Differences at the General Cultural Level

As physical commodities, alcoholic beverages have a range of use-values (Mäkelä, 1983) reflecting their different properties. As liquids taken into the body, they quench thirst. Cold, they can cool the body; hot, they can warm it. As a source of calories, they provide some sustenance. Traditionally, they were used medicinally; with the findings on their protective value for heart disease, this use is returning, although the net health balance from drinking in the population as a whole is negative. As psychoactive substances, they can act as a mood changer; at heavier doses, they can take one out of oneself, or be a means of psychic escape.

Although these use-values can be distinguished from one another, when an alcoholic beverage is used for one purpose, its other properties are also carried along. To use wine as a food and source of calories, as was done traditionally by Italian farm laborers, does not preclude it from also having psychoactive effects.

On top of the physical properties of alcohol, and the use-values attached to them, is an extraordinarily wide range of cultural meanings ascribed to drinking, with their own range of use-values. For a majority of Christians, wine is a sacrament with a range of sacred associations. Sacramental wine is not supposed to intoxicate. Old Anglican prayer books therefore addressed the use of consecrated wine left over after communion. It could not be returned to profane status, but it was also not proper for the priest simply to drink it up, risking drunkenness. Instead, he was instructed to gather other communicants and drink the wine with them “reverently” on the spot (Church of England, 1662).

A crucial use of alcohol, from the perspective of the harms associated with it, is the set of use-values surrounding intoxication from drinking. The “prized but dangerous” psychoactive effects of drinking heavily, as Steele and Josephs (1990) term them, are differentially sought by drinkers in different cultures. As the ethnographic literature has long taught us (MacAndrew and Edgerton, 1969; Room, 2001), there are also big cultural differences in comportment from a given level of drinking—often described, differences in the “disinhibition” associated with the drinking. The combined effects of these differences in drinking patterns and in cultural norms of drunken comportment can be quite dramatic: Time-series analyses of the relation between changes in average alcohol consumption and changes in homicide rates suggest that an extra unit of drinking pushes the homicide rate up twice as much in northern European countries such as Sweden as in southern European countries such as Portugal (Rossow, 2001).

A scale of the degree of hazard in the patterns of drinking in a society has been developed, ranging as a first approximation from 1 for the least hazardous patterns to 4 for the most hazardous (Rehm et al., 2001; see Table 13-4). On this scale, Portugal, for example, is scored at 1, the United States at 2, Sweden at 3, and Russia at 4. Although the proportion of drinking occasions which are relatively heavy is factored into the scale, the scale does not include the dimension of demeanor while drunk, that is, the extent to which norms for drunken behavior allow for violence or other bad behavior. Nevertheless, cross-nationally this dimension appears to cluster with the dimensions included in the scale (Rehm et al., 2001). In a factor analysis of data from ethnographic records in the different frame of traditional tribal and village societies, Partanen (1991, p. 213) also found that violence was particularly associated with a pattern of intermittent but heavy drinking occasions.

TABLE 13-4

Proportion Drinking 5 or More Drinks on 3 or More Occasions in Past 30 Days, Proportion Drinking at All on 3 or More Occasions in the Past 30 Days, Ratio of These, and Minimum Drinking Age, European School Survey Project on Alcohol and Other Drugs (ESPAD), (more...)

The scale has been used so far only at the level of societies as a whole, but the same kind of dimensions of variation exist within societies. In particular, there is some evidence that the social trouble per unit of drinking differs between U.S. regions, with higher rates of trouble in the southern regions, and more generally in the traditionally “dryer” southern and prairie regions (Cahalan and Room, 1974; Room, 1982).

Differences at the Level of Young People and Youth Cultures

In societies such as the United States, the drinking patterns described as characteristic of the upper end of the scale of hazardous drinking are quite characteristic of a particular segment of the population, that is, drinking by adolescents and young adults, particularly young males. This raises the question whether there is simply an upward shift in the hazardous drinking scale for young adults' drinking in different cultures, with the cultures maintaining their relative positions, or whether cultural differences in the extent of hazardous drinking are muted or overridden by drinking patterns in a common youth culture. The ethnographic literature has traditionally held to the former position: It has been common to argue, in an American context, that American drinking customs would be improved if children were taught to drink with diluted wine at the family dinner table, as traditionally done in France or Italy (Heath, 1995, p. 339). However, behind this argument lies the assumption that teaching one use-value of alcohol is necessarily preventive of moving on to other use-values. This seems to be a problematic assumption. For example, the early experiences of drinking by young American teenagers typically do not involve intoxication, but this does not imply they will not be drinking to intoxication three years later.

