The Public Health Crisis That Wasn't

One of our favorite journalists, Annie Lowrey, recently wrote an article titled, "America's Invisible Pot Addicts".  While she is clearly no friend of cannabis prohibition and in fact has repeatedly gone on the record supporting legalization, in this article the author addresses head-on the issue that many (but not all) legalization advocates have heretofore been loath to discuss at all:  cannabis addiction and its apparently growing trend in this country.

As she quotes various self-styled experts on the matter, we seem to get several different answers on the size of the problem and especially how to handle it.  But some facts are undeniable regardless of who says them:

• Some people can indeed become dependent on cannabis, to one degree or another.  And while cannabis is significantly less addictive than alcohol, tobacco, hard drugs, prescription painkillers and sedatives, and even caffeine, it can still become quite habit-forming when used too frequently and heavily.
• While cannabis addiction is usually not as severe as most other addictions, it can be for some people.  Cannabis may be relatively harmless for most of its users, but that does not make it completely safe for everyone.  Some may find that it can have quite a dark side when seriously abused.
• Since the early to mid-1990s and especially since the early 2000s, rates of "cannabis use disorder" (abuse, dependence, or both) as defined by DSM-IV criteria have increased markedly, as have the percentage of daily or near-daily (DND) users of cannabis (about half of whom are dependent).
• While some of those who technically meet DSM-IV criteria for abuse or dependence are pseudoaddicts or an artifact of social stigma and prohibition, others are indeed genuine addicts, and the exact proportion is not entirely clear.
• Likewise, many DND users are truly medical or quasi-medical users, but many are clearly not.
• These trends in heavy and/or dependent use began long before recreational legalization and even before medical legalization in most states, and there is no unambiguously prospective link between legalization and such trends.
• These trends have occurred primarily among adults rather than teenagers.
• Regardless, none of the above facts constitute a real public health crisis at this time, and all of this truly pales in comparison to the opioid epidemic as well as the "pink elephant in the room" that is America's alcohol problem.

So yes, Virginia, there really is a "there", there, but contrary to what some commentators may fear, it is unlikely that legalization is really anything to fear in terms of making it worse.  After all, prohibition clearly couldn't stop it from rising over the past quarter-century.  And us legalization advocates would do wise to stop the denials and face the problem head-on, without fear that it would weaken our movement one bit.  Do not fall into the trap of ceding the moral high ground to the anti- side.  At the same time, we must also tackle head-on the "tyranny of the weaker brother" that really has no place in a free society.

The message really needs to be that spending the majority of one's waking hours under the influence of any psychoactive substance is probably not a wise idea, unless of course one truly needs it for medical reasons.   Saying that cannabis is the safer choice is NOT the same as saying that it is absolutely safe for everyone.  Besides, when you are stoned all the time, it basically loses its fun eventually, and isn't the whole point of recreational use by definition to have fun in the first place?  As Dr. Andrew Weil notes, if it stops being fun or effective, the worst thing one can do is smoke even more weed or seek out stronger strains.  And if you're at the point where you can't even enjoy video games without being stoned, that is definitely a warning sign that you need to at least take a break or cut back significantly, if not quit completely.

It is utterly important to first name and define the problem before discussing it further, to avoid inadvertently reinforcing the lies and half-truths on either side of the debate. We are talking about problematic, chronic, heavy, very heavy, and ultra-heavy use of cannabis here, at ANY age.  We are NOT talking about casual use, use per se by people below some arbitrarily high age limit, or about the roundly debunked "gateway theory" either.   Toking up, say,  once a week (or less) is really NOT the problem here, it's more like toking up every day or nearly so, especially multiple times a day, and/or in very large quantities, that is the real problem.  And while slopes may be slipperier than they appear as one approaches heavier and heavier use, the vast majority of cannabis users still do NOT become chronic heavy users.  And among those who do, it doesn't usually last very long, though for some it unfortunately does.

