The lifelong health hangover of teen drinking

By Sarah Catherall

Teen binge drinking is often brushed off as an experimental phase on the road to adulthood. But as Sarah Catherall reports, research shows early habits die hard - and are setting up young people for a raft of serious health problems later in life.

It's Saturday night and my living room is a sea of teens, the floor swaying as they dance to deafening music.

One of them holds a bowl of vomit and pretends it's his. My 18-year-old daughter is huddled in a group laughing.

About 60 kids have turned up to her house party, including a couple of gatecrashers who found out about it through social media, to celebrate the end of the school year.

As I walk around picking up cans and bottles and try to monitor their alcohol consumption, the party gets louder and louder.

I weave through swaying, rocking, drunk bodies to fill bowls with chips.

Ready to Drink (RTD) boxes and beer cans lie empty and girls walk around sipping or skulling cheap wine from gleaming green bottles. At midnight, when I call the party to a close as planned, the teens pile into Ubers and head for town.

This scene at my house is typical of a New Zealand party involving young drinkers: no one sticks to the Ministry of Health's recommendation of two standards drinks a day for females and three for males, everyone sips themselves into the "risky drinking'' category, by downing five-plus drinks.

A New Zealand Health Survey released last week found a quarter of females and 38 percent of males aged between 18 and 24 have drinking habits that can be categorised as "hazardous'', while 57 percent of 15 to 17-year-olds are drinkers.

It's tempting to shrug off such drinking as a phase of youth, but research shows alcohol habits formed early often continue into adulthood, and that drinking while young can be tied to serious mental and physical health problems, some that may only show up decades down the track.

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Alcohol Healthwatch's Dr Nicki Jackson has three simple words for parents and young people: "Delay, delay, delay.'' She says a recent study showed that half of adults with a drinking problem had developed it by the age of 20, and more than two-thirds by 25.

And there are lot of adults with drinking problems - one in every five Kiwis is a hazardous drinker, according to the New Zealand Health Survey.

"The style or pattern of drinking among those that do drink warrants strong concern and action. This age group has the highest prevalence of hazardous drinking, with about 151,000 young adults being classified as a hazardous drinker," says Dr Jackson.

She says a cocktail of law changes in 1989 - supermarkets were cleared to sell alcohol, the drinking age dropped from 20 to 18, and bars and restaurants began selling alcohol long into the night - contributed to what she believes is a hazardous drinking culture.

That Saturday night scene at my house, in other words, is par for the course. "Young people are price sensitive, and that's why we see so much preloading which is totally driven by prices," she says.

Sitting in a cafe near her university hall, first-year student Amelia* puts it like this: "There's such a drinking culture. You don't drink for the taste. You drink to get drunk.''

The 18-year-old works part-time and is conscientious about her studies. She will typically have four ciders or White Rhinos (a pre-mixed gin drink) before she goes out.

Others Amelia knows buy the cheapest bottle of wine (under $10) they can find at the supermarket and down it before they go out. By the time they leave the hall, they're already stumbling around, and some are vomiting. Once in town, they might buy a couple more drinks but don't really need to splash the cash seeing as they've already "preloaded''.

Some of "the boys'' are competitive about how much they can drink, she says, jibing each other about "who can finish a box first''. "A box" is a 12-pack of RTDs, at 7 percent alcohol a can. "Drinking is so ingrained in the university culture,'' she says.

Indeed, a recent Otago University study found students who didn't drink were ostracised and called names such as "grandma'' and "weirdo''.

Those who drank heavily got kudos.

Co-author Dr Kirsten Robertson says abstinence is not an option in a culture of intoxication.

"Some students could not even understand why you would consider drinking in moderation. For them, alcohol is used as a tool to get drunk. You either drink to get drunk or you don't take part.

Drinking in moderation was seen as a waste of money and unnecessary calories."

***

About 11pm every Friday and Saturday night young drinkers take over Wellington's Courtenay Place. By 1am, the street is full, with queues snaking from the doors of clubs and bars along the one-kilometre strip.

You would expect Hoff Hospitality Group manager Matt McLaughlin to be delighted by the crowds near two of the company's bars and one of its clubs, but he says many of the young drinkers aren't out to buy drinks - they've already preloaded. They often arrive into town already drunk, and his bouncers and bar staff have to deal with them.

McLaughlin says each night, he would turf out out every tenth person from the company's bars. "Young people drink the cheap stuff at home or at their flats and then they come into town wasted. They can walk around the streets intoxicated, but if they come into one of my bars, I risk losing my licence.''

Over two decades in the hospitality industry, the biggest change he has seen is the slump in the relative cost of alcohol. A bottle of wine now costs about the equivalent of half the price it did in 1989. As a consequence, preloading has boomed, he says.

McLaughlin is also head of Hospitality New Zealand's Wellington branch, and he says bar owners are concerned about the huge gulf in the cost of alcohol between off-licences and on-licensed premises.

He knows people will say he has a vested interest in getting people to buy drinks in bars, but he says beyond business reasons, the persuading culture is a concern.

"The accessibility of cheap booze is the number one issue of our drinking culture. You can get a bottle of wine on a street corner and it's as cheap as chips. And young people just want to get wasted.''

He is calling for a public health campaign about drinking responsibly. "Maybe that getting hammered and spewing in the garden is not a good look.''

***

At weekends, hospitals put extra staff in accident and emergency departments to deal with alcohol-fuelled problems.

