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Underage Drinking

Underage drinking is a serious public health problem in the United States. Alcohol is the most widely used substance of abuse among America’s youth, and drinking by young people poses enormous health and safety risks.

The consequences of underage drinking can affect everyone—regardless of age or drinking status. We all feel the effects of the aggressive behavior, property damage, injuries, violence, and deaths that can result from underage drinking. This is not simply a problem for some families—it is a nationwide concern.

Underage Drinking Statistics

How much is a drink? In the United States, a standard drink is one that contains about 14 grams of pure alcohol, which is found in: 12 ounces of beer with about 5 percent alcohol content

5 ounces of wine with about 12 percent alcohol content

1.5 ounces of distilled spirits with about 40 percent alcohol content The percent of “pure” alcohol, expressed here as alcohol by volume (alc/vol), varies within and across beverage types. Although the “standard” drink amounts are helpful for following health guidelines, they may not reflect customary serving sizes. A large cup of beer, an overpoured glass of wine, or a single mixed drink could contain much more alcohol than a standard drink.

Many young people drink alcohol

By age 15, about 33 percent of teens have had at least 1 drink. 1

By age 18, about 60 percent of teens have had at least 1 drink. 1

In 2015, 7.7 million young people ages 12–20 reported that they drank alcohol beyond “just a few sips” in the past month.2

Youth ages 12 to 20 often binge drink

People ages 12 through 20 drink 11 percent of all alcohol consumed in the United States.3 Although youth drink less often than adults do, when they do drink, they drink more. That is because young people consume more than 90 percent of their alcohol by binge drinking. Binge drinking is consuming many drinks on an occasion (see box). Drinking alcohol and binge drinking become more prevalent as young people get older.

5.1 million young people reported binge drinking (for males 5 or more drinks and for females 4 or more drinks on the same occasion within a few hours) at least once in the past month. 2

1.3 million young people reported binge drinking on 5 or more days over the past month.2

More adolescents use alcohol than cigarettes or marijuana

Drinking patterns vary by age and gender

As adolescents get older, they tend to drink more. Prevalence of drinking by boys and girls is similar, although among older adolescents, boys binge more than girls.

Alcohol use among boys Alcohol use among girls

Underage Drinking Is Dangerous

Underage drinking poses a range of risks and negative consequences. It is dangerous because it:



Causes many deaths

Based on data from 2006–2010, the Centers for Disease Control and Prevention (CDC) estimates that, on average, alcohol is a factor in the deaths of 4,358 young people under age 21 each year.4 This includes:

1,580 deaths from motor vehicle crashes

1,269 from homicides

245 from alcohol poisoning, falls, burns, and drowning

492 from suicides

Causes many injuries

Drinking alcohol can cause kids to have accidents and get hurt. In 2011 alone, about 188,000 people under age 21 visited an emergency room for alcohol-related injuries.5

Impairs judgment

Drinking can lead to poor decisions about engaging in risky behavior, including drinking and driving, sexual activity (such as unprotected sex), and aggressive or violent behavior.

Increases the risk of physical and sexual assault

Underage youth who drink are more likely to carry out or be the victim of a physical or sexual assault after drinking than others their age who do not drink.

Can lead to other problems

Drinking may cause youth to have trouble in school or with the law. Drinking alcohol also is associated with the use of other drugs.



Increases the risk of alcohol problems later in life

Research shows that people who start drinking before the age of 15 are 4 times more likely to meet the criteria for alcohol dependence at some point in their lives.



Interferes with brain development

Research shows that young people’s brains keep developing well into their 20s. Alcohol can alter this development, potentially affecting both brain structure and function. This may cause cognitive or learning problems and/or make the brain more prone to alcohol dependence. This is especially a risk when people start drinking young and drink heavily.

Why Do So Many Young People Drink?

What is “binge drinking?” For adults, binge drinking means drinking so much within about 2 hours that blood alcohol concentration (BAC) levels reach 0.08 g/dL, the legal limit of intoxication. For women, this typically occurs after 4 drinks, and for men, about 5. But, according to recent research estimates, children may reach these BAC levels after fewer drinks.

For boys: Ages 9–13: About 3 drinks

Ages 14–15: About 4 drinks

Ages 16–17: About 5 drinks For girls: Ages 9–17: About 3 drinks

As children mature, it is natural for them to assert their independence, seek new challenges, and try taking risks. Underage drinking is a risk that attracts many developing adolescents and teens. Many want to try alcohol, but often do not fully recognize its effects on their health and behavior. Other reasons young people drink alcohol include:

Peer pressure

Increased independence, or desire for it

Stress

In addition, many youth may have easy access to alcohol. In 2015, among 12–14-year-olds who reported that they drank alcohol in the past month, 95.1 percent reported that they got it for free the last time they drank.6 In many cases, adolescents have access to alcohol through family members, or find it at home.

