What makes young people drink so much that they can go into a coma?

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Who are the young people admitted with acute alcohol intoxication? That is what Loes de Veld of Erasmus School of Health Policy & Management investigates in her PhD thesis. The PhD student wants to get a better picture of young people who binge drink. "By mapping risk factors around alcohol abuse, prevention can be targeted more effectively," says De Veld.

During her night shift at the hospital Reinier de Graaf Gasthuis, Loes de Veld, researcher and doctor in paediatrics, was called because four ambulances carrying young people were on their way to the hospital. Not because of a violent accident or a fire, but because of a party that had got out of hand. Three boys of fourteen had drunk so much that they were no longer approachable and sixteen-year-old girl from the party therefore called 112. "I walked with the father of one of the boys to his son's bedside. The emotion of that father when he saw his fourteen-year-old son lying on monitor monitoring, with an IV and without being approachable, impressed me a lot."

Tip of the iceberg

Although four ambulances at a time is exceptional, between 2007 and 2017, there were 7,364 reports of under-eighteens coming in to the emergency room due to alcohol poisoning. "In hospital, we only see the tip of the iceberg. Not all young people with alcohol intoxication are admitted and, moreover, admission is not always reported. For example, adolescents who have suffered injuries under the influence of alcohol are often seen by the surgeon or an emergency room doctor rather than the paediatrician. These patients remain outside our registration. So you can expect the figures to reflect a larger social problem," says the PhD student.

The number of reports showed an upward trend; only at the end of the research period was stabilisation visible. With her research, she tries to get a picture of these young people: What does this group look like and what makes young people more likely to be hospitalised due to binge drinking? De Veld: "By identifying certain risk factors around alcohol abuse, more targeted prevention efforts can be made among minors. My research also shows that young people under 15 have often drunk their first glass well before that age. In some cases, the first contact with alcohol leads straight to admission."

"I find the term binge drinking unfortunate. It implies that young people purposefully drink themselves into hospital, but that is usually not the case."

Six shots sometimes enough

What is striking is that the rise in adolescent admissions with acute alcohol intoxication is almost entirely due to admissions deep into the night. One possible explanation is that parties are starting later and later, causing young people to start drinking more often. The doctor finds the term binge drinking unfortunate: "It implies that young people drink themselves into hospital on purpose. This is usually not the case, while those around them are often very worried. Young people of fourteen still have very little tolerance and do not know their limits. They can already fall into a coma at a promillage of 1.8. That amounts to about six shots or beer glasses."

Rules work

That parents would be wise to familiarise young people with alcohol at home to prevent excesses, De Veld believes is a misconception. For instance, figures from the Dutch Trimbos Institute For mental health show that young people who start drinking early are more likely to drink more often and also drink more. "Our research further shows that young people who have permission to drink, drink more and smoke more often. So this also applies to young people who are only allowed to drink on special occasions, such as New Year's Eve. Rules are important and therefore have an effect."

Loes de Veld

Many referrals to mental health services

Young people admitted to hospital with alcohol intoxication are closely monitored and given a drip. The next day, when the youngsters regain consciousness, a paediatrician talks to the youngster and parents. They are invited for follow-up care at the Youth and Alcohol outpatient clinic. The doctor discusses what alcohol does to the body and how the admission went. The psychologist talks to the young person and parents about the home situation and checks whether there are any mental symptoms that led to excessive alcohol consumption. Field's research shows that 15% of young people are referred for psychological support during the aftercare process. ADHD and ADD are the most common mental illness in young people admitted to hospital."

The doctor finds it worrisome that alcohol is still so normalised in our society. De Veld hopes that a trend towards healthier lifestyles will change this. The 2018 National Prevention Agreement sets the goal of reducing alcohol consumption among under-eighteens. One of the goals is to get alcohol-free places where many young people frequent, think sports clubs and other associations. De Veld: "The prevention agreement sets out good goals to achieve this, young people should have less contact with alcohol."

PhD defence

On Friday 16 December, Loes de Veld will defend her PhD thesis 'Only Just 18? Adolescent alcohol intoxication: the Dutch policy approach' at Erasmus School of Health Policy &Management.

PhD student
Loes de Veld
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L. de Veld will defend her PhD dissertation on Friday 16 December 2022
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