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.

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?