Impinging on bingeing

Messages urging attention to the dangers associated with alcohol abuse are being passed on to young people, yet very seriously problematic behaviour worldwide - most notably in the form of binge drinking at weekends - seems to be signalling back to us that the messages are not being received. This was one of the themes echoed repeatedly during the International Conference on Binge-Drinking held by sedqa some time ago.

The participants - workers from the field of substance abuse, health information personnel, educators, representatives of the alcohol and entertainment industry, doctors and medical students, and representatives from young people's organisations - pooled their experiences and expertise in an attempt to find possible solutions to the problem of binge-drinking among young people. The comments, ideas and proposals which emerged as a result of sometimes animated discussions in plenary sessions and in workshops reflected grave concern about the situation, but also the belief that a multi-pronged approach which addressed the various aspects of the problem could bring about a diminution in the volume of binge-drinking Malta and in the other European countries afflicted with the problem.

The nature of the beast - what constitutes binge drinking, its extent, its cultural and personal significance and its effects - was highlighted by several participants. It was explained that, in a Maltese context, binge drinking could be defined as drinking eight to nine units of alcohol in one sitting with the intention of getting drunk. Due allowance has to be made for the lower resistance to alcohol offered by the still-maturing bodies and personalities of teenagers. It was suggested that lower thresholds for what constitutes adolescent binge-drinking should be adopted: five units for males and four for females. A unit, by the way, is defined as "eight grams of absolute alcohol", roughly the amount found in a bottle of normal strength beer, a small glass of wine or a bar-measure of spirits.

Possibly the question which exercised the minds of the participants most was the all-important one of how to pass on the message that binge-drinking should be shunned, given that it leads to drunkenness, loss of inhibition, manifestations of violence and aggression, falls, problems with the police, unwanted and unprotected sex, unwanted pregnancies, drink-driving and a host of physical and psychological problems. There was general agreement that "preaching" would not work, and that any patronising messages would be likely to be ignored at best, and provoke the opposite reaction at worst.

Participants suggested messages should be devised by, or at least in collaboration with, young people themselves, who should also be involved in planning, and possibly executing, their delivery. The involvement of young people would thus help circumvent the barrier created by the "generation gap" - the perception that anti-binge-drinking messages originate from the establishment as personified by parents, educators and their ilk, and are therefore to be viewed with suspicion, if not contempt.

The so-called "invincibility myth" - the belief that nothing negative will ever happen to one - which characterises adolescent attitudes to risky behaviour must also be subtly tackled, perhaps by the adoption of language which eschews emphasis on negative physical and social effects and stresses image instead: simplistically put, something on the lines that "it's not cool to binge-drink".

At the same time, there were many who emphasised that all information transmitted must be science-based, mainly because otherwise we would be risking indulging in an essentially dishonest exercise which could only bear very sour fruit. Moreover, young people are technologically savvy enough to be able to check with ease the veracity of whatever is presented as fact, and all inexactitudes or sloppy research will soon be exposed for what they are, with consequent loss of credibility for whoever is seen as responsible for the misinformation.

Parents are obviously key-players in this situation. Many participants were of the view that parenting skills needed to be formally and systematically taught and developed. Parents need to be supported in their efforts to transmit the right values and to correct wayward behaviour. A related proposal involved the provision of family therapy in schools, this form of intervention having been indicated by research in various countries as the therapy of choice in cases of adolescent alcohol abuse. However, caution was advised by others who underlined the need for research to be carried out locally to ensure that the characteristics and idiosyncrasies of our society are taken into account when policy decisions are taken.

Some younger participants and adults involved in youth work called for the adoption of a more "realistic" stance which would accept the inevitability of alcohol consumption by teenagers, and the consequent need for educating them in the art of sensible drinking through harm reduction approaches. Thus, the teaching of techniques for reducing amounts imbibed and the provision of localised medical and other assistance aimed at helping those who have over-indulged should feature in the repertoire of services provided by the state, according to the exponents of this school of thought.

In contrast, as one would expect given the strongly stated position of the World Health Organisation, many others clamoured for tighter legislative measures aimed at curbing teenage drinking. There was widespread support for the establishing of the drinking age at 18, and also calls for stronger regulation of advertising. There was practically universal agreement that no association between sports, culture and sexual and social success on the one hand and alcohol consumption on the other should be allowed in advertising. Although some legislation in this regard does exist, its scope was thought to be limited, and its enforcement inadequate.

Legislation was also invoked for the protection of the younger adolescents in the form of a proposal for the imposition of a legal curfew prohibiting those under 16 from being the streets after a certain time. Surprisingly, there were few dissenting voices.

As one would expect, the participants' different backgrounds and agendas made for wide variation in the analyses and in the proposals forwarded. However, the two points which were most forcefully made and which perhaps should inform future efforts to draw up measures to combat binge-drinking are the need to make use of legislation in order to regulate adolescent drinking, and the advisability of roping in the youngsters themselves in the creation and delivery of messages designed to influence young people's decisions to drink.

Mr Mangani is division coordinator of the sedqa Alcohol Services.

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