spobLast year, a landmark study released by the National Institutes of Health estimated that for 1995, the overall societal costs of alcohol abuse and alcoholism were more than 50 percent higher than the costs to society of illegal drug use. The study put the societal price tag for alcohol abuse at $167 billion, compared with $110 billion for illegal drug use.

McCaffrey agrees that alcohol has a more detrimental impact on the nation than illicit drugs: “Undoubtedly, alcohol is the principal drug abuse problem in America today,” McCaffrey told an alcohol policy conference in 1997. In fact, when McCaffrey was first appointed drug czar, he asked Congress to include alcohol in the office’s mandate. Congress said no.

Government statistics strongly suggest that alcohol abuse may contribute more to crime than drugs do. The most recent Bureau of Justice Statistics report found that more than 40 percent of all violent crimes were alcohol-related, while only 29 percent were drug-related. Such statistics haven’t been lost on McCaffrey, who calls alcohol the “most dominant drug causing violence among American people–and it all starts with the abuse of beer and wine coolers by adolescent Americans.”

Which is why health advocates want politicians to pay more attention to underage alcohol use.

This summer, the Justice Department’s Office of Juvenile Justice Delinquency Prevention released the first study ever to isolate the costs to society of underage drinking. It estimated the overall costs at $58 billion. The Pacific Institute, a nonprofit public health research center, found that adolescent deaths attributable to underage alcohol use outnumbered deaths from illicit drug use an alarming 6-to-1.

Drug policy experts point out, however, that teen alcohol use–although disturbingly high–has remained at a fairly steady level since 1991, while teen drug use has gone up dramatically since then. Still, it’s the comparatively high rate of alcohol abuse among teen-agers that troubles public health advocates.

In a 1998 study of college students, the Harvard University School of Public Health found that alcohol abuse was increasing dramatically on campuses around the country. Asked whether they “drank to get drunk,” more than half of the students said yes–up a third from 39 percent in 1993. More than 40 percent engaged in binge drinking, the survey found.

A 1998 study by NIH found that young people who start drinking before the age of 15 are four times as likely to become alcoholics as those who begin drinking at 21. Early efforts to prevent alcohol abuse could help, experts say, and could also help limit other drug use. The White House drug control office has long held that use of alcohol is a precursor to use of marijuana and other illegal drugs–for boys in particular. “The science tells us that preventing or delaying tobacco and alcohol use prevents or delays the use of other drugs as well,” the office states.

Public health advocates tear that the magnitude of the alcohol problem is lost in the anti-drug cacophony. “Parents don’t realize that alcohol–not illicit drugs–is the No. 1 drug killing our children,” said MADD’s Nunnallee. “They think, `Thank God my child is only drinking beer and not using drugs.’ We’ve got to change this mind-set.”

FRAMING AMERICA’S DRUG PROBLEM

There’s sharp disagreement on how best to approach the alcohol problem. “The evidence of need for a public health campaign on alcohol is overwhelming,” Surgeon General David Satcher wrote to McCaffrey this summer, supporting the inclusion of alcohol in the drug czar’s anti-drug media campaign. Satcher wants to see alcohol “deglamorized” along with drugs.

But Rep. Anne Northup, R-Ky., is against including alcohol in the anti-drug campaign. “With drugs, they’re always illegal. They’re illegal at 14 and they’re illegal at 44,” she explains, volunteering that her district is the home of the nation’s bourbon industry. “Every kid who goes to a baseball game in the country is going to see people drinking beer,” she says. “What we say about drugs is different from what we say about alcohol.”

The alcohol industry is determined to prevent the negative connotations associated with drugs from being linked with beer and other alcoholic beverages. “So many good people consume our products moderately and responsibly–that’s not the case with cocaine and heroin,” notes David Rehr, senior vice president of government affairs for the National Beer Wholesalers Association and one of Capitol Hill’s most influential lobbyists. “A can of beer is not the same as a line of cocaine–there’s not one scientific study that says heroin is ever good for you.”

“To us, a glass of chardonnay with our meals should not be equated with cocaine or heroin,” agrees John De Luca, president of the San Francisco-based Wine Institute. “Such a monstrous distortion offends culture, tradition, social science, and common sense.”

But “unselling” America’s youth on beer and alcohol through a national counteradvertising campaign may prove very difficult. Sales of beer, wine, and liquor are buttressed by nearly $2 billion each year spent on advertising and marketing. And efforts to counter that are not likely to sit well with the industry. “A counteradvertising campaign presupposes that we’re doing something bad, that we’re targeting young people,” Rehr emphasized. “And that’s absolutely false.”

Indeed, the Federal Trade Commission, in an eagerly awaited report released in September, said that the alcohol industry’s voluntary efforts to regulate its advertising were generally in compliance with standards designed to prevent alcohol advertising from appealing to underage consumers.

