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Starting a dialogue: against the odds, a former college president takes aim at the 21 drinking age.

The way former Middlebury College President John McCardell sees it, maintaining this country's legal drinking age at 21 leaves parents, and college presidents, with a similar dilemma and two unacceptable choices.

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The first unacceptable choice: to acknowledge that alcohol is a reality in the lives of 18-to-20 year olds, despite what the law says, and create a safe environment for that reality. But that sends a message to a young adult that we only observe the laws we choose to observe. "That's not very responsible parenting and it's certainly not very responsible educational leadership," says McCardell, who served as president of the Vermont liberal arts college from 1991 to 2004.

The second unacceptable choice: to decide that the law must be upheld, and prohibit underage consumption of alcohol at home and on college campuses. "That's a very noble posture to assume, but it overlooks that fact that Prohibition doesn't work, can't work, and has never worked," says McCardell.

The effect of legally prohibiting alcohol use among 18-to-20 year olds is that while it may eliminate underage drinking from visibility, it does not eliminate its presence, says McCardell. "What it does is drive drinking underground. It drives drinking on campus into closets and dark corners, places that are the least manageable and most risky," he says.

McCardell now wants to bring into the spotlight a controversial idea that would allow states to establish pilot education programs based on a minimum drinking age of 18. Earlier this year, he started an organization called Choose Responsibility (www.chooseresponsibility.org) in an attempt to launch such a dialogue.

McCardell says he came to the position that legal age 21 was not working "based on my own experience and my own observations and the fact that if it were working, young adults wouldn't be drinking, but they are."

Campus statistics

Most college presidents share McCardell's overall concerns about drinking on campus. A survey of 747 college administrators published in the Journal of American College Health in 2004 found that 81% of administrators at four-year colleges said students' alcohol use was a major problem on their campus. (1) In a similar survey published in 1999, only 68% of college presidents had expressed that level of concern.

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College presidents fear for good reason. According to the Harvard School of Public Health College Alcohol Study that was published in the Journal of American College Health in 2002, 44% of college students were binge drinkers in 2001. (2) Binge drinking was defined for men as having five or more drinks in a row at least once in the two weeks before administration of the survey questionnaire (and for women, four or more drinks in a row in the same time period). This percentage did not change from 1993-2001, with binge drinking rates actually increasing at women's colleges.

In addition, the number of frequent binge drinkers at colleges rose from 20% in 1993 to 23% in 2001. Frequent binge drinkers were defined as people who binge drank three or more times in the two weeks before the survey.

Though McCardell's views were shaped by his observations on campus, his plans for promoting and teaching responsible alcohol consumption among 18-to-20 year olds applies across the entire young-adult population. During the 1970s and into the early 1980s, many states lowered their legal drinking age from 21 to 18 or 19. In 1984, however, Congress adopted the National Minimum Drinking Age Act, mandating a penalty of a 10% reduction in federal highway funds against any state that failed to raise its drinking age to 21. Within five years, every state had raised its drinking age to 21.

McCardell believes the states offer the best opportunity for a critical examination of legal age 21 and any innovative alternatives. Through Choose Responsibility, he is proposing a pilot alcohol education program based on a minimum drinking age of 18, with the issuance of drinking licenses to young adults between the ages of 18 and 20 who successfully complete the education program.

His organization asserts that states that present a plan for educating and licensing young adults that is designed to maintain low levels of alcohol-related fatalities should be allowed to implement such a plan, maintaining a lower drinking age through the granting of a waiver from the 10% funding reduction. States would have to collect data and monitor the effects of the change in the law, submitting the data to Congress or its designate for the pilot program. States that demonstrated the success of their efforts would be allowed to continue the programs without penalty.

State plans would have to include guidelines for eligibility and sanctions for transgressions by young adults, such as any violations of the state's alcohol laws (in addition, youths who drink before age 18 would forfeit their right to apply for an alcohol license). Choose Responsibility envisions an education program similar to that of driver's education. The alcohol education program would:

* Be taught by a certified alcohol educator who was trained specifically to cover the legal, ethical, health, and safety issues surrounding alcohol consumption and was skilled in teaching young adults;

* Consist of at least 40 hours of instruction, with most of the time spent in a classroom setting, augmented by sessions of community involvement (such as drunk-driving court hearings, safe-ride taxi programs, and community forums); and

* Require applicants to pass a final examination before being issued a license.

The alcohol education program, as espoused by Choose Responsibility, would acknowledge the social reality of alcohol in American society, but would not advocate abstinence or consumption, according to McCardell. It would attempt to provide young adults with a foundation and the tools to make responsible choices on alcohol and would involve a collaboration among state, home, and school.

Many opponents

Those who support maintaining the current drinking age of 21, who certainly appear to vastly outnumber the proponents of lowering the drinking age, point to the reduction in annual alcohol-related traffic fatalities as a major reason for maintaining the current age restriction. The National Highway Traffic Safety Administration has long maintained that increasing the drinking age to 21 has saved 1,000 lives a year.

After reviewing 49 peer-reviewed studies published in scientific journals, the Centers for Disease Control and Prevention (CDC) concluded that alcohol-related traffic crashes increased 10% when the drinking age was lowered and decreased 16% when the drinking age was raised. (3) In addition, according to the U.S. Fatality Analysis Reporting System, alcohol-related fatalities decreased 63% from 1982 to 2005, while non-alcohol related fatalities increased 37% during the same period.

In its literature, Choose Responsibility states that it is impossible to assert a direct cause-and-effect relationship between the raised drinking age and reduced alcohol-related fatalities, citing the "war on drunk driving" beginning in the 1980s that resulted in stricter enforcement of drunk-driving laws, greater public awareness of the issue, and lower legal blood alcohol content limits.

