Saturday, Dec. 10, 2005

The British Disease

By J.F.O. McALLISTER

"We've got a 39 by Canal Metro Station. Male aged about 18, vomiting on the steps. Go immediately," crackled the voice over the radio of Madrid's emergency services on a recent Saturday night. Ten minutes later another "39" call, or alcohol-intoxication case, came in from another part of the city — and it was not yet 9 p.m. As the evening progressed, there were half a dozen drink-related traffic accidents and a booze-fueled stabbing. And through a bitterly cold night, hardy groups of teenagers could still be seen enjoying botellones: a popular pastime which has them huddling in darkened squares around communal concoctions of spirits and mixers, blended to induce oblivion as quickly and cheaply as possible. A group of five off the Plaza Dos de Mayo — only two had reached the legal drinking age of 18 — was guzzling calimocho, a popular brew of red wine and cola, in large plastic cups.

"One drink in a bar costs €3," said Elisa, 17. "I can drink this all night for the same amount." Her friends say they do it every weekend. Down the road at the El Rey Lagarto bar, four 19-year-old students were spending a little more to suck down beers indoors. Asked how they spent their weekends, they replied in unison, "Drinking!" By 11:30 p.m. Pablo, 28, a bartender at nearby retro joint Tupperware, had to open a second room upstairs to handle the crowd. "We're in Spain," he shrugs. "Everyone gets drunk."

That may be. But a growing share of "everyone" these days is a horde of tipplers so young you might expect them to be having milk and cookies instead. Between 2002 and 2004, the percentage of 14- to 18-year-olds in Spain who said they had been drunk in the last month jumped from 19% to 35%; 82% say they drink regularly; 27% say they're drunk every 10 days. And it's not only Spain where teens are boozing. All over Europe — in traditional drink-to-get-drunk cultures like Britain and Scandinavia, and in southern countries such as Italy and Portugal where public drunkenness has traditionally been frowned upon — young people, girls as well as boys, are hitting the bottle harder than their parents and starting younger. Just as Britain introduces new laws to encourage its people to drink more gently, like Continentals, the children of the supposed role models are vying with other young Europeans to become lager louts.

Europe is already the heaviest-imbibing region in the world, with alcohol consumption per head over twice the world average — 11 L of pure alcohol per year. That number has been gradually declining since the mid-1970s, as southern countries have slowly lost the habit of drinking throughout the day. But the younger generation is yanking it up again. The age people start drinking is getting lower — 11.8 years for Europeans who are now students, compared to 15 for those now aged 40 to 54. Across the European Union, 13% of 15- to 16-year-olds have been drunk more than 20 times in their life, and 18% have "binged" — drunk the equivalent of a bottle of wine in one sitting — three or more times in the last month. Irish Minister of State Noel Ahern, speaking about his own country, captures the European trend: "People used to drink for enjoyment, but now many young people are drinking to get plastered."

Kids may think binge drinking is cool, but the hangover — in terms of health problems, crime and accidents causing death or disability — is huge. Spanish Health Minister Elena Salgado says that the number of hospitalizations from alcohol abuse has doubled in a decade. Martin Plant, an alcohol researcher at the University of the West of England, says that "people in their 20s are now dying of alcohol-related liver disease, and even teenagers are developing it." Alcohol is estimated to be a factor in 20-30% of British accidents and 47% of violent crimes. In Germany, young people are drinking almost 30% more alcohol than four years ago. Emergency-room visits caused by "coma drinking" rose 26% between 2000 and 2002; half the patients were female. In Poland, where the number of adolescents who drink jumped 40% between 1995 and 2003, 20% of 17-year-old boys say they got in a booze-fueled fight in the last year. Eight percent of Swedish 15- to 16-year-old girls say drink led to unplanned sex, while 12% say it made them forget to use a condom.

