avoid drinking alcohol essay

Narrative Essay Sample on Avoiding Drinking Alcohol

Most of us will drink at some point in our lives whether it be because we have just got engaged and decided to celebrate, or after a horrendous day at work just trying to get through the rest of the day without curling up into a ball on the sofa watching movies on your own. There are so many possibilities on why people drink and why people don’t and they all stem from the lives we live and the influences around us. I feel that in my life I have felt the pressure from my peers of consuming alcohol many times and that it has taken much strength to refrain from it because of my influences.

The people we surround ourselves with always have an impact on the way we make choices; for example, if we are constantly around a person that is judgy and means then it is most likely going to make at least, a little, part of you think about other people as if you are the Simon Cowell of your own life. The people that surround me, particularly in the family, are far from perfect. Yes, they are kind, smart, selfless and friendly but with all these great qualities there is bound to be a bad one somewhere. And there is. You see my family is terrible at coping with their emotions, they cannot get help from other people as they feel that they are bothering them and this causes them to get help from other places. Alcohol typically is one of the most commonly used things to help get people's minds off their troubles and it is the highest form of coping mechanism that is used in my family. This makes me feel terrible as I take from it that my family feel that asking for help is selfish which ultimately makes me feel that when life gets me down I should not ask for help, which of course is far from correct.

Whenever my family is experiencing loss, hurt or pain instead of the obvious choice of getting help from others they turn to the drink. Not all of them are bad with their drink, most of them will have one or two alcoholic beverages and they feel better but for some, their issues are much larger and they need more to cope. I always struggled with having to watch my family waste their lives drinking and drifting away as I believe so deeply that they are meant for more than that. I lost an auntie when I was 7 years old to the cruel hands of alcohol, this had hit me hard as I had formed an exceptionally big connection with her. She was like my best friend and I loved her very deeply, so naturally, when I found out she had died I was torn apart. The worst part about this death for me was finding out the cause. When I had found out about her major alcohol problem I had pieced the jigsaw pieces together and found out that all those happy memories I had with her were only there in my memory because she had chosen to drink. The only reason I was best friends with my aunt is that her judgement had been clouded. However, unlike my family, I was able to ask for the help needed and learned to deal with this loss without feeling the need to drink my blues away. Yes! I was only seven and would not have thought about drinking as others normally do but that loss has helped me with coping with all sorts of struggles now the recent years. I am now 16 years old and I cope with so much more struggles, the loss of 3 grandpas, the constant stress and doubt that my life won't go the way I want it and the continuous responsibilities of helping my family at their lowest points so that alcohol does not take more of my families fates. You would think that all the influences of alcohol present in my life, within my family or even people my age, that I would have at least once in my life tasted a drop of alcohol however to the surprise of many, I have not. 

My life decided that it wanted to go a different direction than those around me and I am now able to refrain well from the appeal of alcohol. I feel very proud of myself for deciding to stay away from drink and my family are too. They haven’t quite broken the barrier that holds them with this terrible habit but from the influence of myself they have realised their issue and I hope that sooner they can form a solution to help themselves. Still, sometimes I feel hurt from the loss and pain I have had throughout my life, as none of it goes away and I find that the place that I feel most calm and that helps me most, is curled up in a corner chair with my cosy blanket around me, a good book in hand with a hot chocolate lay down beside me. I find myself to be more of an introverted person and find comfort in the company of a few rather than loads of people. This is more appealing to me because I feel that talking through my issues and theirs in smaller groups is more personal than announcing my issues to the world. Asking for help from others is still a huge issue for me as I normally bottle all my struggles up until it gets too much (I have learnt that this is no way to do it). The question lies now, is this all just a hopeful rule set by a delusional child or will I continue to avoid drinking at all costs for a matter of my health and mindset?

Well, I truly believe that I will continue with this journey for the remainder of my life and that my livelihood will be ultimately better for it. I don’t believe that my views will change on the consumption of alcohol as I get older just that potentially I will feel the pressure more. Hate is a strong word and I never truly hate anything, however, the thought of alcohol in my system shortening the span of my life while always corroding my liver is a thought that I do.

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How do I stop drinking?

Set goals and prepare for change, cutting back vs. quitting alcohol altogether, alcohol addiction treatment options, alcohol withdrawal symptoms, get support, find new meaning in life, plan for triggers and cravings, handling setbacks in your recovery, how to help someone stop drinking, overcoming alcohol addiction.

Are you ready to quit drinking or cut down to healthier levels? These tips can help you get started on the road to recovery.

Overcoming an addiction to alcohol can be a long and bumpy road. At times, it may even feel impossible. But it’s not. If you’re ready to stop drinking and willing to get the support you need, you can recover from alcoholism and alcohol abuse—no matter how heavy your drinking or how powerless you feel. And you don’t have to wait until you hit rock bottom; you can make a change at any time. Whether you want to quit drinking altogether or cut down to healthier levels, these guidelines can help you get started on the road to recovery today.

Most people with alcohol problems do not decide to make a big change out of the blue or transform their drinking habits overnight. Recovery is usually a more gradual process. In the early stages of change, denial is a huge obstacle. Even after admitting you have a drinking problem, you may make excuses and drag your feet. It’s important to acknowledge your ambivalence about stopping drinking. If you’re not sure if you’re ready to change or you’re struggling with the decision, it can help to think about the costs and benefits of each choice.

Evaluating the costs and benefits of drinking

Make a table like the one below, weighing the costs and benefits of drinking to the costs and benefits of quitting.

Once you’ve made the decision to change, the next step is establishing clear drinking goals. The more specific, realistic, and clear your goals, the better.

Example #1: My drinking goal

• I will stop drinking alcohol.
• My quit date is __________.

Example #2: My drinking goal

• I will stop drinking on weekdays, starting as of __________.
• I will limit my Saturday and Sunday drinking to no more than three drinks per day or five drinks per weekend.
• After three months, I will cut back my weekend drinking even more to a maximum of two drinks per day and three drinks per weekend.

Do you want to stop drinking altogether or just cut back? If your goal is to reduce your drinking, decide which days you will drink alcohol and how many drinks you will allow yourself per day. Try to commit to at least two days each week when you won’t drink at all.

When do you want to stop drinking or start drinking less? Tomorrow? In a week? Next month? Within six months? If you’re trying to stop drinking, set a specific quit date.

Speak to a Licensed Therapist

BetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours.

How to accomplish your goals

After you’ve set your goals to either stop or cut back your drinking, write down some ideas on how you can help yourself accomplish these goals. For example:

Get rid of temptations. Remove all alcohol, barware, and other alcohol-related paraphernalia from your home and office.

Announce your goal. Let friends, family members, and co-workers know that you’re trying to stop or cut back on drinking. If they drink, ask them to support your recovery by not doing so in front of you.

Be upfront about your new limits. Make it clear that drinking will not be allowed in your home and that you may not be able to attend events where alcohol is being served.

Avoid bad influences. Distance yourself from people who don’t support your efforts to stop drinking or respect the limits you’ve set. This may mean giving up certain friends and social connections.

Learn from the past. Reflect on previous attempts to stop or reduce your drinking. What worked? What didn’t? What can you do differently this time to avoid pitfalls?

Whether or not you can successfully cut back on your drinking depends on the severity of your drinking problem. If you’re an alcoholic—which, by definition, means you aren’t able to control your drinking—it’s best to try to stop drinking entirely. But if you’re not ready to take that step, or if you don’t have an alcohol abuse problem but want to cut back for personal or health reasons, the following tips can help:

Set your drinking goal. Choose a limit for how much you’ll drink, but make sure your limit is not more than one drink a day if you’re a woman, two drinks a day if you’re a man—and try to have some days each week when you won’t drink alcohol at all. Write your drinking goal down and keep it where you will frequently see it, such as on your phone or taped to your refrigerator.

Keep a record of your drinking to help you reach your goal. For 3 to 4 weeks, write down every time you have a drink and how much you drink. Reviewing the results, you may be surprised at your weekly drinking habits.

Cut down drinking at home. Try to limit or remove alcohol from your home. It’s much easier to avoid drinking if you don’t keep temptations around.

Drink slower. When you drink, sip slowly and take a break of 30 minutes or one hour between drinks. Or drink soda, water, or juice between alcoholic drinks. Drinking on an empty stomach is never a good idea, so make sure you eat food when you drink.

Schedule one or two alcohol-free days each week. Then, try to stop drinking for one week. Make a note about how you feel physically and mentally on these days—recognizing the benefits may help you to cut down for good.

Some people are able to stop drinking on their own or with the help of a 12-step program or other support group (see below for links). Others need medical supervision in order to withdraw from alcohol safely and comfortably. Which option is best for you depends on how much you’ve been drinking, how long you’ve had a problem, the stability of your living situation, and other health issues you may have.

The first step is usually to consult your primary care doctor or GP. Your doctor might consider the following six factors before offering a treatment referral:

• Your risk of withdrawal.
• Your physical health history and current conditions.
• Your mental health history and co-occurring disorders .
• Your readiness to change.
• Your risk for relapse.
• Your current level of support social and living situation.

Examples of alcohol treatment programs

• Intensive inpatient service is a short-term option if you need professional medical attention as you recover from intense withdrawal symptoms.
• Residential treatment involves living at a treatment facility while undergoing intensive treatment during the day. Depending on your specific needs, a stay in a residential facility can last a single month or several months.
• Partial hospitalization   programs (PHP) are for people who require ongoing medical monitoring but have a stable living situation to return to at the end of the day. Also known as “day treatment,” these programs require you to spend at least 20 hours per week in a clinical environment.
• Intensive outpatient programs (IOP) focus on relapse prevention and can often be scheduled around work or school. An IOP might require you to commit to between 9 and 19 hours of treatment, such as group therapy, each week.
• Therapy (Individual, Group, or Family) can help you identify the root causes of your alcohol use, repair your relationships, and learn healthier coping skills and how to deal with triggers that could cause you to relapse.

There’s no magic bullet or single treatment that works for everyone. Everyone’s needs are different, so it’s important that you find a program that feels right to you. Any alcohol addiction treatment program should be customized to your unique problems and situation. Read: Choosing an Alcohol Rehab Treatment Program to learn more.

When you drink heavily and frequently, your body becomes physically dependent on alcohol and goes through withdrawal if you suddenly stop drinking.

The symptoms of alcohol withdrawal range from mild to severe, and include:

• Nausea or vomiting
• Anxiety and restlessness
• Stomach cramps and diarrhea
• Trouble sleeping or concentrating
• Elevated heart rate and blood pressure

Alcohol withdrawal symptoms usually start within hours after you stop drinking, peak in a day or two, and improve within five days. But in some alcoholics, withdrawal is not just unpleasant—it can be life threatening.

Coping with alcohol withdrawal symptoms safely

If you’re a long-term, heavy drinker, you may need medically supervised detoxification. Detox can be done on an outpatient basis or in a hospital or alcohol treatment facility, where you may be prescribed medication to prevent medical complications and relieve withdrawal symptoms. Talk to your doctor or an addiction specialist to learn more.

Seek emergency medical help if you experience any of the following withdrawal symptoms:

• severe vomiting
• confusion and disorientation
• hallucinations
• extreme agitation
• seizures or convulsions

The symptoms listed above may be a sign of a severe form of alcohol withdrawal called delirium tremens, or DTs. This rare, emergency condition causes dangerous changes in the way your brain regulates your circulation and breathing, so it’s important to get to the hospital right away.

Whether you choose to tackle your alcohol addiction by going to rehab, getting therapy, or taking a self-directed treatment approach, support is essential. Don’t try to go it alone. Recovering from alcohol addiction or abuse is much easier when you have people you can lean on for encouragement, comfort, and guidance.

Support can come from family members, friends, counselors, other recovering alcoholics, your healthcare providers, and people from your faith community.

Lean on close friends and family – Having the support of friends and family members is an invaluable asset in recovery. If you’re reluctant to turn to your loved ones because you’ve let them down before, consider going to couples counseling or family therapy.

Build a sober social network – If your previous social life revolved around alcohol, you may need to make some new connections. It’s important to have sober friends who will support your recovery. Try taking a class, joining a church or a civic group, volunteering , or attending events in your community.

Make meetings a priority – Join a recovery support group, such as Alcoholics Anonymous (AA) , and attend meetings regularly. Spending time with people who understand exactly what you’re going through can be very healing. You can also benefit from the shared experiences of the group members and learn what others have done to stay sober.

[Read: Support Groups: Types, Benefits, and What to Expect]

While getting sober is an important first step, it is only the beginning of your recovery from alcohol addiction or heavy drinking. Rehab or professional treatment can get you started on the road to recovery, but to stay alcohol-free for the long term, you’ll need to build a new, meaningful life where drinking no longer has a place.

Five steps to a sober lifestyle

• Take care of yourself. To prevent mood swings and combat cravings, concentrate on eating right and getting plenty of sleep. Exercise is also key: it releases endorphins, relieves stress, and promotes emotional well-being.
• Build your support network. Surround yourself with positive influences and people who make you feel good about yourself. The more you’re invested in other people and your community, the more you have to lose—which will help you stay motivated and on the recovery track.
• Develop new activities and interests. Find new hobbies, volunteer activities, or work that gives you a sense of meaning and purpose. When you’re doing things you find fulfilling, you’ll feel better about yourself and drinking will hold less appeal.
• Continue treatment. Your chances of staying sober improve if you are participating in a support group like Alcoholics Anonymous, have a sponsor, or are involved in therapy or an outpatient treatment program.
• Deal with stress in a healthy way. Alcohol abuse is often a misguided attempt to manage stress. Find healthier ways to keep your stress level in check, such as exercising, meditating, or practicing breathing exercises or other relaxation techniques.

Cravings for alcohol can be intense, particularly in the first six months after you quit drinking. Good alcohol treatment prepares you for these challenges, helping you develop new coping skills to deal with stressful situations, alcohol cravings, and social pressure to drink.

Avoiding drinking triggers

Avoid the things that trigger your urge to drink. If certain people, places, or activities trigger a craving for alcohol, try to avoid them. This may mean making major changes to your social life, such as finding new things to do with your old drinking buddies—or even giving up those friends and finding new ones .

[Read: Staying Social When You Quit Drinking]

Practice saying “no” to alcohol in social situations. No matter how much you try to avoid alcohol, there will probably be times where you’re offered a drink. Prepare ahead for how you’ll respond, with a firm, yet polite, “no thanks.”

Managing alcohol cravings

When you’re struggling with alcohol cravings, try these strategies:

Talk to someone you trust: your sponsor, a supportive family member or friend, or someone from your faith community.

Distract yourself until the urge passes. Go for a walk, listen to music, do some housecleaning, run an errand, or tackle a quick task.

Remind yourself of your reasons for not drinking. When you’re craving alcohol, there’s a tendency to remember the positive effects of drinking and forget the negatives. Remind yourself of the adverse long-term effects of heavy drinking and how it won’t really make you feel better, even in the short term.

Accept the urge and ride it out, instead of trying to fight it. This is known as “urge surfing.” Think of your craving as an ocean wave that will soon crest, break, and dissipate. When you ride out the craving, without trying to battle, judge, or ignore it, you’ll see that it passes more quickly than you’d think.

The three basic steps of urge surfing:

• Assess how you’re experiencing the craving. Sit in a comfortable chair with your feet flat on the floor and your hands in a relaxed position. Take a few deep breaths and focus your attention inward. Allow your attention to wander through your body. Notice the part of your body where you’re experiencing the craving and what the sensations are like. Tell yourself what it feels like. For example, “My craving is in my mouth and nose and in my stomach.”
• Focus on one area where you’re experiencing the urge. How do the sensations in that area feel? For example, perhaps you feel hot, cold, tingly, or numb? Are your muscles tense or relaxed? How large an area is involved? Describe the sensations to yourself and any changes that occur. “My mouth feels dry and parched. There is tension in my lips and tongue. I keep swallowing. As I exhale, I can imagine the smell and tingle of a drink.”
• Repeat on each part of your body that’s experiencing the craving. What changes occur in the sensations? Notice how the urge comes and goes. You’ll likely notice that after a few minutes the craving has gone. The purpose of urge surfing is not to make cravings disappear, but to experience them in a new way. However, with practice, you’ll learn how to ride your cravings out until they go away naturally.

Alcohol recovery is a process—one that often involves setbacks. Don’t give up if you relapse or slip. A drinking relapse doesn’t mean you’re a failure or that you’ll never be able to reach your goal. Each drinking relapse is an opportunity to learn and recommit to sobriety, so you’ll be less likely to relapse in the future.

What to do if you slip:

• Get rid of the alcohol and get away from the setting where you lapsed.
• Remind yourself that one drink or a brief lapse doesn’t have to turn into a full-blown relapse.
• Don’t let feelings of guilt or shame keep you from getting back on track.
• Call your sponsor, counselor, or a supportive friend right away for help.

Alcohol abuse and addiction doesn’t just affect the person drinking—it affects their families and loved ones, too. Watching a family member struggle with a drinking problem can be as heartbreakingly painful as it is frustrating. But while you can’t do the hard work of overcoming addiction for your loved one, your love and support can play a crucial part in their long-term recovery.

Talk to the person about their drinking. Express your concerns in a caring way and encourage your friend or family member to get help. Try to remain neutral and don’t argue, lecture, accuse, or threaten.

Learn all you can about addiction. Research the kinds of treatment that are available and discuss these options with your friend or family member.

Take action. Consider staging a family meeting or an intervention, but don’t put yourself in a dangerous situation. Offer your support along each step of the recovery journey.

Don’t make excuses for your loved one’s behavior. The person with the drinking problem needs to take responsibility for their actions. Don’t lie or cover things up to protect someone from the consequences of their drinking.

Don’t blame yourself. You aren’t to blame for your loved one’s drinking problem and you can’t make them change.

For more , read Helping Someone with a Drinking Problem .

Support organizations

Most of these organizations have worldwide chapters:

Women for Sobriety  – Organization dedicated to helping women overcome addictions. (Women for Sobriety, Inc.)

