Adolescents and Alcohol

Alcohol is the substance (drug) most often used and frequently abused by adolescents. According to the 2009 Youth Risk Behavior Surveillance (Centers for Disease Control and Prevention), among high school students, 74% of females and 71% of males have had alcohol at least once and 43% of females and 41% of males have had alcohol in the past month. Binge drinking in the past month is reported by 23% of females (3 or more drinks in a row) and 25% of males (5 or more drinks in a row.) Of concern, 18% of females and 24% of males say they had their first drink of alcohol prior to age 13 years. The earlier the onset of alcohol use in adolescence, the greater likelihood of problem drinking in adulthood.

While alcohol may be used as a beverage and/or for religious rites in many families, excessive alcohol intake to the point of intoxication is a primary factor in many unintended injuries (motor vehicle crashes, drowning, falls from heights, and fires), especially in adolescents and young adults. In the 2009 YRBS, 7.6% of female and 11.6% of male high school students say they have driven a car while or after drinking alcohol in the past month – 29% of females and 28% of males have ridden with a driver who was or had been drinking. The influence of alcohol often impairs judgment regarding sexual relationships leading to unintended, often unprotected sexual intercourse and even acquaintance rape. Although alcohol is a legal substance, states laws govern its availability and provide penalties for its abuse, e.g. public drunkenness, driving under the influence. Because 21 is the legal age to purchase, possess, or drink alcohol, those under age 21 risk legal penalties for buying, selling, or even using alcohol as do those adults who provide alcohol to youth under 21 years.

Adolescents may use alcohol to express independence, to “feel” like adults, to be socially acceptable, to enhance sexual interactions, to deal with boredom or stress, and often just to “party.” Risk factors for alcohol use and especially abuse include alcohol use by parents, siblings, and/or peers, family problems, poor academic performance, mood or anxiety disorders, physical or sexual abuse, use of tobacco and/or other substances, and media depictions of alcohol use as normative, desirable, and safe, even for young people. There is debate about whether adolescents should abstain from all use of alcohol until age 21 or be taught to drink responsibly in the context of family. There is broad consensus that problem drinking by adolescents should be prevented.

ACOG recommends that Obstetrician/Gynecologists and other providers of health care for adolescents should inquire about alcohol use as part of the routine health history during annual preventive health visits. Alcohol use should be asked about whenever there are behavior problems, decline in school performance, serious accidents or evidence for use of other substances, e.g. tobacco, marijuana, non-medical prescription drug use. Alcohol use should be asked whenever pregnancy is diagnosed and the patient should be counseled to stop all use of alcohol as well as tobacco and other drugs. Adolescents who report use of alcohol should be assessed further to determine the extent of use and potential health risks and the use of effective contraception should be encouraged.

An instrument such as the CRAFFT or the NIAAA 2 question screen, which have been validated for use with adolescents is very helpful and is described in several of the references listed below. Adolescents may require assistance to stop their alcohol use and they may experience serious alcohol withdrawal.  There is a national web site available to assist in locating an appropriate treatment facility (www.findtreatment.gov).  The National Institute on Alcohol Abuse and Alcoholism has developed a special tool to address alcohol use by youth (ages 9-18) within a clinical setting.  This includes a 2 question screening specific to age and educational intervention. Download from http://www.niaaa.nih.gov/Publications/EducationTrainingMaterials/YouthGuide

The following resources are listed to assist health professionals in helping patients and their families understand the extent and potential risks of alcohol use by young people as well as strategies for treatment and prevention of underage alcohol use and abuse. Additional related references can be found in the ACOG Resource Guide: Adolescents and Substance Use. If a parent is concerned about alcohol abuse in his/her child, he/she should consult the child’s primary care health professional for guidance. 

The following resources are available from ACOG:

American College of Obstetricians and Gynecologists. Alcohol, tobacco, and other substance use and abuse. In: Guidelines for adolescent health care. 2nd ed. Washington, DC: American College of Obstetricians and Gynecologists; 2011. p. 97-110.

American College of Obstetricians and Gynecologists. Fact sheet: alcohol use. In: Tool kit for teen care. 2nd ed. Washington, DC: ACOG; 2009.

American College of Obstetricians and Gynecologists. Alcohol use: a fact sheet for parents. In: Tool kit for teen care. 2nd ed. Washington, DC: ACOG; 2009.

American College of Obstetricians and Gynecologists. Alcohol and women. Patient Education Pamphlet AP068. Washington, DC: American College of Obstetricians and Gynecologists; 2011.

American College of Obstetricians and Gynecologists. Tobacco, alcohol, drugs, and pregnancy. ACOG Patient Education Pamphlet AP170. Washington, DC: ACOG; 2008.

