Acute Alcohol Intoxication: Differences in School Levels and Effects on Educational Performance

ABSTRACT

This study examines the effects of acute alcohol intoxication on adolescents' school performance. In the 2007–2015 period, 3,317 adolescents (ages 12 to 17 years) were treated for acute alcohol intoxication, and 37 adolescents were admitted to the hospital twice. Alcohol intoxication has an overrepresentation in “low” school levels. The 37 recidivists were more often male. During the second admittance, the period of non-consciousness was longer (four versus two hours). Six recidivists had lower educational levels when measured during the second admittance. The decline in educational level between the first and second hospital admittance suggests the negative impact of alcohol intoxication on school performances. Additional research is needed on the causal relation between (heavy) alcohol use and child development.

KEYWORDS:

• alcohol intoxication
• pediatric care
• recidivists
• school performance

Introduction

Alcohol intoxication among minors is a serious social health problem (Diestelkamp et al., 2015; Kościelniak & Tomasik, 2016), including in the Netherlands, where an increasing number of adolescents are being hospitalized yearly because of acute alcohol intoxication (Van Hoof, Van Zanten, & Van der Lely, 2013). Binge drinking that leads to a state of reduced consciousness is associated with a negative effect on brain function, particularly for young drinkers (Ellickson, Tucker, & Klein, 2003; Heffernan & O'Neill, 2012; Petit, Maurage, Kornreich, Verbanck, & Campanella, 2014; Tapert, Caldwell, & Burke, 2004). Adolescent binge-drinking behaviors may even result in permanent (negative) consequences regarding school performances (Latvala et al., 2014; Miller, Naimi, Brewer, & Jones, 2007). Undoubtedly, acute alcohol intoxication in adolescents as a result of severe binge drinking is an issue of eminent importance. This study examines the relationship between acute alcohol intoxication and school performance from two perspectives. First, the study examines whether youngsters have different sociodemographic characteristics and alcohol intake circumstances based on their present educational level. Second, the researchers investigate the school performance of adolescents with multiple hospital treatments for acute alcohol intoxication.

Studies from a variety of European countries have demonstrated that less-educated adolescents, compared to more highly educated youths, engage more frequently in health-risk behaviors, particularly alcohol consumption (Casswell, Pledger, & Hooper, 2003; Friestad & Klepp, 2006; Geckova, Van Dijk, Groothoff, & Post, 2002; Hagquist, Sundh, & Eriksson, 2007; Richter & Leppin, 2007; Vereecken, Maes, & De Bacquer, 2004). This trend also exists in the Netherlands; students at the “lower” voorbereidend middelbaar beroepsonderwijs (VMBO), (preparatory vocational education), hoger algemeen voortgezet onderwijs (HAVO) (higher general secondary education), voorbereidend wetenschappelijk onderwijs (VWO) (preparatory academic education) (Verdurmen et al., 2011). However, studies have not yet examined whether these trends are also visible with regard to acute alcohol intoxication. In other words, are youngsters in lower educational levels overrepresented in alcohol abuse treatments? And subsequently, what are the effects of excessive drinking on school performances?

This study examines the relationship between acute alcohol intoxication and school performance from these two perspectives. First, the study examines whether youngsters have different sociodemographic characteristics and alcohol intake circumstances based on their present educational level. Second, the researchers investigate the school performance of adolescents with multiple hospital treatments for acute alcohol intoxication. Possible relationships between alcohol use and school performance are currently unknown and are relevant for health policy and prevention strategies.