That gloomy parade didn't trouble the teens around the Continent recently quizzed by Time about their drinking habits. "I see nothing wrong with drinking," says Monika, 15, sitting at the Bolek bar, in Warsaw's Pola Mokotowskie park. "How can you go to a disco and not drink? Or sit and talk with your friends and what, drink Coke? Everyone would think you are a loser or a weirdo." "It's fun and it's cheap," says Alek Stepien, 17, after buying a bottle of vodka in central Warsaw. "This costs the same as going to the movies, and it's fun for the whole night." Pieri, 14, goes to the Campo dei Fiori in central Rome to knock back a few with the crowds there. "They see others doing it, and they do it too," he says.

While Italy has cut its overall consumption of alcohol in half in the past 25 years, its young people are moving in the other direction. Italians have the lowest start-drinking age in Europe: 12.2 years compared to a European average of 14.6. The number of booze-quaffing Italian boys aged 14 to 17 rose 31% between 1995 and 2000; the number of girls more than doubled. There's no minimum age to buy liquor in stores, and 16 is the age for getting served in bars, where a popular drink for novices is a shot of rum followed by pear juice — half the price of an "alcopop," one of the sugary spirit-based drinks targeted at kids. Asked whether they've ever been requested to show ID when out drinking, a group of Roman teenagers erupts in laughter. "Nobody has ever asked me for anything," says Maria Teresa, 15.

Experts say lots of trends are converging to make boozing a bigger part of youth culture. "Puberty and menarche occur ever earlier," says Jürgen Schlieckau, head of pedagogical services at the Dietrich-Bonhoeffer Clinic in Ahlhorn, Germany, which has 48 beds for treating kids with addiction problems. "And so does the difficult search for identity and autonomy that goes with them." Teens want to emulate adults and rebel at the same time. "They have problems communicating," says Dr. Emanuele Scafato, director of the Observatory on Alcohol at Italy's National Institute of Health. "When asked why they drink, they say things like, 'I feel much safer and stronger.'" Anita Gryzicka, a 16-year-old sipping beer with her friends at the Bolek bar, agrees: "I like to drink with my girlfriends. We talk about boys, sex, parents. It's so much easier to talk when you are a bit drunk."

Teenagers have more independence than they used to, more money, and are becoming part of a pan-European lifestyle market that big companies covet. "It used to be that if you were in Italy and grew up in a family that drank wine, you would drink wine, too," says Dr. Peter Anderson, a public-health specialist who has prepared a report on alcohol policy for the European Commission. "Now you're exposed to ads for beer and spirits by companies that know how to devise products young people like, at prices they can afford." A TV ad in Italy shows how booze companies entice the young. Motorcycle champion Valentino Rossi holds a helmet full of bottles while a gorgeous woman looks on, gazing fetchingly.

But girls aren't just watching the boys; they've started to match them round for round. "Before the differences between boys and girls were so much greater," says Giulia, a 15-year-old Roman. "Now we feel equal." In Poland last year, there were actually more 15-year-old girls who drank (54%) than boys (46%). "A few years ago it was hard to remember orders from girls," says Jurek, a bartender at Bolek. "One juice, one Coke, one soda, one beer. Now it's easy: beer, beer, beer." Jerzy Mellibruda, a Warsaw professor who used to head the government's agency for prevention of alcohol problems, says liquor advertising — prohibited under communism but now omnipresent — has "made drinking cool. When I ask my female students why they binge, they tell me it's fun. They see nothing wrong with it."

In Britain they have a term for hard-swigging females: ladettes. British pub culture used to revolve around a strong social network in which regulars enforced unspoken rules about proper behavior among newer drinkers. Now the trend is toward what Plant calls "vertical drinking palaces" (standing-room-only bars) patronized only by young people, located in special "nighttime-industry" districts. Social inhibitions wither under these conditions. One result is a willingness to drink more. A survey of patrons entering bars in Manchester in 2004 found they already rated themselves an average of 1.8 on a five-point scale of intoxication. Women had drunk the equivalent of about one bottle of wine and the men had drunk nearly two, meeting the research definition of "binge drinkers" before they even got to the bar — where they were planning to get to 3.8 on the intoxication scale. Natalie, an 18-year-old lacing up her silver sandals in the ladies room at the Black Sheep Bar, a pub in the London suburb of East Croydon whose main stretch has some 19 bars and clubs, is matter-of-fact about the buzz she's after. Binge drinking "is what we do," she says. "We don't need to get drunk. We just do it because we can."

