Adolescence is the maturation biological, psychological and social development- stage of the person and according to some authors, begins between 10 and 19 years. The adolescent has a poorly defined social function, with doubts and instability, and greatly influenced by persons of a similar age. In this stage, young people acquire their lifestyle which will be maintained for the whole of adulthood.
The consumption of alcoholic drinks is common practice in our society, where many adolescents have had contact with these substances. Young people progressively acquire the habit for several reasons: consumption in the environment, including the family and group of friends--the influence of this latter group is greater than that of the parents--, advertising, and curiosity or the search for sensations.1,2 This consumption is associated with two aspects of social learning: imitation and strengthening; thus, the consumption of alcoholic drinks is seen as a channel of integration into the family or the group. The media and the advertising messages contribute to the favourable climate of starting to drink.
Epidemiology
According to the directives from WHO, abstinence should be the norm until 18 years, but epidemiological studies show a decrease in the age of starting to consume alcoholic beverages, around 9-10 years, consumption in the family environment predominating (parties and celebrations). Later, during adolescence, drinking is normally carried out within the confines of the group of friends or companions. There are differences in consumption between sexes, with a predominance in males; also notable is the increasing consumption with the increase in the age of the adolescent. The consumption of alcohol is also generally associated with that of tobacco, which facilitates the consumption of other drugs.
In recent years a change in the pattern of alcohol consumption by young people has been documented, in which despite some indicators decreasing, such as daily consumption, a more intense consumption appears during the weekend, which is frequently associated with the consumption of other addictive substances. These new forms of compulsive consumption, which around 3% of young people between 15 and 25 years practice and admit getting drunk every weekend, are shared by both sexes, and a tendency to equality has been observed in the indicators of problematic drinking in recent years.3 The indicators of problematic drinking in adolescents are considered to be: drunkenness, consumption of 4 or more drinks on one occasion, buying alcohol, and consuming alcohol on weekdays.
Surveys in the school-age population are of great use for monitoring lifestyle habits, as well as facilitating the study of their determining causes.3 Judging by the results obtained by different authors and in several environments, the time has now arrived to carry out prevention activities.
Primary Prevention
Primary prevention of alcohol consumption consists of a group of measures or activities directed at preventing or delaying the start of consuming this substance, mainly directed at the adolescent ages.4 These measures are normally of a legislative, economic, and educational nature. The legislative and economic measures are aimed at restricting the distribution to certain population groups (minors). The failure of restrictive measures is evident, looking at the accessibility which the adolescents have to alcoholic drinks. Educational measures try to generate and strengthen healthy lifestyles.
The age of taking the first drink is related to the frequency, the quantity ingested and the number of problems associated with alcohol in later stages of life. For this reason, to delay the starting age of this habit must be considered a success.
In the medical literature on this topic, several lines of urgent action are defined to achieve the proposed objective4:
Facilitate information: with the hope of achieving a change in behaviour directed at preventing contact with the substance. Likewise, the threat or fear of the counterproductive effects obtained due to the rash nature of the adolescent. They do not seem to be a very useful strategy since they increase the knowledge of alcohol but they do not manage to prevent its consumption.
Improve self-esteem: the identification of a lower level of self-esteem in consumers of addictive substances has served to promote activities aimed to improve it.
Alternatives to consumption: the carrying out of unspecified, alternative activities, such as sports, community, civic or recreational activities, seek to prevent the consumption of alcohol. They have been formulated, particularly for groups considered high risk.
Skills to resist the social pressure: since social pressure (family, friends, advertising) is a determinant factor in starting to drink, certain programs try to provide the adolescent with the skills necessary to identify and overcome situations associated with the consumption of alcohol. They normally form part of programs integrated into the school curriculum, with active participation by teachers and pupils, and with some health care support.
Prevention and detection of alcohol abuse among adolescents is an unavoidable task of health professionals.
Intervention in the Clinic
Although adolescents infrequently come to health centres, we are obliged to act to prevent and detect alcohol abuse.4,5 The clinical interview with the adolescent has to guarantee confidentiality, maintaining a pleasant and empathetic atmosphere. Referring to the consumption of alcohol by the friends group can help to introduce question on his/her own consumption. We have to make the most of any contact with them, to get to know the consumption by the parents during childhood and, later, of the adolescents themselves and their environment, to detect use and abuse of alcohol. When alcoholic drinks are present in the family environment, it is not difficult to introduce questions on their own consumption in front of their parents.
The suspicion of a problem related to alcohol abuse may require an interview with the adolescent. In the adolescent who has not yet consumed alcohol, we will strengthen the need to maintain this behaviour, recommending that the parents delay the start of drinking alcohol in the family environment as long as possible. The permissiveness in this area is associated with a higher tolerance in the friends group. For the adolescent it is preferable to transmit information on the effects or problems of drinking alcohol in the short term--breath smelling of alcohol, accidents, etc--, since later problems normally do not worry them--cirrhosis, etc.
Intervention in the Community
The prevention of alcohol use among adolescents must form part of the community activities of the primary care teams. School is an ideal place to carry out activities promoting healthier behavioural habits and the primary prevention of consuming addictive substances, as well as alcohol and tobacco, since this takes place in an important and fundamental period of learning. Obligatory education makes it easier to access entire cohorts in a critical stage of their maturing process.
Activities in school must be based on promoting and giving support to the educational professionals, who have direct responsibility of the prevention programs in the school environment. The role of the health professionals should consist in acting as mediators for the promotion of health in the adolescents, and contribute to the awareness of society as a whole. A prevention program in school should integrate the majority of the following aspects:
Activities developed in school and included in the
school curriculum.
Active participation by teachers and pupils.
Moderate health professional support.
Centred on pupils between 10-13 years.
Joint prevention of tobacco and alcohol consumption.
Objective: acquiring of individual skills to resist the social pressures which cause the taking of substances.
The choice of the line of prevention has to be based on evaluated educational programs and with positive results.6-8 The effectiveness of health promotion activities should reduce the future prevalence of certain risk factors, which should be beneficial in the medium-long term for the whole community. A delay in the start of consumption constitutes a desirable objective of prevention, since it is accepted that the delay in starting to consume alcoholic drinks decreases the risk and improves the prognosis of having alcohol dependency in the later stages of life.
