Teens and alcohol abuse

DEFINITION: Alcohol abuse is a pattern of heavy drinking that significantly compromises a person’s physical health and social functioning. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), an estimated 414,000 American adolescents aged twelve to seventeen years qualified for a diagnosis of alcohol use disorder (AUD) in 2019, accounting for 2.3 percent of American teenaged girls and 1.3 percent of American teenaged boys. Despite intensive government efforts to curb the problem, alcohol remained the most common drug among young people in the 2020s. However, the prevalence of underage alcohol use and abuse, including binge drinking, largely decreased during the early twenty-first century.

Scope of the Problem

Alcohol use and abuse among young people in the United States is pervasive and destructive. Despite a nationwide minimum legal drinking age of twenty-one years, 19.9 percent of American teenagers aged fourteen or fifteen have had at least one drink during their lifetime, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) reported in 2023. Likewise, according to the 2021 Youth Risk Behavior Survey conducted by the US Centers for Disease Control and Prevention (CDC), 22.7 percent of high school students had at least one drink in the thirty days before taking the survey. Rates of alcohol use vary by gender, race, ethnic group, and other factors. The CDC reported that more high school girls than boys drank alcohol in 2021, which represented a change from previous years when that trend was reversed. Further, Black students had far lower rates of alcohol use than White students, at 13.2 percent and 25.9 percent, respectively.

The NIAAA reports that most young people binge drink, which is defined as consuming enough alcohol within about two hours to bring blood alcohol levels (BAC) to 0.08 grams of hemoglobin per deciliter (g/dL). According to the NIAAA, about 90 percent of all alcohol consumed by people aged twelve to twenty is consumed through binge drinking.

People who commence heavy or episodic binge drinking before age sixteen years are more than twice as likely as people who start drinking after age eighteen years to develop alcohol dependence. This statistic is often cited as justification for higher drinking ages and for more diligent enforcement of laws against underage drinking. There is some controversy whether this is a matter of cause and effect. Early heavy drinkers usually have parents or siblings who are alcoholics and may be genetically susceptible to alcoholism; also, they probably are subject to environmental influences favoring alcohol abuse.

Rates of both alcohol abuse and alcohol dependence decline steadily after age twenty-five years, a pattern that has been consistent for many decades despite changing social attitudes. Among drinkers with a normal trajectory, work and family responsibilities reduce the opportunities for, and acceptability of, frequent intoxication.

Rates of teen and young-adult alcohol abuse in Europe are similar to those in the United States, except that the average age of onset of heavy drinking is lower; this is in part due to the most common legal drinking age in Europe being eighteen. A 2020 report from the Organisation for Economic Cooperation and Development (OECD) found about two-thirds of all fifteen-year-olds had tried alcohol at least once. There is considerable variation from country to country, with abuse being less frequent in southern Europe. For example, 30 percent of fifteen-year-olds in Hungary, Austria, Lithuania, and Denmark reported drinking, while just 10 percent in Romania and Luxembourg reported the same.

In the United Kingdom and Ireland, which are two European nations with the highest binge drinking rates, drinking among young people is a serious national problem. Until 1960, persons aged sixteen to twenty-four years had the lowest per capita alcohol consumption of any adult group; since 1990, the situation has reversed. Some of this pattern (which is seen to a lesser extent in the United States) may be attributed to the rising age of workforce participation. Fewer sixteen- to eighteen-year-olds are employed full-time, and an increasing proportion of eighteen- to twenty-four-year olds are students with more leisure time and fewer responsibilities than working counterparts. In general, high rates of unemployment that are not accompanied by extreme economic privation produce high levels of alcohol abuse. In England, 44 percent of all teenagers aged eleven to fifteen reported consuming at least one drink in 2018. In Ireland, 41 percent of those aged thirteen to fifteen admitted to drinking.

Effects of Early Alcohol Use and Abuse

Alcohol abuse exacts a heavy toll among young people. According to the CDC, about four thousand people under the age of twenty-one died in 2024 from causes related to alcohol. Approximately one in four college students report adverse academic consequences due to drinking, such as missing classes, performing poorly on tests or exams, or receiving lower grades. Intoxication also increases the likelihood of risk-taking behaviors, such as not following safe-sex practices during intercourse or committing property damage or vandalism.

The negative effects on a person’s life range from short-lived and inconsequential to profound. Drinking leads to a massive loss of productivity, both in poor academic performance and in the resources that college administrators and law enforcement divert toward combating alcohol problems on campuses.

Statistics on alcohol use for persons eighteen to twenty-five years of age who are not enrolled in a college or university are not as comprehensive; in general, rates of binge drinking are lower but still significant. For both college and university students and people in the workforce, an early and persistent pattern of alcohol abuse tends to translate into poorer career prospects and family instability, even if the drinker never becomes alcohol dependent or if the drinker later successfully enters a recovery program.

Alcohol can serve as a gateway drug. A high proportion of younger heavy drinkers also use marijuana, and the culture surrounding binge drinking among young people for whom it is illegal provides opportunities for experimenting with more dangerous street drugs. Many methamphetamine addicts report that they began using the drug to counteract the effects of alcohol on the job.

Reducing Underage Drinking

Federal, state, and local governments devote a great deal of energy, resources, and funding to combating underage drinking through education and increased enforcement. Federal law in the United States has mandated a minimum drinking age of twenty-one years as a condition of receiving federal highway funds since the passage of the National Minimum Drinking Age Act of 1984. This law has reduced the availability of alcohol to middle- and high-school students but has had little effect on levels of consumption among college-aged students.

A comparison of the United States with European countries, where a drinking age of sixteen or eighteen years is typical, calls into question whether the approach in the United States is effective. In no European country is the level of binge drinking among eighteen- to twenty-one-year-olds higher than in the United States. It can be argued that turning any level of alcohol consumption into a criminal activity increases the chances of excessive use and alcohol-associated risky behaviors. According to the CDC, approximately 90 percent of the alcohol consumed by young people in the United States is consumed during a binge-drinking session.

Revenue considerations often complicate efforts to curtail alcohol abuse among young people. Underage drinkers comprise a major market sector. Advertising campaigns continue to target this demographic despite government regulation. Flavored alcoholic beverages are of particular concern to regulators and to opponents of alcohol use among youth. Also, in college and university towns, the revenue stream generated by youth alcohol consumption tends to undermine efforts at truly effective enforcement of liquor laws.

If statistics on traffic accidents are any indication, efforts made toward curbing underage drinking and reducing alcohol abuse among high school and college students do seem to have had a significant effect on driving behavior. The CDC reported that the percentage of high-school students who drink and drive declined by 54 percent between 1991 and 2012. In 2021, 5 percent of high schoolers said they had driven drunk in the past month, while just over 10 percent said they had ridden with a person who had been drinking. Experts pointed to graduated driver's license programs, zero tolerance laws, and increased parental involvement as likely causes of such declines. Furthermore, rates of the consumption of alcohol among teens trended downward in the early twenty-first century, including rates of binge drinking.

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