Medical Examiner

Quicker Liquor

Should we lower the legal drinking age?

College students on spring break

Last week, a coalition of presidents from more than 100 colleges and universities called on authorities to consider lowering the legal drinking age. The so-called Amethyst Initiative, founded by a fed-up former president of Middlebury College, asserts that “twenty-one is not working” because the current drinking age has led to a “culture of dangerous, clandestine binge-drinking” on college campuses. “How many times,” they rhetorically ask, “must we relearn the lessons of prohibition?”

These academic heavyweights—who include the presidents of institutions like Duke, Spelman, Tufts, and Johns Hopkins—believe that lowering the legal drinking age can promote more responsible alcohol use. The familiar argument is that singling out alcohol to make it off-limits is odd, since 18-year-olds may legally join the military, vote, buy cigarettes, and watch porn. Meanwhile over the past decades, binge-drinking has soared among young people. The 1984 federal law that helps determine the legal drinking age is up for renewal next year, and the college presidents believe this law “stifles meaningful debate” and discourages “new ideas” to stop binge-drinking, like allowing kids over 18 to buy alcohol after a course on its “history, culture, law, chemistry, biology, neuroscience as well as exposure to accident victims and individuals in recovery.”

It’s a nice to think that simply lowering the drinking age would make college students behave better (as well as cheer loudly). But the Amethyst Initiative—named for the gemstone believed by ancient Greeks to stave off drunkenness—has naively exaggerated the benefits of a lower legal drinking age. They ignore some of the implications of their recommendations, fail to acknowledge their own complicity in the campus drinking problem, and ultimately gloss over better solutions to bingeing. Kind of like addicts might.

In truth, the higher drinking age saves lives and has little relation to college bingeing. Some history: After her daughter was killed by an intoxicated driver, Candy Lightner founded Mothers Against Drunk Driving and successfully lobbied for the 1984 National Minimum Drinking Age Act (the law that’s up for reauthorization in 2009), which gave full federal highway funds only to states that set the minimum age to purchase or consume alcohol at 21 years. Most states immediately complied, setting the stage for a national experiment.

According to the federal study Monitoring the Future, underage drinking dropped instantly. From 1977 to 2007, the percentage of 12th graders drinking at least monthly fell from 70 percent to 45 percent—almost immediately after the law was enacted, and lastingly. Fatal car crashes involving drunk young adults dipped 32 percent, resulting in 1,000 fewer lives lost per year. Impressively, this decrease occurred despite minimal efforts at enforcement; the mere presence of the law was protective. The relationship is likely causal. In 1999, by comparison, New Zealand lowered the drinking age from 20 to 18, and while  alcohol-related crashes involving 15- to 19-year-olds subsequently fell, they declined far less than in the overall population. * Today, all major public health authorities, including the American Medical Association, Centers for Disease Control, National Highway Traffic Safety Board, and surgeon general, support the higher drinking age.

We also know that kids in more permissive parts of the world don’t drink more responsibly. A magisterial 760-page review from the Institute of Medicine in 2004 noted dryly, “As the committee demonstrates in this report, countries with lower drinking ages are not better off than the United States in terms of the harmful consequences of youths’ drinking.” Those romantic visions of Irish lasses demurely drinking a glass of ale or sophisticated French teens sipping wine just don’t reflect reality.

Still, the college presidents signing the Amethyst statement aren’t hallucinating about the American version of the problem: There are more binge drinkers on campuses today. Among college students, the percentage of “frequent-heavy” drinkers remained stable from 1977-89, at about 30 percent. However, bingeing began increasing steadily throughout the late 1990s, long after the legal age was increased.

So if we can’t blame the drinking age, what’s going on? It’s key to understand that there are huge disparities in bingeing, depending on where you live and go to school. State bingeing rates vary three- to four-fold, with middle-American states like Michigan, Illinois, and Minnesota far outpacing coastal areas like Washington state, North Carolina, New York, and New Jersey. David Rosenbloom, a professor of public health at Boston University who studies alcohol use, told me bingeing rates at colleges even in the same city can differ dramatically.

The reasons aren’t very complicated: The strongest determinants of college bingeing are weak state and campus alcohol control policies (the regulatory environment) and the presence of lots of bingeing older adults (a locale’s overall drinking culture). Impressively, states that severely restrict the promotion of alcohol and its purchase in large quantities—for example, by requiring registration of keg sales, restricting happy hours and beer-pitcher sales, and regulating advertising like billboards—have half the college bingeing rate of states that don’t.

In addition to lobbying for these kinds of local laws, college presidents could also promote alcohol education (obviously) and racial and ethnic on-campus diversity (less obviously). As one might expect, alcohol education does help; for example, a brief educational program at the University of Washington reduced long-term binge-drinking in high-risk students. Additionally, young whites drink far more than young African-Americans and Latinos, men drink more than women, and younger students drink more than older students. When mixed, all the groups moderate their alcohol consumption; thus, colleges with greater student diversity have less bingeing across the board.

There’s a faster and more effective way to reduce underage drinking—and bingeing—as well: Forget the drinking age debate and sharply increase excise taxes on beer, the preferred choice of underage drinkers. (In real dollars, taxes on liquor, and especially beer, have dropped substantially over the past 30 years.) Just as higher cigarette taxes trump all other methods of curbing smoking among young people, higher alcohol taxes stop kids from drinking too much. As this graph from the British Medical Journal shows, alcohol consumption mirrors its price.

David Rosenbloom notes that the five states with the highest beer taxes have half the binge drinking of other states. In 2004, the Institute of Medicine concluded, with characteristic understatement, that the “overall weight of the evidence” that higher taxes reduce alcohol abuse and related harm to young adults is “substantial.” Just as gasoline taxes today don’t fully reflect the societal costs of carbon emissions, alcohol taxes are too low, argue economists P.J. Cook and M.J. Moore, since they cover less than half of alcohol’s external costs, including damage done by drunk young drivers.

Of course, in the end a lot of teens will binge-drink, no matter what the law says. But that’s not an argument against making the legal age 21 years old to buy and consume it. (After all, a third of high-schoolers have smoked marijuana, and few people want to legalize it for them.) Rather, the current law is best viewed as a palliative medical treatment for an incurable condition. Chemotherapy can’t cure terminal cancer, but it can make patients hurt a little less and perhaps survive a little longer. Similarly, the current drinking age undeniably reduces teen binge-drinking and death a little bit, without any bad side-effects. When there’s no complete cure, though, desperate people are vulnerable to the dubious marketing hype of snake-oil peddlers—which is all the Amethyst Initiative is offering up now.

Correction, Aug. 26, 2008:The sentence originally stated that New Zealand lowered its drinking age from 21 to 18. In fact, the drinking age was lowered from 20 to 18. The original sentence also stated that fatal crashes soared, which they did not. (Return to the corrected sentence.)