Method

This study analyzes data collected by the Nederlands Signaleringscentrum Kindergeneeskunde (NSCK), in which approximately 90% of all Dutch pediatric doctors participate. In the Netherlands, when an adolescent is admitted to a pediatric department, the pediatrician interviews the patient the morning after admittance. The information from that conversation is coded into the questionnaire provided. The pediatric department reports an admission and returns the questionnaire by mail or digitally to the research group. The NSCK data collection began in 2007 and is ongoing, and ethical approval has been given by the ethical committee of the faculty of Behavioral, Management and Social Sciences of the University of Twente. To collect information on alcohol intoxication, the NSCK includes all adolescents (age <18 years) with any amount of alcohol in the blood (concentration >0.0 g/l). For our analyses, we selected patients who had been admitted primarily because of alcohol intoxication and who were unresponsive according to alert, voice, pain, unresponsive (AVPU) criteria.

Variables

The questionnaire used to collect patient information contained questions about educational levels (low, middle, high [as described in the Introduction], and additional categories [such as only primary school or no longer attending school]). Educational performance was measured using the following scale: not repeated, repeated, and dropped out. In addition, the questionnaire contains questions about the general characteristics of the adolescent (gender, age), demographic information, substance use patterns (age of first alcoholic drink, smoking) and intoxication characteristics (blood alcohol content, duration of reduced consciousness, time in hospital and intensive care, and the location of alcohol consumption).

Participants

From 2007 to 2014, a total of 3,478 cases are usable for the current analyses (adolescents with acute alcohol intoxication as the primary reason for hospital treatment, and with gender and age registered). Other reasons for admittance were excluded and involve traffic accidents (N = 105), other accidents (e.g., fractures [N = 138]), aggression/violence (N = 80), suicide attempts (N = 19), multiple reasons (N = 23), and vomiting (N = 2). In this data set of 3,478 patients, we found 37 adolescents (74 cases) who were treated twice for acute alcohol intoxication. The patient group consists of 3,441 patients; 3,404 single treatments and 37 recidivist treatments. Patients are 15.3 years of age on average when treated and 51.9% of the patients are male. Regarding the recidivists, the average period between the two treatments was 71 days (ranging from four days to nearly 3.5 years). In the analyses we compare the characteristics and medical treatment of the 37 recidivists with the other 3,317 patients who were treated just once. Of these 3,317 cases, a usable educational level was available in 2,412 cases.

Data analysis

All data were analyzed using SPSS for Windows, version 21. We recoded all educational levels into the three categories “low,” “middle,” and “high,” which resulted in 2,412 usable educational levels for further analyses in the population of 3,317 patients (73%), and 26 out of the 37 recidivists were recoded in the three categories (70%). To compare the Dutch distribution on educational levels, a dummy SPSS file was constructed, including the spread in the national population (Centraal Bureau voor de Statistiek [CBS], 2016). We compare the percentages of distribution for nominal scales chi-square tests (significance level p < .05), and scales with independent t-tests or ANOVA with post hoc Bonferroni.

Results

In this section, first an analysis of the distribution of school level compared to the Dutch population is presented. Second, we compare the intoxication characteristics of the three groups of patients with different educational levels. Next, we analyze the characteristics of the recidivists and the group of patients treated just once, and finally, we focus on the educational performance of the recidivists.

Distribution of educational level and comparison of low, middle, and high levels

In the Netherlands, 43.3% of all students below 18 years of age receive low level education, 28.0% middle level, and 28.7% high level. In the sample of alcohol-intoxicated youths, the low level is overly represented and the high level is underrepresented: χ²(2, N = 573,379) = 75.38, p < .001. As depicted in Table 1, hospital-admitted adolescents with low educational levels are younger than those from the higher two levels and have a lower blood alcohol content (BAC) during treatment. Gender distribution is equal among the three groups.

Table 1. School level related to age, blood alcohol content, and gender.

