1. Adolescent Binge Drinking: Trends, Implications, and New Directions for Schools San Francisco Unified School District October 5-6, 2005 Presented by: Joël L. Phillips Community Prevention Institute (CPI) 771 Oak Avenue Parkway, Suite 2 Folsom, California 95630 Phone:(916) 983-6680Email:joel@emt.org

2. 2 Issues What constitutes excessive alcohol consumption? Is there a problem with excessive alcohol use among California adolescents? If so, to what extent? Are there disparities to address? What are the consequences of excessive alcohol consumption? What can we do?

3. 3 What is Excessive Alcohol Consumption (Binge Drinking)? General Binge (high risk) drinking is the consumption of alcohol to the extent that harmful consequences – health, academic, legal and others – may be expected. Specific (Recent NIAAA definition) A “binge” is a pattern of drinking alcohol that brings the blood alcohol level concentration (BAC) to 0.08 or above. For the typical adult, this pattern corresponds to consuming 5 or more drinks (male), or 4 or more drinks (female), in about 2 hours. A “drink” refers to half an ounce of alcohol (e.g., one 12-oz. beer, one 5 oz. glass of wine, or one 1.5 oz. shot of distilled spirits.)

4. 4 Excessive Alcohol & High-Risk Drug Users Grade 11

5. 5 Dimensions of the Problem Table 1. High Risk Drug Use & Excessive Alcohol Use 91-92* (%) 93-94 95-9697-9899-0001-0202-03 Grade 9 Excessive Alcohol Users (EAU)18.521.023.319.416.417.114.3 High-Risk Drug Users (HRU) a 11.421.220.220.311.010.4 9.3 Total EAU or HRU22.029.128.529.519.420.0 17.4 Grade 11 Excessive Alcohol Users (EAU)27.529.231.330.833.932.4 29.9 High-Risk Drug Users (HRU) a, 17.626.626.826.920.721.3 17.3 Total EAU or HRU32.537.838.438.637.635.7 33.6 a Refers to drug use in the past six months only. *Passive parent consent required for participation; starting in 1995, active (written) consent was required.

6. 6 Trend Data Results The trend data in Table 1 supports several conclusions: 1. High rate use of alcohol or drugs by California students increases significantly in the middle and high school years. 2. Despite the emphasis on alcohol and drug prevention in schools, the percentage of students who report high use rates for alcohol or other drugs has been relatively constant over the last decade; 2002-2003 EAU and HRU rates are nearly the same as the 1991-1992 rates. 3. Excessive alcohol use is more prevalent than high risk drug use. 4. A substantial percentage of California secondary school students report that they are high rate users.

7. 7 Why Focus on Binge Drinking? 16 Sobering Facts. Young People and Early Drinking Consequences… Boys are more likely than girls to begin drinking before age 13.* The earlier underage drinking begins, the greater the risk for developing a serious alcohol-related problem, including addiction. Among 12-17 year olds who are current drinkers, 31% have exhibited extreme levels of psychological distress and 39% have exhibited serious behavioral problems.** *Centers for Disease Control and Prevention. June 2000. Youth Risk Behavior Surveillance – United States, 1999. Morbidity and Mortality Weekly Report 49(SS05):1-96 ** Substance Abuse and Mental Health Services Administration (SAMHSA). 1999. The Relationship Between Mental Health and Substance Abuse Among Adolescents. Rockville, MD: SAMHSA.

8. 8 Why Focus on Binge Drinking? 16 Sobering Facts. Young People and Early Drinking Consequences…cont. Among 8 th grade girls who drink heavily, 37% report attempting suicide, compared to 11% who do not drink.* 40% of children who start drinking before the age of 15 will become alcoholics at some point in their lives. Delaying the use of alcohol until the legal age helps avoid many of the associated problems. If the onset of drinking is delayed by 5 years, a child’s risk of serious alcohol problems is cut in half** *Windle M.A. 1992. Alcohol use, suicidal behavior, and risky activities among adolescents. Journal of Research on Adolescence 2(4). **Grant, B.F. 1998. National Institute of Alcohol Abuse and Alcoholism on The Relationship Between Age at Onset of Alcohol Use and DSM-IV Alcohol Dependence.,Results from the National Longitudinal Alcohol Epidemiologic Survey. Alcohol Health and Research World 22(2).

9. 9 Why Focus on Binge Drinking? 16 Sobering Facts. Young People, Drinking and Sexuality. Alcohol use in adolescents is a strong predictor of both sexual activity and unprotected sex. Teenage girls who drink are more likely to have sex and have it without a condom than girls who do not drink alcohol.* Half of the girls who have sexual intercourse by the age of 16 are intoxicated at the time and half later regret their action.** *Centers for Disease Control and Prevention. 1999. Youth Risk Behavior Surveillance System Summary. Washington DC: U.S. Department of Health and Human Services, Public Health Service. **Sachs, H.C. MD. April 2000. Teens trying drugs and alcohol. Contemporary Pediatrics 17(4):45.

