Lithuania Study Finds Raising Drinking Age Did Not Save Lives After All

Lest anyone speciously claim that Lithuania's raising of the their drinking age from 18 to 20 effective January 1, 2018 somehow saved lives, keep in mind that in 2017 they also greatly raised their alcohol taxes, banned alcohol advertising, and greatly cut trading hours for alcohol sales in 2018.  So once again, we see a great deal of confounding here.  

In fact, one recent study found that once such confounders were adjusted for, any supposed lifesaving effect of the drinking age hike itself on 18-19 year olds disappeared, implying that it was a spurious effect.  The study looked at all-cause deaths, which is probably the most bias-free measurement of the "final bill".  And the drop in deaths was actually larger in 20-21 year olds (who were already too old to have been affected at that time*) than for 18-19 year olds or 15-17 year olds. Relative to the former group, the effect was null, and interestingly no "trickle-down" effect was observed for 15-17 year olds either.  And controlling for alcohol taxes and GDP also rendered the net effect null as well.

Thus, raising the drinking age any higher than 18 is very unlikely to save lives on balance.  But raising alcohol taxes, etc. is very likely to do so, for all ages.

QED

*NOTE:  If many years of post-hike data were observed, it would probably have been better to use a slightly older age group (e.g. 22-23, 23-24, or 24-25 year olds) instead as the control group, since previous studies have found that mortality is often shifted to the age group just above the new drinking age.  However, since just one year of post-hike data was included, the choice of control group remains largely appropriate for such short-term effects, and in any case the relative results were in the "wrong" direction even if mortality were displaced as such.

About That Finland Study

This year, a new study came out in The Lancet that looked at the long-term differences in alcohol-related morbidity and mortality between birth cohorts in Finland that either were or were exposed to the lowering of their legal drinking age from 21 to 18 on January 1, 1969.  That is, based on how old they were when the drinking age was changed.  The study and its interpretation had a clear pro-21 bias. 

While the results did show that, exposed cohorts did have higher morbidity and mortality later in life relative to the unexposed cohorts, the results were ultimately inconclusive since several other changes happened at the same time. For example, the lowering of the drinking age occurred in tandem with other alcohol liberalization policies (in a previously very stringent policy regime with fairly low alcohol consumption) that greatly increased alcohol availability in general and thus consumption in a short period of time.  Urbanization also increased rapidly as well.  Culture changes (especially of the drinking culture) also inevitably occurred as well against a backdrop of increasing general alcohol consumption, and those who came of age during or right after the change would logically have been more affected than those who already came of age just before it, regardless of the legal age limit.  So teasing out the specific effects of the legal drinking age change is really practically impossible in this case.

A cursory reading of the Wikipedia article about Finnish drinking culture will tell you all you need to know about why the age limit is largely irrelevant.

Previous studies on the very long-term effects of the 21 drinking age in the USA and elsewhere have been very scarce and ultimately inconclusive at best as well.  (At least one Swedish study seems to suggest a null effect though.)  And this new Finland study, quite frankly, adds very little.  Causation can thus neither be confirmed nor ruled out, in other words.

Regardless, in any case, even if it were partly causal, using a study like this to justify the ageist abomination that is the 21 drinking age is mission creep at best, and grasping at straws at worst, given that the original justifications for it are either debunked, obsolete, or both.  The idea that some vague conception of "public health", especially theoretically in the distant future, somehow trumps civil rights (and selectively for only one demographic group, no less) is the very worst of utilitarianism and health fascism, and has no place in a free society.

And as long as we are on the subject of Finland, that same country has also since shown us what can be done to rapidly decrease alcohol-related mortality and morbidity at very little cost to society at large and without trampling civil rights:  raising the tax/price of alcohol.  Even the pro-21 crowd, including the authors of the aforementioned study, seem to be willing to concede that.  But apparently that doesn't satisfy the ageists' desire for power and control.  Their libido dominandi seems to know no bounds in that regard.

QED

UPDATE:  And while we are at it, lest anyone speciously claim that Lithuania's raising of the their drinking age from 18 to 20 effective January 1, 2018 somehow saved lives, keep in mind that in 2017 they also greatly raised their alcohol taxes, banned alcohol advertising, and greatly cut trading hours for alcohol sales in 2018.  So once again, we see confounding.  In fact, one study found that once such confounders were adjusted for, any supposed lifesaving effect of the drinking age hike on 18-19 year olds disappeared, implying that it was a spurious effect.

See also a recent 2025 study about Finland as well.