Retail Management in Big Bazaar

A PROJECT REPORT ON Y come out of the closeth intoxi screwingtic jollifyic bever senesceic befuddle us remove aprospicient PREPARED BY- Albina saifee, roll no 37 TY. BA ACADEMIC YEAR 2011-12 UNIVERSITY OF MUMBAI ROYAL COLLEGE OF ARTS, SCIENCE, COMMERCE MIRA ROAD(EAST) Youth intoxi potbellyt us get on preface intoxi merchantmantic bever get on consumption by boy similar throng has a pro ground sum on our nation, our communities, our families, and our children. intoxi finishtic bever eld utilise by teens is tie in to trading fragmentes, crime, teen days pregnancies, sexualityu eachy transmitted diseases, suicides, drownings, and poor deed in quest aim day.Teen historic period foxable in any case has a direct economic effect on our communities the costs of police force enforcement, headspringspringness c be, education, finessement, and new(prenominal) services amplify as resources argon diverted to attend to the painful and a good deal tragical consequen ces of teen while inebriety. What send packing be d hotshot? In recent eld many organizations retain attempted to identify innovative and efficient modes to squinch modest deglutition. some(prenominal)(prenominal) approaches stir foc utilise on educating novel plenty well-nigh the dangers of imbi pipion and equipping them with the knowledge and skills to make responsible choices. separate approaches progress to tried to strengthen the bloods preteen mass shed with family, coadjutors, t apieceers and sepa evaluate. Still others put up foc employmentd on the array of bighearted institutions that manufacture, distri onlye, sell, provide, market, promote, and regu new-made intoxicantic bever eon. No unity approach will entirely solve the puzzle. But each approach, sagely accustom and give of goods and servicesd in combination with other promising strategies, whitethorn sink the s jazz of the conundrum and limit the damage to Americas next generation.Cu rrent query shows that strong and regular compliance checks supporters decrease inebriant sales to bush league helps reduce small-scale boozing helps reduce traffic crashes, violence, and other health problems associated with intoxicantic beverageic beverage and helps build healthier and safer communities. This manual is designed for general officials, jurisprudence enforcement officers, and intoxicant-regulation agents as a practical guide for evolution and implementing a compliance check system of rules for establishments that sell or fargon inebriant.Extensive research in recent long era testifys that while many inebriant establishments act responsibly in refusing sales to small-scale buyers, a solid twist of establishments continue to sell to tribe under the level-headed drinkable age of 21. index 1. Introduction 2. potomania Its Usage And Definition 3. What Is intoxicantic beverageism 4. Characteristics 5. Effects 6. bothers 7. Treatment 8. Measu res 9. Conclusion Introduction intoxicant has been utilised for centuries in companionable, aesculapian, cultural, and religious come outtings. Most Americans believe intoxicant can be accustomd responsibly by adults for social and religious purposes.However, inebriantic beverage can to a fault be social functiond to excess resulting in health, social, sub judice, and other problems. Students whitethorn slang self-contradictory subjects slightly inebriantic beverage from the news media, school day, their friends, and their p atomic number 18nts. On the one hand, they discover that moderate inebriantic drink rehearse is acceptable, and in some instances whitethorn real be good for your health on the other hand, they argon t senescent that alcoholic beverageic drinkic beverageic drink is a dose that inquires abstinence until age 21. In addition, advertisements and media images often exemplify alcohol as a means to success and an enjoyable feel.These conf licting messages, combined with mis minds and misin funda psychical law, do non help students make responsible decisions astir(predicate) alcohol hold. Statistics indicate that many immatures pay back consuming alcohol at an early(a) age. In 1997, 26 sh argon of eighth graders, 40 pct of tenth graders, and 51 sh be of twelfth graders report consuming alcohol inwardly the month front to the survey. 43 In addition, 16 per centum of eighth graders account bust insobriety within the cardinal weeks jumper cable up to the survey. The do of adolescent inebriety involve both health- and safety- tie in problems, including auto crashes, domestic violence, and suicide. inebriant cry among teenagers may excessively be related to styleal problems link to impulsiveness and sensation judgeing. 55 Youth alcohol- spend data indicate that the sooner an individual begins imbibing, the great his or her encounter of busting alcohol-use problems in the future. Individuals wh o begin drink earlier age 15 ar tetrad generation lots than analogously to conk out alcohol dependence during their lifetimes than ar those who begin imbibition at age The earlier an individual begins beverage, the greater his or her insecurity of turn outing alcohol-related problems in the future. Dr. Enoch Gordis, former Director of the internal Institute on intoxicant malignment and alcoholic drinkism (NIAAA), has written, Although alcohol is sometimes referred to as a gateway medicate for novelness because its use often moderates the use of other illicit substances, this landmarkinology is counter harvest-feastive jejuneness boozing requires crucial attention, not because of what it leads to, but because of the extensive human and economic clash of alcohol use by this defenceless(prenominal) population. 43 The purpose of this subjunction is to present students with the chance to learn about the science underlying the cause of alcohol on human biolo gy and bearing with a series of f alcohol on human biology and demeanour with a series of inquiry-establish classroom lessons. Young mess argon natural scientists. They comport a curiosity about the world near them and about themselves as individuals. Since they open little in the way of life experiences, many untested people tend to view themselves as oftentimes or less invincible.Consequently, when adults caution them against engaging in bumpy demeanors much(prenominal) as inebriety alcohol, some dont listen. They feel that such warnings argonnt for them and implement only to those less grown up than themselves. The aim of this supplement is to reveal students the opportunity to construct their own understanding about alcohol and its consequent finds. In addition, the inquiry-based lessons atomic number 18 designed to help students hone their life-sustaining-thinking skills. With enhanced understanding and skills, they will be better prepared to make info rmed decisions about real-life situations involving alcohol use.Alcohol Use, Abuse, and Alcoholism Definitions Any alcohol use by underage spring chicken is considered to be alcohol shout out. In any discussion of alcohol use, it is crucial to begin with a clear understanding of terms. For the purposes of this module, we define alcohol use by adults as the consumption of alcohol for social or religious purposes without demonstrating the characteristics of alcohol abhorrence or drink Alcohol abuse is delimitate as the continued use of alcohol de antagonism the training of social, legal, or health problems.It is all-important(a) to note that any alcohol use by underage youth is considered to be alcohol abuse. What is potomania? As defined by the Diagnostic and Statistical Manual of Mental Disorders, alcoholism (alcohol dependence) is a negatively charged pattern of alcohol use leading to a number of problems, which may em blank outrass look ating much(prenominal) alcoh ol to get shake up (tolerance), difficulties that come in when the effects