Underage Drinking | National Institute on Alcohol Abuse and Alcoholism (NIAAA) (2023)

Underage drinking is a serious public health problem in the United States. Alcohol is the most widely used substance among America’s youth and can cause them enormous health and safety risks.

The consequences of underage drinking can affect everyone—regardless of age or drinking status.

Either directly or indirectly, we all feel the effects of the aggressive behavior, property damage, injuries, violence, and deaths that can result from underage drinking. This is not simply a problem for some families—it is a nationwide concern.

Underage Drinking Statistics

Many Youth Drink Alcohol

• In 2019, about 24.6 percent of youth ages 14to 15reported having at least1 drink in their lifetime.¹

• In 2019, 7.0million youthages 12 to 20 reported drinkingalcohol beyond “just a few sips” in the past month.²

• Adolescent alcohol use differs by race and ethnicity. For example, at age 14, White, Black, and Hispanic youth are equally likely to drink. By age 18, White and Hispanic youth are twice as likely to drink than Black youth.³

Youth Often Binge Drink

People ages 12 to 20 drink 4.0percent of all alcohol consumed in the United States.⁴Although youth drink less often than adults, when they do drink, they drink more. More than 90 percent of all alcohol drinks consumed by youth are consumed through binge drinking⁵ (see the "What Is Binge Drinking?" box).

• In 2019, 4.2million youthreported binge drinking at least once in the past month.²

• In 2019, 825,000 youthreported binge drinking on 5 or more days over the past month.²

Drinking Patterns Vary by Age and Gender

Alcohol use often begins during adolescence and becomes more likely as adolescents age. In 2019, fewer than 2 in 100 adolescents ages 12 to 13 reported drinking alcohol in the past month, and fewer than 1 in 100 engaged in binge drinking. Among respondents ages 16 to 17, fewer than 1 in 5 reported drinking and about 1 in 10 reported binge drinking.⁶ Implementing prevention strategies during early adolescence is needed to prevent this escalation, particularly because earlier alcohol use is associated with a higher likelihood of a variety of alcohol-related consequences.⁷

Historically, adolescent boys were more likely to drink and binge drink than girls. Now, that relationship has reversed. Alcohol use in recent years has declined more among adolescent boys than among girls, with more adolescent girls reporting alcohol use and binge drinking than boys.^8,9

Underage Drinking Is Dangerous

Underage drinking poses a range of risks and negative consequences. It is dangerous because it:

• Causes many deaths. Alcohol is a significant factor in the deaths of people younger than age 21 in the United States each year. This includes deaths from motor vehicle crashes, homicides, alcohol overdoses, falls, burns, drowning, and suicides.
• Causes many injuries. Drinking alcohol can cause youth to have accidents and get hurt. In 2011 alone, about 188,000 people younger than age 21 visited an emergency room for alcohol-related injuries.¹⁰
• Impairs judgment. Drinking can lead to poor decisions about taking risks, including unsafe sexual behavior, drinking and driving, and aggressive or violent behavior.
• Increases the risk of physical and sexual assault.Underage binge drinking is associated with an increased likelihood of being the victim or perpetrator of interpersonal violence.¹¹
• Can lead to other problems. Drinking may cause youth to have trouble in school or with the law. Drinking alcohol also is associated with the use of other substances.
• Increases the risk of alcohol problems later in life. Research shows that people who start drinking before the age of 15 are at a higher risk for developing alcohol use disorder (AUD) later in life. For example, adults ages 26 and older who began drinking before age 15 are 5.6 times more likely to report having AUDin the past year thenthose who waited until age 21 or later to begin drinking.¹²
• Interferes with brain development. Research shows that people’s brains keep developing well into their 20s. Alcohol can alter this development, potentially affecting both brain structure and function. This may cause cognitive or learning problems as well asincrease vulnerability for AUD, especially when people start drinking at a young age and drink heavily.^13,14

Why Do So Many Youth Drink?

