Definition
Alcohol is the drug of choice among youth. Many young people are experiencing the consequences of drinking too much, at too early an age. As a result, underage drinking is a leading public health problem in this country. Research shows that alcohol drinking is widespread among adolescents. For example, 2002 data from Monitoring the Future, an annual survey of U.S. youth, show that more than three-fourths of 12th graders, two-thirds of 10th graders, and nearly half of 8th graders have drunk alcohol at some point in their lives. And when youth drink, they tend to drink heavily. Underage drinkers between the ages of 12 and 17 consume on average 4 to 5 drinks per occasion, about 5 times a month.
Articles
- Underage Drinking Facts
- Teen Alcoholism – the Basics
- Tips for Teens: The Truth About Alcohol
- Talk to Your Child about Alcohol
- Understanding Underage Drinking
- New Advances in Alcoholism Treatment
- Craving Research: Implications for Treatment
- Underage Drinking: A Major Public Health Challenge
- The Genetics of Alcoholism
- Teen Underage Drinking
- Young Adult Drinking
- Underage Drinking
- Drinking and Driving
- Alcohol and Stress
- Preventing Alcohol Abuse and Related Problems -Teen Drinking
- Teen Alcoholism – Alcohol, Violence, and Aggression
- Youth Drinking: Risk Factors and Consequences
Article Summaries
Underage drinking prevention has two goals: prevent harm to the individual drinker and prevent harm to society. Modern prevention programs should be measured not by their intentions, but by their consequences: reducing the number of criminal events (drinking, DWI, date rape, etc.), reducing the amount of harm to individuals (injuries, alcohol overdoses, teen pregnancies, etc.), and reducing the harm to society (criminal and juvenile justice costs, medical and addiction treatment expenses, etc.). The goal of underage drinking prevention is to delay, deter, or eliminate the onset of illegal underage drinking among minors. For the purposes of this booklet, prevention is defined as programs, policies, or activities that are designed to keep youth from using alcohol before they attain the minimum legal drinking age.
Alcoholism, also known as alcohol dependence, is a disease that includes the following four symptoms: Craving—A strong need, or urge, to drink. Loss of control—Not being able to stop drinking once drinking has begun. Physical dependence—Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping drinking. Tolerance—The need to drink greater amounts of alcohol to get “high.”
Tips for Teens: The Truth About Alcohol
Alcohol affects your brain. Drinking alcohol leads to a loss of coordination, poor judgment, slowed reflexes, distorted vision, memory lapses, and even blackouts. Alcohol affects your body. Alcohol can damage every organ in your body. It is absorbed directly into your bloodstream and can increase your risk for a variety of life-threatening diseases, including cancer. Alcohol affects your self-control. Alcohol depresses your central nervous system, lowers your inhibitions, and impairs your judgment. Drinking can lead to risky behaviors, such as driving when you shouldn’t, or having unprotected sex.
Talk to Your Child about Alcohol
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.
Understanding Underage Drinking
Alcohol is the drug of choice among youth. Many young people are experiencing the consequences of drinking too much, at too early an age. As a result, underage drinking is a leading public health problem in this country. Research shows that alcohol drinking is widespread among adolescents. For example, 2002 data from Monitoring the Future, an annual survey of U.S. youth, show that more than three-fourths of 12th graders, two-thirds of 10th graders, and nearly half of 8th graders have drunk alcohol at some point in their lives. And when youth drink, they tend to drink heavily. Underage drinkers between the ages of 12 and 17 consume on average 4 to 5 drinks per occasion, about 5 times a month. By comparison, adult drinkers aged 26 and older consume on average 2 to 3 drinks per occasion, about 9 times a month. Underage drinking can result in a range of adverse short-and long-term consequences, including academic and/or social problems; physical problems such as hangovers or illnesses; unwanted, unintended, and unprotected sexual activity; physical and sexual assault; memory problems; increased risk of suicide and homicide; alcohol-related car crashes and other unintentional injuries such as burns, falls, and drownings; and death from alcohol poisoning.
