The current study reveals more insight into the opinion about and the handling of alcohol use within families in the Netherlands, where underage children are legally allowed to purchase and consume low strength alcoholic beverages. The unique feature of this study is that we talked to adolescents as well as parents about factors that influence binge drinking, so we could get a broad picture about what determines binge drinking in a permissive environment.
The majority of the adolescents we talked to identified themselves as a binge drinker, which is representative for the Dutch population as a whole . Almost all adolescents indicated that the amount of alcohol that is defined as binge drinking (4/5 glasses of alcohol) is low. Interestingly, sports seemed to have positive as well as negative influences on drinking behavior. Non binge-drinking adolescents indicated that individual sports, like swimming or cycling, especially when at a high level, makes them refrain from drinking alcohol, whereas team sports like hockey or soccer seemed to be supportive for binge drinking events, as indicated by binge drinkers. A recent review of high school and college athletes concluded that athletes reported higher levels of alcohol consumption than did non-athletes . However, there are several studies that found sports to be protective for early alcohol debut  and alcohol consumption , and has even shown to be protective against alcohol consumption when adolescents have substance using peers . One study focused on sport-type differences in alcohol use among college athletes and found that swimming and diving athletes reported significantly higher levels of alcohol consumption than other sport types (Baseball/Softball, Basketball/Volleyball, Soccer, Track/Cross country) . This is contrary to the results found in this study, where teams sport seems to be more encouraging alcohol consumption than individual sports. There might perhaps be a change of influence of sport teams. It could be that in late adolescence being a member of a sport team exposes adolescents more to other adolescents who are in an experimenting phase and thus encourage each other to drink together as a team, whereas when adolescents grow older and enter college a feeling of shared responsibility for the success of the team might work as an inhibitor to drink big amounts of alcohol. Another possible contributor to the higher alcohol consumption in team sports might be sponsorship of the teams by the alcohol industry. A study of New Zealand sport teams showed a positive association between alcohol industry sponsorship and AUDIT (Alcohol Use Disorder Identification Test) scores, indicating more hazardous drinking in people who are engaging in sports that are sponsored by the alcohol industry . Sponsorship of sports through the alcohol industry is very common in the Netherlands (http://www.alcoholreclame.nl/alcoholreclame/alcoholreclamebeleid_in_nederland/achtergrond.html). However, we did not check in this study if the adolescents from our sample were subject to alcohol industry sponsorship.
Further, adolescents mentioned that their desire to belong to a group, and the expectation to become more relaxed were important drinking motives. This is in line with the results of a review on drinking motives , where social motives (to obtain social rewards) and enhancement motives (drinking to enhance a good mood or well-being) were associated with moderate and heavy drinking in young people, respectively. The review also showed that conformity motives (drinking to avoid social rejection) are hardly mentioned by adolescents; in the current study adolescents also stated to feel no peer pressure. Nevertheless, influence of friends on drinking behavior seems to be evident as it has been reported in many studies (e.g. [18, 20, 42]). From the literature and our study it seems that adolescents are subject to peer influences but are not explicitly aware of it. In the review of drinking motives adolescents’ ages varied between 10 and 25 years and most of the studies in this review were conducted in countries with a legal drinking age of 18 or higher. It is interesting to see that these motives seem to be the same in a more permissive society.
Environmental cues that would most likely lead to a binge drinking event, like being at a party or in a bar on weekend days together with friends, were also identified as the most difficult situations when trying not to drink. This indicates that alcohol consumption in social situations is widely accepted by Dutch adolescents. Furthermore, adolescents reported feeling pressure to drink alcohol when it is available. Further influences of peers explicitly mentioned were the size of the group and familiarity with the group. The bigger the group and the more familiar the members of the group were, the more alcohol they drank. This is in line with previous research . It seems important that interventions to reduce alcohol intake in adolescents should focus on this difficult situations, strengthen their efficacy to drink in a low risk manner when much alcohol is available and provide adolescents with advice how to handle peer pressure.
Also, parental attitude towards alcohol was perceived as positive by almost all adolescents, as long as they do not get drunk and throw up. Parents themselves indicated that they regard drinking by their children to be acceptable but within appropriate limits. This confirms the adolescents’ perspective; however, those limits were defined by parents to be two glasses of alcohol every two weeks. The attitude towards binge drinking among their children was negative in almost all parents. Apparently, the views of parents and adolescents are not totally in line with each other. In an intervention to reduce alcohol use among adolescents it should be stressed that parents clearly communicate their expectations and definitions of appropriate drinking towards their children, in order to avoid misinterpretations of acceptable limits.