As children mature, it is natural for them to assert their independence, seek new challenges, and engage in risky behavior. Underage drinking is one such behaviorthat attracts many adolescents. They may want to try alcohol but often do not fully recognize its effects on their health and behavior. Other reasons youth drink alcohol include:

• Peer pressure

• Increased independence, or the desire for it

• Stress

In addition, many youth have easy access to alcohol. In 2019, among adolescents ages 12 to 14 who reported drinking alcohol in the past month, 96.5percent reported getting it for free the last time they drank.¹⁵In many cases, adolescents have access to alcohol through family membersor find it at home.

Preventing Underage Drinking

Preventing underage drinking is a complex challenge. Any successful approach must consider many factors, including:

• Genetics

  (Video) Short Takes with #NIAAA: What is Binge Drinking?

• Personality

• Rate of maturation and development

• Level of risk

• Social factors

• Environmental factors

Several key approaches have been found to be successful. They are:

• Individual-level interventions. This approach seeks to change the way youth think about alcohol, so they are better able to resist pressures to drink.
• School-based interventions. These are programs that provide students with the knowledge, skills, motivation, and opportunities they need to remain alcohol-free.
• Family-based interventions. These are efforts to empower parents to set and enforce clear rules against drinking, as well as improve communication between children and parents about alcohol.
• Community-based interventions. Community-based interventions are often coordinated by local coalitions working to mitigate risk factors for alcohol misuse.
• Policy-level interventions. This approach makes alcohol harder to get--for example, by raising the price of alcohol and keeping the minimum legal drinking age at 21. Enacting zero-tolerance laws that outlaw driving after any amount of drinking for people younger than 21 can also help prevent problems.

The Role Parents Play

Parents and teachers can play a meaningful role in shaping youth’s attitudes toward drinking. Parents, in particular, can have either a positive or negative influence.

Parents can help their children avoid alcohol problems by:

• Talking about the dangers of drinking

• Drinking responsibly, if they choose to drink

• Serving as positive role models in general

• Not making alcohol available

• Getting to know their children’s friends

• Having regular conversations about life in general

• Connecting with other parents about sending clear messages about the importance of youth not drinking alcohol

• Supervising all parties to make sure there is no alcohol

• Encouraging kids to participate in healthy and fun activities that do not involve alcohol

  (Video) CADCA-NIAAA Underage Drinking

Research shows that children of actively involved parents are less likely to drink alcohol.¹⁶However, if parents provide alcohol to their kids (even small amounts), have positive attitudes about drinking, and engage in alcohol misuse, adolescents have an increased risk of misusing alcohol. Moreover, if the adolescent has a parent with AUD, they are less likely to be protected from alcohol misuse through parental engagement and other factors.^17,18

Warning Signs of Underage Drinking

Adolescence is a time of change and growth, including behavior changes. These changes usually are a normal part of growing up but sometimes can point to an alcohol problem. Parents, families,and teachers should pay close attention to the following warning signs that may indicate underage drinking:¹⁹

• Changes in mood, including anger and irritability

• Academic or behavioral problems in school

• Rebelliousness

• Changing groups of friends

• Low energy level

• Less interest in activities or care in appearance

• Finding alcohol among an adolescent's belongings

• Smelling alcohol on an adolescent's breath

• Problems concentrating or remembering

• Slurred speech

• Coordination problems

Treating Underage Drinking Problems

Screening youth for alcohol use and AUD is very important and may prevent problems down the road. Screening by a primary care provider or other health practitioner (e.g., pediatrician) provides an opportunity to identify problems early and address them before they escalate. It also allows adolescents to ask questions of a knowledgeable adult. The National Institute on Alcohol Abuse and Alcoholism and the American Academy of Pediatrics both recommend that all youth be regularly screened for alcohol use.

Some youth can experience serious problems as a result of drinking, including AUD, which require intervention by trained professionals. Professional treatment options include:

• Attending individual or group counseling sessions one or more times per week
• Receiving a prescription from a primary care doctor or psychiatrist to help reduce alcohol cravings
• Participating in family therapy to build a supportive foundation for recovery

For more information, please visit:www.niaaa.nih.gov

^1. Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Health Statistics and Quality (CBHSQ), 2019 National Survey on Drug Use and Health. Table 2.6B— Alcohol Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older, by Detailed Age Category: Percentages, 2018 and 2019.https://www.samhsa.gov/data/sites/default/files/reports/rpt29394/NSDUHDetailedTabs2019/NSDUHDetTabsSect2pe2019.htm#tab2-6b. Accessed October 4, 2022.

