Contact us now to get immediate help: 1-855-350-3330
Why Do Adolescents Drink, What Are the Risks, and How Can Underage Drinking Be Prevented?
Alcohol is the drug of choice among youth. Many young people are experiencing the consequences of drinking too much, at too early an age. As a result, underage drinking is a leading public health problem in this country.
Each year, approximately 5,000 young people under the age of 21 die as a result of underage drinking; this includes about 1,900 deaths from motor vehicle crashes, 1,600 as a result of homicides, 300 from suicide, as well as hundreds from other injuries such as falls, burns, and drownings (1–5).
Yet drinking continues to be widespread among adolescents, as shown by nationwide surveys as well as studies in smaller populations. According to data from the 2005 Monitoring the Future (MTF) study, an annual survey of U.S. youth, three-fourths of 12th graders, more than two-thirds of 10th graders, and about two in every five 8th graders have consumed alcohol. And when youth drink they tend to drink intensively, often consuming four to five drinks at one time. MTF data show that 11 percent of 8th graders, 22 percent of 10th graders, and 29 percent of 12th graders had engaged in heavy episodic (or “binge1”) drinking within the past two weeks (6) (see figure). (1 The National Institute on Alcohol Abuse and Alcoholism [NIAAA] defines binge drinking as a pattern of drinking alcohol that brings blood alcohol concentration [BAC] to 0.08 grams percent or above. For the typical adult, this pattern corresponds to consuming five or more drinks [men], or four or more drinks [women], in about 2 hours.)
Percent of young people drinking 5+ drinks at one time in the last 2 weeks. Source: www.monitoringthefuture.org/data/05data.html#2005data-drugs.
Research also shows that many adolescents start to drink at very young ages. In 2003, the average age of first use of alcohol was about 14, compared to about 17 1/2 in 1965 (7,8). People who reported starting to drink before the age of 15 were four times more likely to also report meeting the criteria for alcohol dependence at some point in their lives (9). In fact, new research shows that the serious drinking problems (including what is called alcoholism) typically associated with middle age actually begin to appear much earlier, during young adulthood and even adolescence.
Other research shows that the younger children and adolescents are when they start to drink, the more likely they will be to engage in behaviors that harm themselves and others. For example, frequent binge drinkers (nearly 1 million high school students nationwide) are more likely to engage in risky behaviors, including using other drugs such as marijuana and cocaine, having sex with six or more partners, and earning grades that are mostly Ds and Fs in school (10).
As children move from adolescence to young adulthood, they encounter dramatic physical, emotional, and lifestyle changes. Developmental transitions, such as puberty and increasing independence, have been associated with alcohol use. So in a sense, just being an adolescent may be a key risk factor not only for starting to drink but also for drinking dangerously.
Risk-Taking—Research shows the brain keeps developing well into the twenties, during which time it continues to establish important communication connections and further refines its function. Scientists believe that this lengthy developmental period may help explain some of the behavior which is characteristic of adolescence—such as their propensity to seek out new and potentially dangerous situations. For some teens, thrill-seeking might include experimenting with alcohol. Developmental changes also offer a possible physiological explanation for why teens act so impulsively, often not recognizing that their actions—such as drinking—have consequences.
Expectancies—How people view alcohol and its effects also influences their drinking behavior, including whether they begin to drink and how much. An adolescent who expects drinking to be a pleasurable experience is more likely to drink than one who does not. An important area of alcohol research is focusing on how expectancy influences drinking patterns from childhood through adolescence and into young adulthood (11–14). Beliefs about alcohol are established very early in life, even before the child begins elementary school (15). Before age 9, children generally view alcohol negatively and see drinking as bad, with adverse effects. By about age 13, however, their expectancies shift, becoming more positive (11,16). As would be expected, adolescents who drink the most also place the greatest emphasis on the positive and arousing effects of alcohol.
Sensitivity and Tolerance to Alcohol—Differences between the adult brain and the brain of the maturing adolescent also may help to explain why many young drinkers are able to consume much larger amounts of alcohol than adults (17) before experiencing the negative consequences of drinking, such as drowsiness, lack of coordination, and withdrawal/hangover effects (18,19). This unusual tolerance may help to explain the high rates of binge drinking among young adults. At the same time, adolescents appear to be particularly sensitive to the positive effects of drinking, such as feeling more at ease in social situations, and young people may drink more than adults because of these positive social experiences (18,19).
Personality Characteristics and Psychiatric Comorbidity—Children who begin to drink at a very early age (before age 12) often share similar personality characteristics that may make them more likely to start drinking. Young people who are disruptive, hyperactive, and aggressive—often referred to as having conduct problems or being antisocial—as well as those who are depressed, withdrawn, or anxious, may be at greatest risk for alcohol problems (20). Other behavior problems associated with alcohol use include rebelliousness (21), difficulty avoiding harm or harmful situations (22), and a host of other traits seen in young people who act out without regard for rules or the feelings of others (i.e., disinhibition) (23–25).
