Underage Drinking Risk Factors and Consequences

Early On-Set Drinking Linked to Later Alcohol Use Disorders

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Underage drinking has actually been steadily declining for decades in the United States, but it is still prevalent enough to be a major public health concern.

Underage drinking began a steep decline back in the 1980s when Congress passed the National Minimum Drinking Age Act, which required states to raise the age for legal purchase and possession of alcohol to 21 by October 1986 or lose 10% of their federal highway funds.

By 1988, all 50 states and the District of Columbia had adopted 21 as the minimum drinking age, setting off a steady decline in underage drinking rates among 8th, 10th and 12th grade students that continues today.

Prevalence of Underage Drinking

However, as of the 2014 National Survey on Drug Use and Health (NSDUH), an estimated 8.65 million Americans age 12 to 20 reported that they were current drinkers, meaning they had at least one drink in the past 30 days.

Males still binge drink and drink daily more than underage females, but the differences are diminishing. White students report the highest levels of drinking, Hispanics are next and blacks report the lowest rates.

Of those students who have problems or who dropout, 80% report having gotten drunk in the past month, or reported binge drinking, or reported drinking and driving in the past 30 days.

Drinking and Adolescent Development

For some students, drinking alcohol is their only behavioral problem, but for others drinking goes along with other problem behaviors linked to unconventionality, impulsiveness, and sensation seeking, according to research.

Typically, binge drinking among students follows the pattern of: beginning around age 13, increasing during adolescence, peaking in young adulthood (ages 18-22) and then gradually decreasing.

However, studies have found that young people who increase their binge drinking between ages 18 and 24 or who consistently binge drink at least once a week during those years may having problems in the following areas:

  • Marriage
  • Educational attainment
  • Employment
  • Financial independence

There are many factors that can contribute to the reason that some adolescents develop alcohol use disorders while others do not. Here are some of the key risk factors:

Genetic Risk Factors

Research has shown that genetic factors play a role in a person's vulnerability to developing alcohol problems. We know for certain that children of alcoholic parents are significantly more likely to become alcoholics themselves compared to children of parents who are not alcoholics.

But, a family history of alcoholism is not the only determining factor. Environmental influences also play a role in whether someone develops alcohol use disorders and can vary widely from person to person.

We also know that some environmental influences can mitigate the genetic influences and cause some children of alcoholics to not develop drinking problems.

Biological Markers

Studies have revealed that brain waves caused by a response to specific stimuli can provide measurable brain activity that can predict the risk of alcoholism.

P300, a specific brain wave that occurs about 300 milliseconds following a stimulus of light or sound, is one of the brain waves used in these studies.

If someone demonstrates a low P300 amplitude it indicates an increased risk for developing alcoholism, especially among the sons of alcoholic fathers.

Scientists were able to predict alcohol and other drug use in preadolescent boys four years later at the average age of 16 by measuring their P300 brain waves.

Childhood Behavior

Behavior patterns in early childhood have also be found to be predictors of later drinking problems. At age 3, children who were classified as "undercontrolled" - impulsive, restless or distractible - were twice as likely to be diagnosed with alcohol use disorders at age 21 compared to 3-year-olds classified as "inhibited" or "well-adjusted."

Children who exhibit aggressiveness as early as ages 5-10 are more likely to use alcohol and other drugs during adolescence.

Children who exhibit antisocial behavior are more likely to have alcohol-related problems during adolescence and severe alcohol use disorders in adulthood, research shows.

Psychiatric Disorders

Alcohol consumption and a variety psychiatric disorders have been linked in adolescents and young adults in several research studies:

  • Adolescents who are heavy drinkers are more likely to have conduct disorders.
  • Boys from 6 to 17 with attention deficit hyperactivity disorder (ADHD) and who had weak social relationships were significantly more likely to have severe alcohol use disorders four year later.
  • College freshmen with anxiety disorders were twice as likely to have severe alcohol use disorders compared to those without anxiety disorders.
  • College students with drinking problems were four times as likely to have a major depressive disorder.

Along with the factors listed above, there are a number of psychosocial factors that increase the risk of underaged youth making a decision to begin early-onset alcohol consumption:

Parenting, Family Environment, and Peers

Parents are the single most important influence on their children's decision to become involved in substance abuse or not. Studies show that parents who drink or express favorable attitudes about drinking are linked to their children initiating alcohol consumption and continuing to drink.

