Monday, January 5, 2009

Problem Drinkers: can you spot them in kindergarten?

Have you ever heard or read a statement something like this?
“Children who begin drinking before age 21 are more than twice as likely to develop alcohol-related problems. Those who begin drinking before age 15 are four times likelier to become alcoholics than those who do not drink before age 21.”*

Or how about this:
Research tells us if we can keep the kids off cigarettes and alcohol, by the time they graduate (presumably...from high school) there’s almost zero percent chance they will abuse any other type of drug.”**
Makes it sound like there's a definite link there, doesn't it, between early-onset drinking and alcoholism? That's called causality, as in one thing -- drinking before you're 15, or before you graduate from high school -- causes another -- alcoholism. After all, those who begin drinking before age 15 are four times more likely to become alcoholics. Sounds pretty damning.

Ever considered how ice cream causes drowning? "Research shows" that when ice cream consumption goes up, drowning deaths also increase. It's true, but it's also unrelated, and it's a well-known example of what happens when researchers confuse correlation with causality. See, ice cream consumption goes up in the summer...which is also when more people go swimming. The more people go swimming, unfortunately, the more drowning incidents there are. Nothing to do with ice cream consumption.

I know some of you are thinking, hold on, Lew: there's a lot more connection between teen drinking and adult drinking than there is between ice cream and swimming. How do I know there isn't a real relationship? Good question, fair question (the kind of question I wish more New Dry researchers would ask).

Here's the answer.
“AFD (age at first drink) is not specifically associated with alcoholism but rather is correlated with a broad range of indicators of disinhibited behavior and psychopathology. Moreover, individuals who first drink at a relatively early age manifest elevated rates of disinhibitory behavior and psychopathology before they first try alcohol. Taken together, these findings suggest that the association of AFD with alcoholism reflects, at least in part, a common underlying vulnerability to disinhibitory behavior. Whether an early AFD directly influences risk of adult alcoholism remains unclear.” (McGue, M., et al. Origins and Consequences of Age at First Drink. I. Associations with Substance-Use Disorders, Disinhibitory Behavior and Psychopathology, and P3 Amplitude. Alcoholism: Clinical & Experimental Research. 25(8): 1156-1165, August 2001.)

And further, the same authors also report:
“Problems seen in adulthood among early drinkers existed prior to their taking that first drink, which suggests that developmental processes were already disrupted prior to that first drink. Thus, an early AFD is more likely a 'symptom' of an underlying vulnerability of disinhibitory processes rather than a 'cause' of increased rates of alcoholism."

A 'symptom' ... rather than a 'cause.' It's correlation, not causation. Both behaviors -- early drinking and alcoholism -- are outcomes of disrupted personal development. When I think about the kids in my high school who drank or used drugs, with only a couple exceptions, they were kids who'd been in trouble since grade 3 or 4 (I went to a rural public school where we didn't have a lot of families moving in and out; I was with most of these kids from kindergarten to 12th grade). They started drinking because they already had problems, the kinds of problems that can lead to alcoholism.

Here's what the people who write press releases for groups like CASA and PIRE and the Marin Group probably saw in a report from the National Institute on Alcohol Abuse and Alcoholism. Unfortunately, they probably only read the part in boldface:
People who begin drinking before age 15 are four times more likely to develop alcohol dependence at some time in their lives compared with those who have their first drink at age 20 or older. It is not clear whether starting to drink at an early age actually causes alcoholism or whether it simply indicates an existing vulnerability to alcohol use disorders. For example, both early drinking and alcoholism have been linked to personality characteristics such as strong tendencies to act impulsively and to seek out new experiences and sensations. Some evidence indicates that genetic factors may contribute to the relationship between early drinking and subsequent alcoholism.
But it's the first part that gets quoted in newspaper stories, and in the years since that report came out, the quotes have gotten further and further from the NIAAA's cautions in the rest of the paragraph. And no one ever calls them on this.

I don't want anyone to think that I don't consider underage drinking to be a serious problem. Given the way people under the legal age drink in this country, it's a very serious problem. But here's the thing. I got these quotes from Alcohol Problems & Solutions, an excellent website I've been reading for years, done by David Hanson, a professor emeritus at SUNY Potsdam who's been researching alcohol issues all his life. And Hanson finished up the piece in question with this very neat summation of why we should resist all the ridiculous measures like keg registration and laws that seize houses for underage drinking: "If alcohol policies are based on false assumptions, they are likely to be ineffective and a waste of effort and resources."

I am thinking of the children. I'm thinking of the adults too. I just wish the people who are responsible for creating and implementing alcohol policies...would think more clearly.

*That's former Secretary of Health (and well-known anti-everything loonbag) Joseph Califano, in "Teen Tipplers: America’s Underage Drinking Epidemic," from the ever-popular Center on Addiction and Substance Abuse (CASA) in a 2002 press release.

**And that's a Drug Abuse Resistance Education (DARE) official in the Green Bay Press-Gazette, on May 18, 2004.


bilking said...

If true then most of the UK should be going to AA. I swear I sat next to a 12 year old putting down a pint in Bruxton. And it was a school night.

Spencer said...