At-risk drinking and illicit drug use: ethical issues in obstetric and gynecologic practice. ACOG Committee Opinion No. 422. American College of Obstetricians and Gynecologists. Obstet Gynecol 2008;112:1449-60.

At-risk drinking and alcohol dependence: obstetric and gynecologic implications. Committee Opinion No. 496. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;118:383-8.

The resources listed below are for information purposes only. Referral to these sources and sites does not imply the endorsement of ACOG. Further, ACOG does not endorse any commercial products that may be advertised or available from these organizations or on these web sites. These lists are not meant to be comprehensive. The exclusion of a source or site does not reflect the quality of that source or site. Please note that sites and URLs are subject to change without notice.

REFERENCES FOR PROFESSIONALS

General

Alcohol use by youth and adolescents: a pediatric concern. Policy Statement. American Academy of Pediatrics. Pediatrics 2010;125:1078-87

Faden VB, Goldman MS, editors. Underage drinking: understanding and reducing risk in the context of human development [special issue]. Pediatrics 2008;121(suppl 4).

Irons BL. Alcohol use disorders: a clinical update. Adolesc Med Clin 2006;17:259-82.

Epidemiology

Chartier KG, Hesselbrock MN, Hesselbrock VM. Development and vulnerability factors in adolescent alcohol use. Child Adolesc Psychiatr Clin N Am 2010;19:493-504.

Chung PJ, Garfield CF, Elliott MN, Ostroff J, Ross C, Jernigan DH, et al. Association between adolescent viewership and alcohol advertising on cable television. Am J Public Health 2010;100:555-62.

Eaton DK, Kann L, Kinchen S, Shanklin S, Ross J, Hawkins J, et al. Youth risk behavior surveillance - United States, 2009. Centers for Disease Control and Prevention (CDC). MMWR Surveill Summ 2010;59(SS-5):1-142. Available at: http://www.cdc.gov/mmwr/pdf/ss/ss5905.pdf. Retrieved December 6, 2011.

Grube JW, Waiters E. Alcohol in the media: content and effects on drinking beliefs and behaviors among youth. Adolesc Med Clin 2005;16:327-43, viii.

Grucza RA, Norberg KE, Bierut LJ. Binge drinking among youths and young adults in the United States: 1979-2006. J Am Acad Child Adolesc Psychiatry 2009;48:692-702.

Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future national results on adolescent drug use: overview of key findings, 2010. Ann Arbor (MI): Institute for Social Research, University of Michigan; 2010. Available at: http://monitoringthefuture.org/pubs/monographs/mtf-overview2010.pdf. Retrieved December 6, 2011.

McClure AC, Stoolmiller M, Tanski SE, Worth KA, Sargent JD. Alcohol-branded merchandise and its association with drinking attitudes and outcomes in US adolescents. Arch Pediatr Adolesc Med 2009;163:211-7.

Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics 2007;119:76-85.

Siegel MB, Naimi TS, Cremeens JL, Nelson DE. Alcoholic beverage preferences and associated drinking patterns and risk behaviors among high school youth. Am J Prev Med 2011;40:419-26.

Consequences

The teen driver. Policy Statement. American Academy of Pediatrics. Pediatrics 2006;118:2570-81

Floyd RL, Sobell M, Velasquez MM, Ingersoll K, Nettleman M, Sobell L, Dolan-Mullen P, et al.
Preventing alcohol-exposed pregnancies: A randomized control trial Am J Prev Med 2007;32:749-797.

Hingson RW, Zha W. Age of drinking onset, alcohol use disorders, frequent heavy drinking, and unintentionally injuring oneself and others after drinking. Pediatrics 2009;123:1477-84.

Intervention

Boekeloo BO, Jerry J, Lee-Ougo WI, Worrell KD, Hamburger EK, Russek-Cohen E, et al. Randomized trial of brief office-based interventions to reduce adolescent alcohol use. Arch Pediatr Adolesc Med 2004;158:635-42.

Boekeloo BO, Novik MG. Clinical approaches to improving alcohol education and counseling in adolescents and young adults. Adolesc Med State Art Rev 2011;22:633-48, xiv.

Chung T, Smith GT, Donovan JE, Windle M, Faden VB, Chen CM, et al. Drinking frequency as a brief screen for adolescent alcohol problems. Pediatrics 2012;129:205-12.

Knight JR. The role of the primary care provider in preventing and treating alcohol problems in adolescents. Ambul Pediatr 2001;1:150-61.

Maio RF, Shope JT, Blow FC, Copeland LA, Gregor MA, Brockmann LM, et al. Adolescent injury in the emergency department: opportunity for alcohol interventions? Ann Emerg Med 2000;35:252-7.

