August 13, 2017

Early Alcohol Use Spells Later Trouble

An early age at first drink (AFD) has been linked to later alcohol-related problems, which is one of the reasons behind the legal drinking age of 21 in the U.S. It is unclear, however, if increased risk is primarily due to initiation of any drinking, or initiation of heavier drinking. A comparison of the influence of these potential risk factors among college undergraduates found that both an early AFD as well as a quick progression from the first drink to drinking to intoxication independently predicted later problems.

Results were published in the journal Alcoholism: Clinical & Experimental Research.

Negative Alcohol-Related Outcomes

"Many studies have found relationships between an early AFD and a range of negative alcohol-related outcomes later in life, including the development of alcohol use disorders, legal problems like DUI, and health problems like cirrhosis of the liver," said Meghan Rabbitt Morean, a postdoctoral fellow in the department of psychiatry at Yale University School of Medicine and corresponding author for the study. "There is also evidence that beginning to drink at an early age is associated with more immediate problems, such as compromised brain development and liver damage during adolescence, risky sexual behaviors, poor performance in school, and use of other substances like marijuana and cocaine."

Harriet de Wit, a professor in the department of psychiatry and behavioral neuroscience at The University of Chicago, concurred. "While it is commonly believed that the earlier a person begins drinking alcohol, the more likely it is that he or she will develop problems with drinking, many factors potentially contribute to this relationship, and these factors can only be disentangled with systematic, longitudinal research."

Drinking at an Early Age


While an early AFD is associated with many negative consequences, it is not clear that it directly causes heavy drinking or other negative outcomes, Morean added. "Prior research on early intoxication suggested to us that making a distinction between the age at which an individual first has any alcohol and the age at which an individual first drinks to intoxication may have important implications for understanding the relative risk associated with starting to drink at an early age," she said.

Morean and her colleagues examined 1,160 freshman (766 females, 394 males) using data gathered from bi-annual assessments from the summer following high-school senior year through the fall of the fourth year of college (four years in total). Participants self-reported their age of drinking onset and age of first self-defined intoxication, as well as frequency of heavy drinking and alcohol-related problems. Analyses looked at the effects of AFD and the time from first use to first intoxication as predictors of heavy drinking and problems across the four years from high school through college.

Greater Risk for Heavy Drinking


"As expected, beginning to use alcohol at an earlier age was associated with heavier drinking and the experience of more negative consequences during senior year of college," said Morean. "Quickly progressing from first alcohol use to drinking to intoxication was also an important predictor of heavy drinking and the experience of alcohol related problems during senior year of college. For example, an adolescent who consumed his first drink at age 15 was at greater risk for heavy drinking and problems than an adolescent who took his first drink at age 17. Further, an adolescent who took his first drink at age 15 and also drank to intoxication at age 15 was at greater risk for heavy drinking and problems than an adolescent who had his first drink at age 15 and did not drink to the point of intoxication until he was 17."

"The authors also found that impulsive personality and family history of alcoholism were related to age of first drink and future problems," added de Wit.

Preventing Alcohol Use


Both Morean and de Wit agreed that early drinking should be delayed, but if it occurs, these youth should be counseled to avoid drinking to intoxication.

"The best way to prevent heavy drinking and the experience of alcohol-related problems is to prevent alcohol use," said Morean. "Therefore, our first recommendation would be to delay the onset of any alcohol use as long as possible. However, despite valiant prevention efforts, the average American adolescent has his or her first alcoholic drink between the ages of 14 and 15 years."

"Furthermore," said de Wit, "it is unlikely that education will discourage high school and college students from drinking at all. However, education may help to make them aware of the potential for developing future problems, and modulate their drinking accordingly."

Speak to Your Children


"It is important to speak to children and adolescents openly about the dangers of heavy drinking and provide them with correct information, for example, 'how many drinks does an average male/female need to drink to exceed the legal level for intoxication?,'" said Morean. "It is also extremely important to remember that heavy drinking during adolescence and early adulthood is not confined to college campuses. Most adolescents begin drinking during high school, a significant portion of whom begin drinking heavily. To help address this, we suggest that new alcohol prevention and intervention efforts targeting high school students be developed with the goal of delaying onset of heavy drinking among those at increased risk due to an early onset of drinking."

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College Campus-Community Interventions Successful

The Safer California Universities study found that the program reduced incidence and likelihood of intoxication at off-campus parties and bars/restaurants. Heavy drinking among college students results in over 1800 deaths each year, as well as 590,000 unintentional injuries, almost 700,000 assaults and more than 97,000 victims of sexual assaults. In a study published in the American Journal of Preventive Medicine, researchers report on the results of the Safer California Universities study, a successful community-wide prevention strategy targeted at off-campus settings.

This is one of the first studies to focus on the total environment rather than on prevention aimed at individuals.

Reducing Off-Campus Drinking

The authors found significant reductions in the incidence and likelihood of intoxication at off-campus parties and bars/restaurants for Safer intervention universities. Students from Safer universities were 6% less likely to drink to intoxication during the last time they were at any of the targeted settings, 9% for off-campus parties, and 15% for bars/restaurants.

There was also evidence that drinking was reduced at fraternities and sororities. These declines were equivalent to 6,000 fewer incidents of intoxication at off-campus parties and 4,000 fewer incidents at bars & restaurants during the fall semester at each intervention schools relative to controls. Furthermore, stronger intervention effects were achieved at Safer universities with the highest level of implementation.