Ethnographic and news reports about young people's drinking in southern Europe do not sound much different from patterns in North American cultures. For example, on weekend nights in Madrid, 200,000 youth reportedly gather in 24 central city squares, swigging drinks such as cheap red wine mixed with Coca-Cola until 4 a.m., in a style of street parties known as the botellón (Tremlett, 2002). Adult perceptions in southern Europe are often that these patterns have changed from the time of their youth: that the youth nowadays are drinking in an “Anglo-Saxon” style, treating alcohol as a psychoactive drug. Among the student informants in Pyorälä's study (1995), the Spanish but not the Finns reported a gender gap, with the older generation less accepting of drinking to intoxication. Indeed, much has changed in the environment of young people in southern Europe in the past half-century that might have lent itself to cultural change. Societies are less authoritarian, marriage and family formation occur later, and young people have more money in their pockets. Increasingly, young people in different societies are tied together as a single audience for media and music, and for the promotions of the alcoholic beverage multinationals.

However, there is room for skepticism about how much has really changed in young people's drinking in, say, Italy. The youth drinking parties described by Beccaria and Guidoni (2002) around young men's conscription in northern Italy feature plenty of heavy drinking. One of their informants noted that “you have to drink, to show incredible powers of endurance to alcohol.” But the attachment of the parties to an occasion that extends back in history, and features of the parties such as traditional drinking games, suggest that the parties do not constitute a new cultural innovation.

The somewhat puzzling findings concerning attitudes and norms on drinking among adults in northern and southern Europe (Room and Bullock, 2002) suggest that differences in norms about how drunk one may get, and how one may behave at a given level of drunkenness, are not straightforward. But some customs in the north seem to stand out. No equivalent seems to exist elsewhere, for example, of the Norwegian tradition of russefeiring, in which each high school graduating class (with some pre-echoes in the graduating class from middle school) devotes the 17 days between May Day and the Norwegian national day to a drunken rite of passage, with negotiated rule breaking that is both individualistic and collectively organized (Sande, 2002).

Quantitative evidence on the issue of cross-cultural variation in hazardous drinking patterns in Europe is available from the European Study of Patterns of Alcohol and Drug Use, or ESPAD (Hibell et al., 2000), which administered a common questionnaire (comparable in a number of items with the U.S. Monitoring the Future Study questionnaire—Johnston, O'Malley, and Bachman, 2000) to 15-year-olds in schools in a total of 30 countries in Europe. Table 13-4 shows some results from the 1999 samples of this study, along with results for tenth graders from the U.S. study. The countries listed in Table 13-4 are ordered according to the results in the third column of figures, that is, in terms of a ratio reflecting the proportion of drinking occasions for which respondents reported drinking 5+ drinks (in the U.S. data, being drunk). This might be taken as an indication of the extent to which heavy drinking occasions predominate as the drinking pattern among 15-year-olds. The United States falls at the median on this table in terms of this ratio, with about half as many respondents reporting being drunk at least 3 times in the past 30 days as those who report drinking any amount at least 3 times in the same period. Although there are some surprises in the order on this ratio (Lithuania, Romania, Russia, Slovakia, and Ukraine are unexpectedly low, and Malta somewhat high), the ratio generally follows the hazardous drinking scores assigned for the society as a whole (Rehm et al., in press). By this measure, then, there does seem to be some relation between teenage drinking patterns and the drinking patterns of the larger society.

In terms of the actual proportion drinking 3 or more times in the past 30 days, the United States is tied for the fourth lowest position; in two of the three societies with lower percentages, lack of resources is likely to be one factor keeping the frequency of drinking down. The United States also appears to be at the lower end of the distribution on proportions regularly drinking heavily, although no exact comparison on drinking 5 or more drinks is available (26 percent of U.S. tenth graders reported drinking that much at least once in the past 2 weeks). Compared to Europe, U.S. teenagers are less likely to drink regularly at all, and seem to be somewhat less likely to drink heavily on a regular basis. In several countries—the United Kingdom, Ireland, Poland, and Denmark—the proportion of teenagers drinking 5+ drinks on at least 3 occasions in the past month is substantially greater than the proportion of U.S. teenagers drinking that much at least once in the past two weeks.