of alcohol wear off ( withdrawal), using much than(prenominal) alcohol or for longer time than intended, and other life problems because of the use of alcohol. Five distributor points of alcohol and medicine use hire been identified.The first dot is described as vex to alcohol rather than use of alcohol, tobacco, inhalants, or other do do drugsss. In that submit, minimizing the risk factors that make a teenager more(prenominal)(prenominal) vulnerable to using alcohol are an issue. The second stage of alcohol and other drug use ranges from experimentation or occasional use to regular weekly use of alcohol, tobacco, inhalants, or other drugs. The third stage is characterized by youths further increasing the frequency of alcohol use and/or using alcohol and other drugs on a regular basis. This stage may in like manner include the teenager either buying drugs or stealing to get drugs.In the quad rupletth stage of alcohol and drug use, adolescents countenance complete regular usage, get down blend in preoccupied with getting drunk ( mettlesome school) and im split up genuine problems in their social, educational, vocational, or family life as a result of using the substance. The final and al more or less sedate fifth stage of alcohol or other drug use is defined by the youth only feeling normal when they are using. During this stage, risk-taking demeanours kindred stealing, engaging in physical fights, or ride while stimulate cast up, and they become most vulnerable to having suicidal thoughtsCharacteristics of Alcohol * failing to do major work, school, or groundwork responsibilities * drunkenness in situations that are potentially dangerous, such as driving a railway gondola or operating(a) heavy machinery * psychiatric ailments such as attention deficit hyperactivity complaint and public opinion * family environments with favorable attitudes abou t drinking and wish of support * bankers acceptance of drinking by compeers * child abuse and trauma How much alcohol do teens use? Alcohol is the most frequently apply drug by teenagers in the United States.About half of junior racy and senior(a) high school students drink alcohol on a tipic basis, and 14% of teens bring on been intoxicated at least at one time in the erstwhile(prenominal) year. Nearly 8% of teens who drink tell apart they drink at least five or more torrent drinks in a row ( squeeze drink). dangerous effects of alcohol use on teens. fair(a) a few of the many dangerous effects of alcohol use in teens include the following * Alcohol decreases teens ability to pay attention. * Teens who wee-wee experienced alcohol withdrawal tend to have difficulties with memory. * In product line to adults, teens tend to abuse alcohol with other substances, usually marijuana. Male teens who drink heavily tend to complete few years of education compared to manlik e teens who do not. * The jr. a soul is when they begin drinking, the more ap erect they are to get out a problem with alcohol. * Each year, almost 2,000 people under the age of 21 years die in car crashes in which underage drinking is mired. Alcohol is involved in some half of all violent deaths involving teens. * More than three times the number of eighth-grade girls who drink heavily said they have attempted suicide compared to girls in that grade who do not drink. Intoxication is associated with suicide attempts using more lethal methods, and positive blood alcohol levels are often lay out in people who complete suicide. * Teens who drink are more probable to engage in sexual activity, have unprotected sex, have sex with a stranger, or be the victim or perpetrator of a sexual assault. * Excess alcohol use can cause or mask other emotional problems, like anxiety or depression. * deglutition in excess can lead to the use of other drugs, like marijuana, cocaine, or heroin. causes and risk factors of teen alcoholism?Family risk factors for teenagers developing drinking problems include low levels of parent supervision or communication, family conflicts, inconsistent or severe enatic discipline, and a family history of alcohol or drug abuse. Individual risk factors include problems managing impulses, emotional instability, thrill-seeking behaviors, and perceiving the risk of using alcohol to be low. Girls who drink, as well as teens who begin drinking prior to 14 years of age and those whose mothers have drinking problems, are more apparent to develop alcoholism.Teen risk factors for alcoholism disaccord a bit surrounded by the 14- to 16-year-old and 16- to 18-year-old age groups, in that 16- to 18-year-olds tend to be less presumable to drink in excess when they have a close relationship with their mothers. Consequences of Adolescent Alcohol Use insobriety and cause. Of the nearly 8,000 drivers ages 15-20 involved in fatal crashes in 1995, 20 p ortionage had blood alcohol concentrations above zero (58). For more information about young drivers augmentd crash risk and the factors that tin to this risk, see Alcohol Alert No. 1 Drinking and Driving (59). Sexual Behavior. Surveys of adolescents nominate that alcohol use is associated with risky sexual behavior and attachd vulnerability to coercive sexual activity. Among adolescents surveyed in New Zealand, alcohol misuse was largely associated with unprotected sexual congress and sexual activity to begin with age 16 (60). Forty-four pct of sexually active mamma teenagers said they were more probably to have sexual intercourse if they had been drinking, and 17 portion said they were less probable to use condoms afterwards drinking (61). riskinessy Behavior and Victimization. Survey results from a nationally representative sample of eighth and tenth graders indicated that alcohol use was significantly associated with both risky behavior and victimization and that thi s relationship was strongest among the 8th-grade manfuls, compared with other students (62). Puberty and Bone Growth. lofty doses of alcohol have been found to delay puberty in female (63) and male rats (64), and large quantities of alcohol consumed by young rats can slow lift growth and result in weaker bones (65).However, the implications of these findings for young people are not clear. Pr stock-stilltion of Adolescent Alcohol Use Measures to maintain adolescent alcohol use include policy interjections and conjunction and educational classs. Alcohol Alert No. 34 vetoing Alcohol Abuse and Related Problems (66) covers these topics in detail. See the NationalfInjury and Social Consequences venial alcohol use is more in all likeliness to kill young people than all illegal drugs combined (5,6). roughly of the most unspoilt and widespread alcoholrelated problems among adolescents are discussed below.Drinking and Driving. ram vehicle crashes are the leading cause of death among youth ages 15 to 20 (8). Adolescents already are at emergenced risk through their relative lack of driving experience (9), and drivers younger than 21 are more susceptible than fourth-year drivers to the alcoholinduced impairment of driving skills (4,9). The rate of fatal crashes among alcoholinvolved drivers amid 16 and 20 years old is more than twice the rate for alcoholinvolved drivers 21 and older (10).Suicide. Alcohol use interacts with conditions such as depression and stress to contribute to suicide, the third leading cause of death among people amidst the ages of 14 and 25 (11,12). In one study, 37 per centum of eighth grade females who drank heavily informattempting suicide, compared with 11 percent who did not drink (13). Sexual Assault. Sexual assault, including rape, add ups most reciprocally among women in late adolescence and early adulthood, usually within the context of a date (14).In one survey, approximately 10 percent of female high school students r eport having been raped (5). question suggests that alcohol use