^2.SAMHSA, CBHSQ. 2019 National Survey on Drug Use and Health. Table 7.16A— Alcohol Use in Lifetime, Past Year, and Past Month among Persons Aged 12 to 20, by Gender: Numbers in Thousands, 2002-2019. https://www.samhsa.gov/data/sites/default/files/reports/rpt29394/NSDUHDetailedTabs2019/NSDUHDetTabsSect7pe2019.htm#tab7-16a. Accessed September 15, 2020.

^3.Chen, C.M.; and Yoon, Y.H.NIAAA Surveillance Report #116: Trends in Underage Drinking in the United States, 1991–2019. Figure 1-5. NSDUH: Prevalence of drinking in the past 30 days among 12- to 20-year-olds, by age, sex, and race/Hispanic origin, 2019. https://pubs.niaaa.nih.gov/publications/surveillance116/figures19.htm#f15. Accessed August 2, 2022.

^4.Calculated using past 30-day quantity and frequency of alcohol use from the 2019National Survey on Drug Use and Health public-use data file. SAMHSA, CBHSQ. 2019 National Survey on Drug Use and Health (NSDUH-2019-DS0001). Public-use file dataset. https://www.datafiles.samhsa.gov/dataset/national-survey-drug-use-and-health-2019-nsduh-2019-ds0001. Accessed October 4, 2022.

^5.Calculated using past 30-day quantity and frequency of alcohol use and past 30-day frequency of binge drinking (4+ drinks for females and 5+ drinks for males on the same occasion) from the 2019NSDUH public-use data file. SAMHSA, CBHSQ. 2019 National Survey on Drug Use and Health (NSDUH-2019-DS0001). Public-use file dataset. https://www.datafiles.samhsa.gov/dataset/national-survey-drug-use-and-health-2019-nsduh-2019-ds0001. Accessed October 4, 2022.

^6.SAMHSA, CBHSQ. 2019 National Survey on Drug Use and Health. Table 2.7B—Alcohol Use, Binge Alcohol Use, and Heavy Alcohol Use in Past Month among Persons Aged 12 or Older, by Detailed Age Category: Percentages, 2018 and 2019. https://www.samhsa.gov/data/sites/default/files/reports/rpt29394/NSDUHDetailedTabs2019/NSDUHDetTabsSect2pe2019.htm#tab2-7b. Accessed January 11, 2021.

^7. Hingson, R.W.; and Zha, W. Age of drinking onset, alcohol use disorders, frequent heavy drinking, and unintentionally injuring oneself and others after drinking.Pediatrics123(6):1477–1484, 2009.

^8.Population prevalence estimates (%) are weighted by the person-level analysis weight and derived from the CBHSQ 2019 National Survey on Drug Use and Health (NSDUH-2019-DS0001) public-use file dataset. Binge alcohol use is defined as drinking 5 or more drinks on the same occasion for males or 4 or more drinks on the same occasion for females on at least 1 day in the past 30 days. Any alcohol is defined as a drink of an alcoholic beverage (a can or bottle of beer, a glass of wine or a wine cooler, a shot of distilled spirits, or a mixed drink with distilled spirits in it), not counting a sip or two from a drink. https://www.datafiles.samhsa.gov/dataset/national-survey-drug-use-and-health-2019-nsduh-2019-ds0001. Accessed October 4, 2022.

^9. Chen, C.M.; Yoon, Y-H.; Faden, V.B. Surveillance Report #107: Trends in Underage Drinking in the United States, 1991–2015. Bethesda, MD: NIAAA, March 2017. https://pubs.niaaa.nih.gov/publications/surveillance107/Underage15.htm. Accessed July 30, 2019.

^10. SAMHSA, CBHSQ. The DAWN Report: Alcohol and Drug Combinations Are More Likely to Have a Serious Outcome Than Alcohol Alone in Emergency Department Visits Involving Underage Drinking. Rockville, MD: SAMHSA, 2014. https://www.samhsa.gov/data/sites/default/files/spot143-underage-drinking-2014/spot143-underage-drinking-2014/spot143-underage-drinking-2014.pdf. Accessed January 19, 2018.