The last two columns in the table show responses in the different national samples on getting drunk. What it means to be drunk is a matter of cultural definition, and the responses are also affected by idiom and connotations in the local language, so comparisons should be made with caution. In particular, “drunk” may be tend to be defined in more extreme terms in wine cultures. In four societies—Finland, the United Kingdom, Denmark, and Ireland—half or more of the 15- to 16-year-olds report having been drunk in the past month; in the first three of these societies, along with the students in Moscow, one-third or more of the students report having been drunk by age 13. At the other end of the spectrum, having been drunk by age 13 is relatively uncommon in many of the wine cultures and parts of eastern Europe, and rates of having been drunk in the last 30 days are 20 percent or below in eight wine cultures—Croatia, Cyprus, France, Greece, Macedonia, Malta, Portugal, and Romania. U.S. tenth graders are less likely to report having been drunk in the past 30 days than 15-year-olds in many western European countries. On the other hand, the United States is further up the ordering in terms of early drunkenness, comparing the proportion of U.S. eighth graders who report ever having been drunk with the proportions of Europeans who retrospectively report having been drunk by the age of 13.

Trends and Concerns About Teenage Drinking in Europe

The ESPAD study also offers the broadest set of quantitative data on changes in teenage drinking in Europe, because the questions asked in 1999 in many of the countries involved also had been asked in an earlier survey in 1995. The general trend from 1995 to 1999 in many countries was for an increase in the proportion of 15- to 16-year-olds reporting drinking 5+ drinks on 3 or more occasions in the past 30 days (Hibell et al., 2000:71). The increased proportion was considerable in the three countries that already had the highest rates (Ireland, Denmark, and the United Kingdom) and in Poland and Slovenia, but there were also increases in five other countries, while the proportion stayed much the same in nine countries. No country had a substantial decrease.

Youth drinking has become a general social and health concern in Europe. In fact, concerns about youth drinking have been the main vehicle for expressing concerns about alcohol problems in general at a continental level, such as in the European Union. A flurry of concern about “alcopops” (sweetened alcoholic drinks perceived to be aimed at youth) started in 1995 and brought the first serious attempt at public health-oriented action on alcohol issues within the European union structure (Sutton and Nylander, 1999). In early 2001, European Ministers of Health agreed on a “Declaration on Young People and Alcohol,” stating that “the health and well-being of many young people today are being seriously threatened by the use of alcohol and other psychoactive substances,” and setting goals, including reducing drinking and high-risk drinking substantially, delaying the onset of drinking among young people, and reducing pressures on young people to drink from alcohol advertising and other promotion (World Health Organization, 2001).

Nevertheless, concern about youth drinking is generally less urgent in Europe than in the United States, and measures and programs to counter it have been generally soft and not particularly effective. The discussion about alcopops in Denmark did result in a law imposing a minimum age limit (of 15) for off-premise purchases of alcohol, which seems to have some effect (Møller, 2002). Countries that have traditionally had fairly restrictive alcohol controls (the Nordic countries other than Denmark, the United Kingdom, and Ireland) in areas such as bar and liquor store closing hours and days have continued to loosen the controls (Karlsson and Österberg, 2001), raising the effective availability for youth and others. In Ireland, which has seen an extraordinary rise in alcohol consumption (46 percent in 11 years), with high rates of drinking among teenagers (see Table 13-4), a Strategic Task Force on Alcohol (2002) has called for increased taxes and other measures. In the United Kingdom, the primary policy focus has been on “drunken yobs” (louts; Hinsliff, 2002) and “alcohol-related crime, disorder and violence” (U.K. Home Office, 2000), including proposals to increase regulation and legislation concerning underage drinking. But the government effort has lacked crucial components such as a scheme to provide “proof of age” documentation, a task that has been left in the hands of an alcohol industry organization (Portman Group, 2000). As in the example from Norway, harm reduction efforts are also common in much of Europe. Institutional legal liability for underage drinking is much less likely outside the United States.

Arguments and Issues in the Discourse About Underage Drinking

An interesting study that has not been done would be to read and analyze the discourse in different societies about the minimum legal age for drinking and for other behaviors. Clearly, there is influence between polities on these matters: for example, the age of majority was lowered from 21 in many places in the 1970s, while there is currently a strong tendency to push up the minimum age for purchasing cigarettes. Turkey's legal age of marriage is being raised from 17 for men and 15 for women to 18 for both genders, as part of a modernization of the civil code pushed forward in the process of applying for membership in the European Union. The code which is being replaced was based on Swiss family law in 1926, adopted as “the most modern code of its time” (Fraser, 2001). The lines of influence probably flow mostly from the center to the periphery, so that the discourse in the United States is not strongly influenced these days by provisions and arguments from elsewhere.