New Advances in Alcoholism Treatment
More than 700,000 Americans receive alcoholism treatment on any given day (1). However, the techniques of alcoholism therapy have traditionally been based on clinical experience and intuition, with little rigorous validation of their effectiveness (2). Over the past 20 years, modern methods of evaluating medical therapies have been increasingly applied to alcoholism treatment. These methods include the use of control groups for comparison purposes, random assignment of study participants to different treatment groups and, to the greatest extent possible, followup of all patients who entered the study (3). This issue focuses on the results of recent controlled clinical studies on the effectiveness of self-help groups, psychosocial approaches, and medications in achieving and maintaining abstinence. Self-help groups are the most commonly sought source of help for alcohol-related problems (4). Alcoholics Anonymous (AA), one of the most commonly known self-help groups, outlines 12 consecutive activities, or steps, that alcoholics should achieve during the recovery process. Alcoholics can become involved with AA before entering professional treatment, as a part of it, or as aftercare following professional treatment. Although AA appears to produce positive outcomes in many of its members (5,6), its efficacy has rarely been assessed in randomized clinical trials (7).
Craving Research: Implications for Treatment
Many researchers and clinicians consider craving an important contributor to the development and maintenance of alcoholism (1). Craving has been described as a powerful urge to drink or as intense thoughts about alcohol. The International Classification of Diseases (ICD–10) includes craving as an optional diagnostic criterion for addiction to alcohol or other drugs, defining the term as a strong desire or sense of compulsion to take the drug1(2,3). Understanding the exact nature of craving has been difficult. Nevertheless, scientists have accumulated a large amount of data on its mechanisms and manifestations. This Alcohol Alert reviews how this information has stimulated the development of psychological and pharmacological approaches for maintaining abstinence among alcoholics during and after treatment. The lack of consensus in this area is indicated by the omission of craving from the diagnostic criteria for alcoholism in the Diagnostic and Statistical Manual of Mental Disorders.
Underage Drinking: A Major Public Health Challenge
By the time they reach the eighth grade, nearly 50 percent of adolescents have had at least one drink, and over 20 percent report having been “drunk” (1). Approximately 20 percent of 8th graders and almost 50 percent of 12th graders have consumed alcohol within the past 30 days (1). Among 12th graders, almost 30 percent report drinking on 3 or more occasions per month (2). Approximately 30 percent of 12th graders engage in heavy episodic drinking, now popularly termed “binge” drinking—that is, having at least five or more drinks on one occasion within the past 2 weeks—and it is estimated that 20 percent do so on more than one occasion (2). Apart from being illegal, underage drinking poses a high risk to both the individual and society (3). For example, the rate of alcohol–related traffic crashes is greater for drivers ages 16 to 20 than for drivers age 21 and older (4). Adolescents also are vulnerable to alcohol–induced brain damage, which could contribute to poor performance at school or work. In addition, youthful drinking is associated with an increased likelihood of developing alcohol abuse or dependence later in life. Early intervention is essential to prevent the development of serious alcohol problems among youth between the ages of 12 and 20. This Alcohol Alert describes some of the most harmful consequences of underage drinking as well as prevention and treatment approaches that can be applied successfully to meet the unique needs of this age group.
Research has shown conclusively that familial transmission of alcoholism risk is at least in part genetic and not just the result of family environment (1). The task of current science is to identify what a person inherits that increases vulnerability to alcoholism and how inherited factors interact with the environment to cause disease. This information will provide the basis for identifying people at risk and for developing behavioral and pharmacologic approaches to prevent and treat alcohol problems. The advances being made now are built on the discovery 50 years ago of the role in inheritance of DNA, the genetic material in cells that serves as a blueprint for the proteins that direct life processes. Alcoholism research, like other fields, is capitalizing on the scientific spinoffs of this milestone, among them the Human Genome Project and related efforts to sequence the genomes, the complete DNA sequences, of selected animals.
Alcohol is the drug of choice among youth. Many young people are experiencing the consequences of drinking too much, at too early an age. As a result, underage drinking is a leading public health problem in this country. Each year, approximately 5,000 young people under the age of 21 die as a result of underage drinking; this includes about 1,900 deaths from motor vehicle crashes, 1,600 as a result of homicides, 300 from suicide, as well as hundreds from other injuries such as falls, burns, and drownings (1–5). Yet drinking continues to be widespread among adolescents, as shown by nationwide surveys as well as studies in smaller populations. According to data from the 2005 Monitoring the Future (MTF) study, an annual survey of U.S. youth, three-fourths of 12th graders, more than two-thirds of 10th graders, and about two in every five 8th graders have consumed alcohol. And when youth drink they tend to drink intensively, often consuming four to five drinks at one time. MTF data show that 11 percent of 8th graders, 22 percent of 10th graders, and 29 percent of 12th graders had engaged in heavy episodic (or “binge1”) drinking within the past two weeks (6) (see figure). (1 The National Institute on Alcohol Abuse and Alcoholism [NIAAA] defines binge drinking as a pattern of drinking alcohol that brings blood alcohol concentration [BAC] to 0.08 grams percent or above. For the typical adult, this pattern corresponds to consuming five or more drinks [men], or four or more drinks [women], in about 2 hours.)