Preventing Underage Drinking

Preventing underage drinking is a complex challenge. Any successful approach must consider many factors, including:

Genetics

Personality

Rate of maturation and development

Level of risk

Social factors

Environmental factors

Several key approaches have been found to be successful. They are:7

Environmental interventions

This approach makes alcohol harder to get—for example, by raising the price of alcohol and keeping the minimum drinking age at 21. Enacting zero-tolerance laws that outlaw driving after any amount of drinking for people under 21 also can help prevent problems.

Individual-level interventions

This approach seeks to change the way young people think about alcohol, so they are better able to resist pressures to drink.

School-based interventions

These are programs that provide students with the knowledge, skills, motivation, and opportunities they need to remain alcohol free.

Family-based interventions

These are efforts to empower parents to set and enforce clear rules against drinking, as well as improve communication between children and parents about alcohol.

The Role Parents Play

Parents and teachers can play a big role in shaping young people’s attitudes toward drinking. Parents in particular can have either a positive or negative influence.

Parents can help their children avoid alcohol problems by:

Talking about the dangers of drinking

Drinking responsibly, if they choose to drink

Serving as positive role models in general

Not making alcohol available

Getting to know their children’s friends

Having regular conversations about life in general

Connecting with other parents about sending clear messages about the importance of not drinking alcohol

Supervising all parties to make sure there is no alcohol

Encouraging kids to participate in healthy and fun activities that do not involve alcohol

Research shows that children whose parents are actively involved in their lives are less likely to drink alcohol.



On the other hand, research shows that a child with a parent who binge drinks is much more likely to binge drink than a child whose parents do not binge drink.

Warning Signs of Underage Drinking

Adolescence is a time of change and growth, including behavior changes. These changes usually are a normal part of growing up but sometimes can point to an alcohol problem. Parents and teachers should pay close attention to the following warning signs that may indicate underage drinking:

Changes in mood, including anger and irritability

Academic and/or behavioral problems in school

Rebelliousness

Changing groups of friends

Low energy level

Less interest in activities and/or care in appearance

Finding alcohol among a young person’s things

Smelling alcohol on a young person’s breath

Problems concentrating and/or remembering

Slurred speech

Coordination problems

Treating Underage Drinking Problems

Screening young people for alcohol use and alcohol use disorder is very important and may avoid problems down the road. Screening by a health practitioner (e.g., pediatrician) provides an opportunity to identify problems early and address them before they escalate. It also allows young people to ask questions of a knowledgeable adult. NIAAA and the American Academy of Pediatrics both recommend that all youth be regularly screened for alcohol use.

Some young people can experience serious problems as a result of drinking, including alcohol use disorder, which require intervention by trained professionals. Professional treatment options include:



Seeing a counselor, psychologist, psychiatrist, or other trained professional

Participating in outpatient or inpatient treatment at a substance abuse treatment facility or other licensed program

For more information, please visit: www.niaaa.nih.gov.

1 Substance Abuse and Mental Health Services Administration (SAMHSA). 2015 National Survey on Drug Use and Health (NSDUH). Table 2.19B: Alcohol Use in Lifetime, Past Year, and Past Month, by Detailed Age Category: Percentages, 2014 and 2015. Rockville, MD: SAMHSA, 2016. Available at: http://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.htm#tab2-19b. Accessed 1/20/17.

2 Substance Abuse and Mental Health Services Administration (SAMHSA). 2015 Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health. Figure 24. Rockville, MD: SAMHSA, 2016. Available at: http://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.htm#fig24. Accessed 1/20/17.

3 Centers for Disease Control and Prevention (CDC). Fact Sheets: Underage Drinking. Atlanta, GA: CDC, 2016. Available at: http://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm. Accessed 1/20/17.

4 Centers for Disease Control and Prevention (CDC). Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI). Atlanta, GA: CDC, 2016. Available at: http://go.usa.gov/xkde2. Accessed 1/20/17.

5 Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Health Statistics and Quality. The DAWN Report: Highlights of the 2014 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits. Rockville, MD: SAMHSA, 2014. Available at: http://www.samhsa.gov/data/sites/default/files/spot143-underage-drinking-2014/spot143-underage-drinking-2014/spot143-underage-drinking-2014.pdf. Accessed 1/20/17.

6 Substance Abuse and Mental Health Services Administration (SAMHSA). 2015 National Survey on Drug Use and Health (NSDUH). Table 6.70B: Source Where Alcohol Was Obtained for Most Recent Use in Past Month among Past Month Alcohol Users Aged 12 to 20, by Age Group: Percentages, 2014 and 2015. Rockville, MD: SAMHSA, 2016. Available at: http://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.htm#tab6-70b. Accessed 1/20/17.



7 National Institute on Alcohol Abuse and Alcoholism (NIAAA). Underage drinking: Why do adolescents drink, what are the risks, and how can underage drinking be prevented? Alcohol Alert, No. 67. Rockville, MD: NIAAA, January 2006. Available at: http://pubs.niaaa.nih.gov/publications/AA67/AA67.htm. Accessed 1/20/17.