Can anything be done to pour this genie back in its bottle? One problem is that the more people drink, the more they and those around them consider it normal. In Germany in 1998, for example, tour companies started to offer spring-break getaways to new high school graduates, featuring the chance to get pie-eyed in All You Can Drink evenings. The market mushroomed to 15,000 by 2002 and an estimated 40,000 this year.

It won't be easy or quick, but researchers are confident they know how to stem the teen drinking tide — if European governments would only stand up to alcohol companies and jibes about the "nanny state." The first step is to raise liquor taxes, according to the World Health Organization (who). When Poland removed its 25% tax on spirits in 2003 in advance of joining the E.U., consumption increased 25-28% in a year. When Germany imposed an average €0.83 tax on alcopops that nearly doubled their price, sales dropped 75%, without a noticeable move to substitute drinks. A who report concludes that "the robust finding is that if alcoholic beverage prices go up, consumption goes down. If prices go down, consumption goes up." According to public-health specialist Anderson's report, increasing liquor taxes in the E.U. 15 by 10% would prevent 9,000 deaths and raise billions of euros. Lowering the number and density of booze outlets, reducing pub hours, enforcing minimum-age laws, imposing tough ad restrictions and randomly breathalyzing drivers are all strategies proven to cut the propensity to drink.

But most of these policies would affect adults as well as teens — incurring a political cost and, say alcohol merchants, penalizing the vast majority who manage their drinking without incident. Their preferred answer, one shared by many governments, is education to promote "responsible drinking." But educational measures alone have a poor record of changing drinking behavior, says Anderson. "You need the law to back them up, the same way that enforcement was necessary to spread seat-belt use." The industry is also guilty of mixed messages: funding responsible drinking campaigns at the same time it pushes new low-sugar alcopop formulations to avoid tax.

Britain hopes to dilute binge culture with proposed powers to ban problem drinkers from whole zones of bars and pubs, by enforcing a drinking age of 18, and — more controversially — by extending drinking hours to mirror the Continent, where people feel less pressure to race toward oblivion by closing time. Will those measures be enough to shift a culture that's prized getting sozzled since the Vikings? Andrew McNeill, director of the pro-temperance Institute of Alcohol Studies, says the chance that "fiddling around with drinking hours is going to make British people into Italians is about as likely as my becoming the Archbishop of Canterbury." But James Purnell, the Minister in charge of the new licensing law, says that's only one part of the strategy. "Cultural change takes a long time," he says, "and only happens through a range of influences."

"Short-term interventions" are another promising approach. One British program stations a counselor in court to identify defendants who might regret the one or 10 too many that got them there and offer help. And ambulances in Frankfurt now take under-21s picked up for "coma drinking" to a 42-bed unit specializing in alcohol problems. After they sober up, about half agree to counseling. Some attend group sessions with adult alcoholics, "people who seem normal to them," says Wilfried Köhler, the unit's chief doctor. "They could be their uncles or dads and here they are in detox, many of them without family or jobs thanks to the booze. Their frankness and willingness to admit they are responsible for their habit is the most effective way of getting to the kids."

Over the next few holiday weeks a lot of European kids will be joining, aping or rebelling against their elders with celebratory snorts. Their parents may be relieved: at least it's not drugs. Alcohol is so embedded in European life that its cost to young people — measured one car accident, one boozy fight, one date rape at a time — may not quite be perceived as part of a huge common problem. The E.U. is preparing an alcohol policy to reduce abuse, while at the same time trying to force Sweden to loosen its tough alcohol controls in the name of the common market. Such contradictory impulses litter the political capitals of Europe, because — for all the hue and cry about botellones and bingers — governments are not eager to stand against the major cultural and commercial force that is booze. "I know it could be harmful," says Gryzicka, sipping a beer in Warsaw. "But I think I can control it." She had better be able to, because she won't get much help from the rest of us.