The alcohol’s a reality - but so are the saved lives

The Amethyst of Greek myth would probably be asked for her ID if she tried to get a drink in the United States today, and the age law would rule out any need to turn her to quartz to protect her. It remains a curiosity of US culture that a young person can get a license for a hunting gun at 12, can die for her country at 18 but cannot legally buy alcohol under the age of 21.

John McCardell wants to change all that. Once president of Middlebury College a liberal arts college in Vermont, he is among the many college heads who know how difficult it is to uphold the alcohol law, and as the founder of Choose Responsibility, he wants to open a debate about drinking in the US.

“Alcohol is a reality in the lives of young Americans. It cannot be denied, ignored, or legislated away,” the campaign website protests.

On McCardell’s side of the barricade are another 130 college presidents who have formed the Amethyst Initiative, claiming that the age limit has created a culture of dangerous binge drinking on many campuses.

On the opposing side is a formidable group of prevention researchers, several of whom presented at the Society for Prevention Research conference in Washington DC, last week.

At the core of the preventionist argument is the plain fact that when some states lowered the minimum drinking age in the 1970s, the toll of alcohol-related fatal car crashes went up by ten per cent. Since 1984, when Ronald Reagan compelled states to re-introduce the age 21 lower limit, the number of drink-related crashes fell back by 16 per cent.

The unavoidable conclusion is that 1,000 premature deaths are being prevented – to which must be added claimed reductions in homicides and suicides.

As has been the case in most developed nations, the US has arrived at present policy in a less than evidenced based way. After the repeal of prohibition in 1933, most states set the minimum drinking age at 21. But lowering the voting age to 18 in 1971, prompted several states to relax alcohol laws.

The resulting increase in car accidents led to the formation in the 1980s of the improbably named Mothers Against Drunk Driving, or MADD. It was this powerful lobby group, which included relatives of the victims of drink driving crimes, that captured the attention of the normally law-shy Ronald Reagan and persuaded him to turn back the clock.

It is perhaps unsurprising that the Society for Prevention Research, whose history owes much to efforts to reduce drug and alcohol misuses, should have among its members so many who are prepared to challenge McCardell in front of hostile college students on campus debates around the country.

In terms of fatalities, the prevention researchers have a pretty unassailable case. The results of over 50 reputable studies and a couple of systematic reviews all point in the same direction.

But the bigger story about heavy drinking among young people is more complicated. When surveyed, nearly a half of college students admit to being drunk in the past month. Just over a third of 19- and 20-year-olds have been involved in binge drinking in the past fortnight.

These data worry college presidents. Too many have had to expel grade A students because they have been arrested in possession of alcohol. They think there may be some better model to borrow from the responsible citizenry of a more liberal Europe. (It turns out that well educated North Americans have ideas about Europe that are as misguided as well educated European ideas about some aspects of life in the US!)

So the issue is becoming as much a test of political acumen as science. One ex-US surgeon general, presumably well versed in the evidence, has tried using tobacco to make the point, saying, “We have a lot of people who smoke but nobody is proposing to reduce the legal age of smoking”. Not yet at least.

See: National Academy of Sciences/Institute of Medicine, (2004)Reducing Underaged Drinking: A Collective Responsibility

Wagenaar AC & Toomey TL (2002), 'Effects of minimum drinking age laws: review and analyses of the literature from 1960 to 2000', Journal of studies on alcohol, supplement, 14, pp. 206-225

Shults RA, Elder RW, Sleet DA, Nichols JL, Alao MO, Carande-Kulis VG, et al, (Task Force on Community Preventive Services), 'Reviews of evidence regarding interventions to reduce alcohol-impaired driving', American Journal of Preventive Medicine, 21, 4, pp. 66–88