Alcoholics Anonymous  – Learn more about the 12 steps and find a support meeting in your area. (Alcoholics Anonymous)

SMART Recovery  – Self-Management and Recovery Training (SMART) is a program that aims to achieve abstinence through self-directed change. (SMART Recovery)

Al-Anon and Alateen  – Support groups for friends and families of problem drinkers. (al-anon.alateen.org)

Professional resources and helplines for alcohol treatment and recovery

Search SAMHSA’s  Behavioral Health Treatment Services Locator

Find support services for alcohol addiction  – NHS

Finding Quality Addiction Care   – Canadian Centre on Substance Use and Addiction

More Information

• Intervention: Help a loved one overcome addiction - Tips on holding a successful intervention. (Mayo Clinic)
• Rethinking Drinking - Tools to help you check your drinking patterns, identify signs of a problem, and cut back. (National Institutes of Health)
• What is Substance Abuse Treatment? A Booklet for Families - Learn about treatment options and what you can do. (SAMHSA)
• Overcoming Addiction: Find an effective path toward recovery - Find an effective path toward recovery. Special health report from Harvard Medical School. (Harvard Health Publishing)
• Friedmann, P. D., Saitz, R., & Samet, J. H. (1998). Management of Adults Recovering From Alcohol or Other Drug Problems: Relapse Prevention in Primary Care. JAMA, 279(15), 1227–1231. Link
• Pettersen, H., Landheim, A., Skeie, I., Biong, S., Brodahl, M., Oute, J., & Davidson, L. (2019). How Social Relationships Influence Substance Use Disorder Recovery: A Collaborative Narrative Study. Substance Abuse: Research and Treatment, 13, 1178221819833379. Link
• Kelly, Thomas M., and Dennis C. Daley. “Integrated Treatment of Substance Use and Psychiatric Disorders.” Social Work in Public Health 28, no. 3–4 (2013): 388–406. Link
• Magill, Molly, and Lara A. Ray. “Cognitive-Behavioral Treatment with Adult Alcohol and Illicit Drug Users: A Meta-Analysis of Randomized Controlled Trials.” Journal of Studies on Alcohol and Drugs 70, no. 4 (July 2009): 516–27. Link
• O’Farrell, T. J., K. A. Choquette, and H. S. Cutter. “Couples Relapse Prevention Sessions after Behavioral Marital Therapy for Male Alcoholics: Outcomes during the Three Years after Starting Treatment.” Journal of Studies on Alcohol 59, no. 4 (July 1998): 357–70. Link
• Grant, Bridget F., Frederick S. Stinson, Deborah A. Dawson, S. Patricia Chou, Mary C. Dufour, Wilson Compton, Roger P. Pickering, and Kenneth Kaplan. “Prevalence and Co-Occurrence of Substance Use Disorders and Independent Mood and Anxiety Disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions.” Archives of General Psychiatry 61, no. 8 (August 2004): 807–16. Link
• Drake, Robert E. “Co-Occurring Alcohol Use Disorder and Schizophrenia” 26, no. 2 (2002): 4. Link
• “A Prospective Assessment of Reports of Drinking to Self-Medicate Mood Symptoms with the Incidence and Persistence of Alcohol Dependence.” Accessed July 15, 2021. Link
• ScienceDaily. “Self-Medication of Anxiety Symptoms with Drugs or Alcohol Associated with Increased Risk of Developing Substance Use Disorders.” Accessed July 15, 2021. Link
• Substance-Related and Addictive Disorders. (2013). In Diagnostic and Statistical Manual of Mental Disorders . American Psychiatric Association. Link
• About the ASAM Criteria . (n.d.). Retrieved October 11, 2023, from Link
• ASAM – All Documents . (n.d.). Retrieved October 11, 2023, from Link
• Mutschler, C., Junaid, S., Tellez, C., Franco, G., Gryspeerdt, C., & Bushe, J. (2022). Community‐based residential treatment for alcohol and substance use problems: A realist review. Health & Social Care in the Community , 30 (2). Link

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So you decided to stop drinking? I did - and these are my year’s lessons

Abstaining from alcohol is increasingly being destigmatized as more of us consider a booze-free holiday

A t first, ankle deep, then wading deeper and deeper, a surge of waves crashed into my thighs as I braced against the tidal tug. My friends were on the beach, unfurling towels and applying sunscreen. I had no time for those chores. I wanted the ocean.

I had never been on a tropical island, let alone to the Caribbean. It was also my first sober vacation with my four best friends from college, a friendship tallying 20 years. I had quit drinking seven months earlier, when the days were short and dark. The season had felt like an appropriate match to confront a reckoning with alcohol that was decades in the making.

Now it was spring and I was thousands of miles from home, where snow still lingered in the high country. Although we were well past infamous antics from our college days, this joint 40th birthday celebration presented the potential for nostalgia-inspired fun and that usually included alcohol.

I was nervous before my trip and had confided in my husband. What was the worst that could happen, I mused, if I had a glass of wine at dinner? Would I feel out of place with my friends who had known me as the wild child – would they still like me? Would just one piña colada hurt?

Very few topics of conversation are off-limits among my friends and alcohol was no exception. It was a part of the pre-trip planning conversation, mixed into group text messages about coordinating flights and booking the hotel. My friends knew that I was no longer drinking, and Claire called me from the Dominican Republic, where she was now living with her family, to gauge my comfort level with staying at an all-inclusive resort and the readily available supply of alcohol.

If this call had taken place earlier in my recovery, I would have felt much more uncomfortable. Instead, I was grateful. Thanks to months of addiction-focused group therapy and a concerted effort to unravel the hold alcohol use disorder had on my life, I now felt less vulnerable discussing any potential triggers that would lead me to drinking. With my children squawking in the background, I told Claire that I appreciated her thoughtfulness. Claire ended the call with, “I’m so proud of you, Maggot.”

I snorted but it was a feigned annoyance. Claire’s invocation of my endearing yet antagonistic nickname from college made me feel so very normal. An affirmation-laced jest from someone who knew me for so long and so well.

For the most part, I could float on top of the waves of temptation during our island stay. Each morning I woke up early and walked on the beach, relishing the solitude and my beachcombing finds. If a few in our group opted to go to a bar for a beer after dinner, I didn’t object but I didn’t join them. I didn’t feel left out or slighted. One night we all decided to go out dancing, and I didn’t need a beer or shot to do so. Sobriety was enhancing my connection to my friends. There was no shortage of laughter or fun or inappropriate banter and the support my friends gave me aided my resolve.

Licensed professional counselor Colleen Davis-Timms , who specializes in alcohol and addiction, agrees that a strong and accepting social network is an integral part of staying sober. “Sobriety won’t stick unless a person can find a social circle they connect with. If you feel isolated, you will not succeed in sobriety.”

S obriety is having its moment. “Sober-curious” or “mindful drinking” are now familiar phrases; Sober October and Dry January are popular trends. Whereas problematic drinking used to be hushed or relegated to the edges of polite conversation, confined to anonymous meetings often held in church basements, abstaining from alcohol is increasingly destigmatized. But it still requires a willingness to go against the grain.

The country singer-songwriter Margo Price published an essay in GQ in March 2021 about her decision to quit drinking after one too many stressors caused by the pandemic, including her canceled tours. Relying on alcohol to assuage the brunt of cyberbullying or the uncertainties of a musical career was no longer cutting it. She wrote that while she believed she was in control of her alcohol use and had the intention of taking a sustained break from drinking, after reading Quit Like a Woman by Holly Whitaker she decided to quit for good in January 2021.

Without alcohol and its drowning effects, parenting and work feel easier, and she’s able to enjoy life more. For Price, sobriety was the “‘most rebellious thing’’’ she’d ever done, a fully conscious rejection of the culture of alcohol.

Getting sober was an act of dissent for me as well, but with unintended consequences. When I decided to stop drinking, I felt like my identity was no longer stable. This isn’t an uncommon response; Davis-Timms says that “sobriety becomes an identity shift.” Reassessing my life without alcohol went deeper than what I drank – it shot straight to my inner core.

The aspects of your personality that make you uncomfortable or incite pain don’t simply disappear once you eliminate drinking. One of alcohol’s big lies is that it blunts the pain. I would argue it only buries it until it mutates into a much more ugly monster. In my case, I used it to avoid feelings of not being enough and allowed intoxication to make me feel powerful, funny and emboldened.

There is the very human element of my personality that still seeks pleasure and wants to avoid pain, but with a clearer mind I can sit with my discomfort and meet confrontations with more patience and acceptance than I ever could in the past. Compassion for myself, previously a massive hurdle, is slowly unfurling and it extends to all other areas of my life.

Back in the Caribbean, I joined my friends on the lounge chairs beneath a palm tree after swimming. When they ordered a drink, I raised my hand and added, “Make mine a virgin.”

Those who choose to eschew drinking are helped by a new flood of alcohol-free beverages in grocery stores and mocktails on bar menus, which is what journalist and editor Julia Bainbridge covers. Her book Good Drinks: Alcohol-Free Recipes for When You’re Not Drinking for Whatever Reason , is a recipe collection celebrating innovation in non-alcoholic beverages.

Bainbridge is quick to point out that sober-curious culture and recovery are very different. It’s important not to conflate the two.

“Perhaps the paradigm will shift to the point that this isn’t a thing – drink, don’t drink, whatever, no need for a label or dedicated dry month – but while I appreciate that some people are choosing a sober lifestyle, it’s still important to remember that sobriety has likely been painful for those with substance use disorders,” she said.

This lack of distinction is what makes me a bit concerned whenever I read a glossy magazine boasting a headline such as “ has everyone stopped drinking? ” Trends generate much-needed conversation but also flatten nuance, and alcohol use disorder requires a comprehensive understanding and approach.

Nonetheless, this cultural reckoning is affecting the alcohol industry. The demand for alcoholic beverages is decreasing , especially among the Gen Z generation.

Bainbridge applauds the increased availability and diversity of alcohol-free beverages, but with a word of caution. “Offering good non-alcoholic drinks and normalizing the consumption of them in all social spaces is a good thing for those who want them, whatever their reasons,” she says. “But while the increasing availability of these drinks is helpful and it’s a joy, it’s not treatment. Those in need of treatment usually have to work hard to keep alcohol out of their lives and that work is ongoing.”

I’ve been a hesitant adopter of the alcohol-free beverage offerings because I wasn’t yet at a place where I felt like I could drink a non-alcoholic craft stout and not feel the urge to swap for its alcoholic counterpart. Different friends and acquaintances, out of a genuine desire to offer support but not always knowing how, have given me bottles of alcohol-free wine, beer and spirits. They mostly remain untouched in my fridge.

Although I’ve made it an entire year sober, I still feel uneasy around alcohol-like substitutes. Part of recovery’s difficult but redeeming work is understanding my boundaries, which were all too fluid and porous when I drank.

I don’t consider myself even remotely trendy, but my recovery journey alongside the sober-curious trend is simultaneously exciting (Margo Price and I are both rebels? Hell yes!) and worrisome. I do find it comforting to see there’s finally a deliberate, focused conversation on alcohol, a recalibration of its influence on our lives and health.

Unfortunately, there’s nothing trendy about the work recovery demands. This is a concern that Davis-Timms shared. “It’s a scary thing to say, ‘I’m a sober person’ versus ‘I’m trying out Sober October.’ The worrisome part of the trend is how trends come and go and I don’t want their sobriety journey to depend on that.”

My decision to quit drinking had nothing to do with Sober October. I had a very bad night of drinking and when I woke up, I realized that if I didn’t get help, the relationships that I valued most in my life – with my husband, my two young children, my friends and family – wouldn’t last.

Some days, I don’t even think about alcohol. Other days are much harder and I crave a beer or that once-familiar big pour of wine when the world feels like too much. In those moments, I find that ultimate connection – the one with myself. I take a breath, recall those turquoise Caribbean waves and once again choose not to drink.

• Life and style

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Reducing Underage Drinking: A Collective Responsibility (2004)

Chapter: 1. introduction: the challenge, 1 introduction: the challenge.

A lcohol use by children, adolescents, and young adults under the legal drinking age of 21 produces human tragedies with alarming regularity. Motor vehicle crashes, homicides, suicides, and other unintentional injuries are the four leading causes of death of 15- to 20-year-olds, and alcohol is a factor in many of these deaths. Indeed, so many underage drinkers die in car crashes that this problem, by itself, is a major national concern. In relation to the number of licensed drivers, young people under age 21 who have been drinking are involved in fatal crashes at twice the rate of adult drivers (National Highway Traffic Safety Administration, 2002a).

Car crashes are the most visible and most numbing consequences of underage drinking, but they represent only a small proportion of the social toll that underage drinking takes on the present and future welfare of society. Other damaging problems include dangerous sexual practices that lead to both serious disease and unwanted pregnancies, unintentional injuries, fights, and school failures that lead to expulsions or withdrawals. Levy et al. (1999) estimated that in 1996 underage drinking led to 3,500 deaths, 2 million nonfatal injuries, 1,200 cases of fetal alcohol syndrome, and 57,000 cases of treatment for alcohol dependence. Worse yet, underage drinking reaches into the future by impeding normal development and constricting future opportunities. Conservatively estimated, the social cost of underage drinking in the United States in 1996 was $52.8 billion (Pacific Institute for Research and Evaluation, 1999).

For many children, alcohol use begins early, during a critical developmental period: in 2002, 19.6 percent of eighth graders were current users of alcohol (use within the past 30 days), which can be compared with 10.7 percent who smoked cigarettes and 8.3 percent who used marijuana. Among each older age cohort of high school students, the prevalence, frequency, and intensity of drinking increase, contributing to increasing rates of educational failure, injury, and death as children move from grade to grade. By the time young people are seniors in high school, almost three-quarters (71.5 percent) report having drunk in the past year, almost half (48.6 percent) are current drinkers, and more than one-quarter (28.6 percent) report having had five or more drinks in a row in the past 2 weeks (Johnston et al., 2003). Among 18- to 22-year-olds, 41.4 percent of full-time college students and 35.9 percent of other young adults report heavy drinking (Substance Abuse and Mental Health Services Administration, 2002). Heavy childhood and teenage drinking injures the developing brain and otherwise interferes with important developmental tasks. In addition, children and adolescents who begin drinking early are more likely than others to wind up with alcohol problems throughout their adult lives.

The public is certainly aware of these problems, especially drunk driving by teens. However, recent surveys demonstrate that parents underestimate the prevalence and intensity of alcohol use by their own children and by the underage population (see Chapter 6 ). Moreover, as measured by media attention and government expenditures, public concern about teenage alcohol use has not been remotely commensurate with the magnitude of the problem. A telling measure of the current societal response is the large gap in the federal government’s investment in discouraging illicit drug use among teenagers and in discouraging underage drinking, given that the social damage from underage alcohol use far exceeds the harms caused by illicit drug use. In fiscal 2000, the nation spent approximately $1.8 billion on preventing illicit drug use (Office of National Drug Control Policy, 2003), which was 25 times the amount, $71.1 million, targeted at preventing underage alcohol use (U.S. General Accounting Office, 2001). The amount spent on preventing underage drinking also appears to be less than the amount spent on preventing tobacco use: in fiscal 2000, the Office of Smoking and Health, only one of many agencies in the Department of Health and Human Services concerned with smoking prevention, spent approximately $100 million. In addition, the states spent a great deal more, including funds generated by the agreement that settled the states’ Medicaid reimbursement suits against the tobacco companies.

There are signs that public attention to underage drinking is increasing and that the public recognizes the need to address the problem more aggressively than has thus far occurred. A recent study on public attitudes toward

underage drinking (Wagenaar et al., 2002) shows almost universal recognition of this problem. In fact, 98 percent of adults polled said they were concerned about teen drinking and 66 percent said they were “very concerned.” Moreover, a majority of respondents favored strong regulatory actions, such as additional controls on alcohol sales and advertising that would “make it harder for teenagers to get alcoholic beverages.” In 1999, Mothers Against Drunk Driving (MADD) added the goal of reducing underage drinking to its mission statement, and its activities and public statements increasingly reflect this focus (e.g., Mothers Against Drunk Driving, 2002). Underage drinking has also won the attention of the spouses of the nation’s governors, many of whom have come together to form the Leadership to Keep Children Alcohol Free, in collaboration with the Robert Wood Johnson Foundation (RWJF) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA, part of the National Institutes of Health). In collaboration with the American Medical Association (AMA), the RWJF has also provided long-term support to 12 community and 10 university-based coalitions with the specific mission of reducing and preventing underage drinking. The AMA has itself also become increasingly active on the issue of underage drinking, calling for tighter regulation of alcohol availability, higher excise taxes, and restrictions on alcohol advertising. Members of the alcohol industry also have continued their efforts to discourage underage drinking through responsible drinking campaigns and approaches such as server, parent, and youth-oriented education and involvement in prevention efforts on college campuses.

Underage drinking has also begun to attract increased government attention in Washington. The U.S. Federal Trade Commission (FTC), at the request of Congress, recently reviewed the alcohol industry’s advertising and marketing practices. Its report (U.S. Federal Trade Commission, 1999) called on alcohol companies to move toward the “best practices” in the industry “to reduce underage alcohol ad exposure.” In 2003 Congress called on the FTC to revisit its inquiry into alcohol advertising and youth and to investigate if and how the recommendations issued in its 1999 report have been implemented by the alcohol industry. Advocacy groups have also urged Congress to include underage alcohol use in the major media campaign being waged against illegal drug use under the auspices of the Office of National Drug Control Policy.

THE COMMITTEE STUDY

In 2001 Congress responded to the increasing level of public concern about underage alcohol consumption by appropriating funds for a study by The National Academies. Acting through the NIAAA and the Substance

Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services (HHS), Congress requested 1 The National Academies to undertake an examination of the pertinent literature, to “review existing federal, state, and nongovernmental programs, including media-based programs, designed to change the attitudes and health behaviors of youth,” and to “develop a cost effective strategy for reducing and preventing underage drinking.” Based on consultations with several of the Academies’ standing advisory boards, members of the Academies, and the Academies’ governing bodies, the final statement of task directs the committee to examine programs ranging from environmental interventions (e.g., taxation, access restrictions) to programs focusing directly on the attitudes and behavior of young people (see Appendix A for the full statement of task).