^11. Waterman, E.A.; Lee, K.D.M.; Edwards, K.M. Longitudinal associations of binge drinking with interpersonal violence among adolescents. Journal of Youth and Adolescence48:1342–1352, 2019. PMID: 31079263

^12. The comparison of risk for an alcohol use disorder between different ages at drinking onset is based on the prevalence ratio; the comparison of the increased risk between genders is based on the ratio of the prevalence ratios. The estimates are weighted by the person-level analysis weight and derived from the CBHSQ 2019 National Survey on Drug Use and Health (NSDUH-2019-DS0001) public-use file dataset. Age at drinking onset: age when first drank an alcoholic beverage (a can or bottle of beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with liquor in it), not counting a sip or two from a drink. AUD: alcohol dependence or abuse based on the criteria in the American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). https://www.datafiles.samhsa.gov/dataset/national-survey-drug-use-and-health-2019-nsduh-2019-ds0001. Accessed October 4, 2022.

^13. Squeglia, L.M.; Tapert, S.F.; Sullivan, E.V.; Jacobus, J.; Meloy, M.J.; Rohlfing, T.; and Pfefferbaum, A. Brain development in heavy-drinking adolescents. American Journal of Psychiatry 172(6):531–542, 2015. PMID: 25982660

^14. Pfefferbaum, A.; Kwon, D.; Brumback, T.; Thompson, W. K.; Cummins, K.; Tapert, S. F.; Brown, S. A.; Colrain, I. M.; Baker, F. C.; Prouty, D.; De Bellis, M. D.; Clark, D. B.; Nagel, B. J.; Chu, W.; Park, S. H.; Pohl, K. M.; and Sullivan, E. V. Altered brain developmental trajectories in adolescents after initiating drinking. American Journal of Psychiatry 175(4):370–380, 2018. PMID: 29084454

^15. SAMHSA, CBHSQ. 2019 National Survey on Drug Use and Health. Table 6.16B—Source Where Alcohol Was Obtained for Most Recent Use in Past Month among Past Month Alcohol Users Aged 12 to 20, by Age Group and Gender: Percentages, 2018 and 2019. https://www.samhsa.gov/data/sites/default/files/reports/rpt29394/NSDUHDetailedTabs2019/NSDUHDetTabsSect6pe2019.htm#tab6-16b. Accessed September 16, 2020.

^16. van der Vorst, H.; Engels, R.C.; Meeus, W.; and Deković, M. The impact of alcohol-specific rules, parental norms about early drinking, and parental alcohol use on adolescents’ drinking behavior. Journal of Child Psychology and Psychiatry 47(12):1299–1306, 2006. PMID: 17176385

^17.Yap, M.; Cheong, T.; Zaravinos-Tsakos, F.; Lubman, D.I.; and Jorm, A. Modifiable parenting factors associated with adolescent alcohol misuse: A systematic review and meta-analysis of longitudinal studies. Addiction 112(7):1142–1162, 2017. PMID: 28178373

^18.Rusby, J.C.; Light, J.M.; Crowley, R.; and Westling, E. Influence of parent-youth relationship, parental monitoring, and parent substance use on adolescent substance use onset. Journal of Family Psychology 32(3):310–320, 2018. PMID: 29300096

^19. SAMHSA. How to tell if your child is drinking alcohol. https://www.samhsa.gov/underage-drinking/parent-resources/how-tell-if-your-child-drinking-alcohol. Accessed May 30, 2018.

^20.NIAAA. Defining binge drinking. What Colleges Need to Know Now. https://www.collegedrinkingprevention.gov/media/1College_Bulletin-508_361C4E.pdf. Acessed October 22, 2021.

^21. Chung, T.; Creswell, K.G.; Bachrach, R.; Clark, D.B,l and Martin, C.S. Adolescent binge drinking: Developmental context and opportunities for prevention. Alcohol Research: Current Reviews 39(1):5–15, 2018. PMID: 30557142