Is Alcohol Really a Gateway Drug?

While the "gateway drug" theory has historically been associated more with cannabis than any other substance, many of the theory's proponents have also fingered alcohol and tobacco as possible culprits in somehow inducing hapless youth to "graduate" to harder drugs and eventually become hopeless junkies, tweakers, and/or crackheads.  In this post we revisit the decades-old theory with a fairly new twist.

A new study of high school student survey data claims to find that alcohol, as opposed to cannabis or tobacco, is the real "gateway" drug.  The study found that of all of the numerous psychoactive substances asked about in the Monitoring the Future (MTF) survey, alcohol was the one that was the single most likely to predict (statistically) the use of the others with the greatest accuracy.  Ergo, if there is such a thing as a gateway drug, alcohol would most likely be it.

If there is such a thing, that is.  And that's a pretty big "if" if you ask us.  For starters, the historical background of the gateway theory has a rather tainted pedigree.  The gateway theory as applied to cannabis turns out to be a virtually whole-cloth fabrication in the early 1950s by Harry Anslinger (the man responsible for cannabis being federally banned in 1937) who needed a justification for its continued ban and even harsher laws against it after the original Reefer Madness claims (murder, rape, insanity, and death) had been debunked by the La Guardia Committee Report in 1944.  So he flip-flopped and claimed that cannabis led its users to heroin addiction, which even he himself actually said was not the case in the 1930s.  But it turns out that a more general version of the theory is even older than that.  It can be traced back to at least 1910, when it was believed that indulging in smaller pleasures (such as eating spicy food) would lead one to crave larger pleasures (such as opium).  And that in turn would eventually lead one to the drunkard's grave.   Thus, the latest manifestation of the gateway theory, besides being recycled garbage, has actually come full circle (with alcohol at the start of the sequence rather than the end).  And nearly every major study of drugs and drug policy for the past century has been far more likely to refute the theory than to support it.

If not a causal relationship between alcohol (or cannabis) and later use of harder drugs, what explains the apparently strong association between the two?  One study by RAND in 2002 found that there was a more parsimonious explanation based on a mathematical model of:  1) the age at which each substance was typically first available to an individual, 2) individuals' propensity to use substances, which varies and is assumed to be normally distributed among the population, and 3) chance or random factors.  This explanation was equally accurate at predicting drug use progression compared with a model that assumed a causal relationship.  In the case of cannabis, another likely alternative explanation of the supposed gateway effect is the black market itself, as users are exposed to harder drugs through many of the same dealers who sell them their weed.  This was one of the reasons why the Netherlands adopted their policy of tolerance for cannabis (which can be purchased in "coffeshops" in many towns), and to this day the Dutch have significantly less of a problem with hard drugs than the USA and many other Western nations. 

Additionally, when young people are lied to about the dangers of alcohol and cannabis, they may eventually assume that all anti-drug messages are bunk and experiment accordingly.  Unfortunately, honest alcohol and drug education is not nearly as commonplace as it should be in this country.

So where does the issue of the 21 drinking age figure into all of this?  For starters, the authors of the study that links alcohol with subsequent use of other substances predictably claim that the longer alcohol use is delayed, the fewer problems there will be with not just alcohol abuse but the abuse of other substances as well, and they recommend zero tolerance for teen drinking.  This study would thus most likely be seen as vindication for the pro-21 crowd.  However, one can also look at the study's results a bit differently and see that the supposed gateway effect occurs despite (or perhaps even because of) the 21 drinking age.  For example, forcing alcohol underground makes it more likely to be used in the same environment as other substances, thus increasing young drinkers' exposure to the other substances.  The fact that "underage" drinkers are already breaking the law may encourage them to break other laws as well.   Also, at least some 18-20 year olds may find other substances easier to get than beer, and will thus be more likely to use them as substitutes.  In fact, a recent study found that when alcohol retreats, cannabis advances (and vice versa), and that is discussed in a previous post on this blog.  Therefore, one could say that the 21 drinking age acts as a "social gateway" to other drugs in a somewhat similar manner as cannabis prohibition, albeit much more modestly since there is not much of a real black market in alcohol (save for the modern-day speakeasies known as frat houses).  Indeed, it may not be a coincidence that American teens are more likely to use illicit drugs than their European counterparts despite being less likely to drink or smoke cigarettes.

In other words, we ought not to put too much stock in the rather dubious gateway theory, except to note how it could be one more way that the 21 drinking age yet again does more harm than good.