Too often today’s headlines bring news of yet another alcohol-related tragedy involving a young person—a case of fatal alcohol poisoning on a college campus or a late-night drinking–driving crash. People ages 18 to 25 often are in the news, but are they really at higher risk than anyone else for problems involving alcohol? Some of the most important new data to emerge on young adult drinking were collected through a recent nationwide survey, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). According to these data, in 2001–2002 about 70 percent of young adults in the United States, or about 19 million people, consumed alcohol in the year preceding the survey.
In March 2007, the Acting Surgeon General of the United States issued a Call to Action To Prevent and Reduce Underage Drinking. The National Institute on Alcohol Abuse and Alcoholism’s (NIAAA’s) Underage Drinking Research Initiative provided much of the scientific foundation for that document. The Call to Action highlights the nature and extent of underage drinking and its consequences. It suggests a new, more comprehensive and developmentally sensitive approach to understanding, preventing, and reducing underage drinking. Importantly, the Call to Action emphasizes that everyone has a role in preventing and reducing underage drinking—parents, schools, communities, colleges and universities, the health care system, the criminal and juvenile justice systems and law enforcement, and governments and policymakers. Later in 2007, the Surgeon General also issued three separate guides—for families, educators, and communities—based on the Call to Action.
Driving involves multiple tasks, the demands of which can change continually. To drive safely, one must maintain alertness, make decisions based on ever-changing information present in the environment, and execute maneuvers based on these decisions. Drinking alcohol impairs a wide range of skills necessary for carrying out these tasks. This Alcohol Alert examines alcohol impairment of driving skills and describes some factors that increase motor vehicle crash risk. Some Factors That Influence Crash Risk. Blood alcohol concentration. The proportion of alcohol to blood in the body is expressed as the blood alcohol concentration (BAC). In the field of traffic safety, BAC is expressed as the percentage of alcohol in deciliters of blood—for example, 0.10 percent (i.e., 0.10 grams per deciliter). A 160-pound man will have a BAC of approximately 0.04 percent 1 hour after consuming two 12-ounce beers or two other standard drinks on an empty stomach.
The term “stress” often is used to describe the subjective feeling of pressure or tension. However, when scientists refer to stress, they mean the many objective physiological processes that are initiated in response to a stressor. As this Alcohol Alert explains, the stress response is a complex process; the association between drinking and stress is more complicated still. Because both drinking behavior and an individual’s response to stress are determined by multiple genetic and environmental factors (1-3), studying the link between alcohol consumption and stress may further our understanding of drinking behavior.
Preventing Alcohol Abuse and Related Problems -Teen Drinking
Prevention measures aim to reduce alcohol abuse and its consequences. Such measures include policies regulating alcohol-related behavior on the one hand and community and educational interventions seeking to influence drinking behavior on the other. Researchers use scientific methods, such as randomized controlled trials, time-series analysis, and computer simulation, to determine the effectiveness of prevention initiatives. The resulting data may both inform policy and guide community and educational prevention efforts. This Alcohol Alert summarizes research on the effectiveness of selected initiatives in each of these areas.
Teen Alcoholism – Alcohol, Violence, and Aggression
Scientists and nonscientists alike have long recognized a two-way association between alcohol consumption and violent or aggressive behavior (1). Not only may alcohol consumption promote aggressiveness, but victimization may lead to excessive alcohol consumption. Violence may be defined as behavior that intentionally inflicts, or attempts to inflict, physical harm. Violence falls within the broader category of aggression, which also includes behaviors that are threatening, hostile, or damaging in a nonphysical way (2). This Alcohol Alert explores the association between alcohol consumption, violence, and aggression and the role of the brain in regulating these behaviors. Understanding the nature of these associations is essential to breaking the cycle of alcohol misuse and violence.
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.