Background

Alcohol is the most commonly used drug by young people, with adolescents traditionally using alcohol as a rite of passage to adulthood. A key period for experimentation and risk-taking, it is also a particularly risky time to do so, not only because of the impact alcohol can have on the developing brain but also due to early alcohol initiation increasing the risk of hazardous and harmful drinking in the future.1–4

Globally, in 2019, alcohol use ranked second for attributable disability-adjusted life-years (DALYs) among adolescents and young adults aged 10–24 years.5 Alcohol contributes to all the leading causes of death for young people: suicide, road traffic collisions, poisoning, and assaults, while long-term use is linked to seven different types of cancer, cardiovascular disease, and liver disease.6,7 Consequently, delaying and/or reducinig alcohol use among young people has been key to the World Health Organization’s (WHO) policies and recommendations and on which, here in Ireland, the components of the Public Health (Alcohol) Act 2018 are based.8–10

Given the devastating impact that alcohol can have not only on the individual and their family but also population-wide, it is a welcome finding that survey data from around the world, particularly high-income countries, indicate that youth drinking is in decline and that although some young people are still drinking, and drinking in risky ways, fewer young people overall are choosing to drink and those that do are starting later.11–14

Possible explanations for decline in youth drinking

Several theories have been proposed to explain why more young people are deciding not to drink. Changes in parenting styles and relationships is one such theory. As parents become more aware of, and concerned about, protecting their children from alcohol-related harms, there is increased monitoring and control of alcohol use.15 The Irish Census, which indicated a 4.4% increase between 2011 and 2016 in adult children living at home with their parents, may conclude that declining alcohol use and the restraining effect of living at home are interrelated, extending adolescence and restricting independence.16,17 Also proposed is a byproduct of the digital revolution, where gaming and socialising among young people take place online.11

Attitudes towards alcohol have also changed among young people themselves. They are deemed to be more conscientiousness about school and their physical and mental health and do not view alcohol as an important aspect of their social lives, with a resultant normalisation of non-drinking.11,13,14 Alcohol use is no longer uniformly seen as a rite of passage, there is less time going out with friends, peer pressure to drink has declined, and there is more room for individual choice as adolescents are spending more time cultivating the individual self.11,13,18 An adverse characteristic of millennials and Generation Z is the rise in poor mental health, the increasing uncertainties in employment and housing opportunities, and the additional burden of global matters such as eco-anxiety and war. Combined, these factors may also influence the decision not to use alcohol; rather they are more self-conscious and less inclined to consume any product excessively (e.g. meat, dairy, and alcohol).17

These cultural shifts as well as that of increasing immigration in many high-income countries from communities that do not drink alcohol have been proposed as factors in reducing overall drinking trends.19 Also influencing young people’s behaviour are the competing activities in their lives that do not involve alcohol, such as schoolwork, competitive sports, and the aforementioned gaming and social media use.11,13 The successful public health campaigns and legislation introduced worldwide in reducing tobacco use may also be a factor in declining alcohol use. Traditionally, tobacco was seen as a ‘gateway’ to alcohol use, and the significant reduction in tobacco use may have unintentionally contributed to the decrease in alcohol use among young people.12,20

Although difficult to measure their exact impact, public health campaigns and government policies tackling alcohol use have also been attributed to the decline, especially those that focus on alcohol availability and affordability.

Source: Mongan et al. (2021)²¹

Figure 1: Trends in alcohol consumption among young people aged 15–24 years, 2002–2020

Source: Gavin et al. (2021)²²

Figure 2: Trends in alcohol consumption among adolescents aged 13–17 years, 1998–2018

Does the international decline in youth drinking include Ireland?

In Ireland, alcohol use appears to have been declining among young people aged 15–24 years since the mid-2000s. Last-year alcohol use has steadily declined since the 2006–07 National Drug and Alcohol Survey (NDAS) (see Figure 1), reducing by 14% between that survey and the one carried out in 2019–20, meaning the number of teetotaller young people increased from 17% in 2006–07 to 28% in 2019–20.21 The decline in youth drinking is more pronounced among females than males; a 16% decrease in last-year drinking was noted among young females 15–24 years between 2006–07 and 2019–20 (82–69%) compared with a 12% decrease among young males (85–75%).

