Alcohol and Teens

The symptoms of alcoholism include tolerance to alcohol, withdrawal episodes, craving alcohol, using more alcohol or for longer periods than intended, and problems managing life issues due to alcohol.

• Alcoholism, now diagnostically known as alcohol use disorder, is a substance-use disorder in which the sufferer has problems managing how much and how frequently they drink alcohol and its negative effects on their lives as a result.
• It is important to remember that teenagers are not permitted, by law, to drink before the age of 21.
• In most states in the US, a person's blood alcohol concentration (BAC) of 0.08% is considered legally intoxicated for adults over the age of 21, while a BAC of 0.02% is the legal limit for drivers under the age of 21.
• The average age at which most youths try alcohol for the first time is just 14 in the United State.
• The symptoms of alcoholism include tolerance to alcohol, withdrawal episodes, craving alcohol, using more alcohol or for longer periods than intended, and problems managing life issues due to alcohol.
• Alcoholism is the result of a number of individual, family, genetic, and social factors rather than due to any one cause.
• Although a number of genes play a role in the development of alcoholism, other factors more strongly influence its occurrence in this disease.
• Medical professionals diagnose alcoholism by evaluating whether the individual shows a number of symptoms of problem drinking on a regular basis.
• Alcoholism treatment depends on the stage of the addiction, ranging from management of risk factors and education to intensive residential treatment followed by long-term outpatient care and support.

The amount of alcohol that teens use can vary widely depending on a number of factors, including their age, gender, social environment, and personal experiences with alcohol. However, research has shown that underage drinking is a significant public health concern in many countries around the world and that many teens report drinking alcohol at least occasionally.

According to data from the National Survey on Drug Use and Health in the United States, alcohol is the most frequently used drug by teenagers. Significant statistics regarding alcohol use in teens include that about half of junior high and senior high school students drink alcohol on a monthly basis, and 14% of teens have been intoxicated at least once in the past year. Nearly 8% of teens who drink say they drink at least five or more alcoholic drinks in a row (binge drinking).

Other studies have shown that alcohol use tends to increase with age during adolescence, with older teens more likely to drink and engage in heavy or binge drinking. Teens who start drinking at a younger age are also more likely to develop alcohol use disorders later in life and may be at greater risk for a range of negative consequences, including poor academic performance, mental health problems, and involvement in accidents or other risky behaviors.

It is important for parents, educators, and healthcare professionals to be aware of the risks of underage drinking, and to take steps to prevent and address this behavior. This may include

• providing education and support to young people,
• encouraging healthy coping strategies,
• promoting responsible drinking behavior among those who choose to drink, and
• advocating for policies and programs that can help reduce alcohol-related harm in communities.

Alcohol can affect 16-year-olds both physically and mentally. Adolescents, including 16-year-olds, are particularly vulnerable to the harmful effects of alcohol due to their developing brains and bodies.

• Alcohol decreases teens' ability to pay attention.
• Teens who have experienced alcohol withdrawal tend to have difficulties with memory.
• The teenage brain exposed to alcohol is at risk of being smaller in certain parts.
• In contrast to adults, teens tend to abuse alcohol with other substances, usually marijuana.
• Male teens who drink heavily tend to complete fewer years of education compared to male teens who do not.
• The younger a person is when they begin drinking, the more likely they are to develop a problem with alcohol.
• Each year, almost 2,000 people under the age of 21 die in car crashes in which underage drinking is involved. Alcohol is involved in nearly half of all violent deaths involving youth.
• In 2016, 58% of teen drivers killed in motor-vehicle crashes after drinking and driving were not wearing seat belts.
• More than three times the number of eighth-grade girls who drink heavily said they have attempted suicide compared to girls in that grade who do not drink.
• Intoxication is associated with suicide attempts using more lethal methods, and positive blood alcohol levels are often found in people who complete suicide.
• Teens who drink are more likely to engage in sexual activity, have unprotected sex, have sex with a stranger, or be the victim or perpetrator of a sexual assault.
• Excess alcohol use can cause or mask other emotional problems, like anxiety, depression, and other mental health problems. 
• It increases the risk of engaging in risky behaviors such as unprotected sex or driving under the influence.
• Drinking in excess can lead to the use of other drugs, like marijuana, cocaine, or heroin.

