Tough Questions from Parents

This book is composed of real questions asked by parents and community leaders at forums held by the Health Alliance on Alcohol over the years.

Talking about underage drinking with their adolescent children is often difficult for parents. Many find it hard to believe that their children are experimenting with alcohol at all. Others do not feel it is wrong for their adolescent children to drink occasionally and may actually facilitate access to alcohol for their children and their children’s friends, in spite of laws against this. As parents try to address the issue, among themselves, with their children, and within their communities, many tough questions arise.

This book is composed of real questions asked by parents and community leaders at forums held by the Health Alliance on Alcohol over the years in multiple cities across the nation. The questions you will read are slightly edited for grammar or length, but accurately reflect the concerns of the forum attendees.

Some teens may actively choose to drink because it is part of their social scene, others may succumb to peer pressure, against their better judgment.

What is the magnitude of the underage drinking problem and has it changed in the last 20 years?

Although national surveys show that fewer adolescents are drinking now than 20 years ago, the numbers are still significant.

	2007	1997
High school students:
– Who reported having tried alcohol1	75%	79%
– Who reported having engaged in binge drinking in the last month (5 or more drinks in a short time)1	26%	33%

Is there any research on why kids drink – thrill seeking, boredom, curiosity, because it is a restricted product?

Adolescents drink for a variety of reasons. Adolescence is a biologically tumultuous time – their bodies are changing and teens are trying to find their place in the world. At a time when they are feeling physically and socially awkward, alcohol can relax them. We also know that the adolescent brain grows asymmetrically, and the limbic system - the part of the brain associated with risk-taking, matures faster than the frontal cortex - the part of the brain associated with decision-making. Hence thrill-seeking may win out over good judgment for many teens.

Some teens may actively choose to drink because it is part of their social scene, others may succumb to peer pressure, against their better judgment. Additionally, part of adolescence is pushing the limits – teens may use alcohol to do this – as it is legal for adults and oftentimes incorrectly considered a safe way to experiment.

Certain teens may have a temperament that pushes them toward thrill-seeking.

surveyed

Research has shown that certain children are more at risk for using and then having subsequent problems with alcohol:

• Children whose parents have had problems with alcohol or depression
• Kids who have problems with attention or impulse control
• Kids with aggressive temperaments
• Kids who are engaged in other risky behaviors such as substance abuse, early sexual activity, and school truancy

Adolescents with mood disorders (such as depression) are also more likely to drink and develop later problems with alcohol.2

What is the motivation behind binge drinking?

Teens engage in binge drinking also for a variety of reasons. Many are unable to self-regulate – if a little is good, more is better. Again, research shows that certain teens may have a biological predisposition to risk-taking that eventually leads to problem drinking. Certain teens may have a temperament that pushes them toward thrill-seeking.3 Additionally, kids may associate certain social situations with alcohol and even binge drinking (graduation parties, celebrations for turning 21, fraternity or sorority parties) – and some teens will drink accordingly.

With my generation being so different, is there something different about today’s world that exacerbates the problem of underage drinking?

Alcohol is now clearly adolescents’ substance of choice. In the past ten years, adolescent use of other illegal substances has decreased, as many illegal drugs have become more potent and potentially more harmful. Because of this, many teens turn to alcohol for experimentation. In addition, although the prevalence of underage drinking in general is slightly less than it was 20 years ago, some teens who are feeling pressured to succeed in today’s complicated environment might actively seek situations in which they can relax and forget about the pressure – often these situations involve the use of alcohol.

When should the education process and conversation about alcohol begin?

It is never too early to start the conversation. Children are observant – they see adults drinking around them, and they may even see them acting tipsy or outright intoxicated. Kids are also curious – how does alcohol taste, why do people drink, can’t they see how silly and even scary they become when they drink too much? It is a good idea to answer children’s questions when they arise – in a developmentally appropriate way. The conversation will change over time as your child grows, but it is never too early to start the discussion.

Can giving your kids too much information be counter-productive?

It is wise to remember that the age and maturity of your child will determine how much he/she can process at a time. Be on the lookout for clues that your child has had enough of the conversation (he may look distracted or disgusted or simply change the topic). And remember – this conversation has to be on-going; you will certainly find an opportunity to continue the conversation as your child matures.

After whom do children model their behavior?