 When examining a narrower age cohort, such as the Health Behaviour in School-aged Children (HBSC) survey, Figure 2 illustrates the decline in alcohol use among adolescents aged 13–17 years between 1998 and 2018, where the decline is particularly evident among those aged 13–16 years. The decline is less pronounced among 17-year-olds.22 Reports of lifetime drunkenness among HBSC adolescents have also declined among those aged 13–16 years with, for example, a 45% reduction in the number of 15-year-olds reporting lifetime drunkenness between 1998 (48%) and 2018 (26%). However, a less noticeable decline was noted among 17-year-olds reporting drunkenness, just 5% in the same period (from 65% to 62%).

The decline in adolescent drinking was also observed in the European School Project on Alcohol and Other Drugs (ESPAD), where a 41% decline among 15–16-year-olds in last-month alcohol use was noted between 1995 (69%) and 2015 (36%). However, the downward trajectory reversed between 2015 and 2019 and a 14% increase in last-month alcohol use was noted; alcohol use in the last month had increased to 41% in 2019.23

Is youth drinking definitively in decline in Ireland?

The data presented here indicate at first glance that alcohol consumption has decreased among young people in Ireland. However, when smaller age groups are examined, it appears that this overall decline is being driven by younger adolescents, particularly those less than 17 years. While it is indisputable that young people are delaying alcohol initiation, what appears to be happening is that once they do start drinking (on average at 16.6 years), hazardous drinking, including binge drinking, is commonplace.

By looking at wider age cohorts, such as 15–24 years, perhaps the true scale of youth drinking in decline is being disguised and, in fact, propped up by changing behaviours in 13–16-year-olds. The dramatic decrease in lifetime alcohol use over these years is a finding that would make researchers and policymakers alike believe that alcohol use among young people is a problem solved. However, it is important that public health actors do not get complacent and continue to pursue best practices when it comes to delaying and preventing alcohol use among young people.

Youth drinking in decline: implications for public health, public policy and public debate

A paper published in early 2022, ‘Youth drinking in decline: what are the implications for public health, public policy and public debate?’ considers how the decline in alcohol use among young people may evolve in the future and what it implies for public health, public policy, and public debate.24

How will youth drinking trends develop in future?

It is too early yet to predict the impact that the Covid-19 pandemic will have on this overall decrease in youth drinking. However, surveys carried out during the pandemic indicated that, overall, young people were less likely to increase drinking due to the lockdowns.25,26 There is evidence that the decline in youth drinking is slowing and trends stabilising, although not reversing. Room et al. suggest that due to the large-scale, long-term structural and cultural shifts, the decline is likely to be sustained despite the availability and affordability of alcohol as well as the pervasive alcohol marketing and pleasures associated with alcohol use.27

The fear, however, is that the decline in youth drinking, although welcomed, could result in complacency from public policy actors; encourage lowering of alcohol taxes; an easing of policies and practices in place; and less discourse of alcohol-related harms, along with a drive by the alcohol industry to act on this complacency to renew efforts to boost alcohol sales. Despite concerns, it is important to consider how the decline in youth drinking will translate into improvements in public health.

What will the decline mean for public health?

Reductions in early initiation of alcohol use among schoolchildren and the ensuing overall decline in alcohol use among young people is likely to result in public health benefits, from reductions in road traffic collision deaths, assaults, suicide, self-harm, poisonings, and dependence. However, establishing the potential impact on alcohol-attributable diseases will be more complex due to long latency periods as well as other competing health issues, such as drug use, smoking, and obesity.

Also to be considered is whether the decline is limited to certain sociodemographic groups, for example, females and/or those from lower socioeconomic groups who bear a disproportionate burden of harm from alcohol use, and whether the harm now becomes concentrated among older, heavier drinkers.

What will the decline mean for public debate and policy?

