The
wonderful holiday of Purim is once again on the horizon and, along with the
feasting and fun, comes the yearly challenge of teenage drinking. Many of us
would like to say to our teens, “If you are offered alcohol, just say no,” and
if they listened, there would be no need for this article. The reality,
however, is that teenage drinking on Purim is common and perhaps even
encouraged (or at least accepted) in some parts of our community. The purpose
of this article, therefore, is to present harm reduction strategies for
teenagers who choose to drink on Purim.
We
understand that there are some who do not appreciate the concept of harm
reduction because they feel that it implies permission to use substances. I
feel that there is a difference between permitting a behavior and accepting
that it may occur with or without our permission. We consider harm reduction
when someone is unwilling to refrain from substance use but might benefit from
strategies to reduce some of the negative consequences that come from using
alcohol or drugs. I look at harm reduction as a good opportunity to help people
plan for the often unintended risks of their behavior – because use of harm
reduction can limit damage and possibly save lives.
It
may feel quite awkward to discuss harm reduction with your children when you
have clearly expressed your desire that they stay away from drugs or alcohol. Yet
a critical part of being a teenager is to ignore our precious advice! While
teenagers often underestimate the dangers of substance use, they may appreciate
our concern for their well-being. Introducing a harm reduction plan can keep
our children safe and help ensure that they make it to the next Purim.
While
we have previously presented some of these harm reduction principles in
different contexts, organizing them in one list might help you and your
children consider multiple ways to minimize problems over Purim. Of course,
these principles can be used all year round, and many can be easily applied to
cannabis and other substances used by teenagers.
1)
Understand alcohol equivalence across
beverage types. Some teenagers believe that drinking beer is safer than
drinking shots. These kids have never sat in the 700 level at Veterans Stadium
watching an Eagles game. We should help teenagers understand that standard
alcohol beverages share similar alcohol content: 12 ounces of beer (5% alcohol)
= five ounces of wine (12% alcohol) = 1.5 ounces (shot) of liquor (40%
alcohol). This is not a tricky equation. Each substance, alone or in
combination, causes intoxication and can lead to harm.
2)
Limit the amount of drinking. Intoxication
is a function of alcohol content and how quickly the beverage is consumed and
absorbed into the body. In general, drinking four to five beverages (for boys)
or three to four beverages (for girls) within two hours leads to legal
intoxication (Blood Alcohol Concentration = .08). Everyone is different,
however, and for some, even one small glass of wine can make them disinhibited
and sleepy. Please keep in mind that, because teenagers are less likely to
experience the sedation effects of alcohol, they may also be more likely to
underestimate how much they have consumed. The point is that if you think your
teenager will drink on Purim, it is a good practice to limit drinking to one
beverage per hour.
3)
Increase the amount of time to drink a
beverage. A benefit to drinking beer (instead of other beverages) is that
it often takes longer to consume, thereby reducing levels of intoxication. To
further limit intoxication, beer can be poured from the bottle into a smaller
glass, just as someone on a diet might be encouraged to eat ice cream from a
cup rather than out of the container.
4)
Eat while drinking. Another strategy
to increase the amount of time spent on a single beverage is to eat at the same
time. Food also helps slow the rate that alcohol is absorbed into your body,
further limiting levels of intoxication.
5)
Do not use other drugs while drinking.
Alcohol is a depressant, which means it slows down the activity of the central
nervous system. Drinking while taking other drugs that have sedating effects
(like prescribed drugs designed to reduce anxiety) will intensify intoxication
and sedation and is a leading cause of overdose. For those prone to depression,
this combination can also intensify feelings of sadness. If you take prescribed
medications that have abuse potential (e.g., benzodiazepines, opioids), please
keep them out of the reach of your kids.
6)
Do not use cannabis while drinking. Teenagers
sometimes use alcohol in combination with cannabis, and research into the
impact of taking these substances together is still emerging. What seems to be
the case is that the combination increases alcohol consumption and behavioral
impairment and reduces judgment. It is possible that kids end up drinking more
because they underestimate their level of intoxication. The message is that
kids drinking on Purim should leave the cannabis alone.
7)
Look out for each other. Because
alcohol impairs judgment and enhances disinhibition, teenagers who are under
the influence may engage in behaviors that they might not otherwise do if they
were not drinking. One example is that kids often initiate other drug use while
under the influence of alcohol, remarking later something like, “It seemed like
a good idea at the time.” Some problems like this can be averted when teenagers
look after each other and prevent a drinker from engaging in behavior that he
or she may regret the next day.
8)
Do not drink and drive. In addition
to impairing judgment, alcohol harms coordination. Teenagers should not drink
and drive, should not enter a car when the driver has been drinking, and should
try to persuade a drinker to not get behind the wheel. As we have stated
before, many states, including Maryland, have a zero-tolerance law for drinking
and driving, and driving at even a BAC = .02 (i.e., about one drink) is
illegal. I will mention, too, that cannabis also impairs judgment and
coordination, and driving under the influence of cannabis is also extremely
dangerous.
9)
Devise a back-up plan and emergency
contact. If your teenager is driving to a place where alcohol is served for
Purim, please make sure that they have designated one person who is not drinking
to drive back home. If the drinking will occur at a rabbi’s house, for example,
it seems appropriate to speak with the rabbi about his plans to monitor
drinking and to help kids get home safely. Teenagers should also feel safe to
call their parents if there is nobody sober to drive them home, or at least to
call another friend or take an Uber.
10)
Know when to call 911 or Hatzalah. Every
Purim, there are kids in our community who experience alcohol poisoning, which
can cause hospitalization or death. Alcohol poisoning occurs when the BAC
starts moving past .30; the number of drinks to reach this level varies from
person to person and is also based on how quickly drinks are consumed. Signs of
alcohol poisoning include difficulty remaining conscious, slowed breathing,
confusion, vomiting, clammy skin, and/or seizures. Teenagers who suspect that
someone is suffering an overdose should immediately call Hatzalah (410-358-0000)
or 911 and inform a parent or another responsible adult.
Please
consider using this guide to talk with your teenagers about drinking before
Purim. It could save their life. May we together merit a
happy Purim, a healthy Purim, and, G-d willing, many Purims to come.