I know a bunch of (self-admitted) alcoholics. Most of them are "in recovery" -- sober and working to stay that way. There are behavioral and personality characteristics that are more common among that group than among the population in general. "Disinhibited behavior" might describe some of those -- what the general public is more likely to call "risk taking." Do these personality characteristics cause alcoholism and/or addiction? I think not. I think that they are both indications of underlying brain function that predisposes (makes it more likely that) those people to become alcoholic.

Can you spot them in kindergarten? I don't know. Most young children are pretty "disinhibited".

Of course, if you believe that early drinking causes alcoholism, then most Europeans should be alcoholics! With the (public) drinking age as low as 14 (Germany when in the presence of a guardian, for example) in public and generally unregulated in private, the rate of alcoholism "should be" 4x the rate in the US, right? But it's not.

I believe that drinking does not cause alcoholism, except in the negative: if you don't drink, you won't exhibit alcoholism. I was told, by a doctor who worked in addiction treatment, that for alcoholism/addiction to manifest in a person requires three factors: predisposition, exposure, and time. The "good news" in that triumvirate is that those of us who are not predisposed are very unlikely to become alcoholics. He liked to give the example of Winston Churchill, who drank heavily, but who never exhibited alcoholic behavior.

Those who are predisposed (by genetics or possibly environment), given sufficient exposure for sufficient time, will likely develop alcoholic/addicitive behaviors. I know people who were essentially "hooked" by their first drink, and others who developed it very slowly over years.

It's not simple, it's not a "sin", and it's not a lack of will. It is, and should be treated as, a public health problem. We, as a society, and the individuals who are affected by alcoholism, would be better off, all around, if we did.

bill mc said...

Oh Hell, I remember my Russian Grandfather and Slovakian Grandmother giving me beer when I was 5 years old! What does that make me????

Lew Bryson said...

Well-spoken, and I misspoke: I should not have said that the problems caused the alcoholism, but rather, as you say, are indicators of a predisposition.

The "kindergarten" was a bit facetious, although some of the researchers did say that some indicative behavior shows up as early as preschool.

Your point about the rate of alcoholism in Europe is a good one, and the same one I use to take the wind out of the "underage drinkers' brains are not fully developed and drinking will damage them." This is why there's a rampant epidemic of brain damage in Europe and Canada. Yup.

It's definitely not simple, and we ignore it or trivialize it at our peril.

Lew Bryson said...

bill mc,

I'd say that makes you lucky. My German grandmother gave me prune juice.

Rich Pawlak said...

The twins get to sip a beer whenever they ask; so far I can report accurately that Sophie loves hoppy beers, and Ben tens toward sweeter stuff, Yuengling Porter, Lager, Chesterfield Ale.

JP said...

Correlation is not causality good point Lew. But where are you headed with this? The subject of teenage alcohol abuse and AFD, is so broad and encompassing it is easy to find pretty "conclusive" sounding research from all points of view. I think I understand the point you want to make, and I agree with you that bad science makes for bad policy decisions, but I think this is not the best example.

Bill said...

Giving beer to a baby! Well I never! For shame!




thbeer said...

I grew up in a Catholic Irish-German family where beer/wine was always available to everyone regardless of age. We were taught responsibility by our family and luckily no one in our family has developed a problem with alcohol. IMO it is that there is a causation between early responsible experiences, not just with alcohol, and later responsible use as an adult.

bill mc said...

Lew, yes I agree, I was lucky and it was Ortliebs. Prune juice, eh? Hey, she did what she thought was right and you still turned out a beer lover.

The American Don said...

It's also worth noting what everyone is calling "Alcoholism". I've heard tell that if you EVER woke up hungover or still drunk ONE TIME, you are an alcoholic. If you ever took a drink to cure a hangover, you are an alcoholic. That is how a lot of this BS gets skewed and laws for "our public good" are created.

There was a study and it was pasted all over the news for a hot minute that like 80% of urban women are unmarried. Turns out, they were counting "women" starting at 15 years old. WTF.

When it comes to these studies that will lead to laws, be wary of who's promoting these laws and who funds their campaigns. The beer distributors run the alcohol politics in Texas. As such, microbreweries have a hard time surviving. Hence Asheville, NC has more microbreweries than all of Texas.

Anonymous said...

i heard over 7 drinks a week is a problem drinker . i personally think most people who get into trouble with alcohal have a personality that makes them go there and they use the alcohal as a excuse .if you see someone drinking 15 light beers in a night there most likely a jerk anyway .

Brad said...

Causation vs. correlation. I'm reminded of the following exchange:

Homer: Not a bear in sight. The "Bear Patrol" is working like a charm!
Lisa: That's specious reasoning, Dad.
Homer: Thanks, honey.
Lisa: By your logic, I could claim that this rock keeps tigers away.
Homer: Hmm. How does it work?
Lisa: It doesn't work; it's just a stupid rock!
Homer: Uh-huh.
Lisa: But I don't see any tigers around, do you?
Homer: Lisa, I want to buy your rock.

Zetsumetsu said...

Great cartoon on correlation...

Lew Bryson said...

Good cartoon; one of my son's fave webcomix sites. Thanks!