Cross-national comparison of adolescent drinking and cannabis use in the United States, Canada, and the Netherlands

Abstract

Background

This research examined the prevalence of drinking and cannabis use among adolescents in the United States, Canada, and the Netherlands, countries with substantially different laws and policies relating to these substances.

Methods

Laws regarding drinking and cannabis use were rated for each country. Substance use prevalence data among 10th graders from the Health Behaviour in School-Aged Children Survey conducted in each country in 2005–2006 were examined.

Results

Laws regarding alcohol and cannabis were found to be strictest in the United States, somewhat less strict in Canada, and least strict in the Netherlands. On most measures of drinking, rates were lower in the United States than in Canada or the Netherlands. With United States as the referent, relative risks (RR) for monthly drinking were 1.30 (1.11–1.53) for Canadian boys and 1.55 (1.31–1.83) for girls, and 2.0 (1.73–2.31) for Dutch boys and 1.92 (1.62–2.27) for Dutch girls. Drunkenness was also higher among Canadian boys and girls and Dutch boys. However, rates of cannabis use did not differ between the countries, except that Dutch girls were less likely to use cannabis in the past year (RR = .67; .46–.96).

Conclusions

The lower prevalence of adolescent drinking and drunkenness (except among Dutch girls) in the United States is consistent with the contention that strict drinking policies may limit drinking among 10th graders. However, the finding that cannabis use rates did not differ across countries is not consistent with the contention that prohibition-oriented policies deter use or that liberal cannabis policies are associated with elevated adolescent use. Based on these findings, the case for strict laws and policies is considerably weaker for cannabis than for alcohol.

Introduction

Adolescent use of alcohol and cannabis are major public health and legal concerns in all Western countries, given the evidence of association with concurrent and future harm (Baumeister & Tossmann, 2005; Blows et al., 2005; Ellickson, Tucker, Klein, & Saner, 2004; Hingston, Heeren, Jamanka, & Howland, 2000; Monshouwer et al., 2006). Despite health and safety concerns and societal restrictions on availability, alcohol and cannabis use are relatively prevalent during adolescence, with substantial minorities in Western countries reporting regular use, despite declines over the past decade (Adlaf, Begin, & Sawka, 2005; Andersson et al., 2007; Centers for Disease Control and Prevention, 2006; Hibell et al., 2004; Johnston, O’Malley, Bachman, & Schulenberg, 2007). However, it has been difficult for countries to develop laws and implement policies that limit drinking and cannabis use among adolescents while minimizing economic and social costs.

Laws and policies are in place in most Western countries to limit access and restrict use of substances (Brand, Saisana, Rynn, Pennoni, & Lowenfels, 2007; MacCoun & Reuter, 2001). However, drug laws tend to be complicated, subject to interpretation, and enforced and adjudicated variably. National laws and policies tend to range between strict penalty-and-punishment and harm-minimization (Brand et al., 2007; Grube & Nygaard, 2001; Lenton, 2003, Toumbourou et al., 2007). One basis for penalty approaches is the notion from demand theory that use should decline as the cost of the drug and penalties increase (Desimone & Farrelly, 2003). Accordingly, penalty approaches seek to make drug use difficult and expensive, with strict and certain consequences of arrest. However, the relationship between cost and prevalence is not consistent and penalty approaches can result in substantial negative social and economic consequences (King & Mauer, 2006). In contrast, harm-minimization/harm-reduction approaches focus on reducing higher risk use like drinking and driving and drug trafficking (Grube & Nygaard, 2001; Stockwell, 2001) and seek to minimize the costs to society of enforcement, adjudication, incarceration, and lost productivity (Lenton, 2003). While laws are slow to change, policy guidelines influence actual enforcement and adjudication practices (King & Mauer, 2006; Lenton, 2003).

In theory, laws designed to restrict the availability and use of alcohol and cannabis should influence adolescent prevalence (MacCoun & Reuter, 1997; Toumbourou, 2005), but research on the effectiveness of various policy approaches is limited (Giesbrecht & Greenfield, 1999; Lenton, 2003; MacCoun & Reuter, 1997), and enforcement, adjudication policy and other factors may also contribute to the variance in prevalence (Reuter, 2002, Toumbourou et al., 2007; Degenhardt, Chiu, Sampson, & Kessler, 2008). With respect to alcohol, one of the clearest findings is an inverse relationship between legal drinking age and alcohol-related motor vehicle injuries (Wagenaar & Toomey, 2002; Grube & Nygaard, 2001; Hingston et al., 2000, Toumbourou, 2005). With respect to cannabis, there is little evidence that criminalization reduces use (Senate of Canada, 2001). Notably, the prevalence of cannabis use among adults is no greater in the Netherlands than in the United States (MacCoun & Reuter, 1997; Abraham, Hendrien, Kaal, Peter, & Cohen, 2002; Reinarmann, Cohen, & Kall, 2004).