Hereditary Factors—Some of the behavioral and physiological factors that converge to increase or decrease a person’s risk for alcohol problems, including tolerance to alcohol’s effects, may be directly linked to genetics. For example, being a child of an alcoholic or having several alcoholic family members places a person at greater risk for alcohol problems. Children of alcoholics (COAs) are between 4 and 10 times more likely to become alcoholics themselves than are children who have no close relatives with alcoholism (26). COAs also are more likely to begin drinking at a young age (27) and to progress to drinking problems more quickly (9).
Research shows that COAs may have subtle brain differences which could be markers for developing later alcohol problems (28). For example, using high-tech brain-imaging techniques, scientists have found that COAs have a distinctive feature in one brainwave pattern (called a P300 response) that could be a marker for later alcoholism risk (29,30). Researchers also are investigating other brainwave differences in COAs that may be present long before they begin to drink, including brainwave activity recorded during sleep (31) as well as changes in brain structure (32) and function (33).
Some studies suggest that these brain differences may be particularly evident in people who also have certain behavioral traits, such as signs of conduct disorder, antisocial personality disorder, sensation-seeking, or poor impulse control (34–38). Studying how the brain’s structure and function translates to behavior will help researchers to better understand how predrinking risk factors shape later alcohol use. For example, does a person who is depressed drink to alleviate his or her depression, or does drinking lead to changes in his brain that result in feelings of depression?
Other hereditary factors likely will become evident as scientists work to identify the actual genes involved in addiction. By analyzing the genetic makeup of people and families with alcohol dependence, researchers have found specific regions on chromosomes that correlate with a risk for alcoholism (39–41). Candidate genes for alcoholism risk also have been associated with those regions (42). The goal now is to further refine regions for which a specific gene has not yet been identified and then determine how those genes interact with other genes and gene products as well as with the environment to result in alcohol dependence. Further research also should shed light on the extent to which the same or different genes contribute to alcohol problems, both in adults and in adolescents.
Environmental Aspects—Pinpointing a genetic contribution will not tell the whole story, however, as drinking behavior reflects a complex interplay between inherited and environmental factors, the implications of which are only beginning to be explored in adolescents (43). And what influences drinking at one age may not have the same impact at another. As Rose and colleagues (43) show, genetic factors appear to have more influence on adolescent drinking behavior in late adolescence than in mid-adolescence.
Environmental factors, such as the influence of parents and peers, also play a role in alcohol use (44). For example, parents who drink more and who view drinking favorably may have children who drink more, and an adolescent girl with an older or adult boyfriend is more likely to use alcohol and other drugs and to engage in delinquent behaviors (45).
Researchers are examining other environmental influences as well, such as the impact of the media. Today alcohol is widely available and aggressively promoted through television, radio, billboards, and the Internet. Researchers are studying how young people react to these advertisements. In a study of 3rd, 6th, and 9th graders, those who found alcohol ads desirable were more likely to view drinking positively and to want to purchase products with alcohol logos (46). Research is mixed, however, on whether these positive views of alcohol actually lead to underage drinking.
Whatever it is that leads adolescents to begin drinking, once they start they face a number of potential health risks. Although the severe health problems associated with harmful alcohol use are not as common in adolescents as they are in adults, studies show that young people who drink heavily may put themselves at risk for a range of potential health problems.
Brain Effects—Scientists currently are examining just how alcohol affects the developing brain, but it’s a difficult task. Subtle changes in the brain may be difficult to detect but still have a significant impact on long-term thinking and memory skills. Add to this the fact that adolescent brains are still maturing, and the study of alcohol’s effects becomes even more complex. Research has shown that animals fed alcohol during this critical developmental stage continue to show long-lasting impairment from alcohol as they age (47). It’s simply not known how alcohol will affect the long-term memory and learning skills of people who began drinking heavily as adolescents.
Liver Effects—Elevated liver enzymes, indicating some degree of liver damage, have been found in some adolescents who drink alcohol (48). Young drinkers who are overweight or obese showed elevated liver enzymes even with only moderate levels of drinking (49).
Growth and Endocrine Effects—In both males and females, puberty is a period associated with marked hormonal changes, including increases in the sex hormones, estrogen and testosterone. These hormones, in turn, increase production of other hormones and growth factors (50), which are vital for normal organ development. Drinking alcohol during this period of rapid growth and development (i.e., prior to or during puberty) may upset the critical hormonal balance necessary for normal development of organs, muscles, and bones. Studies in animals also show that consuming alcohol during puberty adversely affects the maturation of the reproductive system (51).
Moreover, much of the treatment available today does not address the specific needs of adolescents (2). For example, most young people prefer easy access to treatment, with strategies tailored to their age group (3), and treatments that do not remove them from their home or academic settings (2). Youth perceive traditional services (e.g., alcoholism treatment programs, Alcoholics Anonymous) as less helpful than brief interventions tailored to their concerns (4). Consequently, alternative formats, attention to developmental transitions, and social marketing are needed to better address alcohol problems that emerge during adolescence.
