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Make A Difference cover

 

CONTENTS

Introduction

Your Young Teen’s World

The Bottom Line: A Strong Parent–Child Relationship

Talking With Your Teen About Alcohol

Taking Action: Prevention Strategies for Parents

Could My Child Develop a Drinking Problem?

Resources

Other NIAAA Resources and Publications

 

A family talking during dinner
  • Kids who drink are more likely to be victims of violent crime, to be involved in alcohol-related traffic crashes, and to have serious school-related problems.

  • You have more influence on your child’s values and decisions about drinking before he or she begins to use alcohol.

  • Parents can have a major impact on their children’s drinking, especially during the preteen and early teen years.

 

INTRODUCTION

With so many drugs available to young people these days, you may wonder, “Why develop a booklet about helping kids avoid alcohol?” Alcohol is a drug, as surely as cocaine and marijuana are. It’s also illegal to drink under the age of 21. And it’s dangerous. Kids who drink are more likely to:

  • Be victims of violent crime.

  • Have serious problems in school.

  • Be involved in drinking-related traffic crashes.

This guide is geared to parents and guardians of young people ages 10 to 14. Keep in mind that the suggestions on the following pages are just that—suggestions. Trust your instincts. Choose ideas you are comfortable with, and use your own style in carrying out the approaches you find useful. Your child looks to you for guidance and support in making life decisions—including the decision not to use alcohol.

“But my child isn’t drinking yet,” you may think. “Isn’t it a little early to be concerned about drinking?” Not at all. This is the age when some children begin experimenting with alcohol. Even if your child is not yet drinking alcohol, he or she may be receiving pressure to drink. Act now. Keeping quiet about how you feel about your child’s alcohol use may give him or her the impression that alcohol use is OK for kids.

It’s not easy. As children approach adolescence, friends exert a lot of influence. Fitting in is a chief priority for teens, and parents often feel shoved aside. Kids will listen, however. Study after study shows that even during the teen years, parents have enormous influence on their children’s behavior.

The bottom line is that most young teens don’t yet drink. And parents’ disapproval of youthful alcohol use is the key reason children choose not to drink. So make no mistake: You can make a difference.

(Note: This booklet uses a variety of terms to refer to young people ages 10 to 14, including youngsters, children, kids, and young teens.)

YOUNG TEENS AND ALCOHOL: THE RISKS

For young people, alcohol is the drug of choice. In fact, alcohol is used by more young people than tobacco or illicit drugs. Although most children under age 14 have not yet begun to drink, early adolescence is a time of special risk for beginning to experiment with alcohol.

While some parents and guardians may feel relieved that their teen is “only” drinking, it is important to remember that alcohol is a powerful, mood-altering drug. Not only does alcohol affect the mind and body in often unpredictable ways, but teens lack the judgment and coping skills to handle alcohol wisely. As a result:

  • Alcohol-related traffic crashes are a major cause of death among young people. Alcohol use also is linked with teen deaths by drowning, suicide, and homicide.

  • Teens who use alcohol are more likely to be sexually active at earlier ages, to have sexual intercourse more often, and to have unprotected sex than teens who do not drink.

  • Young people who drink are more likely than others to be victims of violent crime, including rape, aggravated assault, and robbery.

  • Teens who drink are more likely to have problems with school work and school conduct.

  • The majority of boys and girls who drink tend to binge (5 or more drinks on an occasion for boys and 4 or more on an occasion for girls) when they drink.

  • A person who begins drinking as a young teen is four times more likely to develop alcohol dependence than someone who waits until adulthood to use alcohol.

The message is clear: Alcohol use is very risky business for young people. And the longer children delay alcohol use, the less likely they are to develop any problems associated with it. That’s why it is so important to help your child avoid any alcohol use.

 

YOUR YOUNG TEEN'S WORLD

Early adolescence is a time of immense and often confusing changes for your son or daughter, which makes it a challenging time for both your youngster and you. Understanding what it’s like to be a teen can help you stay closer to your child and have more influence on the choices he or she makes—including decisions about using alcohol.

  • Changes in the Brain. Research shows that as a child matures, his or her brain continues to develop too. In fact, the brain’s final, adult wiring may not even be complete until well into the twenties. Furthermore, in some ways, the adolescent brain may be specifically “wired” to help youth navigate adolescence and to take some of the risks necessary to achieve independence from their parents. This may help explain why teens often seek out new and thrilling—sometimes dangerous—situations, including drinking alcohol. It also offers a possible reason for why young teens act so impulsively, often not recognizing that their actions—such as drinking—can lead to serious problems.

