Abstainers and Drinkers – Two Sides of the Same Coin?
Commentary
Abstract
This commentary discusses a recently published literature review focussing on the growing trend of young people abstaining from consuming alcohol. Despite the recent increase in research on the decline in youth alcohol use, the review only identified 10 papers that explicitly examined abstainers. The inclusion criteria used thus excluded and overlooked the vast literature available on the decline in youth alcohol use.
This commentary discusses the implications of this and raises the issue of how the adolescent alcohol abstainer should be viewed in research; is it a distinct social phenomenon with unique determinants or are abstainers merely the flip side of alcohol users?
Key points
Over the past two decades there have been marked changes in adolescent alcohol use, with both declines in alcohol consumption and increases in non-alcohol use reported from a number of high-income countries. These changes are still largely unexplained.
Systematically reviewing the scientific literature on alcohol abstainers is therefore crucial.
Increases in alcohol abstinence have been so marked that living free from alcohol has even become the majority behavior for young people in some countries.
Therefore an increased research focus on abstainers is important.
Only 10 papers has been included in the systematic review. The vast literature on the declines in youth alcohol use is not properly acknowledged.
Several review articles and reports on the topic have been published in recent years. While the literature broadly focusses on declines in alcohol use, there is a lot to learn from this body of literature with respect to alcohol abstention.
- For example, some key knowledge gaps and research needs identified in this review have been addressed, including cross-national analyses using consistent measures.
- There are already two major data sources that use harmonized questionnaires to measure youth alcohol use:
- the European School Survey Project on Alcohol and Drugs (ESPAD), and
- the Health Behavior of School aged Children (HBSC).
- Researchers have published widely using these questionnaires.
There remains a relative dearth of studies from lower- and middle-income countries.
The current review by Corre et al. as an explicit focus on abstaining. This focus facilitates a key question about the behaviors of alcohol and non-alcohol use among youth:
- Are these inherently different from each other or are they merely each other’s opposites?
For instance, while most HBSC and ESPAD publications predicted the prevalence of lifetime and 30-day alcohol use, the reference category in these analyses was abstinence. Do studies of the predictors of alcohol use usefully inform our understanding of non-alcohol use?
If new and additional studies were needed to understand non-alcohol users/ abstainers this would imply that this behavior is something unique and different from the opposite of alcohol use.
Does research need to separate and distinguish the findings of non-alcohol users from those of alcohol users, or are they two sides of the same coin so that we can use and learn something from both?
A recent paper on this using data from the adult population in Sweden implied that these are not especially separate phenomena or isolated sub-populations, but rather seem to be one population with a shared social behavior.
We talk about abstainers in the context of alcohol use, it is noteworthy that we do not use this word to describe young people who do not engage in other forms of substance use, such as tobacco and cannabis use.
Plausibly, we study alcohol abstinence among young people because societal norms prescribe that alcohol use is still a widely accepted behavior and something that we expect that most will start with later.
This in extension implies that we regard young people who do not engage in [alcohol use] as a special group (with some deficits), while this discussion is non-existing in the literature on tobacco and cannabis use, where we do not assume that everyone not using will start using at some point later on in life.”
Jonas Raninen, Michael Livingston, Kirsimarja Raitasalo, Peter Larm & Margaretha de Looze (2023) Abstainers and Drinkers – Two Sides of the Same Coin?, Substance Use & Misuse, 58:6, 832-834, DOI: 10.1080/10826084.2023.2188559
The literature is also showing that the decline in youth alcohol use has shifted the age of onset upwards and has caused a displacement of consumption so that 17-year olds nowadays consume alcohol in a similar manner as 15-year olds did in the beginning of the millennium.
This would imply that the trends are more the result of a prolonged age of onset rather than abstinence being a newly established and solidified behavior that will accompany the youth as they grow older.
Thus, many of those (currently) not consuming alcohol are future alcohol users that have simply not yet started to consume alcohol. Is it then feasible to treat them as inherently different from the alcohol users?
It is important to shift from a problem-oriented focus on alcohol users to a bigger focus on the non-alcohol users. Insights can be learned about alcohol abstaining from the literature on adolescent alcohol users. Alcohol users and non-alcohol users are not fundamentally different from each other.