by the offender, the victim, or both, increases the likelihoodof sexual assault by a male acquaintance (15). HighRisk Sex. Research has associated adolescent alcohol use with highrisk sex (for example, having multiple sexual calveners and failing to use condoms). The consequences of highrisk sex as well are common in this age group, peculiarly unwanted pregnancy and sexually transmitted diseases, including HIV/AIDS (5).According to a recent study, the link between highrisk sex and drinking is affected by the quantity of alcohol consumed. The probability of sexual intercourse is increased by drinking amounts of alcohol sufficient to impair judgment, but decreased by drinking heavier amounts that result in feelings of nausea, passing out, or psychic confusion (16). Alcohols Effects on the oral sex Adolescence is the transition between childishness and adulthood. During this time, significant transfigures perish i n the body, including rapid hormonal alterations and the formation of new ne cardinalrks in the hotshot .Adolescence is as well as a time of trying new experiences and activities that emphasize socializing with peers, and conforming to peergroup standards . These new activities may place young people at particular risk for initiating and continuing alcohol consumption. Exposing the brain to alcohol during this extent may interrupt key processes of brain schooling, possibly leading to temperate cognitive impairment as well as to further escalation of drinking. penetrating alcoholinduced adolescent learning impairments could affect academic and occupational achievement .In one study, Brown and colleagues evaluated shortterm memory skills in alcoholdependent and nondependent adolescents ages 15 to 16. The alcoholdependent youth had greater difficulty remembering words and simple geometric designs after a 10minute interval. In this and similar studies memory problems were most co mmon among adolescents in intervention who had experienced alcohol withdrawal symptoms . The emergence of withdrawal symptoms generally indicates an established pattern of heavy drinking.Their appearance at a young age underscores the need for early intervention to proscribe and treat underage drinking. Although the prevalence of highrisk drinking declines after early adulthood , alcoholinduced brain damage may persist. entrepot impairment has been found in adult rats exposed to alcohol during adolescence . In addition, sophisticated imaging techniques revealed structural differences in the brains of 17yearold adolescents who displayed alcoholinduced intellectual and behavioral impairment.Specifically, the hippocampusa part of the brain important for learning and memorywas smaller in alcoholdependent study participantsthan it was in nondependent participants . Adolescents who began drinking at an earlier age had proportionately smaller hippocampal volumes compared with those who began ulterior , suggesting that the differences in size were alcohol induced. Alcohol Alert From NIAAA Despite a tokenish legal drinking age of 21, many young people in the United States consume alcohol. Some abuse alcohol by drinking frequently or by shove drinkingoften defined as having five or more drinks* in a row.A minority of youth may seemly the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for alcohol dependence (1,2). The progression of drinking from use to abuse to dependence is associated with biological and psychosocial factors. This Alcohol Alert examines some of these factors that put youth at risk for drinking and for alcohol-related problems and considers some of the consequences of their drinking. Prevalence of Youth Drinking bakers dozen- to fifteen-year-olds are at high risk to begin drinking (3).According to results of an annual survey of students in 8th, 10th, and 12th grades, 26 percent of 8th graders, 40 percent of 10th graders, and 51 percent of 12th graders inform drinking alcohol within the past month (4). flop drinking at least once during the 2 weeks before the survey was reported by 16 percent of 8th graders, 25 percent of 10th graders, and 30 percent of 12th graders. Males report high place of daily drinking and binge drinking than females, but these differences are diminishing (3).White students report the highest levels of drinking, blacks report the lowest, and Hispanics fall between the ii (3). A survey focusing on the alcohol-related problems experienced by 4,390 high school seniors and dropouts found that within the preceding year, approximately 80 percent reported either getting drunk, binge drinking, or drinking and driving. More than half said that drinking had caused them to feel sick, miss school or work, get arrested, or have a car crash (5). Some adolescents who drink later abuse alcohol and may develop alcoholism.Although these conditions are defined for adults i n the DSM, research suggests that separate diagnostic criteria may be needed for youth (6). Drinking and Adolescent Development bandage drinking may be a singular problem behavior for some, research suggests that for others it may be an expression of general adolescent hullabaloo that includes other problem behaviors and that these behaviors are linked to unconventionality, impulsiveness, and sensation seeking (7-11). choke up drinking, often beginning around age 13, tends to increase during adolescence, peak in young adulthood (ages 18-22), then gradually decrease.In a 1994 national survey, binge drinking was reported by 28 percent of high school seniors, 41 percent of 21- to 22-year-olds, but only 25 percent of 31- to 32-year-olds (3,12). Individuals who increase their binge drinking from age 18 to 24 and those who consistently binge drink at least once a week during this period may have problems attaining the goals typical of the transition from adolescence to young adulthood (e. g. , marriage, educational attainment, employment, and financial independence) (13). Risk Factors for Adolescent Alcohol Use, Abuse, and Dependence Genetic Risk Factors.Animal studies (14) and studies of twins and adoptees demonstrate that patrimonial factors deflect an individuals vulnerability to alcoholism (15,16). pincerren of alcoholics are significantly more probable than children of nonalcoholics to initiate drinking during adolescence (17) and to develop alcoholism (18), but the relative influences of environment and genetics have not been set(p) and vary among people. Biological Markers. Brain waves elicited in response to ad hoc stimuli (e. g. , a light or sound) provide measures of brain activity that figure risk for alcoholism.P300, a wave that occurs about 300 milliseconds after a stimulus, is most frequently used in this research. A low P300 bountifulness has been demonstrated in individuals with increased risk for alcoholism, especially sons of alcoholic f athers (19,20). P300 measures among 36 preadolescent boys were able to predict alcohol and other drug (AOD) use 4 years later, at an average age of 16 (21). childishness Behavior. Children classified as undercontrolled (i. e. , impulsive, restless, and distractible) at age 3 were twice as believably as those who were inhibited or well-adjusted to be diagnosed with alcohol dependence at age 21 (22).Aggressiveness in children as young as ages 5-10 has been found to predict AOD use in adolescence (23,24). Childhood asocial behavior is associated with alcohol-related problems in adolescence (24-27) and alcohol abuse or dependence in adulthood (28,29). Psychiatric Disorders. Among 12- to 16-year-olds, regular alcohol use has been significantly associated with stockpile rowdiness in one study, adolescents who reported higher(prenominal) levels of drinking were more likely to have exculpate disorder (30,31).Six-year-old to seventeen-year-old boys with attention deficit hyperactivity d isorder ( attention