One potential consideration in discussions about the minimum legal age for drinking would be the effect of alcohol on the physically developing body. This was a consideration in the recent proposal by a Canadian Senate committee for a minimum age of 16 for a legalized marijuana regime (Senate Special Committee, on Illegal Drugs 2002, pp. I, 166). Other potential considerations are the various ages at which understanding and judgment in different circumstances are considered mature, and how drinking and intoxication may interplay with these factors. Intoxication often enters into legal considerations about consent to sexual intercourse and about intent to perform criminal acts; for both of these issues, there is a minimum age at which a teenager's self-governance is recognized. If a teenager is too young to be held legally accountable for the results of drinking, maybe he or she is too young to be drinking.

In the United States, arguments defending a drinking age of 21 emphasize the higher probabilities of later drinking problems for those who start drinking earlier (e.g., National Advisory Council on Alcohol Abuse and Alcoholism, 2002, p. 51), although there is room for questioning the causal significance and relevance to the minimum drinking age of the relationships used in these arguments. Issues of the relation of the drinking age to other normative ages can also come into the discussion. For example, a consideration in raising the minimum drinking age from 18 to 19 in Ontario in 1979 was to move legal drinking out of the ages of high school attendance. As we have noted, the relation of minimum drinking age to minimum driving age and driving customs is particularly relevant in the United States; one argument that has been given for discounting European experience is that “youth drive less frequently in Europe than in the U.S.” (National Advisory Council on Alcohol Abuse and Alcoholism, 2002:52).

An important consideration with respect to minimum drinking age is the issue of how and in what circumstances drinking is to be initiated. A position paper of the National Youth Rights Association (n.d.) summarizes the main line of argument on this issue that has been used in the United States:

“Drinking age laws discourage rather than encourage a transition period between youthful abstinence and adult use of alcoholic beverages,” writes journalist and sociologist Mike A. Males (1996:207).

Under such laws, many young people learn drinking in unsafe environments, like basement keg parties. They use alcohol with the intention of getting drunk rather than as an accompaniment to food. Researchers say American young people engage in dangerous “binge drinking” far too often and far more often than some of their European counterparts, who learn to drink in the open. The United States should take lessons from cultures like those of Jews, Italians and Greeks, who traditionally focus on misuse of alcohol, rather than simple use of alcohol, as the source of problems. “Educational efforts should encourage moderate use of alcohol among those who choose to drink,” explains sociologist David J. Hanson (1996:45).

There are several empirical problems with the line of argument as it is stated. The first is that, as Table 13-4 indicates, European teenagers are at least as likely as Americans to initiate drinking before the local legal age. Table 13-4 also suggests that the United States is about in the middle of the range of European countries when it comes to the proportion of teenagers engaged in drinking that—in U.S. terminology—is often called binge drinking. Furthermore, there is no clear relationship, viewed cross-nationally in the table, between the minimum drinking age and the proportion of binge occasions among teenage drinking occasions. As we have seen, there is also some evidence of a generational shift in teenage drinking patterns in southern Europe, moving toward more binge drinking.

Perhaps most importantly, the evidence that a solution of “educational efforts” would have much success is not compelling at the level of the individual educational program (Paglia and Room, 1999), let alone at the level of the society. Examples of societies that have successfully changed their patterns on hazardous drinking and drunken comportment are hard to find (Room, 1992). Considering the development of amounts and patterns of drinking in western Europe in the past 50 years, Simpura (2001:11) concludes that changes in “qualitative features of drinking” may

take decades and even longer to become visible. Some traditional qualitative features of drinking seem very persistent to change, even in the midst of major quantitative changes in consumption levels etc. Therefore, the analysis of this report suggests that the natural time frame for changes in drinking patterns is a generation, rather than a decade or any shorter period. If this is accepted, it implies that efforts to prevent alcohol-related harm by measures targeted at drinking patterns will produce gains only in the very long run, if ever.

On the other side of the argument, it must be acknowledged that there has been one substantial change already in drinking patterns in the United States over a period of about a generation—the shift away from drinking before driving. Given the U.S. culture's dependence on the automobile, this has been a significant change, even if an incomplete one. But an effort to reduce rates of drinking before age 21 to insignificance seems to be taking on a much more difficult task, particularly in a cultural environment saturated in promotion of drinking in youth-oriented media, and in a legal environment where restrictions on alcohol advertising and promotion are increasingly suspect from a constitutional perspective (Hudson, 2002).

Underage Drinking Can Be Reduced—But What Then?

