Harm reduction may be underpowered to avert alcohol problems in youth

More lenient harm minimization policies appear to be less effective at cutting alcohol-related problems during young adulthood compared with stricter, zero-tolerance measures, a recent study has found.

Drawing from the International Youth Development Study, researchers looked at 1,965 young adults from Victoria, Australia (n=984) and Washington state, US (n=961). Early alcohol drinking behaviours were assessed at ages 13, 14 and 15 years, while problematic consumption was evaluated at 25 years of age using the Alcohol Use Disorder Identification Test.

At 15 years of age, 70 percent of Victorian participants had reported alcohol use in the previous month. This was statistically greater than the 42-percent rate in the Washington group (p<0.01).

This persisted until age 25 years, at which point 29 percent of the Victorians had an AUDIT score of at least 1, indicating some risk of problematic alcohol consumption. In comparison, only 17 percent of the Washington group had the same score (p<0.001). In both locations, alcohol misuse was more common among males.

Probit regression analysis found that before adjusting, early alcohol use was a significant predictor of AUDIT scores at 25 years of age (p=0.006). This remained true even when constrained to either location. “Thus, early use was equally predictive of later alcohol problems in both states,” the researchers said.

Victoria employed a harm-minimization approach to alcohol control, while Washington state adopted a zero-tolerance policy. “[R]esults from this study do not support harm reduction policy for preventing early alcohol use by normalizing adolescent use but discouraging excess use.”

While the effect of early use on AUDIT was comparable between groups, “because youth in Victoria reported higher rates of early use than youth in Washington by age 15 years, more Victorian youth were at risk for developing alcohol problems,” they added.