What the Obamacare Ruling Means

NOTE:  This post is on both the TSAP blog and the Twenty-One Debunked blog

The recent Supreme Court ruling on the Affordable Care Act ("Obamacare") was a mixed bag overall.  The individual mandate (which the TSAP does not support) was upheld, but as part of the government's taxing power rather than under the Commerce Clause.  While it is clearly a stretch to say it is constitutional because it is a tax (just think of poll taxes), and thus unfortunately provides a roadmap on how to make an end-run around some parts of the Constitution in the future, at least the Court recognized that the Feds do not have unlimited power under the Commerce Clause.  Thus, the ruling took some of the wind out of the sails of the dangerous Gonzalez v. Raich precedent in 2005.

One thing the Court did strike down was the primary mechanism for ensuring state compliance with the Medicaid expansion, namely the withholding of existing federal Medicaid funds as a penalty for noncompliance.  This was basically the same form of coercion used by the feds to force states to raise the drinking age to 21 in the 1980s, which was upheld by South Dakota v. Dole in 1987.  Since then, this power has been used to coerce the states to follow other mandates as well, and not just ones related to highways.  Thus if there is any silver lining to the Obamacare ruling, it is the fact that it may make it easier for states to lower the drinking age (and possibly even legalize cannabis) without federal interference.

As we have noted before, the TSAP supports a single-payer healthcare system similar to what Canada currently has, which is also what President Obama originally wanted as recently as 2008.  Anything less would be uncivilized.

BC's New and Improved DUI Laws Take Effect

Last year, we noted the success story of British Columbia, Canada in reducing DUI fatalities by over 40% in a single year.  This notable achievement, which nonetheless occured without raising the drinking age one iota, was most likely due to the province adopting (and enforcing) tougher DUI laws that provided for immediate roadside suspensions and impoundment of vehicles of alcohol-impaired drivers.  To wit, if a driver is stopped by police and blows:

0.05-0.08 BAC, 1st offense = 3 day license suspension, 3 day impoundment
0.05-0.08 BAC, 2nd offense = 7 day license suspension, up to 7 day impoundment
0.05-0.08 BAC, 3rd offense = 30 day license suspension, up to 30 day impoundment

0.08+ BAC, any offense = 90 day license suspension, up to 30 day impoundment

There are also stiff fines and towing and storage costs, and an ignition interlock device must be installed (at the driver's expense) when the impoundment ends. Thus, total costs can range from $600 to $4060 (OUCH!!!) depending on the severity and number of offenses, and that alone can be a strong deterrent in itself for many people.  And all of this is in addition to the possibility of criminal charges (and jail time) for those who blow above 0.08 BAC.  Thus, it's not at all surprising that DUI deaths went down dramatically.

However, despite its apparent success this law was not without its detractors.  In November 2011, part of the law was struck down as unconstitutional due to the lack of an adequate appeals process.  In addition, there were also concerns about the accuracy of roadside breathalyzers.  The province was given six months to fix these flaws or else the law would effectively become a dead letter. 

And fix it they did.  The new and improved version of the law, which is now in effect, now requires that the police offer drivers the option of being tested on a second breathalyzer if they fail the first, and the lower of the two readings is what will stand.  Also, the accuracy of breathalyzers used by police must now be confirmed by sworn reports from the officers, and drivers retain the right to challenge their suspensions and impoundments via an administrative review.  Thus, all of the tough penalties from before are officially back on the menu, so drunk drivers beware.

In addition, the neighboring province of Alberta has already adopted similar laws to BC, and those laws will go into effect on July 1 and September 1 of this year following a massive publicity campaign over the summer.  And there is really no good reason why laws like this would be unconstitutional in the USA either--in fact, many states already have administrative license suspension (ALS) laws, with varying degrees of enforcement.

The truth is in.  Swift justice works.  So what are we waiting for?

Teen Drinking Plummets--In the UK

In the USA, teen drinking has been falling since about 1980, with the exception of a brief increase from 1993-1997, and has reached a record low in 2011 according to the Monitoring the Future survey.  While many pro-21 folks like to claim credit for the decrease, they might want to rethink their position after reading the latest news from across the pond.  In the UK, where the drinking age is 18, teen drinking (including "binge" drinking) has also declined recently despite not raising the drinking age to 21.  In fact, weekly drinking among 11-15 year olds dropped by half since 2001, while disapproval of peers' drinking has increased.  Drinking among 16-24 year olds has also dropped significantly since 1998.  Unfortunately, at the same time, the drinking habits of people over 25 have gotten worse--kind of like it has over here.

So why haven't the mainstream media been talking about this good news?  For starters, bad news tends to sell more than good news.  But even more importantly, this news contradicts the popular belief that teenagers and young adults are the biggest contributors to the nation's drinking problem, and exposes the problem for what it really is.  And that doesn't sit well with older adults too well--in either country.

