Youth Drinking: Risk Factors and Consequences

espite a minimal legal imbibing age of 21, many immature people in the United States consume intoxicant. Some maltreatment intoxicant by imbibing often or by orgy imbibing — frequently defined as holding five or more drinks* in a row. A minority of young person may run into the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
( DSM-IV ) standard for intoxicant dependance ( 1,2 ) . The patterned advance of imbibing from usage to mistreat to dependence is associated with biological and psychosocial factors. This Alcohol Alert
examines some of these factors that put youth at hazard for imbibing and for alcohol-related jobs and considers some of the effects of their imbibing.

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Prevalence of Youth Drinking

Thirteen- to fifteen-year-olds are at high hazard to get down imbibing ( 3 ) . Harmonizing to consequences of an one-year study of pupils in 8th, 10th, and 12th classs, 26 per centum of 8th graders, 40 per centum of 10th graders, and 51 per centum of 12th graders reported imbibing intoxicant within the past month ( 4 ) . Binge imbibing at least one time during the 2 hebdomads before the study was reported by 16 per centum of 8th graders, 25 per centum of 10th graders, and 30 per centum of 12th graders.

Males study higher rates of day-to-day imbibing and orgy imbibing than females, but these differences are decreasing ( 3 ) . White pupils report the highest degrees of imbibing, inkinesss report the lowest, and Hispanics autumn between the two ( 3 ) .

A study concentrating on the alcohol-related jobs experienced by 4,390 high school seniors and dropouts found that within the predating twelvemonth, about 80 per centum reported either acquiring “ rummy, ” orgy imbibing, or imbibing and drive. More than half said that imbibing had caused them to experience ill, miss school or work, acquire arrested, or have a auto clang ( 5 ) .

Some striplings who drink subsequently abuse intoxicant and may develop alcohol addiction. Although these conditions are defined for grownups in the DSM, research suggests that separate diagnostic standards may be needed for young person ( 6 ) .

Drinking and Adolescent Development

While imbibing may be a remarkable job behaviour for some, research suggests that for others it may be an look of general stripling convulsion that includes other job behaviours and that these behaviours are linked to unconventionality, impulsiveness, and esthesis seeking ( 7-11 ) .

Binge imbibing, frequently get downing about age 13, tends to increase during adolescence, extremum in immature maturity ( ages 18-22 ) , so bit by bit lessening. In a 1994 national study, orgy imbibing was reported by 28 per centum of high school seniors, 41 per centum of 21- to 22-year-olds, but merely 25 per centum of 31- to 32-year-olds ( 3,12 ) . Persons who increase their orgy imbibing from age 18 to 24 and those who systematically binge drink at least one time a hebdomad during this period may hold jobs achieving the ends typical of the passage from adolescence to immature maturity ( e.g. , matrimony, educational attainment, employment, and fiscal independency ) ( 13 ) .

Hazard Factors for Adolescent Alcohol Use, Abuse, and Dependence

Familial Hazard Factors.

Animal surveies ( 14 ) and surveies of twins and adoptees demonstrate that familial factors influence an person ‘s exposure to alcohol addiction ( 15,16 ) . Children of alkies are significantly more likely than kids of nonalcoholics to originate imbibing during adolescence ( 17 ) and to develop alcohol addiction ( 18 ) , but the comparative influences of environment and genetic sciences have non been determined and vary among people.

Biological Markers.

Brain moving ridges elicited in response to specific stimulations ( e.g. , a visible radiation or sound ) provide steps of encephalon activity that predict hazard for alcohol addiction. P300, a moving ridge that occurs about 300 msecs after a stimulation, is most often used in this research. A low P300 amplitude has been demonstrated in persons with increased hazard for alcohol addiction, particularly boies of alcoholic male parents ( 19,20 ) . P300 measures among 36 preadolescent male childs were able to foretell intoxicant and other drug ( AOD ) use 4 old ages subsequently, at an mean age of 16 ( 21 ) .

Childhood Behavior.