Likewise, while there currently is no hard scientific evidence (and not for lack of trying to find it) that using cannabis at 18 is really any worse in practice than using it at 21, 25, or even 30 for that matter, there is nevertheless some evidence that using before 18 and especially before 15 may indeed be riskier overall, both in terms of potential harm as well as addiction potential.  It is quite nuanced and the studies still need to be fleshed out, for sure.  But we should note that the aforementioned chronic, heavy users that represent the real problem typically started toking before 15 and/or transitioned to heavy use before 18 as a rule.  And many, if not most, of those users have also used alcohol and/or tobacco at an early age as well, again especially before 15.

As for public policy within the framework of legalization, Lowrey notes that probably one of the best--if not the best--measures that policymakers can take is to raise the taxes on cannabis.  That would, by definition, hit the heaviest users the hardest, while casual users would barely even notice the resulting price hike.  Of course, it would be best to keep the taxes very low at first in order to destroy the black market, and then gradually but sharply raise them beginning a year or two after legal recreational sales begin in a given state.  Lowrey also notes other ideas as well, such as capping THC levels in products, dispensing public health information, and restricting advertising, which are likely good ideas.  But excise taxes, especially if they are proportional to THC content (and perhaps inversely proportional to CBD content as well), would probably have the largest effect size of all in terms of reducing cannabis-related problems.  As for the fear that higher cannabis taxes would drive users back to alcohol, well, we all know by now how to prevent that hypothetical from happening:  simply raise the taxes on alcohol as well.

In other words, freedom has nothing to fear from the truth.  That, and don't fear the reefer--but DO treat it with the respect it deserves nonetheless.

Why Are Traffic Deaths on the Rise? (Part Deux)

After decades of a massive secular decline in traffic deaths, reaching an all-time record low in 2014 per VMT as well as per capita, such deaths have been creeping up again since then.  2015 and 2016 both saw national increases in fatalities, and while 2017 saw a slight decrease from 2016, the number of deaths still remains stubbornly higher than it was before the increase.  In fact, 2015-2016 is the largest two-year jump in deaths in half a century.  So why has progress stalled and begun to reverse in recent years?

The list of most likely factors includes the following:

• Lower gas prices
• An improving economy since the Great Recession
• An increase in distracted driving (and walking), primarly from smartphones
• Higher speed limits than in the past 
• Infrastructure in disrepair from decades of gross neglect
• Slacking on traffic safety improvements in general since the early 1990s

All of these things are true, and all of them are known to be correlated with traffic casualties.  Other factors are involved as well, to be sure, but these are the big ones.  The first three are the proximal causes, while the last three are the more distal ones.

Of course, drunk driving and not wearing seatbelts remain rather persistent contributors to the number of these deaths, but such behaviors remain far lower than they were decades ago.  Nevertheless, they remain at dangerous levels, and it is apparently a bit too early to feel safe in that regard.  And with real alcohol prices at record lows today and alcohol consumption on the rise for the past two decades, there is definitely a cause for concern in that regard.

What about drugged driving, then?  Is it really on the rise, like some have claimed?  Perhaps, but it may simply be that we are getting better at detecting it rather than an actual increase.  Or perhaps it is a bit of both.  The opioid epidemic certainly doesn't make the roads any safer, with such doped-up drivers nodding off behind the wheel.  And contrary to the anti-legalization folks, there does not seem to be any firm link between cannabis legalization and traffic fatalities.  In fact, some studies have found decreases in highway deaths following cannabis liberalization, due to an apparent substitution with alcohol (and perhaps opioids as well).  As for the specious claim of preliminary evidence linking the increase in pedestrian deaths in some legalization states in the first half of 2017 with legalization, that does not really pass the smell test because 1) not all legalization states even saw any increase during that time, 2) small numbers tend to fluctuate wildly, and 3) why would cannabis legalization only affect pedestrian deaths and not other traffic deaths during that time as well?

