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Underage Drinking

Philippe De Witte
Mack C. Mitchell Jr.


Franca Beccaria, Patricia J. Conrod, Kim Fromme, Antti Latvala, Sherry H. Stewart, Helene R. White et Reinout W. Wiers

Note de l’éditeur

Order of authorship is alphabetical

Texte intégral

1This chapter attempts to draw recommendations based on evidence presented in Chapters 1 – 3 on underage drinking in European countries, the U.S., and Canada. As stated in previous chapters, underage drinking means different things in different cultures so this review has focused on research covering the second decade of life, which includes mostly studies on adolescent drinking, especially middle and high school students, as well as some relevant studies on college student drinking. The literature review has led us to provide a number of recommendations aimed at: 1) delaying the age of onset of drinking and 2) preventing heavy episodic (i.e., binge) drinking (usually defined as 4 or more drinks per occasion for females and 5 or more for males) and intoxication among youthful drinkers. By achieving these goals, many of the short-term and long-term problems associated with drinking by youth will be reduced.

2We would like to work towards a situation where all young people can have access to effective prevention programmes with good fidelity. Considering the harms associated with early onset use, all policies, whether they target demand for, or supply of alcohol to young people, should be aimed at delaying the onset of regular or heavy drinking. However, only evidence-based policies should be promoted and this report offers policy-makers with a review of the evidence-base for interventions aimed at reducing demand on the part of young people. A similar review of the interventions aimed at reducing supply/availability of alcohol to young people in Europe and North America should be made available to policy makers to further protect young people from alcohol-related harm.

3The current prevalence and patterns of underage drinking are set out in Chapter 1. This chapter concludes that drinking is a normative behaviour among adolescents in both the European and North American contexts. Lifetime and annual prevalence rates are on average much higher in Europe than in the U.S. and Canada yet prevalence rates for drunkenness do not differ that greatly across the two continents. However, this conclusion masks some differences across individual countries in terms of frequency, quantity, and intoxication levels. Some countries, mostly in the north of Europe, and to some extent Canada, show a drinking culture with less frequent drinking but a tendency to drink to intoxication. In the south of Europe, the drinking culture is characterized by drinking more moderately and more frequently, while in the U.S. the drinking culture is generally moderate compared to most of the other countries examined in Chapter 1. However, the traditional classification of countries into “dry” and “wet” drinking cultures does not fit well for classifying the drinking of contemporary young people. This is due to many factors, one of them being the converging alcohol consumption levels in countries across Europe with per-capita consumption among the general population falling in southern and rising in northern Europe. Although, the most recent data show a decline in adolescent drinking in the U.S. and Europe (trend data are not available for Canada as a whole), the fact that last year 39% of European 15- or 16-year-olds consumed five or more drinks at least once in the last month and 15% of U.S. 10th graders consumed that amount in the last two weeks indicates that there is still a serious problem around underage drinking.


4Chapters 2 and 3 clearly indicate that there are some risk factors which cannot easily be modified, such as genetics (although the expression of genetic risk may be moderated) and socio-economic status, which may be addressed by public policy or environmental interventions, such as efforts to reduce child poverty. Fortunately, there are also many other risk factors which do respond to effective interventions and which inform the recommendations made below. In addition, there are a variety of actions which can effectively reduce drinking in young people and prevent associated harms. The evidence base for all the recommendations set out below appears in the previous chapters. The recommendations are grouped by subject. It should be highlighted that we recommend that all interventions should adhere to evidence-based treatment protocols and be delivered by trained personnel. Furthermore, we note that there is a need for more research to evaluate evidence-based programmes, especially outside of the U.S. Finally, we need to determine whether those interventions which are effective in one country are transferrable to another country and what types of changes need to be made to an intervention in order to make it culturally appropriate for delivery in another country. In addition, we recommend that all interventions should be implemented with careful evaluation of behavioural outcomes.

Recommendations Regarding the Role of Parents and Families

5Parents should provide effective parental monitoring, consistent rule setting, and clear communication about alcohol.

6Parents should consistently disapprove of binge/heavy drinking.

7In most instances, except perhaps family or religious gatherings, parents should avoid providing alcohol to adolescents.