Surprisingly, no studies have compared the population prevalence of alcohol and cannabis use among adolescents in the United States, Canada, and the Netherlands, countries with quite different laws and policies regarding minimum age to purchase, jurisdiction, and criminal sanctions for possession and consumption and enforcement and adjudication policies (Brand et al., 2007; MacCoun & Reuter, 2001). U.S. laws and policies are relatively strict, enforcement is a priority, and strict penalties apply to both users and sellers (Grube & Nygaard, 2001; Lenton, 2003; Beyers, Toumbourou, Catalano, Arthur, & Hawkins, 2004). In contrast, the Netherlands employs a unique, harm-reduction policy approach that does not impose criminal sanctions for possession and use of small amounts and employs lax enforcement of possession laws (Lenton, 2003). Canadian policies (Health Canada, 2006), are somewhere in between, with federal laws that are similar to those in the United States, but with enforcement and judicial practices that are more consistent with harm-reduction (Senate of Canada, 2001).

Notably, the legal age to drink in the United States is 21 (with some exceptions for drinking with parents) in all states, 19 in Canada (18 in three provinces), and no minimum age to drink in the Netherlands and 16 to purchase alcohol (Brand et al., 2007, World Health Organization, 2004a). Alcoholic beverage purchase, possession, and consumption (in some states) are criminal offenses in the United States, but not in Canada or the Netherlands where these are statutory offences involving fines at most. Except for legal age, jurisdiction of alcohol policies is somewhat decentralized in the United States, where national laws are sometimes preempted by local laws, which usually results in more strict policies (Wagenaar & Toomey, 2002). The legal drinking age in Canadian is determined provincially. In the Netherlands laws are national, with a few provincial or local exceptions.

Cannabis policies also vary across countries (MacCoun & Reuter, 2001; NORML, 2003). There is no legal age for purchase in the United States and Canada, but for decades the Netherlands has allowed regulated sales of small amounts of cannabis to those 18 and older. The jurisdiction of legislation is federal in Canada, but in the Netherlands and the United States some local or state policies are stricter than national policies (NORML, 2003, NORML, 2006). Purchase and possession (in some states) of cannabis are nominally criminal offences in the United States and Canada. In the United States most offenses are treated as criminal misdemeanors, resulting in a criminal record and incarceration or probation, but in Canada most offenses are treated as statutory offenses, resulting in a fine with no criminal record or incarceration. Only the United States requires mandatory sentencing (for all federal offences and in 23 states) for convictions of possession of relative small amounts (typically > .05 oz) of cannabis. In the United States cannabis laws are primary and enforcement is a priority, leading to hundreds of thousands of arrests annually for cannabis offenses, mostly for possession (King & Mauer, 2006). In Canada and the Netherlands cannabis possession and use are generally tolerated by police, with considerable local variability in enforcement. The complexity of policy is illustrated by the approach in the Netherlands, where the sale of cannabis in officially designed “coffee shops” to those over age 18 is regulated (and taxed), but it is not actually legal to grow or sell cannabis, even to coffee shop owners, although such transactions are tolerated (Abraham et al., 2002; MacCoun & Reuter, 2001).

A key indicator of the lower social costs of harm-reduction approaches compared with penalty approaches is the number of arrests for drug-related offenses. Arrests of juveniles for drug-related offenses are extremely low in Canada, with only 2236 such cases in 2006 (Statistics Canada, 2008). Meanwhile, the same year in the United States there were 168,888 arrests of juveniles for drug use, most of which was for cannabis possession, and another 250,000 alcohol-related arrests of juveniles, mostly for underage possession (Federal Bureau of Investigation, 2006). While drug-related arrests are not uncommon in the Netherlands and Holland (Barclay & Tavares, 2003), arrests of juveniles for possession of alcohol or cannabis are virtually non-existent (Statistics Netherlands, 2008).

While substance use policies change over time, most youth-directed alcohol and cannabis policies have been in place in the United States, Canada, and the Netherlands for at least a decade. If demand theory is correct, the prevalence in these countries should be related to the strictness of national policies (MacCoun & Reuter, 1997). The Health Behaviour in School-Aged Children (HBSC) survey was conducted in the United States, Canada, and the Netherlands (and other countries) in 2005–2006 (Roberts et al., 2007). The survey provided an unusual opportunity to compare alcohol and cannabis use rates in these countries using national survey data with the same questionnaire items and participant ages. The purpose of this study is to examine the prevalence of drinking and cannabis use among 10th grade boys and girls in the United States, Canada, and the Netherlands.