Teens and Alcohol

Although the minimum legal drinking age is 21, alcohol use and abuse continue to be major health problems amongst adolescents and young adults.

Alcohol use in children and adolescents can interfere with brain development. Underage drinking can also lead to other serious complications, including death and injuries.

According to the 2019 Youth Risk Behavior Surveillance (YRBS), 15 percent of surveyed students 9th through 12th grade in the United States had their first drink before the age of 13. In other surveys, 29.2 percent had least one drink 30 days before the survey, and 3.1 percent said they had binge drank 10 or more drinks within 30 days of survey. Most people who start drinking before age 21 start when they are 13-14 years of age. 

Why do teens drink?

• Peers. One of the strongest predictors of substance use is having friends who use substances, including alcohol.
• Community. Access to easily attainable and inexpensive alcohol increases the risk of alcohol use.
• Families. Youth are at an increased risk of drug and alcohol abuse if parents and/or older siblings use drugs and/or alcohol or exhibit permissive attitudes towards drugs and/or alcohol.
• Genetics. Twin studies have been conducted in adults and consistently shown a correlation between genetics and alcohol use. Studies in adolescents show a greater risk of genetic influence than environmental influence on problem alcohol use.
• Media. Media often portray alcohol (and other substance) use in a positive and attractive light without displaying the consequences of use. Research has consistently shown that media exposure can make youth experimentation with alcohol more likely.
• Untreated mental illness. Several mental health disorders place individuals at an increased risk of alcohol use. Teens with behavior problems are at an increased risk of alcohol use. Other risk factors include: untreated ADHD, personality disorders, conduct disorder, untreated anxiety and depression.

Risks from youth alcohol use

• Brain damage. The adolescent brain is undergoing many changes that make it more susceptible to effects of alcohol. Research has shown impacts from alcohol to areas of the brain that control thought processes, memory functions, emotional regulation, planning and organizing, and inhibition.
• Motor vehicle accidents. Motor vehicle accidents are the leading cause of death for teenagers and young adults in the US. Once the drinking age was increased to 21, there was a 16 percent median decline in motor vehicle crashes. According to the 2019 Youth Risk Behavior Surveillance System (YRBSS), 16.7 percent of students had ridden with a driver who had been drinking alcohol and 5.4 percent had drove when they had been drinking.
• Binge drinking. Underage drinking is more commonly related to episodic heavy drinking or binge drinking. According to the YRBS, 3.1 percent of students reported drinking 10 or more drinks within 30 days of completing the survey. Binge drinking increases the likelihood of overdose and alcohol poisoning, which can be fatal.
• Future alcohol-related problems. Alcohol use disorder is the formal diagnosis to describe the diseases related to alcohol use. People who begin drinking at earlier ages are at an increased risk of lifetime alcohol dependence. Specifically, people who drinking before age 15 are four times more likely to meet the criteria for alcohol use disorder. Alcohol use disorder is associated with many other mental and physical disorders. Specifically, depression, anxiety, attention deficit hyperactivity disorder (ADHD), conduct disorders, and personality disorders are likely to co-occur with alcohol use disorder. Other health risks include, but are not limited to, liver disease, heart disease, sexually transmitted infections, gastrointestinal bleeds, sleep disorders, stroke, and several types of cancer.
• Sexual risk taking. Early alcohol use has been shown to correlate with increased sexual risk taking, including unprotected intercourse, multiple partners, substance use during intercourse, and teen pregnancy. Additionally, drinking during pregnancy can cause brain damage and other serious problems to the fetus.
• Injuries. In 2010, there were about 189,000 emergency department visits for people under 21 years of age for complaints related to alcohol.
• Other problems. Alcohol impairs judgment and can lead to poor decision-making. Other risks include, but are not limited to, bad grades, legal issues, and physical violence.  

Signs of underage drinking

• Changes in mood
• Academic problems
• Behavior problems and/or changes
• Rebellion
• Changing group of friends
• Little interest in activities
• Smelling alcohol on your teen’s clothes or breath
• Slurred speech
• Coordination problems
• Trouble concentrating and/or remembering

Tips for parents to prevent underage drinking

• Talk with your teens about alcohol. Saying nothing may imply to teens that teen drinking is acceptable. Make clear expectations with your teen. Discuss the minimum legal drinking age and the dangers of underage drinking.
• Be a positive role model. If you drink, drink responsibly. Don’t drink too much or too often and stay away from alcohol in high-risk situations.
• Seek help if you struggle with alcohol use. Talk to your children about how alcohol has impacted your family and family members.
• Be understanding. Let your teen know that curiosity is a normal part of growing up. Remain calm and provide a safe environment for your teen to talk.
• Get help for your child. Talk to your child’s pediatrician if you have concerns.

Additional resources:

• Underage drinking resources (Medline Plus)
• Alcoholism and alcohol abuse resources (Medline Plus)
• Resources for family and friends of alcoholics (Al-Anon/Alateen)
• Underage drinking prevention (Substance Abuse and Mental Health Services Administration)
• Resources for alcoholics (Alcoholics Anonymous)
• Effects of alcohol use on the brain (Handbook of Clinical Neurology)

Suggested reading:

• Big Book Unplugged: A Young Person’s Guide to Alcoholics Anonymous by John R. Center City, MN: Hazelden Publishing, 2003.
• Buzzed: The Straight Facts About the Most Used and Abused Drugs from Alcohol to Ecstasy, 3rd ed., by Cynthia Kuhn, et al. New York: W. W. Norton & Company, 2008.
• From Binge to Blackout: A Mother and Son Struggle with Teen Drinking by Chris Volkmann and Toren Volkmann. New York: New American Library, 2006.
• I’ve Got This Friend Who …: Advice for Teens and Their Friends on Alcohol, Drugs, Eating Disorders, Risky Behaviors, and More by Anna Radev and KidsPeace. Center City, MN: Hazelden Publishing, 2007.
• On the Rocks: Teens and Alcohol by David Aretha. New York: Franklin Watts, 2007.
• Safe Road Home: Stop Your Teen from Drinking & Driving by Karen Goodman and Kirk Simon. New York: Sterling, 2005.
• Talking with College Students About Alcohol: Motivational Strategies for Reducing Abuse by Scott T. Walters and John S. Baer. New York: The Guilford Press, 2006.
• The Truth About Alcohol, 2nd ed., by Barry Youngerman, et al. New York: Facts on File, 2010.
• Young People & Alcohol: Impact, Policy, Prevention, Treatment by John B. Saunders and Joseph M. Rey. Chester, UK: Wiley-Blackwell, 2011.

Written by Katie Baughman, MD
Reviewed by Sydney Ryckman, MD, and Sara Laule, MD 

Updated March 2023