Still More Things Underage Drinkers Didn't Do (Part 5)

See previous posts as well.   It's been a while, and in the past few months or so:

An underage drinker did NOT drunkenly drive her Mercedes-Benz through a 96 year old woman's house.

An underage drinker did NOT drive while drunk (and coked-up) and crash her Jeep, severely injuring her three kids and sending two elderly people in another car to the hospital.

An underage drinker did NOT drive drunk with her 2 year old daughter in tow, try to outrun the cops, and crash into a tree, all while pregnant.

An underage drinker did NOT drunkenly crash into an AutoZone store and then attempt to speed off.

An underage drinker did NOT kill a 6 year old child in a crash after driving with a BAC of more than  double the legal limit.

An underage drinker did NOT injure a police officer by dragging him along the roadway while driving drunk.

An underage drinker did NOT steal an ambulance from a hospital and drunkenly crash it into two parked cars.

An underage drinker did NOT drunkenly strike a blind man in a crosswalk.

And that, my friends, is just the tip of the iceberg.

Happy Memorial Day!

This Memorial Day, let's not forget those who died for our country BEFORE they were old enough to drink legally.  A list of all those who made the ultimate sacrifice for America before the age of 21 since 2001 can be found here.  Let's also not forget the countless others who came back wounded as well.

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 to the bar.  'Nuff said.

Just How Dangerous Are Alcohol/Energy Drink Combinations?

Recently, there has been a great deal of scare stories regarding the supposed dangers of alcohol mixed with energy drinks (AMEDs for short).  In 2010 this led to the banning of premixed canned AMEDs such as the notorious Four Loko, which still is on the market but without the caffeine and taurine.  Of course, drinkers (and bartenders) are free (for now at least) to mix energy drinks with alcohol after obtaining them separately.  But are such fears (and laws based on them) actually warranted, or are they exaggerated?

A recent review of the scientific literature on the topic of AMEDs suggests that the dangers have been greatly exaggerated.  After surveying numerous studies of the effects of combining the two beverages, the authors concluded that there was, contrary to popular opinion:

• virtually no hard evidence that adding energy drinks to the mix significantly alters the behavioral effects of alcohol
• no reliable evidence that energy drinks significantly affect the perceived level of intoxication by drinkers
• zero evidence that mixing energy drinks with alcohol increases the odds of alcohol or drug abuse or dependence, and
• no significant adverse health effects for healthy individuals from combining energy drinks and alcohol in moderation.

Of course, it should go without saying that both alcohol and energy drinks, alone or in combination, can indeed be harmful when consumed to excess.  Also, one should always remember that caffeine (in energy drinks or otherwise) does not make a drunk person less impaired or more able to drive.  The best take-home message from all this is that moderation is the key.

In the case of Four Loko and similar drinks, it appears that the real issue was not that it contained alcohol and caffeine in combination, but rather that it contained such large amounts of each per can.  One 23-ounce can apparently contained the equivalent of 5 shots of vodka and 3 cans of Red Bull, and typically cost less than $3.00.  Such cheap and highly potent concoctions don't exactly promote moderation.  But unfortunately that fact was lost in all the hysteria over alcohol and energy drinks.

Hand Sanitizer Hype

Anyone who has looked at the news in the past two weeks is probably familiar with the latest moral panic:  teenagers drinking hand sanitizer to get drunk.   Apparently, most hand sanitizers (which unlike beer don't have an age limit) contail large amounts of ethanol (i.e. drinking alcohol), up to 60-70% in fact--making it nearly as strong as 151.  So strong, in fact, that some teens ended up in the emergency room with alcohol poisoning as a result.  (WARNING:  DO NOT TRY THIS AT HOME!)  And the media are clearly eating it up.

But is there really any reason to panic?  Probably not.  For one thing, overall teenage drinking is actually at a record low according to the Monitoring the Future survey and other surveys.  Secondly, alcohol "surrogates" are nothing new--vanilla extract, mouthwash, and cough medicine all typically contain alcohol and have no age limit to purchase them despite the fact that they are (ironically) more harmful than normal alcoholic beverages.  There have always been at least some people consuming them, and there is zero hard evidence that surrogates in general are any more popular among young people today than they were a generation ago.  In fact, very few teens actually end up resorting to drinking sanitizer or any other surrogate alcohol, and so far the number reportedly ending up in the ER from sanitizer remains in the single digits.  But just like moral panics and media hype about glue-sniffing in the 1960s actually made the practice more popular among teenagers, there is the same potential for hand sanitizer to follow such a trend if the media keeps at it long enough.

