youth alcohol usage

  Youth Alcohol Usage

Underage drinking

Why Do Adolescents Drink, What Are the Risks, and How Can Underage Drinking Be Prevented?

 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.

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 (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.)

Binge Drinking

Percent of young people drinking 5+ drinks at one time in the last 2 weeks. 

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.
 



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.
Risk-Taking—Research shows the brain keeps developing well into the twenties, during which time it continues to establish important communication connections and further refines its function. Scientists believe that this lengthy developmental period may help explain some of the behavior which is characteristic of adolescence—such as their propensity to seek out new and potentially dangerous situations. For some teens, thrill-seeking might include experimenting with alcohol. Developmental changes also offer a possible physiological explanation for why teens act so impulsively, often not recognizing that their actions—such as drinking—have consequences.
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. Beliefs about alcohol are established very early in life, even before the child begins elementary school. 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. 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 before experiencing the negative consequences of drinking, such as drowsiness, lack of coordination, and withdrawal/hangover effects. 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.
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. Other behavior problems associated with alcohol use include rebelliousness, difficulty avoiding harm or harmful situations , 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).
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. COAs also are more likely to begin drinking at a young age 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. 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. 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 as well as changes in brain structure and function.
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. 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. Candidate genes for alcoholism risk also have been associated with those regions. 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.

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. 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. Young drinkers who are overweight or obese showed elevated liver enzymes even with only moderate levels of drinking.
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, 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.

PREVENTING UNDERAGE DRINKING WITHIN A DEVELOPMENTAL FRAMEWORK

Complex behaviors, such as the decision to begin drinking or to continue using alcohol, are the result of a dynamic interplay between genes and environment. For example, biological and physiological changes that occur during adolescence may promote risk-taking behavior, leading to early experimentation with alcohol. This behavior then shapes the child’s environment, as he or she chooses friends and situations that support further drinking. Continued drinking may lead to physiological reactions, such as depression or anxiety disorders, triggering even greater alcohol use or dependence. In this way, youthful patterns of alcohol use can mark the start of a developmental pathway that may lead to abuse and dependence. Then again, not all young people who travel this pathway experience the same outcomes.

Perhaps the best way to understand and prevent underage alcohol use is to view drinking as it relates to development. This “whole system” approach to underage drinking takes into account a particular adolescent’s unique risk and protective factors—from genetics and personality characteristics to social and environmental factors. Viewed in this way, development includes not only the adolescent’s inherent risk and resilience but also the current conditions that help to shape his or her behavior.

Children mature at different rates. Developmental research takes this into account, recognizing that during adolescence there are periods of rapid growth and reorganization, alternating with periods of slower growth and integration of body systems. Periods of rapid transitions, when social or cultural factors most strongly influence the biology and behavior of the adolescent, may be the best time to target delivery of interventions. Interventions that focus on these critical development periods could alter the life course of the child, perhaps placing him or her on a path to avoid problems with alcohol.

To date, researchers have been unable to identify a single track that predicts the course of alcohol use for all or even most young people. Instead, findings provide strong evidence for wide developmental variation in drinking patterns within this special population.

CONCLUSION
Today, alcohol is widely available and aggressively promoted throughout society. And alcohol use continues to be regarded, by many people, as a normal part of growing up. Yet underage drinking is dangerous, not only for the drinker but also for society, as evident by the number of alcohol-involved motor vehicle crashes, homicides, suicides, and other injuries.
People who begin drinking early in life run the risk of developing serious alcohol problems, including alcoholism, later in life. They also are at greater risk for a variety of adverse consequences, including risky sexual activity and poor performance in school.
Identifying adolescents at greatest risk can help stop problems before they develop. And innovative, comprehensive approaches to prevention, such as Project Northland, are showing success in reducing experimentation with alcohol as well as the problems that accompany alcohol use by young people.