Research has shown that it is not only the perceived approval of alcohol consumption of peers or the approval of drinking of parents that determine alcohol consumption in adolescents but the disparity between these two . The bigger the perceived gap between parental approval and peer approval, the more adolescents tended to drink. Reducing this gap may be a valuable component in an attempt to reduce alcohol consumption. Correction of the perceived norm of peer drinking [45–47] on the one hand and encouraging parents to stay involved and communicate with their children to choose friends with similar attitudes towards drinking could be possibilities to reduce the gap . Interventions that encouraged parents to talk with their children about alcohol before they left for college showed that those students had less positive perceptions regarding drinking activities and showed less drinking and drunkenness . Furthermore, those students also perceived their peers to have similar perceptions regarding drinking . These studies indicate that parents still have considerable influence on their childrens’ drinking behavior even when they are about to leave home. When adolescents still live at home, as is the case with our target group , this influence should be even easier to achieve.
Further, parents were quite aware of a number of negative effects of binge drinking on the health of their children, but despite their ideas about appropriate limits and knowledge about the consequences, most parents did not set clear rules concerning alcohol use and going out. Instead, parents rather talked to their children in, an understanding, non-accusatory fashion. This again is in line with the adolescents’ reports that their parents stopped handling clear rules concerning alcohol consumption and going out when they turned 16. Parents should be encouraged to keep setting appropriate rules concerning alcohol use, as these have been proven to be effective in reducing alcohol intake among adolescents [26, 27]. Also, some adolescents indicated that this would have effect on their drinking behavior, so this may be a successful strategy in at least some adolescents.
Most parents had alcohol available at home and often thought it was more safe if adolescents drank alcohol at home in their presence than outside with peers. Yet, this perception may be incorrect as one study has shown that adult-supervised settings for alcohol use, in line with harm-minimization policies are associated with higher levels of harmful alcohol consequences compared to zero-tolerance policies that favor abstinence of alcohol . Often parents were convinced that their children had to learn how to drink, and that prohibiting the use of alcohol, or just allowing a certain amount of alcohol, would have no effect on the alcohol use of the child. Three factors mainly contributed to these stances: that parents experienced a lack of controllability of their child’s alcohol intake, due to the easy availability of alcohol in grocery stores; the fact that parents could not be around their children 24/7; and the legal purchasing age of 16. Some parents indicated that they had difficulties with these policies because they weaken their position as a parent. Parents explicitly stated that as soon as their children turn 16 they do not have any control about how much their child is drinking and where the child is drinking. This generally accepted, yet wrong, assumption that parents’ influence on adolescent drinking disappears when they leave home for college has been mentioned earlier .
Even though some parents mentioned strategies they could use to decrease the amount of alcohol their child drank, there were also a couple of parents who thought that the responsibility to reduce the problem of binge drinking lies with the legal authorities and not with themselves. This may possibly be a side effect of the permissive rule setting from the Dutch government. Hence, interventions for Dutch parents should also focus on strengthening parents’ feelings of responsibility and self-efficacy to control the alcohol intake of their child. Another possibility would be to plead to increase the legal purchasing age from 16 to 18 years. This would at least have three advantages. First, it would probably increase the feeling of control and responsibility in parents. Second, it would give a clear signal to the adolescents that underage drinking is not (no longer) acceptable and third, make it more difficult for under-age adolescents to get hold of and consume alcohol. Of course, there is a difference between the introduction of law and observing the law, as in our sample many adolescents reported drinking before the age of 16, but increasing the age limit might possibly also increase the age of first alcohol consumption. Grocery stores and bars may be more triggered to check the ID of adolescents that do not look adult and parents could also become more sensible towards providing their adolescents with alcohol when they are under 18.
The results of these focus group interviews need to be quantified using questionnaires. This would lead to more insight into which of the factors named in this qualitative research are important and changeable  and could give further indications on what kind of interventions to reduce binge drinking in this age group need to be developed. It is known that parents still have considerable influence on the child’s alcohol intake [25–28], and that combining parents and children in an intervention is indeed more successful than delivering separate interventions to either the child or the parent . It therefore seems of upmost importance that parents are also included in these interventions to maximize the effect. Concerning the parents, we can conclude that many parents, at least from our sample, are not fully aware of the negative consequences of alcohol use, and they lack self-efficacy to control and reduce alcohol intake in their children. It also seems useful to reconsider the policies concerning the legal purchasing age and availability of alcohol to strengthen the position of parents and make availability of alcohol more difficult.
Limitations and strengths
A limitation of focus group interviews in general is that you most likely engage with people who are motivated to talk about a certain problem. This could have particularly played a role in the interviews with parents. Parents were hard to reach and response rates were low. Despite this, we managed to get a good insight into alcohol use in Dutch families, because despite their awareness of the problem and their motivation to talk to us, these parents acted as do many parents who see no problem: i.e. not setting rules and experiencing helplessness. Furthermore, we had to use one-on-one interviews with some parents, because for them it was not possible to join a focus group (e.g., because of the distance or time constraints). A disadvantage of this method is that you miss discussion with other parents in the group, but a big advantage is that you can get more in-depth insights in comparison with focus group interviews. Finally, we relied on self-reports of adolescents and parents, which can be prone to subjective bias, and due to a lack of insight information from self-report data can be missing.
The major strength of this study is that we combined focus group interviews from adolescents and parents, which creates a broader view on the problem and possible solutions to reduce binge drinking in adolescents.