Alcohol and Development in Youth

The Scope of the Problem
by National Institute of Health

Alcohol is the drug of choice among youth, often with devastating consequences. Alcohol is a leading contributor to injury death, the main cause of death for people under age 21. Drinking early in life also is associated with an increased risk of developing an alcohol use disorder at some time during the life span. Data consistently indicate that rates of drinking and alcohol-related problems are highest among White and American Indian or Alaska Native youth, followed by Hispanic youth, African Americans, and Asians. Prevalence rates of drinking for boys and girls are similar in the younger age groups; among older adolescents, however, more boys than girls engage in frequent and heavy drinking, and boys show higher rates of drinking problems. This article summarizes research on the epidemiology of youth drinking, including the consequences of youthful drinking, risk and protective factors and drinking trajectories, and information on special populations at particular risk for drinking-related problems. Key words: underage drinking; adolescent; survey; AODU (alcohol and other drug use) pattern; binge drinking; AOD (alcohol and other drug) induced risk; risk and protective factors; alcohol and other drug related consequences; AODR injury; epidemiology; special populations; children of alcoholics; undergraduate student; military; ethnic group; gender differences.

National surveys make it clear that alcohol drinking among youth is both widespread and harmful. Surveys provide data not only on the numbers of middle and high school students who drink but also on how they drink. The data show that when youth drink, they drink heavily in comparison with adults, consuming on average four to five drinks per occasion about five times a month, compared with two to three drinks per occasion about nine times a month for adults. Studies also find that drinking often begins at very young ages; a recent survey found that more than one-fourth of 14-year-olds reported drinking within the last year.

The negative consequences of underage drinking include a range of physical, academic, and social problems. Perhaps most frightening, alcohol is the leading contributor to injury death, the main cause of death for people under age 21. However, alcohol also plays a powerful role in risky sexual behavior, including unwanted, unintended, and unprotected sexual activity, and sex with multiple partners. Alcohol is associated with academic failure and drug use. Over the longer term, data have shown that drinking early in life is associated with an increased risk of developing an alcohol use disorder at some time during the life span.

Although almost all U.S. youth grow up in a culture permeated by alcohol, they are not uniformly at risk for alcohol consumption or its consequences. Epidemiology provides clues to risk and protective factors associated with youth drinking, including family history and genetic vulnerability, comorbid conditions, sociodemographic characteristics, social stressors such as poverty and lack of social support, family characteristics, alcohol availability, temperament, and other individual factors. Epidemiology also provides a profile of how specific populations of young people differ in their drinking patterns. Drinking, including heavy drinking, is common and accepted among college students, with consequences affecting both those who do the drinking and those who do not. Rates of heavy drinking among 18- to 25-year-olds in the military are much higher than among civilians. There is considerable variation between Whites and other ethnic/racial minority youth with respect to drinking, but also significant variation within these populations. Research is needed to determine how national origin, tribal affiliation, acculturation, immigration status, and language all influence drinking patterns among youth.

Epidemiology of Underage Drinking

Alcohol is the drug of choice among youth. Young people drink too much and at too early an age, thereby creating problems for themselves, for people around them, and for society as a whole. Hence, underage drinking is a leading public health problem in this country.

Prevalence and Age of Initiation

Nationwide surveys, as well as studies in smaller populations, show that alcohol drinking is widespread among adolescents. For example, 2004 data from Monitoring the Future, an annual survey of U.S. youth, show that more than three-fourths of 12th graders, nearly two-thirds of 10th graders, and more than two in five 8th graders have consumed alcohol at some point in their lives. And when youth drink, they tend to drink heavily. Underage drinkers consume on average four to five drinks per occasion about five times a month. By comparison, adult drinkers ages 26 and older consume on average two to three drinks per occasion about nine times a month. A particularly worrisome aspect of underage drinking is the high prevalence of heavy episodic drinking, defined as drinking five or more drinks in a row in the past 2 weeks. MTF data show that 12 percent of 8th graders, 22 percent of 10th graders, and 28 percent of 12th graders engage in heavy episodic drinking. It should come as no surprise, then, that about three-fifths of 12th graders, two-fifths of 10th graders, and one-fifth of 8th graders say they have been drunk. In fact, the highest prevalence of dependence is seen in people ages 18-24.

Studies also indicate that drinking often begins at very young ages. Data from recent surveys show that approximately 10 percent of 9- to 10-year-olds have already started drinking, nearly a third of youth begin drinking before age 13 and more than one-fourth of 14-year-olds report drinking within the past year. Other researchers have documented that drinking becomes increasingly common through the teenage years. In addition, a number of studies have documented that the early onset of alcohol use as well as the escalation of drinking in adolescence are both risk factors for the development of alcohol-related problems in adulthood.

These findings clearly are cause for concern, as are recent data suggesting that the age of first use of alcohol is declining. These data indicate that the average age of first use among young people of all ages was about 16 in 1999, compared with about 17 1/2 in 1965. Looking at underage drinkers only, 12- to 18-year-olds who report drinking report that they began doing so between 2 and 3 years earlier, when they were about 9 to 15, respectively. This is important because, as already noted, initiating alcohol consumption earlier in adolescence or in childhood is a marker for later problems, including heavier use of alcohol and other drugs during adolescence and meeting criteria for an alcohol dependence diagnosis in adulthood.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.