There is little question, from data predominantly from the United States, but also from Canada and Australasia, that changing the drinking age affects levels of alcohol consumption and rates of traffic crashes in the applicable ages and to some extent at lower ages (Wagenaar and Toomey, 2002). However, the effects on other health and social problems are less clear. A Danish study has recently found that instituting a minimum age of 15 for purchases for off-premise consumption had an effect on consumption levels (Møller, 2002). In this case, the effect also extended above age 15, which may have reflected a sensitization of Danish parents to watching over their children's drinking as a result of the public debate about the measure.

But stiffer policing of underage drinking presumably has its limits in a situation where alcohol is readily available to those over legal age. Despite much police pressure, marijuana—though not legally available—has not disappeared from the life of young American adults. In the case of alcohol, repression may in the end provoke a rebound, as Prohibition did among American youth in the 1920s and 1930s (Room, 1984). In the context of official repression, drinking—and indeed intoxication—became a symbol of a generational rebellion. As a member of that generation remarked, looking back, “drinking, we proved to ourselves our freedom as individuals and flouted Congress …. It was the only period in which a fellow could be smug and slopped concurrently” (Liebling, 1981:667).

Even if there is no rebound, there will still be a substantial residue of drinking under the age of 21 in the United States at any time in the foreseeable future. This leaves open the following question: What is the best way to handle the discrepancy—which exists in Europe as well as in the United States—between the actual ages at which teenagers start drinking and the age at which the behavior becomes legal? Age-specific prohibition is more likely to reduce the frequency of drinking than the amount drunk on one occasion. In fact, although a rigorous enforcement may result in fewer intoxicated occasions, it may well raise the proportion of drinking occasions that involve intoxication.

Environmental strategies such as high taxes on alcohol and reducing the general availability of alcohol can be brought into play and will have some effect (Toomey and Wagenaar, 2002). But, again, the effect will have its limits.

The general policy choices at that point are by now familiar from the world of illicit drugs, although there are differences in their application in the case of underage drinking. One choice is the “zero tolerance” model. Underage drinking is vigorously pursued, if necessary with urine testing, and those detected are punished, secondarily deterred, or “treated,” hopefully back into line. Public attitudes in the United States generally do not support the application of such an approach with anything like the rigor used for illicit drugs, except perhaps in connection with drinking and driving.

A second choice is an institutionalized “patterned evasion” of norms. This is how marijuana smoking is handled these days in much of Europe and parts of the United States. If the young cannabis smoker does not insist on lighting up on the steps of the police station, but keeps the use within private space, he or she is generally left alone. The police, however, retain the possibility of a “drug bust” as a handy lever in the pursuit of their duties, which tends to mean that the strategy results in many arrests and police records, potentially on a discriminatory basis. Institutionalized patterned evasion was the traditional approach of American colleges to underage drinking before the last two decades.

A third choice is a “harm reduction” strategy, which involves acknowledging the reality of youthful drinking in the course of making provision to reduce the harms associated with it. This third strategy is pursued by the Norwegian local police in dealing with russefeiring (Sande, 2002). Each year the elected leaders for that year's celebration negotiate in considerable detail with the local authorities about which public rules are available to individual participants to be broken (with the achievement of breaking it marked by a trophy sign on the russefeiring costume). The adult world has made various unsuccessful attempts to eliminate russefeiring, but given that these have failed, there is no hesitation in falling back on minimizing the harm.

The approach to underage drinking by American colleges traditionally included some elements of harm reduction, along with the patterned evasion strategy. But in the past two decades, a harm reduction strategy has been becoming more difficult for colleges: to acknowledge that illegal behavior is occurring puts the colleges at risk of legal liability for adverse consequences. More generally, American culture seems to be uncomfortable with the uneasy compromises with disapproved behavior which harm reduction strategies often involve. Thus the trend seems to be toward the first choice. This is the policy choice that offers the best target for a potential future generational rebellion. As we have noted, Europe does not seem to be moving in the same direction in terms of policy choices.

Although some young people, particularly in the United States, remain abstainers, drinking and intoxication seem to be involved in the process of growing up for many young people in all societies with European roots. One way or another, the damage from the intoxication to the drinker and to others can be reduced, but it is unlikely to be eliminated in the foreseeable future. Nor is it likely that state actions can succeed in cutting off all drinking below the age of 21. In these circumstances, there is a need to look not only at means of prevention of underage drinking, but also at means of handling it to minimize the adverse consequences. These adverse consequences would include any lasting stigma and its adverse effects on those found to be drinking. There is also a need for a greater understanding of the place of drinking and intoxication in the various subcultures and social worlds of young people. U.S. researchers and policy makers have much to gain from encouraging a greater internationalism in studying these issues.