In response, the Board on Children, Youth, and Families (BCYF) of the National Research Council and the Institute of Medicine of the National Academies established a committee of 12 members with special expertise in key domains relating to underage drinking. To supplement the expertise of its members, the committee commissioned a set of papers to provide systematic reviews of the scientific literature on determinants of underage drinking and effective ways of reducing it. Topics explored in these papers include the demographics of underage drinking; its economic and social costs; adolescent decision making and risk and protective factors; and the effectiveness of various prevention programs and approaches, including media campaigns, school-based education, pricing, and access. Draft papers were presented at public meetings in October and November 2002 (see Appendixes B and C ) and subsequently reviewed and revised. 2

Numerous programs with the common goal of reducing underage drinking have been implemented at the national, state, and local levels, by governments and nonprofit and grassroots organizations. At the federal level, the Departments of Health and Human Services (HHS), Justice, and Transportation operate several programs that specifically target underage drinking. Seven other federal agencies fund efforts that include underage alcohol use within a broader mandate (U.S. General Accounting Office, 2001). Similarly, numerous state-level agencies administer programs to reduce underage drinking. In most states, the health, human service, transportation, criminal justice, and education departments play some role. State alcohol beverage control bodies also play a role. Many communities, colleges and universities, and grassroots organizations across the country have initiated

efforts to reduce underage drinking and its associated problems in their communities. The alcohol industry also has implemented a range of efforts with the goal of reducing underage drinking.

The committee reviewed the 2001 report of the General Accounting Office on federal programs. This report focused on federal funding that targets underage drinking or includes underage drinking within a broader mandate. It does not include evidence on the effectiveness of specific programs. For the programs operated by the Departments of Transportation and Justice, the report provides general information on the types of activities funded—traffic safety and enforcement of underage drinking laws, respectively. No information is provided on the HHS-funded programs or activities, the largest overall funder of targeted underage drinking activities (see Chapter 12 ), probably because the funds generally do not represent a national program but, rather, funding for select state or local programs or research aimed at specific aspects of the problem. Although HHS has funded evaluations of specific state and community-level programs, the committee is not aware of any national-level HHS evaluations, or national evaluations of the Department of Transportation program. Each of the federal agencies have initiatives to highlight promising practices, based on varying levels of evidence. Evaluations of state or local programs that receive federal funding that are available in the literature, are reflected in the papers prepared for the committee’s study.

The largest single federal program that targets underage drinking is the Enforcing the Underage Drinking Laws (EUDL) Program, operated by the Department of Justice’s Office of Juvenile Justice and Delinquency Prevention (OJJDP). A national evaluation of this program is in its fourth year, with only very preliminary outcomes information now available (see Chapter 9 ). The training and technical assistance center funded by the EUDL program produces a variety of materials that highlight best practices, many of which were reviewed by the committee.

The committee also reviewed written materials submitted by numerous organizations and individuals and considered both written and oral information presented at a public meeting held on November 21, 2002, by a wide range of organizations and people (see Appendix C ). This input highlighted programs or approaches considered effective by diverse communities and provided insights into their attitudes and experiences. The judgments provided through this process regarding effectiveness of particular programs or interventions were primarily subjective or based on informal evaluations.

Industry representatives provided extensive materials that were reviewed by the committee on the multiple activities they fund to reduce underage drinking. Included were descriptive materials such as summaries, brochures, pamphlets, videos, and guidebooks; testimonials from commu-

nity representatives on the utility of specific activities, and an evaluation of Alcohol 101, an industry-funded college-based intervention (see Chapter 7 for further discussion of these activities).

The committee’s basic charge is to provide science-based recommendations about how best to prevent and reduce underage drinking. Based on its expertise, consideration of public input, and review of the available scientific literature, including the papers written for the committee, the committee identified eight categories of programs or interventions and presents the evidence for each in the relevant chapter:

media campaigns designed to discourage underage drinking directly, to affect the behavior of adults, and to build a broader public awareness of the nature and magnitude of the problem ( Chapter 6 for adult-oriented campaigns and Chapter 10 for youth-oriented campaigns);

measures to curtail or counteract activities by individuals or businesses, including alcohol marketing practices, that tend to encourage or facilitate underage drinking (Chapters 7 and 8 );

measures restricting youth access to alcohol in both commercial and noncommercial settings, together with programs enforcing these laws ( Chapter 9 );

measures to reduce alcohol-related social harms by enforcing compliance with underage drinking restrictions, such as zero tolerance laws and other programs to reduce alcohol-related traffic injuries and criminal behavior ( Chapter 9 );

educational activities undertaken by schools, colleges and universities, faith-based institutions, healthcare organizations, alcohol companies, parent associations, and other entities designed to discourage underage drinking ( Chapter 10 );

community-based initiatives designed to tailor comprehensive approaches to the specific underage drinking problems of local communities ( Chapter 11 );

screening, counseling, and treatment programs to assist underage drinkers who have developed alcohol problems ( Chapter 11 ); and

methods of increasing the price of alcohol to underage purchasers, including increases in excise taxes ( Chapter 12 ).

It is important to recognize that implementation of any national “strategy” will depend on the cooperative actions of thousands of organizations and millions of individuals who have their own ideas about what is likely to be effective and valuable. These organizations include agencies at all levels of government (federal, state, and local) with an interest in underage drinking (e.g., alcoholic beverage control commissions, schools, and agencies responsible for law enforcement, substance abuse prevention, social ser-

vices, and public health). It also includes all the companies and establishments involved in producing, distributing, and selling alcohol—including distillers, vintners, breweries, package stores, and bars—as well as the advertising agencies that advise companies about how to position their products in different segments of the markets they seek to reach. It includes entertainment companies and other organizations that shape popular culture and affect young people’s attitudes about alcohol. A key role in any national response to the problem is played by parents who set models of drinking behavior for their children and who can affect the conditions under which their children have access to alcohol products. Of course, youths themselves make important decisions—not only about their own drinking, but also about how they view the drinking of their friends and peers.

The scope of the current efforts of many national, state, local, and nongovernmental group initiatives to prevent underage drinking or the consequences of drinking, particularly drinking and driving, is impressive. These programs include educational interventions, media campaigns, and activities to support enforcement of minimum drinking age laws. Young people themselves have organized efforts to discourage drinking among their peers. While few of these activities have been evaluated in any formal way, a successful national strategy will require the continued involvement, wisdom, and experience of the range of people and organizations that have been committed to preventing and controlling underage drinking.

A CHALLENGING TASK

The committee was charged with “developing a cost-effective strategy for preventing and reducing underage drinking.” As we set about this important task, it soon became evident that preventing and reducing underage alcohol use poses unusual challenges. Four of those challenges are the pervasiveness of drinking in the United States, the need for a broad consensus for a national strategy, ambivalence about goals and means, and commercial factors.

Pervasiveness of Drinking

Alcohol is readily available to adults (those over 21) through a large number of outlets for on-premise or off-premise consumption. About half of U.S. adults currently drink alcohol; among drinkers , the mean number of drinking days per month in 1999 was approximately eight. 3

Notwithstanding the legal ban, alcohol is also readily available to underage drinkers. In recent surveys of high school students, 94.7 percent of twelfth graders and 67.9 percent of eighth graders reported that alcohol is “fairly” or “very” easy to get (Johnston et al., 2003). Purchase surveys reveal that from 30 to 70 percent of outlets may sell to underage buyers, depending in part on their geographic location (Forster et al., 1994, 1995; Preusser and Williams, 1992; Grube, 1997). Focus groups have also indicated that underage youths typically procure alcohol from commercial sources and adults or at parties where parents and other adults have left the youths unchaperoned (Jones-Webb et al., 1997; Wagenaar et al., 1993). Wagenaar et al. (1996) reported that 46 percent of ninth graders, 60 percent of twelfth graders, and 68 percent of 18- to 20-year-olds obtained alcohol from an adult on their last drinking occasion. Commercial outlets were the second most prevalent alcohol source for youths 18 to 20. For younger adolescents, the primary sources of alcohol are older siblings, friends and acquaintances, adults (through third-party transactions), and at parties (Harrison et al., 2000; Jones-Webb et al., 1997; Schwartz et al., 1998; Wagenaar et al., 1993). National surveys of college student drinking find that a large percentage of college youth report they do not have to pay anything for alcohol, presumably because they are at a party where someone else is supplying the alcohol (Wechsler et al., 2000).

American culture is also replete with messages touting the attractions of alcohol use, which often imply that drinking is acceptable even for people under 21. Recent content analyses of television showed that alcohol use was depicted, typically in a positive light, in more than 70 percent of episodes sampled from prime-time programs shown in 1999 (Christensen et al., 2000), and in more than 90 percent of the 200 most popular movie rentals for 1996-1997 (Roberts et al., 1999b). Roberts et al. (1999b) also found that 17 percent of 1,000 of the most popular songs in 1996-1997 across five genres of music that are popular with youth contained alcohol references, including almost one-half of the rap music recordings. Positive images are also disseminated by the alcohol industry, which spent $1.6 billion on advertising in 2001 and at least twice that amount in other promotional activity. Thus, overall, young people are exposed to a steady stream of images and lyrics presenting alcohol use in an attractive light.

Need for Consensus

An effective strategy to reduce a behavior as pervasive and widely facilitated as underage drinking will depend on a public consensus about both goals and means, which will require an unequivocal commitment from a broad array of public and private institutions. If the nation is to succeed in promoting abstention or reduced consumption by minors in a country

that has more than 120 million drinkers, the need to do so has to be understood and embraced by many people in a position to reduce drinking opportunities for minors. An effective strategy will depend on adoption of public policies by authoritative decision makers about how to use tax money and public authority—for example, whether to use federal dollars to fund a national media campaign, how to enforce existing state laws banning sales to underage drinkers, or how local school boards should discipline students who drink. The process of enacting such policies will require some degree of public consensus, but this is only the start.

Ultimately, the effectiveness of government policies will depend on how enthusiastically a great many public and private agencies join in the effort to implement them. If parents, animated by a national media campaign, join local police and school boards in concerted efforts to discourage underage drinking and if alcohol distributors join with regulatory agencies to find means to deny underage drinkers easy access to alcohol, then the impact of government policies will be increased. In short, a public consensus to deal determinedly and effectively with underage drinking is needed not only to generate support for adopting strong policies, but also to make them effective. Conversely, both enactment and implementation will be seriously impeded if the public is divided or ambivalent about the importance of reducing underage drinking.

It is here that the greatest challenge lies. In the nation’s diverse society, communities have differing beliefs and sensibilities about the consumption and social meaning of alcohol use in general, as well as about what should be expected and demanded of young people during the transition between childhood and adulthood. These differences contribute to varying beliefs, varying public policies, and varying individual practices regarding underage access to alcohol. Although the vast majority of families would agree that the nation as a whole has a powerful interest in reducing the negative consequences of underage drinking on society and on the youths themselves, individuals, families, groups, and communities all have different views on the wisdom and propriety of various approaches to the problem.

In this respect, surveys that show that certain steps by governments (e.g., increasing alcohol excise taxes or restricting advertising) are widely supported obscures disagreements about whether young people should be severely punished for using alcohol, whether parents should be punished for allowing parties with alcohol for youth in their homes, or whether the legal drinking age should be 21.

Ambivalence About Goals and Means

The problem of mustering a societal consensus to achieve an objective as subtle, complex, and contested as reducing underage drinking can be

seen most sharply when one compares underage drinking with illegal drug use and underage smoking. The goal of the nation’s policy toward illegal drugs and tobacco—abstention by everyone—is both unambiguous and widely, if not universally, embraced. Thus, the nation aims to discourage and suppress nonmedical use of marijuana, cocaine, and other controlled substances by everyone (whatever their age) through a comprehensive legal regime prohibiting the manufacture, distribution, and possession of these drugs for nonmedical purposes. Even though tobacco products, by contrast, are lawfully available to adults, the nation’s clearly expressed goal is to discourage tobacco use by everyone, by preventing initiation and promoting cessation. The messages to young people and adults in these two contexts are identical: indeed, because few people take up smoking as adults, the overall success of the nation’s anti-tobacco policy depends substantially on the success of its efforts to prevent initiation among young people.

The task of developing a strategy for preventing and reducing alcohol use among young people, in contrast, faces an uncertain policy goal. A strong cultural, political, economic, and institutional base supports certain forms of drinking in the society. Unlike the goals for illegal drugs and tobacco, the nation does not aim to discourage or eliminate alcohol consumption by adults. It is probably a fair characterization to say that the implicit aims of the nation’s current alcohol policy are to discourage excessive or irresponsible consumption that puts others at risk, while being tolerant of moderate consumption (at appropriate places and times) by adults (especially in light of the possible health benefits of moderate use for some populations over 40). For example, as long as others are not endangered or offended, attitudes toward intoxication (per se) vary according to religious beliefs and personal moral standards. In short, current alcohol policy rests on a collective judgment, rooted in the Prohibition experience, that the wisdom and propriety of alcohol use among adults should be left to the diverse moral judgments of the American people. This is not to say that everyone supports this stance of government neutrality. Many public health experts would like to take steps (short of prohibition) to suppress alcohol consumption as a way of reducing alcohol problems, and some conservative religious groups would take a more aggressive public stance against intoxication itself. However, the current stance of tempered neutrality seems to be widely accepted and therefore fairly stable.

In this policy context, the message to young people as well as adults about alcohol use is both subtle and confusing. The message to young people is “wait” or “abstain now,” rather than “abstain always,” as it is with tobacco and illegal drugs. Unlike the policies for those other products, the ban on underage alcohol use explicitly represents a youth-only rule, and its violation is often viewed as a rite of passage to adulthood. The problem

is exacerbated because the age of majority is higher for alcohol than it is for any other right or privilege defined by adulthood (e.g., voting, executing binding contracts). Explaining convincingly—to young people as well as adults—why alcohol use is permissible for 21-year-olds but not for anyone younger is a difficult but essential task for reducing or preventing underage drinking.

There is also confusion about whether messages to young people should emphasize abstention, perhaps drawing together alcohol, tobacco, and illegal drugs, or whether messages should focus on the dangers of intoxication and heavy drinking. Many people believe that abstention messages are more appropriate (and more likely to be effective) for younger teens than for older teens and college students.

This overall debate raises the same question posed by all wait rules: What is the age of demarcation between childhood and adulthood (see, generally, Zimring, 1982; Kett, 1977). The argument has been given a raw edge by the trend, in recent years, to curtail the jurisdiction of juvenile courts and to prescribe severe punishments, including the death penalty, for teenagers who commit crimes (Fagan and Zimring, 2000).

Commercial Factors

Alcohol is a $116 billion-per-year industry in the United States, catering to the tastes and needs of the more than 120 million Americans who drink. All states generate revenue from the sale of alcohol, either through excise taxes or product mark-ups, and 18 states participate in the alcohol market through retail and/or wholesale monopolies over distribution of certain alcoholic beverages. A strategy to suppress underage alcohol use must somehow be implemented in the very midst of a society replete with practices and messages promoting its use, and with a strong sector of deeply vested economic interests and the accompanying political and economic power. A significant level of underage use is inevitable under these circumstances—as an inevitable spillover effect, even if unintended by the industry—no matter what strategy is implemented. Foster et al. (2003) recently estimated that underage drinkers account for 19.7 percent of all drinks consumed and 19.4 percent of the revenues of the alcohol industry (about $22.5 billion). On the basis of the committee’s independent calculations, we conclude that youth consumption falls somewhere between 10 and 20 percent of all drinks and accounts for a somewhat lower, although still significant, percentage of total expenditures (see Chapter 2 ).

Although a similar challenge confronts tobacco control policy makers in the effort to prevent youthful use of tobacco products, the potency and impact of tobacco industry activity are gradually being lessened by the growing consensus that tobacco is a deadly and disapproved product, that

the industry has misled its customers for decades, and that aggressive regulation is needed to prevent young people from using tobacco and otherwise to protect the public health. It is generally believed that the tobacco industry has targeted young people to maintain demand for tobacco products as older consumers quit or die, notwithstanding the industry’s professed efforts, in the wake of the Master Settlement Agreement, to discourage underage use of their products. In short, public health officials and the major tobacco companies are not on the same side, and “big tobacco” is regarded as the enemy of the public’s health.

In contrast, the alcohol industry is diverse and uniformly acknowledges the dangers of underage drinking. Alcohol experts generally assume that the level of adult demand for alcohol products will not be substantially affected, over the long term, by reducing underage consumption—although getting young people to wait will obviously reduce the overall level of consumption. Thus, while the commercial interests of the alcohol industry are not perfectly aligned with the public health, they are not as antagonistic to the public health as the interests of the tobacco industry. In any case, a strategy for preventing and reducing underage drinking will have a much better chance for success if it attracts the active cooperation, and at least the acquiescence, of various segments of the alcohol industry.

The effectiveness of any policy focused explicitly on reducing underage drinking will be limited by the existence of a large legitimate practice of drinking and by the power of a large industry responding to legitimate consumer demand. When alcohol is available in many home liquor cabinets, the success of strategies to discourage young people from buying at package stores will be much different than in a world where relatively few parents have stocks of alcohol. The widespread legal use of alcohol in the society affects not only cultural and individual attitudes toward drinking, but also the extent to which any youth-oriented control regime can be effective in reducing opportunities for youths’ access to alcohol and drinking opportunities. One can establish a clear-cut boundary between acceptable drinking and unacceptable drinking at conceptual, policy, and legal levels, but it must be understood not only that different communities will construct that boundary differently as a matter of policy but also that the scope created for legal drinking has a profound, practical effect on the effectiveness of other policy instruments in discouraging unwanted, underage drinking.

In sum, the committee set about its task of developing a strategy for preventing and reducing underage drinking while being fully aware of the complexity of defining the public interest in this area and mindful of the severe constraints within which the strategy must be framed and implemented.

UNDERLYING ASSUMPTIONS

In conducting its work, the committee did not begin with a blank slate. Instead, we were asked to develop a national strategy given the basic framework of the nation’s current policy toward underage drinking. That policy aims to delay drinking by young people as long as possible and forbids lawful access to alcohol for people under 21.

Some people argue that the delay strategy is misguided and that the legal drinking age should be lower than 21 (typically 18). According to this view, allowing drinking at younger ages would mitigate youthful desire for alcohol as a “forbidden fruit”; would provide opportunities to “learn” to drink, thereby reducing harms; and would bring the age at which youth are allowed to drink into alignment with the age at which they can join the military, vote, and participate in other aspects of adult life. Whatever the merits of this view, the committee believes that Congress intended us to work within the framework of current law, anchored in the National Minimum Drinking Age Act of 1984, and that reconsideration of the 21-year-old drinking age, and of the premises on which it is predicated, is beyond our mandate. Moreover, as a practical matter, the current policy framework, though disputed by some, rests on a strong scientific foundation, is widely accepted, and is certain to be preserved for the foreseeable future.