Characteristics	Low (N = 1,218)	Middle (N = 662)	High (N = 509)
Sample percentage ^a^*	51.0%	27.7%	21.3%
(N = 2,412)
Dutch population 12- to 18-year-olds^*	43.3%	28.0%	28.7%
(N = 570,990)	(N = 247,492)	(N = 159,847)	(N = 163,651)
Average age^b	15.05 (1.11)^1	15.32 (1.11)^2	15.39 (1.12)^2
BAC gram/liter^b	1.85 (.55)^1	1.97 (.56)^2	1.99 (.53)^2
Gender^a ^n.s.
- Male	50.0%	50.7%	48.5%
- Female	50.0%	49.3%	51.5%

^a Chi-square (non-significant);

^b ANOVA, with Bonferroni post hoc. Identical numbers in superscript represent identical values.

* p < .001.

A total of 10 different drinking locations were identified. Most frequently (43% of all cases) the intoxicated patients reported to have consumed alcohol at a friend's home (41% for low education, 44% for middle, and 47% for high). The second most popular place (24%) to drink was on the streets, where youngsters in the low education level drink more often (27%) compared to the other two levels (both 21%). Other places where youngsters drink are bars (10%), parental house (9%), and school (parties) 4%. These places are equally popular for the three groups.

Recidivists versus non-recidivists

As depicted in Table 2, the 37 recidivists are more often male (73.0%), compared to all patients (51.7% male); χ²(1, N = 3,340) = 5.17, p = .02. The categories of age when intoxicated, age during the first alcoholic drink, educational level and performance, percentage smokers, percentage drug use during drinking event, BAC level, duration of reduced consciousness, duration of hospitalization and intensive care, percentage who use medicine, and drinking location are shown to be equal for recidivists (at their first admittance) and all other patients.

Table 2. Sociodemographic and medical characteristics recidivists compared with all patients.

Characteristics	Non-recidivists (N = 3,404)	Recidivists^a(N = 37)
Gender ^b^*
- Male	51.7%	73.0%
- Female	48.3%	27.0%
Age during treatment ^c(SD)	15.32 (1.19)	15.08 (1.12)
Age at first alcoholic consumption ^c(SD)	14.04 (1.89)	13.67 (2.76)
Educational level ^b
- Low	50.8%	50.0%
- Middle	27.8%	19.2%
- High	21.4%	30.8%
Educational performance ^b
- Not repeated	78.1%	75.0%
- Repeated	19.4%	21.4%
- Dropout	2.5%	3.6%
Smoking ^b	24.6%	20.0%
Combined drug use during alcohol intoxication ^b	11.1%	11.8%
Blood alcohol content gram/liter ^c (SD)	1.91 (0.57)	1.81 (0.53)
Duration of reduced consciousness in hours ^c (SD)	2.97 (3.32)	1.96 (1.41)
Days in the hospital ^c (SD)	0.96 (0.44)	1.05 (0.58)
Days at Intensive Care ^c (SD)	0.09 (0.39)	0.00 (0.00)
Medication use ^b	20.2%	16.7%
Place of consumption ^b
- At parental home	8.4%	8.6%
- At own home	1.0%	2.9%
- At friends' home	42.3%	42.9%
- On the street	22.0%	31.4%
- In bar/restaurant	12.2%	11.4%

^a Data from first treatment presented;

^b Chi-square;

^c Independent sample t-test: all n.s.

* p < .01.

Effects of multiple treatments on school performances

In Table 3, the relevant characteristics for the 37 recidivists are depicted for the first and second treatment. The average age significantly increased from 15.08 to 15.76 between the first and the second treatment: t(72) = –2.70, p < .01. Notably, the second acute intoxication is more severe, indicated by the period of reduced consciousness lasting twice as long (two hours versus four hours): t(28) = –2.24, p < .05. Although educational levels did not significantly change, six patients (16%) were in a lower educational level than when they were treated the first time. This statistic primarily reflected students who were in a high-level educational program during the first treatment.

Table 3. Recidivists and treatment characteristics during first and second admittance.