  • Growing Up and Fitting In. As children approach adolescence, “fitting in” becomes extremely important. They begin to feel more self-conscious about their bodies than they did when they were younger and begin to wonder whether they are “good enough”—tall enough, slender enough, attractive enough—compared with others. They look to friends and the media for clues on how they measure up, and they begin to question adults’ values and rules. It’s not surprising that this is the time when parents often experience conflict with their kids. Respecting your child’s growing independence while still providing support and setting limits is a key challenge during this time.

A young teen who feels that he or she doesn’t fit in is more likely to do things to try to please friends, including experimenting with alcohol. During this vulnerable time, it is particularly important to let your children know that in your eyes, they do measure up—and that you care about them deeply.

An African-American father and sons fishing.

DID YOU KNOW?

  • That according to a recent national survey, 16 percent of eighth graders reported drinking alcohol within the past month?

  • That 32 percent of eighth graders reported drinking in the past year?

  • That 64 percent of eighth graders say that alcohol is easy to get?

  • That a recent survey shows that more girls than boys ages 12 to 17 reported drinking alcohol?

 

THE BOTTOM LINE:
A STRONG PARENT–CHILD RELATIONSHIP

You may wonder why a guide for preventing teen alcohol use is putting so much emphasis on parents’ need to understand and support their children. But the fact is, the best way to influence your child to avoid drinking is to have a strong, trusting relationship with him or her. Research shows that teens are much more likely to delay drinking when they feel they have a close, supportive tie with a parent or guardian. Moreover, if your son or daughter eventually does begin to drink, a good relationship with you will help protect him or her from developing alcohol-related problems.

The opposite also is true: When the relationship between a parent and teen is full of conflict or is very distant, the teen is more likely to use alcohol and to develop drinking-related problems.

This connection between the parent–child relationship and a child’s drinking habits makes a lot of sense when you think about it. First, when children have a strong bond with a parent, they are apt to feel good about themselves and therefore be less likely to give in to peer pressure to use alcohol. Second, a good relationship with you is likely to encourage your children to try to live up to your expectations, because they want to maintain their close tie with you. Here are some ways to build a strong, supportive bond with your child:

  • Establish open communication. Make it easy for your teen to talk honestly with you. (See box “Tips for Talking With Your Teen.”)

  • Show you care. Even though young teens may not always show it, they still need to know that they are important to their parents. Make it a point to regularly spend one-on-one time with your child—time when you can give him or her your loving, undivided attention. Some activities to share: a walk, a bike ride, a quiet dinner out, or a cookie-baking session.

  • Draw the line. Set clear, realistic expectations for your child’s behavior. Establish appropriate consequences for breaking rules and consistently enforce them.

  • Offer acceptance. Make sure your teen knows that you appreciate his or her efforts as well as accomplishments. Avoid hurtful teasing or criticism.

  • Understand that your child is growing up. This doesn’t mean a hands-off attitude. But as you guide your child’s behavior, also make an effort to respect his or her growing need for independence and privacy.

Mother and daughter talking.

GOOD REASONS FOR TEENS NOT TO DRINK

  • You want your child to avoid alcohol.

  • You want your child to maintain self-respect.

  • You want them to know drinking is illegal.

  • Drinking at their age can be dangerous.

  • You may have a family history of alcoholism.

 

TIPS FOR TALKING WITH YOUR TEEN

Developing open, trusting communication between you and your child is essential to helping him or her avoid alcohol use. If your child feels comfortable talking openly with you, you’ll have a greater chance of guiding him or her toward healthy decisionmaking. Some ways to begin:

  • Encourage conversation. Encourage your child to talk about whatever interests him or her. Listen without interruption and give your child a chance to teach you something new. Your active listening to your child’s enthusiasms paves the way for conversations about topics that concern you.

  • Ask open-ended questions. Encourage your teen to tell you how he or she thinks and feels about the issue you’re discussing. Avoid questions that have a simple “yes” or “no” answer.

  • Control your emotions. If you hear something you don’t like, try not to respond with anger. Instead, take a few deep breaths and acknowledge your feelings in a constructive way.

