured.  And there was no substance that saw any significant increases in 2014.

One thing that makes such results remarkable is that 2014 was the first year that cannabis was fully legalized in Colorado and Washington, with a few more states on the way as well.  And there is currently zero evidence that any of the prohibitionists' fears have actually materialized.  Another remarkable observation is the fact that "extreme binge drinking" (i.e. 10+ drinks in the same occasion at least once in the past two weeks) among high school seniors has finally dropped to the lowest level since it was first recorded in 2005.  For example, from 2005-2011, it remained flat at 11%, and from 2011-2014 it had dropped by more than a third to 7%.  And lest you erroneously think that the longstanding 21 drinking age (or tougher enforcement thereof) is somehow the cause of that drop, significant decreases in teen drinking have also occurred in other countries where the drinking age is still 18.

But don't expect to hear such good news from the fearmongering mainstream media, of course.