Do Adolescents Who Stop Abusing Alcohol Pick Up Other Vices?

Researchers report that not only does a reduction in the use of alcohol in adolescence not lead to replacement by tobacco or cannabis use, but that the same clustering effect blamed for high abuse of all three substances may also contribute to decreases across use of all three substances.

Alcohol prevention campaigns targeted at adolescents seem like a great idea. But is it possible that adolescents discouraged from drinking take up other habits instead, including smoking tobacco or cannabis? A study in BMC Psychiatry says: “No.”

Previous studies involving adolescent habits show that risky behaviors are generally clustered together. Unprotected sex, criminal behavior, and other behaviors that could result in future morbidity and premature mortality tend to be exhibited together. And, as the study authors note, initiation of alcohol, tobacco, or drug use at a young age is a risk factor for abuse as an adult.

In The Netherlands, national drinking policies and school-based education have been developed since 2006, with the goal of preventing drinking until adolescents reach age 16. Tobacco prevention campaigns have similarly targeted the age group, but marijuana usage has not been a target of preventive efforts. While admirable, the researchers note that, “…The coherence in these policies and their evaluation is lacking; there is an alcohol policy, a tobacco policy, and a drugs policy. Policies are rarely developed and evaluated on a more general level. To date, there are no studies about whether a decrease in the use of one substance leads to an increase in the use of another. In other words, is there replacement? Does a reduction in the use of alcohol lead to more drug use? Do people who stopped smoking drink more in compensation?”

The study used two cross-sectional surveys conducted among two different education levels of Dutch students aged 13 to 16. The surveys indicated significant decreases in alcohol consumption, tobacco and cannabis use between 2005 and 2009. The decreases were similar across sexes and educational levels. A significant decrease in cannabis use was found among girls and students with a high educational level. The decrease of lifetime cannabis use was significantly stronger among girls than boys. The strongest decline was seen in alcohol consumption. The last survey reading showed alcohol consumption was down from 61.8% in 2005 to 36.5 % in 2009. Binge drinking was also down precipitously. Weekly or daily tobacco and cannabis use were also down significantly as well.

The results led researchers to the conclusion that not only does a reduction in the use of alcohol in adolescence not lead to replacement by tobacco or cannabis use, but that the same clustering effect blamed for high abuse of all three substances may also contribute to decreases across use of all three substances.

Limitations of the study include its cross-sectional nature and the fact that the study years were characterized by a significant economic crisis and lower family incomes. “However, the strong decrease between 2005 and 2009 in alcohol use among adolescents in high school parallels the national campaign that was started in 2006 and used the slogan ‘Not sixteen, not a drop’.”