Emine Saner 

Drunk young things

Teenage drinkers don't just risk making fools of themselves. Doctors now say that binge-drinking in your youth can cause long-term health damage. Emine Saner reports.
  
  


I still remember the first cocktail I ever made: half a bottle of red wine, a few glugs of vermouth, vodka and whisky, topped up with an aniseed liqueur from a dusty bottle bought by my parents on a long-ago holiday. All poured into an empty orange-squash bottle and shaken vigorously. It was consumed (and reappeared sometime later) on the school playing fields near my house but it didn't put me off drinking. I was 12 and I thought Babycham was the height of sophistication.

I moved on to cider - big, cheap plastic bottles usually, until I discovered Diamond White, with its glamorous name and a taste somewhere between petrol and aftershave. The boys drank beer. One, Nick, still had a squeaky voice but could grow facial hair and so was the one responsible for buying it. We'd drink, we'd run around shouting, I'd vomit. That is how it was most Friday nights for the next few years. Isn't this what all teenagers do?

I never got pregnant or arrested, and unlike one of my friends back then, I never had to have my stomach pumped. I don't even think my school work suffered. I might have snogged a few boys I wish I hadn't and I remember doing the MC Hammer dance at a cider-fuelled school disco but, apart from those brief flashes of shame, I seem to have emerged from my years of teenage drunkenness unscathed. Or have I?

According to a huge American survey published in the Archives of Pediatrics and Adolescent Medicine this week, the consequences of teenage drinking are far more serious than the embarrassment of merely doing things you wish you hadn't. The study, which questioned more than 43,000 adults, suggested that early drinking can lead to a significant risk of alcoholism in later life: 47% of those who began drinking alcohol - anything more than sips or tastes - before they were 14 became dependent on alcohol (criteria included withdrawal symptoms, alcohol affecting their social or professional lives and unsuccessful attempts to cut down) at some point in their lives.

In this country, which has one of the highest rates of binge-drinking teenagers in Europe, getting drunk before you sit your GCSEs is seen as a rite of passage. "It [the survey] is worth taking notice of," says a spokesperson for Alcohol Concern. "We're very interested but I think it's a case of watch this space. Other studies suggest that alcohol only continues to be a problem if a young person continues to drink heavily. One of the difficulties of measuring the effects of alcohol consumption in young people is there just doesn't seem to be much research."

In this country, where 29% of girls aged 15-16 and 26% of boys binge drink, surveys on alcohol problems focus on people aged 16 and above (15% of those aged 16-24 are dependent on alcohol, but the majority of these are described as "mildly dependent" - where the dependence is psychological, rather than physical. If you have ever thought: "I really need a drink" you could be considered "mildly dependent".) Alcoholism tends to affect those in their 30s and 40s more seriously. "Alcohol dependency, if mild, can be reversed, especially with help," says Alcohol Concern. "If people stop drinking in their 20s they can usually go back to being in control of their drinking."

But alcoholism isn't the only long-term risk teenagers take when they drink. Another study in the United States suggests that alcohol causes more long-term damage to the developing brains of teenagers than previously thought, and that they are more susceptible to damage than adults. "We definitely didn't know five or 10 years ago that alcohol affected the teen brain differently," says Dr Aaron White, assistant research professor in the psychiatry department of Duke University, North Carolina, who was involved in the study. "Now there's a sense of urgency. It's the same place we were in when everyone realised what a bad thing it was for pregnant women to drink."

One of the brain areas known to be affected by alcohol is the hippocampus, the part responsible for learning and memory. One study, using MRI scans, showed that this region of the brain in binge-drinking teenagers was significantly smaller than in their teetotal peers. (It is thought that an underdeveloped hippocampus can result in learning or behavioural difficulties.) In another study, in experiments on rats, researchers discovered that after the equivalent of one or two alcoholic drinks, the activity of the chemical receptors in this region slowed; with more, they shut down almost entirely and the effect was stronger in adolescent than adult rats. This, they believe, explains "blackouts".

While the ability to form new memories does return, the team found that adolescent rats subjected to the equivalent of binge drinking displayed lasting problems in learning and memory.

Alcohol also appears to damage the area of the adolescent brain responsible for controlling impulses and the ability to foresee the consequences of actions. That is why snogging someone inappropriate might be embarrassing the next day, but having unprotected sex, getting into a car with a stranger, or starting a fight are scarier thoughts altogether.

"It has been shown that alcohol affects the brain in young people and it's possible that prolonged and excessive drinking from age 11 onwards can affect the maturation of the frontal lobes [of the brain] and the danger is that this could lead to personality disorders," says Dr Guy Ratcliffe, medical director of the Medical Council on Alcohol. "We have been specific about the recommended limits of alcohol men and women should not exceed but we haven't been clear about limits for teenagers, which would be lower than for adults."

Drinking is more dangerous for adolescents than for adults, because a teenager can experience coma at lower blood alcohol levels than in adults. Deaths from alcohol poisoning are rare - in 2002, nine teenagers died in Britain - but alcohol plays a significant part in teenage deaths due to accidents, violence and suicide. Thirteen teenagers a day are hospitalised as a result of drinking - either for alcohol poisoning or from injuring themselves when drunk. By the age of 13, more teenagers drink than those who don't and the amount consumed has doubled since 1990.

"It's an epidemic and we're seeing the consequences," says Ratcliffe. "The area of great concern in the medical profession is the greater incidence of alcoholic liver disease in young people. This is clearly a very serious development."

I have been drinking regularly for more than half of my life now and I suspect, like most people, that even though I know it's bad for me, I don't worry about just how bad it is. Have I got the onset of liver disease already? Are my frontal lobes for ever damaged? I don't think I'm dependent on alcohol but what if I just can't remember that I am? Can I repair any of the damage? "I would say a guarded yes," says Ratcliffe. "With the liver, early changes are reversible if you abstain from alcohol or reduce consumption considerably. Full-blown cirrhosis occurs after 10 to 15 years of heavy drinking. Any impact on blood pressure is reversible too."

But I am reminded that if I continue to drink as much as I do, I'm at a higher risk of developing breast cancer, as well as cancer of the mouth, larynx and oesophagus. Then there's the liver and heart disease - and that's before I've even thought of the ageing effects of alcohol.

Faced with this kind of bad news, I would usually have a stiff drink but I don't think I should.

 

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