Drink wisely -- taught by whom?

Whether the legal drinking age is 18, 21 or something in between, at some point the odds are better than even that eventually a young adult is going to have that first drink. About 61% of American adults 18 or older said they’ve had alcohol in the last year, according to a 2006 national survey by the Centers for Disease Control and Prevention.

For the most part, lessons in how to drink come through experimentation with excess, essentially trial and error, exploring how much can be consumed, as young people go through what has become a rite of passage to adulthood.

“It’s a forbidden-fruit sort of thing,” says Brenda Chabon, associate professor of psychiatry and behavioral sciences at Montefiore Medical Center, New York. “We haven’t done a good job on educating kids. We kind of demonize alcohol on one hand and embrace it in another way.”

With ignorance as a guide, the long-awaited rite of passage too often ends up with mangled cars and ruined lives.

But whose job is it to teach responsible drinking? Middle and high schools have their hands tied, says Robert Turrisi, professor of biobehavioral health at the Prevention Research Center at Pennsylvania State University. “School-based programs teach abstinence only,” he says. “Schools can’t legally teach how to do illegal behaviors.”

Beginning in elementary school, students are given the simple message that drugs, including alcohol, are forbidden and bad, a message that often conflicts with what they see at home -- parents having a cocktail before dinner or a glass of wine with the meal. If statistics are proof, the anti-alcohol messages have little effect on kids’ drinking. A CDC survey last year found that 45% of high school students drank some alcohol in the 30 days before the survey, 26% binge drank, 11% drove after drinking and 29% rode with a driver who had been drinking.

Once kids step on a college campus for the first time, they’re surrounded by new freedoms and temptations. The largely ineffective “just say no” message is likely to go right out the window. So lessons in moderate and responsible drinking are up to parents and, increasingly, colleges.

Lessons from home

Parents and families have been the subject of Turrisi’s studies. He’s found in a 2000 study published in the journal Psychology of Addictive Behaviors, for example, that among 266 incoming college freshmen, what they learned at home affected the consequences they experienced after binge drinking. If, in questionnaires, they reported that they had learned that alcohol can be a social lubricant or transform them in good ways, they were more likely to suffer a blackout, headache or hangover or get into a fight or a regrettable sexual situation after heavy drinking. But if they learned at home that drinking was normal behavior, they were less likely to suffer those consequences, despite drinking too much.

Those who had fewer consequences from excess drinking were more likely to have talked to their mothers (the students were more likely to report talking to their mothers than to their fathers, Turrisi found) about such things as how drinking changes behavior, the importance of being able to improve mood without alcohol and the negative health consequences of alcohol abuse.

To help prevent future binges, or the worst consequences of binge drinking, Turrisi says, parents need to talk openly to kids about alcohol, throughout their lives. “Let them know that you understand the reasons why kids like to drink, but teach them the difference between drinking and binge drinking. And be prepared to answer questions about your own drinking behavior.”

Those who are in favor of lowering the drinking age point to European cultures in which children are exposed to alcohol -- often in small, diluted quantities -- at early ages at family meals. They argue that drinking at home with parents teaches kids that alcohol is normal and reduces the odds that they’ll overindulge when on their own.

But it’s important to be sure what’s meant by “drinking at home,” according to a study in the October 2004 issue of the Journal of Adolescent Health. A survey of 6,200 teenagers in 242 U.S. communities found that the occasional glass of wine at a family dinner can have a protective effect. Kids who reported such moderate drinking at the family table were two-thirds less likely to have engaged in binge drinking in the two weeks before the survey.

But the study also found that parents who were oblivious to the drinking in their homes weren’t doing their youngsters any favors. Teens who drank with peers at parties with an adult present were twice as likely to have engaged in binge drinking.

The college effect

Eventually, many of these almost-adults land on college campuses. Whether colleges like it or not, the ball is then in their court.

G. Alan Marlatt, director of the Addictive Behaviors Research Center at the University of Washington, has been focusing his research on helping students learn about alcohol, to (if they decide to drink) moderate their drinking and to drink without hurting themselves or others. He does the research in a campus laboratory designed to look like a dimly lit tavern. Students of legal drinking age get real alcohol; younger students get substitutes with little or no alcohol content, though they’re often unaware of the substitution.

One study had actors come in and drink a lot, or a little. When the actors drank a lot, the student subjects drank a lot. When the actors drank moderately, so did the students. “If others around you are drinking just a little, you can bring it down,” Marlatt said. The copycat effect was more pronounced with men than with women.

Students say they drink more when they feel stressed. So he had actors insult or annoy them in a “waiting room” outside the mock bar. Sure enough, when they were under stress, they drank more.

With that kind of information in hand, he began developing, with funding from the National Institute on Alcohol Abuse and Alcoholism, programs to help college students control their drinking. Two of them, Basics and the Alcohol Skills Training Program, are available at many colleges and universities -- and some provide training to entire dormitories, sororities, fraternities and even whole incoming freshman classes.

In the Basics program, one-on-one counseling is offered to students at high risk of excessive drinking because of a family history of alcoholism or because they have reported drinking more than their peers in high school. In the Alcohol Skills Training Program, students at normal risk get group training. All of them learn what alcohol does to the body, how long it takes to feel its effects, how long it takes the body to be rid of the effects and how to be assertive in saying “no more.” Marlatt has found that students in either program were able to reduce their drinking by 40% and maintain the reduction for two years after the program.

“We don’t lecture. We say that drinking is like driving. It can be dangerous. It’s a skill. You have to learn how it works,” he said.

The approach, called harm reduction, has proved effective in reducing alcohol consumption and cutting down on consequences of drinking, according to a 2002 paper in Addictive Behaviors.

Parents sending their charges off to college can look for things that might discourage drinking, says Henry Wechsler, director of the College Alcohol Study at the Harvard School of Public Health. “Make sure there are other things to do, like arts or volunteer efforts,” he says. Look for a town that offers recreational and productive outlets, not just block after block of taverns. Help your student choose carefully where to live. Some dorms have turned themselves into alcohol-free zones.

“Even in a heavily drinking college there are places where there is less drinking,” he said. “And be very careful of going into a fraternity.” That’s because drinking rates are uniformly higher in the Greek system. Wechsler found in a 1995 study that students in sororities were almost twice as likely as non-sorority women to be binge drinkers. Fraternity members had the highest rates among college students, with 75% binge drinking, compared with 45% of non-fraternity college men.

Alcohol education from whatever source -- home, family or a formal program -- can help prevent tragedies like the one on the University of Washington campus in the spring of 2001. A student fell to his death off a seventh-floor balcony while drinking with friends. “He was 19, telling a funny story, gesticulating -- and off he went,” Marlatt says. “His blood alcohol level was .28.”

--

susan.brink@latimes.com