Teen Drinking: Risk Factors
Alcohol, the most widely used and abused drug among youth,
causes serious and potentially life-threatening problems for teens. 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.
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
drinkingoften defined as having five or more drinks in a row. The progression of
drinking from use to abuse to dependence is associated with biological and psychosocial
factors. This fact sheet examines some of these factors that put youth at risk for
drinking and for alcoholrelated problems and considers some of the consequences of
Prevalence of Teen
fifteen-year-olds are at high risk to begin drinking. 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. 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. White students report the highest levels of drinking, blacks
report the lowest, and Hispanics fall between the two.
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
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: 1.) Unconventionality,
2.) Impulsiveness, and 3.) Sensation seeking.
Binge drinking, often
beginning around age 13, tends to increase during adolescence, peak in young adulthood
(ages 18-22), then gradually decrease. In a recent 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. 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
Risk Factors for
Alcohol Use, Abuse, and Dependence
Animal studies and
studies of twins and adoptees demonstrate that genetic factors influence an individual's
vulnerability to alcoholism. Children of alcoholics are significantly more likely than
children of non-alcoholics to initiate drinking during adolescence and to develop
alcoholism, but the relative influences of environment and genetics have not been
determined and vary among people.
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. Aggressiveness in children as young as ages 5-10 has been
found to predict alcohol and other drug use in adolescence. Childhood antisocial behavior
is associated with alcohol-related problems in adolescence and alcohol abuse or dependence
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. 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.
Whether anxiety and
depression lead to or are consequences of alcohol abuse is unresolved. In a study of
college freshmen, diagnosis of alcohol abuse or dependence was twice as likely among those
with anxiety disorder as those without this disorder. 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. In most of these cases, depression preceded
alcohol abuse. In a study of adolescents in residential treatment for alcohol and other
dependence, 25 percent met the criteria for depression, three times the rate reported for
controls. In 43 percent of these cases, the onset of alcohol and other drug dependence
preceded the depression; in 35 percent, the depression occurred first; and in 22 percent,
the disorders occurred simultaneously.
Alcohol use among
adolescents has been associated with considering, planning, attempting, and completing
suicide. In one study, 37 percent of eighth-grade females who drank heavily reported
attempting suicide, compared with 11 percent who did not drink. Research does not indicate
whether drinking causes suicidal behavior, only that the two behaviors are correlated.
Environment, and Peers
behavior and favorable attitudes about drinking have been positively associated with
adolescents' initiating and continuing drinking. Early initiation of drinking has been
identified as an important risk factor for later alcohol-related problems. Children who
were warned about alcohol by their parents and children who reported being closer to their
parents were less likely to start drinking.
Lack of parental
support, monitoring, and communication have been significantly related to frequency of
drinking, heavy drinking, and drunkenness among adolescents. Harsh, inconsistent
discipline and hostility or rejection toward children have also been found to
significantly predict adolescent drinking and alcohol-related problems.
Peer drinking and peer acceptance of drinking have been associated with adolescent
drinking. While both peer influences and parental influences are important, their relative
impact on adolescent drinking is unclear.
alcohol-related expectancies have been identified as risk factors for adolescent drinking.
Positive expectancies about alcohol have been found to increase with age and to predict
the onset of drinking and problem drinking among adolescents.
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. 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.
Research on the
effects of alcohol advertising on adolescent alcohol-related beliefs and behaviors has
been limited. While earlier studies measured the effects of exposure to advertising, 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. This suggests that alcohol advertising may influence
adolescents to be more favorably predisposed to drinking.
Teen Alcohol Use
Of the nearly 8,000
drivers ages 15-20 involved in fatal crashes in the last year, 20 percent had blood
alcohol concentrations above zero.
Surveys of adolescents
suggest that alcohol use is associated with risky sexual behavior 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.
Risky Behavior and
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.
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