Parents are teens’ number one role models. Research shows that parents are the greatest determinant of how a teen will use alcohol.4

How can a parent model good behavior for children? Since actions speak louder than words, should adults not drink in order to set an example?

Some parents are very frank with their children about completely forbidding underage drinking. Others may believe that adolescent drinking is a “rite - of - passage”, and a normal part of a teen’s experimentation. They may remember themselves drinking while underage, and may implicitly condone such behavior in their own children. Some parents may say in words that they do not want their children to drink at all, yet they may actually imply that it is okay, and may even facilitate it.

With this in mind, teens are very sensitive to adults in their environment being hypocrites. So, parents who tell children not to drink at all, and then drink themselves, possibly excessively – may be sending confusing double messages to their kids. Be careful and be aware of the “hypocrite challenge” with which your child may confront you. It is important to be honest, to be a role model, and to remember that keeping your child safe is of utmost importance.

Deciding whether or not to drink is a personal decision. Just keep in mind that the decisions you make are being observed and could shape your own child’s decisions. If you choose to drink, please remember to make responsible choices and most certainly do not drink and drive.

Since I drank as a teen and turned out OK, why should I worry about my teen having a few drinks at a party?

Your child may be concerned about a friend and how much that friend is drinking.

If you read the paper or watch the news today, you know that underage drinking is a major threat to teen safety. Kids often drink to excess, and can become ill or even die from alcohol poisoning - even first time drinkers. Teens who drink are also more likely to be involved in accidents or engage in risky behaviors. And remember – we often look back on our own childhoods through rose-colored lenses. Many teens in previous generations did not make it either. Parents – think back and perhaps you can remember some of your own friends or acquaintances who were arrested, severely injured, involved in car crashes – some fatal, or whose lives were destroyed by excessive drinking.

If kids choose to experiment, how should parents respond?

Some parents may choose to emphasize the illegality of underage drinking. Others may use safety as the central theme in discussing teens and alcohol use. Either way, just having the conversation with your child, and showing that you care about your child’s safety is a major first step. And conversations should be real within the context of your own family. State and restate your thoughts and family rules on alcohol. And remember to avoid the ‘hypocrite challenge’ by modeling good behavior if you choose to drink.

How should parents respond when their teenagers confide in them about their friends’ experiences with alcohol or other risky behaviors?

Again, emphasizing safety may be the way to handle this conversation. Your child may be concerned about a friend and how much that friend is drinking. You need to listen sympathetically and non-judgmentally, and perhaps offer your child some strategies to help that friend. If at any point your child feels that a friend may be in real danger, discuss ways that your child, perhaps with your help, can notify an important adult who can take action. Also, remind your teen not to allow him/herself to be put at risk because of another’s bad decisions. For example, your child should never get into a car with a friend who has been drinking.

Some parents have differing views on alcohol (some provide alcohol to teenagers, or allow them to drink at their homes after collecting car keys) - how should a parent respond?

The issue of liability is often the most effective and compelling one in curtailing the serving of alcohol to minors.

There are many parents who believe their children are going to drink anyway and that it is safer to have children drink in the family home, where they can be supervised by adults – themselves, adult siblings or adult relatives. Also, some parents mistakenly believe that as long as teens don’t drive, it is okay for them to drink. Unfortunately, accidents and injuries do not always involve a car – other serious consequences of underage drinking include alcohol poisoning, involvement in fights, falls, burns, and property damage.

And there are risks beyond alcohol-related injuries and death associated with underage drinking. For example, the underage drinker, the provider of alcohol and the owner of the home in which the drinking occurred can all incur civil or criminal liability when accidents or injuries occur, depending on the role they played. This can mean jail time, loss of employment and/or loss of personal assets. The issue of liability is often the most effective and compelling one in curtailing the serving of alcohol to minors.

The reality is that other adults may have opinions about underage drinking that differ from your own. First, it is important to talk to your own child and emphasize your own rules. When talking to other parents, you may want to share your opinions and clearly state your own family’s rules. Emphasizing the potential dangers and legal consequences can help. And you can always just not allow your child to attend a party if you think underage drinking may take place.

How can parents control their kids and prevent them from getting alcohol outside of the home (i.e. asking adults outside of a liquor store to buy it for them)?

The best way to influence your teen’s decisions is to have a conversation with your child – to really listen, try not to judge, and always emphasize safety.