Adolescent Treatment Interventions—Complex interventions have been developed and tested in adolescents referred for treatment of alcohol and other drug disorders. Many of these patients are likely to have more than one substance use disorder (e.g., alcohol and marijuana) and to have other psychiatric disorders as well (e.g., depression, anxiety, or conduct disorder). Brief interventions are, as a rule, delivered to adolescents in general medical settings (e.g., primary care clinics, emergency rooms) or in school-based settings. These settings offer an excellent opportunity for intervening with adolescents to address their drinking before they progress to serious alcohol use disorders and to prevent the development of alcohol-related problems (5).
(1) Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2002 National Survey on Drug Use and Health: National Findings. NHSDA Series H–22, DHHS Pub. No. SMA 03–3836. Rockville, MD: SAMHSA, Office of Applied Studies, 2003. Available online at: http://www.oas.samhsa.gov/nhsda/2k2nsduh/Results/2k2Results.htm. (2) Brown, S.A. Facilitating change for adolescent alcohol problems: A multiple options approach. In: Wagner, E.F., and Waldron, H.B., eds. Innovations in Adolescent Substance Abuse Intervention. Oxford, England: Elsevier Science, 2001. pp. 169–187. (3) Metrik, J.; Frissell, K.C.; McCarthy, D.M.; et al. Strategies for reduction and cessation of alcohol use: Adolescent Preferences. Alcoholism: Clinical and Experimental Research 27:74–80, 2003. PMID: 12544009 (4) D’Amico, E.J.; McCarthy, D.M.; Metrik, J.; and Brown, S.A. Alcohol-related services: Prevention, secondary intervention and treatment preferences of adolescents. Journal of Child & Adolescent Substance Abuse 14:61–80, 2004. (5) Wagner, E.F.; Brown, S.A.; Monti, P.; et al. Innovations in adolescent substance abuse intervention. Alcoholism: Clinical and Experimental Research 23:236–249, 1999. PMID: 10069552
End of Sidebar
PREVENTING UNDERAGE DRINKING WITHIN A DEVELOPMENTAL FRAMEWORK
Complex behaviors, such as the decision to begin drinking or to continue using alcohol, are the result of a dynamic interplay between genes and environment. For example, biological and physiological changes that occur during adolescence may promote risk-taking behavior, leading to early experimentation with alcohol. This behavior then shapes the child’s environment, as he or she chooses friends and situations that support further drinking. Continued drinking may lead to physiological reactions, such as depression or anxiety disorders, triggering even greater alcohol use or dependence. In this way, youthful patterns of alcohol use can mark the start of a developmental pathway that may lead to abuse and dependence. Then again, not all young people who travel this pathway experience the same outcomes.
Perhaps the best way to understand and prevent underage alcohol use is to view drinking as it relates to development. This “whole system” approach to underage drinking takes into account a particular adolescent’s unique risk and protective factors—from genetics and personality characteristics to social and environmental factors. Viewed in this way, development includes not only the adolescent’s inherent risk and resilience but also the current conditions that help to shape his or her behavior (52).
Children mature at different rates. Developmental research takes this into account, recognizing that during adolescence there are periods of rapid growth and reorganization, alternating with periods of slower growth and integration of body systems. Periods of rapid transitions, when social or cultural factors most strongly influence the biology and behavior of the adolescent, may be the best time to target delivery of interventions (53). Interventions that focus on these critical development periods could alter the life course of the child (54), perhaps placing him or her on a path to avoid problems with alcohol.
To date, researchers have been unable to identify a single track that predicts the course of alcohol use for all or even most young people. Instead, findings provide strong evidence for wide developmental variation in drinking patterns within this special population (55,56).
Rates of drinking and alcohol-related problems are highest among White and American Indian or Alaska Native youth, followed by Hispanic youth, African Americans, and Asians.
Prevalence rates of drinking for boys and girls are similar in the younger age groups; among older adolescents, however, more boys than girls engage in frequent and heavy drinking, and boys show higher rates of drinking problems.
INTERVENTIONS FOR PREVENTING UNDERAGE DRINKING
Intervention approaches typically fall into two distinct categories: (1) environmental-level interventions, which seek to reduce opportunities for underage drinking, increase penalties for violating minimum legal drinking age (MLDA) and other alcohol use laws, and reduce community tolerance for alcohol use by youth; and (2) individual-level interventions, which seek to change knowledge, expectancies, attitudes, intentions, motivation, and skills so that youth are better able to resist the prodrinking influences and opportunities that surround them.
Environmental approaches include:
Raising the Price of Alcohol—A substantial body of research has shown that higher prices or taxes on alcoholic beverages are associated with lower levels of alcohol consumption and alcohol-related problems, especially in young people (57–60).
Increasing the Minimum Legal Drinking Age—Today all States have set the minimum legal drinking at age 21. Increasing the age at which people can legally purchase and drink alcohol has been the most successful intervention to date in reducing drinking and alcohol-related crashes among people under age 21 (61). NHTSA (1) estimates that a legal drinking age of 21 saves 700 to 1,000 lives annually. Since 1976, these laws have prevented more than 21,000 traffic deaths. Just how much the legal drinking age relates to drinking-related crashes is shown by a recent study in New Zealand. Six years ago that country lowered its minimum legal drinking age to 18. Since then, alcohol-related crashes have risen 12 percent among 18- to 19-year-olds and 14 percent among 15- to 17-year-olds (62). Clearly a higher minimum drinking age can help to reduce crashes and save lives, especially in very young drivers.