The report, however, singled out the industry’s current standard that allows it to place alcohol ads in media for which as much as 50 percent of the audience is under the age of 21, despite the fact that only 30 percent of the population is underage. “The [industry’s] 50 percent standard, therefore, permits placement of ads on programs where the underage population far exceeds its representation in the population.” And for the first time, the FTC quietly concluded that alcohol advertising does play some role in a teen’s decision to drink.

Rehr, however, noted that the weight of academic research shows that parents and peers–not advertising–remain the strongest influences on kids when it comes to drinking. “Television ads,” Rehr points out, “rank very low on the list of pressures that influence kids to drink.”

Rehr said the industry is not against a federally funded media campaign that encourages parents to talk to their kids about delaying their use of alcohol. In fact, Anheuser-Busch Cos. has long provided free guides and videos–in five languages–to help parents talk to their children about drinking. Other beer, wine, and liquor companies have developed antidrinking campaigns geared toward youth.

The most recent example of effective teen-oriented counteradvertising comes out of Florida, where the state’s $26 million “Truth” campaign against cigarette smoking has experienced remarkable success. After the TV ad campaign’s first year, smoking dropped 10 percent among teens, and among middle-school students, it dropped 19 percent. Even the current White House anti-drug media campaign, though just over a year old, is working better than hoped, according to its proponents. In August, McCaffrey boasted that the campaign had reached more youth than it had targeted at the outset.

But most academics following the issue feel it is still too early to tell whether a billion-dollar media campaign is the most effective approach to the problem. And in advertising and marketing circles, skepticism prevails. “It’s easier to unsell tobacco to kids than beer,” said Steve Dnistrian, executive vice president of the Partnership for a Drug-Free America, a coalition of advertising agencies that works with the drug control Office.

Indeed, Dnistrian doubts whether the federal government can compete with the alcohol industry’s media muscle. “That’s a humongous marketing challenge, and you’re going to need a ton of cash to change that,” Dnistrian cautions. “At the end of the day, this is about completely changing our society’s attitudes on beer and alcohol, which is a far more daunting prospect than selling a pair of sports shoes.”

COORDINATED ATTACK

Counteradvertising and educational campaigns may be parts of a broader, multi-front war to combat alcohol abuse and underage drinking. For example, a growing number of cities around the country are placing strict limits on where alcohol advertisers can promote their products. A new Los Angeles city ordinance that took effect in October prohibits all advertising for beer, wine, and other alcoholic beverages within 1,000 feet of any residence, school, park, church, or youth center–effectively putting 97 percent of the city off-limits. When Baltimore’s ban on beer and alcohol billboards survived repeated court challenges on free-speech grounds, a number of other major cities–including Chicago; Cincinnati; Cleveland; and Oakland, Calif.–adopted their own bans. New York City, Washington, D.C., and San Diego are also considering such bans.

Joel Grube, an alcohol-abuse prevention expert at the Prevention Research Center in Berkeley, Calif., argues that much more is needed. “If you compare the effects of counteradvertising with other environmental efforts–increasing drinking ages, lowering blood alcohol levels for drunk driving, enforcing illegal sales to minors–these efforts are exponentially more effective than counteradvertising.”

One promising way to attack underage drinking may be simply to enforce the laws already on the books. Consider how the federal and state governments fight underage tobacco sales with a law known as the Synar Amendment, named after the late Rep. Mike Synar, D-Okla. The law requires states to lower their violation rate (the percentage of vendors that sell tobacco to minors) each year to a set level, with a target violation rate of 20 percent by 2003. Those states that don’t meet the target violation rate risk losing part of their federal substance-abuse block grants.

In a very short time, the law has pushed states to enforce laws that went unenforced for years. Before the Synar Amendment took effect in 1996, the federal Center for Substance Abuse Prevention estimated that (50 percent to 90 percent of all tobacco vendors sold tobacco products to minors. One year after Synar became effective, the median noncompliance rate of sales to minors had dropped to 40 percent. And this year, several states show noncompliance rates in the single digits.

At the urging of Sen. Robert C. Byrd, D-W.Va., Congress last year appropriated $25 million to fund an Office of Juvenile Justice Delinquency Prevention program to help states enforce laws against underage drinking. But critics say the effort lacks the teeth of the Synar Amendment. Still, adding alcohol to Synar’s mandate and actually enforcing laws against sales to minors could reduce underage drinking. Gayle Boyd, the director for alcohol and youth research at the National Institute for Alcoholism and Alcohol Abuse, says that alcohol’s accessibility is a critical problem. “If kids can’t get it,” Boyd reasons, “they won’t drink.”