There is really no way for a parent to literally control his/ her adolescent child. The best way to influence your teen’s decisions is to have a conversation with your child – to really listen, try not to judge, and always emphasize safety. Also, making your child aware of both the legal and personal consequences of getting caught trying to purchase alcohol can be an effective deterrent.

The best way to influence your teen’s decisions is to have a conversation with your child – to really listen, try not to judge, and always emphasize safety.

What conversations should parents have with their children before their teen leaves for college, especially if their kids have had no prior experience with alcohol?

Many young people who go off to college are away from home and independent for the first time, and will use their newfound freedom to experiment and engage in behavior that was considered off-limits while in high school. Unfortunately, drinking - and sometimes heavy drinking - is common on many college campuses.

Some teens are completely unfamiliar with drinking prior to going to college. Others, who may have experimented with alcohol in high school, can be particularly challenging in that they may feel that they know more than you. For both types of teens, having a conversation about what to expect regarding college drinking is crucial.

First, you may want to investigate how your child’s college is addressing underage drinking on campus (information is often provided to parents in a Parent Handbook, or accessible on-line on the college website). Then, it is smart to discuss with your child what the college expects. Make it clear that these are college policies with consequences, and that you support these policies. Brainstorm with him how he will react to situations where alcohol is around. Emphasize the dangers of binge drinking – often adolescents who have not been around situations with alcohol during high school are caught unaware and may overindulge – with negative health, social and academic consequences.

Emphasize the dangers of binge drinking – often adolescents who have not been around situations with alcohol during high school are caught unaware and may overindulge...

How do children get access to alcohol while at college?

Alcohol use is prevalent on college campuses. A national survey reports that 85% of college students have tried alcohol, and up to 40% admit to at least one episode of heavy drinking in the two weeks prior to being surveyed.5 Access to alcohol is often easy on college campuses because many students are over the age of 21 and are able to legally purchase alcohol – they in turn, may offer it to younger friends. Additionally, many students choose to buy fake ID’s in order to access bars or buy alcohol. This poses a challenge for local bars and restaurants; some are more vigilant that others about checking to see whether their patrons are underage.

Isn’t it better to teach children how to drink responsibly while they are still teenagers?

This is a hard question – one that was asked a number of times within our forums around the country. It may help to reach out to other parents within your parent network to discuss their experiences, both positive and negative, on the subject.

...many students choose to buy fake ID’s in order to access bars or buy alcohol.

First of all – parents should know that in some places, it is illegal to provide alcohol to even your own child in your own home. Check your state and local laws to see if this applies to where you live. Given that – some families may elect to allow their adolescent to have a drink - for example, a little wine with dinner in the context of family gatherings - this is a family choice. If it is legal and you choose to allow this type of drinking:

• Clearly explain the house rules and how this fits in with those rules.
• Beware of giving contradictory messages. Any acceptance of underage drinking could pose a challenge for your teen if they are not allowed to drink outside of the home.
• Understand that there is no evidence that this type of experience teaches kids to drink more responsibly.
• Be aware that studies indicate that heavy alcohol use, especially binge drinking, can damage the developing adolescent brain.6

Do you think statistics of teens driving after drinking are better or worse than they were 10-15 years ago?

When compared with statistics from 1991, 2005 data show that fewer high school students were driving under the influence of alcohol. However, this was unfortunately not true for older teens (ages 18-20) who showed an increase in drinking and driving. Since 2003, however, there is an indication that less youth overall are drinking and driving.7

While the numbers may be improving, partly due to the enactment of Zero Tolerance laws, teen drinking and driving is still a major problem. Teens still have the highest rate of motor vehicle accidents of any age group – and combining a lack of driving experience with alcohol can be deadly.

Parents should set clear expectations regarding driving privileges, especially with respect to drinking and driving.

Motor vehicle collisions are the leading cause of death among teens. During 2006, over 3,400 15 - 20 year old drivers were killed, and an additional 272,000 were severely injured in motor vehicle crashes.8 In addition, teens who are passengers in a car driven by another teen are at risk; in 2006, 85% of teens who died in car crashes were passengers, and not drivers.9

We also know that for any blood alcohol concentration, the risk of involvement in a motor vehicle crash is greater for teens than for older drivers.9

What is zero tolerance?

