Prevalence and trends of alcohol use and misuse among adolescents and young adults in the Netherlands from 1993 to 2000☆
Introduction
In most western societies, adolescents experiment with alcohol and alcohol use becomes a ‘normal’ phenomenon during adolescence. The majority of the adolescents develop a drinking pattern that is socially acceptable, but a small group of adolescents use alcohol more frequently and is exposed to the accompanying risks of heavy drinking (e.g. Bauman and Phongsavan, 1999, Van Laar et al., 2002). Alcohol is among the most commonly used substances in many western societies including the Netherlands, but a complete overview in English of prevalence and trends concerning various aspects of drinking among young people in the Netherlands is not available. Previous studies on drinking among young people are described in Dutch reports. The aim of the present study was to give an overview of existing studies on alcohol use of Dutch adolescents and young adults and add findings from our study on adolescents and young adults to this overview.
First, the Dutch situation regarding alcohol use in adolescents is described briefly. In the Netherlands, it is illegal to sell light alcoholic beverages (for example, beer and wine) to people under the age of 16. This limit is 18 years for strong alcoholic beverages (liquor). Despite these strict criteria, it is not difficult for under-aged adolescents to obtain alcoholic beverages. Bieleman et al. (2002) showed that among 13–15-year olds who ordered a light alcoholic beverage in catering establishments, 98% obtained this drink. Of the 14 and 15-year olds, 73% successfully purchased strong alcoholic beverages in a liquor store. Among 16 and 17-year olds, who wanted to order or buy strong alcoholic beverages in catering establishments and liquor stores, 98% and 85%, respectively, actually obtained these beverages.
During the 1990s, several changes have taken place that may have altered adolescent and young adult alcohol consumption. First, alcopops, consisting of soft drinks with a small amount of alcohol, were introduced and bottled mixed drinks became easily available. Alcopops and bottled mixed drinks are easy to drink and have a sweet and pleasant taste that tends to conceal the taste of alcohol. Recent studies in the Netherlands show that alcopops and mixed drinks are among the most popular alcoholic beverages among students in secondary education (De Zwart et al., 2000, Ter Bogt et al., 2002). Other European studies by Roberts et al. (1999) and Romanus (2000) reported that alcopops account for the increase of alcohol consumption among 13–16-year olds. Furthermore, in the Netherlands, the 1990s was a period of welfare. Figures of Centraal Bureau voor de Statistiek Central Bureau of Statistics (2001) (CBS) and Nationaal Instituut voor Budgetvoorlichting, National Institution for Budget Information (2002) (NIBUD) show an increase in income among adolescents and young adults during this period, providing them with more opportunities to go to pubs and discos, which is likely to have resulted in an increase in alcohol consumption. Data of research performed between 1994 and 2002 show that adolescents between 12 and 18 years of age and particularly adolescents between 16 and 18 years of age increased their expenses on alcohol. In fact, alcohol is the most important expense for Dutch adolescent males and the second most important expense for Dutch adolescent females (CBS, 2001, NIBUD, 2002).
Two studies systematically collected data on adolescent alcohol use in the Netherlands between 1992 and 2001 (De Zwart et al., 2000, Ter Bogt et al., 2002). The European School Survey Project on Alcohol and Other Drugs (ESPAD) collects data on alcohol use in European Countries including the Netherlands, in 15 and 16-year olds (Hibell et al., 2000). One other study on alcohol use among Dutch aged 12 and older (Abraham et al., 2002) did not differentiate between males and females. Findings of the last two studies have not been included in the present paper because of the restricted age range and the pooling of data from males and females. The study by De Zwart et al. (2000) is a large prevalence study on smoking, drinking, drug use and gambling among students from 12 to 20 years of age by the Trimbos Institute and Ter Bogt et al. (2002) present data from the Dutch part of the Health Behaviour in School-aged Children (HBSC) study on substance use. These studies show that prevalence rates of lifetime alcohol use, lifetime drunkenness and quantity of drinking increase with age and are higher among males than among females. De Zwart et al. (2000) conclude that alcohol use among adolescents has not changed in the period 1992–1999. Figures show that about 60% of 12–13-year-old males and about 50% of 12–13-year-old females have used alcohol at least once; by the age of 18, this percentage rises to about 90% for males and females. About 20% of 12–13-year-old males and 15% of females have been drunk at least once; for 16–17-year olds, this was about 70% for males and about 60% for females. Prevalence rates on quantity of drinking show that about 80% of 12–13-year-old males and 90% of females drank one to four drinks on the last occasion they drank. At the age of 18, about 65% of males and about 35% of females drank more than four drinks on the last occasion they drank.
