Alcohol and Youth: Time for Effective Action

The problems associated with alcohol use were once largely considered to be primarily due to long-term heavy intake of ethanol. The major causes of death and hospitalization attributed to alcohol use were thought to be chronic diseases such as cirrhosis and alcohol dependence. Until recently, this view was largely supported by available research. The health benefits of alcohol consumption were not well established, and prevailing estimates of alcohol-related mortality indicated chronic disease accounted for most alcohol-related deaths. Based on results of a 1984 Health Canada expert committee regarding the attribution of alcohol to major causes of death, 1 it was estimated that 80% of alcohol-attributable deaths were due to chronic disease and alcohol dependence. 2 Youthful drinking was viewed with benign neglect ‐ although there were concerns that consumption rates established in youth influence lifelong drinking patterns, youthful drinking in itself was not seen as a major component of alcohol-attributable mortality. We now know differently. More recent estimates indicate that acute causes contribute a great deal more to overall levels of alcohol-related mortality than previously thought. 3,4 Unlike earlier results, these estimates are based on specific disease categories controlling for age and gender. They show that accidents, suicide and other acute causes actually account for approximately one half of the deaths caused by alcohol misuse. 5 Furthermore, because such deaths often involve young persons, acute causes account for two thirds of years of potential life lost due to alcohol misuse. 3 Mitic and Greschner’s timely analysis of the role of alcohol in the deaths of British Columbia youth and children 6 corroborate these findings. One could raise questions regarding their exact findings ‐ only a subset of youthful fatalities are available for analysis and, as the authors are well aware, the attribution of causality based solely on whether or not drinking had taken place, is subject to criticism. But combined with evidence from other sources, the primary conclusion of their analysis is undeniable: alcohol plays a major role in the premature death of our children and youth. Given the significance of alcohol to youthful mortality, the key issue is what should be done to enhance the effectiveness of prevention policy and programming. Not long ago, when the primary problems associated with alcohol were chronic conditions stemming from long-term drinking, the answer to this question would have focused on controls over alcohol availability and preventive programming emphasizing the message that drinking less is better. The use of tax policy and availability controls to reduce alcohol problems has certain advantages. Such population-based measures are relatively easy to implement. There is reasonably good evidence that they can reduce levels of drinking and alcohol problems. 7-9 Tax