Youth Drinking – Risks and Factors

National Institute on Alcohol Abuse and Alcoholism

No. 37 July 1997

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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.

Prevalence of Youth Drinking

Thirteen- to fifteen-year-olds are at high risk to begin drinking (3).
According to results of an annual survey of students in 8th, 10th, and
12th grades, 26 percent of 8th graders, 40 percent of 10th graders, and
51 percent of 12th graders reported drinking alcohol within the past
month (4). Binge drinking at least once during the 2 weeks before the
survey was reported by 16 percent of 8th graders, 25 percent of 10th
graders, and 30 percent of 12th graders.

Males report higher rates of daily drinking and binge drinking than
females, but these differences are diminishing (3). White students report
the highest levels of drinking, blacks report the lowest, and Hispanics
fall between the two (3).

A survey focusing on the alcohol-related problems experienced by 4,390
high school seniors and dropouts found that within the preceding year,
approximately 80 percent reported either getting “drunk,” binge drinking,
or drinking and driving. More than half said that drinking had caused
them to feel sick, miss school or work, get arrested, or have a car crash
(5).

Some adolescents who drink later abuse alcohol and may develop
alcoholism. Although these conditions are defined for adults in the DSM,
research suggests that separate diagnostic criteria may be needed for
youth (6).

Drinking and Adolescent Development

While drinking may be a singular problem behavior for some, research
suggests that for others it may be an expression of general adolescent
turmoil that includes other problem behaviors and that these behaviors
are linked to unconventionality, impulsiveness, and sensation seeking
(7-11).

Binge drinking, often beginning around age 13, tends to increase
during adolescence, peak in young adulthood (ages 18-22), then gradually
decrease. In a 1994 national survey, binge drinking was reported by 28
percent of high school seniors, 41 percent of 21- to 22-year-olds, but
only 25 percent of 31- to 32-year-olds (3,12). Individuals who increase
their binge drinking from age 18 to 24 and those who consistently binge
drink at least once a week during this period may have problems attaining
the goals typical of the transition from adolescence to young adulthood
(e.g., marriage, educational attainment, employment, and financial
independence) (13).

Risk Factors for Adolescent Alcohol Use, Abuse, and
Dependence

Genetic Risk Factors. Animal studies (14)
and studies of twins and adoptees demonstrate that genetic factors
influence an individual’s vulnerability to alcoholism (15,16). Children
of alcoholics are significantly more likely than children of
nonalcoholics to initiate drinking during adolescence (17) and to develop
alcoholism (18), but the relative influences of environment and genetics
have not been determined and vary among people.

Biological Markers. Brain waves elicited in
response to specific stimuli (e.g., a light or sound) provide measures of
brain activity that predict risk for alcoholism. P300, a wave that occurs
about 300 milliseconds after a stimulus, is most frequently used in this
research. A low P300 amplitude has been demonstrated in individuals with
increased risk for alcoholism, especially sons of alcoholic fathers
(19,20). P300 measures among 36 preadolescent boys were able to predict
alcohol and other drug (AOD) use 4 years later, at an average age of 16
(21).

Childhood Behavior. Children classified as
“undercontrolled” (i.e., impulsive, restless, and distractible) at age 3
were twice as likely as those who were “inhibited” or “well-adjusted” to
be diagnosed with alcohol dependence at age 21 (22). Aggressiveness in
children as young as ages 5-10 has been found to predict AOD use in
adolescence (23,24). Childhood antisocial behavior is associated with
alcohol-related problems in adolescence (24-27) and alcohol abuse or
dependence in adulthood (28,29).

Psychiatric Disorders. Among 12- to
16-year-olds, regular alcohol use has been significantly associated with
conduct disorder; in one study, adolescents who reported higher levels of
drinking were more likely to have conduct disorder (30,31).

Six-year-old to seventeen-year-old boys with attention deficit
hyperactivity disorder (ADHD) who were also found to have weak social
relationships had significantly higher rates of alcohol abuse and
dependence 4 years later, compared with ADHD boys without social
deficiencies and boys without ADHD (32).

Whether anxiety and depression lead to or are consequences of alcohol
abuse is unresolved. In a study of college freshmen, a DSM-III (33)
diagnosis of alcohol abuse or dependence was twice as likely among those
with anxiety disorder as those without this disorder (34). In another
study, college students diagnosed with alcohol abuse were almost four
times as likely as students without alcohol abuse to have a major
depressive disorder (35). In most of these cases, depression preceded
alcohol abuse. In a study of adolescents in residential treatment for AOD
dependence, 25 percent met the DSM-III-R criteria for depression, three
times the rate reported for controls. In 43 percent of these cases, the
onset of AOD dependence preceded the depression; in 35 percent, the
depression occurred first; and in 22 percent, the disorders occurred
simultaneously (36).

Suicidal Behavior. Alcohol use among
adolescents has been associated with considering, planning, attempting,
and completing suicide (37-39). In one study, 37 percent of eighth-grade
females who drank heavily reported attempting suicide, compared with 11
percent who did not drink (40). Research does not indicate whether
drinking causes suicidal behavior, only that the two behaviors are
correlated.