Because the current policy framework provides the foundation for the committee’s work, and for the strategy recommended in this report, it is useful to summarize it here and to highlight its basic rationale.

Evolution of Current Policy

Until the last decades of the 19th century, society relied largely on nonlegal mechanisms of social control to constrain youthful drinking. However, in the wake of urbanization, immigration, and industrialization, alcohol came under tighter control, including bans against selling it to people under the legal age (Mosher et al., 2002). After the repeal of Prohibition in 1933, it became settled that decisions about alcohol control rested with the states, and the structure of modern alcohol regulation took shape.

Until 1970, the minimum drinking age in most states was 21. Between 1970 and 1976, 21 states reduced the minimum drinking age to 18, and another 8 states reduced it to 19 or 20 (usually as part of a more general statutory reform reducing the age of majority to 18) (Wagenaar, 1981). Proposals to restore a higher age were soon introduced, however, largely because alcohol-related automobile crashes had significantly increased among teenagers and young adults. Of the 29 states that lowered their drinking age, 24 raised the age again between 1976 and 1984. By that time, only three states allowed 18-year-olds to drink all types of alcoholic bever-

ages, while five others (including the District of Columbia) allowed 18-year-olds to drink beer and light wine while setting the age limit for distilled spirits and wine with high alcohol content at 21. Thirteen states set a uniform age of 19, and four others allowed 19-year-olds to drink beer and set the limit at 21 for other alcoholic beverages. Four states set the age at 20 for all alcohol, and the remaining 22 states set a uniform age of 21 (Bonnie, 1985).

In 1984 Congress enacted the National Minimum Drinking Age Act, as recommended by the Presidential Commission on Drunk Driving, using the threat of withholding 10 percent of federal highway funds to induce states to set the minimum drinking age at 21 for all alcoholic beverages. All states eventually complied and have a variety of mechanisms in place to enforce this restriction

The Goal of Delay

The explicit aim of existing policy is to delay underage alcohol use as long as possible and, even if use begins, to reduce its frequency and quantity as much as possible. Most people recognize that drinking itself is not the issue. Rather, the underlying challenge is protecting young people while they are growing up. Children and adolescents need to be protected in the first instance from the immediate harms that can occur when they are drinking. But they also need to be protected from the possibility that they will mortgage their own future prospects by initiating practices that could cause them permanent harm during a critical developmental period and that could lead to patterns of drinking that will worsen as they grow older.

The question is how best to go about that protective task. As indicated, some people argue that the most sensible approach is to permit drinking by young people (at least older teens) rather than trying to suppress it. In their view, a “wait” rule is not the best way to reduce the problems associated with underage drinking—at least in a society in which it is bound to occur with considerable frequency anyway. They would allow youthful drinking and focus on supervision rather than drinking per se (at least for older adolescents). In their view, a “learner’s permit” for drinking is preferable to a prohibition that drives underage drinking into the shadows and sacrifices the opportunity for supervision. A learner’s permit approach could be implemented in a variety of ways, such as by permitting youth access to only certain kinds of alcohol during the learning period (analogous to a graduated driving license) and by prescribing particular requirements for adult supervision.

If the drinking age were lowered, the critical question is whether the intensity of youthful drinking, and the accompanying problems, would decrease, as contended by proponents of the learner’s permit approach.

Admittedly, the current approach may create incentives for heavy unsupervised drinking on the occasions where alcohol is available. However, as discussed in Chapter 9 , young people who drink tend to do so heavily even in societies with a learner’s permit approach.

In addition, a substantial body of scientific evidence shows that raising the minimum drinking age reduced alcohol-related crashes and fatalities among young people (Cook and Tauchen, 1984; U.S. General Accounting Office, 1987; Wagenaar and Toomey, 2002) as well as deaths from suicide, homicide, and nonvehicle unintentional injuries (Jones et al., 1992; Parker and Rebhun, 1995). Increasing the minimum drinking age to 21 is credited with having saved 18,220 lives on the nation’s highways between 1975 and 1998 (National Highway Traffic Safety Administration, 1998). Voas, Tippetts, and Fell (1999), using data from all 50 states and the District of Columbia for 1982 through 1997, concluded that the enactment of the uniform 21-year-old minimum drinking age law was responsible for a 19 percent net decrease in fatal crashes involving young drivers who had been drinking, after controlling for driving exposure, beer consumption, enactment of zero tolerance laws, and other relevant changes in the laws during that time.

These findings reinforce the decision by Congress to act in 1984. In short, current national policy rests on the view, supported by substantial evidence, that delaying drinking reduces problem drinking and its consequences. The nation’s legislators and public health leaders have reached the nearly uniform judgment that the benefits of setting it at 21 far exceed the costs of doing so.

The Instrumental Role of the Law

Our earlier comparison among alcohol, tobacco, and illegal drugs raises another important preliminary question—about the role of the law in the prevention of underage drinking. It is possible to imagine an official policy aiming to delay and discourage underage drinking that does not rely in any way on the coercive authority of the state to implement this policy: instead of banning underage access to alcohol by law, society might rely entirely on parenting, education, community expectations, and other mechanisms of social control to suppress youthful drinking and, for older teens, to transmit the desired drinking-related norms and to encourage adults to refrain from supplying youths with alcohol or otherwise facilitating their drinking. Various forms of social disapproval, including social and economic sanctions (e.g., not patronizing stores or bars that serve minors) can be imagined.

In contrast, the United States has decided that there must be laws against supplying alcohol to young people and that it should also be illegal for young people to possess or use alcohol, at least in public. Thus, because

the law plays such a central role in the nation’s policy toward underage drinking, it is essential to clarify the functions that these laws should reasonably be expected to serve.

At the outset, it should be emphasized that a secular society seeks to delay underage drinking because it is dangerous to youths and others, not because it is inherently evil or wrong. The ban on underage drinking is an age-specific prohibition, implying that the aim is to delay alcohol use, not to condemn it or inoculate against it. For this reason, the prohibition is distinctly instrumental in nature and is not grounded in the moral disapproval that characterizes many legal prohibitions. To use a traditional legal classification, underage drinking is an example of a prohibition that is malum prohibitum (wrong because it is prohibited) rather than malum in se (wrong in itself). Punishment for an underage drinker, or even for an adult facilitator, is not an expression of public moral condemnation as is, for example, punishment for child sexual abuse or robbery.

Enforcement of prohibitions against immoral behavior serves the twin goals of reducing the harmful behavior and condemning and punishing the perpetrator for the transgression. The prohibition of underage drinking does not aim to serve this second (retributive) objective in any strong sense. Its aim is exclusively instrumental. Consequently, the measure of the prohibition’s effectiveness, and of the social policy it implements, has to be whether it reduces or avoids the dangerous consequences associated with youthful drinking.

Law is a blunt instrument. It is not self-executing, and it requires the affirmative support of a substantial proportion of the population and of those who are expected to enforce it. These characteristics of a law are particularly important for instrumental prohibitions, such as the ban against underage drinking, because the level of compliance will depend heavily on the willingness of a large number of individuals to adhere to the law simply because they accept its moral authority to command their obedience. That is, a legal norm of this kind, which affects so many people in so many everyday social and economic contexts, cannot be successfully implemented based on deterrence (the threat of punishment) alone. It must rely heavily on the “declarative” or “expressive” function of the law: by forbidding the conduct, it aims to shape people’s beliefs and attitudes about what is acceptable social behavior and thereby to draw on their disposition to obey.

Since the ultimate goal is to protect youths (and others within the zone of danger) from harmful consequences, one might wonder whether it is possible to implement an underage alcohol policy by focusing exclusively on the dangerous behavior rather than the drinking itself. In theory, it might be possible to define the prohibited conduct exclusively in relation to the magnitude of the risk: for example, “don’t drive a car after having had alcohol” or “don’t give alcohol to a youth who intends to drive a car or is

otherwise likely to behave dangerously.” However, any such dangerous drinking prohibitions are extremely difficult to implement successfully and would not exert a sufficient deterrent by themselves to prevent the risky behaviors associated with underage alcohol use. As the nation’s lawmakers have concluded, only a categorical prohibition of underage access to alcohol has any realistic chance of doing that, especially in a large industrial society in which the risks are pervasive (and magnified by developmental vulnerability) and where young people have large periods of time outside parental supervision and outside the reach of formal social controls. It is also relevant to note that at least one of the risks associated with underage drinking is intrinsic to the drinking itself—the permanent damage of alcohol consumption on the adolescent brain (see Chapter 3 ).

Given an age-based categorical prohibition aiming to serve exclusively instrumental aims, other policy judgments are needed regarding the scope of the restrictions, the severity of the prescribed sanctions, and the resources and tools that should be used to enforce the law. Banning commercial distribution of alcohol to underage persons is an essential element of the prohibition, but what about noncommercial distribution? Even if noncommercial distribution is banned, what about parental distribution to their own children in their own home? (Many states do not prohibit this distribution.) Is it also necessary to penalize young people who purchase or consume alcohol? Even in their own homes? What enforcement strategies should be used? And how severe should the sanctions be? These issues are addressed in Chapter 9 . The answers require careful assessment of the possible benefits (in reducing harms associated with underage drinking) and the costs of any particular strategy. The degree of public support and the difficulty of enforcement bear on both the potential effectiveness and on the possible costs.

A POPULATION PERSPECTIVE

In requesting the National Academies to develop a strategy for reducing and preventing underage drinking, Congress clearly anticipated that we would do so from a public health perspective, reviewing the etiology and consequences of alcohol use by the underage population and assessing the effectiveness of interventions that might be deployed to reduce the prevalence of drinking in this population, particularly the patterns of consumption most clearly associated with alcohol problems. (The outcomes of interest in assessing the effectiveness of interventions are discussed in Chapter 5 .) Recognizing that underage drinking substantially increases the short-term risks of death, injury, and other harms, as well as long-term risks of alcoholism and other dysfunction, a population-oriented strategy aims to lower the mean level of risk in the underage population in order “to shift

the whole distribution of exposure in a favorable direction,” typically by “altering some of society’s norms of behavior” (Rose, 1985, p. 371). Accordingly, we emphasize the population-oriented tools of primary prevention, rather than the individually oriented methods of secondary or tertiary prevention. Thus, identification and treatment of youths with drinking problems, or at high risk for developing such problems, and the challenge of instilling habits of responsible drinking as young people mature are addressed only incidentally in this report. These issues are important for improved policy and practice, but they are peripheral to our basic charge—delaying underage drinking and reducing its prevalence.

In developing a strategy to delay and reduce underage drinking, the committee has tried to understand the problem from two angles. First, we looked at the problem from the viewpoint of a young person deciding whether and under what circumstances to use alcohol. Our framework draws on the developing literature regarding adolescent decision making, especially in relation to health and risk behaviors. We pay particular attention to youthful decision-making abilities at various ages in the context of the changing social realities of teenage alcohol use. Some components of a comprehensive strategy must aim to help young people make the right decisions, depending on their age and developmental stage, taking account of the dangers of alcohol use at varying points in development.

It is not enough, however, to try to persuade young people to make the right choices. If the strategy relied exclusively on tools directed at changing the attitudes and behavior of underage youths, it would not have much chance of succeeding. To complement a youth-centered decision-making perspective, the committee also drew on the multidisciplinary perspective used by public policy analysts. This framework combines the disciplines of epidemiology, economics, health communications, law, and other social sciences to envision the array of policy instruments that can be brought to bear on the problem and to assess their probable effectiveness and costs, used alone or in combination.

OVERVIEW OF THE REPORT

Although the committee’s recommended strategy responds to a congressional request, the report is intended for a broad audience, including parents, businesses, alcohol companies, educators, state and local policy makers and legislators, healthcare producers and retailers, practitioners, and community organizers. Our work is presented in two parts.

Part I , Chapters 2 through 4 , provides important contextual information about underage drinking and its consequences and determinants. Chapter 2 discusses key definitions and presents pertinent demographic and epidemiological data regarding the scope of underage drinking and the

characteristics of underage drinkers. It includes data on the prevalence of alcohol use and drinking behavior by gender, race, and ethnicity as well as comparisons of youth and adult drinking patterns. Chapter 3 provides an account of the social consequences and costs of underage drinking.

Chapter 4 offers a context for the underlying reasons, motivations, social influences, and risk factors that influence young people’s decisions about drinking. The chapter explores the specific motivations and influences relevant to young people’s drinking behavior and attempts to answer why some young people choose to drink and do so intensively while others choose to drink moderately or not at all. The chapter also discusses the social environment in which young people are immersed and the ways that community and social factors affect underage drinking.

Part II , Chapters 5 through 12 , presents the committee’s recommended strategy to prevent and reduce underage drinking. In each of these chapters, the committee summarizes what is known about the effectiveness of existing programs or interventions in the pertinent domain and presents its conclusions and recommendations. The committee has tried to be realistic in assessing the potential effectiveness of efforts to prevent and reduce underage drinking. The committee assumes that most adults in the United States will continue to use alcohol and that most drinkers will begin their alcohol use sometime before they are 21, despite laws and policies to the contrary. Within that constraint, however, there is substantial room for preventing and reducing underage drinking in the United States, and this part of the report explores various tools that can be used in this effort.

At the heart of the committee’s proposed strategy is the effort to foster a collective societal acceptance of responsibility for reducing underage drinking. Although continued efforts to speak directly to young people about the dangers of alcohol use are an important component of the committee’s proposed strategy, the committee believes that the highest priority should be given to changing the attitudes and behaviors of adults. Adults often facilitate or enable underage drinking directly by supplying alcohol to young people, by failing to take effective precautions to prevent it, or by sending the message that alcohol use is to be expected. Few programs currently seek to influence parents to alter their behaviors and attitudes toward youth drinking as a way of reducing youth access to alcohol, changing permissive social norms about underage drinking, and galvanizing community action.

In Chapter 5 we explain our interpretation of the committee’s charge and some of the key assumptions underlying the strategy, including the criteria for assessing effectiveness and cost. This chapter is the foundation for the rest of the report. In Chapter 6 we discuss development of a national media effort as a major component of a campaign aimed at educating parents and other adults about underage drinking and ways adults can help

reduce opportunities for youth drinking. In Chapter 7 we discuss how the alcoholic beverage industry can become a partner in the overall effort by helping to establish and fund an independent nonprofit organization charged with reducing underage drinking and by exercising greater self-restraint in advertising and promotional activity. Our messages to the alcohol industry (and other industries that benefit from a large alcohol market) are clear: Your efforts to satisfy and expand the legitimate adult market for alcohol inevitably spill over to a large underage market. Even if you do not intend to stimulate or satisfy underage demand, you derive financial benefits from it. As a society, we cannot have a substantial impact on underage drinking without your active engagement in this effort. Chapter 8 issues a similar challenge to the entertainment media, urging more attentive self-regulation to reduce exposure of children and adolescents to lyrics and images that portray drinking in an attractive way. The committee believes that market incentives can be used to reward companies, including entertainment media, who take meaningful steps to help reduce underage drinking, and to punish companies that do not. Chapter 9 explores ways to reduce youth access to alcohol through both commercial and noncommercial channels.

Chapter 10 explains why the committee does not recommend a youth-oriented national media campaign at this time, preferring instead a cautious program of research and development. It also addresses educational efforts in schools, colleges, and other settings designed to persuade young people to choose not to drink and to reduce alcohol problems. The chapter also briefly discusses programs for assisting youths with alcohol problems. Chapter 11 reviews the potential advantages of mobilizing communities to implement locally specific efforts to reduce underage drinking.

Chapter 12 identifies several ways in which the federal and state governments can help implement the proposed strategy, including through increases in excise taxes. Regulatory action by the government is not at the center of the committee’s proposed strategy. The major priority, in the committee’s view, is to galvanize the necessary societal commitment to prevent and reduce underage drinking. Thus, the committee focuses its attention on community action, business responsibility, public-private partnerships, and all the other institutional expressions of a genuine social movement. In this context, government has a supportive, but nonetheless indispensable, role—to provide funding (possibly through increased excise taxes on alcohol) and technical support to strengthen and enforce access restrictions, to keep regulatory pressure on the alcohol industry to act responsibly, and to monitor the effectiveness of the overall strategy.

Alcohol use by young people is extremely dangerous - both to themselves and society at large. Underage alcohol use is associated with traffic fatalities, violence, unsafe sex, suicide, educational failure, and other problem behaviors that diminish the prospects of future success, as well as health risks – and the earlier teens start drinking, the greater the danger. Despite these serious concerns, the media continues to make drinking look attractive to youth, and it remains possible and even easy for teenagers to get access to alcohol.

Why is this dangerous behavior so pervasive? What can be done to prevent it? What will work and who is responsible for making sure it happens? Reducing Underage Drinking addresses these questions and proposes a new way to combat underage alcohol use. It explores the ways in which may different individuals and groups contribute to the problem and how they can be enlisted to prevent it. Reducing Underage Drinking will serve as both a game plan and a call to arms for anyone with an investment in youth health and safety.

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Alcohol Use Disorder

• Binge Drinking
• Drinking Problem

Illegal Drug Addiction

Prescriptions.

• Benzodiazepines
• Antidepressants
• Inpatient Rehab
• Residential Rehab

Alcohol Rehab

• Methadone Clinics
• Sober Living
• Family Therapy

Recovery Programs

• 12-Step Programs
• SMART Recovery
• Families of Addicts

Early Recovery

• Stages of Change
• Handle Triggers
• Rehab Insights

Sustained Recovery

• Sober Curious Life

Long-Term Recovery

• Jellinek Curve
• Life After Rehab

Find Treatment

• Find Addiction Center
• Find Suboxone Center

How to Prevent Alcoholism

In This Article

Key takeaways.

• Alcohol addiction or alcohol abuse can lead to long-term physical and mental health complications
• You can prevent alcohol addiction with moderate drinking and professional treatments
• Alcohol can affect people differently, because of this there is no single way to prevent addiction
• If you start to notice physical and mental side effects from alcohol abuse, consider seeking medical attention
• Various treatment options are available to help you recover from addiction and stay sober

Can You Prevent Alcohol Abuse?