On the other hand, children who are warned about the dangers of alcohol by their parents are less likely to start drinking underage. The same is true for children who report being close to their parents.

A lack of parental communication, support and monitoring has been linked by researchers to frequency of drinking, heavy drinking and drunkenness among adolescents. Studies have also linked parental hostility, rejection and harsh, inconsistent discipline to childhood drinking and alcohol-related problems.

Adolescents are more likely to drink if their peers drink, but beyond that, even if their peers exhibit a acceptance of drinking it can influence a child's decision to initiate alcohol consumption.

Positive Expectancies of Alcohol

Research shows that adolescents are more likely to begin drinking if they have developed a positive expectancy about drinking. These positive expectancies generally increase with age and can predict both the onset of drinking and problem drinking among young people.

Childhood Trauma

Child abuse and other traumatic events are also risk factors for later alcohol problems among youth. Of those adolescents who end up in treatment for alcohol abuse disorders rates of physical abuse, sexual abuse, violent victimization, and witnessing violence are much higher than the general population of adolescents.

Compared to study controls, adolescents in alcohol treatment programs were:

  • 6 times more likely to have been abused physically
  • 18 times more likely to have been sexually abused
  • More likely to have experienced posttraumatic stress disorder

Those adolescents treated for alcohol abuse were 10 times more likely to have had PTSD while those treated for alcohol dependence were 13 times more likely.

Alcohol Advertising

Studies of the effects of alcohol advertising on children have found that alcohol ads can significantly increase positive expectancies about alcohol. Alcohol advertising targeted at adolescents has been found to influence alcohol brand preferences and increase the adolescent's intention to drink as adults.

Consequences of Adolescent Alcohol Use

In the late 1960s and early 1970s, in the Vietnam war era, many states dropped their legal drinking age to 18. The political thinking was, "if they are old enough to get drafted and fight for their country, they are old enough to drink."

The effect was almost immediate. Alcohol-related traffic fatalities increased dramatically. Highway deaths not only increased in the states where the drinking age was lower, but also in the states that bordered those states.

That's when Congress stepped in and mandated a nationwide legal drinking age of 21 by threatening to withhold federal highway funding to those states that did not increase the drinking age.

The higher legal drinking age immediately prompted a decrease in underage drinking and a decrease in drinking and driving as well as alcohol-related highway fatalities.

The legal drinking age no doubt had an effect in others areas where underage drinking can result in problems, including:

Sexual Behavior

Underage drinking is linked not only to increased risky sexual behavior but also increased vulnerability to coerced sex. Adolescents who drink are more likely to have sex before age 16, more likely to have sex while they are drinking and less likely to practice safe sex after drinking.

Risky Behavior and Victimization

Alcohol use among 8th and 10th graders has been found to increase both risky behavior and victimization. This is particularly true for 8th grade students.

Puberty and Bone Growth

If studies conducted with laboratory animals are an indication, heavy alcohol consumption in adolescents can delay puberty, slow bone growth, and result in weaker bones.

Preventing Underage Drinking Is Essential

Several studies have found that early-onset drinking is linked to the risk of greater substance abuse problems later in life. The earlier a child begins to drink alcohol, the greater the problems he or she will face in adulthood, not only with substance abuse, but with meeting important life goals such as education and careers.

Therefore, it is important for parents - and for society - to do everything possible to prevent the initiation of childhood drinking. Laws and policies will only work so far, the real work begins in the home within the family.


National Highway Traffic Safety Administration. "Lives Saved in 2008 by Restraint Use And Minimum Drinking Age Laws." June 2009.

National Highway Traffic Safety Administration. "Traffic Safety Facts 2008: Young Drivers." 2009.

National Institute on Alcohol Abuse and Alcoholism. "Youth Drinking: Risk Factors and Consequences." Alcohol Alerts July 1997

Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. Monitoring the Future national survey results on drug use, 1975-2012. Volume I: Secondary school students. Bethesda, MD: National Institute on Drug Abuse, 2012.

Shults, Ruth, et al. "Reviews of Evidence Regarding Interventions to Reduce Alcohol-Impaired Driving." American Journal of Preventive Medicine 2001

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