One thing is clear, however.   The idea that the drinking age should be 21 (as opposed to 18) to keep booze away from high-schoolers now appears to be even more of a canard in light of the fact that kids of any age can just drink sanitizer (and other more harmful surrogates) to catch a cheap buzz when all else fails.  It appears that this "trickle-down" theory is just as bogus as the other one.

If all this sounds similar to what happened during Prohibition, you would be correct.  "Paint remover" (industrial denatured alcohol) and various patent medicines like "ginger jake" were among the surrogates used by drinkers in the 1920s, with disastrous consequences.   Sadly, as many as 10,000 people died as a result, and their blood lies on the hands of the feds who mandated the deliberate poisoning of alcohol surrogates while simultaneously denying legal, quality-controlled alcoholic beverages to the people for thirteen years in a row.  The results were all too painfully predictable.  And unfortunately, those who fail to learn from history are doomed to repeat it.

When Alcohol Retreats, Cannabis Advances (And Vice-Versa)

A number of studies suggest that alcohol and cannabis (marijuana) are economic substitutes, meaning that when one increases, the other tends to (albeit unequally) decrease.  The past five years are one example of such opposing trends.  Thus, one apparent unintended consequence of raising the drinking age to 21 was a modest increase in cannabis use among 18-20 year olds and high school seniors.

The most recent study by Crost and Guerrero (2011) found that, using a regression discontinuity approach, upon turning 21 young adults tend to increase their drinking and decrease their cannabis use, both in terms of probability and frequency.  The authors estimate from this pattern that the 21 drinking age law decreases past-month alcohol use by 16% while increasing past-month cannabis use by 10% among 18-20 year olds.  The apparently larger effect size for alcohol may reflect greater reporting bias of drinking (which is illegal before 21 but legal afterward) relative to cannabis use (which is illegal for all ages), so the real effect on alcohol may be considerably smaller.  This study dovetails nicely with an older study by DiNardo and Lemieux (2001), which found that raising the drinking age to 21 in the 1980s led to a decrease in self-reported alcohol use accompanied by an increase in self-reported cannabis use by high school seniors, though both effects were fairly small.  It also dovetails somewhat with the webmaster's own (albeit unscientific) observations of his peers' behavior in high school and especially college.

Further evidence for substitution effects can be found in another recent study by Anderson and Rees (2011).  This study found that legalization of medical cannabis was associated with a modest increase in self-reported cannabis use among young adults aged 18-25 (but not among people under 18) and a modest decrease in alcohol sales and consumption.  Even more notably, legalization of medical cannabis was associated with a 9% decrease in traffic fatailites, which was most likely a result of reduced alcohol consumption.  Also, the same DiNardo and Lemieux study mentioned before found that state-level decriminalization of cannabis was associated with a decrease in drinking among high school seniors, even though there was no corresponding increase in cannabis use (actually, both went down).  Interestingly, in contrast to the effects of the drinking age, higher beer taxes were found to reduce both alcohol and cannabis use.

So is this apparent substitution effect of the 21 drinking age a good thing or a bad thing?  While it is true that unadulterated cannabis is generally safer than alcohol by just about any objective measure of harmfulness, neither substance is absolutely safe for everyone, and most of the pro-21 crowd would probably not be very thrilled about an increase in cannabis use.    Furthermore, reporting bias may very well overstate the effects of the drinking age on alcohol (but not cannabis) use, and thus the net effect is uncertain.  Even though probability and frequency of drinking may be reduced somewhat by a 21 drinking age, the intensity of the clandestine drinking that remains may very well increase to more dangerous levels for a variety of reasons.  More ominously, though there have been no direct studies to our knowledge of the effects of the drinking age on hardcore drug (cocaine, heroin, methamphetamine, etc.) or prescription drug abuse among teens and young adults, it is nonetheless plausible that there may be some substitution of those more dangerous substances for alcohol as well.  After all, the crack epidemic of the late 1980s and early 1990s roughly coincided with the drinking age being raised to 21, and the more recent increase in prescription drug abuse coincided with increasingly tougher enforcement of the 21 drinking age.  And while the gateway drug theory is largely a bogus concept, as long as cannabis remains illegal, users will continue to expose themselves to dealers who may also be peddling more dangerous wares.

While Twenty-One Debunked does not take an explicit position on whether cannabis should be legalized, it should be noted that our parent organization, the True Spirit of America Party (TSAP), fully supports cannabis legalization for all adults 18 and over.  And Twenty-One Debunked believes that, if and when cannabis does become legal, the age limit should be 18 rather than 21, for many of the same reasons that we believe that the drinking age should be lowered to 18.

