The Underage Drinking Epidemic (Parade Magazine)

The following article ran in the June 12, 2011 edition of Parade Magazine.

By Emily Listfield

Linda B.* and her husband were sound asleep when the phone rang at 2 a.m. Their oldest daughter, Rory, 18, had left two weeks earlier for her first year at a college in Connecticut. An honor student and athlete, Rory had never been in trouble. They didn’t think they had any reason to worry. 

“When I picked up the phone, Rory was crying hysterically; she was completely disoriented,” Linda recalls. “She kept saying, ‘Mom, can you come get me?’ but she had no idea where she was—and we live hours away. I’ve never been that scared—she could barely speak.”

Finally, Linda heard other people’s voices in the background and had Rory pass the phone to someone who told her where they were. While Linda stayed on the line with her daughter, her husband called campus security. When officials found Rory a few minutes later, her face was covered in blood. She had fallen and broken her nose, though she was so intoxicated that she hadn’t realized it.

“She managed to tell me she’d been drinking something called Jungle Juice,” Linda recalls. 

Like many parents, Linda had never heard of the potentially lethal concoction. A syrupy mix of hard liquors and fruit juices, it often includes Everclear, whose alcohol content can be as high as 190 proof (a level banned in some states). Some kids throw in energy drinks for good measure. There are dozens of recipes for Jungle Juice online; one popular site calls it “Suicide in a Kettle.”

Kegs and watered-down beer have long been as much a part of the campus experience as trying to avoid early-morning classes. And it’s not exactly unheard of for teens in high school and even middle school to sneak into their parents’ liquor cabinets. What is new—and increasingly alarming to those confronting the issue—is the rising trend of extreme underage drinking. Such is the concern that the legal drinking age itself has come into question. Some argue that lowering it from 21 to 18 would help curb the behavior by demystifying alcohol. Critics point out that drunk-driving fatalities among teens have dropped greatly since the drinking age became 21 nationwide. But both sides agree that binge drinking is a growing problem.

“We’re seeing kids coming in with blood alcohol levels in the mid-.3s, even .4, which is four to five times the legal limit for driving. That’s the level at which 50% of people die,” says Dr. Mary Claire O’Brien, an emergency medicine physician and assistant professor at Wake Forest University School of Medicine in North Carolina who specializes in alcohol-related research. “Ten years ago, we saw those levels only in chronic alcoholics.”

Adolescents tend to drink differently than adults. Their goal is not to sit around enjoying a glass or two of wine over the course of an evening. Rather, for many teens, the point is to get as drunk as possible, as quickly and cheaply as possible, in part to reduce the social anxiety rife at that age. Unfortunately, there are now more—and more dangerous—ways to accomplish this than ever before. The practice of mixing alcohol with super-caffeinated energy drinks; the marketing of flavored malt beverages in 23.5-ounce cans, each containing a serious dose of alcohol; a shift in preference from beer to hard liquor; and the influence of social media, through which kids avidly share Jungle Juice recipes and tales of their exploits, have all raised the stakes.

If you think your kids are immune, think again. According to the CDC, about 90% of all teen alcohol consumption occurs in the form of binge drinking, which, experts say, peaks at age 19. Forty-one percent of 12th graders report having had a drink in the previous 30 days, and by the time kids are in college, that number climbs to 72%. Approximately 200,000 adolescents visit emergency rooms each year because of drinking-related incidents, and more than 1,700 college students die. “Underage drinking doesn’t discriminate,” says Adrian Lopez, director of community outreach for the SoBeSober program for teens in Miami. “Whether you are an upper-middle-class, straight-A student or from an inner city, it impacts all demographics and communities. And it often peaks in May and June, when kids are celebrating proms and graduations. We call it ‘The Killing Season.’”

Blackout in a Can
The craze for combining energy drinks, which can  have far more caffeine than coffee or cola, with alcohol is particularly troubling. Dr. O’Brien first became aware of the phenomenon in 2006 when a student was brought in near-comatose. “The caffeine blocks the part of alcohol that makes you sleepy and might otherwise cause you to pass out. This enables you to drink far more than you might have. By the time many of these kids get to the hospital, they have to be put temporarily on respirators because of depressed breathing.” Disturbed by what they were seeing, Dr. O’Brien and her colleagues conducted a survey that year of 4,271 students from more than 10 universities in North Carolina. “We found that about a quarter of the kids who’d had a drink in the past 30 days said they were mixing alcohol with energy drinks, either the premixed kind or Red Bull and vodka. They got drunk twice as often and drank more per session than those who had alcohol without caffeine. They were much more likely to be injured, much more likely to be taken advantage of sexually or to take advantage of someone sexually, much more likely to drive drunk.”

Colleges are on the front lines of this battle. Ramapo College in New Jersey banned energy drinks containing alcohol on campus in 2010 after a number of students were sent to the ER for alcohol-related reasons over a few weeks. James L. Gaudino, president of Central Washington University in Ellensburg, Wash., took similar action. “We banned alcoholic energy drinks when we became aware of the extraordinary threat they pose,” he says. “What shocked us was the hospitalization of 11 students after a single party.”