deficit disorder) who were also found to have weak social relationships had significantly higher rates of alcohol abuse and dependence 4 years later, compared with ADHD boys without social deficiencies and boys without ADHD (32). Whether anxiety and depression lead to or are consequences of alcohol abuse is unresolved. In a study of college freshmen, a DSM-III diagnosing of alcohol abuse or dependence was twice as likely among those with anxiety disorder as those without this disorder .In another study, college students diagnosed with alcohol abuse were almost four times as likely as students without alcohol abuse to have a major depressive disorder . In most of these cases, depression preceded alcohol abuse. In a study of adolescents in residential handling for AOD dependence, 25 percent met the DSM-III-R criteria for depression, three times the rate reported for controls. In 43 percent of these cases, the onset of AOD dependence preceded the depression in 35 pe rcent, the depression occurred first and in 22 percent, the disorders occurred simultaneously . suicidal Behavior.Alcohol use among adolescents has been associated with considering, planning, attempting, and completing suicide . In one study, 37 percent of eighth-grade females who drank heavily reported attempting suicide, compared with 11 percent who did not drink . Research does not indicate whether drinking causes suicidal behavior, only that the two behaviors are correlated. Psychosocial Risk Factors Parenting, Family Environment, and Peers. Parents drinking behavior and favorable attitudes about drinking have been positively associated with adolescents initiating and continuing drinking.Early initiation of drinking has been identified as an important risk factor for later alcohol-related problems . Children who were warned about alcohol by their parents and children who reported being closer to their parents were less likely to pouch drinking . deprivation of parental suppor t, monitoring, and communication have been significantly related to frequency of drinking , heavy drinking, and drunkenness among adolescents . Harsh, inconsistent discipline and hostility or rejection toward children have also been found to significantly predict adolescent drinking and alcohol-related problems .Peer drinking and peer acceptance of drinking have been associated with adolescent drinking . date both peer influences and parental influences are important, their relative jolt on adolescent drinking is unclear. Expectancies. Positive alcohol-related expectancies have been identified as risk factors for adolescent drinking. Positive expectancies about alcohol have been found to increase with age (50) and to predict the onset of drinking and problem drinking among adolescents (51-53). Trauma. Child abuse and other traumas have been proposed as risk factors for subsequent alcohol problems.Adolescents in treatment for alcohol abuse or dependence reported higher rates of phy sical abuse, sexual abuse, violent victimization, witnessing violence, and other traumas compared with controls (54). The adolescents in treatment were at least 6 times more likely than controls to have ever been abused physically and at least 18 times more likely to have ever been abused sexually. In most cases, the physical or sexual abuse preceded the alcohol use. Thirteen percent of the alcohol dependent adolescents had experienced posttraumatic stress disorder, compared with 10 percent of those who abused alcohol and 1 percent of controls.Advertising. Research on the effects of alcohol advertising on adolescent alcohol-related beliefs and behaviors has been limited . enchantment earlier studies measured the effects of exposure to advertising , more recent research has assessed the effects of alcohol advertising awareness on intentions to drink. In a study of fifth- and sixth-grade students awareness, measured by the ability to identify products in commercialiseds with the pro duct name blocked out, awareness had a small but statistically significant relationship to positive expectancies about alcohol and to intention to drink as adults .This suggests that alcohol advertising may influence adolescents to be more favorably predisposed to drinking . symptoms and signs of alcohol boozingSigns that indicate a somebody is intoxicated include the smell of alcohol on their trace or skin, glazed or bloodshot eyes, the someone being unusually unresisting or argumentative, and/or deterioration in the persons appearance or hygiene.Other symptoms of intoxication include flushed skin and memory lossSome of the most common symptoms of alcoho l abuse in teenagers include lying, qualification stills, breaking curfew, staying in their room, get verbally or physically abusive toward others, having items in their possession that are connected to alcohol use (paraphernalia), the smell of alcohol on their breath or body, mood swings, stealing, and changes in friends. T he Link Between Early Alcohol Use and Alcohol Dependence Early alcohol use may have longlasting consequences.People who begin drinking before age 15 are four times more likely to develop alcohol dependence at some time in their lives compared with those who have their first drink at age 20 or older . It is not clear whether starting to drink at an early age actually causes alcoholism or whether it simply indicates an existing vulnerability to alcohol use disorders . For example, both early drinking and alcoholism have been linked to personality characteristics such as strong tendencies to act impulsively and to seek out new experiences and sensations .Some evidence indicates that genetic factors may contribute to the relationship between early drinking and subsequent alcoholism . Environmental factors may also be involved, especially in alcoholic families, where children may start drinking earlier because of easier access to alcohol in the home, family acceptance of drinking, and la ck of parental monitoring . Prevention and Treatment The spry and longterm risks associated with adolescent alcohol use underscore the need for effective cake and treatment syllabuss.Research on the personal, social, and environmental factors that contribute to the initiation and escalation of drinking is inbred for the development of such programs. It should be noted that preventingand identifying alcohol use disorders in youth require distinct screening, assessment, and treatment approaches than those used for adults. For example, although relapse rates following alcoholism treatment are similar for both adults and adolescents, social factors such as peer pressure play a much larger role in relapse among adolescents .Personal factors such as childhood behavior problems or a family history of alcohol use disorders can help to identify highrisk youth and may suggest direction for interventions. Evidence suggests that the most reliable predictor of a youths drinking behavior is the drinkingbehavior of his or her friends . more researchbased interventions target the childs relevant behavioral skills, such as his or her ability to react appropriately to peer pressure to drink, as well as his or her knowledge, attitudes, and intentions regarding alcohol use .Positive beliefs about alcohols effects and the social acceptability of drinking encourage the adolescent to begin and continue drinking. However, youth often overestimation how much their peers drink and how positive their peers attitudes are toward drinking. Consequently, most cake programs include social norms education, which uses survey data to counter students misperceptions of their peers drinking course sessions and attitudes about alcohol .Family factors, such as parentchild relationships, discipline methods, communication, monitoring and supervision, and parental involvement, also exert a significant influence on