Enacting Zero-Tolerance Laws—All States have zero-tolerance laws that make it illegal for people under age 21 to drive after any drinking. When the first eight States to adopt zero-tolerance laws were compared with nearby States without such laws, the zero-tolerance States showed a 21-percent greater decline in the proportion of single-vehicle night-time fatal crashes involving drivers under 21, the type of crash most likely to involve alcohol (63).
Stepping up Enforcement of Laws—Despite their demonstrated benefits, legal drinking age and zero-tolerance laws generally have not been vigorously enforced (64). Alcohol purchase laws aimed at sellers and buyers also can be effective (65), but resources must be made available for enforcing these laws.
Individual-focused interventions include:
School-Based Prevention Programs—The first school-based prevention programs were primarily informational and often used scare tactics; it was assumed that if youth understood the dangers of alcohol use, they would choose not to drink. These programs were ineffective. Today, better programs are available and often have a number of elements in common: They follow social influence models and include setting norms, addressing social pressures to drink, and teaching resistance skills. These programs also offer interactive and developmentally appropriate information, include peer-led components, and provide teacher training (66).
Family-Based Prevention Programs—Parents’ ability to influence whether their children drink is well documented and is consistent across racial/ethnic groups (67,68). Setting clear rules against drinking, consistently enforcing those rules, and monitoring the child’s behavior all help to reduce the likelihood of underage drinking. The Iowa Strengthening Families Program (ISFP), delivered when students were in grade 6, is a program that has shown long-lasting preventive effects on alcohol use (69,70).
SELECTED PROGRAMS SHOWING PROMISE
Environmental interventions are among the recommendations included in the recent National Research Council (NRC) and Institute of Medicine (IOM) report on underage drinking (71). These interventions are intended to reduce commercial and social availability of alcohol and/or reduce driving while intoxicated. They use a variety of strategies, including server training and compliance checks in places that sell alcohol; deterring adults from purchasing alcohol for minors or providing alcohol to minors; restricting drinking in public places and preventing underage drinking parties; enforcing penalties for the use of false IDs, driving while intoxicated, and violating zero-tolerance laws; and raising public awareness of policies and sanctions.
The following community trials show how environmental strategies can be useful in reducing underage drinking and related problems.
The Massachusetts Saving Lives Program—This intervention was designed to reduce alcohol-impaired driving and related traffic deaths. Strategies included the use of drunk-driving checkpoints, speeding and drunk-driving awareness days, speed-watch telephone hotlines, high school peer-led education, and college prevention programs. The 5-year program decreased fatal crashes, particularly alcohol-related fatal crashes involving drivers ages 15–25, and reduced the proportion of 16- to 19-year-olds who reported driving after drinking, in comparison with the rest of Massachusetts. It also made teens more aware of penalties for drunk driving and for speeding (72).
The Community Prevention Trial Program—This program was designed to reduce alcohol-involved injuries and death. One component sought to reduce alcohol sales to minors by enforcing underage sales laws; training sales clerks, owners, and managers to prevent sales of alcohol to minors; and using the media to raise community awareness of underage drinking. Sales to apparent minors (people of legal drinking age who appear younger than age 21) were significantly reduced in the intervention communities compared with control sites (73).
Communities Mobilizing for Change on Alcohol—This intervention, designed to reduce the accessibility of alcoholic beverages to people under age 21, centered on policy changes among local institutions to make underage drinking less acceptable within the community. Alcohol sales to minors were reduced: 18- to 20-year-olds were less likely to try to purchase alcohol or provide it to younger teens, and the number of DUI arrests declined among 18- to 20-year-olds (74,75).
Multicomponent Comprehensive Interventions—Perhaps the strongest approach for preventing underage drinking involves the coordinated effort of all the elements that influence a child’s life—including family, schools, and community. Ideally, intervention programs also should integrate treatment for youth who are alcohol dependent. Project Northland is an example of a comprehensive program that has been extensively evaluated.
Project Northland was tested in 22 school districts in northeastern Minnesota. The intervention included (1) school curricula, (2) peer leadership, (3) parental involvement programs, and (4) communitywide task force activities to address larger community norms and alcohol availability. It targeted adolescents in grades 6 through 12.
Intervention and comparison communities differed significantly in “tendency to use alcohol,” a composite measure that combined items about intentions to use alcohol and actual use, as well as in the likelihood of drinking “five or more in a row.” Underage drinking was less prevalent in the intervention communities during phase 1; higher during the interim period (suggesting a “catch-up” effect while intervention activities were minimal); and again lower during phase 2, when intervention activities resumed (76).
Project Northland has been designated a model program by the Substance Abuse and Mental Health Services Administration (SAMHSA), and its materials have been adapted for a general audience. It now is being replicated in ethnically diverse urban neighborhoods.
Today, alcohol is widely available and aggressively promoted throughout society. And alcohol use continues to be regarded, by many people, as a normal part of growing up. Yet underage drinking is dangerous, not only for the drinker but also for society, as evident by the number of alcohol-involved motor vehicle crashes, homicides, suicides, and other injuries.