  • Make every conversation a “win-win” experience. Don’t lecture or try to “score points” on your teen by showing how he or she is wrong. If you show respect for your child’s viewpoint, he or she will be more likely to listen to and respect yours.

 

TALKING WITH YOUR TEEN ABOUT ALCOHOL

For many parents, bringing up the subject of alcohol is no easy matter. Your young teen may try to dodge the discussion, and you yourself may feel unsure about how to proceed. To make the most of your conversation, take some time to think about the issues you want to discuss before you talk with your child. Consider too how your child might react and ways you might respond to your youngster’s questions and feelings. Then choose a time to talk when both you and your child have some “down time” and are feeling relaxed.

You don’t need to cover everything at once. In fact, you’re likely to have a greater impact on your child’s decisions about drinking by having a number of talks about alcohol use throughout his or her adolescence. Think of this talk with your child as the first part of an ongoing conversation.

And remember, do make it a conversation, not a lecture! You might begin by finding out what your child thinks about alcohol and drinking.

Your Child’s Views About Alcohol. Ask your young teen what he or she knows about alcohol and what he or she thinks about teen drinking. Ask your child why he or she thinks kids drink. Listen carefully without interrupting. Not only will this approach help your child to feel heard and respected, but it can serve as a natural “lead-in” to discussing alcohol topics.

Important Facts About Alcohol. Although many kids believe that they already know everything about alcohol, myths and misinformation abound. Here are some important facts to share:

  • Alcohol is a powerful drug that slows down the body and mind. It impairs coordination; slows reaction time; and impairs vision, clear thinking, and judgment.

  • Beer and wine are not “safer” than hard liquor. A 12-ounce can of beer, a 5-ounce glass of wine, and 1.5 ounces of hard liquor all contain the same amount of alcohol and have the same effects on the body and mind.

  • On average, it takes 2 to 3 hours for a single drink to leave a person’s system. Nothing can speed up this process, including drinking coffee, taking a cold shower, or “walking it off.”

  • People tend to be very bad at judging how seriously alcohol has affected them. That means many individuals who drive after drinking think they can control a car—but actually cannot.

  • Anyone can develop a serious alcohol problem, including a teenager.

Good Reasons Not to Drink. In talking with your child about reasons to avoid alcohol, stay away from scare tactics. Most young teens are aware that many people drink without problems, so it is important to discuss the consequences of alcohol use without overstating the case. Some good reasons why teens should not drink:

  • You want your child to avoid alcohol. Clearly state your own expectations about your child’s drinking. Your values and attitudes count with your child, even though he or she may not always show it.

  • To maintain self-respect. Teens say the best way to persuade them to avoid alcohol is to appeal to their self-respect—let them know that they are too smart and have too much going for them to need the crutch of alcohol. Teens also are likely to pay attention to examples of how alcohol might lead to embarrassing situations or events—things that might damage their self-respect or alter important relationships.

  • Drinking is illegal. Because alcohol use under the age of 21 is illegal, getting caught may mean trouble with the authorities. Even if getting caught doesn’t lead to police action, the parents of your child’s friends may no longer permit them to associate with your child.

  • Drinking can be dangerous. One of the leading causes of teen deaths is motor vehicle crashes involving alcohol. Drinking also makes a young person more vulnerable to sexual assault and unprotected sex. And while your teen may believe he or she wouldn’t engage in hazardous activities after drinking, point out that because alcohol impairs judgment, a drinker is very likely to think such activities won’t be dangerous.

  • You have a family history of alcoholism. If one or more members of your family has suffered from alcoholism, your child may be somewhat more vulnerable to developing a drinking problem.

  • Alcohol affects young people differently than adults. Drinking while the brain is still maturing may lead to long-lasting intellectual effects and may even increase the likelihood of developing alcohol dependence later in life.

The “Magic Potion” Myth. The media’s glamorous portrayal of alcohol encourages many teens to believe that drinking will make them “cool,” popular, attractive, and happy. Research shows that teens who expect such positive effects are more likely to drink at early ages. However, you can help to combat these dangerous myths by watching TV shows and movies with your child and discussing how alcohol is portrayed in them. For example, television advertisements for beer often show young people having an uproariously good time, as though drinking always puts people in a terrific mood. Watching such a commercial with your child can be an opportunity to discuss the many ways that alcohol can affect people—in some cases bringing on feelings of sadness or anger rather than carefree high spirits.

