Spring break offers chance to counsel adolescents on sex, drugs, binge drinking

Adolescents often ignore the dangers of risky behavior, but the odds are against them when they do.

Spring break offers physicians an excellent opportunity to discuss with their patients the dangers of unprotected sex, binge drinking and illegal drug use.

“Start off by acknowledging that these kids really do need a break,” Cynthia M. Holland-Hall, MD, associate professor of clinical pediatrics at The Ohio State University College of Medicine, told Infectious Diseases In Children. “Academic stresses are huge, both in high school and in college. If they’re a college student, then the stress they’re escaping from probably is greater than any they’ve experienced before. So that might put them at that much more risk for wanting to party their brains out, but we need to tell them, ‘Let’s not completely lose good sense.’”

Peer pressure

During spring break, there is also a lot of peer pressure to engage in risky behavior. “We talk in terms of the ‘lizard’ vs. the ‘wizard’ brain. It’s a concept central to the BrainWise curriculum, which helps children and teens build their critical faculties,” said Meera S. Beharry, MD, FAAP, of the adolescent medicine division of the department of pediatrics, Golisano Children’s Hospital at the University of Rochester Medical Center. “The adolescent brain is still in its “lizard brain” stage, the section that governs the fight or flight, more reactionary types of responses to stimuli. During adolescence, young people develop their “wizard brain”, which is more rational. When teens are in large groups, they tend to default to their less rational sides.”

A report in a 2007 issue of Journal of Studies on Alcohol and Drugs stated that, “Students who vacation with friends during spring break dramatically increased their alcohol use [an average 17.6 drinks per week increase over their individual baseline consumption].”

Students who stayed home or vacationed with parents during spring break, the study found, were at low risk for excessive alcohol use, and in some cases, even decreased their alcohol consumption.

“Some events, such as spring break, are known to be associated with more extreme and potentially dangerous levels of alcohol use and sexual behavior,” researchers wrote in a 2011 issue of Journal of Youth and Adolescence. Their study of understandings between peers during spring break surveyed 651 college students (48% men) and showed that 43% of adolescents made pacts with friends regarding “safe drinking;” 31% had “safe or no sex” pacts; 24% had “get drunk” pacts; 18% had “have sex without a condom” understandings; and 5.2% had “have sex with someone new” pacts.

According to the Core Institute, 52.7% of US college students (n=209,576) surveyed between 2006 and 2008 on their attitudes toward alcohol and drugs believed that their peers engaged in some form of recreational drug use.

“That’s important because we are talking about perception vs. reality. Some young adults, especially when away on spring break want to fit in and might use drugs on a celebratory trip just because they think it’s normal, especially if it compliments peer behavior,” Laura Talbott, PhD, chair of the American College Health Association’s Alcohol, Tobacco and Other Drugs Coalition, and assistant professor of health education at the University of Alabama, Birmingham, told Infectious Diseases In Children.

“The message to your patients should be the same as always: Don’t make stupid decisions about sex, drinking and drugs. And don’t let the fact that you’re unsupervised and with a group of friends contribute to making less than good decisions,” Holland-Hall said. “Exercise your good sense and have a designated person who is keeping tabs on everyone else.”

Binge drinking and negative outcomes

Patients who claim not to drink heavily, with or without friends, can still experience alcohol-related dangers when on spring break.

A survey of 726 first-year college students published in a 2009 issue of Psychology of Addictive Behaviors found that students classified as “lighter drinkers” were at greater risk for “experiencing acute harm” if they increased their alcohol consumption while away on spring break. “Typically, lighter drinkers may … falsely believe that they are at less risk for consequences, since they typically are less likely in general to experience consequences,” researchers wrote.

“You can’t neglect talking with your patients about alcohol … because usually when you think of all the tough situations that might come up for patients, whether it ranges from something sexual to some kind of injury, like falling off a balcony, alcohol is usually a factor,” Holland-Hall said.