People who begin drinking early in life run the risk of developing serious alcohol problems, including alcoholism, later in life. They also are at greater risk for a variety of adverse consequences, including risky sexual activity and poor performance in school.
Identifying adolescents at greatest risk can help stop problems before they develop. And innovative, comprehensive approaches to prevention, such as Project Northland, are showing success in reducing experimentation with alcohol as well as the problems that accompany alcohol use by young people.
(1) National Highway Traffic Safety Administration (NHTSA). Traffic Safety Facts 2002: Alcohol. DOT Pub. No. HS–809–606. Washington, DC: NHTSA, National Center for Statistics & Analysis, 2003. Available online at: http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/TSF2002/2002alcfacts.pdf. (2) Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC). Web-Based Injury Statistics Query and Reporting System (WISQARS), 2004. Available online at: http://www.cdc.gov/ncipc/wisqars/default.htm. (3) Smith, G.S.; Branas, C.C.; and Miller, T.R. Fatal nontraffic injuries involving alcohol: A meta-analysis. Annals of Emergency Medicine 33:659–668, 1999. PMID: 10339681 (4) Levy, D.T.; Miller, T.R.; and Cox, K.C. Costs of Underage Drinking. Washington, DC: U.S. Dept. of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention, 1999. Available online at: http://www.udetc.org/documents/costunderagedrinking.pdf. (5) Hingson, R., and Kenkel, D. Social, health, and economic consequences of underage drinking. In: National Research Council and Institute of Medicine. Bonnie, R.J., and O’Connell, M.E., eds. Reducing Underage Drinking: A Collective Responsibility. Washington, DC: National Academies Press, 2004. pp. 351–382. Available online at: http://www.nap.edu/books/0309089352/html. (6) Johnston, L.D.; O’Malley, P.M.; Bachman, J.G.; and Schulenberg, J.E. Monitoring the Future, National Survey Results on Drug Use, 1975–2004. Volume I: Secondary School Students. NIH Pub. No. 05–5727. Bethesda, MD: National Institute on Drug Abuse, 2005. Available online at: http://monitoringthefuture.org/pubs/monographs/vol1_2004.pdf. (7) Newes-Adeyi, G.; Chen, C.M.; Williams, G.D.; and Faden, V.B. NIAAA Surveillance Report No. 74: Trends in Underage Drinking in the United States, 1991–2003. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism, 2005. Available online at: http://pubs.niaaa.nih.gov/publications/surveillance74/Underage03.htm. (8) Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2002 National Survey on Drug Use and Health: National Findings. NHSDA Series H–22, DHHS Pub. No. SMA 03–3836. Rockville, MD: SAMHSA, Office of Applied Studies, 2003. Available online at: http://www.oas.samhsa.gov/nhsda/2k2nsduh/Results/2k2Results.htm. (9) Grant, B.F., and Dawson, D.A. Age at onset of drug use and its association with DSM–IV drug abuse and dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey. Journal of Substance Abuse 10:163–173, 1998. PMID: 9854701 (10) Grunbaum, J.A.; Kann, L.; Kinchen, S.; et al. Youth risk behavior surveillance—United States, 2003. Morbidity and Mortality Weekly Report Surveillance Summary, May 21;53:1–96, 2004. Erratum in MMWR, June 25; 53:536, 2004. Erratum in MMWR, June 24; 54:608, 2005. PMID: 15152182 (11) Dunn, M.E., and Goldman, M.S. Empirical modeling of an alcohol expectancy memory network in elementary school children as a function of grade. Experimental and Clinical Psychopharmacology 4:209–217, 1996. (12) Lang, A.R., and Strizke, W.G.K. Children and alcohol. In: Galanter, M., ed. Recent Developments in Alcoholism, Vol. 11: Ten Years of Progress. New York: Plenum Press, 1993. pp. 73–85. PMID: 8234939 (13) Smith, G.T.; Goldman, M.S.; Greenbaum, P.E.; and Christiansen, B.A. Expectancy for social facilitation from drinking: The divergent paths of high-expectancy and low-expectancy adolescents. Journal of Abnormal Psychology 104:32–40, 1995. PMID: 7897051 (14) Zucker, R.A.; Kincaid, S.B.; Fitzgerald, H.E.; and Bingham, C.R. Alcohol schema acquisition in preschoolers: Differences between children of alcoholics and children of nonalcoholics. Alcoholism: Clinical and Experimental Research 19:1011–1017, 1995. PMID: 7485810 (15) Noll, R.B.; Zucker, R.A.; and Greenberg, G.S. Identification of alcohol by smell among preschoolers: Evidence for early socialization about drugs occurring in the home. Child Development 61:1520–1527, 1990. PMID: 2245743 (16) Dunn, M.E., and Goldman, M.S. Age and drinking-related differences in the memory organization of alcohol expectancies