Understanding and Preventing Underage Drinking

It’s a fact of life for many: telling our kids not to do something all but guarantees they’ll do it. Maybe you remember those ubiquitous red cups with the questionable “punch” in orange coolers in your freshman dorm. Or maybe you played truth-or-dare in your parents’ basement in 10th grade and someone dared you to go take a swig of vodka in the kitchen. Maybe you even struggled with alcohol during your teenage years. 

Whatever our experience, when it comes to our kids, we hope for the best but naturally fear the worst. Surely they won’t stumble out of a frat house after falling asleep on a beer-soaked couch? Or wake up with a blinding headache and parched lips as they leaf through their calculus textbook, trying to make sense of the blurry numbers swimming across the page? But ready or not, the truth is that teenagers rebel (yes, even the “good” ones) and underage drinking is a reality. So, how can we understand it better? And how can we prevent teenage drinking (or at least minimize the risks)? Let’s take a closer look.

Underage Drinking: The Facts

Underage drinking is a fact — and a sobering one at that. According to the NIAAA, teens often start drinking during early adolescence but are more likely to do so as they get farther into their teenage years. 

Let’s look at the statistics:

• Almost a fifth of young people have had a drink by age 15. The NIAAA reports that in 2022, the National Survey on Drug Use and Health (NSDUH) showed that “about 19.7% of youth ages 14 to 15 reported having at least 1 drink in their lifetime.”
• Many of them drank in the last month. Even more alarmingly, in 2022, as many as 5.8 million youngsters ages 12 to 20 said they’d had more than “just a few sips” in the past month.
• Boys tend to drink a bit more, but girls are “catching up.” According to the NIAAA, “Historically, adolescent boys were more likely to drink and binge drink than girls. Now, that relationship has reversed. Past-month alcohol use among adolescents ages 12 to 17 has declined more in recent years for boys than girls, with more girls reporting more alcohol use (8.5% vs. 5.5%) and binge drinking (4.0% vs. 2.6%) than boys.”

Underage Drinking: The Dangers

We all know the downsides of drinking too much, including the costs.

Among underage drinkers, according to the CDC, excessive alcohol consumption among underage drinkers cost the U.S. $24 billion in 2010 alone. But the cost is so much more than that, one that goes way past any monetary costs.

Alcohol-Related Deaths and Accidents

• Lost lives. The latest reports show that excessive drinking claims about 4,000 adolescent lives each year from drunk driving, alcohol poisoning, and alcohol-related accidents.
• Risk of injuries. The CDC reports high numbers of “unintentional injuries, such as burns, falls, or drowning” as a result of underage drinking. In 2010 alone, there were 189,000 emergency room visits for “injuries related to underage drinking.” 
  
  Many studies confirm this sad truth. A study in The Journal of Trauma and Acute Care Surgery tracked emergency room visits involving underage patients and found that out of the 303 whose primary complaint was “unintentional injury,” most were male and had higher blood alcohol levels.
• Drunk driving. An enormous portion of those deaths and injuries happen on the road. According to the United States Department of Transportation, “Car crashes are a leading cause of death for teens, and about a quarter of fatal crashes involve an underage drinking driver. In 2021, 27% of young drivers 15 to 20 years old who were killed in crashes had BACs of .01 g/dL or higher.”

Substance Misuse Problems Later in Life

According to the NIAAA, those who start drinking before the age of 15 are more likely to develop alcohol use disorder (AUD) when they’re older. By the time we’re 26 and older, we’re 3.5 more likely to report having AUD if we started drinking before age 15!

Long- and Short-Term Health Problems

Alcohol misuse can wreak havoc on our health, and when we’re talking about underage drinking, the risks — and the stakes — are even higher. According to a Pediatrics article, binge drinking in particular — defined as 5 or more drinks in one sitting for men and 4 or more for women — takes an especially high toll. Let’s take a closer look at the dangers.

• Brain and memory problems. According to the American Journal of Psychiatry, heavy drinking during adolescent years can disrupt the developing brain, altering its structure and function and leading to cognitive problems, learning difficulties, and vulnerability to AUD later in life. 
• Alcohol poisoning. Alcohol poisoning is a scary reality of heavy drinking. While people in all age groups are vulnerable, this particular risk is especially strong among college students. According to the 2022 National Survey on Drug Use and Health (NSDUH) that tracked full-time college students ages 18 to 22, nearly half drank on a regular basis and almost a third “engaged in binge drinking in the past month.”
• Hangovers. While hangovers — those unpleasant reminders of a night of overindulgence — might pose less long-term risk to our health, they play a role as well. Waking up groggy from the night before isn’t fun at any age, and for those trying to keep up with school work or participating in extracurricular or athletic activities, they can end up having long term consequences.
• Illnesses. Drinking impacts our overall health, making us more prone to physical and mental illnesses. According to Current Addiction Reports, adolescents who misuse alcohol are at a higher risk of major depressive disorder (MDD).

The ‘Why’ Behind Underage Drinking

It can sometimes be difficult to untangle the exact reasons behind drinking or to separate causes from effects when it comes to its consequences. An NIH publication touches on this question, pointing out that there are other factors at play, especially when it comes to impulsivity — a trademark characteristic of youth. 

That said, there are many reasons behind underage drinking. Let’s explore some of the most common ones.

Social Stressors 

Wanting to fit in isn’t unique to teens, but those high school (and sometimes college) years are when things ramp up in the social department. There’s a whole genre of movies dedicated to high school “drama”; depending on your generation, it may be Heathers, 10 Things I Hate About You, Mean Girls, and so forth.