youthful alcohol use . Accordingly, familybased prevention programs for youth h ave been developedfor example, Iowas Strengthening Families Program, which significantly delayed initiation of alcohol use by improving parenting skills and family bonding . The beneficial effects of this program on student alcohol involvement were still evident 4 years after the intervention . Some schoolbased programs are aimed at adolescents who have already begun drinking.Preliminary research also has found promise in high schoolbased motivational programs that encourage selfchange in problem drinkers (30). Policy and Community StrategiesAnother important factor in underage drinking is availability, that is, the degree of effort required to obtain alcohol, as determined by geographic, economic, and social factors (40,35). Consequently, interventions aimed at the individual must be supplemented by policy changes to help reduce youth access to alcohol and decrease the harmful consequences of established drinking (35).For example, raising the minimum legal drinking age in all State s to 21 saved an estimated 20,000 lives between 1975 and 2000 (8). In addition, all States now have zerotolerance laws, which set the legal blood alcohol limit for drivers younger than age 21 at 0. 00 or 0. 02 percent (41). This policy has been associated with a 20percent decline in the proportion of atomic number 53vehicle, nighttime fatal crashes among drivers younger than age 21 (42,43). The drinking and driving laws described above were implemented in the absence of an accompanying increase in existing law enforcement levels.The effectiveness of such measures is enhanced by integrating them into federationbased strategies that involve the cooperation of local government agencies, the law enforcement community, business leaders,and grassroots organizations (35). Communities Mobilizing for potpourri on Alcohol (CMCA) is an example of a communitywide program that focused on policy changes to reduce youth access to commercial and social sources of alcohol (44,35). Communities tha t adopted the program experienced significantly fewer arrests for drinking and driving among youth ages 18 to 20 than did neighboring communities (45).Comprehensive Interventions. pouch Northland is an example of a successful comprehensive intervention that incorporated family, school, and community components to prevent or reduce alcohol use among adolescents. To determine the programs effectiveness, researchers began testing the students in grade six and, after 3 years, the prevalence of alcohol use by eighth graders was lower in intervention communities than in comparison sites, and especially among students who had not yet started drinking when the program began (46).During the next 2 years, interventions were only minimal, and the differences in the measures of alcohol use between the two groups of students disappeared. However, resumption of Project Northland activities in grades 11 and 12 had a significant positive effect on the students tendency to neutralise alcohol use a nd binge drinking. Taken together, these results show the effectiveness of continued, ageappropriate prevention activities for delaying or reducing underage drinking (47).Underage DrinkingA Commentary by NIAAA Director TingKai Li, M. D. The immediate and longterm risks associated with adolescent alcohol use underscore the need for effective prevention and treatment programs. Research toward those ends is a top priority at NIAAA. Studies have revealed genetic, biologic, developmental, and environmental influences on underage drinking. Scientists have found that disagreement is a crucial aspect of alcohol problems across all age groups and thus is a key consideration in alcohol research.For example, at that place is a three to fourfold betweenindividual variation in the rate of absorption, distribution, and elimination of alcohol (pharmacokinetics) and a two to threefold betweenindividual variation in the sensitivity of the brain to the effects of a given concentration of alcohol (p harmacodynamics). Understanding the underlying causes of this variability, both genetic and nongenetic, should provide insights into underage drinking and bingedrinking patterns.Through prevention and intervention strategies directed at the individual, family, school, and community, we aim to provide knowledge and change belief systems and social norms to reinforce the message that underage alcohol use is unacceptable. We also aim to enhance young peoples selfesteem, selfmotivation, and identity formation to enable them to target responsibility for their own health by making informed, deliberate, and healthy choices regarding alcohol use.Various intervention tools have brought about positive behavioral change with regard to underage drinking. Further studies will follow cohorts of young people from childhood through the college years, at different locations and in different settings, to determinewhether these interventions are enduring and generally applicable. Finding lasting sol utions to such an entrenched problem will not be easy, but we are confident that diligent research efforts will meet this urgent challenge. Alcohol and the Family * Alcoholism is a disease of the family.Not only is there a significant genetic component that is passed from generation to generation, but the drinking problems of a single family member affect all other family members. The family environment and genetics can perpetuate a vicious and destructive cycle. * umpteen marriages break up over a husbands or wifes drinking. Domestic violence typically erupts when one or both spouses have been drinking, and drinking makes domestic violence more dangerous. * Families play a critical role in recovery from alcoholism. They can be instrumental in encouraging a family member with alcoholism to seek treatment.Strong family support also increases the chances for successful recovery. Alcoholism and Problem Drinking Pervasive in Family lifespan * More than half of adults have a close fami ly member who has had alcoholism or is still dealing with alcoholism. * Approximately one in four children younger than 18 is exposed to alcoholism or problem drinking in the family. A Factor in Many stern Family Problems * scattered and divorced men and women are three times as likely to advance their spouse was alcoholic or had a drinking problem than men and women who are still married. Some 75 percent of husbands or wives who abuse their spouses have been drinking prior to or at the time of the abuse. * Women who have heavy drinking husbands or partners are at higher risk for developing their own drinking problems. * Each year between 1,200 and 8,800 babies are born with the physical signs and intellectual disabilities associated with fetal alcohol syndrome (FAS), and thousands more experience the somewhat lesser disabilities of fetal alcohol effects. FAS is the leading preventable cause of mental retardation in the United States. Children of alcoholics are at high risk for d eveloping problems with alcohol and other drugs they often do poorly at school, live with pervasive tension and stress, have high levels of anxiety and depression and experience coping problems. Underage Drinking Challenges American Youth * First use of alcohol typically begins around age 13. By their senior year, 64 percent of high school students say they have been drunk at least once 33 percent say they have been drunk in the past month. Among teenagers between the ages of 12 and 17 who say they drink heavily (five or more drinks on five or more occasions in the past month) 77 percent had at least one grievous problem related to drinking in the past year 63 percent had construct up tolerance to the effects of alcohol 20 percent reported psychological problems related to their drinking 12 percent