in 3rd, 6th, 9th, and 12th grade children. Journal of Consulting and Clinical Psychology 66:579–585, 1998. PMID: 9642899 (17) Johnston, L.D.; O’Malley, P.M.; and Bachman, J.G. Monitoring the Future, National Survey Results on Drug Use, 1975–2002. Volume I: Secondary School Students. NIH Pub. No. 03–5375. Bethesda, MD: National Institute on Drug Abuse, 2003. Available online at: http://monitoringthefuture.org/pubs/monographs/vol1_2002.pdf. (18) Spear, L.P. The adolescent brain and age-related behavioral manifestations. Neuroscience and Biobehavioral Reviews 24:417–463, 2000. PMID: 10817843 (19) Spear, L.P., and Varlinskaya, E.I. Adolescence: Alcohol sensitivity, tolerance, and intake. In: Galanter, M., ed. Recent Developments in Alcoholism, Vol. 17: Alcohol Problems in Adolescents and Young Adults: Epidemiology, Neurobiology, Prevention, Treatment. New York: Springer, 2005. pp. 143–159. PMID: 15789864 (20) Zucker, R.A.; Wong, M.M.; Puttler, L.I.; and Fitzgerald, H.E. Resilience and vulnerability among sons of alcoholics: Relationship to developmental outcomes between early childhood and adolescence. In: Luthar, S.S., ed. Resilience and Vulnerability: Adaptation in the Context of Childhood Adversities. New York: Cambridge University Press, 2003. pp. 76–103. (21) Brook, J.S.; Whiteman, M.; Finch, S.; and Cohen, P. Aggression, intrapsychic distress, and drug use: Antecedent and intervening processes. Journal of the American Academy of Child & Adolescent Psychiatry 34:1076–1084, 1995. PMID: 7665446 (22) Jones, S.P., and Heaven, P.C. Psychosocial correlates of adolescent drug-taking behaviour. Journal of Adolescence 21:127–134, 1998. PMID: 9585491 (23) Colder, C.R., and O’Connor, R. Attention biases and disinhibited behavior as predictors of alcohol use and enhancement reasons for drinking. Psychology of Addictive Behaviors 16:325–332, 2002. PMID: 12503905 (24) Moss, H.B., and Kirisci, L. Aggressivity in adolescent alcohol abusers: Relationship with conduct disorder. Alcoholism: Clinical and Experimental Research 19:642–646, 1995. PMID: 7573787 (25) Colder, C.R., and Chassin, L. Affectivity and impulsivity: Temperament risk for adolescent alcohol involvement. Psychology of Addictive Behaviors 11:83–97, 1997. (26) Russell, M. Prevalence of alcoholism among children of alcoholics. In: Windle, M., and Searles, J.S., eds. Children of Alcoholics: Critical Perspectives. New York: Guilford, 1990. pp. 9–38. (27) Donovan, J.E. Adolescent alcohol initiation: A review of psychosocial risk factors. Journal of Adolescent Health 35:529.e7–18, 2004. PMID: 15581536 (28) Tapert, S.F., and Schweinsburg, A.D. The human adolescent brain and alcohol use disorders. In: Galanter, M., ed. Recent Developments in Alcoholism, Vol. 17: Alcohol Problems in Adolescents and Young Adults: Epidemiology, Neurobiology, Prevention, Treatment. New York: Springer, 2005. pp. 177–197. PMID: 15789866 (29) Begleiter, H.; Porjesz, B.; Bihari, B.; and Kissin, B. Event-related brain potentials in boys at risk for alcoholism. Science 255:1493–1496, 1984. PMID: 6474187 (30) Hill, S.Y., and Steinhauer, S.R. Assessment of prepubertal and postpubertal boys and girls at risk for developing alcoholism with P300 from a visual discrimination task. Journal of Studies on Alcohol 54:350–358, 1993. PMID: 8487544 (31) Dahl, R.E.; Williamson, D.E.; Bertocci, M.A.; et al. Spectral analyses of sleep EEG in depressed offspring of fathers with or without a positive history of alcohol abuse or dependence: A pilot study. Alcohol 30:193–200, 2003. PMID: 13679113 (32) Hill, S.Y.; De Bellis, M.D.; Keshavan, M.S.; et al. Right amygdala volume in adolescent and young adult offspring from families at high risk for developing alcoholism. Biological Psychiatry 49:894–905, 2001. PMID: 11377407 (33) Schweinsburg, A.D.; Paulus, M.P.; Barlett, V.C.; et al. A fMRI study of response inhibition in youths with a family history of alcoholism. Annals of the New York Academy of Sciences 1021:391–394, 2004. PMID: 15251915 (34) Bauer, L.O., and Hesselbrock, V.M. P300 decrements in teenagers with conduct problems: Implications for substance abuse risk and brain development. Biological Psychiatry 46:263–272, 1999. PMID: 10418702 (35) Bauer, L.O., and Hesselbrock, V.M. Subtypes of family history and conduct disorder: Effects on P300 during the Stroop Test. Neuropsychopharmacology 21:51–62, 1999. PMID: 10379519 (36) Schuckit, M.A. Biological, psychological and environmental predictors of the alcoholism risk: A longitudinal study. Journal of Studies on Alcohol 59:485–494, 1998. PMID: 9718100 (37) Schuckit, M.A., and