&
Facts
Conversations
TOUGH QUESTIONS
FROM PARENTS
On Teens and Alcohol
Facts & Conversations is a series of
communications provided by the Health
Alliance on Alcohol.
Publications to Date Include:
Underage Drinking
Peer Pressure
Prom, Graduation, and Alcohol
College & Alcohol
Teen Driving & Alcohol
Parents & Underage Access to Alcohol
Spring Break
Parents, Adults & Mentors
Available online for view, download or order
at: EnjoyHeinekenResponsibly.com and
HealthAllianceonAlcohol.com.
This series is also available in Spanish.
table of contents
Introduction
QUESTIONS FROM PARENTS
—— What is the magnitude of the underage drinking problem and has it changed
in the last 20 years?
—— Is there any research on why kids drink – thrill seeking, boredom, curiosity,
because it is a restricted product?
—— What is the motivation behind binge drinking?
—— With my generation being so different, is there something different about
today’s world that exacerbates the problem of underage drinking?
—— When should the education process and conversation about alcohol begin?
—— Can giving your kids too much information be counter-productive?
—— After whom do children model their behavior?
—— 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?
—— Since I drank as a teen and turned out OK, why should I worry about my
teen having a few drinks at a party?
—— If kids choose to experiment, how should parents respond?
—— How should parents respond when their teenagers confide in them about
their friends’ experiences with alcohol or other risky behaviors?
—— 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?
—— 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)?
—— 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?
—— How do children get access to alcohol while at college?
—— Isn’t it better to teach children how to drink responsibly while they are still
teenagers?
—— Do you think statistics of teens driving after drinking are better or worse than
they were 10-15 years ago?
—— What is zero tolerance?
—— How do you recommend parents address underage drinking with their children as they near driving age?
—— How does alcohol affect the body and what are the signs to determine if the
level of intoxication is dangerous?
—— At what point does your intoxicated teen need to be taken to the Emergency
Room?
—— How do you determine if a teen has an alcohol problem?
CONCLUSION
introduction
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
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.
Alliance on
composed of
real questions
asked by
parents and
community
leaders at
forums held
by the Health
Alcohol over the
years.
Tough
Questions
From Parents
&
On Teens Alcohol
1
QUESTIONS FROM PARENTS
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%
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.
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.
Tough
Questions
From Parents
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On Teens Alcohol
2
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
Certain teens
may have a
temperament
that pushes
them toward
thrill-seeking.
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 sub-
3
Tough
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From Parents
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On Teens Alcohol
stances 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.
It is never too
early to start the
conversation.
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
Tough
Questions
From Parents
&
On Teens 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.
Be careful and
be aware of
the “hypocrite
challenge” with
which your child
may confront
you.
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?
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
5
Tough
Questions
From Parents
&
On Teens Alcohol
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.
Your child may
be concerned
about a friend
and how much
that friend is
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.
Tough
Questions
From Parents
&
On Teens Alcohol
6
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?
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.
The issue of
liability is often
the most effective
and compelling
one in curtailing
the serving of
alcohol to minors.
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)?
There is really no way for a parent to literally control his/
her adolescent child. The best way to influence your teen’s
7
Tough
Questions
From Parents
&
On Teens Alcohol
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.
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.
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.
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
Tough
Questions
From Parents
&
On Teens Alcohol
8
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
9
Tough
Questions
From Parents
&
On Teens Alcohol
reach out to other parents within your parent network to
discuss their experiences, both positive and negative, on the
subject.
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:
...many students
choose to buy
fake ID’s in
order to access
bars or buy
alcohol.
• 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.
Tough
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10
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
Parents should
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
with respect to
set clear
expectations
regarding
driving
privileges,
especially
drinking and
driving.
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.
11
Tough
Questions
From Parents
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On Teens Alcohol
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.
How does alcohol affect the body and what are the signs to determine if the level of intoxication is dangerous?
Adolescents
watch adults
closely,
and notice
those who
drive while
intoxicated.
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.
Tough
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12
At what point does your intoxicated teen need to be taken to the
Emergency Room?
Any adolescent
who has
consumed so
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.
much alcohol
that he/
she appears
confused
and poorly
responsive,
with slow
or shallow
breathing, is in
severe distress.
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.
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CONCLUSION
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.
Tough
Questions
From Parents
&
On Teens Alcohol
14
bibliography
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
15
author
Karen Soren, MD
Associate Clinical Professor of Pediatrics and Public Health,
Columbia University Medical Center
Director of Adolescent Health Care
Morgan Stanley Children’s Hospital
of NewYork-Presbyterian
www.Healthallianceonalcohol.com