Health advocates strongly agree. Alex Wagenaar, a professor of epidemiology at the University of Minnesota School of Public Health and one of the nation’s leading experts on alcohol accessibility, found that in some communities he studied, more than 90 percent of outlets failed to check for identification or challenge minors attempting to purchase alcohol. Grube argues, “There needs to be stronger enforcement to cut down on alcohol availability, taking away driving privileges for underage alcohol users, and zero tolerance for people who provide alcohol to minors.” Toward that end, Rehr said, the National Beer Wholesalers Association is currently drafting a model state statute that would take away the driver’s license of any minor caught illegally possessing or purchasing alcohol.

“How can you really expect a counteradvertising campaign to affect kids’ drinking where [alcohol is] readily available, where everyone does it, where it’s glamorized?” Grube asks. Nonetheless, he and other public health advocates believe that a national media effort against underage drinking could reinforce positive messages coming from parents and educators.

William J. Bennett, who was President Bush’s drug czar, argues in his book Body Count that the concentration of stores that sell alcohol should be limited, especially in poor and urban areas. “If the liquor industry does not start acting in a more socially responsible way, it may soon find itself held in the same kind of esteem in which the tobacco companies are now held,” Bennett warned. It was no surprise when the National Beer Wholesalers last year withdrew their imitation to Bennett to be the keynote speaker at their national convention.

UNDER THE INFLUENCE

The implicit argument of public health advocates is that if the country can afford a billion-dollar anti-drug campaign, surely it can muster the financial resources to fight alcohol abuse, which is a comparatively greater public health problem. “That’s what I want to do,” stressed Northup, who led the House Appropriations Committee’s successful effort to exclude alcohol from the drug czar’s media campaign. “If there’s some money, I’d support a separate media campaign for underage drinking.”

Sen. Byron Dorgan, D-N.D., who voted against the Senate bill excluding alcohol from the drug czar’s campaign, also advocated two separate media campaigns. “I will gladly support–and with great excitement–a program on alcohol,” said Dorgan, whose mother was killed by a drunk driver.

Even Sen. Ben Nighthorse Campbell, R-Colo.–whose state is home to the Coors Brewing Co.–said that while he opposed including alcohol in the anti-drug campaign, he favored a separate effort against underage drinking. “I will be more than willing to fight the battle to make sure we reduce teen-age drinking in any kind of ad campaign that would be effective,” Campbell said.

But some fear that the alcohol industry’s influence in Congress may be too powerful to overcome. “Can you see trying to get that through this place, with all of the friends of the alcohol industry? There is not a chance,” Sen. Frank Lautenberg, D-N.J., predicted after the Senate voted down his amendment to include alcohol in the drug czar’s campaign. “I think [Congress] has chosen to dismiss an opportunity that I think is the only one that existed for us. We will not have an anti-alcohol program.”

Indeed, the alcohol industry’s lobbying muscle flexes across party lines. The National Beer Wholesalers’ Rehr is tightly allied with House Majority whip Tom DeLay, R-Texas, and the Wine Institute’s man in Washington, Robert Koch, is married to Texas Gov. George W. Bush’s sister, Doro Bush Koch. Robert Koch was also a former staff director for Rep. Richard A. Gephardt, D-Mo., whose St. Louis district is home to Anheuser-Busch, the world’s largest brewer.

In fact, the Philip Morris Cos., which includes the Miller Brewing Co., was the largest “soft-money” donor to Republicans in 1998, while Joseph E. Seagram & Sons was the Democratic Party’s top soft-money donor in 1996. And more than 90 percent of the nation’s wine is produced in vote-rich California, a key Democratic stronghold.

Alcohol interests are likely to fiercely challenge any taxpayer-funded advertising campaign trying to “deglamorize” drinking. A 1992 report by Anheuser-Busch and Coors criticized the Center for Substance Abuse Prevention for advocating alcohol-prevention policies that, they claimed, had an overall anti-drinking bias. The report repeatedly criticized the federal agency’s choice of grant recipients and conference speakers, who advocated counteradvertising campaigns as a way to address alcohol abuse.

Similarly, a 1995 John Locke Foundation study by columnist Doug Bandow, a senior fellow at the libertarian Cato Institute, charged the Center for Substance Abuse Prevention with pushing “a sub-rosa prohibitionism.” Bandow argued that “taxpayers have paid to arm neo-prohibitionists for political battle.” He recommended the dismantling of the agency, and that nearly happened in 1995. Beer and liquor interests, citing Bandow’s report, pressured the newly elected Republican majority in Congress to send a message to the Center for Substance Abuse Prevention. The center took a significant hit: For 1996, Congress appropriated only $91 million for the agency, down from $239 million the year before.

Rehr said his industry may or may not support a media effort to target underage drinking; it depends on whether the industry is included in its development. “If there’s a mission mentality that’s anti-beer, or makes us out to be drug dealers, of course we would be opposed to it,” Rehr said. “But if they sat us down and involved us in the process, I think you’d have a lot in the industry support this.”