A 15 year-old girl and a bottle of vodka

A couple of years ago I wrote a piece on Neil, a 16 year-old young man I had recently met who had approached me after my talk extremely concerned about what I had just said about spirits and their potential impacts on a teen's long-term health. What had disturbed him were my comments around the sheer amount of alcohol a young person was consuming when they shared a bottle of vodka between three or four of them (i.e., 21-22 standard drinks - the equivalent of 21 glasses of beer), and the impact that this could have on the developing liver. As I wrote at the time, I'm simplifying the conversation, but essentially this is what Neil said to me:

"Do you build a tolerance to alcohol and if you do, what does that actually mean to your health? If you are able to drink a whole lot more than you used to and not get any of the 'drunk' effects, does that mean your liver and the rest of your body are also not getting negative effects? When I drink I usually drink at least a bottle of bourbon to myself and I have no outward negative effects and I have to drink that much to get any effect at all. I was drinking less than that a couple of years ago but now that is the norm. I've never thought it was a problem because I don't get sick and usually I'm the one in my group of friends who is 'sober' enough to look after anyone should they get into trouble. Now I'm beginning to worry that maybe I am doing some damage!"

When I asked him how often he was drinking a full bottle of spirits to himself he replied that it was usually fortnightly! Neil had been doing this for the past 12 months at least and had actually started drinking alcohol regularly at around 13 years of age. He asked me whether I thought he had an 'alcohol problem' and I had to be honest and tell him that I believed he had to take a serious look at his patterns of drinking and make changes quickly. This was truly dangerous behaviour!

Last week I received an email from a Year 10 girl with a very similar story, once again very concerned after hearing my talk and my comments on spirits. I have edited it down quite a bit, but once again, we are talking extremely dangerous drinking here ...

"When you spoke to us about spirits you said that if we drank a bottle of vodka we were drinking the same as 22 glasses of beer. Is that true? I find that very hard to believe as I often drink a whole bottle to myself, or share it with a friend and I have never even felt sick. If I drink less than that I don't even ever even feel drunk and I've never been sick after drinking. I never have a hangover and I don't think I have ever done anything really stupid when I have been drunk. Does that mean that I don't get affected by alcohol like other people? Could I still be hurting my liver or am I just one of those people who can handle alcohol better than others? My boyfriend says he has never known anyone who can handle alcohol like me and he finds it really hard to keep up with me. Does it make a difference that I never drink my vodka by itself? I always mix it with coke or lemonade. Is it only people who drink it straight who have the problem?"

Realistically how do you respond to an email like this? This is a teenage girl who is playing around with a product that she simply does not understand - I have cut out a whole pile of other questions she included, all very similar to 'Does it make a difference that I never drink vodka by itself?' Really? She's drinking a bottle of vodka, whether she mixes it or drinks it straight, she's still consuming a bottle of vodka! Truly frightening!

Is this 'normal' teenage behaviour? Absolutely not! If we look at the data that we have on school-based 'current drinkers' (those that drank in the previous week), the numbers have fallen quite sharply since 1984. However, there continues to be a core group of teens who drink at extremely dangerous levels when they drink and the number of young people in this group has remained fairly consistent over time. These teens are our greatest worry and when I meet young people like the ones described above I realize that it is this group that we are failing badly when it comes to providing them appropriate education.

Admittedly some of these young people have a range of social problems and one of the major reasons they are drinking that much is to 'block out' bad feelings, i.e., they're using to cope, and that was my 'gut reaction' about Neil. Simply providing these teens with information about the risks associated with heavy drinking is most probably not going to make a great deal of difference. In those cases, often the best we can do is to provide them with ways to look after themselves and their friends should something go wrong. However, there are also many young people who simply have no idea what damage they're causing to themselves and have an extremely skewed view of what is 'normal'. Without a doubt this is the case with the young woman who sent me the email. She was obviously drinking for 'fun', didn't appear to be having any issues with her drinking and this sort of behaviour appeared to be the 'norm' for her social group and she hadn't seen anything wrong with it until I provided her with some information that challenged her views.

Spirit education is a must and it needs to be delivered early (it would be great to see parents doing some of the work here!). When I give any information on vodka (in Year 10, as that is the drink of choice for many in that year group who do choose to drink) you literally can see jaws dropping around the room. Many young people simply have no idea what they are doing to themselves when they consume these products and the risks involved with drinking large quantities when they are so young! Shouldn't we be telling them about the potential dangers before they start drinking them?

Young people today are far more likely to choose to drink spirits or, at the very least, premixed spirits than in the past. Where beer and wine-based drinks were once the drinks of choice for the majority of young people, spirits such as vodka are now much more likely to be consumed. There are a number of reasons why these drinks have become increasingly popular, some of these include:

• Spirits are more affordable than they were in the past – unlike wine, which has dropped in price since 1980, spirit prices have actually increased to some extent. Australian incomes have risen however, making all forms of alcohol, including spirits, more affordable
• Marketing and promotion of spirits has changed dramatically – vodka, in particular, is now marketed to a much younger age group than in the past. Where once spirit advertising targeted older men, drinks such as vodka are now closely associated with the youth nightlife scene, particularly young women
• Spirits provide better 'bang for their buck' – if their intention is to drink to get drunk, some young people believe that spirits are able to achieve this more effectively for less money

Vodka is seen as particularly attractive to young women as it is seen as a 'cool' drink (due mainly to the advertising and its target audience), free of calories (completely untrue), undetectable (where they get this idea is beyond me - have they ever smelt a vodka drinker's breath?) and is less likely to cause a hangover (unfortunately, absolutely true!).

The problem is that spirits are so much more dangerous than other alcoholic drinks, particularly in relation to the following:

• Spirits or premixed spirits enable you to drink more alcohol, much more quickly when compared to other drinks. If a group of young people share a bottle of spirits between them in a session they are drinking the equivalent of up to 22 glasses of full strength beer, 22 cans of mid-strength beer, more than 2 litres of a cask of red wine, or more than three bottles of champagne. For many young people, if they tried to drink this amount of wine or beer they would find it difficult to do so quickly - unlike spirits they are 'self-limiting' to some extent, i.e., you drink, you bloat, you vomit!
• Due to the high alcohol content, it takes a comparatively small amount of spirits to cause alcohol poisoning or overdose. It is important to remember that it takes much less vodka, rum or whisky to get drunk than beer or wine. It would only take minutes to drink two shots of vodka (60mls), whereas for most people it would take much longer to drink beer containing the equivalent amount of alcohol (two 285ml glasses – 570mls), thus greatly increasing the risk of poisoning or overdose

Do I believe that simply providing information to teens on the potential risks involved with spirit consumption will solve all our problems and result in them choosing not to drink these products? Of course not, but young people certainly deserve to have all the information we can give them so that they can at least make an informed choice. Drinking a bottle of vodka (or bourbon or any other spirit) is potentially life threatening, whether you're a teenager or an adult. If it doesn't kill you as a result of alcohol poisoning, the possibility of major damage to the liver and the rest of your body over time is very real!