Saturday, 21 May 2016

What about a 16 year-old having a beer with his Dad or a teen having a glass of wine with the family at dinner? Is that 'wrong'?

This week I had two parents ask me almost identical questions after one of my presentations - both around the notion of the provision of alcohol in a controlled family setting. One mother wanted to know whether the age-old practice of a son in his late teens (she talked about a 16 year-old) having a beer with his father at home was still appropriate and the other was a father who had been brought up in an Italian family where a small glass of wine was given to the children with a meal. Both acknowledged the message in my talk around 'delay, delay, delay' but wanted to know my thoughts on the whole concept of the importance of providing alcohol in a controlled setting in an effort to hopefully 'teach' a teen to drink responsibly.

Firstly, there are no 'rights' or 'wrongs' as far as parenting in this area is concerned. Don't get me wrong, some parental behaviour is truly bizarre in my opinion, but as I've said many times before, no-one can tell you how to raise your child and as long as you believe what you are doing is right and you feel comfortable with your decision, then go for it! The most important thing is that you make your rules around alcohol and parties based on the best possible information you can find and that you are not bullied into doing something based on what another parent says or what your child tells you other people do ... Most importantly never impose your beliefs in this area onto other parents. If you believe giving your teen a glass of wine at a family function is appropriate, that's fine - but don't ridicule others at the event for making the decision not to allow the same behaviour.

So is drinking with your child encouraging them, controlling them or teaching them responsible drinking? Some people, like the father I mentioned above, cite the 'Mediterranean Model' as a good example of how you could introduce alcohol to a child in the home, i.e., with a meal with the family like they do in countries like Greece and Italy. Unfortunately, simply 'transplanting' the Mediterranean Model to Australia does not necessarily work as there are so many other social influences at play. In this country, alcohol is associated with success in so many areas of life, whether it be sport or celebration and that is difficult to challenge simply by providing alcohol with a meal. It is also important to acknowledge that even in countries where this model once appeared to have been successful there are now growing problems, e.g., France now has one of the highest rates of liver disease in the world and are now seeing some significant youth drinking issues. Although family influence is incredibly important, there are so many other external influences that bombard our kids from a very early age, most of which are almost impossible to control, the positive messages you are trying to send can become confused, sometimes resulting in a completely different message being conveyed to the one intended.

Most importantly, this notion of 'teaching a child to drink responsibly' really makes little sense. In reality, teens learn from you and start modelling your behaviour from a very early age, so whether you drink with them, around them or even away from them they will be watching ... You certainly don't need to sit there with them and 'teach' them how to drink in a responsible way - they've been picking up how you and your partner (and the rest of your family and friends) drink alcohol for years. Do you really believe that all of a sudden drinking a couple of beers watching the TV with Dad is suddenly going to significantly affect how they perceive alcohol? Research that has been conducted in Australia around the impact of the 'Mediterranean Model' has found that instead of being protective, drinking (even small amounts) with your son or daughter is instead likely to send them the message that you condone and support their drinking at an early age - the positive messages you wanted to get across are often lost.

Delaying drinking for as long as possible is still the best message for teenagers as the research is clear that the younger the child is introduced to alcohol, the more likely they are to develop a range of problems, including dependence later in life. Researchers have long known that the age at which a person starts drinking or taking drugs is a good predictor of whether or not he or she will have future problems, particularly dependence or addiction.

So am I saying that a father shouldn't have a beer with his teenage son or families should avoid allowing their teens to have a glass of wine with a meal? As I've said before, the evidence is confusing here and as I discussed recently there are essentially four messages that are acknowledged as important for parents in this area:
  • Delay, delay, delay - try to delay their first drink of alcohol for as long as possible
  • If a teen is to drink, ensure their first drink of alcohol is with you in a controlled environment
  • If a teen believes their parent approves of teen drinking they're more likely to drink
  • If teens obtain alcohol from sources other than their parents, they're more likely to drink in a risky way
What we are telling parents, therefore, is that you should never give a young person alcohol (due to impact on brain development), but, in fact, you have to give it to them (in your home preferably) before they drink it anywhere else. If you do give it to them, however, this could indicate that you approve of their drinking leading to potential drinking problems in the future. In addition, you certainly don't want them to get alcohol from other sources when they go to a party or gathering as the research says that if they do they're at greater risk! One statement seems to contradict the next and it ends up being totally confusing!