10. 10 Why Focus on Binge Drinking? 16 Sobering Facts. Young People and Unwanted Sexual Encounters. Researchers estimate that alcohol use is implicated in one to two thirds of sexual assault and “date rape” cases among teens and college students.* A survey of high school students found that 18% of females and 39% of males say it is acceptable for a boy to force sex if the girl is stoned or drunk.** *Office of the Inspector General, U.S. Department of Health and Human Services (HHS). April 1992. Youth and Alcohol: Dangerous and Deadly Consequences. Washington DC: HHS. **Office of the Inspector General, U.S. Department of Health and Human Services. Last accessed On September 21, 1999. Dangerous and Deadly Consequences. www.ncadd.org/youthalc.html.

11. 11 Why Focus on Binge Drinking? 16 Sobering Facts. Young People, Drinking and School. A survey of students at 119 colleges found that 44% of students are binge drinkers (have five or more drinks per occasion).* As many as 360,000 of the Nation’s 12 million undergraduates will eventually die from alcohol-related problems, many of which began in college. This is more than the number who will get M.A.s and Ph.D.s combined.** Alcohol on college campuses is a factor in 40% of all academic problems and 28% of all dropouts.*** *Weschler, H; Lee, J; Kuo, M.; and Lee, H. 2000. College Binge Drinking in the 1990s: A continuing Problem. Results of the Harvard School of Public Health 1999 College Alcohol Study. Cambridge, MA: Harvard School of Public Health. **Eigen, L. February 1991. Alcohol Practices, Policies and Potentials of American Colleges and Universities. An OSAP White Paper, Rockville, MD: Office for Substance Abuse Prevention. ***Anderson, D. 1994. Breaking the Tradition on College Campuses: Reducing Drug and Alcohol Misuse. Fairfax, VA: George Mason University.

12. 12 Why Focus on Binge Drinking? 16 Sobering Facts. Drinking and our Culture. In recent television programs, 9 out of 10 drinkers are portrayed as either experiencing no effects at all or only positive personal and social outcomes from their alcohol consumption.* *Gerbner, G. October 1996. Television Violence and Alcohol Use Declines, but Smoking Still Shown as Risk-Free. Center for Substance Abuse Prevention News Release.

13. 13 Why Focus on Binge Drinking? 16 Sobering Facts. Young People, Drinking and Driving. 33% of 9 th graders report having ridden in a car driven by someone who has been drinking alcohol.* For every 100,000 licensed drivers, young drinking drivers are involved in fatal crashes at approximately twice the rate of drivers age 21 and older.** Even small amounts of alcohol are dangerous for young, Inexperienced drivers. In 1998, more 18 year olds died in low blood alcohol concentration (between.01 and.09) alcohol-related crashes than individuals of any other age.*** About 3 in every 10 Americans will be involved in an alcohol-related crash at some time in their lives.**** *Centers for Disease Control and Prevention. 1997. Youth Risk Behavior Surveillance – United States Morbidity and Mortality Weekly Report 47(SS-3):1-89. **National Highway Traffic Safety Administration (NHTSA). 1999. 1998 Youth Fatal Crash and Alcohol Facts. Washington DC: U.S. Department of Transportation. ***Ibid ****NHTSA. 1999. Traffic Safety Facts 1998 – Alcohol. (DOT HS 808 950). Washington DC: U.S. Department of Transportation.

14. 14 Binge Drinking Grade 7Grade 9Grade 11 1999- 2000 2001- 2002 2003- 2004 1999- 2000 2001- 2002 2003- 2004 1999- 2000 2001- 2002 2003- 2004 (%) Never94.297.296.386.786.688.573.873.776.7 1+ days5.82.83.713.313.411.526.226.323.3 3+ days1.71.01.36.17.25.114.214.012.2 10+ days0.90.6 2.52.41.94.55.14.2 Table 2. Frequency Consumed Five or More Drinks in a Row, Past 30 Days By the 11 th grade, approximately one fourth of the student sample reported binge drinking at least once in the last 30 days. Approximately 12 percent of 11 th graders binged 3 or more days in the past month.