“The No. 1 cause of death of this age group is auto accidents, but alcohol is so often implicated in these accidents,” said Beharry, who also noted that, “Other high-speed activities, like snow or water skiing, also become more risky when alcohol is involved. The same is true for swimming and the elevated risk for drowning when a person is significantly intoxicated.”

Another danger of binge drinking (defined by the National Institute on Alcohol Abuse and Alcoholism as a pattern of drinking that brings a person’s blood alcohol concentration to 0.08 percent or more; in men, this is typically five or more drinks in 2 hours or less; in women, it is four or more drinks in 2 hours or less). Beharry said this type of drinking brings with it an increased chance of becoming the victim of theft or sexual violence. “Alcohol is the No. 1 “date-rape drug.” People with intent to harm will know that. They will watch you, and maybe even offer to buy you drinks. Perpetrators act on impulse, whether their intent is rape or theft. If they see you drinking, they know you’re inclined to become disinhibited. And binge drinking hits you like a ton of bricks, so you’re really disadvantaged then,” she said.

Unprotected sex, unplanned pregnancy and STIs

In the event of sexual violence or disinhibited behavior (eg, not using a condom), Beharry recommended that to protect against unwanted pregnancy, female patients consider bringing emergency contraception with them. “Levonorgestrel is a small dose of progestin that delays ovulation and thickens cervical mucus so that the egg is less available to sperm,” she said. Levonorgestrel is available over-the-counter and is FDA approved for use up to 72 hours post-event.

The FDA also recently approved ulipristal acetate (Ella, Lab HRA Pharma) for emergency contraception. This treatment is effective up to 120 hours post-event and is available by prescription only. Ulipristal acetate’s side effects are similar to those of levonorgestrel.

“But if a patient’s period is late, she should take a pregnancy test,” Beharry said.

“In terms of avoiding infection, the so-called morning-after pill won’t help you, but bringing it along is a good idea. Students 17 years of age and older can purchase emergency contraception over-the-counter from their local pharmacy,” Holland-Hall said.

A 2007 issue of Chronobiology International reported that the risk for infection with chlamydia, gonorrhea and syphilis increases in America from March to May. Because the majority of STIs reported to the CDC occur in those 15 to 24 years of age, researchers concluded this peak occurrence “could be the result of the large number of unprotected casual sexual encounters of young adults that take place during the spring break recess … [when] huge numbers of sexually active youth congregate at beach resort settings.”

According to Beharry, many STIs are preventable with condom use, which is the safest way to decrease a patient’s risk. She also recommended patients get tested for STIs before traveling to establish a baseline, in case there is a question of infection after their trip. If there is a perceived danger of a patient having been exposed to HIV during their trip, Beharry said that most EDs will have on hand the antiretroviral tenofovir disoproxil fumarate.

“In terms of traveling somewhere exotic, patients should take the risk of HIV and syphilis infection seriously,” Holland-Hall said. “Female patients who are traveling should consider packing their own supply of condoms,” Beharry said.

Illegal drugs and their consequences

Statistics from the Core Institute survey indicated that the illegal drug with the highest annual prevalence on college campuses was marijuana, which was consumed by 30.3% of students surveyed.

“So if students plan to use marijuana while they’re on break, how are they obtaining it?” Talbott said. “It’s important because I don’t think 16-, 17- or 18-year-olds are considering whether the drugs they buy on vacation are the same as the ones they’re used to getting in their own backyard, but there can be huge differences.”

For example, the drugs might be adulterated with something patients have not ingested before.

“Patients also need to think about what happens when they mix drugs and alcohol, especially if they’ve never done it before and they are in an unfamiliar and unsupervised setting,” she said. – by Whitney McKnight

For more information:

• Core Institute – Southern Illinois University. Core Alcohol and Drug Study. Available at: www.core.siuc.edu/results.html. Accessed Feb. 15, 2011.
• Grekin ER. J Stud Alcohol Drugs. 2007;68:681-688.
• Lee CM. Psychol Addict Behav. 2009;23:689-694.
• Patrick ME. J Youth Adolesc. 2011. 40:108-120.
• Shah AP. Chronobiol Int. 2007;24:947-960.