Keeping an eye on underage drinking

Touted health and social benefits of moderate alcohol consumption should not blind us to the potentially serious effects of underage drinking.
By Chong Siow Ann, Published The Straits Times, 18 Jul 2014

THE consumption of alcohol can be dated to the Neolithic period with the discovery of Stone Age jugs in China that contained traces of fermented beverages. Since antiquity, the Chinese have had a romance with wine - seeing it as a font of artistic creativity and a salve for life's difficulties.

The ancient Greeks loved their wine just as fervently, Dionysus was the god of winemaking and wine. He was said to have two sides, one of unbridled joy and another of unrestrained rage.

The Greeks certainly understood that immoderate drinking would lead to ugliness and violence. So did Shakespeare's Cassio who lamented: "O God that men should put an enemy in their mouths to steal away their brains, that we should, with joy, pleasance, revel, and applause, transform ourselves into beasts."

Drunk and disorderly

IN SINGAPORE, the consumption of alcohol is thought to be a contributing factor in the Little India riots. There are therefore calls for the imposition of no-alcohol zones in certain public places and shorter retail sales hours.

Studies have shown a strong association between alcohol availability, consumption and crime. Most crime is, of course, not related to drinking. But there are some people who are more prone to violence when intoxicated.

Cosmopolitan Singapore has never been puritanical about alcohol consumption, but alcoholism and what it entails in the popular imagination - a wasteful and dissipated life ravaged by broken relationships and personal degradation - is perceived by most people to be a personal and moral failing. The truth is that alcoholism is a complex medical disease that can damage the liver, heart, pancreas and brain.

Yet, it has not quite assumed the magnitude of a pressing public health concern in Singapore. Perhaps, this is because there is a high level of acceptance and tolerance for drunkenness as long as it not socially disruptive.

Hidden problem

THE other reason is that most people with alcohol-related disorders stay hidden. The Singapore Mental Health Study of 2010 examined the current mental health status of Singaporeans and permanent residents aged 18 years and above.

Based on a sample of 6,616 respondents constituting a representative sample of the general adult population, it found that the rate of alcohol abuse was three per cent while that of alcohol dependence was 0.5 per cent.

But behind these seemingly low figures is a trio of issues that should concern us.

First, these alcohol disorders have an early age of onset in most people (by their early 20s).

Second, only about one in 10 had sought help of any kind.

And third, there are many who have not yet developed any of these disorders but are drinking heavily.

Dr Mythily Subramaniam of the Institute of Mental Health, one of the lead investigators of the Singapore Mental Health Study, delved into the data collected to examine the rates of heavy drinking.

(This was defined as the consumption of four or more drinks for women per day, and five or more drinks per day for men in at least a day over the past one year.)

She found that 13 per cent of the population admitted to heavy drinking and that the highest rate was among those aged 18 to 34. "We need to keep an eye on the younger age group where the rate of heavy drinking is not so low and where there is the possibility of them developing alcoholism", Dr Subramaniam concluded.

Drinking among the young

THE legal drinking age in Singapore is 18 years. We do not at this time have an accurate estimate of underage drinking in the country, but there is a vague but general sense of unease that it might be fairly pervasive.

The dire consequences of early heavy drinking in the young can happen even before it develops into a disorder. There are increased risks of fatal accident, self-harm, violent behaviour, criminality, unprotected sex, teenage pregnancy - and for girls, of being sexually assaulted.

Heavy drinking over time damages the adolescent brain more than the adult brain and makes them less able to curb cravings for alcohol.

This may explain why people who begin drinking at an early age are at greater risk of becoming alcoholics.

I was once flummoxed by a patient, a 17-year-old, who told me that she went clubbing twice a month with friends, and would down two "Courvoisier" on her own each time.

I thought it was a type of cocktail, until she told me in a matter-of-fact way that she meant two whole bottles of Courvoisier brandy. That, she informed me, would make her feel less anxious and more sociable.

Adolescence is that tumultuous period during which teenagers strive to become independent of their parents, form romantic attachments, be accepted by their peers, and to forge an identity of their own.

All of these things can provoke anxiety. Recent research has shown that during adolescence, certain brain regions that are relevant in the modulation of fear mature at different times. This uneven development renders an adolescent more vulnerable to anxiety and fear.

But there are probably a myriad of other contributing and interacting factors. Not least of all, is the clubbing and drinking culture among the young that is engendered by the easy availability of alcohol, laxity of liquor sellers, glitzy advertisements with celebrity endorsement, and less than vigorous enforcement of the law.

Dealing with underage drinking requires the cooperation of all levels of society.

At the top is the government with its powers for policy making, legislation and taxation. Studies have demonstrated that increasing the tax, with its knock-on effect of higher sales prices, will reduce drinking, especially among 18- to 21-year olds. So the recent hike in alcohol tax might have that prohibitive effect on the young.

The often touted health merits from moderate alcohol drinking is a dubious argument against increasing tax - particularly where young people are concerned. There are better (and cheaper) ways to health - and without those untoward consequences.

At the level of the family, the inevitable onus is on the parents. In certain US states, this parental responsibility is made abundantly clear with liability laws that can see parents prosecuted if underage drinking is found to be going on under their roof.

The rates of alcohol related disorders may be relatively low for now, but nestling within our somewhat laid-back attitude towards alcohol might be a time bomb with terrible social and public health repercussions

The writer is the vice-chairman, Medical Board (Research) of the Institute of Mental Health. and Principal Investigator of the Singapore Mental Health Study.