Gordie Bailey Jr. had been in college only one month before he overdosed on alcohol. Urged on by members of a fraternity he was intent on joining, the 18-year-old drank until he passed out, was dumped onto a couch and was found dead the next morning.
The 2004 incident at the University of Colorado was one of the approximately 1,700 alcohol-related deaths that occur among college students each year in the United States, including traffic accidents, falls, suffocation, drowning and alcohol poisoning. Hundreds of thousands of other students commit crimes, become crime victims, fail classes, make poor sexual decisions or sicken themselves by drinking too much alcohol.
The case for 18
- Rates of binge drinking have increased 56 percent among underage drinkers from 1993-2001
- In many countries with lower minimum drinking ages, 15- and 16-year-olds are less likely to become intoxicated compared with teens in the U.S.
The case for 21
- 67 percent of college students reported drinking during one month in 2000, down from 82 percent in 1980
- Alcohol use by high school seniors was 66 percent in 2007, compared with 77 percent in 1991
In a survey published last year by the American College Health Association, more than one-third of college students admitted they had binged on alcohol at least once in the previous two weeks — a number that appears to be rising.
Underage drinking has long alarmed college administrators and health professionals. But now a deep schism is forming among those same people on how to address the problem.
Last month, more than 100 college presidents signed a petition calling for a debate on whether the minimum legal drinking age should be lowered from 21 to 18.
The statement says: "Our experience as college and university presidents convinces us that twenty-one is not working. A culture of dangerous, clandestine 'binge-drinking' — often conducted off-campus — has developed."
Some health professionals agree it's time to discuss the proposal, but other health experts and college officials are aghast.
Each side has statistics to support its position, but most of the health and safety evidence falls squarely on the side of an age-21 limit.
"There is a growing body of knowledge that suggests strong reasons for parents and other concerned people to try to keep alcohol out of the hands of young people as long as we can," said Susan Foster, vice president and director of policy research at the National Center on Addiction and Substance Abuse at Columbia University.
Statistics on traffic fatalities prove the law works, said Michele Simon, research and policy director at the Marin Institute, an alcohol industry watchdog group in San Rafael, Calif.
In 1984, a federal standard was established setting the minimum legal drinking age at 21. Since then, traffic fatalities among drivers ages 18 to 20 have fallen by an estimated 13 percent, according to the National Highway Traffic Safety Administration.
"That is a really important measure of success," says Simon. "Back in the 1970s when states started lowering the drinking age to 18, that's when this experiment began. There were increases in traffic fatalities, and people said let's go back to the way it was. We forget there is so much science and historical context here. We have been down this road before."
- Among those studies comparing the years before 1984 with the current era was a 2001 report from the National Institute on Drug Abuse, which found that college students who reported drinking in the last month fell from 82 percent in 1980 to 67 percent in 2000.
- In 2007, the University of Michigan's annual Monitoring the Future survey found that annual alcohol use by high school seniors has dropped from 77 percent in 1991 to 66 percent last year.
Perhaps the strongest evidence for the harmful health effects of drinking at a young age come from studies on biology and addiction, Foster said.
- A 2002 report from the American Medical Association that cited numerous studies concluded that alcohol use during adolescence and young adulthood causes damage to memory and learning capabilities.
- A study in the 2006 Archives of Pediatrics & Adolescent Medicine found that teens who began drinking before age 14 had a lifetime risk of alcohol dependence, which was estimated to be 47 percent compared with 9 percent for those who began drinking at 21. For each additional year under age 21 of drinking, the greater the odds he or she would develop alcohol dependence. Although the cause of this correlation is unknown, some experts believe pure biology — priming the young brain to need alcohol — is involved.
"This is a public health problem and a medical problem," Foster said. "It's about the national failure to recognize addiction as a disease. If we think of it as kids behaving badly or breaking the rules, that gets in the way."
- And in a 2002 analysis of 33 high-quality studies on the age-21 drinking law's effects, University of Minnesota researcher Traci L. Toomey found all but one study showed the higher age resulted in lower rates of alcohol consumption and traffic crashes.
"It is the most well-studied alcohol control policy we have in this country," said Toomey, an associate professor in the school of public health. "Usually we find no effect when we do policy studies. Here we have this policy effect that is very consistent — a big chunk of the studies showing this inverse relationship."
