lcohol 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.)
|Percent of young people drinking 5+ drinks at one time in the last 2 weeks. Source: www.monitoringthefuture.org/data/05data.html#2005data-drugs.|
Research also shows that many adolescents start to drink at very young ages. In 2003, the average age of first use of alcohol was about 14, compared to about 17 1/2 in 1965 (7,8). People who reported starting to drink before the age of 15 were four times more likely to also report meeting the criteria for alcohol dependence at some point in their lives (9). In fact, new research shows that the serious drinking problems (including what is called alcoholism) typically associated with middle age actually begin to appear much earlier, during young adulthood and even adolescence.
Other research shows that the younger children and adolescents are when they start to drink, the more likely they will be to engage in behaviors that harm themselves and others. For example, frequent binge drinkers (nearly 1 million high school students nationwide) are more likely to engage in risky behaviors, including using other drugs such as marijuana and cocaine, having sex with six or more partners, and earning grades that are mostly Ds and Fs in school (10).
WHY DO SOME ADOLESCENTS DRINK?
As children move from adolescence to young adulthood, they encounter dramatic physical, emotional, and lifestyle changes. Developmental transitions, such as puberty and increasing independence, have been associated with alcohol use. So in a sense, just being an adolescent may be a key risk factor not only for starting to drink but also for drinking dangerously.
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Expectancies—How people view alcohol and its effects also influences their drinking behavior, including whether they begin to drink and how much. An adolescent who expects drinking to be a pleasurable experience is more likely to drink than one who does not. An important area of alcohol research is focusing on how expectancy influences drinking patterns from childhood through adolescence and into young adulthood (11–14). Beliefs about alcohol are established very early in life, even before the child begins elementary school (15). Before age 9, children generally view alcohol negatively and see drinking as bad, with adverse effects. By about age 13, however, their expectancies shift, becoming more positive (11,16). As would be expected, adolescents who drink the most also place the greatest emphasis on the positive and arousing effects of alcohol.
Sensitivity and Tolerance to Alcohol—Differences between the adult brain and the brain of the maturing adolescent also may help to explain why many young drinkers are able to consume much larger amounts of alcohol than adults (17) before experiencing the negative consequences of drinking, such as drowsiness, lack of coordination, and withdrawal/hangover effects (18,19). This unusual tolerance may help to explain the high rates of binge drinking among young adults. At the same time, adolescents appear to be particularly sensitive to the positive effects of drinking, such as feeling more at ease in social situations, and young people may drink more than adults because of these positive social experiences (18,19).
Personality Characteristics and Psychiatric Comorbidity—Children who begin to drink at a very early age (before age 12) often share similar personality characteristics that may make them more likely to start drinking. Young people who are disruptive, hyperactive, and aggressive—often referred to as having conduct problems or being antisocial—as well as those who are depressed, withdrawn, or anxious, may be at greatest risk for alcohol problems (20). Other behavior problems associated with alcohol use include rebelliousness (21), difficulty avoiding harm or harmful situations (22), and a host of other traits seen in young people who act out without regard for rules or the feelings of others (i.e., disinhibition) (23–25).
Hereditary Factors—Some of the behavioral and physiological factors that converge to increase or decrease a person’s risk for alcohol problems, including tolerance to alcohol’s effects, may be directly linked to genetics. For example, being a child of an alcoholic or having several alcoholic family members places a person at greater risk for alcohol problems. Children of alcoholics (COAs) are between 4 and 10 times more likely to become alcoholics themselves than are children who have no close relatives with alcoholism (26). COAs also are more likely to begin drinking at a young age (27) and to progress to drinking problems more quickly (9).
Research shows that COAs may have subtle brain differences which could be markers for developing later alcohol problems (28). For example, using high-tech brain-imaging techniques, scientists have found that COAs have a distinctive feature in one brainwave pattern (called a P300 response) that could be a marker for later alcoholism risk (29,30). Researchers also are investigating other brainwave differences in COAs that may be present long before they begin to drink, including brainwave activity recorded during sleep (31) as well as changes in brain structure (32) and function (33).
Some studies suggest that these brain differences may be particularly evident in people who also have certain behavioral traits, such as signs of conduct disorder, antisocial personality disorder, sensation-seeking, or poor impulse control (34–38). Studying how the brain’s structure and function translates to behavior will help researchers to better understand how predrinking risk factors shape later alcohol use. For example, does a person who is depressed drink to alleviate his or her depression, or does drinking lead to changes in his brain that result in feelings of depression?
Other hereditary factors likely will become evident as scientists work to identify the actual genes involved in addiction. By analyzing the genetic makeup of people and families with alcohol dependence, researchers have found specific regions on chromosomes that correlate with a risk for alcoholism (39–41). Candidate genes for alcoholism risk also have been associated with those regions (42). The goal now is to further refine regions for which a specific gene has not yet been identified and then determine how those genes interact with other genes and gene products as well as with the environment to result in alcohol dependence. Further research also should shed light on the extent to which the same or different genes contribute to alcohol problems, both in adults and in adolescents.
Environmental Aspects—Pinpointing a genetic contribution will not tell the whole story, however, as drinking behavior reflects a complex interplay between inherited and environmental factors, the implications of which are only beginning to be explored in adolescents (43). And what influences drinking at one age may not have the same impact at another. As Rose and colleagues (43) show, genetic factors appear to have more influence on adolescent drinking behavior in late adolescence than in mid-adolescence.
Environmental factors, such as the influence of parents and peers, also play a role in alcohol use (44). For example, parents who drink more and who view drinking favorably may have children who drink more, and an adolescent girl with an older or adult boyfriend is more likely to use alcohol and other drugs and to engage in delinquent behaviors (45).
Researchers are examining other environmental influences as well, such as the impact of the media. Today alcohol is widely available and aggressively promoted through television, radio, billboards, and the Internet. Researchers are studying how young people react to these advertisements. In a study of 3rd, 6th, and 9th graders, those who found alcohol ads desirable were more likely to view drinking positively and to want to purchase products with alcohol logos (46). Research is mixed, however, on whether these positive views of alcohol actually lead to underage drinking.
WHAT ARE THE HEALTH RISKS?
Whatever it is that leads adolescents to begin drinking, once they start they face a number of potential health risks. Although the severe health problems associated with harmful alcohol use are not as common in adolescents as they are in adults, studies show that young people who drink heavily may put themselves at risk for a range of potential health problems.
Brain Effects—Scientists currently are examining just how alcohol affects the developing brain, but it’s a difficult task. Subtle changes in the brain may be difficult to detect but still have a significant impact on long-term thinking and memory skills. Add to this the fact that adolescent brains are still maturing, and the study of alcohol’s effects becomes even more complex. Research has shown that animals fed alcohol during this critical developmental stage continue to show long-lasting impairment from alcohol as they age (47). It’s simply not known how alcohol will affect the long-term memory and learning skills of people who began drinking heavily as adolescents.
Liver Effects—Elevated liver enzymes, indicating some degree of liver damage, have been found in some adolescents who drink alcohol (48). Young drinkers who are overweight or obese showed elevated liver enzymes even with only moderate levels of drinking (49).
Growth and Endocrine Effects—In both males and females, puberty is a period associated with marked hormonal changes, including increases in the sex hormones, estrogen and testosterone. These hormones, in turn, increase production of other hormones and growth factors (50), which are vital for normal organ development. Drinking alcohol during this period of rapid growth and development (i.e., prior to or during puberty) may upset the critical hormonal balance necessary for normal development of organs, muscles, and bones. Studies in animals also show that consuming alcohol during puberty adversely affects the maturation of the reproductive system (51).