Children classified as “ undercontrolled ” ( i.e. , unprompted, restless, and distractible ) at age 3 were twice every bit likely as those who were “ inhibited ” or “ well-balanced ” to be diagnosed with intoxicant dependance at age 21 ( 22 ) . Aggressiveness in kids every bit immature as ages 5-10 has been found to foretell AOD usage in adolescence ( 23,24 ) . Childhood antisocial behaviour is associated with alcohol-related jobs in adolescence ( 24-27 ) and intoxicant maltreatment or dependance in maturity ( 28,29 ) .

Psychiatric Disorders.

Among 12- to 16-year-olds, regular intoxicant usage has been significantly associated with behavior upset ; in one survey, striplings who reported higher degrees of imbibing were more likely to hold behavior upset ( 30,31 ) .

Six-year-old to seventeen-year-old male childs with attending shortage hyperactivity upset ( ADHD ) who were besides found to hold weak societal relationships had significantly higher rates of intoxicant maltreatment and dependance 4 old ages subsequently, compared with ADHD male childs without societal lacks and male childs without ADHD ( 32 ) .

Whether anxiousness and depression lead to or are effects of intoxicant maltreatment is unresolved. In a survey of college freshers, a DSM-III ( 33 ) diagnosing of intoxicant maltreatment or dependance was twice every bit likely among those with anxiousness upset as those without this upset ( 34 ) . In another survey, college pupils diagnosed with intoxicant maltreatment were about four times every bit likely as pupils without intoxicant maltreatment to hold a major depressive upset ( 35 ) . In most of these instances, depression preceded intoxicant maltreatment. In a survey of striplings in residential intervention for AOD dependance, 25 per centum met the DSM-III-R standards for depression, three times the rate reported for controls. In 43 per centum of these instances, the oncoming of AOD dependance preceded the depression ; in 35 per centum, the depression occurred foremost ; and in 22 per centum, the upsets occurred at the same time ( 36 ) .

Suicidal Behavior.

Alcohol usage among striplings has been associated with sing, planning, trying, and finishing self-destruction ( 37-39 ) . In one survey, 37 per centum of eighth-grade females who drank to a great extent reported trying self-destruction, compared with 11 per centum who did non imbibe ( 40 ) . Research does non bespeak whether imbibing causes self-destructive behaviour, merely that the two behaviours are correlated.

Psychosocial Hazard Factors

Rearing, Family Environment, and Peers.

Parents ‘ imbibing behaviour and favourable attitudes about imbibing have been positively associated with striplings ‘ initiating and go oning imbibing ( 41,42 ) . Early induction of imbibing has been identified as an of import hazard factor for later alcohol-related jobs ( 43 ) . Childs who were warned about intoxicant by their parents and kids who reported being closer to their parents were less likely to get down imbibing ( 42,44,45 ) .

Lack of parental support, monitoring, and communicating have been significantly related to frequence of imbibing ( 46 ) , heavy imbibing, and inebriation among striplings ( 47 ) . Harsh, inconsistent subject and ill will or rejection toward kids have besides been found to significantly foretell stripling imbibing and alcohol-related jobs ( 46 ) .

Peer imbibing and peer credence of imbibing have been associated with adolescent imbibing ( 48,49 ) . While both peer influences and parental influences are of import, their comparative impact on stripling imbibing is ill-defined.


Positive alcohol-related anticipations have been identified as hazard factors for adolescent imbibing. Positive anticipations about intoxicant have been found to increase with age ( 50 ) and to foretell the oncoming of imbibing and job imbibing among striplings ( 51-53 ) .


Child maltreatment and other injuries have been proposed as hazard factors for subsequent intoxicant jobs. Adolescents in intervention for intoxicant maltreatment or dependance reported higher rates of physical maltreatment, sexual maltreatment, violent victimization, witnessing force, and other injuries compared with controls ( 54 ) . The striplings in intervention were at least 6 times more likely than controls to hold of all time been abused physically and at least 18 times more likely to hold of all time been abused sexually. In most instances, the physical or sexual maltreatment preceded the intoxicant usage. Thirteen per centum of the intoxicant dependent striplings had experienced posttraumatic emphasis upset, compared with 10 per centum of those who abused intoxicant and 1 per centum of controls.