8Parents should maintain an active involvement with the activities of their children, including helping direct their selection of a peer group.

9Parents should be encouraged to monitor their children’s social media sites, especially for their alcohol content.

10Parents should avoid modelling heavy drinking or intoxication.

11In selecting alcohol prevention programmes, it should be kept in mind that parent-based programmes can be effective in preventing or reducing alcohol use in young people and that the most effective parent-based programmes emphasise active parental involvement as well as development of parenting skills to enhance competence, self-regulation, and parenting skills.

12In selecting an alcohol prevention programme, family-based prevention programmes should be considered. Although their effects are small, they are generally consistent and long lasting, and even small effects can be important from a public health perspective.

13In countries with more liberal alcohol policies and lower legal drinking ages, parental programmes should be combined with other evidence-based programmes.

Recommendations for School Programmes

14Policy makers and service deliverers should attempt to deliver programmes that have been shown to be evidence-based within a cultural and social context that closely matches the context in which they wish to deliver that particular programme.

15Small modifications to programme delivery methods and content should always be tested, considering the potential for iatrogenic effects in alcohol prevention.

16It is best to deliver alcohol prevention in sequential and developmentally appropriate stages.

17Normative feedback, especially for high school students, should be provided in the context of a comprehensive approach to skill development.

18Universal interventions should not be exclusively delivered by police or other authority figures.

19Prevention programmes should use an interactive delivery style.

20Targeted school-based prevention programmes should be introduced in the early adolescent years, ideally before initial exposure to alcohol.

21Selective interventions should be targeted toward at-risk groups, particularly those with personality or behavioural traits that put them at-risk for alcohol use disorders and for whom targeted interventions have been shown to be effective. Other at-risk groups have been identified, but should only be targeted in prevention with programmes that have an evidence base for those particular populations.

22Strategies such as personalized feedback designed to correct misperceived norms for both high school and college students should not be used as a method to prevent onset of drinking and are indicated as a method to reduce drinking in those who have already begun to drink, particularly those who drink more heavily.

23Researchers and practitioners should consider adapting evidence-based programmes for use on the Internet, but more research is needed in both Europe and North America before this becomes standard practice (see research recommendations below).

24When disseminating an efficacious alcohol prevention programme, it is very important to attend to intervention fidelity including adequate training and supervision of those delivering the intervention.

25As it has been shown that school staff can be trained to effectively deliver evidence-based universal (e.g., Life Skills Training/ Unplugged) and selective (e.g., Personality-targeted) programmes, we recommend public investment in broader dissemination of training in these and other evidence-based practices

26Greater investment in comparative effectiveness and cost effectiveness research will guide policy makers to develop effective strategies for broader dissemination of alcohol prevention.

27An international system for evaluating and disseminating evidence-based practices in alcohol prevention should be made available to the public and maintained by a research organisation that is neutral with respect to a theoretical approach to prevention, yet experienced with respect to reviewing and synthesizing the evidence base.

Recommendations Regarding Multi-component Programmes

28When selecting an alcohol prevention programme, it should be kept in mind that multi-component interventions for alcohol misuse prevention in young people can be effective, although generally speaking, interventions with multiple components are no more effective than those with a single component.

29However, there is some limited evidence from one study that both parents and children should be targeted simultaneously in multi-component interventions in countries with more liberal alcohol policies and lower legal drinking ages.


30The research reviewed in Chapters 1-3 identified several gaps in the literature. Most importantly, there has been inadequate evaluation of interventions for youth to prevent alcohol onset and later heavy drinking and a paucity of cross-cultural studies comparing intervention approaches. Below we list some additional areas of research, which we think are critical for guiding future development of appropriate interventions and enactment of policies to deal with the problems related to youthful drinking.

Epidemiological Research

31Definitions and measurement of drinking patterns, including heavy episodic (binge) drinking should be standardized across studies.

32Better assessment of the exact amounts consumed should be collected and details reported in national surveys.

33In addition to analysing drinking behaviours across all youth, some analyses should provide results for drinkers only, to shed more light on cross-cultural differences in drinking patterns.

