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Underage drinking
(From "Alcohol Alert," The National
Institute on Alcohol Abuse and Alcoholism No. 37 July 1997)
Youth Drinking: Risk Factors and
Consequences
Despite a minimum legal drinking age of 21, many young people
in the United States consume alcohol. Some abuse alcohol
by drinking frequently or by binge drinking--often defined
as having five or more drinks* in a row. A minority of youth
may meet the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (DSM-IV) criteria for alcohol
dependence (1,2). The progression of drinking from use to
abuse to dependence is associated with biological and psychosocial
factors. This Alcohol Alert examines some of these factors
that put youth at risk for drinking and for alcohol-related
problems and considers some of the consequences of their
drinking.
Prevalence of Youth Drinking
Thirteen- to fifteen-year-olds are at high risk to begin
drinking (3). According to results of an annual survey of
students in 8th, 10th, and 12th grades, 26 percent of 8th
graders, 40 percent of 10th graders, and 51 percent of 12th
graders reported drinking alcohol within the past month
(4). Binge drinking at least once during the 2 weeks before
the survey was reported by 16 percent of 8th graders, 25
percent of 10th graders, and 30 percent of 12th graders.
Males report higher rates of daily drinking
and binge drinking than females, but these differences are
diminishing (3). White students report the highest levels
of drinking, blacks report the lowest, and Hispanics fall
between the two (3).
A survey focusing on the alcohol-related
problems experienced by 4,390 high school seniors and dropouts
found that within the preceding year, approximately 80 percent
reported either getting "drunk," binge drinking,
or drinking and driving. More than half said that drinking
had caused them to feel sick, miss school or work, get arrested,
or have a car crash (5).
Some adolescents who drink later abuse alcohol
and may develop alcoholism. Although these conditions are
defined for adults in the DSM, research suggests that separate
diagnostic criteria may be needed for youth (6).
Drinking and Adolescent Development
While drinking may be a singular problem behavior for some,
research suggests that for others it may be an expression
of general adolescent turmoil that includes other problem
behaviors and that these behaviors are linked to unconventionality,
impulsiveness, and sensation seeking (7-11).
Binge drinking, often beginning around age
13, tends to increase during adolescence, peak in young
adulthood (ages 18-22), then gradually decrease. In a 1994
national survey, binge drinking was reported by 28 percent
of high school seniors, 41 percent of 21- to 22-year-olds,
but only 25 percent of 31- to 32-year-olds (3,12). Individuals
who increase their binge drinking from age 18 to 24 and
those who consistently binge drink at least once a week
during this period may have problems attaining the goals
typical of the transition from adolescence to young adulthood
(e.g., marriage, educational attainment, employment, and
financial independence) (13).
Risk Factors for Adolescent Alcohol
Use, Abuse, and Dependence
Genetic
Risk Factors. Animal studies (14) and studies of twins and
adoptees demonstrate that genetic factors influence an individual's
vulnerability to alcoholism (15,16). Children of alcoholics
are significantly more likely than children of nonalcoholics
to initiate drinking during adolescence (17) and to develop
alcoholism (18), but the relative influences of environment
and genetics have not been determined and vary among people.
Biological Markers. Brain
waves elicited in response to specific stimuli (e.g., a
light or sound) provide measures of brain activity that
predict risk for alcoholism. P300, a wave that occurs about
300 milliseconds after a stimulus, is most frequently used
in this research. A low P300 amplitude has been demonstrated
in individuals with increased risk for alcoholism, especially
sons of alcoholic fathers (19,20). P300 measures among 36
preadolescent boys were able to predict alcohol and other
drug (AOD) use 4 years later, at an average age of 16 (21).
Childhood Behavior. Children
classified as "undercontrolled" (i.e., impulsive,
restless, and distractible) at age 3 were twice as likely
as those who were "inhibited" or "well-adjusted"
to be diagnosed with alcohol dependence at age 21 (22).
Aggressiveness in children as young as ages 5-10 has been
found to predict AOD use in adolescence (23,24). Childhood
antisocial behavior is associated with alcohol-related problems
in adolescence (24-27) and alcohol abuse or dependence in
adulthood (28,29).
Psychiatric Disorders.
Among 12- to 16-year-olds, regular alcohol use has been
significantly associated with conduct disorder; in one study,
adolescents who reported higher levels of drinking were
more likely to have conduct disorder (30,31).
Six-year-old to seventeen-year-old boys
with attention deficit hyperactivity disorder (ADHD) who
were also found to have weak social relationships had significantly
higher rates of alcohol abuse and dependence 4 years later,
compared with ADHD boys without social deficiencies and
boys without ADHD (32).
Whether anxiety and depression lead to or
are consequences of alcohol abuse is unresolved. In a study
of college freshmen, a DSM-III (33) diagnosis of alcohol
abuse or dependence was twice as likely among those with
anxiety disorder as those without this disorder (34). In
another study, college students diagnosed with alcohol abuse
were almost four times as likely as students without alcohol
abuse to have a major depressive disorder (35). In most
of these cases, depression preceded alcohol abuse. In a
study of adolescents in residential treatment for AOD dependence,
25 percent met the DSM-III-R criteria for depression, three
times the rate reported for controls. In 43 percent of these
cases, the onset of AOD dependence preceded the depression;
in 35 percent, the depression occurred first; and in 22
percent, the disorders occurred simultaneously (36).