"These findings should give college administrators some degree of optimism that student drinking is amenable to a combination of well-chosen, evidence-based universal prevention strategies," commented lead investigator Robert F. Saltz, PhD, Pacific Institute for Research and Evaluation (PIRE), Berkeley, CA. "Here, one set of alcohol control strategies was found to be efficacious, but other combinations may work as well, or even better. With a growing body of such evidence, and combined with strategies already shown to be effective, it will be possible to craft a comprehensive prevention program that ratchets down the harm currently produced by alcohol use on and near college campuses."

Off-Campus Consumption

The Safer California Universities study involved 8 campuses of the University of California and 6 campuses in the California State University system. Half of these schools were randomly assigned to the Safer intervention, which took place in the fall semesters of 2005 and 2006.

Student surveys were completed by undergraduates in four fall semesters (2003 through 2006) and random samples of 1,000 to 2,000 students per campus per year were analyzed. Students were asked about where they drank, whether they had gotten drunk, and whether they had engaged in so-called "binge drinking." They were also questioned about their grade point averages and their general health, as well as other sociodemographic characteristics.

Safer environmental interventions included nuisance party enforcement operations, minor decoy operations, DUI checkpoints, social host ordinances, and use of campus and local media to increase the visibility of environmental strategies. Intervention campuses differed in their level of implementation, but all concentrated on off-campus activities for drinking.

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Alcohol, Energy Drinks A Dangerous Mix

Energy drinks, favored among young people for the beverages' caffeine jolt, also play a lead role in several popular alcoholic drinks, such as Red Bull and vodka. But combining alcohol and energy drinks may create a dangerous mix, according to University of Florida research.

In a study of college-aged adults exiting bars, patrons who consumed energy drinks mixed with alcohol had a threefold increased risk of leaving a bar highly intoxicated and were four times more likely to intend to drive after drinking than bar patrons who drank alcohol only.

Eliminates Sedating Effects of Alcohol


The study appears in the journal Addictive Behaviors.

"Previous laboratory research suggests that when caffeine is mixed with alcohol it overcomes the sedating effects of alcohol and people may perceive that they are less intoxicated than they really are," said the study's lead researcher Dennis Thombs, an associate professor in the UF College of Public Health and Health Professions' department of behavioral science and community health. "This may lead people to drink more or make uninformed judgments about whether they are safe to drive."

Experts believe that among college drinkers, as many as 28 percent consume alcohol mixed with energy drinks in a typical month.

The UF study is the first of its kind to evaluate the effects of alcohol mixed with energy drinks in an actual drinking environment, that is, at night outside bars. Research on college student alcohol use in campus communities has traditionally relied on self-report questionnaires administered to sober students in daytime settings, Thombs said.

Data for the UF study were collected in 2008 from more than 800 randomly selected patrons exiting establishments in a college bar district between the hours of 10 p.m. and 3 a.m. Researchers conducted face-to-face interviews with participants to gather demographic information and details on participants' energy drink consumption and drinking behavior. Participants also completed self-administered questionnaires that asked
about their drinking history and intention to drive that night. Next, researchers tested participants' breath alcohol concentration levels. Participants received feedback on their intoxication levels and advice about driving risk.

Wide Awake Drunks


Bar patrons who reported drinking alcohol mixed with energy drinks -- 6.5 percent of study participants -- were three times more likely to be intoxicated than drinkers who consumed alcohol only. The average breath-alcohol concentration reading for those who mixed alcohol and energy drinks was 0.109, well above the legal driving limit of 0.08. Consumers of energy drink cocktails also left bars later at night, drank for longer periods of time, ingested more grams of ethanol and were four times more likely to express an intention to drive within the hour than patrons who drank alcohol only.

Consumers of alcohol mixed with energy drinks may drink more and misjudge their capabilities because caffeine diminishes the sleepy feeling most people experience as they become intoxicated. It's a condition commonly described as "wide awake and drunk," said study co-author Bruce Goldberger, a professor and director of toxicology in the UF College of Medicine.

"There's a very common misconception that if you drink caffeine with an alcoholic beverage the stimulant effect of the caffeine counteracts the depressant effect of the alcohol and that is not true," Goldberger said. "We know that caffeine aggravates the degree of intoxication, which can lead to risky behaviors."

The study, funded by the University of Florida Office of the President, raises a lot of questions and suggests topics for future research, Thombs said.

Unsafe Levels of Caffeine?


"This study demonstrates that there definitely is reason for concern and more research is needed," he said. "We don't know what self-administered caffeine levels bar patrons are reaching, what are safe and unsafe levels of caffeine and what regulations or policies should be implemented to better protect bar patrons or consumers in general."

Thombs' study is a very valuable addition to the existing body of research on the association of energy drink consumption and alcohol-related consequences, said Dr. Mary Claire O'Brien, an associate professor of emergency medicine and public health sciences at Wake Forest University who has studied the relationship between energy drink cocktails and high-risk behavior.

"His approach is unique because it was conducted in a natural drinking environment college bars," O'Brien said. "His results clearly support the serious concern raised by previous research, that subjective drunkenness may be reduced by the concurrent ingestion of caffeinated energy drinks, increasing both the likelihood of further alcohol consumption, and of driving when intoxicated."

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