One thing is for sure.  Whether this spike in traffic casualties is a short-term blip or the start of a longer-term trend (which will only be known in hindsight), it should be a major wake-up call that we clearly cannot afford to be complacent about it any longer.  The USA has seriously lagged behind other industrialized countries for decades in terms of progress on traffic safety (all of which have lower drinking ages than we do, interestingly enough), and we need to catch up, yesterday.  That includes the safety of pedestrians and cyclists as well, who have borne the brunt of the recent increase in traffic deaths.  And even when vehicle miles (or kilometers) traveled are taken into account, the USA still has either higher fatality rates and/or has seen less progress since the 1980s compared with nearly all other industrialized (and even semi-industrialized) nations.

A short list of things we can do include:

• Crack down on drunk driving, drug-impaired driving, reckless driving, and distracted driving--yesterday.
• Stiffen the penalties for hit-and-run crashes--yesterday.
• Reduce speed limits, especially on side streets, arterials, and smaller highways--yesterday.
• Install speed cameras and red-light cameras in more places (but be sure to also lengthen the yellow lights and double-reds to prevent it from backfiring with more rear-enders).
• Raise the gas tax by a penny per week until it is at least 50 cents/gal higher than now ("A Penny for Progress") and/or implement a carbon tax-and-dividend scheme.
• Raise the alcohol taxes significantly as well (note how those taxes have been lagging behind inflation for decades in most states).
• Design roads/streets to be more pedestrian-friendly and bike-friendly as well.
• Invest more in public transportation, as well as "safe-rider" programs as well. 
• Rebuild America's neglected and crumbling infrastructure, generating millions of new jobs in the process.
• And last but not least, make the road test harder like it is in many other countries, and make driver's licenses easier to lose for serious and/or repeated traffic violations.

After all, if it saves even ONE life, it's worth it, right?  Thought so.  So what are we waiting for?

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.

Halfway Decent Study, Wrong Conclusion

Much has been made of a recent Australia and New Zealand study finding that teens who drink regularly (at least once a week) before the age of 17, and especially by age 13, are statistically more likely to go on to drink heavily, become alcohol-dependent, drive drunk, use/abuse other substances, and smoke cigarettes during adulthood.  And while correlation itself does not prove causation, there may very well still be at least somewhat of a causal link all the same that cannot be readily explained away, particularly for those who begin any significant drinking before age 15.  That said, the specious conclusion that New Zealand and Australia somehow should raise their drinking ages any higher than 18 is unwarranted and not actually supported by the data in this study.

Take it from us in the USA, who have had a legal drinking age of 21 since the 1980s (and much earlier than that in some states).   It simply does NOT work, and merely forces drinking further underground and makes it far more dangerous than it has to be.   It infantilizes young people and erodes respect for the law, and overall does more harm than good.  So what should be done to reduce and/or delay youth drinking, assuming that is the goal?

• Raise the taxes on all alcoholic beverages across the board, ideally making such levies proportional to alcohol content.  That is the single most effective and cost-effective way to reduce alcohol-related harms without actually violating anyone's rights.  So raise them as high as you possibly can without triggering widespread moonshining and bootlegging.
• Set a minimum price floor for alcoholic beverages as well, for both on and off-premise sales.  Both this as well as raising alcohol taxes would have a larger impact on young people since they are more price-sensitive on average.
• Reduce alcohol outlet density in places where such outlet density is very high.
• Restrict or ban alcohol advertising, especially ads aimed at young people.
• Crack down on drunk driving, drunk violence, drunk vandalism, and drunk and disorderly conduct--for ALL ages.  Hold individuals accountable for their behavior, no matter how wasted they are.  Period.
• Increase alcohol education and treatment programs.  Yesterday.  And include social norms marketing in this broadly-defined education program.
• And last but not least, before they even consider raising the drinking age, how about actually enforcing the 18 drinking age they have now?  Seriously.  And by that, we mean targeting vendors with complicance checks, rather than the young people themselves.