15. 15 Percentage of students who had at least one drink of alcohol on one or more of the past 30 days 0 20 40 60 80 100 TotalMalesFemales 9th10th11th12th 24.5 25.6 23.5 18.3 15.8 31.3 31.4 San Francisco High School Survey 2003 Youth Risk Behavior Survey

16. 16 Percentage of students who had five or more drinks of alcohol in a row, that is, within a couple of hours, on one or more of the past 30 days San Francisco High School Survey 2003 Youth Risk Behavior Survey 0 20 40 60 80 100 TotalMalesFemales 9th10th11th12th 10.2 11.6 8.9 6.8 5.7 13.0 14.2

17. 17 San Francisco High School Survey 2003 Youth Risk Behavior Survey Percentage of students who had at least one drink of alcohol on school property on one or more of the past 30 days 0 20 40 60 80 100 TotalMalesFemales 9th10th11th12th 5.4 6.1 4.9 5.5 3.9 7.2 4.5

18. 18 Binge Drinkers and Problem Behavior Binge drinkers are much more likely to put themselves and others in harm’s way through being intoxicated and through drinking and driving. Binge drinkers are more likely to be involved in gangs and potential violence than students who do not binge. Binge drinkers are more likely to be involved in relationship violence, an issue of particular relevance to Student Assistance Programs (SAPs). Table 3. Other Alcohol-use Correlates of Binge Drinking, 11th Graders, 2003 CSS Total Sample Binge Drank, Past 30 Days Non-binge Drinker, 30 Days No Alcohol, 30 Days Likes to get really drunk7.021.24.12.2 Was drunk 3 or more times19.656.820.96.2 Drink/drive episode, 3 or more12.532.414.65.8 Fight between groups, year17.729.520.412.7 Used weapon to threaten, year8.617.111.35.9 Been in a gang, ever9.215.810.47.5 Relationship violence, year8.214.97.96.4

19. 19 Binge Drinkers and School Behavior Total Sample Binge Drank, Past 30 Days Non-binge Drinker, 30 Days No Alcohol, 30 Days School-related Alcohol Use Used alcohol at school, past 30 days8.023.65.92.8 Drunk/high at school, 3 or more times12.130.411.55.7 School Violence (Year) Physical fight at school 20.5 32.230.614.7 Taken a weapon to school 13.0 23.113.69.2 Damaged school property 17.8 31.220.113.2 School Behavior Skip school/cut class (ever) 60.3 82.954.250.9 Skip school/cut class (“few times” or more) 39.3 60.733.029.8 Low school connectedness 21.0 26.319.419.3  Much more likely to use substances at or before school, and to be under the influence of substances at school;  Somewhat more likely to engage in violent or destructive behavior at school;  Much more likely to skip school or cut class; and  Tend to have lower connectedness to school. Table 4: Binge Drinking and School Behaviors

20. 20 Other Behaviors that Go Hand-in-Hand with Excessive Alcohol Consumption Youth with serious alcohol problems (approximately 9% of CA males and females ages16 to 17): 11 times more likely to have serious problems with other drugs 10 times more likely to drink and drive 4 times more likely to be arrested 2 times more likely to have a C average or lower and are likely to miss twice as much school 2 times more likely to smoke 1.5 times more likely to require hospital emergency care 5 times more likely to commit suicide 4 times more likely to get into a serious fight 3.5 more times more likely to carry a weapon 3 times more likely to have a conduct disorder 3 times more likely to be hospitalized with a mental health problem 2 times more likely to get into an accident, injure another person or themselves Almost twice as likely to have multiple sex partners (Source: George Washington University Medical Center)

21. 21 Other Consequences Binge drinking in high school, especially among males, is strongly predictive of binge drinking in college. (NIAAA) Young persons who begin drinking before age 13 are four times as likely to develop alcohol dependence and twice as likely to develop alcohol abuse as those who begin drinking at age 21. (National Longitudinal Alcohol Epidemiologic Survey)

22. 22 Gender Discrepancies Underage youth saw more alcohol advertising than adults, on a per capita basis, in magazines in 2002. Girls were even more overexposed to this advertising than boys (Archives of Pediatrics & Adolescent Medicine, 2004). In 2002, MTF found that eighth- and 10 th -grade girls surpassed boys for the first time as current drinkers. In 2003, CDC found that more girls consume alcohol than boys and they binge drink more often. An AMA poll found that the average age of a girl’s first drink is now 13.

23. 23 Why Worry About Girls? Girls tend to feel the impairing effects of alcohol much faster than males. Effects include liver, brain and heart damage as well as gender-specific complications such as increased chances of breast cancer, osteoporosis, menstrual disorders and pregnancy. Relationship violence. Sexual assault and date rape. Unplanned and unprotected sex. Fetal alcohol syndrome.

24. 24 Adolescent Brain Development New information constantly emerging. Ethical considerations prevent use of adolescents – But brain scans and animal studies are revealing Some facts Brain is still maturing in adolescents – Can account for “poor decisions” BUT – Place teens for elevated risks to the effects of drugs and alcohol.

