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Risky 21st-birthday booze ritual gains popularity

The ritual of drinking 21 or more alcoholic beverages to celebrate the 21st birthday appears to be far more common than expected, according to new research.

Jesse Drews died in March on his 21st birthday after a drinking binge. It's estimated that more than four out of every five American 21-year-olds drink alcohol to celebrate the birthday milestone, which is the the legal drinking age in the United States. But a new study from University of Missouri researchers of 2,518 students shows that many young adults aren't just drinking to celebrate — they are drinking to extremes.

Among those students who drank alcohol to celebrate their 21st birthdays, 34 percent of the men and 24 percent of the women reported consuming 21 or more drinks, according to the research to be published in The Journal of Consulting and Clinical Psychology. The report is believed to be the largest study of the drinking ritual, which often involves shots of alcohol. The students in the study were followed for four years and asked a variety of questions about their drinking behavior over the course of their time in college. Although the findings likely can't be applied to the general population, the data likely do reflect the drinking culture at large, public universities, say researchers.

Based on the data, researchers estimated that half of the men and more than a third of the women who drank on their birthdays experienced blood alcohol levels of 0.26 or higher, the level at which a person is severely impaired and at risk for choking on vomit or suffering serious injury. While researchers say it's possible some students overstated how much they actually drank, the consistency of the answers suggests that students are consuming large quantities of alcohol when they celebrate a 21st birthday.

"I think a lot of people view this as a feel-good rite of passage and don't calibrate what a big risk it is,'' said Kenneth Sher, professor of psychological sciences at the University of Missouri-Columbia and the study's lead author.

Alcohol researchers have been searching for ways to curb the extreme drinking common on the 21st birthday. One concern is that interest in the ritual appears to be spreading because drinkers who attempt or succeed at downing 21 drinks post videos and photos of the drinking binges on YouTube or Flickr or social networking sites like MySpace.

One of the biggest worries about the ritual is alcohol poisoning. The body's ability to metabolize alcohol depends on several factors, including gender, weight, the type of alcohol, whether the person vomits during the binge and the time period during which the alcohol is consumed. But in some cases, as few as 10 drinks can push blood alcohol levels to 0.30, the point at which the respiratory system slows enough that death is possible.

That appears to be what happened to Jesse Drews, a 21-year-old Fox Lake, Wis., resident who died on March 24, his 21st birthday. Although the death is still under investigation, it's believed he may have attempted to drink 21 shots to celebrate at a Waupun, Wis., tavern. A friend who brought him home said he had "10 or 12 shots,'' although his parents have since been told different stories about how much alcohol was consumed.

What is known is that his family found him unresponsive at 4 a.m., and a hospital test showed a blood alcohol level of 0.38, according to his family and the Dodge County Sheriff's Office. Waupun police chief Dale Heeringa said he couldn't comment on the details of the investigation until the medical examiner's report is finished. He said Mr. Drews did not finish 21 shots, although he did consume "a significant amount of alcohol.''

Jesse's mother, Jody Drews, said her son had been reluctant to go out that night but relented after friends persuaded him. He returned home around 1:15 a.m. and went to bed, and Mrs. Drews checked on him throughout the night, including around 3:30 a.m., when she heard him snoring and returned to bed.

"I never in a million years thought we would be in this situation,'' Mrs. Drews said. "Kids have to know about this risk. I hope anybody who goes into a bar and sees this happening will say something.''

Clayton Neighbors, associate professor of psychiatry and behavioral sciences at the University of Washington Center for the Study of Health and Risk Behaviors in Seattle, is studying Internet-based interventions he hopes will convince more young people to moderate their drinking on their 21st birthdays. In one study of 316 students, to be presented at the American Psychological Association conference this year, those who were given Web-based information about drinking prior to their 21st birthday drank less than students who didn't receive the information.

Students in the intervention group were asked how much they planned to drink on their 21st birthday and how common they believed extreme drinking really is. The interactive tool then showed them that only a minority of students drink 21 or more drinks. It also calculated a student's blood alcohol level based on the amount he or she planned to drink. Giving students extra information about drinking appeared to result in blood alcohol levels that were about 25 percent lower than the group that wasn't given the information, he said.

"One of the problems is a lot of these kids don't realize that 21 drinks in an hour can kill you,'' Dr. Neighbors said.

One group, Be Responsible About Drinking (B.R.A.D.), was started by family and friends of Michigan State University student Bradley McCue, who died from extreme drinking on his 21st birthday. The group sends out birthday cards prior to the 21st birthday warning people about the dangers of alcohol poisoning. The site also includes numerous charts showing how various numbers of drinks affect blood alcohol levels. For a more detailed look at the 21st birthday drinking binge, see an earlier story by my colleague Kate Zernike.

Tara Parker-Pope writes about health for the .

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