And there you have it.  There are far better alternatives than raising the legal drinking age.  And raising the drinking age can actually work at cross-purposes with the alternatives discussed above.  True, delaying the onset of youth drinking--especially regular drinking--can evidently be beneficial to a point.  But when you make the perfect the enemy of the good, you ultimately end up with neither.

To South Africa: Don't Be Like Us, Seriously

In recent international news, South Africa has apparently been getting closer to raising their legal drinking age to 21, which if it passes will put them among the tiny handful of countries with the drinking age that high (Palau, Sri Lanka, Kazakhstan, some Muslim countries, and of course the biggest outlier of all, the USA).  So here is our advice to South Africa:

We know you want to join the 21 Club and raise your drinking age to 21, in the hopes that it will reduce your legendary drinking problem.  But take it from us in the USA, who have had a legal drinking age of 21 since the 1980s (and much earlier than that in some states).   It simply does NOT work, and merely forces drinking further underground and makes it far more dangerous than it has to be.   It infantilizes young people and erodes respect for the law, and overall does more harm than good.  Think about that.

So what should you do to reduce your legendary drinking problem?  Well, for starters:

• Raise the taxes on all alcoholic beverages across the board, ideally making such levies proportional to alcohol content.  That is the single most effective and cost-effective way to reduce alcohol-related harms without actually violating anyone's rights.  So raise them as high as you possibly can without triggering widespread moonshining and bootlegging.
• Set a minimum price floor for alcoholic beverages as well, for both on and off-premise sales. 
• Reduce alcohol outlet density in places where such outlet density is very high.
• Restrict or ban alcohol advertising, especially ads aimed at young people.
• Crack down on drunk driving, drunk violence, drunk vandalism, and drunk and disorderly conduct--for ALL ages.  Hold individuals accountable for their behavior, no matter how wasted they are.  Period.
• Increase alcohol education and treatment programs.  Yesterday.
• And last but not least, before you even consider raising the drinking age, how about actually enforcing the 18 drinking age you have now?  And by that, we mean targeting vendors with complicance checks, rather than the young people themselves.

And there you have it.  There are far better alternatives to raising the drinking age. And raising the drinking age can actually work at cross-purposes with the alternatives discussed above.  Take it from us, you will one day regret doing so.  Honestly, the best advice we can give you is "don't be like us".

Seriously.

The Verdict Is In: Legalizing Weed Does Not Increase Crime Rates

The latest studies on the matter have confirmed what the TSAP and Twenty-One Debunked have kinda always known.  Legalizing weed does NOT seem to increase crime rates like the prohibitionists often claimed it would, and if anything, appears to decrease violent and property crimes a bit, as well as improve their clearance rates by police.  But we could've told you that years ago, for those actually willing to listen.

The theory for how legalization of cannabis would reduce crime is fairly simple.  First, it frees up relatively scarce police and other resources that would otherwise be used to bust people for weed, and allows such resources to be put to more productive uses (i.e. targeting real crime rather than victimless crime).  Secondly, cannabis is basically a non-violent drug, and can often substitute for alcohol, which is often (rightly or wrongly) linked to violence to one degree or another.  Thirdly, there is the systemic aspect, the violence linked to the illicit drug trade itself, which would self-evidently decrease if not disappear upon legalization, at least with regard to the substance being legalized. And finally, victimless crime laws, especially widely unpopular ones like cannabis prohibition (and, of course, the 21 drinking age) erode respect for the law in general and also erode cooperation and cohesion between the police and the community.  Thus, it really doesn't take a rocket scientist to see how removing such illiberal and pharisaical laws from the books would tend to decrease crime in general.

What about the opposite theory?  Not the long-debunked one that cannabis per se actually causes violent and property crime (which is rather silly on its face, mind you), but the one that claims that cannabis prohibition is a useful crime-fighting tool for police?  Well, as the saying goes, the proof is in the pudding, and we really don't see any credible evidence of that on balance.  Any utility that such an abomination would have in that regard appears to be more than outweighed by its very real downsides, and thus we can consider that theory debunked as well.

