More evidence for the argument that lowering drinking ages would lead to more alcohol and drug problems later in life. The point about age of first use vs. regular use is interesting and offers some interesting questions about goals and strategies for prevention programming.

Background: Many studies have found that earlier drinking initiation predicts higher risk of later alcohol and substance use problems, but the causal relationship between age of initiation and later risk of substance use disorder remains unknown.

Method: We use a "natural experiment" study design to compare the 12-month prevalence of Diagnostic and Statistical Manual, Fourth Edition, alcohol and substance use disorders among adult subjects exposed to different minimum legal drinking age laws minimum legal drinking age in the 1970s and 1980s. The sample pools 33,869 respondents born in the United States 1948 to 1970, drawn from 2 nationally representative cross-sectional surveys: the 1991 National Longitudinal Alcohol Epidemiological Survey (NLAES) and the 2001 National Epidemiological Study of Alcohol and Related Conditions. Analyses control for state and birth year fixed effects, age at assessment, alcohol taxes, and other demographic and social background factors.

Results: Adults who had been legally allowed to purchase alcohol before age 21 were more likely to meet criteria for an alcohol use disorder [odds ratio (OR) 1.31, 95% confidence intervals (95% CI) 1.15 to 1.46, p < 0.0001] or another drug use disorder (OR 1.70, 95% CI 1.19 to 2.44, p = 0.003) within the past-year, even among subjects in their 40s and 50s. There were no significant differences in effect estimates by respondent gender, black or Hispanic ethnicity, age, birth cohort, or self-reported age of initiation of regular drinking; furthermore, the effect estimates were little changed by inclusion of age of initiation as a potential mediating variable in the multiple regression models.

Conclusion: Exposure to a lower minimum legal purchase age was associated with a significantly higher risk of a past-year alcohol or other substance use disorder, even among respondents in their 40s or 50s. However, this association does not seem to be explained by age of initiation of drinking, per se. Instead, it seems plausible that frequency or intensity of drinking in late adolescence may have long-term effects on adult substance use patterns.

UPDATE: Oops. Here's the link.

I'm not much of Mitch Albom fan, but good for him. Whether one agrees with him or not, it's something we all take for granted and it deserves discussion.

The video featured two attractive women.

It was shot by an onlooker.

It hit YouTube by storm.

You're no doubt thinking "sex," but let me assure you the women kept their clothes on. Unfortunately, that was the only ladylike thing about them.

On the video, they appeared intoxicated, swore like sailors, got in fights, then screamed, shoved and cursed until security finally took them away, one in handcuffs.

This was not a women's penitentiary. It was a Lions game. You can argue that watching the Lions might make anyone go ballistic. But I'm guessing these women, like many football fans, had another reason for their belligerence:

They were hammered before the game began.

And you could shoot this video every Sunday.

Look, it's bad enough that most NFL games begin at 1 p.m. and that people are buying beers before kickoff. But thanks to tailgating, many fans are blotto before they hand over their tickets. One day, we'll explain to Martians our tradition of arriving hours before a football game, sitting in cold parking lots in fold-up beach chairs, swigging beers and grilling fatty foods between bumpers of pickups (at which point the Martians will bolt to their spaceships).

...

I blame the tailgaters, but I also blame the teams -- pro and college. By encouraging a seven-hour drinking experience, football now sees its stadiums marred with behavior like this past week's wildly popular YouTube moment (billed as "Two Drunk Girls Kicked out of Vikings vs Lions Game").

Presentations (hopefully video too) will be up next week. I'll post a link when they're up.

Sarah Zemore gave a great presentation on the evidence for the effectiveness of 12 step groups. It was powerful and well organized. I found a link to an identical presentation here.

She very effectively rebutted the Cochrane Review from a few years ago by making the following points. (These are based on notes I took and are incomplete. Hopefully they post video so that you can see her complete rebuttal for yourself.)

• It was limited only to randomized trials and ignored the overwhelming observational evidence.
• It included one of Zemore's studies which was NOT a randomized study of AA.
• She acknowledged that the randomized evidence is ambiguous.
  
• Randomized trials of AA are hard to do because some subjects in other groups end up participating in AA. This happened in Project MATCH.
• The Cochrane Review did not find Twelve-step Facilitation ineffective. It found it no more effective that CBT and MET.
• Finally, she cited 4 randomized studies of Twelve-step Facilitation: The outpatient arm of Project MATCH, a study by her colleague Kaskutas, and two others that I missed.

It was important for me because supporters of Twelve-step Facilitation are too often painted as the equivalent of intelligent design advocates. It's just not so and the evidence in this presentation made this unequivocally clear. Twelve-step Facilitation is not the only approach that works, but it's an evidence based practice.

Laudet made one self-evident point that jarred me because it is almost never made in professional circles. She pointed out that the subjects of one of her studies were infected with HIV at a rate of 22% and Hep C at a rate of 33%. She then said something to the effect of, "As a public health matter, we need to focus on keeping these people in recovery. If they relapse they are likely to spread these illnesses."

When's the last time you read anything about recovery as a strategy to reduce communicable disease?

Laudet (as did Zemore) attempted to deconstruct AA, so that it's mechanisms for change could be identified and still be offered to clients who prefer not to participate in AA or NA.

Bill White gave a rousing historical perspective of AA and NA's histories and pointed out the looming challenges that face twelve-step recovery groups. These challenges included matters like methadone maintenance patients as full NA members and the limitations of the 3rd tradition and singleness of purpose in AA. He noted that fewer that 18% of people entering treatment in the U.S. were primarily identified as alcohol dependent.