How to Handle Peer Pressure. It’s not enough to tell your young teen that he or she should avoid alcohol—you also need to help your child figure out how. What can your daughter say when she goes to a party and a friend offers her a beer? (See “Help Your Child Say No.”) Or what should your son do if he finds himself in a home where kids are passing around a bottle of wine and parents are nowhere in sight? What should their response be if they are offered a ride home with an older friend who has been drinking?

Brainstorm with your teen for ways that he or she might handle these and other difficult situations, and make clear how you are willing to support your child. An example: “If you find yourself at a home where kids are drinking, call me and I’ll pick you up—and there will be no scolding or punishment.” The more prepared your child is, the better able he or she will be to handle high-pressure situations that involve drinking.

THE COOL SPOT

It’s not always easy to get through to adolescents. Parents need all the help they can get. NIAAA’s Web site for middle schoolers, thecoolspot.gov, is an interactive tool designed specifically for kids. The site helps parents reinforce many of the ideas presented here, including:

  • A “reality check” on the drinking behavior of their peers (not everyone drinks).

  • Cool Spot web pageCompelling reasons not to drink.

  • An inside look at peer pressure, how to recognize it, and how to avoid it.

  • The most effective ways to say “no” to drinking.

Help your child better understand the risks of underage drinking and ways to resist peer pressure. Log on together www.thecoolspot.gov.

Mom, Dad, Did You Drink When You Were a Kid?

This is the question many parents dread—yet it is highly likely to come up in any family discussion of alcohol. The reality is that many parents did drink before they were old enough to legally do so. So how can one be honest with a child without sounding like a hypocrite who advises, “Do as I say, not as I did”?

This is a judgment call. If you believe that your drinking or drug use history should not be part of the discussion, you can simply tell your child that you choose not to share it. Another approach is to admit that you did do some drinking as a teenager, but that it was a mistake—and give your teen an example of an embarrassing or painful moment that occurred because of your drinking. This approach may help your child better understand that youthful alcohol use does have negative consequences.

HOW TO HOST A TEEN PARTY

  • Agree on a guest list—and don’t admit party crashers.

  • Discuss ground rules with your child before the party.

  • Encourage your teen to plan the party with a responsible friend so that he or she will have support if problems arise.

  • Brainstorm fun activities for the party.

  • If a guest brings alcohol into your house, ask him or her to leave.

  • Serve plenty of snacks and non-alcoholic drinks.

  • Be visible and available—but don’t join the party!

 

TAKING ACTION: PREVENTION STRATEGIES FOR PARENTS

While parent–child conversations about not drinking are essential, talking isn’t enough—you also need to take concrete action to help your child resist alcohol. Research strongly shows that active, supportive involvement by parents and guardians can help teens avoid underage drinking and prevent later alcohol misuse.

In a recent national survey, 64 percent of eighth graders said alcohol was “fairly easy” or “very easy” to get and 32 percent reported drinking within the last year. The message is clear: Young teens still need plenty of adult supervision. Some ways to provide it:

Monitor Alcohol Use in Your Home. If you keep alcohol in your home, keep track of the supply. Make it clear to your child that you don’t allow unchaperoned parties or other teen gatherings in your home. If possible, however, encourage him or her to invite friends over when you are at home. The more entertaining your child does in your home, the more you will know about your child’s friends and activities.

Connect With Other Parents. Getting to know other parents and guardians can help you keep closer tabs on your child. Friendly relations can make it easier for you to call the parent of a teen who is having a party to be sure that a responsible adult will be present and that alcohol will not be available. You’re likely to find out that you’re not the only adult who wants to prevent teen alcohol use—many other parents share your concern.

Keep Track of Your Child’s Activities. Be aware of your teen’s plans and whereabouts. Generally, your child will be more open to your supervision if he or she feels you are keeping tabs because you care, not because you distrust him or her.

Develop Family Rules About Youthful Drinking. When parents establish clear “no alcohol” rules and expectations, their children are less likely to begin drinking. Although each family should develop agreements about teen alcohol use that reflect their own beliefs and values, some possible family rules about drinking are:

  • Kids will not drink alcohol until they are 21.

  • Older siblings will not encourage younger brothers or sisters to drink and will not give them alcohol.

  • Kids will not stay at teen parties where alcohol is served.