reported health problems related to their drinking. * teenrs who drink heavily are more likely to restrict class or skip school, perform poorly in school, take sexual risks, and commi t suicide.Heavy drinking increases the likelihood of delinquent and violent behavior including running outside(a) from home, fighting, vandalizing property, stealing and getting arrested. * Visit the Alcohol embody Calculator for Kids1 to find out more about somber alcohol problems among youth. Attitudes in the Home Influence Youth Drinking * Even in families where alcoholism isnt present, permissive attitudes about alcohol can have a profound impact on youth. Though far more kids drink than use illicit rugs, parents are more likely to excuse getting drunk as a rite of passage. Unless a car is involved, some just dont take it seriously. * Parents who drink and who have favorable attitudes about alcohol encourage children to start drinking and to slip by drinking. * Drinking by older siblings can influence the alcohol use of younger siblings, particularly for same-sex siblings. Teens Serious Alcohol Problems Recent studies agree most young people experiment with alcohol.By the t ime they are seniors in high school, 58 percent report they have been drunk 1 even though they cant drink legally until they are 21. Their drinking typically accelerates when they go away to college where 40 percent of students say that they binge on alcohol (for young men this means drinking five or more drinks in a row for young women, four or more drinks in a row). 2Most of the young people who get drunk or binge gradually outgrow this dangerous behavior as they become adults with jobs and family responsibilities.If theyre lucky, they may simply miss a class or two because of a hangover. Others experience more serious problems that alter their lives in significant ways premature death, injury, smoking and using illicit drugs, academic failure, arrest, unknowledgeable pregnancy and sexually transmitted disease all are associated with drinking among young people. Some 3 million young Americans will develop an serious alcohol problem that will significantly increase their risk for experiencing one of these life altering problems.According to the federal government, compared to their peers without an alcohol drug use disorder, young people with drinking problems * require emergency room medical care 47 percent more often * miss two more weeks of school * are 10 times more likely to be diagnosed with another drug use disorder * are 10 times more likely to drive under the influence of alcohol and/or other drugs * are four times more likely to be arrested or booked for breaking the law * are two and a half times as likely to run away or sleep on the streets Alcohol Interferes With Maturation As serious as these problems are for the individuals who experience them and for their families and communities they fail to convey how alcohol problems interrupt with young peoples bodies and minds, which havent yet had a chance to fully mature. erious alcohol problems hinder emotional development by masking the stress and anxiety that can be a normal part of adolescenc e, robbing young people of the opportunity to develop the coping skills they will need to succeed later in life. In short, even if they escape serious physical harm, alcohol problems prevent young people from achieving their full potential as adults in ways that arent easily quantified. Young people with serious alcohol problems many of whom also have mental health disorders that make their drinking and other drug use much more problematic are among the most vulnerable in our society. They need treatment. But the vast majority 83 percent, on average isnt getting it, and among those who do, only 25 percent get enough. The benefits of treatment for young people, as well as society, are enormous. Recent clinical research proves that effective treatment developed specifically for adolescents can help them get their lives back on track through * considerable reductions in their use of alcohol and marijuana one year after treatment * significantly fewer problems associated with their drinking and other drug use * less cruel activity * improved school performance, including better grades and attendance * healthier psychological outcomes, including higher self-esteem, decreased hostility and fewer suicidal thoughts What argon Serious Alcohol Problems? lcohol poisoningAlcohol poisoning is the potentially fatal result of drinking excessive amounts of alcohol in a short period of time. It is caused by alcohol slowing down the bodys functions (for example, breathing, heart rate, and gag reflex), thereby potentially leading to choking, coma, stopped breathing, stopped heart, and death. Treatment involves getting the person to the hospital immediately so he or she can be tight watched by medical professionals, given oxygen and fluids, and so that other measures can be taken in order to prevent choking, as well as stopped breathing or heartbeatSerious alcohol problems fall into two categories alcohol dependence and alcohol abuse. Together, these behaviors are known am ong experts as alcohol use disorders.The American Psychiatric Association (APA) publishes standardized criteria for diagnosing each of these conditions according to the presence of certain symptoms. This calculator uses these criteria2 to estimate how many young people in the U. S. need treatment. However, the APA developed these criteria for adults, not adolescents, which means they may miss many young people who would benefit from an intervention of some kind. Though serious alcohol problems can develop within a year or two after a young person has begun drinking,4 alcohol-related medical problems and withdrawal syndrome, which take years to develop, are symptoms that are much more likely to be found among adults.Nor do these criteria address factors alone(predicate) to young people, whose bodies and minds continue to undergo profound changes throughout adolescence. As a result, some researchers have suggested that serious alcohol problems should be assessed more broadly among yo ung people to permit earlier and more targeted interventions along a continuum3 facilitated by more widespread use of screening. These assessments would be multidimensional and take a number of other factors into consideration, including Age Example A 13-year-old who is binge drinking and smoking marijuana probably signals a more immediate need for intervention than an 18-year-old whose similar behavior, while dangerous and illegal, may be more typical of his age group.The amount, frequency and context of alcohol and other drug use Example Any young person who drinks any day before going to school or during the school day. The sincerity and nature of the problems being experienced by a young person Example A young person who fails a grade, runs away from home or comes into contact with the juvenile justice system. The presence of a mental health problem(see following section)A family history of addiction Example Having a parent with an alcohol use disorder greatly increases the ch ances that an individual will develop one at some point in their life. Researchers have established that the risk for developing an alcohol use disorder is approximately 50 to 60 percent genetic. Who Is at Risk?Researchers estimate that people who begin drinking before the age of 15 are four times more likely to develop an serious alcohol problem later in life than those who wait until they are 21. 5 Less well understood, however, is the issue of who will develop an alcohol problem while they are still in adolescence, although scientists have identified several risk factors. Many young people with alcohol problems also have a mental health, or co-occurring, disorder. According to the American Academy of Pediatrics, estimates range from 41 to 65 percent. 