25. 25 Adolescent Brain Changes Prefrontal Cortex (PFC) – helps process high complex information – “seat of sobering second thought” (judgment) – not fully developed until mid 20’s. Amygdala – Structure responsible for integrating how to emotionally react to pleasurable and aversive experiences. It’s developing in adolescence. Result: Youth tend to react to situations with “hot” emotions rather than more controlled “cool” emotions. Tends to dominate the PFC.

26. 26 Introduce Alcohol Into The Mix Immature PFC “Hot” button of the amygdala Result: Poor decisions. But there’s more….

27. 27 Alcohol Hijacks the Brain’s Reward Circuitry Continued use of alcohol reduces the brain’s dopamine production. Because dopamine is part of the reward system, the brain is “fooled” that alcohol has survival value for the organism. The reward system responds with “drug seeking behaviors.” Craving occurs and, eventually, dependence.

28. 28 Adolescents with a History of Extensive Alcohol Use Decrease in hippocampus by 50% (hippocampus converts information to memory). Decrease in brain activity during memory tasks. Increase in brain activation when shown alcohol images (trigger for relapse).

29. 29 Adolescents Are More Susceptible to Alcohol Than Adults Reduced sensitivity to intoxication Increased sensitivity to social disinhibitions Greater adverse effects to cognitive functioning Medicates “excitability”

30. 30 Long-Term, Heavy Use of Alcohol Significant shrinking of the brain 50-70% show cognitive impairment Effects remain even after detoxification and abstinence Alcohol dementia is the 2 nd leading cause of adult dementia

31. 31 Findings Brain undergoes tremendous amount of development during adolescents Alcohol affects teens differently from adults – Bigger impairments in learning/memory – Less sensitivity to effects Repeated alcohol exposure might alter path of teen brain development Decisions youth make can influence brain development We may not be able to make up for decisions made as teens – brain is more hardwired in 20’s. Unhealthy Choices = Unhealthy Brain

32. 32 What Can We Do? 1. Recognize there is a serious problem with binge drinking in our schools and communities. 2. Increase awareness/knowledge of consequences of underage binge drinking by sharing information with health care providers and educators, teachers, administrators, business leaders, public officials, community advocates, parents, and students. Utilize existing infrastructure of local coalitions if possible. 3. Examine local prevention/intervention services for alignment with best practice strategies. 4. Modify existing services as needed. CPI can provide no-cost technical assistance and training.

33. 33 Understand… Need for best data on underage use of AOD Need for a simple process/procedure to identify this group of students Need for Intervention services – SAP’s Need to get community/parents involved

34. 34 Role of Parents Reports on a study that concludes parents strongly influence their children’s drinking behavior. Teens were twice as likely to binge drink and use alcohol within a 30-day period if their parents or friends’ parents provided alcohol at their homes for a party. Parents who set strict consequences for breaking the house rules regarding drinking can help prevent underage drinking.

35. 35 Student Assistance Programs A recognized, school-based approach to providing focused services to students needing interventions for substance abuse or other problems. Few studies, but with promising results. SAPs are uniquely tailored to local needs. Selective participation. Collaboration. Screening and assessment. Multiple services.

36. 36 Potential SAP Services Academic support Counseling services After-school activities Substance use education Violence prevention and conflict mediation Peer support and mentoring programs Career services

37. 37 Complementary Model Programming: Project Toward No Drug Abuse Recommended for indicated and selective high school youth. Originally developed to work with youth in alternative high schools with higher risk youth, but has since been adopted by many traditional high schools. Targets ATOD by encouraging youth to participate in lower-risk activities, to appreciate the risks of drugs on the body, and to develop positive decision-making skills. 40- to 50-minute interactive curriculum designed to be presented in 12 lessons. Good fit for a pullout group format.

38. 38 Complementary Model Programming: Too Good For Drugs Recommended for selective middle and high school youth. Middle school curriculum is grade-specific; high school is not. Designed to reduce the intention to use ATOD during the middle and high school years. Relies on small group activities, role play and group discussions regarding appropriate attitudes toward ATOD use, knowledge of ATOD’s negative consequences, the benefits of a drug-free lifestyle, and positive peer norms. Also meets the needs of sites seeking to prevent conflict and violence on their campuses. Pullout structure okay as long as the same students are served throughout the program. 10-lesson curriculum once a week for 14 lessons. Optional home workouts for parents and infusion lessons are included

39. 39 Questions?

40. 40 www.ca-cpi.org 771 Oak Avenue Parkway, Suite 3 Folsom, CA 95630 916-983-8929-MAIN 916-983-5738-FAX