(Cue the Law and Order DUN DUN sound effect.)

We need to legalize cannabis in all 50 states and all territories as well, yesterday, and lower the age limit to 18 as well, just like our neighbor to the north.  It is LONG overdue.  So what are we waiting for?

You May Not Like It, But Here's the Answer to (At Least Greatly Reducing) College Rape and Sexual Assault

As we had noted in a previous post four years ago, rape and sexual assault is a persistent epidemic in the USA, including (but not limited to) college campuses nationwide.  Lately, the chattering classes have been endlessly wringing their hands about it for years, but little real progress has been made in recent years, and since the Trump administration began we seem to have even regressed a bit in that regard, the #MeToo movement notwithstanding.

Most rapes and sexual assaults, especially those involving college students on or near campus, are committed by people known to the victim, and many if not most of those involve alcohol to one degree or another, whether by the perpetrator, the victim, or both.  We should first and foremost note that the only thing that actually causes rape is the rapists themselves, period.   While alcohol (among other substances) can indeed fuel it and is often used as a weapon to incapacitate victims, rape would simply not happen without rapists, period.  And the onus should always fall on men not to rape in the first place, instead of falling on women not to "get themselves raped".  The fact that so many people still deny such an obvious truth in 2018 shows just how far we have yet to go towards eliminating or even reducing this epidemic, and those who blame or otherwise put the onus on potential or actual victims are in fact part of the problem.

We seriously need to drain the proverbial swamp of rape culture, yesterday, and thus revoke the rapists' social license to operate.  Culturally, we need to tackle the root causes of sexual violence by rejecting the highly toxic "commodity model" of sexuality and replacing it with the "performance model" (while also avoiding the negative connotations and pitfalls of the word "performance"), and more generally rejecting the "dominator model" of society and replacing it with the "partnership model".  And for alcohol, we need to recognize that while adopting a "Prohibition-Lite" approach of any sort is most likely to backfire and would throw the proverbial baby out with the bathwater, its link with sexual violence still needs to be dealt with in the meantime as cultural changes can take much time to occur.

So what measures can be taken in the very near term to quickly reduce or at least take the dangerous edge off of this seemingly intractable epidemic?  The reader may or may not like the answer, but here goes:

1. Lower the legal drinking age to 18, yesterday, full stop.  The 21 drinking age makes drinking that much more dangerous than it has to be by forcing it underground, which can put young drinkers in more dangerous situations that increase the risk of sexual assault, and the law itself can be used as a cudgel to silence victims.
2. Raise the tax on alcoholic beverages, both federally as well as at the state and local level (especially in college towns), with extra levies on bulk alcohol such as kegs, cases, and handles. Studies have shown a significant inverse correlation between alcohol prices and rape in general.
3. Legalize cannabis for everyone 18 and older, yesterday.  Cannabis is clearly the safer choice in that regard, as it is highly unlikely to fuel violence or be used as a date-rape drug the way that alcohol all too often is.
4. Pass "Yes Means Yes" laws (aka affirmative consent laws) similar to California's.  If properly written, these laws will essentially eliminate the concept of so-called "gray area rape" by putting the onus on the initiator of sexual activity to be sure that they actually have consent before proceeding further.
5. Last but not least, hold the perpetrators accountable for a change, no matter how powerful or privileged they happen to be.  That includes enforcing both criminal laws as well as campus conduct policies to the fullest extent of the law.  No more Brock Turners.

As for the idea of colleges trying to influence upward the prices of cheap alcohol at parties (particularly Greek parties) that are typically $5 or so at the door for all-you-can-drink, that would be rather difficult to enforce in practice.  But if the drinking age was lowered to 18, most frats would likely end up having a "going out of business party" since their modern-day speakeasy services would no longer be necessary.  And those that remain would, in practice, throw less frequent parties and/or  ones with less beer (or liquor) to go around if the tax on such beverages is also hiked as well.