Yes, you can prevent alcohol abuse. However, alcohol has different effects on everyone. Because of this, there’s no single way to prevent alcoholism.

Drinking patterns vary depending on factors such as:

• Environment

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Tips for Preventing Alcohol Abuse & Addiction in Adults

If you are struggling with alcohol, the following tips will help you create healthy drinking habits and prevent alcohol use disorder ( AUD ).

Drink Moderately or Practice Low-Risk Drinking

The Dietary Guidelines for Americans recommend non-drinkers abstain from alcohol completely. If you've already started drinking, limit yourself to 1 drink a day for women or 2 drinks a day for men. 8

You can also practice low-risk drinking. Limit your intake to 7 drinks per week for women or 14 for men.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), only 2 out of 100 drinkers within these limits develop AUD. 4

Monitor Your Drinking

Whether you drink alone or with others, drink within the recommended limits. One way to do this is to alternate drinking with other activities. For example, you can:

• Talk to people
• Drink water in between drinks
• Substitute alcohol with non-alcoholic drinks

Before you grab a drink, ask yourself why you are doing it. Do not drink alcohol if you feel any negative emotions.

Drinking to cope with sadness or stress will sometimes cause you to consume more alcohol than usual. This can lead to alcohol dependence and long-term alcohol abuse. 9,10

Avoid Triggers

A trigger can be any place, person, object, or situation that urges you to drink alcohol. Learning to recognize your triggers is important in alcohol prevention.

Here are some ways you can avoid them:

• Do not attend gatherings or celebrations where there is alcohol
• Stay away from people who drink heavily or encourage you to drink
• Do not store alcohol at home or keep a stock of it
• Replace alcohol with non-alcoholic drinks and healthy foods
• Avoid people and situations that remind you of past trauma
• Do not live in places that provide easy access to alcohol, such as nearby bars
• Learn healthy coping mechanisms to prevent emotional drinking

Avoiding triggers can be difficult. If you are constantly exposed to triggers, consider moving to an alcohol-free environment, such as a halfway house .

Get Support

Having people who support you is a great way to reinforce your alcohol prevention strategies. They can help you:

• Regulate your drinking
• Avoid triggers
• Create healthy coping mechanisms
• Hold you accountable if you drink
• Call healthcare professionals in case of emergencies

Get Professional Help

BetterHelp can connect you to an addiction and mental health counselor.

How to Prevent Underage Drinking

As a parent or family member, here are some ways to prevent alcohol use in teenagers:

• Encourage teens to feel confident about turning down alcohol
• Speak openly and honestly about drinking and its risks
• Establish boundaries on what will happen if a teen drinks
• Monitor your alcohol at home so you can tell if they have been drinking
• Do not allow them to go to parties without a chaperone
• Set a rule that it is unacceptable to consume alcohol at home
• Encourage healthy relationships with peers who do not drink
• Set a good example with responsible alcohol consumption
• Enroll your child in alcohol prevention programs

The main consequence of underage drinking is that it causes impulsive behavior. This often increases the risk of: 

• Sexual assault
• Alcohol overdose
• Premature death

Studies show that people who start drinking in their teenage years are at higher risk of developing alcohol use disorder (AUD) in adulthood. 12 Because of this, it's important to help them as early as possible.

Preventing Harmful Alcohol Use in Older People

Alcohol use disorders are less common in older adults. But with nearly half of those aged 65 and over still drinking, alcohol consumption is still associated with age-related risks.

Older people have a lower tolerance for alcohol. They can suffer from alcohol-related harm even if they drink within the recommended limits.

To help them avoid harmful alcohol use, involve healthy and safe approaches and seek help from family members and health professionals. 

Here are some ways you can reduce the harmful consequences of alcohol among older adults:

• Ensure they do not mix alcohol with over-the-counter (OTC) and prescription drugs.
• If they have pre-existing health conditions, limit or stop their alcohol intake.
• Watch out for triggers that may cause them to drink excessively.
• Provide support.

Phone, Video, or Live-Chat Support

BetterHelp provides therapy in a way that works for YOU. Fill out the questionnaire, get matched, begin therapy.

When Should You Get Help for You or Your Loved One?

AUD can affect anyone, regardless of age. Knowing the early signs of alcoholism can help you prevent it.

Signs and symptoms of alcoholism include:

• Drinking alcohol alone or hiding one's drinking
• Needing to increase consumption to achieve the same effect
• Decreasing appetite and gradual weight loss
• Lack of personal hygiene
• Decreasing function at work or school
• Becoming angry when confronted about their alcohol misuse

If you experience these or know someone who does, don’t hesitate to seek professional treatment and advice. Doctors and healthcare providers can help you explore harm reduction programs and assist with staging interventions if needed.

How Is Alcohol Addiction Diagnosed?

You’ll start by seeing your primary healthcare provider. If they think you have a problem with alcohol, you’ll be referred to a mental health provider.

You may go through assessments and examinations that include:

• Asking you about your drinking habits
• Alcohol screening and brief interventions
• Lab and image testing
• Psychological evaluations 

Treatment Options for AUD

If you have a drinking problem or alcohol addiction, various treatment options can help you recover and stay sober. However, alcohol affects people differently, and so does treatment.

Consult a doctor or health professional to help find the right treatment program for your needs. Available treatment options for AUD include:

• Medical detox : Medically supervised detox used to avoid harmful withdrawal symptoms
• Inpatient treatmen t: Involves checking yourself into a rehab facility for 24-hour medical supervision
• Outpatient treatment : A treatment program where people are allowed to leave the rehab facility
• Dual-diagnosis treatment : A treatment program that treats any co-occurring condition alongside alcohol use disorder
• Cognitive behavioral therapy (CBT) : A short-term therapy technique that explores the link between thought patterns and addiction
• Partial hospitalization program (PHP) : A treatment program where you stay at a rehab facility for a day and return home at night
• Support groups : Provide a much-needed community to help maintain sobriety after treatment

Preventing Excessive Alcohol Use

Alcohol is a psychoactive substance with immediate effects on the brain. Repeated use can change the way your brain functions and cause alcohol addiction . 3 Preventing alcoholism can help you avoid long-term, life-altering consequences. 

Excessive alcohol use or alcoholism can lead to: 1,2

• Alcoholic liver disease
• Heart disease
• Disabilities
• Social or relationship problems
• Work or school problems
• Mental health problems

Before you take on alcohol prevention, you should examine your relationship with alcohol. Doing so will help determine whether you have a mild or severe alcohol problem.

How to Tell if You Drink Too Much

Take note of how many drinks you typically consume and how often you drink in a day, week, and month. If you drink excessively, you may have an alcohol problem among the following:

• Binge drinking: 4 or more drinks for women in 2 hours or 5 or more drinks for men 
• High-intensity drinking: Alcohol consumption that is 2 or more times than binge drinking levels
• Heavy drinking: 3 or more drinks a day or at least 8 drinks per week for women or 4 or more drinks a day or at least 15 drinks per week for men

Heavy, high-intensity, and binge drinking are signs you drink too much alcohol. Any type of alcohol use in pregnant women and adolescents below 21 is also considered excessive. 4,5

What's Next?

• What Is Rehab Like?
• Why Call an Addiction Hotline?
• How to Sober Up
• Tapering off of alcohol

Get matched with an affordable mental health counselor

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Peyote Statistics on Usage and its Legal Status

• " Harmful use of alcohol ." World Health Organization Eastern Mediterranean Regional Office.
• " Alcohol Abuse Statistics ." The National Center for Drug Abuse Statistics, 2023.
• U.S. Department of Health and Human Services. " Biology of Addiction: Drugs and Alcohol Can Hijack Your Brain ." News in Health, 2015.
• " Drinking Patterns and Their Definitions ." Alcohol Research: Current Reviews, 2018.
• Centers for Disease Control and Prevention. " Excessive Alcohol Use ." National Center for Chronic Disease Prevention and Health Promotion, 2022.
• Harding et al. “ Underage Drinking: A Review of Trends and Prevention Strategies. ” American Journal of Preventive Medicine, 2016.
• Patrick, M., and Azar, B." High-Intensity Drinking ." Alcohol Research: Current Reviews, 2018.
• U.S. Department of Health and Human Services. " 2015–2020 Dietary Guidelines for Americans ." Office of Disease Prevention and Health Promotion, 2015.
• Merrill, J., and Thomas, S. " Interactions between Adaptive Coping and Drinking to Cope in Predicting Naturalistic Drinking and Drinking Following a Lab-Based Psychosocial Stressor ." Addictive Behaviors, 2012.
• Turner et al. “ Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature. ” Depression and Anxiety, 2018.
• Kelly et al. " The relationship of social support to treatment entry and engagement: The Community Assessment Inventory ." Substance Abuse, 2010.
• U.S. Department of Health and Human Services. " Alcohol Facts and Statistics ." National Institute on Alcohol Abuse and Alcoholism, 2023.

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• The Symptoms, Complications, Treatments, and Prevention of Alcoholism
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• Understanding Alcoholism and How a User Develops into an Alcoholic
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• The Objectives Of Client Advocacy In Alcoholism And Drug Abuse Treatment
• Understanding the Process in the Development of Alcoholism
• Alcoholism and Native America: The Therapeutic Pertinence of the Movie Smoke Signals
• The Psychological Effects and Problems about Alcoholism
• The Nature Vs. Nurture Debate In Learning More About Alcoholism
• The Reasons Why Alcoholism Should Be Considered a Disease
• The Proposition for Legal Age in the United States in Response to Alcoholism
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• Work Hard, Party Harder: Alcoholism And College Campuses
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• Alcoholism and Its Effects on Women’s Reproductive Systems and Pregnancy
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• Living With Alcoholism: How Does Alcoholism Affect Other Family Members
• What Alcoholism Is and What Are Its Side Effects?
• Does Drinking Every Day Make You an Alcoholic?
• What Are the Symptoms of Alcoholism?
• Is Alcoholism a Disease or a Habit?
• What Is the Best Definition of Alcoholism?
• How Does Alcohol Affect Behavior?
• What Are the Problems of Alcoholism?
• How Do You Stop a Man From Drinking?
• What Does Alcohol Do to the Brain?
• Can a Person Drink a Lot and Not Be an Alcoholic?
• What Is the Root Cause of Alcoholism?
• Which Person Would Be Most Likely to Develop Alcoholism?
• What Is the Life Expectancy of an Alcoholic?
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• What Happens if You Drink Alcohol Every Day for a Month?
• Does Alcohol Cause Anger Issues?
• What Does Your Drunk Personality Say About You?
• Does Alcohol Affect Mental Health?
• What Happens When You Stop Drinking?
• Does Alcohol Cause Dementia?
• What Are the Statistics of Recovering Alcoholics?
• How Does Alcohol Affect Sleep?
• What Are the Signs of Someone Who Drinks Too Much?
• When Is Drinking a Problem in a Relationship?
• What Are the First Signs of Liver Damage From Alcohol?
• Is Damage From Alcohol Reversible?
• What Is the Most Successful Way to Stop Drinking?
• Is It True That Once an Alcoholic Always an Alcoholic?
• What Are the Four Types of Drinkers?
• What Is the First Step in the Development of Alcoholism?
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Building Your Drink Refusal Skills

The following activity offers suggestions to support you in your decision to cut back or quit drinking. It can be used with counseling or therapy and is not meant as a substitute for professional help. If you choose to try it on your own and at any point feel you need more help, then seek support (see Help Links ).

Plan ahead to stay in control.

Even if you are committed to changing your drinking, "social pressure" to drink from friends or others can make it hard to cut back or quit. This short activity offers a recognize-avoid-cope approach commonly used in cognitive-behavioral therapy, which helps people to change unhelpful thinking patterns and reactions. It also provides links to worksheets to help you get started with your own plan to resist pressure to drink.

Recognize two types of pressure.

The first step is to become aware of the two different types of social pressure to drink alcohol—direct and indirect.

• Direct social pressure is when someone offers you a drink or an opportunity to drink.
• Indirect social pressure is when you feel tempted to drink just by being around others who are drinking—even if no one offers you a drink.

Take a moment to think about situations where you feel direct or indirect pressure to drink or to drink too much. You can use the form linked below to write them down. Then, for each situation, choose some resistance strategies from below, or come up with your own. When you're done, you can print the form.

Avoid pressure when possible.

For some situations, your best strategy may be avoiding them altogether. If you feel guilty about avoiding an event or turning down an invitation, remind yourself that you are not necessarily talking about “forever.” When you have confidence in your resistance skills, you may decide to ease gradually into situations you now choose to avoid. In the meantime, you can stay connected with friends by suggesting alternate activities that don't involve drinking.

Cope with situations you can’t avoid.

Know your “no.”

When you know alcohol will be served, it’s important to have some resistance strategies lined up in advance. If you expect to be offered a drink, you'll need to be ready to deliver a convincing “no, thanks.” Your goal is to be clear and firm, yet friendly and respectful. Avoid long explanations and vague excuses, as they tend to prolong the discussion and provide more of an opportunity to give in. Here are some other points to keep in mind:

• Don’t hesitate, as that will give you the chance to think of reasons to go along.
• Look directly at the person and make eye contact.
• Keep your response short, clear, and simple.

The person offering you a drink may not know you are trying to cut down or stop, and his or her level of insistence may vary. It's a good idea to plan a series of responses in case the person persists, from a simple refusal to a more assertive reply. Consider a sequence like this:

• No, thank you.
• No, thanks, I don’t want to.
• You know, I’m (cutting back/not drinking) now (to get healthier/to take care of myself/because my doctor said to). I’d really appreciate it if you’d help me out.

You can also try the “broken record” strategy. Each time the person makes a statement, you can simply repeat the same short, clear response. You might want to acknowledge some part of the person’s points (“I hear you ...”) and then go back to your broken-record reply (“... but no, thanks”). And if words fail, you can walk away.

Script and practice your “no.”

Many people are surprised at how hard it can be to say no the first few times. You can build confidence by scripting and practicing your lines. First imagine the situation and the person who’s offering the drink. Then write both what the person will say and how you’ll respond, whether it’s a broken record strategy (mentioned above) or your own unique approach. Rehearse it aloud to get comfortable with your phrasing and delivery. Also, consider asking a supportive person to role-play with you, someone who would offer realistic pressure to drink and honest feedback about your responses. Whether you practice through made-up or real-world experiences, you’ll learn as you go. Keep at it, and your skills will grow over time.

Try other strategies.

In addition to being prepared with your “no, thanks,” consider these strategies:

• Have alcohol-free drinks always in hand if you’re quitting.
• Keep track of every drink if you’re cutting back so you stay within your limits.
• Ask for support from others to cope with temptation.
• Plan an escape if the temptation gets too great.
• Ask others to refrain from pressuring you or drinking in your presence (this can be hard).

If you have successfully refused drink offers before, then recall what worked and build on it.

Remember, it’s your choice.

How you think about any decision to change can affect your success. Many people who decide to cut back or quit drinking think, “I am not allowed to drink,” as if an external authority were imposing rules on them. Thoughts like this can breed resentment and make it easier to give in. It’s important to challenge this kind of thinking by telling yourself that you are in charge, that you know how you want your life to be, and that you have decided to make a change.

Similarly, you may worry about how others will react or view you if you make a change. Again, challenge these thoughts by remembering that it’s your life and your choice, and that your decision should be respected.

Plan to resist pressure to drink.

The links below will take you to forms to plan how you'll handle tempting situations and offers to drink:

• Plan your resistance strategies
• Script your "no"

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Is your "lite" beer light in alcohol.

Not necessarily. Although they have fewer calories, many light beers have almost as much alcohol as regular beer—about 85% as much, or 4.2% versus 5.0% alcohol by volume, on average.

Check the alcohol content of your beverage. Malt beverages are not required to list their alcohol content on the labels, so you may need to visit the bottler's Web site.

See What's a standard drink ?

How many "drinks" are in a bottle of wine?

A typical 25-ounce (750 ml) bottle of table wine holds about 5 "standard" drinks, each containing about 5 ounces. This serving size of wine contains about the same amount of alcohol as a 12-ounce regular beer or 1.5 ounces of 80-proof spirits.

Get to know what 5 ounces looks like by measuring it out at home. That way you can estimate how many standard drinks you're being served in a restaurant or bar that uses large glasses and generous serving sizes.

Mixing alcohol with certain medications can cause nausea, headaches, drowsiness, fainting, a loss of coordination, internal bleeding, heart problems, and difficulties in breathing. Alcohol can also make a medication less effective. For more information, see Harmful Interactions: Mixing Alcohol with Medicines .

Examples of medical conditions for which it's safest to avoid drinking include liver disease (such as from hepatitis C), bipolar disorder, abnormal heart rhythm, and chronic pain.

Among the dangers of underage drinking:

• Each year, an estimated 5,000 people under age 21 die from alcohol-related injuries.
• The younger people are when they start to drink, the more likely they are to develop alcohol use disorder at some point in their lives.
• Underage drinking is illegal—an arrest can lead to losing a job, a driver's license, or a college scholarship.

Even moderate amounts of alcohol can significantly impair driving performance and your ability to operate other machinery, whether or not you feel the effects of alcohol.

Heavy drinking during pregnancy can cause brain damage and other serious problems in the baby. Because it is not yet known whether any amount of alcohol is safe for a developing baby, women who are pregnant or may become pregnant should not drink.

Highest risk

About 50% of people who drink in this group have alcohol use disorder.

Increased risk

This "increased risk" category contains three different drinking pattern groups. Overall, nearly 20% of people who drink in this category have alcohol use disorder.

Low-risk drinking

Only about 2% of drinkers in this group has alcohol use disorder.

A U.S. standard drink contains about 0.6 fluid ounces or 14 grams of pure alcohol (also known as an alcoholic drink-equivalent). That's the amount in 12 ounces of regular beer, 5 ounces of table wine, or 1.5 ounces of 80-proof distilled spirits.

Distilled spirits include vodka, whiskey, gin, rum, and tequila.

Light to moderate drinking

• Men: Up to 2 drinks per day
• Women: Up to 1 drink per day

Heavy or at-risk drinking

• Men: More than 4 drinks on any day or more than 14 drinks per week
• Women: More than 3 drinks on any day or more than 7 drinks per week

Men: No more than 4 drinks on any day and no more than 14 per week

Women: No more than 3 drinks on any day and no more than 7 per week

People with a parent, grandparent, or other close relative with alcoholism have a higher risk for becoming dependent on alcohol. For many, it may be difficult to maintain low-risk drinking habits.

