Underage Drinking

A Major Public Health Challenge

By the time they reach the eighth grade, nearly 50 percent of adolescents have had at least one drink, and over 20 percent report having been "drunk". Approximately 20 percent of 8th graders and almost 50 percent of 12th graders have consumed alcohol within the past 30 days. Among 12th graders, almost 30 percent report drinking on 3 or more occasions per month. Approximately 30 percent of 12th graders engage in heavy episodic drinking, now popularly termed "binge" drinking-that is, having at least five or more drinks on one occasion within the past 2 weeks-and it is estimated that 20 percent do so on more than one occasion.

Apart from being illegal, underage drinking poses a high risk to both the individual and society. For example, the rate of alcohol-related traffic crashes is greater for drivers ages 16 to 20 than for drivers age 21 and older. Adolescents also are vulnerable to alcohol-induced brain damage, which could contribute to poor performance at school or work. In addition, youthful drinking is associated with an increased likelihood of developing alcohol abuse or dependence later in life. Early intervention is essential to prevent the development of serious alcohol problems among youth between the ages of 12 and 20. This Alcohol Alert describes some of the most harmful consequences of underage drinking as well as prevention and treatment approaches that can be applied successfully to meet the unique needs of this age group.

Injury and Social Consequences

Underage alcohol use is more likely to kill young people than all illegal drugs combined. Some of the most serious and widespread alcohol-related problems among adolescents are discussed below. For a more detailed discussion of alcohol problems in the college-age population, see Alcohol Alert No. 58.

Drinking and Driving. Motor vehicle crashes are the leading cause of death among youth ages 15 to 20. Adolescents already are at increased risk through their relative lack of driving experience, and drivers younger than 21 are more susceptible than older drivers to the alcohol-induced impairment of driving skills. The rate of fatal crashes among alcohol-involved drivers between 16 and 20 years old is more than twice the rate for alcohol-involved drivers 21 and older.

Suicide. Alcohol use interacts with conditions such as depression and stress to contribute to suicide, the third leading cause of death among people between the ages of 14 and 25. In one study, 37 percent of eighth grade females who drank heavily reported attempting suicide, compared with 11 percent who did not drink.

Sexual Assault. Sexual assault, including rape, occurs most commonly among women in late adolescence and early adulthood, usually within the context of a date. In one survey, approximately 10 percent of female high school students reported having been raped. Research suggests that alcohol use by the offender, the victim, or both, increases the likelihood of sexual assault by a male acquaintance.

High-Risk Sex. Research has associated adolescent alcohol use with high-risk sex (for example, having multiple sexual partners and failing to use condoms). The consequences of high-risk sex also are common in this age group, particularly unwanted pregnancy and sexually transmitted diseases, including HIV/AIDS. According to a recent study, the link between high-risk sex and drinking is affected by the quantity of alcohol consumed. The probability of sexual intercourse is increased by drinking amounts of alcohol sufficient to impair judgment, but decreased by drinking heavier amounts that result in feelings of nausea, passing out, or mental confusion.

Alcohol's Effects

Adolescence is the transition between childhood and adulthood. Adolescence is also a time of trying new experiences and activities that emphasize socializing with peers, and conforming to peer-group standards. These new activities may place young people at particular risk for initiating and continuing alcohol consumption. Exposure to alcohol during this period may interrupt key processes of development, possibly leading to mild cognitive impairment as well as to further escalation of drinking.

Subtle alcohol-induced adolescent learning impairments could affect academic and occupational achievement. In one study, Brown and colleagues evaluated short-term memory skills in alcohol-dependent and nondependent adolescents ages 15 to 16. The alcohol-dependent youth had greater difficulty remembering words and simple geometric designs after a 10-minute interval. In this and similar studies, memory problems were most common among adolescents in treatment who had experienced alcohol withdrawal symptoms. The emergence of withdrawal symptoms generally indicates an established pattern of heavy drinking. Their appearance at a young age underscores the need for early intervention to prevent and treat underage drinking.

Although the prevalence of high-risk drinking declines after early adulthood, alcohol-induced damage may persist. Memory impairment has been found in adult rats exposed to alcohol during adolescence.

The Link Between Early Alcohol Use and Alcohol Dependence

Early alcohol use may have long-lasting consequences. People who begin drinking before age 15 are four times more likely to develop alcohol dependence at some time in their lives compared with those who have their first drink at age 20 or older. It is not clear whether starting to drink at an early age actually causes alcoholism or whether it simply indicates an existing vulnerability to alcohol use disorders. For example, both early drinking and alcoholism have been linked to personality characteristics such as strong tendencies to act impulsively and to seek out new experiences and sensations. Some evidence indicates that genetic factors may contribute to the relationship between early drinking and subsequent alcoholism. Environmental factors may also be involved, especially in alcoholic families, where children may start drinking earlier because of easier access to alcohol in the home, family acceptance of drinking, and lack of parental monitoring.

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