Doing these things will go a long way towards reducing the rape and sexual assault epidemic in the near term.  Anything less would be uncivilized. So what are we waiting for?

Do Alcohol Taxes Still Work to Save Lives?

Avid readers of our blog would note that Twenty-One Debunked supports raising the tax on alcoholic beverages almost as wholeheartedly as we support lowering the drinking age to 18.  And there are reams and reams of research evidence over many decades--locally, nationally, and internationally--that find that higher alcohol prices (and thus taxes) save lives both on and off the highways as well as reduce crime, violence, and other alcohol-related problems.   In contrast, the ageist abomination that is the 21 drinking age has not consistently demonstrated similar effectiveness in that regard, no matter what sort of pseudo-consensus exists in the minds of its most ardent supporters, and the best evidence thus far has exposed the specious claim of saving lives as little more than a mere statistical mirage all along.

That said, for the specific endpoint of alcohol-related traffic fatalities, among the reams of evidence there have been a few outlier studies that seem to cast doubt on the lifesaving effect of alcohol prices/taxes as well.  The most recent one in 2017 by McClelland and Iselin of the Urban-Brookings Tax Policy Center studied the effects of the Illinois alcohol tax hikes in both 1999 and 2009, and found no long-term lifesaving effect from either one in terms of drunk driving deaths.  In contrast, a previous 2015 study by Wagenaar et al. had found a fairly large drop in alcohol-related traffic deaths following the 2009 Illinois tax hike, even after controlling for the effects of the Great Recession.  The biggest difference between the two studies was that McClelland and Iselin used the Synthetic Control Method (SCM) while Wagenaar et al. did not, and while a good method, like all methods it too can have its own share of pitfalls.

As for the other outlier studies, most of those are dissected and discussed in a 2015 replication review by David Roodman, which still concludes that a true lifesaving effect is likely.  One such outlier study is by Dee (1999), whose control for state-specific time trends apparently removed too much useful variation in state-level beer taxes.  And while Roodman did not discuss our all-time favorite study by Miron and Tetelbaum (2009), we should note that this study in fact began by replicating Dee (1999) using more years of data and including Alaska, Hawaii, and DC, and in contrast to Dee they did apparently find a fairly strong inverse correlation between beer taxes and 18-20 year old traffic deaths even after adjusting for state-specific time trends.

Granted, it is true that for the specific endpoint of DUI deaths, the price of alcohol may not be quite as important as it once was.  Drunk driving is far less common and far less socially acceptable than it was a generation ago, and legal sanctions against it are much stiffer now as well.  And with alcohol prices currently at a record low in relative terms, and alcohol taxes generally being a small portion of the overall price, the link between the two may not be as salient or noticeable as it once was due to being swamped or masked by other factors.  But that does not mean that it is ineffective, given the fact that several more recent studies continue to find such effects, and the numerous studies that continue find fairly large benefits in terms of reducing non-traffic deaths and harms as well (cirrhosis, unintentional injuries, cancer, crime, violence, STDs, etc.).

Thus, the overwhelming weight of the evidence still continues to support the idea that raising alcohol taxes/prices is an effective (and especially cost-effective) public health policy in terms of saving lives both on and off the highways as well as reducing alcohol-related problems in general.  And if it is high enough, it is also justified on Pigouvian grounds as well.  So what are we waiting for?

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.

Update on Guam

Eight years ago this month, we at Twenty-One Debunked were chagrined when Guam unfortunately raised the drinking age from 18 to 21.  We have enough data to give some sort of an update on Guam since the drinking age was raised, and we see that the results were at best a mixed bag overall.