Research on the effects of intoxicant advertisement on adolescent alcohol-related beliefs and behaviours has been limited ( 55 ) . While earlier surveies measured the effects of exposure to advertisement ( 56 ) , more recent research has assessed the effects of intoxicant advertisement consciousness on purposes to imbibe. In a survey of fifth- and sixth-grade pupils ‘ consciousness, measured by the ability to place merchandises in commercials with the merchandise name blocked out, consciousness had a little but statistically important relationship to positive anticipations about intoxicant and to purpose to imbibe as grownups ( 57 ) . This suggests that intoxicant advertisement may act upon striplings to be more favourably predisposed to imbibing ( 57 ) .

Consequences of Adolescent Alcohol Use

Drinking and Driving.

Of the about 8,000 drivers ages 15-20 involved in fatal clangs in 1995, 20 per centum had blood intoxicant concentrations above nothing ( 58 ) . For more information about immature drivers ‘ increased clang hazard and the factors that contribute to this hazard, see Alcohol Alert No. 31: Drinking and Driving
( 59 ) .

Sexual Behavior.

Surveies of striplings suggest that intoxicant usage is associated with hazardous sexual behaviour and increased exposure to coercive sexual activity. Among striplings surveyed in New Zealand, intoxicant abuse was significantly associated with unprotected intercourse and sexual activity before age 16 ( 60 ) . Forty-four per centum of sexually active Massachusetts adolescents said they were more likely to hold sexual intercourse if they had been imbibing, and 17 per centum said they were less likely to utilize rubbers after imbibing ( 61 ) .

Hazardous Behavior and Victimization.

Survey consequences from a nationally representative sample of 8th and 10th graders indicated that intoxicant usage was significantly associated with both hazardous behaviour and victimization and that this relationship was strongest among the 8th-grade males, compared with other pupils ( 62 ) .

Puberty and Bone Growth.

High doses of intoxicant have been found to detain pubescence in female ( 63 ) and male rats ( 64 ) , and big measures of intoxicant consumed by immature rats can decelerate bone growing and consequence in weaker castanetss ( 65 ) . However, the deductions of these findings for immature people are non clear.

Prevention of Adolescent Alcohol Use

Measures to forestall stripling intoxicant usage include policy intercessions and community and educational plans. Alcohol Alert No. 34: Preventing Alcohol Abuse and Related Problems
( 66 ) covers these subjects in item. See the National Institute on Alcohol Abuse and Alcoholism ‘s ( NIAAA ‘s ) World Wide Web site at hypertext transfer protocol: //

Young person Drinking: Hazard Factors and Consequences — A Commentary by NIAAA Director Enoch Gordis, M.D.

lcohol, the most widely used and abused drug among young person, causes serious and potentially dangerous jobs for this population. Although intoxicant is sometimes referred to as a “ gateway drug ” for young person because its usage frequently precedes the usage of other illicit substances, this nomenclature is counterproductive ; youth imbibing requires important attending, non because of what it leads to but because of the extended homo and economic impact of intoxicant usage by this vulnerable population.

For some young person, intoxicant usage entirely is the primary job. For others, imbibing may be merely one of a configuration of bad behaviours. For these persons, intercessions designed to modify bad behaviour probably would be more successful in forestalling intoxicant jobs than those designed entirely to forestall the induction of imbibing. Determining which influences are involved in specific young person imbibing forms will allow the design of more powerful intercessions. Finally, we need to develop a better apprehension of the intoxicant intervention demands of young person. Future inquiries for scientific attending include, what types of specialised diagnostic and assessment instruments are needed for young person ; whether intervention in segregated, “ young person merely ” plans is more effectual than in general population plans ; and, irrespective of the scene, what types of specific modes are needed by young person to increase the long-run effectivity of intervention.