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Underage Drinking A Growing Health Care Concern

group of kids in a huddleUnderage alcohol use isn't limited to frat houses and football games. In fact the age at which kids start experimenting with alcohol is younger than ever. By the time they reach the eighth grade, nearly half of all adolescents have had a least one drink, and over 20 percent report having been “drunk.” A recent study of 12th graders showed that nearly a third of these students “binge” drink–that is, they reported drinking at least five drinks at one time within the last 2 weeks.

Apart from being illegal, underage drinking is risky business–to both the drinker and the community. Each drink increases the total crash risk more among drivers under 21 than drivers 21 and older. Adolescents who drink also may be at greater risk for alcohol–induced brain damage, which could lead to poor performance at school or work. Moreover, a person who starts drinking at an early age is more likely to develop serious alcohol problems, including alcoholism, later in life.

Kids sitting on steps at school

Preventing underage drinking continues to be central to the mission of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). NIAAA supports research aimed at developing early intervention approaches that will prevent alcohol problems among youth, especially those between the ages of 12 and 20. Helping people understand the significance of this problem is an important component of this initiative. This publication describes the scope of underage drinking today, including the most harmful consequences, as well as prevention and treatment approaches that are proving particularly effective in meeting the needs of this age group.

The Dangers of Adolescent Alcohol Use

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 described below.

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 drinking drivers under age 21 is more than twice the rate for those 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.

all girl team cheering after scoreSexual 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, failing to use condoms, and having unplanned sex). 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.

three boys at pizza palor

Lasting Consequences

Adolescence is the transition between childhood and adulthood. During this time, significant changes occur in the body, including rapid hormonal alterations and the formation of new networks in the brain. Adolescence also is a time of trying new things and, especially, conforming to peer–group standards. These new activities may place young people at particular risk for experimenting with alcohol and continuing to drink. Exposing the brain to alcohol during this period may interrupt key processes of brain development, possibly leading to subtle learning impairments as well as to further escalation of drinking.

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 also may 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.

2 girls listening to CD at music storePrevention and Treatment

Effective prevention and treatment programs are vital to reduce the risks associated with adolescent alcohol use. Research on the factors that contribute to the initiation and escalation of drinking is essential for the development of such programs. It should be noted that preventing and identifying alcohol use disorders in youth require different screening, assessment, and treatment approaches than those used for adults. For example, although relapse rates following alcoholism treatment are similar for both adults and adolescents, social factors such as peer pressure play a much larger role in relapse among adolescents.

Personal factors such as childhood behavior problems or a family history of alcohol use disorders can help to identify high–risk youth and may suggest directions for interventions. Perhaps the most reliable predictor of a youth's drinking behavior is the drinking behavior of his or her friends.

boy jumping on a skateboard

Most adolescents overestimate how much their peers drink and how positive their peers' attitudes are toward drinking. Many prevention programs that help dispel these myths about peers' drinking practices.

Family factors, such as parent–child relationships, discipline methods, communication, monitoring and supervision, and parental involvement, also exert a significant influence on youthful alcohol use. Accordingly, family–based prevention programs for youth have been developed, which have significantly delayed initiation of alcohol use by improving parenting skills and family bonding.

Some school–based programs are aimed at adolescents who have already begun drinking. Preliminary research also has found promise in high school–based motivational programs that encourage self–change in problem drinkers.

Policy and Community Strategies

Another important factor in underage drinking is availability, that is, how easy it is for an underage drinker to obtain alcohol. Interventions aimed at the individual must be supplemented by policy changes to help reduce youth access to alcohol and decrease the harmful consequences of established drinking. For example, raising the minimum legal drinking age in all States to 21 saved an estimated 20,000 lives between 1975 and 2000. In addition, all States now have zero–tolerance laws, which set the legal blood alcohol limit for drivers younger than age 21 at 0.00 or 0.02 percent. These lower blood alcohol limits for young drivers have been associated with a 20–percent decline in the proportion of single–vehicle, nighttime fatal crashes among drivers younger than age 21.

high school football gameAnother successful prevention strategy uses simple fear of punishment to deter drinking and driving. That is, increased enforcement of laws to stop driving under the influence (DUI), coupled with increased media attention on those enforcement tactics, increases people's perception that they will be caught if they drink and drive, making them less likely to drive while under the influence.

The most successful interventions will draw on family, school, and community components to prevent or reduce alcohol use among adolescents. Project Northland is one such promising program. This intervention was initiated in a group of sixth graders. By the eighth grade, these students were less likely to use alcohol, especially the students who had not yet started drinking when the program began. Project Northland activities were resumed in grades 11 and 12 and had a significant positive effect on the students' tendency to avoid alcohol use and binge drinking. Taken together, the results show the effectiveness of continued, age–appropriate prevention activities for delaying or reducing underage drinking.

NIAAA—Taking the Lead to Stop Underage Drinking

The immediate and long–term risks associated with adolescent alcohol use underscore the need for effective prevention and treatment programs. Research toward these ends is a top priority at NIAAA.

Through prevention and intervention strategies directed at the individual, family, school, and community, NIAAA seeks to increase public awareness of alcohol's effects and to reinforce the message that underage drinking is unacceptable, illegal, and dangerous.

Intervention tools such as Project Northland have shown promise in curbing underage alcohol use. Additional studies that follow groups of young people from childhood through their college years, at different locations and in different settings, will help determine whether interventions such as these are enduring and broadly applicable. Finding lasting solutions to the problem of underage drinking will be difficult; diligent research efforts offer the best hope for meeting this urgent challenge.

NIAAA is the lead Federal agency charged with conducting research on alcohol abuse and alcoholism. Central to this mission is the dissemination of information on alcohol and its effects. Visit the NIAAA Web site ( for a complete listing of publications and other materials on a wide range of alcohol–related topics.