The Invisible Knapsack

Two decades ago, Wellesley College professor Peggy McIntosh coined the term "invisible knapsack" to refer to the subtle and not-so-subtle advantages that come with white privilege and male privilege resulting from inequality.  She describes such privilege as being "like an invisible weightless knapsack of special provisions, maps, passports, codebooks, visas, clothes, tools and blank checks".  The idea is that while we are generally taught that racism and sexism put some people (i.e. women and people of color) at a disadvantage, we are often taught to remain blissfully unaware of its corollary advantages that accrue to white males.  Hence, the "invisible knapsack" of privilege.

We at Twenty-One Debunked couldn't help but notice just how much this metaphor also relates to America's 21 drinking age and the "over-21 privilege" that results.  Being well over 21 myself, as the webmaster and founder of Twenty-One Debunked I have put together a list of advantages in the invisible knapsack of over-21 privilege that people like myself carry every day.  As a person over 21, as long as I have an ID to prove it:

1. I can buy alcoholic beverages at any store that sells them, in any quantity I wish.
2. I can enter pretty much any bar or nightclub of my choosing without fearing that people of my age group cannot get in or will be mistreated in the places I have chosen.
3. If I do not want to associate with people under 21, I may frequent numerous establishments that ban younger people from entering.
4. I am never asked to speak for all of the people in my age group, nor do I have to worry about my individual behavior reflecting on my entire age group.
5. I can legally host a drinking party with my friends, as long as all the guests are over 21.
6. I can join my co-workers for happy hour after work, and even talk about it at work, without any sort of shame.
7. When I go out with people under 21, it is generally understood that one (or more) of them will be the designated driver instead of me.
8. Generally speaking, I can drink alcoholic beverages fairly openly without having to worry about getting arrested, fined, jailed, expelled, having my driver's license revoked, or being publicly humiliated.
9. As long as I am not driving, I can legally get as drunk as I please in many states. 
10. Even in states where public drunkenness is technically illegal, the cops are unlikely to arrest me unless my behavior is really out of control.
11. If I get in alcohol-related trouble on campus, I will likely face lesser penalties, and I will not have to worry about my parents being notified without my consent.
12. If I think one of my peers may have alcohol poisoning, there would be no reason for me to hesitate to call 911 for fear of the law (and vice-versa).
13. I can have a drink or two (or maybe even three!) before driving without having to worry about being over the legal limit for DUI.
14. Even if I drive while over the limit, I can be assured that drunk drivers in my age group will NOT be the highest law enforcement priority.
15. If I choose to drive drunk, I can know that I am statistically more likely to kill someone under 21 than the other way around.
16. Even if I had several convictions for DUI or drunken violence, I can rest assured that I will still be allowed to buy and consume alcohol.
17. I enjoy less scrutiny over my own behavior, because I live in a society in which young people are scapegoated for adult problems.
18. I do not have to worry about being a good role model when it comes to drinking, since people under 21 can be punished (often severely) for emulating me.
19. Finally, I have a much better chance of being taken seriously on the issue of lowering the drinking age, without being accused of selfishness or immaturity.

And the list goes on.  As we see, the 21 drinking age is not just about disadvantaging people under 21, but giving unearned advantages to people over 21 as well.  And while some of these advantages are positive rights that should be extended to everyone (or at least all adults over 18), others are not "rights" at all, but wrongs that are an unfortunate byproduct of setting arbitrary age limits and of adultism in general.  Still others could be considered either rights or wrongs depending on the context.  And let's not forget the luxury of being able to ignore the issue entirely.

So, are the advantages found in this invisible knapsack really worth it?  Many people over 21 would say yes, but upon closer examination these advantages actually come at a hefty price, even for people over 21.  Just think about social host liability laws, other annoying ancillary laws, millions of tax dollars wasted on enforcement, loss of social cohesion, and precedent that can be used to make our supposedly free country even more of a police state.  In fact, the only people over 21 who, on balance, really benefit from the status quo are the ones who least deserve to benefit--those who drive drunk or otherwise behave irresponsibly when it comes to alcohol, as well as those parents who would rather stick their heads in the sand than teach their kids how to drink responsibly.

Do you hear that?  That's (hopefully) the sound of the pro-21 crowd throwing up all of the proverbial Kool-Aid they drank long ago.

2022 UPDATE:  Ten years after writing this, we felt the need to update this list to also include tobacco and cannabis well.  The smoking age for the former was raised to 21 in recent years, and all the states that legalized cannabis set the age limit at 21 as well.