In our own study, we describe alcohol use during adolescence and during the transition into young adulthood (age 12–30 years). The focus of this paper is on prevalence and trends of young people's alcohol use in the Netherlands. This study adds to existing knowledge on alcohol use for several reasons. First, the studies by De Zwart et al. (2000) and Ter Bogt et al. (2002) focused on students in secondary education. However, it may be useful to examine drinking after secondary education because, in general, problems with alcohol consumption start during this period of life. Second, in our study, a larger variety of alcohol measures than in existing Dutch studies were used: lifetime alcohol use, frequency of drinking, quantity of drinking, lifetime drunkenness, frequency of drunkenness and problem drinking. In addition, we examined age and gender differences. Until the age of 17, the prevalence of drinking increases, in particular between 12 and 15 years (De Zwart et al., 2000, Kuipers et al., 1997, Sutherland and Sheperd, 2001, Ter Bogt et al., 2002, Van Laar et al., 2002, Young et al., 2002). Prevalence rates of alcohol consumption show significant higher rates for males than for females in earlier Dutch studies (De Zwart et al., 2000, Kuipers et al., 1997, Ter Bogt et al., 2002, Van Laar et al., 2002) and in studies conducted in other western countries (Gross, 1993, Sutherland and Sheperd, 2001, Wilsnack et al., 2000, Young et al., 2002). However, recent figures from the United Kingdom show an increase in binge drinking by adolescent and young adult females (Plant et al., 2004, Plant and Plant, 2001). We want to investigate whether we see an increase in prevalences for different aspects of drinking behavior with age, whether the sex difference is becoming smaller and whether we can find time trends in drinking among Dutch adolescents and young adults during the 1990s.
Section snippets
Procedure and participants
Data reported in this study are part of an ongoing longitudinal survey study by the Netherlands Twin Register. From 1991 onwards, families with twins have been questioned about lifestyle, personality and psychopathology roughly every 2 years. Twins were asked to participate in each wave (1991, 1993, 1995, 1997 and 2000), parents only in 1991, 1993 and 1995, and siblings only in 1995, 1997 and 2000. Some individuals participated once, while others participated several times. General information
Results
Table 1 presents prevalence rates of lifetime alcohol use for each age group and gender. The majority of the adolescents and young adults had used alcohol at least once. Within each wave, lifetime alcohol use sharply increased with age, showing significant differences between all age groups for both males and females. In 1993, significantly more 12–15-year-old males than females had used alcohol at least once. No significant differences for gender were found for other age categories and at
Discussion
The current study aimed at describing alcohol use among adolescents and young adults in the Netherlands. Our study showed that a substantial part of Dutch adolescents and young adults were exposed to alcohol use at early age, but rates of regular drinking and drunkenness were considerably lower in the Netherlands. A minority of the Dutch adolescents and young adults were excessive drinkers but excessive drinking was virtually absent among 12–15-year olds. These figures are consistent with
Acknowledgments
This work was supported by the Netherlands Organization of Scientific Research (NWO 016-005-029, NWO 900-562-137, NWO 575-25-006, NWO 985-10-002 and NWO-MW 904-61-193).
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Supplementary information for this article can be found by accessing the online version of this paper at http://dx.doi.org by entering doi:10.1016/j.drugalcdep.2005.03.020. Please see Appendix A for more information.