Alcohol often comes up as a plot element in these films, and social pressures are certainly a major reason why a lot of teens end up drinking. Science backs this idea up as well: a Journal of Drug Education study found that peer drinking in particular had a strong effect when it came to influencing underage drinking and driving by young men.

Family Factors and Community Environment

Studies show that there’s a relationship between adult and adolescent drinking patterns. For example, a study in the American Journal of Preventive Medicine shows a connection between binge drinking among adults and the chance of underage drinking. 

Likewise, an Addiction study found a correlation between drinking patterns in the community and the rates of underage alcohol use. As it turned out, adolescent drinking “appears to be influenced by community-level adult drinking.” Specifically, “bar density” was linked to higher rates due to “perceived alcohol availability and approval of alcohol use.”

Cognitive Development

Finally, it’s no secret that our brain continues to develop well into our mid-20s, and during our adolescent years, we’re simply not quite there yet. We’re more likely to make impulsive decisions, especially when additional risk factors are part of the picture. A study in Alcohol Research and Health shows a link between executive functions and alcohol misuse in adolescents, with factors such as conduct disorder and attentional disorders amping up the risk.

Strategies To Curb Underage Drinking

According to the NIAAA, it’s essential to use prevention strategies to curb underage drinking and address problems before they escalate. And, as the SAMHSA 2021 survey shows, prevention works: “Between 2002 and 2019, current drinking by 12- to 20-year-olds declined from 29 percent to 19 percent. From 2015 to 2018, binge drinking and heavy alcohol use declined from 13 percent to 11 percent and 3 percent to 2 percent, respectively.”

Education 

Alcohol education can take place both at school and at home. It’s important to hear the message in different contexts. What our parents tell us and what we learn from teachers at school tends to land differently — the more information we have, the better equipped we can be to understand the potential impact of alcohol on our lives.

Here’s what alcohol education involves:

• School programs. Remember those student assemblies about the effects of drunk driving? SADD (Students Against Drunk Driving), MADD (Mothers Against Drunk Driving) and D.A.R.E. (Drug Abuse Resistance Education are among the big ones. Whether or not we found those to be effective, the point is to get the message out there. These days, education programs at schools have expanded, presenting vital information about underage drinking in many different formats. It’s important to keep them going strong!
• Community initiatives. Communities can come together to organize workshops and meet-ups to help their youngest members build self-esteem, teaching coping skills, and fostering healthy hobbies.
• Family strategies. Finally, it’s essential to have open communication about alcohol within families. Parental monitoring and setting a good example can make an enormous difference! (For more information about alcohol and teenagers, check out our blog: “How To Help Your Teen With Alcohol Recovery.”) In addition to addressing teenage drinking, alcohol dangers, and staying safe, it’s also important to keep a close eye on the stress levels your teen might be experiencing.

Screening 

The NIAAA and the American Academy of Pediatrics both recommend regular screening by medical professionals who can spot underage drinking early and address it before it gets out of hand. It can also be easier for teens to talk to an adult who is not a teacher or family member about sensitive questions, knowing that they’re with a professional who knows what they’re doing and will be discreet while offering tangible advice.  

Policy and Enforcement

Laws and regulations to prevent underage drinking can make a difference. These can include enforcing a minimum legal drinking age, creating penalties for supplying alcohol to minors, and supporting laws that limit driving privileges to underage minors who drink.

Role of Media and Technology

Social media can be a double-edged sword when it comes to underage drinking. On the one hand, technology can promote alcohol use; on the other, it can be a valuable prevention tool with apps and online resources fostering education and support. 

Talking to Teens About Alcohol

So how do we talk to teens about alcohol? It’s not exactly the easiest topic to bring up. Here are some ideas:

• Start the conversation. The key is to start — somewhere. It’s not a lecture, and you don't have to have all your ducks in a row when it comes to knowing the medical facts, statistics, and recommendations. 
• Listen actively. Make sure the conversation isn’t one-sided. Encourage your teen to ask questions, and give them space to process what might be difficult emotions around a potentially heavy subject. Silences are okay, too! Making sure they know you’re there for them no matter what is key.
• Share your story. This one is powerful. If you have your own alcohol story to share, please consider doing so. Yes, it might make you feel vulnerable, but this is the best possible type of vulnerability there is. You’re human, and you made it through something that’s incredibly challenging for anyone to tackle. Knowing this will not only make your teen proud of you but will reassure them that they can trust and rely on you if they face similar problems themselves.
• Know when to ask for help. It’s also important to recognize when you might be out of your league and when it’s time to get some professional help. There’s no shame in admitting that you’re in too deep — in fact, that makes you a great parent! There are medical professionals, counselors, and specialized addiction therapists ready to jump on board and help you navigate anything that comes up. And Reframe is here for you every step of the way, whether you would like to explore your own relationship with alcohol or get support from others just like you on our 24/7 Forum!

Summing Up

As Daniel Handler writes in The Basic Eight, “Maybe, generations ago, young people rebelled out of some clear motive, but now, we know we’re rebelling. Between teen movies and sex-ed textbooks we’re so ready for our rebellious phase we can’t help but feel it’s safe, contained.” And yet, the reality is that it’s not always as safe as it might seem if alcohol is in the picture.

But while rebellion might be a natural part of adolescence, alcohol misuse doesn’t have to be. Let’s work together to keep our kids healthy as we continue our own journeys to the happiest and healthiest versions of ourselves!