The American Academy of Pediatrics recently published a policy statement on "Alcohol Use by Youth and Adolescents." In addition to being a call to action to health care providers, the statement offered a compelling look at what research tells us about teenage drinking.
A survey done in 2009 asked 46,000 students whether they had used alcohol in the previous month. Over 5% of the eighth graders, 15.5% of tenth graders and 27.4 % of twelfth graders reported that they had been drunk at least once in the previous thirty days. Over 90% of twelfth graders and 60% of eighth graders reported that alcohol was easy to obtain. (1)
Bingeing, Driving and Social, Sexual and Other Risks
Teenagers tend to binge drink and these episodes of heavy drinking carry high risk of alcohol poisoning or overdose. The definition of binge drinking, consuming five or more drinks within a few hours, is actually quite high for teens since they become intoxicated on less alcohol. When drinks are consumed in rapid succession, the tendency is for the teen to be suddenly very intoxicated, in a manner that makes it difficult for them to think clearly, make responsible decisions, and keep themselves and their friends safe.
Motor-vehicle accidents are the top cause of death for teens and young adults in the United States (2). A survey done in 2007 showed that 29% of surveyed students had, in the month preceding the study, ridden at least once in a vehicle whose driver had been drinking. Ten percent of the students had themselves driven while intoxicated. (3) Numerous studies have shown that drinking and driving are a deadly combination for teens.
Teen drinking is also associated with increased risk of suicide and excessive use of alcohol is often found in teens with anxiety and depressive disorders, ADHD, conduct and behavior disorders, eating disorders, and psychotic illnesses such as schizophrenia. (4)(5). Teenagers who are abusing alcohol should be evaluated for signs of mental health disorders and for the presence of increased stressors in their lives. Using alcohol to "feel better" is both a poor and dangerous choice. The odds of engaging in risky sexual encounters are also far greater for teens who have been drinking heavily.
What Makes Kids Drink? Genes? Parents? Friends? TV? Movies?
The answer is all of the above. Teenagers are surrounded by forces that influence them in both positive and negative ways. Some children have uniquely resilient temperaments and/or have sources of support, which enable them to tolerate the strongest of influences without succumbing to risky behavior. Unfortunately, many can't.
It is well known that alcohol misuse has some genetic basis.
Studies have shown that one's genes may have more of an influence on whether alcohol use turns into abuse than on whether or when a teen starts drinking.
The home/ family environment, including parental attitudes toward alcohol and drug use strongly influence drug and alcohol use by teens and it has been shown that when parents have clear rules and systems to monitor their children's substance use, such use is decreased. (6)(7) Children who live with parents who abuse alcohol are much more likely to have behavioral problems and to abuse substances themselves. (8)
There are seven million US children under the age of 18 who are at high risk because of exposure to their parents' alcoholism. Thus, both the internal neurochemical environment produced by one's genes, and the external environment created by alcoholic families perpetuates the cycle of substance use/abuse through generations.
Unfortunately, when friends use tobacco, alcohol and other substances, teens are much more likely to take up these habits themselves. (9) Similarly, when entire communities have high patterns of substance use, so do the younger members of those communities.
Media exposure tends to portray substance use in the context of romance, adventure, sophistication and glamour. Many studies have documented the fact that this encourages experimentation with smoking and substance use among teens.
Alcohol's Effects on Brain Development
Major areas of our brains are not fully developed until the third decade of our lives. When developing brain tissue is exposed to alcohol, the alcohol can influence the growth and fine-tuning of critically important neurological structures. This means that alcohol, when consumed by teens, has the capability of altering the final outcome of brain maturation.
Alcohol affects the areas of the brain involved with reasoning, decision-making, impulse suppression, regulation of emotions, planning, and assessing consequences. These functions are located in the frontal lobes and the prefrontal cortex. These areas and their neurochemical connections are in an active process of development during adolescence and are influenced by experiences and exposures. Some studies have even shown that adolescents who abuse alcohol have a more difficult time learning new information, and have reduced memory. These tasks continue to deteriorate with ongoing alcohol use. (10)
Additionally, when an immature brain is exposed to alcohol, brain pathways that influence decision-making and response to substance use may be influenced in ways that increase the risk of poor judgment and increased substance seeking. (11) If a teen is already burdened by a genetic predisposition towards substance abuse, the additional impact of exposing immature brain circuitry to alcohol may have devastating consequences.
Parents and Doctors Can Help
The American Academy of Pediatrics' recent alcohol policy echoes the Surgeon General's Call to Action to Prevent Underage Drinking from 2007.(12) The Surgeon General's report describes every arena in which adolescents' views of alcohol use can be influenced, from home to school, to court, to entertainment/media, and offers strategies for helping prevent alcohol abuse to each. It also urges people and policy makers in these areas them to join the effort to reduce the burden of alcohol on our teens and our society as a whole.
The AAP specifically addresses health care providers and the multiple roles that they can play in the lives of their patients and their families. They urge pediatricians to ask about a family's history of alcohol and substance use so they can determine the genetic and familial risks present in their patients. Doctors also should offer children and teens age-appropriate information about drug and alcohol abuse. The AAP also encourages routine screening of the pediatric patients for evidence of substance use and excessive peer pressure and for mental health issues such as anxiety and depression, both of which may encourage and result from alcohol use. Finally, doctors need to be knowledgeable about treatment programs for adolescents and their families who are burdened by alcohol use.
Parents, too, have a responsibility to teach their children about the risks of alcohol, to model responsible behavior, and to monitor their children and the influences to which they are subjected. Parents should pay careful attention to their teens' behavior and seek professional help for their child if they notice lasting problems with negative mood, school failure, or worrisome changes in habits and social activities.
Parents should talk with their growing children regularly about healthful habits and should provide age appropriate counseling about the risks of drugs and alcohol. They also need to provide clear rules with feedback and consequences for unacceptable behavior. The risks posed by alcohol and substance abuse to the healthful lives of our children should not be underestimated.
There are numerous online and in print resources. Parents should feel they can turn to their family's health care provider for help as well. Some websites are listed below:
http://www.al-anon.alateen.org/
www.acde.org (American council for Drug Education)
www.collegedrinkingprevention.gov
www.drugfree.org
www.sadd.org (students against destructive decisions)
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