McCardell maintains that more than the 1,000 lives saved on the highways each year are being lost to alcohol abuse each year in "other settings," and that the problem is worsening. "That's a statistic that advocates of legal age 21 don't want to talk much about because it requires them to ask, 'Well, these deaths aren't occurring on the highway; where are they occurring?'" McCardell says the deaths are occurring in the same hidden places where reckless use of alcohol is occurring.

McCardell acknowledges that most of the research supports maintaining the drinking age at 21. "The research establishment overwhelmingly supports legal age 21 and they probably think I'm a menace. I say, 'Let's talk about it.'"

Ralph Hingson, ScD, director of the Division of Epidemiology and Prevention Research at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), says there is solid evidence that raising the drinking age was accompanied by reductions in drinking and alcohol-related crashes, particularly fatal crashes. "This age group [16-to-20 year olds] went from being one with the very highest proportion of fatal crashes that were alcohol-related to the second lowest," behind only the elderly, Hingson says. Studies also have shown that people who grew up in a state with a legal drinking age of 21 drank less than their counterparts in other states, he says.

While maintaining the drinking age at 21 has had the greatest impact on alcohol-related traffic fatalities, Hingson acknowledges that the group that has exhibited the least change is college students. "That's probably why Dr. McCardell has shaped the views he has--he's looking at one subset of the population and sees little in the way of change," says Hingson. "But if you look at the overall number of people, there were very substantial reductions in drinking among high school students as well as the overall fatality declines."

College initiatives

Colleges are increasingly taking action to manage student drinking. The aforementioned survey of 747 college administrators found that all of the schools in the survey were taking some preventive measures. Thirty-four percent of the colleges in the survey banned alcohol on campus for all students. This was more likely to happen at small schools, schools in the South, less competitive schools, and historically black colleges.

Forty-three percent of schools banned alcohol in all residences (this counts the completely dry campuses), and 81% of colleges offered some alcohol-free dorms or floors. The survey found that 84% of schools provided alcohol education for freshmen, 72% provided education for fraternity and sorority members, and 69% for athletes.

A Harvard School of Public Health study published in the American Journal of Preventive Medicine in 2004 found that a program called A Matter of Degree: The National Effort to Reduce High-Risk Drinking Among Students reduced drinking rates and alcohol-related harms at colleges that fully implemented the model. The program, which was implemented at 10 colleges, fosters collaboration between universities and surrounding communities to change environments around campus that promote heavy alcohol consumption. (4)

Similarly, a study by the Harvard School of Public Health and the CDC found that binge drinking rates at colleges were lower in states where there were fewer adult binge drinkers. The study, published in the American Journal of Public Health in 2005, suggests that states can play an important role in helping colleges reduce binge drinking. (5)

McCardell's goals

Choose Responsibility's current aim is to engage the public in a debate over the question of the legal drinking age and to determine whether a significant portion of the public shares the organization's concerns. "We're not proposing legislation, we're not endorsing candidates, we're not doing anything that even remotely smacks of advocacy," says McCardell.

It would be premature, McCardell believes, to engage public officials on this topic. "They will respond to the public if the public thinks this is an issue, so our focus is on the public," he says.

He believes the public will respond to this issue because binge drinking represents a serious public health crisis. "So let's ask, 'Where is binge drinking taking place?' It isn't taking place out in the open, in bars or restaurants. It's taking place underground."

McCardell reports that most of the interest and support he has received so far has been from parents of high school and college-age students. His organization is also starting to receive mainstream media attention, including a cover story in the Aug. 12 issue of Parade magazine. That article reported that in countries that do not restrict alcohol for all citizens, only Mongolia, Palau, and Indonesia have the same age-21 threshold as the United States.

Choose Responsibility is located in downtown Middlebury with a staff of three, a Web site, and a blog. "We've got scrounged furniture, donated computers, and a shoestring operation, but we're committed and we're enthusiastic," says McCardell.

The organization is starting to build a volunteer network around the country, and is counting on the Internet as a critical tool. "There have been enough examples in recent times to show that one can mount a pretty successful grassroots effort using the Internet," says McCardell.

Brion P. McAlarney is a freelance writer. Photo of John McCardell by Trent Campbell.

References

1. Wechsler H, Seibring M, Liu IC, et al. Colleges respond to student binge drinking: reducing student demand or limiting access. J Am Coll Health 2004;52:159-68.

2. Wechsler H, Lee JE, Kuo M, et al. Trends in college binge drinking during a period of increased prevention efforts: findings from four Harvard School of Public Health College Alcohol Study Surveys 1993-2001. J Am Coll Health 2002;50:203-17.

3. Shults RA, Elder RW, Sleet DA, et al. Reviews of evidence regarding interventions to reduce alcohol-impaired driving. Am J Prev Med 2001;21(4S):66-88.

4. Weitzman ER, Nelson TF, Lee H, et al. Reducing drinking and related harms in college: evaluation of the 'A Matter of Degree' program. Am J Prev Med 2004;27:187-96.

5. Nelson TF, Naimi TS, Brewer RD, et al. The state sets the rate: the relationship among state-specific college binge drinking, state binge drinking rates, and selected state alcohol control policies. Am J Public Health 2005;95:441-6.
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Title Annotation:Feature; Middlebury College's John McCardell
Author:McAlarney, Brion P.
Publication:Addiction Professional
Article Type:Cover story
Geographic Code:1USA
Date:Sep 1, 2007
Words:2177
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