Kendra: We recently addressed a teen’s request to clarify the limits of confidentiality in therapy, particularly where substance use is concerned. In responding, I wrote, “Although I don’t personally condone alcohol or drug use, weekend drinking is common among my peers and rarely has long-term harmful effects.” A subsequent letter to the editor (“Harmful Effects,” Nov. 22) countered that underage drinking does have long-term effects.

But my comment must be taken in the context of the original topic about therapist disclosure, which Wes described as being based on “imminent risk” to the teen. There was no indication that the teen in question met that standard.

The letter does suggest a need for better dialog around the real prevalence of teen drinking. As I discussed this with a few teachers and other adults, their stunned reactions surprised me. They seemed a little behind the curve. In my parents’ generation — at least as they remember it — underage drinking and smoking were common only among the partiers and the “cool kids.”

Today, teens that don’t drink are anomalies. In fact, according to the 2013 Kansas Communities That Care survey, 71.97 percent of the seniors at my own high school have used alcohol at least once, but only 10.83 percent have used alcohol more than 40 times.

Those who drink regularly and significantly during and beyond high school and college are more likely to suffer the long-term effects the writer described. But social drinkers who rarely binge are less likely to see those life-long harmful effects.

Because they are now the majority, “underage drinkers” cannot be stereotyped or their futures predicted. Some teens will face severely detrimental short-term effects such as having to have their stomachs pumped or being sexually assaulted. Those teens might well be at “imminent risk,” requiring the violation of confidentiality the original letter questioned. Far fewer will grow up to face problems like cirrhosis of the liver or heart disease. Lumping all teen drinkers together doesn’t advance the discussion.

The real problem for parents and society is the ease of access teens have to alcohol and drugs. Few struggle to get ahold of a six-pack of beer, a handle of vodka, or more marijuana than they could possible smoke in a week.

And as long as that’s the case, any discussions of long-term harmful effects of teen substance abuse will be largely academic.

Wes: I’m one of those rare adults who wishes prohibition had worked. It didn’t and it never will. Externally imposed restrictions enlighten no one as to the harm of substance abuse. Understanding the dangers the letter writer describes comes not from research or statute, but from a personal assessment of how substance use does (or could) affect one’s life and then deciding if it’s worth the risk.

While that risk varies from one person to the next, whether one is a teen or an adult, teens are not cognitively ready to make that kind of honest personal assessment. That’s why parents should enforce rules about drinking. It’s why the legal drinking age was raised to 21 — though from the standpoint of cognitive maturity, that three-year difference doesn’t mean a lot.

Statistically, for American teens, the most imminent dangers of substance abuse are from alcohol-fueled rapes, murders, assaults and other violent crimes, followed by drunken-driving accidents. Yet, Kendra is right. Excessive drinking remains far more normal than abstinence and for many teens, even moderation is considered odd. I differ with Kendra only in my experience that more parents are aware of these excesses than one might think. They just don’t like dealing with them.

Teens may legitimately argue that when it comes to substance abuse, adults have little room to lecture. People of all ages are prone to ignore the impact of addictive behavior, particularly their own. Moreover, a media culture of alcohol and drug use extolls the drama, beauty and awesomeness of excess consumption and downplays the hazards.

Having a couple of beers with friends is a social rite for millions of people in most Western societies. But having a couple of six-packs? Drinking a friend under the table? The 21-shot birthday party? Weekly blackout binges? I see little benefit from those expanding social customs and incalculable harm.

— Wes Crenshaw, Ph.D., ABPP, is author of “Dear Dr. Wes: Real Life Advice for Teens” and “Real Life Advice for Parents of Teens.” Learn about his practice Family Psychological Services at dr-wes.com. Kendra Schwartz is a Lawrence High School senior. Send your confidential 200-word question on adolescence and parenting to ask@dr-wes.com. Double Take opinions and advice are not a substitute for psychological services.