At Wellington Hospital, Dr Paul Quigley, an emergency medical specialist and clinical toxicologist, says that on average about 36 patients affected by alcohol need treatment over the weekend.

It's 18-year-olds who most commonly arrive in ED after overdoing it, he says.

"They learn their lesson, and for 90 percent of them, they never return.'' But, Dr Quigley says, he's noticed an increasing number of 16 and 17-year-olds, who have been given alcohol by a legal drinker, showing up.

"That's a huge problem. The age of initiation of drinking is a leading predictor of outcomes.''

Health researchers Jude Ball and Terry Fleming have studied 15 to 17-year-olds through the Youth 2000 survey and found secondary students are starting drinking later and not drinking as much as they used to.

But, Ball says, those that do drink are still drinking to excess.

"The style of drinking does not appear to have changed much - for a lot of young drinkers, and an increasing proportion of older adults, it's still about drinking to get drunk. That's definitely of concern."

A recent Health Promotions Agency study found that more than a third of underage drinkers said their parents bought their alcohol for them.

Dr Quigley says: "My personal opinion is that a 16 or 17-year-old shouldn't be drinking. If they do, it should only be with an adult over a meal - not at a party with lots of loose other 16-year-olds.''

It's not just emergency doctors worried about the impact of alcohol on young people. Doctors from across the specialities shake their heads at young New Zealanders' drinking habits.

Dr Erica Whineray Kelly, a breast cancer specialist at the Auckland Breast Centre, is concerned about young female drinkers. She says the riskiest time for binge drinking is the time when women often drink the most - between the onset of the first menstrual cycle and before the first pregnancy, when breast cells are not fully developed.

"Breast cells are not very good at dividing as they are immature so make mistakes or mutations when they do, and do not repair themselves.

"These abnormal cells can be the start of the cancers that turn up decades down the track.

"We need to look after those immature breast cells until they fully develop. Our young women need to move, eat more grains and veggies, abstain from alcohol, and keep weight in the healthy range. I think that we will see the consequences of that drinking in some decades to come."

"Alcohol has become so much more widely available,'' she says.

"I'd like the drinking age to go back to 20. Alcohol is a drug and young people often can't handle it. We need to show young women the unsexy side of drinking.''

It's brains that worry Professor Jennie Connor, chairperson in Preventive and Social Medicine at Otago University.

"Alcohol is a neurotoxin and there is reliable evidence that prolonged heavy drinking in young adults causes irreversible damage to their brains because the brain hasn't fully developed or matured until about age 25," she says.

"Heavy drinking in adolescence and young adulthood increases the risk of problematic drinking or dependence later in life, with all of the injury, chronic disease, mental health and social outcomes that are associated with that.''

Alcohol Healthwatch's Dr Nicki Jackson is also worried about the brains of young New Zealanders.

In 2015, she requested statistics from the Ministry of Justice and discovered 73 percent of 20-24 year olds had some alcohol in their system at the time of suicide.

With so many medical professionals worried by alcohol, perhaps it's not surprising the newly-formed Health Coalition Aotearoa argues alcohol is one of three public health issues, along with tobacco and unhealthy food, that require urgent action.

It's calling for a number of policy changes, including restricting alcohol sponsorship and marketing, and increasing taxes on booze.

Others, including Professor Connor, want to see the drinking age returned to 20. "Eighteen-year-olds should not be expected to make a healthy decision about drinking when the system they live in suggests it is fun and harmless to drink heavily as much as they feel like.

"The current purchase age of 18 means that a majority of 15 to 17-year-olds drink."

Talk to Alcohol Beverages Council's executive director Nick Leggatt and you'll have a different conversation.

The council, which represents liquor companies, points out that youth drinking is actually dropping - in 2006/07, 89.1 percent of 18-to-24 year-olds were drinkers, whereas in 2017/18 that had fallen to 83.6 percent, according to NZ Health Surveys.

Leggatt says youth drinking has dropped since the age was lowered to 18, evidence that the legal drinking age has no bearing on whether young people drink or not.

On price and the widespread availability of alcohol, he says New Zealand already has the sixth highest excise tax out of 27 countries and introducing a minimum price or a higher tax would only make moderate drinkers consume less.

"The vast majority of Kiwi drinkers are responsible and have a right to purchase alcohol. Supermarkets are a very important part of them being able to do that.''

Professor Jennie Connor isn't having it.

"There is no evidence that young people are 'more sensible', and I think that should be framed as a lay interpretation of these changes, or a 'view'."

She is concerned about talk that 18 to 24-year-olds are drinking less, when the rates have not changed over three successive health surveys.

"Heavy drinking in adolescence and young adulthood increases the risk of problematic drinking or dependence later in life, with all of the injury, chronic disease, mental health and social outcomes that are associated with that.''

***

Back at the cafe by her university hall, Amelia considers some of the disincentives proposed to slow teen drinking.

She mulls over whether higher taxes would put her contemporaries off drinking but decides price hikes - and in fact not much else - wouldn't deter them. "Drinking is so ingrained in university culture."

I know that only too well. A year has passed since that pack of 18-year-olds littered my house with bottles and vomit.

My daughter is at university now and she and her friends have moved onto attending parties in her university hall and at flats. They frequently join the throngs on Courtenay Place at the weekends. But the locations are all that's changed; the drinking continues.

*Not her real name

Where to get help

Alcohol Drug Helpline - 0800 787 797, free text 8681, alcoholdrughelp.org.nz