  • Kids will not ride in a car with a driver who has been drinking.

Set a Good Example. Parents and guardians are important role models for their children—even children who are fast becoming teenagers. Studies indicate that if a parent uses alcohol, his or her children are more likely to drink as well. But even if you use alcohol, there may be ways to lessen the likelihood that your child will drink. Some suggestions:

  • Use alcohol moderately.

  • Don’t communicate to your child that alcohol is a good way to handle problems. For example, don’t come home from work and say, “I had a rotten day. I need a drink.”

  • Let your child see that you have other, healthier ways to cope with stress, such as exercise; listening to music; or talking things over with your spouse, partner, or friend.

  • Don’t tell your kids stories about your own drinking in a way that conveys the message that alcohol use is funny or glamorous.

  • Never drink and drive or ride in a car with a driver who has been drinking.

  • When you entertain other adults, serve alcohol-free beverages and plenty of food. If anyone drinks too much at your party, make arrangements for them to get home safely.

HELP YOUR CHILD SAY NO

Your child can learn to resist alcohol or anything else he or she may feel pressured into. Let him or her know that the best way to say “no” is to be assertive—that is, say no and mean it.

RESIST THE PRESSURE TO DRINK

Say no and let them know you mean it.

  • Stand up straight.

  • Make eye contact.

  • Say how you feel.

  • Don’t make excuses.

  • Stand up for yourself.

Don’t Support Teen Drinking. Your attitudes and behavior toward teen drinking also influence your child. Avoid making jokes about underage drinking or drunkenness, or otherwise showing acceptance of teen alcohol use. Never serve alcohol to your child’s underage friends. Research shows that kids whose parents or friends’ parents provide alcohol for teen get-togethers are more likely to engage in heavier drinking, to drink more often, and to get into traffic crashes. Remember, too, that in almost every State it is illegal to provide alcohol to minors who are not family members.

Help Your Child Build Healthy Friendships. If your child’s friends use alcohol, your child is more likely to drink too. So it makes sense to try to encourage your young teen to develop friendships with kids who do not drink and who are otherwise healthy influences on your child. A good first step is to simply get to know your child’s friends better. You can then invite the kids you feel good about to family get-togethers and outings and find other ways to encourage your child to spend time with those teens. Also, talk directly with your child about the qualities in a friend that really count, such as trustworthiness and kindness, rather than popularity or a “cool” style.

When you disapprove of one of your child’s friends, the situation can be tougher to handle. While it may be tempting to simply forbid your child to see that friend, such a move may make your child even more determined to hang out with him or her. Instead, you might try pointing out your reservations about the friend in a caring, supportive way. You can also limit your child’s time with that friend through your family rules, such as how after-school time can be spent or how late your child can stay out in the evening.

Encourage Healthy Alternatives to Alcohol. One reason kids drink is to beat boredom. So it makes sense to encourage your child to participate in supervised after-school and weekend activities that are challenging and fun. According to a recent survey of preteens, the availability of enjoyable, alcohol-free activities is a big reason for deciding not to use alcohol.

If your community doesn’t offer many supervised activities, consider getting together with other parents and teens to help create some. Start by asking your child and other kids what they want to do, because they will be most likely to participate in activities that truly interest them. Find out whether your church, school, or community organization can help you sponsor a project.

Smiling young latin teen

COULD YOUR CHILD DEVELOP
A DRINKING PROBLEM?

This booklet is primarily concerned with preventing teen alcohol use. We also need to pay attention to the possibility of youthful alcohol abuse. Certain children are more likely than others to drink heavily and encounter alcohol-related difficulties, including health, school, legal, family, and emotional problems. Kids at highest risk for alcohol-related problems are those who:

  • Begin using alcohol or other drugs before the age of 15.

  • Have a parent who is a problem drinker or an alcoholic.

  • Have close friends who use alcohol and/or other drugs.

  • Have been aggressive, antisocial, or hard to control from an early age.

  • Have experienced childhood abuse and/or other major traumas.

  • Have current behavioral problems and/or are failing at school.

  • Have parents who do not support them, do not communicate openly with them, and do not keep track of their behavior or whereabouts.

  • Experience ongoing hostility or rejection from parents and/or harsh, inconsistent discipline.

The more of these experiences a child has had, the greater the chances that he or she will develop problems with alcohol. Having one or more risk factors does not mean that your child definitely will develop a drinking problem, but it does suggest that you may need to act now to help protect your youngster from later problems.

