Alcohol and Irishness have always been seen as synonymous. In Eugene O'Neill's Long Day's Jouney into Night, our national attitude to drink is summed up by the ever present bottle of whiskey. The play explores the central role of alcohol in family life.
One of the measures of the O'Neill sons' rebellion is how much alcohol they can `sneak' from under their father's nose. Could the present trend amongst young males to go out and binge on alcohol be seen as a modern equivalent?
GPs rarely see young males in their practices, let alone for the alcohol-related problems which older men present to us. However, they are being seen in increasing numbers in accident and emergency departments, sometimes with severe alcohol poisoning.
Is there any evidence to suggest that binge drinking amongst teenagers has any negative consequences for health? Certainly, while drunk, adolescents have an increased risk of sustaining accidental injury. Transient inflamation of the lining of the stomach (gastritis) is also common, although it rarely progresses to a full-blown stomach ulcer.
Repeated hangovers do affect school performance; there is convincing evidence of reduced concentration and impaired academic performance among adolescent drinkers.
While under the influence, teenagers are more likely be tempted by illicit drug-taking. The risk of cross addiction to ecstasy or marijuana is a real one. Alcohol also reduces sexual inhibition, which brings with it an increased risk of unprotected sex, leading to other health problems.
One of the most worrying consequences of teenage drinking is the relationship between it and depression. The psychological effects of bingeing are two-fold; depression secondary to alcohol abuse is a well established outcome in all age groups. Among the young, however, there appears to be a transient - but real - risk of a suicidal gesture at a point when they are deeply ashamed of their alcoholic excess. This is an acute and temporary phenomenon, but an important finding in the context of increasing suicide in our society.
Most alcohol is drunk by a small percentage of the population. Research shows that 70 per cent of drinkers consume only 20 per cent of the total volume of alcohol consumed. These figures suggest that most of us adhere to the guidelines for weekly intake; less than 21 units of alcohol per week for males and less than 14 units for females. A unit of alcohol is a glass of beer or a small measure of spirits.
These guidelines are for adults; young people are among a group who should drink less than this, including pregnant women, anyone taking medication and those who operate machinery or drive for a living.
I am sometimes asked whether alcoholism runs in families. Studies show about 25 per cent of the sons of alcoholics become alcoholics themselves, as do between 5 and 10 per cent of daughters. Alcoholism in the general population is at 5 per cent in men and less than 1 per cent in women. Therefore, having alcoholism in the family means one's chances of becoming alcoholic are five times more likely. One study reports that physical aggression and low anxiety are the traits which best distinguish sons of male alcoholics from sons of non-alcoholic males, at both age six and 12. This finding was not social-class dependent. There is also some evidence linking hyperactivity in childhood with alcoholism in adults, particularly when there is a family history of alcohol problems.
A simple but crude measurement of whether alcohol is causing a problem in a person's life is to run through the CAGE questionnaire. Have you ever felt you ought to Cut down on your drinking? Have you felt Annoyed about others criticising your drinking? Have you ever felt Guilty about your drinking habits? Have you ever used alcohol as an Eye-opener (to overcome a hangover)? A positive answer to two or more questions suggests you have an alcohol problem.
There are no simple answers to teenage drinking. Education undoubtedly is a key, using the Less is Better message of the National Alcohol Policy of 1996. As a recognition of the increasing need to help patients with alcohol problems, the Irish College of General Practitioners recently appointed Rolande Anderson as its alcohol project director, to develop training modules for GPs to improve their management of alcohol problems. One module will specifically address alcohol and young people.
Contact Dr Houston at mhouston@irish-times.ie or leave messages at 01-6707711 ext 8511