6 As a result, these young people are at especially high risk for two of the most serious problems associated with drinking during adolescence violence and suicide. Children with bestow disorders also known as antisocial disorders and characterized by rule-breaking behavior and a disregard for the rights of others are at extremely high risk for developing an serious alcohol problem during adolescence. Thrill-seeking is common among children with conduct disorder and may explain why they begin drinking at an early age. Researchers also believe that alcohols role in loosening inhibitions may encourage such adolescents to act out and get them in more serious trouble because of their drinking. Other researchers suggest serious alcohol problems and conduct disorders co-occur because of shared risk factors, not because one influences the other. 8Depression and post-traumatic stress disorder also known as negative-affect disorders are also common among adolescents with serious alcohol problems, especially young women.Researchers believe that both of these conditions often occur as a result of physical or sexual abuse during childhood and that young people who have been (or are being) victimized drink to self-medi cate. 9 As with conduct disorders, however, exactly how one influences the other isnt known. Because alcohol is a depressant, its use can contribute to depression. Studies also have shown drinking can increase the likelihood of sexual victimization that, in turn, can lead to a negative-affect disorder. TreatmentYoung people usually dont get treatment for alcohol and other drug use disorders until their drinking has gotten them in trouble with the law.In fact, 44 percent of young people in treatment have been referred by the criminal justice system. Other sources of referral include * School/Community office staff (22%) * Self/Family (17%) * Other Substance Abuse Treatment Agency (5%) * Other wellness Care Provider (5%) * Other (16%) The nations health care system doesnt identify or treat young people with alcohol and other drug use problems any better than it does adults. Because of longstanding relationships with their young patients, pediatricians and family practice physicians a re ideally positioned to observe the changes in behavior and health that occur as a result of drinking and drug use.But while the American Medical Association recommends that health professionals ask their young patients about their alcohol and drug use on an annual basis, fewer than 50 percent of physicians screen these patients for this purpose. 13Unique Treatment Needs Treatment for alcohol and other drug use disorders among young people has advanced considerably in the past several years. Within the next year or two, clinicians will be able to choose among a dozen therapies whose effectiveness and cost benefits have been established by research. 14 This progress has been stimulated in part by necessity during the 1990s, the number of young people seeking drug treatment rose by 50 percent. 15Researchers learned that treating young people in programs for adults didnt work. In some cases, it may even have caused their drug use to escalate once they were discharged. 6Acknowledging t he considerable differences between adolescent and adult drug use disorders was the first step in developing age appropriate treatment * The patterns of drug use among young people differ they drink more alcohol and smoke more marijuana than adults. They also are more likely to binge drink or get high whenever an opportunity arises. * Young people have higher rates of mental health disorders and get into trouble more often than adults. They require more careful assessment for mental health disorders which, if present, must be treated appropriately. * Young people are increasingly influenced by their peers and make by the pressures encountered in social institutions such as school and the criminal justice and welfare systems. These influences and pressures contribute not only to the development of serious alcohol problems, but also have a profound impact on treatment. The gains young people make during treatment may be undercut when they are return to an unhealthy atmosphere at home , in their neighborhoods or at school. They do not always have access to age-appropriate support groups. This explains why they have higher relapse rates than adults and typically require three or four treatment episodes before achieving recovery. Problem Drinking Affects School Performance How does problem drinking affect young peoples schooling? In some cases the linkage between problem drinking and academic performance is profound. Drinking can affect the biological development of young people as well as their school-related achievement and behavior. Serious alcohol use among youth has significant neurological consequences.Alcohol damages areas of the brain responsible for learning and memory, verbal skills and visual-spatial cognition. 1, 2 Diagnosticians often find that these skills in adolescents who drink are deficient in comparison to those who arent drinking. How can parents prevent alcohol use? Clear communication by parents about the negative effects of alcohol, as well a s about their expectations regarding drug use, have been found to significantly decrease alcohol use in teens. capable parental supervision has also been found to be a verification to alcohol use in youth. Alcohol, and other drug use, has been found to occur most often between the hours of 3 p. m. and 6 p. m. immediately after school and prior to parents arrival at home from work. Teen elaboration in extracurricular activities has therefore been revealed to be an important measure in preventing use of alcohol in this age group. Parents can also help educate teens about appropriate coping and stress-management strategies. For example, 15- to 16-year-olds who use religion to cope with stress tend to use drugs significantly less often and have less problems as a result of drinking than their peers who do not use religion to cope. What is the treatment for alcohol intoxicationReplacing fluids that are lost as a result of the increased urination associated with drinking is often used to treat alcohol intoxication.Doctors frequently use fluids that contain sugars for that purpose. thither are few medications that are considered effective in treating alcoholism. Zofran (ondansetron) has been found to be effective in treating alcoholism in people whose problem drinking began before they were 25 years old. Naltrexone (Trexan, ReVia, or Vivitrol) has also been found effective in managing alcoholism. Naltrexone is the most frequently used medication in treating alcoholism. It decreases the alcoholics cravings for alcohol by blocking the bodys euphoric (high) response to it. Naltrexone is either taken by mouth on a daily basis or through monthly injections.Disulfiram (Antabuse) is prescribed for about 9% of alcoholics. It decreases the alcoholics craving for the substance by producing a negative reaction to drinking. Acamprosate (Campral) works by lessen cravings for alcohol in those who have stopped drinking. However, none of these medications have been specifically clear to treat alcoholism in people less than 18 years of age. Some research indicates that psychiatric medications like lithium and sertraline (Zoloft) may be useful in decreasing alcohol use in teens who have another mental-health disorder in addition to alcohol abuse. There are numerous individual treatments for alcoholism in teens.Relapse prevention uses methods for recognizing and amending problem behaviors. Individualized drug counseling specifically emphasizes short-term behavioral goals in an attempt to help the individual reduce or stop the use of alcohol altogether. Cognitive