Asian father talking with son.

Talking with your child is more important now than ever. If your child has serious behavioral problems, you may want to seek help from his or her school counselor, physician, and/or a mental health professional. And if you suspect that your child may be in trouble with drinking, consider getting advice from a health care professional specializing in alcohol problems before talking with your teen (see box “Warning Signs of a Drinking Problem”). To find a professional, contact your family doctor or a local hospital. Other sources of information and guidance may be found in your local Yellow Pages under “Alcoholism” or through one of the resources listed at the end of this booklet.

WARNING SIGNS OF A DRINKING PROBLEM

Although the following signs may indicate a problem with alcohol or other drugs, some also reflect normal teenage growing pains. Experts believe that a drinking problem is more likely if you notice several of these signs at the same time, if they occur suddenly, and if some of them are extreme in nature.

  • Mood changes: flare-ups of temper, irritability, and defensiveness.

  • School problems: poor attendance, low grades, and/or recent disciplinary action.

  • Rebelling against family rules.

  • Switching friends, along with a reluctance to have you get to know the new friends.

  • A “nothing matters” attitude: sloppy appearance, a lack of involvement in former interests, and general low energy.

  • Finding alcohol in your child’s room or backpack, or smelling alcohol on his or her breath.

  • Physical or mental problems: memory lapses, poor concentration, bloodshot eyes, lack of coordination, or slurred speech.

 

ACTION CHECKLIST

  • Establish a loving, trusting relationship with your child.

  • Make it easy for your teen to talk honestly with you.

  • Talk with your child about alcohol facts, reasons not to drink, and ways to avoid drinking in difficult situations.

  • Keep tabs on your young teen’s activities, and join with other parents in making common policies about teen alcohol use.

  • Develop family rules about teen drinking and establish consequences.

  • Set a good example regarding your own alcohol use and your response to teen drinking.

  • Encourage your child to develop healthy friendships and fun alternatives to drinking.

  • Know whether your child is at high risk for a drinking problem; if so, take steps to lessen that risk.

  • Know the warning signs of a teen drinking problem and act promptly to get help for your child.

  • Believe in your own power to help your child avoid alcohol use.

 

RESOURCES

Join Together
One Appleton Street, 4th Floor
Boston, MA 02116
(617) 437-1500
Internet address: http://www.jointogether.org

A national resource center for communities across the nation that are working to prevent alcohol and other drug abuse.

National Council on Alcoholism and Drug Dependence
244 East 58th Street, 4th Floor
New York, NY 10022
(800) NCA–CALL (622–2255)
(toll-free; 24-hour affiliate referral)
Internet address: http://www.ncadd.org

Provides educational materials on alcohol abuse and alcoholism as well as phone numbers of local NCADD affiliates who can supply information on local treatment resources.

National Institute on Alcohol Abuse and Alcoholism
5635 Fishers Lane, MSC 9304
Bethesda, MD 20892–9304
(301) 443-3860
Internet address: http://www.niaaa.nih.gov

Makes available free informational materials on many aspects of alcohol use, alcohol abuse, and alcoholism.

Substance Abuse and Mental Health Services Administration
National Drug Information Treatment and Referral Hotline
800–662–HELP (4357) (toll free)
Internet address: http://www.findtreatment.samhsa.gov

Provides information, support, treatment options, and referrals to local rehab centers for drug or alcohol problems. Operates 24 hours, 7 days a week.

 

OTHER NIAAA RESOURCES AND PUBLICATIONS

If you are interested in learning more about alcohol abuse and alcoholism, NIAAA has developed a number of resources for the public:

  • www.thecoolspot.gov—Web site developed specifically for children ages 11 through 13. See box, above.

  • A Family History of Alcoholism: Are You at Risk?—pamphlet containing basic information for anyone who is concerned about a family history of alcoholism. Lists organizations that can help relatives or friends of alcoholics. English version: NIH Publication Number 03–5340; Spanish version: NIH Publication Number 04–5340–S.

To order, write to: National Institute on Alcohol Abuse and Alcoholism, Publications Distribution Center, P.O. Box 10686, Rockville, MD 20849–0686, or access the full text of the above publications online at http://www.niaaa.nih.gov.

 

NIH Publication No. 13-4314
Published 2003
Revised 2009

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