34Data should be collected to better estimate blood alcohol concentration levels (i.e., information on duration of consumption, gender, and weight).

35More qualitative research is needed to understand youth’s perceptions of and motivations for drunkenness and how these attitudes are culturally influenced.

Research on Risk and Protective Factors

36Better controlled studies are needed for regional and cross-national comparisons to understand the influence of parental supervised alcohol use within the family setting on underage drinking in different cultural/drinking contexts.

37More quantitative and qualitative research is needed to compare risk and protective factors and their association with drinking outcomes across European and North American countries.

38More research utilizing “natural experiments” (e.g., adoption studies, twin studies, longitudinal studies of samples experiencing important secular changes) is needed to clarify the causal status of several risk factors.

39More research is needed on both implicit and explicit alcohol-related cognitions in adolescents to determine the causal status of these cognitive processes in youth.

40Controlled, experimental studies are needed within naturalistic settings, such as those relating exposure to alcohol-related content in films/movies with adolescent drinking.

41Research is needed on the effects of social media and, in particular, the practice of posting alcohol-related messages by underage people (on Facebook, Twitter, etc.).

Intervention Research

42More research comparing peer-led versus professionally-led interventions is needed to clarify their relative effectiveness in different situations, and what factors might moderate their effectiveness.

43More research should evaluate the use of web-based adaptations of evidence-based programmes for adolescents and parents, with an emphasis on evaluating their behavioural outcomes.

44More research should evaluate web-based adaptations of evidence-based training programmes for teachers and providers.

45More research should evaluate the use of social media and other technologies to promote youth access to evidence-based interventions.

46Research is needed to evaluate the use of social media and the internet to better disseminate knowledge and guidelines for evaluating the evidence in support of prevention programmes and policies.

47More research should systematically evaluate the cultural and policy-level contexts that may enhance or interfere with the impact of evidence-based programmes.

48More work is needed to further investigate the effectiveness of parent-based alcohol prevention programmes, especially in different cultures.

49Future work should examine cross-cultural similarities and differences in the efficacy of multi-component interventions involving both school- and family-based components in preventing or decreasing alcohol use in adolescents.

50There is a need for additional studies that attempt to enhance the efficacy of school-based programmes by including broader community components such as media, community services, and alcohol retailer involvement within a multi-component intervention.

51Research has demonstrated that both implicit and explicit alcohol-related cognitions are malleable in adults with promising outcomes, but hardly any research has been done in adolescents. More research is needed on this topic to develop new intervention strategies to moderate drinking in this age-group.

52More data are needed on the health-economics of alcohol prevention programmes with youth to help guide policy makers around improving young people’s access to effective intervention programmes.


53This report represents an attempt to provide information to researchers and policy makers from Europe and North America to help them address the issues related to underage drinking. We hope that a dialogue will begin and that we will move towards the development and implementation of efficacious programmes that can delay the onset of drinking among youth and reduce the extent of heavy and problematic drinking on both continents. More governmental funding of research and greater spending on evidence-based prevention programmes and comparative research evaluating programmes will help achieve these goals.


Institute for Training and Research
via Silvio Pellico 1
IT – 10125 Torino

Ph.D., Senior Lecturer and Consultant Clinical Psychologist
Department of Psychological Medicine and Psychiatry
Institute of Psychiatry
King’s College London
4 Windsor Walk, Denmark Hill
UK – London, SE5 8BB
Ph.D., OPQ, Chercheure Agrégée, Psychiatrie
Centre de recherche du CHU Ste-Justine
Université de Montréal, Bureau 1551
3175 Chemin de la Côte Sainte-Catherine
CA – Montreal, H3T 1C5

Ph.D., Professor
Department of Psychology
The University of Texas at Austin
108 E. Dean Keeton, Mail Stop A8000
USA – Austin TX 78712;

Department of Public Health
Hjelt InstituteUniversity of Helsinki
FI – 00014 Helsinki
Department of Mental Health and Substance Abuse Services
National Institute for Health and Welfare
FI – 00271 Helsinki

Ph.D., Professor of Psychiatry and Psychology
Psychology Department
Dalhousie University, 1355 Oxford Street
CA – Halifax, Nova Scotia

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