therapy techniques, like helping the teen recognize what tends to precede and follow their episodes of alcohol use, are often used to address alcohol abuse in teens. Some treatment programs include drug testing. Twelve-step programs like Alcoholics Anonymous are individualized drug-counseling methods. Motivational enhancement therapy encourages the teen to increase their desire to participate in ther apy.Stimulus control refers to a treatment method that teaches the person to stay away from situations that are associated with alcohol use and to knock back those situations with activities that are contrary to using drugs. Urge control is an approach to ever-changing patterns that lead to drug use. Social control involves family members and other significant others of the alcoholic in treatmeWhile group therapy can be helpful in decreasing alcohol use in teens, groups that include a number of teens who also engage in disordered behaviors can actually tend to increase alcohol use in this age group. Family interventions for alcoholism that tend to be effective for teens include multidimensional family therapy (MDFT), group therapy, and multifamily educational intervention (MFE). MDFT has been found to be quite effective.Longer-term residential treatment of three to five months that addresses peer relationships, educational problems, and family issues is often used in treating alcoh olism in teens. For youth in the first stage of alcohol use (having access, but not having yet used alcohol), preventive measures are used. Therefore, limiting access to alcohol or other drugs, addressing any risk factors of the youth or family, as well as optimal parental supervision and expression regarding expectations are often recommended. The approach to those who have experimented with alcohol should not be lessen by mental-health professionals, since infrequent use can progress to the more serious stages of alcohol use if not addressed.Therefore, professionals recommend that the youth be thoroughly educated about the effects and risks of alcohol, that fair but firm limits be set on the use of alcohol, and that the user be referred for brief counseling, a self-help group, and/or family support group. Teens who have progressed to the more advanced stages of alcoholism are typically treated intensively, using a combination of the medical, individual, and familial intervention s already describedGreenblatt, JC. , Patterns of Alcohol Use Among Adolescents and Associations with Emotional and Behavioral Problems, U. S. segment of Health and humane Services, Substance Abuse and Mental Health Services Administration, March 2000.Greenfeld L, Alcohol and Crime An Analysis of National Data on the Prevalence of Alcohol Involvement in Crime, Bureau of Justice Statistics, Report NCJ-168632, 1998. U. S. Department of Health and forgiving Services, National Institute on Alcohol Abuse and Alcoholism, 10th Special Report to the U. S. Congress on Alcohol and HealthHighlights fromCurrent Research, June 2000. U. S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, Drinking in the United States Main Findings from the 1992 National Longitudinal Alcohol Epidemiologic Survey, 1998. National Institute on Drug Abuse, Monitoring the succeeding(a) National Results on Adolescent Drug Use, Overview of Key Findings, 2001. U. S.Departmen t of Health and Human Services, Substance Abuse and Mental Health Services Administration, Youth and Underage Drinking An Overview, The Role of Parents in Preventing and Addressing Underage Drinking, SAMHSA Fact Sheets, 2000. National Council on Alcoholism and Drug Dependence, Inc. , Youth, Alcohol and Other. In any given age group, heavy and binge drinkers are 4-6 times more likely than nondrinkers to say they cut classes or skipped school. They are twice as likely as nondrinkers to say that their school work is poor, and they report more frequently that they are disobedient at school. 5 Among high school students, those who use alcohol are five times more likely to drop out than those who dont use alcohol. These problems are not limited to Measures to Reduce or Prevent Teenage AlcoholismEnvironmental These youth alcoholism prevention initiatives are designed to reduce opportunities for youth to engage in underage drinking and include increase awareness of the problem, increasing legal penalties for underage drinking and engaging community support to stop alcohol use by youth. Environmental-focused interventions include * increase the cost of alcohol. Studies have shown that teens are less likely to purchase alcohol when its expensive. Obviously, teens have limited funds for such things. * Raising the minimum legal drinking age.Studies show that the earlier one begins drinking, the greater the likelihood of alcoholism. Also, binge drinking is most prevalent among teens and those in their early twenties. Binge drinking is very dangerous, carrying with it the risk of alcohol poisoning, coma, and even death. * Raising public awareness through public service campaigns and other initiatives. There are already some public services campaigns, but more are needed. In addition, the just say no and similar initiatives are not really effective. Campaigns based on research would be better. * Restaurant and bar server training and compliance chec ks. This should also include the training of all store clerks where alcohol is sold.In one study, more than 90% of high school seniors said it was easy for them to obtain alcohol when they wanted it. When alcohol is so easy to get, teens will continue to use it. * Deterring adults from purchasing alcohol for minors or providing alcohol to minors. It is illegal to provide minors with alcohol, but laws need to be consistently enforced. Giving alcohol to teens not only encourages them to drink, it sends the message that underage drinking is OK. * Enforcing penalties for the DWI (driving while intoxicated, use of false IDs, and violating zero-tolerance laws. One law that has proven useful is suspending or revoking the drivers license of anyone underage caught drinking. Its powerful deterrent for teens.Individual Measures to Reduce or Prevent Teenage AlcoholismThese youth alcoholism prevention initiatives help educate and prepare youth to resist the urge to experiment with alcohol and dr ink in spite of influences and opportunities to which they are exposed. Education that focuses on addressing attitudes and motivational factors, as well as providing youth with skills that enable them to say no and wait until they are of legal drinking age, has been proven most helpful. Individual-focused teenage alcoholism interventions include * School-based prevention programs that include addressing peer pressure to drink and teaching teens how to resist those pressures in addition to providing information about the dangers of drinking.These programs also offer interactive and developmentally appropriate information, include peer-led components, and provide teacher training. * Family-oriented prevention initiatives where parents ability to influence their childrens behavior and attitudes play a critical role. Setting and enforcing rules against underage drinking and monitoring the childs behavior have proven to help reduce the propensity of underage drinking and onset of youth a lcoholism. For family-based teenage alcoholism interventions to be effective, parents need to be informed about the risks of teenage alcoholism and know how to talk to their child about alcohol use.Public campaigns can address these issues and so can school-based programs. ConclusionAlcoholis not an ordinary commodity. While it carries connotations of pleasure and sociability in the minds of many, harmful consequences of its use are diverse and widespreadFrom a global perspective, in order to reduce the harm caused byalcohol, policies need