Pace yourself: It's best to have no more than one standard drink per hour, with nonalcoholic "drink spacers" between alcohol beverages. On any day, stay within low-risk levels of no more than 4 drinks for men or 3 for women. Note that it takes about 2 hours for the adult body to completely break down a single drink. Do not drive after drinking.

For comparison, regular beer is 5% alcohol by volume (alc/vol), table wine is about 12% alc/vol, and straight 80-proof distilled spirits is 40% alc/vol.

The percent alcohol by volume (alc/vol) for distilled spirits is listed on bottle labels and may be found online as well. It is half the "proof," such that 80-proof spirits is 40% alc/vol.

Convert proof to alc/vol

Enter in the proof of the alcohol in the left field to automatically calculate the alc/vol.

Convert to fluid ounces

Enter in the measurement in milliliters in the left field to automatically calculate the amount in fluid ounces.

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Less alcohol, or none at all, is one path to better health

Moderate drinking was once thought to have benefits for the heart. But better research methods have thrown cold water on that idea. A growing number of public health experts say if you choose to drink alcohol, you should drink as little as possible. (AP Video: Laura Bargfeld)

FILE - Bottles of alcohol sit on shelves at a bar in Houston on June 23, 2020. Moderate drinking was once thought to have benefits for the heart, but better research methods starting in the 2010s have thrown cold water on that. (AP Photo/David J. Phillip, File)

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It’s wine time. Beer Thirty. Happy hour. Five o’clock somewhere.

Maybe it’s also time to rethink drinking ?

Moderate drinking was once thought to have benefits for the heart, but better research methods have thrown cold water on that.

“Drinking less is a great way to be healthier,” said Dr. Timothy Naimi, who directs the Canadian Institute for Substance Use Research at the University of Victoria in British Columbia.

AP AUDIO: Less alcohol, or none at all, is one path to better health.

AP correspondent Haya Panjwani reports.

ARE DRINKING GUIDELINES CHANGING?

Guidelines vary a lot from country to country but the overall trend is toward drinking less.

The United Kingdom, France, Denmark, Holland and Australia recently reviewed new evidence and lowered their alcohol consumption recommendations. Ireland will require cancer warning labels on alcohol starting in 2026.

“The scientific consensus has shifted due to the overwhelming evidence linking alcohol to over 200 health conditions, including cancers, cardiovascular diseases and injuries,” said Carina Ferreira-Borges, regional adviser for alcohol at the World Health Organization regional office for Europe.

From Dry January to Sober October to bartenders getting creative with non-alcoholic cocktails , there’s a cultural vibe that supports cutting back.

“People my age are way more accepting of it,” said Tessa Weber, 28, of Austin, Texas. She stopped drinking for Dry January this year because she’d noticed alcohol was increasing her anxiety. She liked the results — better sleep, more energy — and has stuck with it.

“It’s good to reevaluate your relationship with alcohol,” Weber said.

WAIT, MODERATE DRINKING DOESN’T HAVE HEALTH BENEFITS?

That idea came from imperfect studies comparing groups of people by how much they drink. Usually, consumption was measured at one point in time. And none of the studies randomly assigned people to drink or not drink, so they couldn’t prove cause and effect.

People who report drinking moderately tend to have higher levels of education, higher incomes and better access to health care, Naimi said.

“It turns out that when you adjust for those things, the benefits tend to disappear,” he said.

Another problem: Most studies didn’t include younger people. Almost half of the people who die from alcohol-related causes die before the age of 50.

“If you’re studying people who survived into middle age, didn’t quit drinking because of a problem and didn’t become a heavy drinker, that’s a very select group,” Naimi said. “It creates an appearance of a benefit for moderate drinkers that is actually a statistical illusion.”

Other studies challenge the idea that alcohol has benefits. These studies compare people with a gene variant that makes it unpleasant to drink to people without the gene variant. People with the variant tend to drink very little or not at all. One of these studies found people with the gene variant have a lower risk of heart disease — another blow to the idea that alcohol protects people from heart problems.

HOW MANY DRINKS CAN I HAVE PER DAY?

That depends.

Drinking raises the risk of several types of cancer , including colon, liver, breast and mouth and throat. Alcohol breaks down in the body into a substance called acetaldehyde, which can damage your cells and stop them from repairing themselves. That creates the conditions for cancer to grow.

Thousands of U.S. deaths per year could be prevented if people followed the government’s dietary guidelines, which advise men to limit themselves to two drinks or fewer per day and women to one drink or fewer per day, Naimi said.

One drink is the equivalent of about one 12-ounce can of beer, a 5-ounce glass of wine or a shot of liquor.

Naimi served on an advisory committee that wanted to lower the recommendation for men to one drink per day . That advice was considered and rejected when the federal recommendations came out in 2020.

“The simple message that’s best supported by the evidence is that, if you drink, less is better when it comes to health,” Naimi said.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Alcoholism Prevention: How to Avoid Becoming an Alcoholic

Last Updated: August 7, 2019

In the United States, approximately 14 million people fall under the criteria for severe alcohol use disorders (AUD). On average, more than 88,000 deaths annually are attributed to alcoholism. This makes alcohol prevention a priority.  

The financial cost of alcohol abuse is astronomical. The Centers for Disease Control and Prevention put the amount at more than $200 billion per year. Most of these costs (40%) are borne by the federal state and local governments. Therefore, prevention of alcohol abuse can save the economy a lot of resources.

Other than the financial cost, excessive consumption of alcoholic drinks has implications for health care costs, aggression and violence, and family upbringing.

Table of contents

• How much drinking is too much?
• What are the risk groups to target in alcohol prevention?
• How to prevent alcoholism?
• What are the alcoholism prevention laws and regulations?
• When to seek professional help?

Drinking Levels: How Much is Too Much

A standard drink contains 14.0 grams or 0.6 ounces of pure alcohol. 12 ounces of beer contains approximately 5% alcohol content while 5 ounces of wine contains 12% alcohol content. On the other hand, distilled spirits such as rum, vodka, gin, and whiskey have the highest content at 40% alcohol in 1.5 ounces.

There are two broad levels of drinking: excessive drinking and moderate drinking. Excessive drinking is further categorized into heavy drinking, binge drinking, and any drinking by minors (under age 21) and pregnant women.

The most common form of excessive drinking and one of the early signs of alcoholism is binge drinking. Taking 4 or more drinks in a single occasion for women and 5 or more drinks for men, constitute binge drinking. There is a strong positive correlation between binge drinking and alcoholism. Most people targeted in alcoholism prevention fall in this category.

Heavy drinking means 8 or more drinks per week for women and 15 or more for men. Taking one drink per day and two drinks per day for women and men respectively is classified by the Dietary Guidelines for Americans as moderate drinking.

Risk Groups to Target in Alcohol Prevention

The potential causes and risk factors associated with alcoholism have been the subject of studies done on ways to prevent alcoholism. Data analyzed shows a multiplicity of factors influencing alcohol abuse.

Alcoholism can impact anyone irrespective of gender, personal beliefs, ethnicity, age, or body type. However, the following groups have been identified as being at a higher risk hence the focus of prevention interventions.

People with Low Esteem

Low levels of self-esteem can be a catalyst for  alcohol addiction . Feelings of inadequacy, inferiority, worthlessness, and hopelessness can push you to alcoholism as a form of emotional escape. Low self-esteem occurs when your mental impression of your ideal-self differs from your actual self. Once the mind registers this escape route, it becomes difficult to avoid alcohol.

Professionals

One of the greatest underlying causes of alcoholism in the United States is work-related stress. In addition, some professions revolve around alcohol, require people to network socially outside of the office, or have irregular work shift hours, thus posing a challenge to the prevention of alcoholism.

Statistics reported by the Substance Abuse and Mental Health Services Administration reveals that mining, construction, and accommodation services have the highest incidences of alcoholism. The rates stood at 17.5%, 16.5%, and 11.8% respectively.

People with Mental Disorders

There is well-documented evidence that shows a strong relationship between mental disorders such as depression, bipolar, anxiety, and panic disorders and alcohol abuse.

The National Comorbidity Survey shows that more than 40% of bipolar sufferers and about 20% of depression sufferers either abuse or are dependent on alcohol.  Most of these people turn to alcoholism as a coping mechanism for their illnesses.

Drug Abusers

If you are a drug abuser, it becomes difficult to avoid alcohol abuse. When individuals abuse drugs, their tolerance levels increase. This means for them to experience the same or higher desirable effects, they must up their intake or include another substance. Most drug abusers find it difficult to prevent alcohol abuse.

Families with a Drinking History

People coming from a family with a history of diagnosable alcoholic problems are more at risk of becoming alcoholics. On average, children born to alcohol-dependent parents have a 300% greater chance of developing a problematic pattern of drinking compared to the rest.

Alcoholism is more of a behavioral condition. The position of the family in early childhood development is important in instilling social behavior and values. Alcoholic parents tend to be a great influence on their children and lack the moral authority to teach them ways to avoid alcohol.

Practical Tips to Prevent Alcoholism

If you are already into drinking, preventing the urge and ultimately stopping, can be a challenge. However, there are strategies and routines on how to prevent alcoholism you can adapt to cut back and eventually stop drinking altogether.

Recognize Triggers

Internal and external triggers such as places, people, times of day, positive emotions, and negative emotions like frustration can leave you craving a drink . Recognizing these triggers is one way how to avoid alcohol. Move away from certain places, change the company, or switch to something else.

Don’t Keep Alcohol at Home

Access to alcohol increases the likelihood of drinking. Fully-stocked liquor cabinets and half-drunk bottles of wine can set off your drinking triggers . If there is no social purpose, keep alcoholic drinks out of your house. In fact, you can substitute with other drinks such as tea, water, and lemonade.

Engage in Other Activities

Instead of spending time in bars, look for other joints where there are non-drinking activities. You can take a walk, watch a movie or pick up a sport as a strategy on how to avoid drinking alcohol.

Cut Down on the Number of Drinks

Stopping alcoholism is a gradual process that takes time. You should start by cutting down on the drinks you take per day or week. Work on a practical prevention schedule and have an accountability partner. The best way on how to avoid alcohol poisoning is by taking water in between your drinks.

Build a Social Support Network

Alcoholism Prevention Laws and Regulations

In the United States, the debate on how to avoid alcoholism is far from over. Federal state and local governments have put in measures to reduce alcohol abuse and the resulting consequences. Policy interventions such as zero tolerance laws, raising the minimum legal drinking age, warning labels, rehabs for alcoholics , and administrative license revocation laws are already in place.

Community-based interventions and prevention measures such as the Saving Lives Program, Life Skills Training, and Alcohol Misuse Prevention Study have proved effective. With the right information and training on how to prevent alcohol abuse, individuals can put their drinking under control.

When to Seek Professional Help

Alcoholism is a disorder that needs professional support during treatment and recovery. Depending on the  stage of alcoholism , therapists can help families share the mental and emotional burden of supporting alcohol abuse family members.

By attending therapy and alcohol treatment program , alcoholics can regain control over their lives including their habitual drinking and live productive lives once again. If alcoholism has overwhelmed a person that can’t find the support they need, there are professionals to talk to.

Dr. Gregory Okhifun

Medical Reviewer

Dr. Okhifun is a passionate medical doctor, with over five years’ experience as a general practitioner. His passion for medical education led to his journey in medical writing. He has a wealth of experience writing for hospitals and medical centers, health organizations, telemedicine platforms, wellness organizations, medical tourism publications, addiction websites, and websites focused on nutrition and nutraceuticals. He also serves as medical coordinator and content writer for Gerocare Solutions, for which he also volunteers as a health advisor/consultant for the elderly. Dr. Okhifun enjoys traveling, meditation, and reading.

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Speech on Alcohol

Alcohol, a liquid often enjoyed in social settings, has a rich history and diverse impacts on society. You may know it from parties, dinners, or even from the movies.

Yet, it’s not all about fun. Alcohol can affect your health and behavior. It’s important to understand these effects to make informed choices.

1-minute Speech on Alcohol

Ladies and Gentlemen,

Let’s talk about alcohol today. It’s something you see in many places – parties, restaurants, and sometimes, even at home. But what is it exactly? Simply put, alcohol is a drink that can change how you think, feel, and act.

Now, some people believe that drinking alcohol makes them happy or helps them relax. It’s true, alcohol can make you feel this way at first. But, it’s important to remember that these feelings don’t last. Over time, drinking too much alcohol can make you feel sad, tired, and even sick.

It’s also essential to understand that alcohol can harm your body. Think about your liver, the organ that cleans your blood. Alcohol can damage your liver and make it hard for it to work properly. It can also hurt your heart and brain, leading to serious health problems.

Let’s not forget, alcohol can change the way you behave. You might do things you wouldn’t normally do, like argue with friends or make bad decisions. This is because alcohol affects your brain, making it hard for you to think clearly.

Lastly, let’s think about the young people in our lives. We must teach them about the effects of alcohol. We should show them that it’s possible to have fun and enjoy life without drinking.

In conclusion, alcohol is not as harmless as it seems. It’s important to understand its effects and make smart choices. Let’s protect our health, our relationships, and our future by being mindful of our alcohol consumption. Thank you.

Also check:

• Essay on Alcohol
• 10-lines on Alcohol

2-minute Speech on Alcohol

Let’s talk about alcohol. It’s something many of us know about and some of us might have even tasted it. It’s found in drinks like beer, wine, and whiskey. Many people enjoy it at parties, during holidays, or at the end of a long day. But it’s important to understand what alcohol is and how it affects us.

Alcohol is a type of drug. It changes the way our brains work. It can make us feel happy, relaxed, and more confident. But it can also make us feel dizzy, confused, and even sick. Too much alcohol can make it hard for us to think clearly, walk straight, or even remember what happened.

It’s also important to know that not everyone can drink alcohol. It’s illegal for anyone under 21 years old in many countries. This is because alcohol can be very harmful to young people. Their brains are still growing and alcohol can stop them from developing properly.

Alcohol can also be addictive. This means that some people start to need it to feel normal. They might drink more and more, and find it hard to stop. This is called alcoholism. It can lead to serious health problems, like liver disease and heart problems. It can also cause problems in relationships and at work.

But it’s not all bad news. If we drink alcohol in a safe and responsible way, it can be part of a healthy lifestyle. This means not drinking too much, and not drinking too often. It means not drinking if we’re pregnant, or if we’re planning to drive. And it means knowing when to stop.

So, ladies and gentlemen, the next time you reach for a glass of beer or wine, remember what you’ve learned today. Remember that alcohol can be fun, but it can also be dangerous. Remember to drink responsibly, and to respect the laws about who can and can’t drink. And remember, it’s okay to say no to alcohol. It’s your body, your choice.

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How To Write Your Best Alcoholism Essay?

Table of Contents

To start off, alcoholism is a physical and psychological disease characterized by regular consumption of high qualities of alcohol and troubles with giving up drinking.

It is a well-known fact that alcoholism is quite an issue nowadays. It breaks the lives of people, their families, and the whole society. According to WHO (World Health Organization), excessive use of alcohol causes 5.3% of deaths yearly, which makes a total of 3 million deaths.

The topic is quite vast, so it won’t be hard to find a thrilling aspect to cover in your essay.

6 facts for your alcoholism essay

The main goal of writing an essay on alcoholism is to highlight the problem, it’s causes, reasons, and outcomes.

Keep things simple, precise and informative. Use only credible sources in references. Try visiting official websites of WHO, Medical News Today (website specialized on medical information), ASAM (American Society of Addiction Medicine, on different addictions), etc.

Also, here are several facts for you to start off somewhere.

• Alcoholism is not only a disease but also an addiction. This may seem obvious. Therapists state that it can be as dangerous as drug addiction since a person gets used to it not only on a mental level but also on a physical. As a result, there are loads of difficulties when giving up.
• Alcoholism shouldn’t be regarded as a personal choice. Like any other addiction, it differs from person to person. Usually, people can’t notice that something is wrong before they actually try to stop drinking.
• Except for being a disease itself, alcoholism leads to health and social issues. Doctors claim that alcoholism results in liver disease, pancreatitis, cancers, brain damages, and others. Moreover, it leads to socialization problems as alcoholics can be depressed, aggressive and struggle from a negative attitude of society.
• Alcoholism has a genetic complex. It is stated that children of alcoholics are 4 times more predisposed to alcoholism. Scientists claim that alcohol and drug addiction usually starts with families.
• There are more men alcoholics than women. The research shows that men are more likely to become alcoholics than women. Investigation can’t actually explain this fact, but the main reason is considered to be the fact that men drink more alcohol overall.
• Alcohol makes people feel worse. Some may say that they drink to “drown sorrows,” but it doesn’t work in a long-term perspective. Actually, alcohol is a depressant.

How to structure the essay on alcoholism?

A good structure is essential for any writing. As a rule, the essay is divided into three parts: introduction, main body, and conclusion.

You might also want to write an outline for your work. Here are some easy instructions to follow:

Outline. Basically, it is a table of contents. You briefly plan your essay and organize your thoughts. Write down the statement you are about to use in the introduction, note several arguments supporting your statement and think of how to summarize these thoughts in conclusion .

Introduction. Here you need to provide the reader with some basic information on the topic. It may include the definition of alcoholism, statistics, and rates of how many alcoholics are out there, the yearly amount of deaths, age statistics, and so on. Include a thesis explaining the main idea of your essay and your standpoint. It shouldn’t be longer than 1 sentence.

The Main Body. Explain your standpoint step by step. Add arguments gradually. Each supporting statement takes 1 paragraph and is accompanied by a brief explanation . Put them in a logical order.

Conclusion. Sum up everything you said before and confirm the thesis. Do not add new ideas , statements, or facts. Here, in the alcoholism essay conclusion, you may express your own vision of the problem.

Causes and effects of alcoholism essay: what to cover?

Each case of alcoholism is unique and has its own set of reasons and consequences. Thus, you may need to know some general statistics and information on the causes and effects of alcoholism. Here are several prompts.

Causes of alcoholism essay:

• A stressful environment that enforces the person to seek consolation.
• Drinking at an early age.
• Mental issues (like depression, apathy, etc.).
• Genetics and family history.
• Mixing alcohol with medicine: possible outcomes.
• The experience of trauma.
• Bad influence of the company.
• Lack of family care.
• Power of the mass media.
• No awareness of the possible psychological problems.