Characteristics	First Admittance (N = 37)	Second Admittance (N = 37)
Age during treatment ^a(SD)	15.08^* (1.12)	15.76^* (1.04)
Educational level ^b
- Low	50.0%	47.8%
- Middle	19.2%	30.4%
- High	30.8%	21.7%
Smoking ^b	24.6%	20.0%
Combined drug use during alcohol intoxication ^b	11.1%	11.8%
Blood alcohol content gram/liter ^a (SD)	1.89 (0.57)	1.81 (0.53)
Duration of reduced consciousness in hours ^a (SD)	1.96^* (1.41)	3.97^* (3.24)
Days in the hospital ^a (SD)	1.05 (0.58)	0.89 (0.46)
Days at Intensive Care ^a (SD)	0.00 (0.00)	0.00 (0.00)
Place of consumption ^b
- At parental home	8.6%	3.7%
- At own home	2.9%	3.7%
- At friends' home	42.9%	44.4%
- On the street	31.4%	18.5%
- In bar/restaurant	11.4%	14.8%

^a Independent sample t-test;

^b Chi-square.

* p < .01.

Discussion

This study shows that acute alcohol intoxication occurs more frequently in adolescents with low educational levels, aligning with previous studies suggesting that less-educated youths consume more alcohol than other youths (Friestad & Klepp, 2006). When admitted to hospitals, these low-educated patients tend to be younger and have lower blood alcohol contents than youths in more highly educated groups. These findings make sense because these youths begin drinking at a younger age and their tolerance for alcohol is not well-established (thus explaining the lower BAC). Second, males are found to be at higher risk for a subsequent acute alcohol intoxication treatment, which is in line with previous studies on severe youth drinking (Laghi et al., 2016).

In general, many adolescents label negative drinking events as positive experiences, and these negative events do not lower drinking intentions and behaviors (Van Hoof, Van den Boom, & De Jong, 2011). This finding is also supported by the data for the second alcohol intoxication treatment; notably, the patients' reported period of unconsciousness was double the length of the first admittance (approximately four versus two hours). Despite the fact that the BAC levels were equal during the two treatments, the consequences were more severe the second time. This result can be explained by the fact that other circumstances were different in the second event (e.g., drinking various types of drinks in a mix or a different pace of drinking). Because this study did not examine the specific reasons for the patients' longer period of reduced consciousness, this issue could be the subject of future investigations.

The group of recidivists was small (37 adolescents), thereby making solid analyses challenging. However, the trend showing a more severe second intoxication event, as well as a possible decrease in the educational level of six adolescents (16%), is worrisome. These findings regarding development raise serious concerns that must be investigated further.

Limitations

In our recidivist data, we only see the tip of the iceberg regarding the effects of the first intoxication event, and numerous unknowns remain. We did not study what happened concerning the drinking behavior of the other 3,317 adolescents. We do not know whether these adolescents use more (illicit) drugs than their peers, and how their attitudes toward alcohol and other drugs might have been influenced. Therefore, a long-term tracking study of these teens would be valuable.

Conclusion

Alcohol intoxication is more strongly represented in students with “low” educational levels, represented at an average rate in students with “middle” educational levels, and less represented in students with “high” educational levels. Gender is distributed equally among the three school levels. Adolescents with lower schooling levels tend to be younger and have lower blood alcohol contents than other educational groups when admitted to the hospital.

The 37 recidivists (1.1% relapse percentage) are more often male. During the second hospital admittance, their period of unconsciousness is twice as long as during the first treatment (four versus two hours). In the recidivist sample, six patients showed a decline in educational level at the second admittance.

Although the study's numbers are small, we find strong indications that extensive alcohol use causes a decrease in school performance.

In conclusion, acute alcohol intoxication in (Dutch) youths remains a prevalent issue. We recommend the following: (a) additional resources for medical treatment and research, resulting in better treatment and more research (preferably a clinical monitoring system); (b) stronger enforcement and increased penalties for both on-premise and off-premise alcohol outlets when selling alcohol to underage people; and (c) additional and improved prevention programs aimed at youths and parents.