As outrage grew, the FDA stepped in, and last year essentially ordered the makers of four brands, including Phusion Projects, which sells the cult favorite Four Loko, to remove the caffeine. Four Loko was reformulated and is now back on the market. The sweetened beverage no longer contains caffeine, but each 23.5-ounce can may have the alcohol equivalent of four to five beers. (Four standard beers for a female and five for a male over a two-hour period is considered binge drinking.) Though it’s too early to tell if its popularity is abating, Four Loko, a.k.a. “Blackout in a Can,” has been a hit on YouTube, with more than 5,000 videos extolling its virtues.  

“Four Loko is everywhere,” says Gabby K., 17, a high school junior in New Jersey. “It tastes like candy, so you can drink a lot of it fast. It’s pretty potent and it only costs around $3 a can. It’s a faster way to get drunk without having to deal with the taste of liquor.” Gabby notes that the cans look a lot like iced tea. “It seems user-friendly,” she says. But she won’t drink it herself, pointing out that a number of kids in her school were hospitalized this year due to binge drinking. The makers of Four Loko reply: “We are fully committed to doing our part to ensure that our products are consumed legally and responsibly. Phusion Projects’ marketing message is clear: If you are under the age of 21, respect the law and do not drink.”

Even in its new incarnation, Four Loko falls into a category that teens love but that has authorities worried: flavored malt beverages. Like Four Loko, many of them are sold in brightly decorated 23.5-ounce cans and have an alcohol content of 12%. 

On April 21, attorneys general from 16 states co-signed a letter to Pabst, makers of the malt beverage Blast. “We believe the manufacture and marketing of this flavored ‘binge in a can’ poses a grave public safety threat,” the letter states. It cites concerns that Blast—with such varieties as strawberry lemonade and grape, a pervasive online presence, and the rap star Snoop Dogg as a spokesman—is aimed at underage drinkers. Jon Sayer, chief marketing officer of Pabst Brewing Company, issued this reply: “Blast is produced only for consumers above legal drinking age and is marketed as such.” The president of Anheuser-Busch, meanwhile, announced in late May that the company will lower the alcohol content in its 24-ounce flavored malt beverage Tilt from 12% by volume to 8%.

Drinking Games Go Hard-Core
Teens’ growing preference for hard liquor over beer is also setting off alarms. Dr. Michael Siegel, professor at the Boston University School of Public Health, recently completed a study of high school students. “We found that, by far, liquor is the beverage of choice. This definitely represents a change.”

Hard liquor is increasingly replacing beer in drinking games. “Kids easily drink seven or eight shots at a time,” Gabby says of her buddies. But Dr. O’Brien notes, “That’s low ballpark, from what we are seeing. Teens in our studies are having 10 or more drinks.”

Helene F., 20, a junior in college in Colorado, explains the appeal: “Everyone’s so much friendlier after a couple of drinks. It takes the pressure off. And if you want to get drunk quickly, shots are key. There’s a sense that you need to be wasted to go to a party, and if you’re not, you won’t have fun. Certain events, like Halloween and homecoming, it’s kind of guaranteed that kids are going to end up in hospitals.” After 14 students were hospitalized during a graduation celebration in 2008, Colby College in Maine studied the issue and, in 2010, banned hard liquor on most of the campus.
The Long-Term Damage
“The adolescent brain is much more sensitive to alcohol toxicity than adults’, including being vulnerable to cell death,” says Dr. Fulton Crews, director of the Bowles Center for Alcohol Studies at the University of North Carolina School of Medicine. “Adolescents showed much more frontal cortical damage than adults. We found that one high dose of alcohol caused significant loss of brain stem cells.”

Early drinking also poses a risk later in life. “If you start drinking early, you’re 40% to 60% more likely to become an alcoholic, regardless of family history,” Dr. Crews says. And studies indicate a potential for permanent memory impairment.

*Names have been changed to protect minors and their parents.


What Parents Can Do
If you’re worried that your teen might be binge drinking, consider taking these steps.

• Know the warning signs.
Signs of extreme drinking include a drop in grades, changes in behavior and mood, a new set of friends, memory lapses, and difficulty concentrating.

• Open a dialogue.
Ask your kids what kinds of  experiences they’re having, make your personal values clear, and calmly lay out the risks. Studies have found that parents who combine clear expectations of accountability with support and warmth have more success in curbing binge drinking than either strictly authoritarian or overly indulgent parents.

• Establish a code word.
Before your kids go out, agree on a phrase they can say if they are in an uncomfortable situation and need to give you a signal to come get them right away, no questions asked.

• If you tell your kids just one thing, make it this:
“If someone has been drinking Jungle Juice or doing shots in a short amount of time, their blood alcohol level can continue to rise dangerously after they appear to fall asleep,” Dr. O’Brien says. This could have fatal consequences. “Tell your kids: If you can’t rouse someone, call 911.  The worst that can happen is you’ll be embarrassed or your parents will get angry. But the alternative is far worse. We all know kids make mistakes. Unfortunately, some mistakes can’t be fixed.”

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