Effects of alcoholism essay:

• Health problems, like heart and liver diseases, brain damage, low immunity, cancer, etc.
• Depression, apathy, suicidal thoughts.
• Slurred speech, confusion, trouble remembering things.
• Concentration issues.
• Bad academic performance.
• Increased chance of committing a crime.
• Domestic violence.
• Adverse effect on children.
• Loss of job and financial troubles.
• Mood swings.

Alcoholism is quite an issue in modern society. Essays, exploring this topic, are needed to spread the awareness of the risks we all encounter.

No time to write your essay on alcoholism? We have some! Order your perfect essay from one of our professionals and save the evening to yourself. Pssst, it’s completely confidential…

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80 Great Compelling Argumentative Research Topics

How To Create A Best Abortion Argumentative Essay?

• Open access
• Published: 01 December 2023

Protective strategies and motivations to control drinking among Brazilian college students: a qualitative study

• Marina Noto Faria 1 ,
• Elaine Lucas dos Santos 2 ,
• Ana Regina Noto 1 ,
• André Bedendo 3 &
• Maria Lucia O. Souza-Formigoni 1  

BMC Public Health volume  23 , Article number:  2390 ( 2023 ) Cite this article

663 Accesses

Metrics details

To develop prevention programs or early interventions to reduce alcohol consumption and related problems among college students, it is essential to understand their motivations for drinking and the spontaneous (effective and non-effective) strategies they employ to control, considering the social and cultural contexts influence. This study aimed to explore these factors and the student’s application of selfcare in different situations and environments, as well as to identify their reasons for not drinking.

The students were invited to participate using a snowball sampling, up to the theoretical saturation point. Qualitative individual semi-structured interviews were carried out and the interviews contents were analyzed using the NVivo software. The participants were 23 college students between 18 and 24 years old, with diverse patterns of alcohol use (low-risk to suggestive of dependence).

Data analysis highlighted three main themes: (a) Contexts (such as bars, “open bar” parties and others) and consumption patterns; (b) Protective Strategies (such as stop-drinking intervals, eating before or during drinking, returning home in the company of a friend); (c) Motivations to control drinking (such as sense of responsibility, bad previous experiences, family and religious issues). Protective strategies and motivation to control drinking were perceived to be less prominent in specific contexts that favor high alcohol consumption, as open bar parties.

Conclusions

Motivations and protective strategies varied according to the drinkers’ profile, social situations and settings in which they consumed alcohol. The results highlight the need for preventive interventions planned for specific drinking patterns and contexts.

Peer Review reports

Alcohol consumption among young people is a behavior that poses several risks to their safety. Even though alcohol use in Brazil is forbidden for those under 18 years of age, 34.3% of adolescents from 12 to 17 years old reported having drunk alcohol in the last twelve months, according to the 3rd National Survey on Drug Use by the Brazilian population [ 1 ]. Moreover, 8.8% of those surveyed had been drinking in a binge pattern, defined as the intake of at least four standard drinks (for females) or five (for males), corresponding to 48 and 60 g of pure alcohol, respectively, in a two-hour period. The same survey showed a high prevalence of alcohol consumption in those aged between 18 and 34 in the last 12 months (72.1% and 74.5% among 18–24 and 25–34 years old, respectively). The prevalence of binge drinking was 35.1% and 38.2% among 18–24 and 25–34 years old, respectively. Considering the educational background, a higher binge drinking prevalence was observed among those with complete university level (43.9%) than in those with complete high school or incomplete university levels (35.7%).

A previous study in São Paulo State (Brazil) with college students [ 2 ] reported that 21.8% of the participants were classified as “at-risk” or “suggestive of dependence” users, according to the scores of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) [ 3 ].

Eckschmidt et al. (2013) [ 4 ] compared the alcohol consumption of Brazilian and North American college students and found similarly high rates (respectively 88.6 and 89.3%) of lifetime alcohol use. Other authors also found high-risk drinking rates in young adults in the United States [ 5 ]. Among the short-term consequences of alcohol use in youth, there are many risk behaviors, such as being a passenger in a vehicle driven by someone who has consumed alcohol; acting impulsively and then regretting it; having unprotected sex; drink driving; having problems with close relationships; being involved in car accidents; having problems with the law, skipping classes and hurting themselves or others [ 6 ]. Binge drinking is widely associated with a state of intoxication that leads to risky behaviors and consequences such as hangovers, blackouts, memory loss, nausea and vomiting [ 7 ]. Blackout behavior is considered a marker of problematic alcohol consumption [ 7 ]. Approximately 50% of young adults who drink reported that they blacked out at least once in their life [ 8 ]. This phenomenon occurs when an individual reaches a high level of alcohol intoxication, which can damage the cellular communication of the hippocampus, and other structures and regions related to it, resulting in partial or complete memory loss [ 9 , 10 ]. A qualitative study carried out in the USA analyzed the knowledge of college students about the risk factors associated with alcohol-induced blackout. Participants reported as the main factors that increased its likelihood: heavy drinking in a short period of time; drinking on an empty stomach; and drinking alcohol in combination with caffeine, antibiotics, cough medicine, painkillers, Xanax, and cocaine. Some of the students reported having alcohol tolerance is a protective factor for blackout [ 11 ].

Protective behavioral strategies (PBS) are cognitive and behavioral strategies aimed at decreasing heavy alcohol use and alcohol problems. The most common types of strategies include limiting or stopping drinking, drinking control or adopting harm reduction [ 12 , 13 , 14 ]. PBS have been considered important tools in preventive programs. Some recent studies suggested that the use of PBS by young people are greatly influenced by the drinkers’ profile and the context of use [ 14 ]. The motivations for drinking seem to influence the probability of drinkers using these strategies, either facilitating or hindering them [ 15 ]. Regarding the context of use, despite the large literature on PBS, little is known about how young people choose to adopt PBS in specific social contexts [ 16 ].

Motivations can be defined as reasons, conscious or not, for behaving in a certain way [ 17 ]. Studies have shown that the motivations for alcohol consumption are strongly related to the context in which it occurs, a reason why it is important to understand the phenomenon among college students [ 18 , 19 ] as it can affect, in different ways, the use and patterns of consumption [ 20 ].

There are different theoretical models that aim to clarify how behaviors are expressed in social contexts. The influences of psychosocial and cognitive-behavioral parameters can be interpreted from the perspective of the social norms theory [ 21 , 22 ], which stresses the importance of the influence of relational aspects for understanding human motivations and behaviors. However, individual capacity for observation and self-regulation of consumption also seems to be essential [ 23 , 24 , 25 ]. The social norms theory posits that social behavior stems from learning by means of operant conditioning and imitation, with individuals tending to behave according to the norm, that is, they generally adjust their behavior to be close to what the group they belong to considers “normal”. However, students often have misperceptions about the normative behaviors of risk and protection, which leads to a distorted adjustment of behavior [ 21 , 22 ].

In addition to the normative social context, alcohol use among college students is influenced by motivations that can be external or internal [ 18 ]. External motivations are associated with family, friends and the media - such as alcohol advertisements. Internal motivations are related to entertainment, curiosity, low self-esteem, the need to belong and a wish to forget problems [ 18 ]. Motivations not to drink are resources that strengthen self-regulation, influencing and reinforcing the behavior. The relationship between alcohol consumption and self-regulation has, therefore, been the focus of several studies [ 23 , 24 , 25 ]. Self-regulation is the capacity to control one’s immediate desires to gain future benefits. Motivations for the control of consumption strengthen the self-regulation of students when facing a situation where there are alcoholic beverages. Therefore, they might be considered an important part of self-care [ 26 , 27 ] that is, a set of daily behaviors for the prevention of illnesses and the maintenance of well-being [ 28 ]. Although the literature contains many studies that describe the motivations for the consumption of alcohol [ 29 , 30 , 31 ], few studies have evaluated the motivations for drinking control or strategies of personal care to minimize risks among college students in low- or middle-income countries. Most of the studies in this area employed epidemiological methodologies and questionnaires with closed questions, which limit the types of possible answers. According to Merrill et al. (2021) [ 32 ], qualitative methods can elucidate why certain drinking behaviors occur from a drinker’s perspective, helping to understand the associated internal and external factors. These authors, as have many others, studied the predictors of high intensity drinking (HID) episodes in samples of individuals with regular high alcohol consumption, classified either as at-risk of dependence or already dependent. However, there is a paucity of data in the literature on internal and external factors associated with low drinking levels, as well as on the strategies used by young adults to cope with drinking situations and avoid the related problems, such as blackout behavior.

A recent study by Stevens et al. (2021) [ 33 ] pointed out that although there are many studies focused on the motivations related to why individuals drink, studies on reasons for not drinking at all or on a given day are less frequent. They reported that the variability in non-use of alcohol on days when the use was planned occurred more frequently at the within-person level (26%) than at the between-person level (74%). They recommended future studies could benefit from offering a free response option to better explore these issues. This kind of study could make a significant contribution to enhance alcohol or other drugs-related preventive or harm reduction interventions.

Given these gaps in the literature, this study used a qualitative approach to analyze Brazilian college students’ protective behavioral strategies and motivations to control drinking, taking into account internal and external factors associated with alcohol consumption, in a sample of urban college students with “low” or “at risk” levels of alcohol consumption in diverse drinking settings.

Qualitative research procedures were used for this study to describe and analyze college students’ beliefs and behaviors about alcohol consumption. Content analysis allows evaluating the phenomenon using the subjects’ conceptual framework [ 34 , 35 ].

Participants

An intentional criterion sampling was used for selecting the participants, who were 23 college students over 18 years old. The exclusion criteria were evident cognitive impairment or psychiatric disorder that could bias the interview. They were enrolled in universities in the city of São Paulo (N = 18) and the surrounding area (N = 5) and a criteria for inclusion was to had consumed alcoholic beverages, at least occasionally. Convenience sampling and snowball sampling techniques were used to include participants. This sampling technique consists of creating a chain of new participants starting from the first respondent who, in turn, suggests another college student to be interviewed [ 36 ]. The first participants of each chain were invited through social media (Instagram or Facebook). A maximum of three participants per network were invited to the study. None of the college students interviewed refused to participate or dropped out. The data collection was completed when the contents of interviews became redundant, indicating the “point of theoretical saturation” was achieved. This occurs when significant new information was no longer obtained regarding the contexts of alcohol consumption, motivations to drink and to stop drinking, and protective behavioral strategies (PBS) [ 36 , 37 ]. The authors determined this point using a triangulation process, focusing the PBS mentioned by the students regarding different patterns and contexts of alcohol use.

Semi-structured individual interviews took 24 min on average and started after had granted permission for the interview to be recorded. All interviews were carried out by the first author, a psychology student, trained and supervised by researchers with extensive experience in qualitative studies. All the interviews were conducted in public environments with little movement or noise, in coffee shops or isolated places on the university campus. The interviews were carried out before the COVID-19 pandemic, between August 2019 and February 2020. After the interviews, the first author completed the field diaries with comments about the participants’ behaviors and interview process. The interviews were audio-recorded for the subsequent transcription of their full content. The transcripts were not returned to participants for comment or correction. The interviews followed a semi-structured script which included open questions about the contexts of alcoholic beverage consumption, motivations to drink or not and protective behavioral strategies used by the participants. Cognitive-behavioral approaches and the theory of social norms were used to design the interview script [ 15 , 18 , 21 , 23 , 25 ]. The interviews began with generic questions to establish rapport between interviewer and interviewee, followed by the main questions: “ How do you perceive alcohol consumption among college students? ”, “ In what contexts does consumption occur? ”, “How does consumption occur?”, “How do you realize that you’ve crossed the line?”, “What are the motivations for not crossing the line?”, “What measures of self-care do you take (protective behavioral strategies)?”.

Although the participants had reported their alcohol consumption during the interview, to classify their pattern of use, after the interview we asked them to complete the Brazilian version of the Alcohol Use Disorders Identification Test (AUDIT) [ 38 ]. The AUDIT has been used for the identification of at-risk drinkers among college students [ 39 ], including questions about frequency of drinking, drinks consumed on a typical day, frequency of heavy drinking and alcohol-related problems. According to their AUDIT scores, the participants were classified into four zones: low-risk (< 8), hazardous use (8–15), harmful use (16–19) or suggestive of dependence (> 19).

Processing and content analysis

All stages of data collection and analysis were triangulated and supervised. In the data collection stage the authors analyzed the data in depth to create categories and determine the theoretical saturation point [ 40 ] The categories were based on the participants’ discourse, field diary and qualitative information available in the literature on alcohol consumption and motivation to drink. The main categories were: Self-care strategies, Group dynamics and Memories of personal experiences . All the data were fully transcribed and inserted in NVivo 12 software [ 41 ], to organize and perform the analysis. The data analysis process consisted of six steps: skimming the first interviews, creating initial codes, skimming other interviews, reviewing initial codes, defining main and final categories. Skimming the interviews consists of quickly reading the transcriptions, identifying the themes that emerge from the participants’ discourse [ 34 , 35 ]. In order to guarantee the quality of the categorization, a triangulation process was performed by four researchers: three Ph.D. psychologists (ARN, AB, ELS) and one psychology student (MNF).

In order to ensure the confidentiality of the information provided by the participants, an alphanumeric code was defined to identify the interviews using: interview number (order of interviews), the gender of the respondent (“F” - female; “M” - male), the stage of the college course they are in (“F” - first half of the course; “S” - second half of the course), the general area of the course (“H” - humanities, “HL” - health, “E” – exact sciences) and the educational institution (“1” – public, “2” – private). Therefore, a participant with the code “06MSH1” would mean: sixth interview (06), male respondent (M) in the second half of the course (S), main area Humanities (H) at a public institution [ 1 ].

Ethical aspects

Before starting the interview, all participants signed an informed consent form and had the opportunity to ask for any additional information if they had doubts about the research project. They were informed about their right to request partial or final data of the research as well as the exclusion of their data from the research at any stage of the project. The study was submitted to and approved by the UNIFESP Research Ethics Committee (Report 2.450.631/2018).

Profile of the participants

The participants were between 18 and 24 years old, with an average age (mean ± SD) of 20.2 ± 1.6 (women) and 21.6 ± 1.7 years (men). Out of the 23 students interviewed, eleven (47.8%) were female. Most of the students (78.2%) were from private institutions, enrolled in Humanities courses (66.8%). The others were in the same proportion from Health (16.6%) and Exact Sciences (16.6%) areas. Most of them (60.8%) were in the second half of the course. As regards alcohol consumption and related problems, their average AUDIT scores were in the beginning of the hazardous use zone (M: 8.6, SD: 7.0) and women presented lower means (M: 6.9, SD:5.4) than men (M: 10, SD:8). Among the 23 participants, just one woman but no men reported not having been using alcohol recently. Most of the participants, five women (45.5%) and seven men (53.8%) were classified in the AUDIT low-risk zone; four women (36.4%) and three (23.1%) men in the hazardous use zone; one woman (9%) and no man in the harmful use zone, and no woman and three men (23.1%) in the suggestive of dependence zone (AUDIT scores > 19).

The participants answers to the questions about their perception of alcohol consumption among college students, their motivations for controlling it and the contexts where they drink were submitted to a qualitative analysis. We identified four main themes: “ Contexts and alcohol consumption patterns” ; “ Protective strategies”; “Motivations for controlling alcohol consumption” and “Influence of patterns of alcohol use and the environment”. All participants reported having already attended environments where alcohol consumption was available.

Contexts and alcohol consumption patterns

When participants were asked about the contexts in which their alcohol consumption happened, most of them associated the pattern of use with the environments where it is consumed, as well as with the people present in the specific place and the kind of social interaction at the time of consumption (Table  1 ) . The main places of use they mentioned were bars, “open bar” parties (admission fee includes free drink consumption), cash-bar parties (pay for each drink), nightclubs, living spaces in the university, meetings at fraternities or friends’ houses, and in street environments (including street meeting points and consumption in front of convenience stores or bars).

The participants considered bars as a relatively controlled consumption environment, used with the main purpose of socializing through conversations. On the other hand, “open bar” parties were reported as an environment of more intense consumption. Participants recognized in these places the presence of many environmental triggers for alcohol consumption such as unlimited drinks, music, wide range of drinks and associated them with a high frequency of risky behaviors due to the high consumption. Cash-bar places were referred to as relatively controlled consumption environment, in which consumption is limited by the amount of money available. The use of alcohol on the streets surrounding the university and drinking in get-together spaces were reported by a smaller number of participants, who considered this context as an environment for socializing with friends and classmates where alcohol is frequently present. Drinking in get-together places was reported only by students from public universities.

Protective strategies

When participants were asked about effective self-care or protection strategies, they reported drinking slowly, consuming beverages with low alcohol content, short no-drinking intervals or alternating alcoholic beverages with water; eating before or during drinking, returning home in the company of friends, drinking in the presence of friends or trusted persons and inducing vomiting when feeling sick ( Table  2 ).

Motivations for controlling alcohol consumption

When participants were asked about university students’ motivations to control alcohol consumption, they reported motivations related to themselves or others, which could be grouped into three factors: psychosocial, cognitive-behavioral, and self-monitoring (Table  3 ).

In the p s ychosocial factors category, we included issues related to the social systems in which the individual is inserted, mainly those related to religious issues, relationships with friends or family. The cognitive-behavioral category included perception, memories, self-belief, or other person’s beliefs, self-care, fear of judgment, a sense of commitment and responsibility, as well as bad memories of personal experiences. The self-monitoring category was related to feedback and behavior maintenance, occurring through self-perception of the physical and behavioral effects of alcohol, or through group dynamics, when friends warn them about their state of inebriation.

Influence of patterns of alcohol use and the environment

The use of protective strategies, motivation and sense of responsibility varied according to the student’s profile regarding patterns of drinking, and the drinking environment. Students with high alcohol consumption (AUDIT zones 2 and 3) and those with scores suggestive of dependence (AUDIT zone 4), reported low motivation to control alcohol consumption, frequency of use of protective strategies, and sense of responsibility. This situation is illustrated by the comment of one participant who said: “ The truth is that my friends are always the ones who take care of me ” (12MSHL2). Only those participants characterized as low or moderate alcohol users mentioned “responsibility” as a motivation to control the consumption.