It is illegal in every state for persons under the age of 21 to purchase and publicly possess alcoholic beverages. A zero tolerance law makes it illegal per se (in and of itself) for persons under the age of 21 to drive with any measurable amount of alcohol in their blood.10

How do you recommend parents address underage drinking with their children as they near driving age?

As your child approaches adolescence, it is important to start talking about the risks and responsibilities associated with driving. Parents should set clear expectations regarding driving privileges, especially with respect to drinking and driving. Remind children that for those under 21, there is zero tolerance for driving after drinking any alcohol. Kids can lose their licenses if they are caught driving with any detectible amount of alcohol in their bloodstream.

Also – remember to model what you preach. Be sure you are making good decisions when planning to drink. This may involve limiting what you drink, having a designated driver if you do drink, or arranging another mode of transportation. Adolescents watch adults closely, and notice those who drive while intoxicated.

Adolescents watch adults closely, and notice those who drive while intoxicated.

How does alcohol affect the body and what are the signs to determine if the level of intoxication is dangerous?

After one or two drinks, with a blood alcohol concentration (BAC) of 0.05 - 0.10, most drinkers will feel more relaxed and have decreased inhibitions. Even at this level of intoxication, reflexes are slightly delayed, making driving dangerous and putting teens at risk for accidents.

After three to four drinks (BAC from 0.10 - 0.20), drinkers will be noticeably drunk. Speech will be slurred and reflexes will be more significantly delayed. For some, this level of intoxication leads to more aggressive or violent behavior.

After five or more drinks, nausea and vomiting are common. Eventually, high levels of alcohol in the blood (BAC 0.20 - 0.30) can lead to neurological depression or “passing out.” Kids may initially appear confused; they can then become unresponsive. In severe cases (BAC > 0.30), toxic levels of alcohol in the blood can result in body salt disturbances, slow erratic breathing, vomiting with choking, coma and even death.

Intoxication may be dangerous at any level, in that intoxicated teens are more likely to engage in risky behaviors and get into trouble. However, as the blood alcohol concentration increases to greater than 0.20, the severe medical consequences of drinking start to come into play.

At what point does your intoxicated teen need to be taken to the Emergency Room?

Any adolescent who has consumed so much alcohol that he/ she appears confused and poorly responsive, with slow or shallow breathing, is in severe distress.

Any adolescent who has consumed so much alcohol that he/she appears confused and poorly responsive, with slow or shallow breathing, is in severe distress. Unfortunately, friends will often try to let someone “just sleep it off” – this can be dangerous, as teens this intoxicated may have poor breathing, and may vomit and choke. Kids who appear this intoxicated should be brought to an emergency room.

Also, it is important to talk with your kids to give them the confidence to reach out for medical help in an emergency. Many times in the news you hear that someone thought a child or fellow student had merely passed out when they were in real medical trouble. Teens may be afraid that they will get in trouble themselves – reassure them that calling for help when in doubt is always the right decision.

How do you determine if a teen has an alcohol problem?

These are a few examples of problem drinking:

• When a teen drinks more than he/she is comfortable with and then feels guilty about it
• When a teen loses control over the amount or frequency of drinking
• When a teen drinks to excess and embarrasses herself, or
• When a teen engages in unsafe and regrettable sexual experiences after drinking to excess.

Binge drinking is also viewed as problem drinking, as is drinking when alone or daily drinking. Particularly for teens with a family history of alcoholism, frequent drinking can be a red flag that signals future alcohol abuse problems. Also, teens who are depressed or suffering from other untreated mental health problems may self-medicate with alcohol - this is a form of problem drinking as well.

Talking to teens is always a challenge for parents - and even more so when the topic involves risky behaviors. Tough questions invariably arise when parents try to talk to teens about underage drinking. Hopefully, this book has given you some tools to help address a few of these questions. Although the topic may seem daunting to parents of teens, rest assured that most parents face these issues at some point in their lives. And although they are never easy, the conversations must be had, and your child will be safer for having had them with you.

Health Alliance on Alcohol

A national education initiative on underage consumption of alcohol through parent/child communications.

NewYork-Presbyterian Healthcare System

The NewYork-Presbyterian Healthcare System, the largest secular not-for-profit nongovernmental health care system in the U.S., is committed to providing high quality, cost-effective, and accessible care to communities throughout the greater New York metropolitan region. The System, made up of 33 acute care hospitals, 100 ambulatory sites, four residential health care facilities, three specialty institutions, two rehabilitation hospitals and more than 18,500 affiliated physicians, serves one in four patients in the greater New York metropolitan area. The System is also the largest not-for-profit employer in New York City.

