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.

A Generation of Sociopaths?

Are Baby Boomers (i.e. the generation born between 1946-1964) really a generation of sociopaths and/or narcissists?  That is in fact the conclusion of a controversial new book by Bruce Gibney, titled A Generation of Sociopaths.  And while we at Twenty-One Debunked are really not fond of condescending broad generalizations about any generation, there does seem to be at least a kernel of truth to his thesis, and it is nonetheless a breath of fresh air to have a book that at least doesn't glibly vilify Millennials and/or Gen Z like so many do nowadays.

According to Gibney, himself a member of Gen X, traits associated with antisocial personality disorder and narcissism do seem to be more prevalent in Boomers compared to any generation before or since.  And the hard data pertaining to behaviors associated with such traits, especially crime rates and substance abuse, do indeed seem to bear this thesis out rather nicely, as do the voting records of that generation.  Reagan, both Bushes, Bill Clinton, and especially Trump could never have been elected without the Boomers voting for them in large numbers.  These candidates all basically promised Boomers (especially white, middle class ones) the moon while asking essentially nothing of them in return, and no price was too high as long as someone else (i.e. future generations) paid for it.  And all of these candidates, to one degree or another, did serious damage to our country--economically, socially, and ecologically.

Granted, "not ALL Boomers" are like that.  But enough of them are to be a problem, and more so than any other generation.  Sound familiar?  It really should.

The real question here is WHY this generation who had so many advantages in terms of wealth and power turned out the way that they are.  Gibney, predictably, blames "permissive parenting" and the fact that they were the first generation raised with television.  True, as the Dr. Spock generation they (mainly white, middle-class Boomers) were raised more permissively than previous generations, and likely more so than subsequent generations in at least some ways.  The mid to late 1970s could indeed be considered a time of "peak permissiveness" in terms of both parenting practices and public policy, and such trends towards permissiveness indeed began from about 1945 onward.   No doubt about that.

But stating such time-series correlations does NOT actually establish causation.  Another factor, overlooked by Gibney, explains Boomer (and early Gen X) traits, behaviors, and statistics far more than anything else:  preschool lead poisoning from leaded gasoline and paint.   Leaded gasoline begain being used in the 1930s, and after WWII, gasoline consumption (and thus lead pollution) increased dramatically until the 1973-1974 oil crisis and the phaseout of leaded gasoline beginning in 1976.  Lead paint, which was banned completely in 1978, had already been phased down in decades prior, but lingers in older housing stock.  Thus, the first permissively-raised generation and the first televison-raised generation and the wealthiest generation in history and the most heavily lead-poisoned generation in history are all in fact one and the same.

And unlike the specious correlations with parental permissiveness and screen time, the correlation with early lead poisoning (a known nasty neurotoxin) and various traits and behaviors that can be described as sociopathic (or at least poor impulse control) is undeniable and meets all of the Bradford-Hills criteria of causation.  As researcher Rick Nevin notes, relationship between preschool lead exposure and such adverse later outcomes as major and minor crime, juvenile delinquency, unwed/early pregnancy, and stuff like that remains highly robust across studies numerous time periods, nations, cultures, and functional forms.  And while white, suburban and rural, middle-class Boomers were arguably much less affected by such lead poisoning than their poorer, urban, black, and/or Latino counterparts in terms of lead poisoning, that doesn't mean that they were completely unaffected by it, since there was still plenty of lead to go around everywhere.  The difference was really one of degree, not kind.

Fortunately, thanks to the phaseout of leaded gasoline and paint, newer housing stocks, and reduction of lead emissions from incinerators, lead poisoning in children today is now at the lowest level in at least a century.   But there is still much work to be done.  There is plenty of old housing stock with deteriorating lead paint, and there is still too much lead in the drinking water of many communities across the country.  According to Nevin, replacing old windows in old housing with new, double-glazed, energy-saving windows, along with stablilizing currently deteriorating old lead paint on walls, would be "low-hanging fruit" in terms of lead abatement that would more than pay for itself in the long run.  As for drinking water, replacing the older service lines would be expensive and time consuming (though still worth doing nonetheless), but in the meantime we could stop adding fluoride yesterday (which is not only neurotoxic in its own right, but potentiates the neurotoxicity of lead and increases lead corrosion and leaching from pipes) and perhaps use ozone instead of chlorine (which also leaches lead) for disinfection of the drinking water supply.

And while many of the Boomer-induced problems left for future generations are indeed real, we should also note that Gibney's fretting about the national debt and Social Security's supposedly impending insolvency is misplaced since these things are really non-problems for a Monetarily Sovereign government like our own federal government.  It is in fact a Big Lie that federal taxes actually pay for federal spending and that the federal government can somehow run short on dollars.  And that big, scary number that is our so-called "national debt" is not debt in the usual sense of the term but rather more like a national savings account.  Author Rodger Malcolm Mitchell, himself a member of the Silent Generation, would have some choice words for authors like Gibney in that regard.  But that is a topic for another discussion.

So perhaps what is really needed here, instead of vilification of an entire generation, is that crucial trait that sociopaths and narcissists lack:  empathy.