At least one Guam news website since then has trumpeted the July 2010 law change as a success.  For example, they note (correctly) that according to the 2011 Youth Risk Behavior Survey (YRBS), 13.6% of Guam's high school students engaged in "binge" drinking, compared to 19.2% in 2007, the last available year in the survey before the law change.  This drop by nearly a third sounds impressive until you consider the following facts:

1. The decline in high school "binge" drinking actually began in 2001, from a high of 24.9%.  The drop from 2001 to 2007 was almost as large as the drop from 2007 to 2011.
2. The figures also declined in the nation as a whole, from 29.9% in 2001 to 26.0% in 2011 to 21.9% in 2011.
3. Due to the fact that the surveys were not done every year, we have no idea when the decline in Guam began to accelerate.
4. For grades 9 and 10, the differences in "binge" drinking rates between the years 2007 and 2011 were not statstically significant, despite the fact that the differences were significant for the nation as a whole. 
5. In fact, 9th and 10th graders in Guam actually saw increases in self-reported riding with a drinking driver, while the mainland saw decreases.  So much for the trickle-down theory.
6. Guam's teen drinking and "binge" drinking rates have been consistently below the national average, even when their drinking age was 18.
7. Compared with 2007, high school students in Guam saw increases in boozy sex as well as unprotected sex in 2011.
8. While the overall decline in teen drinking did continue in recent years in Guam, we must keep in mind that Puerto Rico (drinking age 18 unchanged) and Northern Mariana Islands (drinking age 21 unchanged) also saw similar declines as well.

As for whether there were any effects on drunk driving arrests or crashes, at first it was too soon to tell since 2011 and 2012 data were not yet available right away.  Even the 2010 data were problematic since the drinking age changed in midyear and there were not enough age-specific data yet for alcohol-related crashes and deaths.   But several years later, we now have enough data to conclude that raising the drinking age in Guam did NOT save lives, since the number of DUI deaths (in total and among people under 21) did not decrease, and in fact even increased a bit since the law change.

We had previously noted the Uniform Crime Report for 2010.  In it we see that total DUI arrests dropped significantly from 2009 but nonetheless remain higher than 2008.  DUI arrests for 18-19 year olds were 42 in 2008, 52 in 2009, and 35 in 2010, which was a slight decrease from 2008.  (Data for 20 year olds in 2010 was lumped in with 21-24 year olds, so it could not be used.)  Juvenile crime (i.e. under 18) saw zero progress overall in 2010, and in fact nearly doubled from 2009.  Specific crimes that rose in 2010 among juveniles included not just DUI but also murder, rape, assault, robbery, vandalism, liquor law, and drug abuse violations among others.

One must also remember that in 2010 Guam had a major crackdown on drunk driving with tougher new penalties (after many years of a very lax policy), and also increased education and awareness about the alcohol problems on the island.  Also, the new drinking age of 21 appears to be more heavily enforced that the previous drinking age of 18, which was poorly enforced.  That's a lot of variables to consider.

The most recent Uniform Crime Report for Guam was for 2016, and the data show that there were 17 DUI arrests for 18-19 in 2015, about half the number there were in 2010. Apparently, data were rather spotty for the years in between.  That said, the number of DUI deaths nonetheless went up from 2010-2013 before dropping again through 2015, so it would be facile and fatuous to link this longer term trend to the drinking age hike.  More likely it was due to increasing crackdowns on DUI in general.

Finally, we should note that if Miron and Tetelbaum's groundbreaking study of the 21 drinking age is any guide, any apparent benefits of Guam raising the drinking age to 21 should disappear beyond the first year or two of adoption.  And while tourism actually went up in 2011 (except for Japanese tourists after the tsunami) contrary to our predictions, and reached a record high in 2017, one could argue that Guam was simply lucky due to a confluence of other factors.  For example, the US military buildup on the island generated increased economic growth that could have potentially masked (or delayed) any declines in tourism that would have otherwise occurred.  The Fijian experience is instructive in that it took fully three years for Fiji to see that tourism was suffering due to the 2006 drinking age hike to 21, and then it was lowered back to 18 in 2009.  And now that Guam has raised the smoking age to 21 as well in 2018, they are really pushing their luck in that regard now.