Psychosocial Risk Factors

Parenting, Family Environment, and Peers.
Parents’ drinking behavior and favorable attitudes about drinking have
been positively associated with adolescents’ initiating and continuing
drinking (41,42). Early initiation of drinking has been identified as an
important risk factor for later alcohol-related problems (43). Children
who were warned about alcohol by their parents and children who reported
being closer to their parents were less likely to start drinking
(42,44,45).

Lack of parental support, monitoring, and communication have been
significantly related to frequency of drinking (46), heavy drinking, and
drunkenness among adolescents (47). Harsh, inconsistent discipline and
hostility or rejection toward children have also been found to
significantly predict adolescent drinking and alcohol-related problems
(46).

Peer drinking and peer acceptance of drinking have been associated
with adolescent drinking (48,49). While both peer influences and parental
influences are important, their relative impact on adolescent drinking is
unclear.

Expectancies. Positive alcohol-related
expectancies have been identified as risk factors for adolescent
drinking. Positive expectancies about alcohol have been found to increase
with age (50) and to predict the onset of drinking and problem drinking
among adolescents (51-53).

Trauma. Child abuse and other traumas have
been proposed as risk factors for subsequent alcohol problems.
Adolescents in treatment for alcohol abuse or dependence reported higher
rates of physical abuse, sexual abuse, violent victimization, witnessing
violence, and other traumas compared with controls (54). The adolescents
in treatment were at least 6 times more likely than controls to have ever
been abused physically and at least 18 times more likely to have ever
been abused sexually. In most cases, the physical or sexual abuse
preceded the alcohol use. Thirteen percent of the alcohol dependent
adolescents had experienced posttraumatic stress disorder, compared with
10 percent of those who abused alcohol and 1 percent of controls.

Advertising. Research on the effects of
alcohol advertising on adolescent alcohol-related beliefs and behaviors
has been limited (55). While earlier studies measured the effects of
exposure to advertising (56), more recent research has assessed the
effects of alcohol advertising awareness on intentions to drink. In a
study of fifth- and sixth-grade students’ awareness, measured by the
ability to identify products in commercials with the product name blocked
out, awareness had a small but statistically significant relationship to
positive expectancies about alcohol and to intention to drink as adults
(57). This suggests that alcohol advertising may influence adolescents to
be more favorably predisposed to drinking (57).

Consequences of Adolescent Alcohol Use

Drinking and Driving. Of the nearly 8,000
drivers ages 15-20 involved in fatal crashes in 1995, 20 percent had
blood alcohol concentrations above zero (58). For more information about
young drivers’ increased crash risk and the factors that contribute to
this risk, see Alcohol Alert No. 31: Drinking and Driving (59).

Sexual Behavior. Surveys of adolescents
suggest that alcohol use is associated with risky sexual behavior and
increased vulnerability to coercive sexual activity. Among adolescents
surveyed in New Zealand, alcohol misuse was significantly associated with
unprotected intercourse and sexual activity before age 16 (60).
Forty-four percent of sexually active Massachusetts teenagers said they
were more likely to have sexual intercourse if they had been drinking,
and 17 percent said they were less likely to use condoms after drinking
(61).

Risky Behavior and Victimization. Survey
results from a nationally representative sample of 8th and 10th graders
indicated that alcohol use was significantly associated with both risky
behavior and victimization and that this relationship was strongest among
the 8th-grade males, compared with other students (62).

Puberty and Bone Growth. High doses of
alcohol have been found to delay puberty in female (63) and male rats
(64), and large quantities of alcohol consumed by young rats can slow
bone growth and result in weaker bones (65). However, the implications of
these findings for young people are not clear.

Prevention of Adolescent Alcohol Use

Measures to prevent adolescent alcohol use include policy
interventions and community and educational programs. Alcohol Alert No.
34: Preventing Alcohol Abuse and Related Problems (66) covers these
topics in detail. See the National Institute on Alcohol Abuse and
Alcoholism’s (NIAAA’s) World Wide Web site at
http://www.niaaa.nih.gov.

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Youth Drinking: Risk Factors and Consequences–A
Commentary by
NIAAA Director Enoch Gordis, M.D.

Alcohol, the most widely used and abused drug among youth, causes
serious and potentially life-threatening problems for this population.
Although alcohol is sometimes referred to as a “gateway drug” for youth
because its use often precedes the use of other illicit substances, this
terminology is counterproductive; youth drinking requires significant
attention, not because of what it leads to but because of the extensive
human and economic impact of alcohol use by this vulnerable
population.

For some youth, alcohol use alone is the primary problem. For others,
drinking may be only one of a constellation of high-risk behaviors. For
these individuals, interventions designed to modify high-risk behavior
likely would be more successful in preventing alcohol problems than those
designed solely to prevent the initiation of drinking. Determining which
influences are involved in specific youth drinking patterns will permit
the design of more potent interventions. Finally, we need to develop a
better understanding of the alcohol treatment needs of youth. Future
questions for scientific attention include, what types of specialized
diagnostic and assessment instruments are needed for youth; whether
treatment in segregated, “youth only” programs is more effective than in
general population programs; and, irrespective of the setting, what types
of specific modalities are needed by youth to increase the long-term
effectiveness of treatment.

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*A standard drink is 12 grams of pure alcohol, which is equal to one
12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5
ounces of 80-proof distilled spirits.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service * National Institutes of Health