Holmes et al. consider two model scenarios that may result from the decline in youth drinking: the reinforcement scenario and the withdrawal scenario.24

The reinforcement scenario

The reinforcement scenario is based on the prediction that as young people continue to abstain from alcohol into older adulthood and focus on healthier practices that alcohol-related harms reduce. Alcohol-related harm thus becomes viewed as a manageable problem resulting in governments no longer working in partnership with the alcohol industry, as they reap the political rewards of successful, evidence-based and popular public health alcohol control policies.

The reinforcement model is based on alcohol use replicating the tobacco experience, whereby increased negative attitudes towards smoking, multiple effective policies in place, and increased tobacco control reduced smoking. Typically, in public discourse, alcohol is not framed as a black-and-white issue in the way that smoking is. In practice, this means it is hard to form a public consensus against drinking, which in turn leads to challenges in getting public buy-in to alcohol policy interventions. This is particularly evident in relation to a lack of success in public health measures addressing youth drinking.

The withdrawal scenario

An alternative scenario, one that Holmes et al. consider more probable, is the withdrawal scenario that envisages a population that drinks less and is therefore unconcerned with alcohol-related problems. Motivation to address alcohol-related harm is reduced, particularly due to the emphasis on the economic consequences of restricting alcohol sales, which would see a lack of support from government for public health measures and a continuation of government and alcohol industry partnerships, reducing the effectiveness of restrictive policies, while focus (and resources) turn to other public health challenges.28

The withdrawal scenario predicts an easing of alcohol restrictions and extended periods of fluctuating trends of alcohol use, as well as, potentially, global corporations using the apparent success of reducing youth drinking to partner with governments of low-income and middle-income countries in order to expand their markets and secure influence over government policymaking.29

In recognition of the lack of policymakers’ support, public health actors may alternatively turn their attention to more focused alcohol issues that are deemed manageable, or those arguably less contentious, such as campaigns around short-term temperance like Dry January, calorie labelling, and no-alcohol or low-alcohol drinks. This approach may thus be viewed in a more favourable light as opposed to that of the reinforcement model or, indeed, the withdrawal scenario.

Conclusion

In the face of an improving public health trend, that of a decline in youth drinking, both scenarios illustrate the challenges presented for public health actors. The authors conclude by highlighting suggestions to consider, namely, to increase our knowledge of the reasons for the decline in youth drinking; to understand children’s and young people’s attitudes towards alcohol and alcohol policy to improve the effectiveness of future policies; for public health actors to continue to advocate for governments to address the weaknesses in existing alcohol policy environments; and, finally, for public health actors to consider their ultimate aim or end goal, especially if alcohol-related harms decline.
 

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2    Spear LP (2018) Effects of adolescent alcohol consumption on the brain and behaviour. Nat Rev Neurosci, 19(4): 197–214.

3    Park SH, Zhang Y, Kwon D, et al. (2018) Alcohol use effects on adolescent brain development revealed by simultaneously removing confounding factors, identifying morphometric patterns, and classifying individuals. Sci Rep, 8(1): 8297.

4    McNamara E, Murphy D, Murray A, et al. (2020) Growing up in Ireland: the lives of 17/18-year-olds. Dublin: Department of Children and Youth Affairs. https://www.drugsandalcohol.ie/32535/

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9    World Health Organization (WHO) Regional Office for Europe (2021) Making the WHO European region safer: developments in alcohol control policies, 2010–2019. Copenhagen: WHO Regional Office for Europe. https://www.drugsandalcohol.ie/34060/

10  Office of the Attorney General (2018) Public Health (Alcohol) Act 2018. https://www.drugsandalcohol.ie/33698/

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22  Gavin A, Költő A, Kelly C, et al. (2021) Trends in health behaviours, health outcomes and contextual factors between 1998–2018: findings from the Irish Health Behaviour in School-aged Children Study. Dublin: Department of Health. https://www.drugsandalcohol.ie/33868/

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26  Central Statistics Office (2020) Social impact of COVID-19 Survey November 2020: well-being and lifestyle under level 5 restrictions. Cork: Central Statistics Office. https://www.drugsandalcohol.ie/33458/

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28  Hawkins B and McCambridge J (2020) ‘Tied up in a legal mess’: the alcohol industry’s use of litigation to oppose minimum alcohol pricing in Scotland. Scott Aff, 29(1): 3–23.

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