White Plains Hospital Center

White Plains Hospital Center (WPHC) is a 292-bed voluntary, not-for-profit health care organization with the primary mission of offering high quality, acute health care and preventive medical care to all people who live in, work in, or visit Westchester County and its surrounding areas. Centers of Excellence include the Dickstein Cancer Treatment Center, The William & Sylvia Silberstein Neonatal & Maternity Center, The Ruth and Jerome A. Siegel Stroke Center and The Westchester Orthopaedic Institute. The Hospital has the busiest Emergency Department in Westchester County, treating more than 45,000 patients a year. White Plains Hospital Center is a five-time winner of the Consumer Choice Award, an honor given to the nation’ top hospitals by the National Research Corporation. WPHC is a member of the NewYork-Presbyterian Healthcare System and the Stellaris Health Network, Inc. For additional information, visit www.wphospital.org.

Morgan Stanley Children’ Hospital of NewYork-Presbyterian

Ranked by U.S. News & World Report as one of the top six children’ hospitals in the country, Morgan Stanley Children’ Hospital of NewYork-Presbyterian offers the best available care in every area of pediatrics — including the most complex neonatal and critical care and all areas of pediatric subspecialities — in a family-friendly and technologically advanced setting. Building a reputation for more than a century as one of the nation’ premier children’ hospitals, Morgan Stanley Children’ Hospital of NewYork-Presbyterian is affiliated with Columbia University College of Physicians and Surgeons, and is New York City’ only hospital dedicated solely to the care of children and the largest provider of children’ health services in the tristate area with a longstanding commitment to its community. Morgan Stanley Children’ Hospital of NewYork-Presbyterian is also a major international referral center, meeting the special needs of children from infancy through adolescence worldwide. For more information, visit www. nyp.org.

Heineken USA

Heineken USA is the nation’ premier beer importer and a subsidiary of Heineken International (Netherlands), the world’ most international brewer. The company and its affiliates are firmly committed to promoting responsible consumption of alcoholic beverages. Among other distinctions, Heineken was the first brewer in the world to place a responsible consumption message on all of its bottles and cans. Heineken USA was also the first alcohol company to place a responsibility message on all of its television, radio, and print advertising. Please visit www.EnjoyHeinekenResponsibly.com.

1. Youth Risk Behavior Survey: 2007. Available from: URL: http://www.cdc.gov/HealthyYouth/yrbs/index.htm
2. Masten AS et al. Underage drinking- a developmental framework. Pediatrics 2008; Volume 121, Supplement 4.
3. Brown RT. Risk factors for substance abuse in adolescents. Pediatr Clin North America 2002; 49:247.
4. Nash SG, McQueen A, Bray JH. Pathways to adolescent alcohol use: family environment, peer influences, and parental expectations. J Adolesc Health 2005; 37:19-28.
5. Monitoring the Future, National Survey Results on Drug Use, 1975-2006. Volume II: College Students and Young Adults Ages 19-25. National Institutes of Health, US Dept Health and Human Services, 2007, available from: URL: http://monitoringthe future.org/pubs/monographs/vol2_2006.pdf
6. Nagel BJ, Schweinsburg AD, Phan V, Tapert SF. Reduced hippocampal volume among adolescents with alcohol use disorders without psychiatric comorbidity. Psychiatry Res. 2005; 139 (3); 181-190.
7. National Institute on Alcohol Abuse and Alcoholism. Trends in underage drinking in the United States – 1991-2005, available from: URL: http://pubs.niaaa.nih.gov/publications/surveillance81/Underage05.htm
8. National Highway Traffic Safety Administration (NHTSA), Dept. of Transportation (US). Traffic safety facts 2006: young drivers. Washington (DC), available from: URL: http://www-nrd.nhtsa.dot.gov/pubs/810817.pdf
9. Insurance Institute for Highway Safety (IIHS). Fatality facts: teenagers 2005. Arlington (VA): The Institute; 2006, available from: URL: http//www.iihs.org/research/fatality_facts_2006/teenagers.htm
10. http://www.nhtsa.dot.gov/people/outreach/safesobr/13qp/facts/factzero.html