With all of that in mind, I believe the best way forward for any parent is to 'follow their heart' - I know that sounds so corny but it really is the best answer. If you believe that allowing your teen to have a drink at home in a controlled setting is appropriate for your family situation and that they will get something positive from that experience, that's what you should do. My only suggestion is that if you do, try and delay it for as long as possible and at the same time, rules and boundaries are discussed and established around alcohol and parties. Believing that simply allowing your child to drink with you at home, no matter how controlled, is going to somehow protect them from drinking in a risky manner in the future is not only na├»ve but dangerous ...

Saturday, 14 May 2016

A 15 year-old girl and a bottle of vodka

A couple of years ago I wrote a piece on Neil, a 16 year-old young man I had recently met who had approached me after my talk extremely concerned about what I had just said about spirits and their potential impacts on a teen's long-term health. What had disturbed him were my comments around the sheer amount of alcohol a young person was consuming when they shared a bottle of vodka between three or four of them (i.e., 21-22 standard drinks - the equivalent of 21 glasses of beer), and the impact that this could have on the developing liver. As I wrote at the time, I'm simplifying the conversation, but essentially this is what Neil said to me:

"Do you build a tolerance to alcohol and if you do, what does that actually mean to your health? If you are able to drink a whole lot more than you used to and not get any of the 'drunk' effects, does that mean your liver and the rest of your body are also not getting negative effects? When I drink I usually drink at least a bottle of bourbon to myself and I have no outward negative effects and I have to drink that much to get any effect at all. I was drinking less than that a couple of years ago but now that is the norm. I've never thought it was a problem because I don't get sick and usually I'm the one in my group of friends who is 'sober' enough to look after anyone should they get into trouble. Now I'm beginning to worry that maybe I am doing some damage!"

When I asked him how often he was drinking a full bottle of spirits to himself he replied that it was usually fortnightly! Neil had been doing this for the past 12 months at least and had actually started drinking alcohol regularly at around 13 years of age. He asked me whether I thought he had an 'alcohol problem' and I had to be honest and tell him that I believed he had to take a serious look at his patterns of drinking and make changes quickly. This was truly dangerous behaviour!

Last week I received an email from a Year 10 girl with a very similar story, once again very concerned after hearing my talk and my comments on spirits. I have edited it down quite a bit, but once again, we are talking extremely dangerous drinking here ...

"When you spoke to us about spirits you said that if we drank a bottle of vodka we were drinking the same as 22 glasses of beer. Is that true? I find that very hard to believe as I often drink a whole bottle to myself, or share it with a friend and I have never even felt sick. If I drink less than that I don't even ever even feel drunk and I've never been sick after drinking. I never have a hangover and I don't think I have ever done anything really stupid when I have been drunk. Does that mean that I don't get affected by alcohol like other people? Could I still be hurting my liver or am I just one of those people who can handle alcohol better than others? My boyfriend says he has never known anyone who can handle alcohol like me and he finds it really hard to keep up with me. Does it make a difference that I never drink my vodka by itself? I always mix it with coke or lemonade. Is it only people who drink it straight who have the problem?"

Realistically how do you respond to an email like this? This is a teenage girl who is playing around with a product that she simply does not understand - I have cut out a whole pile of other questions she included, all very similar to 'Does it make a difference that I never drink vodka by itself?' Really? She's drinking a bottle of vodka, whether she mixes it or drinks it straight, she's still consuming a bottle of vodka! Truly frightening!

Is this 'normal' teenage behaviour? Absolutely not! If we look at the data that we have on school-based 'current drinkers' (those that drank in the previous week), the numbers have fallen quite sharply since 1984. However, there continues to be a core group of teens who drink at extremely dangerous levels when they drink and the number of young people in this group has remained fairly consistent over time. These teens are our greatest worry and when I meet young people like the ones described above I realize that it is this group that we are failing badly when it comes to providing them appropriate education.

