1. Adolescent Binge Drinking: Trends, Implications, and New Directions for Schools Colusa County Office of Education February 16, 2005 Presented by: Joël Phillips Community Prevention Institute (CPI)

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. 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. 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.

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

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. 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.

8. 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

9. 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

10. 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)

11. 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)

12. 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

13. 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.

14. 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).

15. 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”

16. 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.

17. 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.

18. 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.

19. Paradigm Shift Away from Blaming Youth Youth are not the primary producers, promoters, distributors, sellers, or users of alcohol...ADULTS AND ADULT BUSINESSES ARE [adult drinkers / brewers, distillers & wine producers / bars, taverns, restaurants / mass media / advertising / merchants / etc.]

20. Journal of Adolescent Health (Oct. 2004) 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.

21. 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.

22. 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

23. Common Characteristics Support groups Individual counseling Community involvement Supportive environments

24. Collaboration Facilitate accessibility Avoid duplication Support groups Health clinics Health care providers Cessation programs Law enforcement agencies Social service organizations

25. Identification Teachers Counselors Administrators Other school personnel Law enforcement Disciplinary referrals Parents Peers Self

26. Common Challenges Funding Staffing Program awareness Buy-in

27. 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.

28. 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

29. Complementary Model Programming: LifeSkills Training Recommended for indicated and selective middle school youth. Flexibility to be used with a universal or elevated risk middle school population, and to be used in a classroom or support group setting. Drug Resistance Skills. Personal Self-Management Skills. General Social Skills. Interactive skills-based curriculum with follow-up boosters.

30. CPI Services Prevention Extension Workshop: Community Action to Reduce Binge Drinking Profile population needs, resources, and readiness to address the problems and gaps in service delivery. Mobilize and/or build capacity to address needs. Develop a comprehensive strategic plan. Implement evidence-based prevention programs and infrastructure development activities. Monitor process, evaluate effectiveness, sustain effective programs/activities, and improve or replace those that fail.

31. On-Line Resources www.ca-cpi.org www.jointogether.org www.marininstitute.org www.saddonline.com www.westcapt.org www.camy.org http://modelprograms.samhsa.gov

32. Local and State Data Sources California Healthy Kids Survey (CHK) California Healthy Kids Survey (CHK) ASIPS/GIS mapping ASIPS/GIS mapping Place of Last Drink (POLD) Place of Last Drink (POLD) SWITRS—California Highway Patrol SWITRS—California Highway Patrol Police Department Police Department Emergency Medical Services Emergency Medical Services Hospital Discharge Data Hospital Discharge Data

33. National Data Sources Monitoring the Future Monitoring the Future National Survey on Drug Use and Health National Survey on Drug Use and Health NIAAA—College Drinking Prevention NIAAA—College Drinking Prevention Harvard School of Public Health, College Alcohol Study Harvard School of Public Health, College Alcohol Study SAMHSA—Clearinghouse SAMHSA—Clearinghouse

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