Smith, T.L. Assessing the risk for alcoholism among sons of alcoholics. Journal of Studies on Alcohol 58:141–145, 1997. PMID: 9065891 (38) Tarter, R.E.; Alterman, A.I.; and Edwards, K.L. Vulnerability to alcoholism in men: A behavior-genetic perspective. Journal of Studies on Alcohol 46:329–356, 1985. PMID: 4033133 (39) Reich, T.; Edenberg, H.J.; Goate, A.; et al. Genome-wide search for genes affecting the risk for alcohol dependence. American Journal of Medical Genetics 81:207–215, 1998. PMID: 9603606 (40) Long, J.C.; Knowler, W.C.; Hanson, R.L.; et al. Evidence for genetic linkage to alcohol dependence on chromosomes 4 and 11 from an autosome-wide scan in an American Indian population. American Journal of Medical Genetics. Part B: Neuropsychiatric Genetics 81:216–221, 1998. PMID: 9603607 (41) Foroud, T.; Edenberg, H.J.; Goate, A.; et al. Alcoholism susceptibility loci: Confirmation studies in a replicate sample and further mapping. Alcoholism: Clinical and Experimental Research 24:933–945, 2000. PMID: 10923994 (42) Edenberg, H.J., and Kranzler, H.R. The contribution of genetics to addiction therapy approaches. Pharmacology & Therapeutics 108:86–93, 2005. PMID: 16026844 (43) Rose, R.J.; Dick, D.M.; Viken, R.J.; and Kaprio, J. Gene-environment interaction in patterns of adolescent drinking: Regional residency moderates longitudinal influences on alcohol use. Alcoholism: Clinical and Experimental Research 25:637–643, 2001. PMID: 11371711 (44) Halpern-Felsher, B.L., and Biehl, M. Developmental and environmental influences on underage drinking: A general overview. In: National Research Council and Institute of Medicine. Bonnie, R.J., and O’Connell, M.E., eds. Reducing Underage Drinking: A Collective Responsibility. Washington, DC: National Academies Press, 2004. pp. 402–416. Available online at: http://www.nap.edu/books/0309089352/html. (45) Castillo Mezzich, A.; Giancola, P.R.; Lu, S.Y.; et al. Adolescent females with a substance use disorder: Affiliations with adult male sexual partners. American Journal of Addictions 8:190–200, 1999. PMID: 10506900 (46) Austin, E.W., and Knaus, C. Predicting the potential for risky behavior among those “too young” to drink as the result of appealing advertising. Journal of Health Communications 5:13–27, 2000. PMID: 10848029 (47) White, A.M.; Jamieson-Drake, D.W.; and Swartzwelder, H.S. Prevalence and correlates of alcohol-induced blackouts among college students: Results of an e-mail survey. Journal of American College Health 51:117-119, 122–131, 2002. PMID: 12638993 (48) Clark, D.B.; Lynch, K.G.; Donovan, J.E.; and Block, G.D. Health problems in adolescents with alcohol use disorders: Self-report, liver injury, and physical examination findings and correlates. Alcoholism: Clinical and Experimental Research 25:1350–1359, 2001. PMID: 11584156 (49) Strauss, R.S.; Barlow, S.E.; and Dietz, W.H. Prevalence of abnormal serum aminotransferase values in overweight and obese adolescents. Journal of Pediatrics 136:727–733, 2000. PMID: 10839867 (50) Mauras, N.; Rogol, A.D.; Haymond, M.W.; and Veldhuis, J.D. Sex steroids, growth hormone, insulin-like growth factor-1: Neuroendocrine and metabolic regulation in puberty. Hormone Research 45:74–80, 1996. PMID: 8742123 (51) Dees, W.L.; Srivastava, V.K.; and Hiney, J.K. Alcohol and female puberty: The role of intraovarian systems. Alcohol Research & Health 25(4):271–275, 2001. PMID: 11910704 (52) Sroufe, L.A., and Rutter, M. The domain of developmental psychopathology. Child Development 55:17–29, 1984. PMID: 6705619 (53) Greenough, W.T.; Black, J.E.; and Wallace, C.S. Experience and brain development. Child Development 58:539–559, 1987. PMID: 3038480 (54) Masten, A.S. Regulatory processes, risk, and resilience in adolescent development. Annals of the New York Academy of Sciences 1021:310–319, 2004. PMID: 15251901 (55) Steinman, K.J., and Schulenberg, J. A pattern-centered approach to evaluating substance use prevention programs. In: Damon, W.; Peck, S.C.; and Roeser, R.W.; eds. New Directions for Child and Adolescent Development, Vol. 101: Person-Centered Approaches to Studying Development in Context. San Francisco: Jossey-Bass, 2003. pp. 87–98 (56) Schulenberg J.; O’Malley, P.M.; Bachman, J.G.; et al. Getting drunk and growing up: Trajectories of frequent binge drinking during the transition to young adulthood. Journal of Studies on Alcohol 57:289–304, 1996. PMID: 8709588 (57) Leung, S.F., and Phelps, C.E. My kingdom for a drink. . . . ? A review of estimates of the price sensitivity of demand for alcoholic beverages. In: Hilton, M.E., and Bloss, G., eds. Economics and the Prevention of Alcohol-Related Problems. NIAAA Research Monograph No. 25. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism, 1993. pp. 1–31. (58) Kenkel, D.S., and Manning, W.G. Perspectives on alcohol taxation. Alcohol Health & Research World 20(4):230–238, 1996. (59) Chaloupka, F.J.; Grossman, M.; and Saffer, H. The effects of price on the consequences of alcohol use and abuse. In: Galanter, M., ed. Recent Developments in Alcoholism, Vol. 14: The Consequences of Alcoholism. New York: Plenum Press, 1998. pp. 331–346. PMID: 9751952 (60) Cook, P.J., and Moore, M.J. The economics of alcohol abuse and alcohol-control policies. Health Affairs 21:120–133, 2002. PMID: 11900152 (61) Wagenaar, A.C., and Toomey, T.L. Effects of minimum drinking age laws: Review and analyses of the literature from 1960 to 2000. Journal of Studies on Alcohol (Suppl. 14):206–225, 2002. PMID: 12022726 (62) Kypri, K.; Voas, R.B.; Langley, J.D.; et al. Minimum purchasing age for alcohol and traffic crash injuries among 15- to 19-year-olds in New Zealand. American Journal of Public Health 96:126–131, 2006. PMID: 16317197 (63) Hingson, R.; Heeren, T.; and Winter, M. Lower legal blood alcohol limits for young drivers. Public Health Reports 109:738–744, 1994. PMID: 7800781 (64) Jones, R.K., and Lacey, J.H. Alcohol and Highway Safety 2001: A Review of the State of Knowledge. DOT Pub. No. HS–809–383. Washington, DC: National Highway Traffic Safety Administration, 2001. Available online at: http://www.nhtsa.dot.gov/people/injury/research/AlcoholHighway. (65) Preusser, D.F.; Williams, A.F.; and Weinstein, H.B. Policing underage alcohol sales. Journal of Safety Research 25:127–133, 1994. (66) National Institute on Alcohol Abuse and Alcoholism. Interventions for alcohol use and alcohol use disorders in youth. Alcohol Research & Health 28(3):163–174, 2004/2005. (67) Barnes, G.M.; Reifman, A.S.; Farrell, M.P.; and Dintcheff, B.A. The effects of parenting on the development of adolescent alcohol misuse: A six-wave latent growth model. Journal of Marriage and Family 62:175–186, 2000. (68) Steinberg, L.; Fletcher, A.; and Darling, N. Parental monitoring and peer influences on adolescent substance use. Pediatrics 93(6 Pt 2):1060–1064, 1994. PMID: 8197008 (69) Spoth, R.L.; Redmond, C.; and Shin, C. Randomized trial of brief family interventions for general populations: Adolescent substance use outcomes 4 years following baseline. Journal of Consulting and Clinical Psychology 69:627–642, 2001. PMID: 11550729 (70) Spoth, R.; Redmond, C.; Shin, C.; and Azevedo, K. Brief family intervention effects on adolescent substance initiation: School-level growth curve analyses 6 years following baseline. Journal of Consulting and Clinical Psychology 72:535–542, 2004. PMID: 15279537 (71) National Research Council (NRC) and Institute of Medicine (IOM), Committee on Developing a Strategy to Reduce and Prevent Underage Drinking. Bonnie, R.J., and O’Connell, M.E., eds. Reducing Underage Drinking: A Collective Responsibility. Washington, DC: National Academies Press, 2004. Available online at: http://www.nap.edu/books/0309089352/html. (72) Hingson, R.W., and Howland, J. Comprehensive community interventions to promote health: Implications for college-age drinking problems. Journal of Studies on Alcohol (Suppl. 14):226–240, 2002. PMID: 12022727 (73) Holder, H.D. Community prevention of alcohol problems. Addictive Behaviors 25:843–859, 2000. PMID: 11125775 (74) Wagenaar, A.C.; Murray, D.M.; Gehan, J.P.; et al. Communities Mobilizing for Change on Alcohol: Outcomes from a randomized community trial. Journal of Studies on Alcohol 61:85–94, 2000. PMID: 10627101 (75) Wagenaar, A.C.; Murray, D.M.; and Toomey, T.L. Communities Mobilizing for Change on Alcohol (CMCA): Effects of a randomized trial on arrests and traffic crashes. Addiction 95:209–217, 2000. PMID: 10723849 (76) Perry, C.L.; Williams, C.L.; Komro, K.A.; et al. Project Northland: Long-term outcomes of community action to reduce adolescent alcohol use. Health Education Research 17:117–132, 2002. PMID: 11888042
Find Top Treatment Facilities Near You
Speak with a Certified Treatment Assesment Counselor who can go over all your treatment options and help you find the right treatment program that fits your needs.
Discuss Treatment Options!
Our Counselors are available 24 hours a day, 7 days a week to discuss your treatment needs and help you find the right treatment solution.
© Copyright 1998 - 2018 All Rights Reserved. Content is protected under copyright laws, do not use content without written permission.