Alcohol use by persons under age 21 years is a major public health problem.1 Alcohol is the most commonly used and abused drug among youth in the United States, more than tobacco and illicit drugs. Although drinking by persons under the age of 21 is illegal, people aged 12 to 20 years drink 11% of all alcohol consumed in the United States.2 More than 90% of this alcohol is consumed in the form of binge drinks.2 On average, underage drinkers consume more drinks per drinking occasion than adult drinkers.3 In 2008, there were approximately 190,000 emergency rooms visits by persons under age 21 for injuries and other conditions linked to alcohol.4
Drinking Levels among Youth
The 2009 Youth Risk Behavior Survey5 found that among high school students, during the past 30 days
- 42% drank some amount of alcohol.
- 24% binge drank.
- 10% drove after drinking alcohol.
- 28% rode with a driver who had been drinking alcohol.
Other national surveys indicate
- In 2008 the National Survey on Drug Use and Health reported that 28% of youth aged 12 to 20 years drink alcohol and 19% reported binge drinking.6
- In 2009, the Monitoring the Future Survey reported that 37% of 8th graders and 72% of 12th graders had tried alcohol, and 15% of 8th graders and 44% of 12th graders drank during the past month.7
Consequences of Underage Drinking
Youth who drink alcohol1, 3, 8 are more likely to experience
- School problems, such as higher absence and poor or failing grades.
- Social problems, such as fighting and lack of participation in youth activities.
- Legal problems, such as arrest for driving or physically hurting someone while drunk.
- Physical problems, such as hangovers or illnesses.
- Unwanted, unplanned, and unprotected sexual activity.
- Disruption of normal growth and sexual development.
- Physical and sexual assault.
- Higher risk for suicide and homicide.
- Alcohol-related car crashes and other unintentional injuries, such as burns, falls, and drowning.
- Memory problems.
- Abuse of other drugs.
- Changes in brain development that may have life-long effects.
- Death from alcohol poisoning.
In general, the risk of youth experiencing these problems is greater for those who binge drink than for those who do not binge drink.8
Youth who start drinking before age 15 years are five times more likely to develop alcohol dependence or abuse later in life than those who begin drinking at or after age 21 years.9, 10
Prevention of Underage Drinking
Reducing underage drinking will require community-based efforts to monitor the activities of youth and decrease youth access to alcohol. Recent publications by the Surgeon General1 and the Institute of Medicine3 outlined many prevention strategies that will require actions on the national, state, and local levels, such as enforcement of minimum legal drinking age laws, national media campaigns targeting youth and adults, increasing alcohol excise taxes, reducing youth exposure to alcohol advertising, and development of comprehensive community-based programs. These efforts will require continued research and evaluation to determine their success and to improve their effectiveness.
- U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking. Rockville, MD: U.S. Department of Health and Human Services; 2007. Available at http://www.surgeongeneral.gov/topics/underagedrinking/. Accessed March 28, 2008.
- Office of Juvenile Justice and Delinquency Prevention. Drinking in America: Myths, Realities, and Prevention Policy. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention, 2005. Available at http://www.udetc.org/documents/Drinking_in_America.pdf [PDF–1.08MB]. Accessed March 28, 2008.
- Bonnie RJ and O’Connell ME, editors. National Research Council and Institute of Medicine, Reducing Underage Drinking: A Collective Responsibility. Committee on Developing a Strategy to Reduce and Prevent Underage Drinking. Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press, 2004.
- Drug Abuse Warning Network, 2008: Selected Tables of National Estimates of Drug-Related Emergency Department Visits. Rockville, MD: Office of Applied Studies, SAMHSA, 2009. Available at https://dawninfo.samhsa.gov/data/default.asp?met=All. Accessed March 25,2010.
- Eaton DK, Kann L, Kinchen SA, et al. Youth Risk Behavior Surveillance—United States, 2009. CDC Morb Mort Surveil Summ 2010;59(SS-5):1–148. Available at http://www.cdc.gov/mmwr/PDF/ss/ss5905.pdf [PDF–3.5MB]. Accessed June 3, 2010.
- Substance Abuse and Mental Health Services Administration. (2009). Results from the 2008 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-36, HHS Publication No. SMA 09-4434). Rockville, MD. Available at http://www.oas.samhsa.gov/nsduh/2k8nsduh/2k8Results.pdf [PDF–1.46MB] . Accessed March 25, 2010.
- Johnston, L D, O’Malley P M, Bachman, J G, & Schulenberg J E (December 14, 2009). “Teen Marijuana Use Tilts Up, While Some Drugs Decline in Use.” University of Michigan News Service: Ann Arbor, MI. [Online]. Available at www.monitoringthefuture.org. Accessed March 25, 2010.
- Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics 2007;119:76–85.
- Hingson RW, Heeren T, Winter MR. Age at drinking onset and alcohol dependence: age at onset, duration, and severity. Pediatrics 2006;160:739–746.
- Office of Applied Studies. The NSDUH Report: Alcohol Dependence or Abuse and Age at First Use. Rockville, MD: Substance Abuse and Mental Health Services Administration, October 2004. Available at http://www.oas.samhsa.gov/2k4/ageDependence/ageDependence.htm. Accessed March 31, 2008.