Thursday, 17 December 2009

Government message to teenagers: Don't drink, you might enjoy it

The advice from the government's Chief Nanny Medical Officer Sir Liam Donaldson couldn't be clearer. On no account must anyone under the age of 15 touch a drop of alcohol, ever. Otherwise they will descend into an inevitable pit of binge-drinking, casual sex, alcoholism and liver failure. People who think differently - who remember, for example, the glass of wine they enjoyed at Christmas when they were ten or eleven didn't seem to do them any harm - are either irresponsible parents or, at best, guilty of having a "middle-class obsession" with sensible drinking in the home.

Donaldson claims, as all government advisers must, that his advice (which, fortunately, doesn't have the force of law) is evidence-based. The evidence appears at the back of the booklet (pdf) which his department has issued today. And it's a mess. Although there are, indeed, studies quoted which appear to show that many alcoholics and other problem drinkers started early, there's nothing to suggest that 15 is a particularly significant age. Other ages - 11, 13, 14, 16, 18, even 21 - are used in the various pieces of research as cut-off points, but they all seem to have been arbitrarily chosen. Donaldson's choice of 15 might be the result of a compromise, or it might have been plucked out of the air. It does not, however, have any discernible basis in science.

If any message emerges from this mass of research, it is that people's experiences of alcohol are different and one size does not fit all.

We learn of one study in which "vulnerability to the risk of abuse was highest for adolescents who started drinking between the ages of 11 and 14, followed by those who started drinking before the age of 11 and participants who had their first drink at age 15 or 16." Taken literally, that would seem to suggest that it's not a bad idea to start children off on alcohol before their 11th birthday. One piece of research concluded that "age of first drink was not significantly related to the probability of current alcohol abuse or dependence"; another, by contrast, asserted that "the odds of lifetime alcohol dependence and abuse were reduced by 14% and 8% respectively with each increasing year of age at first use."

There was also research "that found that participants who reported an early age of onset of binge drinking but who had matured out of binge drinking by late adolescence (‘early highs’) were no more likely than non-binge drinkers to be alcohol dependent at age 21." It was, in fact, "participants whose binge drinking frequency increased between the ages of 15 and 18" who "had the highest likelihood of alcohol abuse or dependence at age 21."

As for the "middle-class obsession" with introducing children to alcohol at family functions, today's report quotes research to the effect that "drinking in family contexts has been shown to be protective against underage drinking and problem drinking in later life." So why is Donaldson so against it?

Much of the research does appear to show strong correlations between heavy drinking among teenagers and other forms of problematic behaviour - substance abuse, risky sexual behaviour, criminality, poor school performance and so on. But it does not show causality either way. Thus kids from broken homes are more likely to become "problem drinkers" and more likely to get into other kinds of trouble than those from more stable backgrounds. That, however, scarcely amounts to evidence of the dangers of alcohol, and certainly doesn't prove that their consumption of alcohol causes misbehaviour or even makes it worse. If anything, it suggests that their drinking is a consequence, not a cause, of their unhappy situation. For example, we learn that "psychiatric diagnoses of conduct disorder, oppositional defiant disorder or any externalising disorder at 11 years of age have been shown to significantly increase the likelihood of starting to drink by age 14".

On the other hand, some of the studies suggest that juvenile alcohol consumption goes along with more positive features of the adolescent experience. Like money. Children who get more pocket money drink more. So do those who have a part-time job. Those who grow up earlier both physically and mentally are more likely to drink - moderately - than those who are more backward. Drinking alcohol thus seems to go along with maturity, independence and entry into the world of work. It may even be an indication of future success.

Nor are the horror stories of drunken incapacitation borne out by the figures. We learn that the vast majority of teenagers have tasted alcohol earlier than Donaldson recommends - 81% of those aged between 13-15. But of the almost 3 million 11-17 year olds who had ever had a drink, less than half a million drank every week and a mere seven thousand (around 0.3 percent) had been admitted to hospital with alcohol-related problems. Moreover, both the number of children drinking, and the amount consumed (outside a small hard core of problem drinkers) have been declining for some years.

And what's this?

The 2007 ESPAD survey asked 15 and 16 year olds about the different positive and negative consequences that they thought might happen to them if they drank alcohol (Hibell et al, 2009). The majority of respondents associated alcohol consumption with positive consequences, with an average 71% endorsement across a range of positive outcomes. These included having a lot of fun (80%), feeling happy (77%), feeling more friendly and outgoing (76%), feeling relaxed (66%) and forgetting problems (54%).

Inevitably, the report treats this as deeply worrying. If young people have such happy experiences of alcohol, after all, they might keep on drinking - and some of them will become alcoholics, or, years down the line, require the services of the NHS. This, of course, is why middle-class parents (like, for example, David Cameron), with their "obsession" with introducing their children to moderate, civilised alcohol consumption, present such a social danger. Their attitude "normalises" alcohol, by giving young people the impression that there might be something normal about it; while fanatics like Donaldson, while no longer speaking the language of religion, clearly pine for Prohibition.

Talking of religion, the report also suggests, as part of its plans for spreading the anti-booze message, "special support should be developed for those whose faith might require abstention." Does this mean that mosques will be given public funds for launching anti-alcohol campaigns?

It's scarcely surprising that anti-alcohol puritans like Donaldson should turn for support to the leaders of like-minded faiths. For the pursuit of "evidence-based" outcomes in public health is now pursued with religious zeal. His world-view contains no concept of moderation and leaves no room for joy in life. The danger is in alcohol per se, not merely the over-use or abuse of it. The fact that a minority of teenagers who consume alcohol will drink in unhealthy quantities or have pre-existing problems doesn't mean that it is a danger to the majority. It does, however, suggest to those who think like him that the greater good is somehow served by making everybody's life miserable.

Similarly, Donaldson refuses to admit the obvious difference between moderate consumption en famille and unsupervised, unrestrained binge drinking. In his black and white universe, people are too stupid to understand the concept of proportionality. This is the man, remember, who previously lectured pregnant women, despite clear evidence to the contrary, that the merest drop of alcohol might "harm their baby".

What we are dealing with in campaigns such as this is less alcohol itself than alcohol as a manifestation of moral panic. As James Davidson put it in his invaluable study of the ancient Athenians, Courtesans and Fishcakes, summing up the prevailing official attitude towards drinking,

The broad range of intoxicating liquors known to man are viewed as manifestations of a single drug, alcohol, in various disguises. The wide experience of enjoying these beverages and the manifold forms of consuming them are viewed as manifestations of a monotonous pathology of intoxication and addiction, as ethyl first ensnares and then takes over the body.

Of course, the adult attitude towards teenage drinking, like the adult attitude towards teenage sex and teenage fearless self-endangerment (otherwise known as "irresponsible behaviour") is influenced by several different factors, among which are nostalgia, jealousy and fear of one's own mortality. Once one has reached the age at which such behaviour seems dangerous, and destructive of society, one is, almost by definition, no longer having fun. In the case of Sir Liam Donaldson, it may be wondered if he ever did.