The environment was also mentioned as a factor that influenced the motivation to control alcohol consumption and adopt protective strategies. Environments associated with high availability of alcohol, such as “open bar” parties, were also reported as triggers of high alcohol consumption, low motivation to control drinking or employment of protective strategies. The following comments exemplify this situation: “I think that alcohol consumption changes according to the environment. If I’m at a party, I drink more than if I’m doing something more casual with friends in the afternoon, for example.” (19FFH2 ). “(…) I drink a lot (at open bar parties), first to make the ticket price worthwhile, second because “open bar” parties are something that do not happen every day (…) the best thing to do is drink like a crazy (…)” (16MFH2).

Participants mentioned some motivations for controlling alcohol consumption: “(…) “ When I drink alcohol, you know, those social locks, they shrink, so like, one thing… when I got into college, I was very shy, and I didn’t go to bars (…) I started going, you know, and feeling comfortable in those environments because of alcohol, you know, interacting with people I don’t know, sometimes I end up using alcohol as a good-luck charm (…) and I believe most college students do it, too! (…)” (06MSH1) “ Like I said, the motivation (to control alcohol consumption) both not to make a fool of myself in front of my friends, then motivation like for the money, the “great, I’m partying, I’m here, I paid for that, and if I get sick I will have to go home and I’m going to waste money” you know, I think it is more those two things! (…)” (06MSH1).

The use of protective strategies was related to the context and the pattern of alcohol consumption “(…) in the Atlética* we already do that, you know, we have a party that is famous, “the Shower”, I don’t know if you’ve heard about it, then it’s an open bar party that lasts for ten, twelve hours on end, everybody knows the party because everybody gets sick, then there are moments when the open bar stops, then they give food, they give things with a high glycemic index for the people really hold on a little longer and go back a little sober ” (09FSHL1).

*Atlética: Atlética is a university organization that aims to promote the social integration of students through sports.

The originality of this qualitative study on the main motivations for drinking, or not, and protective strategies employed by college students to control their alcohol consumption is the inclusion of participants with diverse levels of associated risks. Interviewing not only those classified as “at risk” or “suggestive of dependence” but also those with occasional, low consumption or currently abstainers brought new information on their behavior and influence of different contexts. The participants’ reports highlighted the importance of understanding the influence of both the context in which alcohol is used and peers’ behaviors. The students’ reports also allowed to explore their main motivations to drink, or not, and how they use protective strategies. These aspects are affected by individual (internal) and contextual (external) factors that interact in different ways, leading to higher or lower alcohol consumption and associated problems. Among the external factors that favor heavy use of alcohol, open bar parties and peer pressure stand out, while among the internal aspects factors such as low self-esteem and a desire to fit in emerge. These external and internal factors can contribute to a lower probability of using protective strategies in alcohol contexts. Overall, our findings are in line with those of Lorant at al (2013) [ 42 ]. According to them, students who were more exposed to some specific college environmental factors had a higher risk of abusive alcohol consumption. Most of these environmental factors were associated with social involvement, such as participation in student culture, pre-parties, and normative expectations.

A study carried out in the USA showed that engagement in protective behavior strategies (PBS) can increase or decrease depending on the celebration of a holiday, the time of year and the context of alcohol use [ 43 ]. According to Liden et al. (2014) [ 15 ], when motivations are positively linked with high alcohol consumption, people tend to have a lower frequency of PBS. On the other hand, when they are negatively related to alcohol consumption, PBS are used more often. In our study, participants had similar responses in the protective strategies category. Only participants characterized as low or moderate alcohol users, according to their AUDIT score, mentioned “responsibility” as a motivation to control consumption. The valuation of “responsibility” as a desirable characteristic of students may be a point which deserves attention in programs to promote PBS.

Previous studies carried out with Brazilian college students confirmed that university parties, especially open bar ones, were associated with high consumption of alcoholic beverages and associated risk behaviors [ 44 ]. They are considered by some students a leisure alternative and an escape valve from the pressure and anxiety arising from college life [ 44 , 45 , 20 ]. For these reasons, open bar parties and other similar environments deserve special attention in preventive and harm reduction actions [ 46 ].

On the other hand, some studies showed that most of college students, despite intense alcohol consumption in some specific contexts, in general, present a low-risk consumption pattern. [ 45 , 47 ]. Most of them control their alcohol use, possibly by adopting protective strategies. Some of these behaviors seem to be spontaneously adopted, without previous preventive interventions, suggesting that individuals can develop protective strategies that reflect their values. Such findings contrast with the prohibitionist and “war on drugs” approaches, which do not offer youth credit in respect of their skills to act autonomously and consciously, and practice self-care in contexts where alcohol is present [ 46 ]. However, protective strategies can be influenced by the context of alcohol use, alcohol consumption patterns, and motivations to drink, or not to drink.

The psychosocial and cognitive-behavioral motivations observed in this study are aligned with the categories of external and internal motivators, previously described in other countries and cultures [ 17 , 18 , 19 ]. These studies describe external motivations as families, TV, and friends, and describe internal motivations as personal characteristics, curiosity, pleasure and shyness. Both the motivations for alcohol consumption and control are related to the individual, the context and “coping” behaviors, that is, the way they try to deal with external and/or internal demands [ 18 , 19 ]. The self-monitoring category is related to the skill of observing internal and external signals, and adjusting the level of consumption based on bodily sensations and environmental perceptions. In this sense, the ability to self-monitor is closely related to self-regulation processes [ 27 ].

One of the main strengths of this study is its focus on the variables that may affect the students use of protective strategies for alcohol consumption. Through the qualitative analysis of the participants’ reports, it was possible to detect that the protective strategies can be influenced by contexts, motivations, and consumption patterns. These strategies were reported to be less used by people with a high consumption pattern, positive motivations for drinking and who were in environments that encourage the consumption of beverages, such as open bar parties. Therefore, understanding the factors that encourage drinking, the strategies that are already used by individuals to restrict their consumption of alcohol, and the patterns of consumption of the population is extremely important to develop more effective interventions.

The college students who participated in the study were mostly from middle-class and private institutions. To understand the phenomenon in other populations, further studies must be carried out in other samples with diverse cultural and socioeconomic characteristics. Regarding the level of risk associated with alcohol consumption, our sample had only one person classified as a “harmful user” and only a few men classified as “suggestive of dependence” users.

In summary, to develop preventive approaches and early interventions to reduce alcohol related problems among specific populations, it is crucial to have a comprehensive understanding of student´s motivations to drink, or not, as well the spontaneous strategies they employ to control their consumption. It is important to develop preventive programs considering the specificities of university alcohol consumption contexts, patterns of alcohol consumption, motivations for consuming and controlling alcohol ingestion strategies already existing among college students. Preventive programs in the university context can enhance the frequency of strategic protective behavior in this population, as well as interventional programs for self-care, body self-perception, and financial education. In this study students reported that saving money was one of the reasons for drinking less. Therefore, financial education seems to be an important factor to minimize consumption and its associated risks.

“Considering motivations and preventive strategies may vary according to the context and the pattern of use. As a result, they may impact targeting preventive damage reduction actions. In open bar parties, for example, the care should involve protective resources that do not depend on the decision-making of heavy drinkers. In this context, damage control actions such as wide availability of free water and food establish considerable protective relevance” [ 18 , 19 , 46 ].

This study identified protective behavioral strategies and motivations to control drinking among Brazilian college students and found they were less used in contexts where there is an overall high alcohol consumption. These findings corroborate other recent studies in the area that point in the same direction [ 14 , 15 ] and highlight the need for the development of preventive programs considering specific drinking contexts and patterns of alcohol consumption.

Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Marina Noto Faria ([email protected]).

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Acknowledgements

FAPESP - Fundação de Amparo à Pesquisa do Estado de São Paulo (Scientific Initiation fellowship to MNF grant 2019/13281-4) and AFIP (Associação Fundo de Incentivo à Pesquisa) for financial and infrastructure support.

FAPESP - Fundação de Amparo à Pesquisa do Estado de São Paulo (Grants 2015/19472-5 and 2019/13281-4). Financial support CAPES PrInt Grant 88881.310787/2018-01

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Marina Noto Faria, Ana Regina Noto & Maria Lucia O. Souza-Formigoni

Biological Sciences Center, Universidade Estadual do Norte do Paraná- UENP, Campus Luiz Meneghel, Jacarezinho, Brazil

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Contributions

MNF was responsible for the conceptualization and execution of the study, development of the research question, content analysis and drafted the first version of the manuscript. ELS contributed with data analysis and interpretation. ARN contributed with conceptualization, data analysis and interpretation of the study, reviewed and edited the manuscript. AB and MLOSF contributed with conceptualization of the study, reviewed and edited the manuscript. All authors have revised and approved the final version of the manuscript.

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Correspondence to Maria Lucia O. Souza-Formigoni .

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The authors declare no competing interests.

Ethics approval, guidelines, and consent to participate

This study was performed in accordance with all ethical guidelines and regulations. The study was reviewed and approved by the Research Ethics Committee of Universidade Federal de São Paulo (2.450.631/2018). All participants signed a written informed consent.

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Not applicable.

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Faria, M.N., dos Santos, E.L., Noto, A.R. et al. Protective strategies and motivations to control drinking among Brazilian college students: a qualitative study. BMC Public Health 23 , 2390 (2023). https://doi.org/10.1186/s12889-023-16854-7

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Received : 27 December 2022

Accepted : 27 September 2023

Published : 01 December 2023

DOI : https://doi.org/10.1186/s12889-023-16854-7

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• College Students
• Protective behavioral strategies
• Alcohol consumption
• Motivations

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When Mass General transplant hepatologist Wei Zhang says he wants his colleagues to think before they speak, he has the tragedy of a recent patient in mind.

Admitted to intensive care for advanced alcohol-associated liver disease, the 36-year-old woman hid the truth when asked about her drinking. “She was like, ‘No, I quit over a year ago, I didn’t drink at all,’” said Zhang, also director of the hospital’s Alcohol-Associated Liver Disease Clinic. “But we have tools that can detect the use of alcohol in the past three, four weeks.”

The patient, who had been traumatized by years of physical abuse, was denied a liver transplant, in part because she withheld information about her alcohol use. Her death days later was “a consequence of stigma,” Zhang said. Patients too often “feel they’re being judged and may fear that their condition is seen as a result of personal failing rather than a medical issue that needs treatment.” 

Amid increases in high-risk drinking and alcohol-associated liver disease across the country , he hopes  that new research can help complete the years-long work of erasing that stigma, saving lives in the process. 

For decades, medical terminology has labeled liver disease and other alcohol-related conditions as “alcoholic”: alcoholic liver disease, alcoholic hepatitis, alcoholic cirrhosis, alcoholic pancreatitis. Meanwhile, clinicians and administrators have described patients as addicts and alcoholics. 

More recently, specialists and advocates have sought with some success to revise how we talk about substance use and those struggling to overcome it, not just to reduce stigma but also to combat bias among medical professionals. According to the  National Institute on Alcohol Abuse and Alcoholism , the term “alcohol use disorder” is now preferable to “alcohol abuse,” “alcohol dependence,” and “alcoholism.”

“Emphasizing non-stigmatizing language is crucial not only for fostering honesty but also for supporting the overall treatment process and patient outcomes,” Zhang said. 

The new study is a step toward that goal. Inspired by his patients, Zhang set out to observe whether the terminology used by institutions that treat alcohol-associated liver disease reflects or rejects stigma. He and his team reviewed messages on more than 100 accredited liver transplant center websites, along with language used by addiction psychiatry sites. They found that almost nine of 10 transplant center websites use stigmatizing language such as “alcoholic.” Less than half of addiction psychiatry websites do the same.

“The gap between professional society recommendations and actual practice is concerning, since patients frequently use these online resources for information which can significantly influence their behavior and perceptions about alcohol-associated liver disease,” Zhang said.

Zhang’s anti-stigma efforts are grounded in strong evidence, according to Harvard Medical School psychiatrist  John F. Kelly , who published “Does It Matter How We Refer to Individuals with Substance-Related Conditions?” in 2009.

“Emphasizing non-stigmatizing language is crucial not only for fostering honesty but also for supporting the overall treatment process and patient outcomes.”

“Drug use disorder and alcohol use disorder are among the most stigmatized conditions universally across different societies because people feel that it’s self-induced — that people are to blame because they put it in their body,” said Kelly, also the founder of Mass General’s  Recovery Research Institute . “Just because they made that decision initially, doesn’t mean they plan on becoming addicted.”

In the 2009 study, Kelly and his colleagues described patients to more than 600 clinicians, alternating between “substance abuser” and “having a substance use disorder.” Those in the latter category were viewed more sympathetically and as more worthy of treatment. 

“I was quite surprised just how susceptible they were,” Kelly said. “These were passionate, dedicated clinicians. They were still susceptible to the negative punitive bias.”

They still are today, Zhang’s findings suggest. 

“We are very good at seeing patients with liver disease but if we add this behavioral mental disorder, it is somewhat out of our scope,” he said. “I think education could at least have them be more familiar with this topic and be willing to at least listen to the adoption and use of non-stigmatizing language.” 

“I think education could at least have them be more familiar with this topic and be willing to at least listen to the adoption and use of non-stigmatizing language.”

Building on the new study, Zhang has recommended to healthcare institutions and professional societies that they implement website feedback mechanisms and carry out regular content audits to guard against potentially harmful language. 

“The steps we are recommending should not only help to align clinical practice with sound language guidelines, but also foster a more empathetic and supportive healthcare environment for patients,” he said. 

Zhang also said healthcare institutions should look to leverage technology to support adoption of appropriate standards.

His team is collaborating with Mass General’s Research Patient Data Registry to obtain de-identified patient records, which they plan to review for instances of stigmatizing language. He hopes the process will help researchers quantify the prevalence of such language in clinical notes and identify patterns that can inform interventions. The team will also analyze the association of stigmatizing language with patient outcomes.  

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Anne Hathaway's plan was to stop drinking until her kids were grown up. Now, she says she's over 5 years sober.

• Anne Hathaway is celebrating over five years of sobriety.
• "That feels like a milestone to me," the actor told The New York Times .
• In 2019, Hathaway said she wanted to quit alcohol "for 18 years" until her son is grown up.

Anne Hathaway , 41, is celebrating over five years of sobriety.

The actor spoke to The New York Times about her health and what it's like being in her forties.

"There are so many other things I identify as milestones. I don't normally talk about it, but I am over five years sober. That feels like a milestone to me. Forty feels like a gift," Hathaway told The New York Times.

The actor also shared that she wasn't comfortable referring to herself as middle-aged because "we don't know if this is middle age."

"The fact of the matter is I hesitate at calling things 'middle age' simply because I can be a semantic stickler and I could get hit by a car later today," Hathaway added.

Hathaway first spoke about quitting alcohol during an appearance on " The Ellen DeGeneres Show " in January 2019.

"I quit drinking back in October," Hathaway told DeGeneres. "For 18 years. I'm going to stop drinking while my son's living in my house because I don't totally love the way I do it and he's getting to the age where he really needs me all the time in the morning."

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She later clarified in an April 2019 interview with Modern Luxury that she stopped drinking not because she had an alcohol problem but because she had really bad hangovers, per People .

"My last hangover lasted for five days," Hathaway told Modern Luxury. "When I'm at a stage in my life where there is enough space for me to have a hangover, I'll start drinking again, but that won't be until my kid is out of the house."

Hathaway has two sons, Jonathan, 8, and Jack, 4, with her husband Adam Shulman . The couple have been married for 12 years.

In a Vanity Fair interview from March, Hathaway also spoke about how her mental health has improved since she quit alcohol.

"It's a path everybody has to walk for themselves," Hathaway said. "My personal experience with it is that everything is better. For me, it was wallowing fuel. And I don't like to wallow."

A CDC report found that the loss in productivity due to hangovers cost the economy almost $90 billion in 2010, per The Atlantic .

Although they can vary from person to person, hangover symptoms typically include fatigue, headache, and nausea, among others.

Research has also found that the effects of a hangover can continue to affect a person even after the alcohol has already left the bloodstream.

Apart from Dry January , there are also other ways for people to cut down on their alcohol consumption , including the " One Week No Booze Method. "

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Alec Baldwin reflects on nearly 40 years of sobriety, admits he does ‘miss drinking’

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Alec Baldwin has been sober for 39 years – but admits he does “miss drinking.”

“I don’t discuss this a lot, I discuss it every now and then when it makes sense. I’m 39 years sober. I got sober February 23, 1985,” he said on Wednesday’s episode of the “Our Way with Paul Anka and Skip Bronson” podcast.

The “30 Rock” actor recalled having a “white hot problem every day for two years” when he lived in Los Angeles in the early 1980s.

“I think I snorted a line of cocaine from here to Saturn. We did one on the rings of Saturn, then we came home, we took it home,” he shared. “I mean, cocaine was like coffee back then; everybody was doing it all day long. So I did a lot of coke.”

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Baldwin, 66, eventually “stopped doing drugs,” but after his drinking increased as a result, he made the choice to become totally sober in 1985.

“The thing I miss is drinking. I don’t miss drugs at all, but I do miss drinking. I like to drink,” he admitted.

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When asked what he does in place of drinking to “deal with the pressures of the outside forces,” Baldwin credits living in New York City for the last 45 years.

“New York relaxes me. I walk around, and I see aspects of it that I’ve never seen before,” he explained, noting that he goes to lunch and coffee with friends and frequents arts events like the opera and the ballet.

“I [also try] to meditate,” he added. “[Though] meditating with seven children is like trying to play ping pong on the deck of an aircraft carrier –– it’s a real pain in the ass.”

The Emmy winner and his wife, Hilaria Baldwin, share seven children together under the age of 10. He also shares daughter Ireland with ex-wife Kim Basinger.

Baldwin previously reflected on his sobriety journey in his 2017 memoir, “Nevertheless,” admitting in the tome that he was secretly “overdosing on drugs” in his 20s.

“I know that at that time, what I describe [in the book] — overdosing on drugs — which I’ve kept very private for years and years and years. I think I would have gotten it eventually, but, I’m glad I got [sober] when I did ’cause not many people get sober when they’re young,” he said in an interview with “Good Morning America” at the time.

Baldwin added that he was previously a “daily drug abuser” and “daily drinker” to help him deal with “a lot of pain.”

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