Suicidal Behavior. Alcohol
use among adolescents has been associated with considering,
planning, attempting, and completing suicide (37-39). In
one study, 37 percent of eighth-grade females who drank
heavily reported attempting suicide, compared with 11 percent
who did not drink (40). Research does not indicate whether
drinking causes suicidal behavior, only that the two behaviors
are correlated.
Psychosocial Risk Factors
Parenting, Family Environment, and Peers. Parents' drinking
behavior and favorable attitudes about drinking have been
positively associated with adolescents' initiating and continuing
drinking (41,42). Early initiation of drinking has been
identified as an important risk factor for later alcohol-related
problems (43). Children who were warned about alcohol by
their parents and children who reported being closer to
their parents were less likely to start drinking (42,44,45).
Lack of parental support, monitoring, and
communication have been significantly related to frequency
of drinking (46), heavy drinking, and drunkenness among
adolescents (47). Harsh, inconsistent discipline and hostility
or rejection toward children have also been found to significantly
predict adolescent drinking and alcohol-related problems
(46).
Peer drinking and peer acceptance of drinking
have been associated with adolescent drinking (48,49). While
both peer influences and parental influences are important,
their relative impact on adolescent drinking is unclear.
Expectancies. Positive
alcohol-related expectancies have been identified as risk
factors for adolescent drinking. Positive expectancies about
alcohol have been found to increase with age (50) and to
predict the onset of drinking and problem drinking among
adolescents (51-53).
Trauma. Child abuse and
other traumas have been proposed as risk factors for subsequent
alcohol problems. Adolescents in treatment for alcohol abuse
or dependence reported higher rates of physical abuse, sexual
abuse, violent victimization, witnessing violence, and other
traumas compared with controls (54). The adolescents in
treatment were at least 6 times more likely than controls
to have ever been abused physically and at least 18 times
more likely to have ever been abused sexually. In most cases,
the physical or sexual abuse preceded the alcohol use. Thirteen
percent of the alcohol dependent adolescents had experienced
posttraumatic stress disorder, compared with 10 percent
of those who abused alcohol and 1 percent of controls.
Advertising. Research on
the effects of alcohol advertising on adolescent alcohol-related
beliefs and behaviors has been limited (55). While earlier
studies measured the effects of exposure to advertising
(56), more recent research has assessed the effects of alcohol
advertising awareness on intentions to drink. In a study
of fifth- and sixth-grade students' awareness, measured
by the ability to identify products in commercials with
the product name blocked out, awareness had a small but
statistically significant relationship to positive expectancies
about alcohol and to intention to drink as adults (57).
This suggests that alcohol advertising may influence adolescents
to be more favorably predisposed to drinking (57).
Consequences of Adolescent Alcohol
Use
Drinking and Driving. Of the nearly 8,000 drivers ages 15-20
involved in fatal crashes in 1995, 20 percent had blood
alcohol concentrations above zero (58). For more information
about young drivers' increased crash risk and the factors
that contribute to this risk, see Alcohol Alert No. 31:
Drinking and Driving (59).
Sexual Behavior. Surveys of adolescents
suggest that alcohol use is associated with risky sexual
behavior and increased vulnerability to coercive sexual
activity. Among adolescents surveyed in New Zealand, alcohol
misuse was significantly associated with unprotected intercourse
and sexual activity before age 16 (60). Forty-four percent
of sexually active Massachusetts teenagers said they were
more likely to have sexual intercourse if they had been
drinking, and 17 percent said they were less likely to use
condoms after drinking (61).
Risky Behavior and Victimization. Survey
results from a nationally representative sample of 8th and
10th graders indicated that alcohol use was significantly
associated with both risky behavior and victimization and
that this relationship was strongest among the 8th-grade
males, compared with other students (62).
Puberty and Bone Growth.
High doses of alcohol have been found to delay puberty in
female (63) and male rats (64), and large quantities of
alcohol consumed by young rats can slow bone growth and
result in weaker bones (65). However, the implications of
these findings for young people are not clear.
Prevention of Adolescent Alcohol
Use
Measures to prevent adolescent alcohol use include policy
interventions and community and educational programs. Alcohol
Alert No. 34: Preventing Alcohol Abuse and Related Problems
(66) covers these topics in detail. See the National Institute
on Alcohol Abuse and Alcoholism's (NIAAA's) World Wide Web
site at http://www.niaaa.nih.gov.
*A standard drink is 12 grams of pure alcohol,
which is equal to one 12-ounce bottle of beer or wine cooler,
one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled
spirits.
Full text of this publication is available
on NIAAA's World Wide Web site at http://www.niaaa.nih.gov
All material contained in the Alcohol Alert
is in the public domain and may be used or reproduced without
permission from NIAAA.
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