National Institute on Alcohol Abuse and Alcoholism. Alcohol screening and brief intervention for youth: a practitioner's guide. Bethesda (MD): NIAAA; 2011. Available at: http://pubs.niaaa.nih.gov/publications/Practitioner/YouthGuide/YouthGuide.pdf. Retrieved December 6, 2011.

Tripodi SJ, Bender K, Litschge C, Vaughn MG. Interventions for reducing adolescent alcohol abuse: a meta-analytic review. Arch Pediatr Adolesc Med 2010;164:85-91.

Prevention

Elder RW, Nichols JL, Shults RA, Sleet DA, Barrios LC, Compton R. Effectiveness of school-based programs for reducing drinking and driving and riding with drinking drivers: a systematic review. Task Force on Community Preventive Services. Am J Prev Med 2005;28:288-304.

Heyman RB. Combating underage drinking with the 6Gs. Contemp Pediatr 2007;24(6):63-6, 68-70.

Schinke SP, Schwinn TM, Fang L. Longitudinal outcomes of an alcohol abuse prevention program for urban adolescents. J Adolesc Health 2010;46:451-7.

Wagenaar AC, Erickson DJ, Harwood EM, O'Malley PM. Effects of state coalitions to reduce underage drinking: a national evaluation. Am J Prev Med 2006;31:307-15.

Books for Professionals/Parents

Balkin KF, editor. Alcohol: opposing viewpoints. San Diego (CA): Greenhaven Press; 2004.

Institute of Medicine. Reducing underage drinking: a collective responsibility. Washington, DC: National Academies Press; 2004.

Volkmann C, Volkmann T. From binge to blackout: a mother and son struggle with teen drinking. New York (NY): New American Library; 2006.

Windle M. Alcohol use among adolescents. Thousand Oaks (CA): Sage Publications; 1999.

Zailckas K. Smashed: story of a drunken girlhood. New York (NY): Viking; 2005.

Books for Adolescents

Green CR. Alcohol. Berkeley Heights (NJ): MyReportLinks.com Books; 2005.

Lankford RD, editor. Alcohol abuse. Detroit (MI): Greenhaven Press; 2007.

Omnigraphics, Inc., 2005.Bakewell L, editor. Alcohol information for teens: health tips about alcohol and alcoholism including facts about alcohol’s effects on the body, brain, and behavior, the consequences of underage drinking, alcohol abuse prevention and treatment, and coping with alcoholic parents. 2nd ed. Detroit (MI): Omnigraphics; 2009.

Organizations/Websites

Al-Anon Family Group Headquarters
www.al-anon.alateen.org

Alcoholics Anonymous
www.aa.org

American Academy of Child and Adolescent Psychiatry – www.aacap.org

 Facts for Families: Teens: alcohol and other drugs

American Academy of Family Physicians
www.aafp.org/online/en/home.html

http://familydoctor.org/familydoctor/en/diseases-conditions/alcohol-abuse.html

American Academy of Pediatrics
www.aap.org

Werner MJ, Adger H Jr. Early identification and intervention for adolescent alcohol use.
Adolesc Health Update 1997;10(1):1-8.
Pamphlet: Alcohol: Your Child and Drugs

Center for Adolescent Substance Abuse Research (CeASAR)
www.ceasar.org

ETR Associates
www.etr.org

Pamphlets: Alcohol: Incredible Facts
Binge Drinking
Drinking and Driving
Drinking Doesn’t Mix: Smart Choices About Alcohol

Join Together
www.drugfree.org/join-together

National Clearinghouse for Alcohol and Drug Information
http://store.samhsa.gov/home

National Institute on Alcohol Abuse and Alcoholism
www.niaaa.nih.gov

National Youth Anti-Drug Media Campaign: Above the Influence
www.abovetheinfluence.com

The Partnership at Drugfree.org
www.drugfree.org

The Prevention Researcher
www.tpronline.org

Windle M. Alcohol use among adolescents. Prev Res 2002;9(3):1, 3.

Students Against Destructive Decisions
www.sadd.org

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

Surgeon General’s Office
www.surgeongeneral.gov

Office of the Surgeon General. The Surgeon General’s call to action to prevent and reduce underage drinking. Rockville (MD): OSG; 2007. Available at: http://www.surgeongeneral.gov/topics/underagedrinking/calltoaction.pdf. Retrieved November 18, 2011.

Contact:

Caitlin Phelps, MA
Director of Gynecology
cphelps@acog.org

Lyndona Charles
Special Assistant, Gynecology and Ethics
lcharles@acog.org