Admittedly some of these young people have a range of social problems and one of the major reasons they are drinking that much is to 'block out' bad feelings, i.e., they're using to cope, and that was my 'gut reaction' about Neil. Simply providing these teens with information about the risks associated with heavy drinking is most probably not going to make a great deal of difference. In those cases, often the best we can do is to provide them with ways to look after themselves and their friends should something go wrong. However, there are also many young people who simply have no idea what damage they're causing to themselves and have an extremely skewed view of what is 'normal'. Without a doubt this is the case with the young woman who sent me the email. She was obviously drinking for 'fun', didn't appear to be having any issues with her drinking and this sort of behaviour appeared to be the 'norm' for her social group and she hadn't seen anything wrong with it until I provided her with some information that challenged her views.

Spirit education is a must and it needs to be delivered early (it would be great to see parents doing some of the work here!). When I give any information on vodka (in Year 10, as that is the drink of choice for many in that year group who do choose to drink) you literally can see jaws dropping around the room. Many young people simply have no idea what they are doing to themselves when they consume these products and the risks involved with drinking large quantities when they are so young! Shouldn't we be telling them about the potential dangers before they start drinking them?

Young people today are far more likely to choose to drink spirits or, at the very least, premixed spirits than in the past. Where beer and wine-based drinks were once the drinks of choice for the majority of young people, spirits such as vodka are now much more likely to be consumed. There are a number of reasons why these drinks have become increasingly popular, some of these include:
  • Spirits are more affordable than they were in the past – unlike wine, which has dropped in price since 1980, spirit prices have actually increased to some extent. Australian incomes have risen however, making all forms of alcohol, including spirits, more affordable
  • Marketing and promotion of spirits has changed dramatically – vodka, in particular, is now marketed to a much younger age group than in the past. Where once spirit advertising targeted older men, drinks such as vodka are now closely associated with the youth nightlife scene, particularly young women
  • Spirits provide better 'bang for their buck' – if their intention is to drink to get drunk, some young people believe that spirits are able to achieve this more effectively for less money
Vodka is seen as particularly attractive to young women as it is seen as a 'cool' drink (due mainly to the advertising and its target audience), free of calories (completely untrue), undetectable (where they get this idea is beyond me - have they ever smelt a vodka drinker's breath?) and is less likely to cause a hangover (unfortunately, absolutely true!).

The problem is that spirits are so much more dangerous than other alcoholic drinks, particularly in relation to the following:
  • Spirits or premixed spirits enable you to drink more alcohol, much more quickly when compared to other drinks. If a group of young people share a bottle of spirits between them in a session they are drinking the equivalent of up to 22 glasses of full strength beer, 22 cans of mid-strength beer, more than 2 litres of a cask of red wine, or more than three bottles of champagne. For many young people, if they tried to drink this amount of wine or beer they would find it difficult to do so quickly - unlike spirits they are 'self-limiting' to some extent, i.e., you drink, you bloat, you vomit!
  • Due to the high alcohol content, it takes a comparatively small amount of spirits to cause alcohol poisoning or overdose. It is important to remember that it takes much less vodka, rum or whisky to get drunk than beer or wine. It would only take minutes to drink two shots of vodka (60mls), whereas for most people it would take much longer to drink beer containing the equivalent amount of alcohol (two 285ml glasses – 570mls), thus greatly increasing the risk of poisoning or overdose
Do I believe that simply providing information to teens on the potential risks involved with spirit consumption will solve all our problems and result in them choosing not to drink these products? Of course not, but young people certainly deserve to have all the information we can give them so that they can at least make an informed choice. Drinking a bottle of vodka (or bourbon or any other spirit) is potentially life threatening, whether you're a teenager or an adult. If it doesn't kill you as a result of alcohol poisoning, the possibility of major damage to the liver and the rest of your body over time is very real!