A growing number of college administrators and health professionals aren't convinced the age-21 laws help curb problem drinking.
"Not all the evidence is on one side of the question," said John M. McCardell Jr., former president of Middlebury College in Vermont and founder of Choose Responsibility, a nonprofit group that advocates changes in minimum-drinking-age laws and circulated the college president's petition. "We're not ignoring science. There is science on both sides of the question."
For example, the reduction in traffic fatalities may be credited to other safety measures, such as the use of restraints, better automobile design, improved hospital trauma care and stricter traffic laws, in addition to the older drinking age, some studies suggest.
Those on the age-18 side have studies as well.
- A 2003 study from the Centers for Disease Control and Prevention found that, though fewer high school-age students drink now compared with the late 1970s, the rates of binge drinking among all adults 18 and older have risen. Published in the Journal of the American Medical Association, the study encompasses 1993 to 2001 and showed rates of binge drinking have increased the most (56 percent) among underage drinkers.
This out-of-control drinking may be fueled by the age-21 laws, which drive underage youth to drink in clandestine settings and apart from older adults who might model more appropriate behavior, McCardell said.
"College presidents are limited on campus to a message of abstinence-only," he said. "They can't say drink moderately or drink responsibly. They can only say abstain."
Although alcohol-related traffic deaths have declined overall since 1982, deaths have begun to inch up again in recent years, according to the National Highway Traffic Safety Administration.
- A 2003 study showed that in many countries with lower minimum drinking ages, 15- and 16-year-olds are less likely to become intoxicated compared with teens in the U.S.
McCardell agrees that studies show the younger someone starts drinking, the greater the likelihood of developing alcohol dependence. But, he says, the 2006 Archives of Pediatrics & Adolescent Medicine study shows that the correlation is greatest at younger ages.
"Between 13 and 18, the effect is dramatic. But between 18 and 21 it's visible but insignificant," McCardell says. "What we ought to look at is not keeping 18-year-olds from drinking, it's keeping 13-year-olds from drinking."
A major question not answered by research is whether mild or occasional drinking, such as a beer or glass of wine, causes any physical harm or precipitates harmful behavior in 18-year-olds, said Brenda Chabon, associate professor of clinical psychiatry and behavioral sciences at Montefiore Medical Center in New York.
"It's the way people drink, not the fact of drinking," Chabon said. "What would harm a developing brain is repeated hangovers and blackouts and head trauma from falling. But if someone were drinking moderately from age 18, I haven't seen any data to show that would have harmful effects in the long run."
There is little evidence in humans to suggest that mild to moderate drinking in late adolescence causes any damage, said David J. Hanson, professor emeritus of sociology at the State University of New York at Potsdam, who has studied the literature.
"The research is almost exclusively based on rats and humans who are alcohol addicted," he said. "It doesn't look at moderate drinking at all. We've got a lot of cross-cultural evidence that it isn't harmful at all."
The argument over the minimum legal drinking age has heated up in recent years due to publicity given to out-of-control drinking among college-age youth and tragic deaths such as Gordie Bailey Jr.'s.
"We need to ask what is driving this behavior," Foster said. "We're really tolerating a culture of substance abuse on our college campuses. There is no evidence that lowering the drinking age would address these problems."
The alcohol industry, which advertises heavily to college students, should come under the microscope, as well as the role of parents in setting attitudes and expectations for their children, she says.
Bailey's stepfather, Michael B. Lanahan, who has started a foundation to raise awareness about college drinking, says he doesn't know if a lower drinking age would have saved his stepson, but he's pleased that the issue is getting attention.
"Parents have to question their own governance of the children in high school," said Lanahan, who lives in Dallas. "Why do so many kids have fake IDs and we let it go? Why do bars get away with serving underage kids? If parents think college presidents are going to police this issue, they are sorely mistaken."
Proposals to curb youth drinking should explore all solutions, not just lowering the drinking age, Toomey said.
"You can't make conclusions without looking at what the research literature says," she added. "McCardell makes these alternative proposals without backing up that they work."
"It's not 1984 any more," McCardell said. "Who can object to examining this closer? We need to do whatever we can as parents, college presidents, responsible citizens to minimize the harm that people do to other people. That is a reasonable goal of public policy."