Op-Ed: Disagreeing with "the guess"

I won’t take the time to respond to Mr. Alexander’s vituperative, unprofessional and insulting (possibly slanderous) comments, except to say his endorsement of the European Myth about drinking is regrettable. Research has demonstrated that there is more consumption and more hazardous consumption among European youths than their peers in the U.S. Perhaps it would be useful for Mr. Alexander to actually read the research summaries I provided in my previous comments. As I have mentioned, simply asserting something is so does not make it so.

However, I would like to address the very thoughtful comments of Mr. Trombulak. While his very reasonable idea of a graduated drinking license seems appealing, there are some logical and science-based issues that need to be addressed. Other than the “old enough to fight, old enough to drink” argument I hear during my presentations (which I won’t address here), there is the idea that if we (parents and the educational system) could only take the time to inform youth about the dangers of hazardous drinking this would then provide a basis for them to drink responsibly. It’s a very nice sounding idea — unfortunately, it has no basis in science. The closest analogy to this educational process is driver’s education, which presumably prepares young drivers for the daunting task of safely negotiating the demands of driving a car. Here is what the National Highway Traffic Safety Administration recently (2009) reported about driver’s education: “Studies have failed to show that driver education courses produce safer drivers.”

The World Health Organization (WHO) Expert Committee on Problems Related to Alcohol has stated: “The Committee considered that while provision of information and persuasion is perennially attractive as an intervention to reduce alcohol related harm, particularly in relation to younger people, theory and evidence would suggest that this is unlikely to achieve sustained behavioral change, particularly in an environment in which many competing messages are received in the form of marketing material and social norms supporting drinking, and in which alcohol is readily accessible.” Also: “The Committee noted the results of a number of careful systematic reviews that have been published of evaluations of school-based education which aimed to reduce alcohol-related harm and concluded that the results have not provided support for classroom-based education as an effective intervention to reduce alcohol-related harm. Although there is evidence of positive effects on increased knowledge about alcohol and in improved attitudes, there is no evidence for a sustained effect on behavior.” So, the bottom line is that studies have clearly demonstrated that educational efforts to reduce hazardous drinking in 16-20 year olds have been ineffective. There are many psychological, social, developmental and biological reasons for this failure which I won’t take the time to explain in this short note, except to restate the WHO Expert Committee’s and Dr. Jernigan’s point about the amount of pro-alcohol media our youth are exposed to on a daily basis.

Let me address the specific program proposed by Mr. Trombulak. He is incorrect in stating there are no peer-reviewed studies that address the principles underlying the program. First, there are a wealth of studies that clearly and conclusively demonstrate age of drinking onset is a robust predictor of later alcohol–related problems. More to the point, in a study published in January of this year, researchers from The Netherlands (in Europe!) examined the effect of drinking at home with and without parental supervision. They concluded: “However, in our study, drinking at home predicted increased levels of drinking at home, of drinking outside the home, and problem drinking, while also controlling for previous use in both contexts.” They further stated that “Our findings suggest that parents who do not want their children to develop heavy drinking patterns later on should prohibit the alcohol use of their adolescent children at home and outside the home at an early age.” And finally: “Based on all of the aforementioned results, we could conclude that, if adolescents start to drink, no matter in what setting, with whom they drink [parents or friends], or their age, adolescents will drink more alcohol over time and (consequently) are at risk for problem drinking, a trend also found in previous research.”

Finally, I would ask Mr. Trombulak this question: What would be the criteria for success or failure of the programs you proffer? That is, how many lives need to be sacrificed in alcohol-related traffic accidents or other alcohol-related deaths, how many traumatic sexual assaults have to occur, or how many suicides have to happen before these types of programs are deemed ineffective or worse, harmful? Since we know that increasing access to alcohol in this age group will most certainly increase alcohol-related harms this is a fundamental question.

“It doesn’t matter how beautiful the guess is, or how smart the guesser is, or how famous the guesser is; if the experiment disagrees with the guess, then the guess is wrong. That’s all there is to it.”

— Richard Feynman, Nobel Laureate