Parents can take several steps to prevent their teens from using alcohol:

• Clear communication by parents about the negative effects of alcohol, as well as about their expectations regarding drug use, has been found to decrease teenage drinking significantly.
• Set clear expectations and boundaries around alcohol use, and enforce consequences if those boundaries are violated. Make it clear that underage drinking is not acceptable and that there will be consequences for any violations of this rule.
• Adequate parental supervision is a deterrent to alcohol use in youth. Alcohol, and other drug use, occur most often between the hours of 3 p.m. and 6 p.m., immediately after school and prior to parents' arrival at home from work.
• Model responsible drinking behavior yourself. If you choose to drink, do so in moderation and avoid drinking to excess or in situations where it may be unsafe.
• Teen participation in extracurricular activities is therefore an important measure in the prevention of alcohol use in this age group.
• Parents can also help educate teens about appropriate coping and stress-management strategies. For example, 15- to 16-year-olds who use religion to cope with stress tend to use drugs significantly less often and have fewer problems as a result of drinking than their peers who do not use religion to cope.
• Monitor your teen's activities and social connections, and be aware of any signs of alcohol use or other risky behaviors. Stay involved in their lives and know where they are and who they are with at all times.
• Since effective treatment of teen depression can be a deterrent to alcohol use, parents who seek help for their depressed teen in a timely manner can also help prevent their adolescent from engaging in underage drinking.
• Educate yourself about the risks of underage drinking and the resources available to help prevent and address this behavior. Talk to your healthcare provider or seek out community resources for more information and support.

Signs that indicate a person is intoxicated include

• the smell of alcohol on their breath or skin,
• impaired vision and hearing,
• impaired memory and cognitive function,
• impaired reflexes and reaction time,
• nausea and vomiting,
• headaches and dizziness,
• rapid heartbeat,
• difficulty breathing,
• glazed or bloodshot eyes,
• the person being unusually passive or argumentative,
• loss of consciousness or blackouts,
• having slurred speech, unsteady walking or poor coordination, and/or
• deterioration in the person's appearance or hygiene.

In severe cases, alcohol intoxication can also lead to alcohol poisoning, which is a potentially life-threatening condition. Symptoms of alcohol poisoning can include:

• Mental confusion and disorientation
• Seizures
• Low body temperature
• Slow or irregular breathing
• Bluish skin or lips
• Unresponsiveness or unconsciousness
• In a coma in extreme instances

As defined by the Diagnostic and Statistical Manual of Mental Disorders, a medical professional can make a diagnosis of alcoholism (formerly referred to as alcohol dependence and currently known as alcohol use disorder) when he or she determines that a negative pattern of alcohol use leading to a number of problems has been established. Those problems can include needing more alcohol to get intoxicated (tolerance), difficulties that occur when the effects of alcohol wear off (withdrawal), using more alcohol or for a longer time than intended, and other life problems because of the use of alcohol.

There are five stages of alcohol and drug use. The first stage involves access to alcohol rather than the use of alcohol, tobacco, inhalants, or other drugs. In that stage, minimizing the risk factors that make a teenager more vulnerable to using alcohol is an issue. The second stage of alcohol and other drug use ranges from experimentation or occasional use to regular weekly use of alcohol, tobacco, inhalants, or other drugs. The third stage involves a youth further increasing the frequency of alcohol use and/or using alcohol and other drugs on a regular basis. This stage may also include the teenager buying alcohol or other drugs or stealing to get their drug of choice. In the fourth stage of alcohol and drug use, adolescents have established regular usage, have become preoccupied with getting intoxicated ("high"), and have developed problems in their social, educational, vocational, or family life due to the use of the substance. The final and most serious fifth stage of alcohol or other drug use involves the youth only feeling normal when they are using. During this stage, risk-taking behaviors like stealing, engaging in physical fights or driving under the influence of alcohol increase, and they become most vulnerable to having suicidal thoughts.

Family risk factors for teenagers developing drinking problems include

• low levels of parental supervision or communication,
• family conflicts, inconsistent or severe parental discipline, and
• a family history of alcohol or drug abuse.

Individual risk factors include

• problems managing impulses,
• emotional instability,
• thrill-seeking behaviors, and
• perceiving the risk of using alcohol to be low.

Poverty and neighborhood violence are community risk factors for teens to develop alcohol use disorder.

• Girls who drink, as well as teens who begin drinking prior to 14 years of age and those whose mothers have drinking problems, are more likely to develop alcoholism.
• While boys are more likely to binge drink and incur alcohol-related offenses, girls more often describe drinking as an effort to cope with negative emotions or family problems and to drink due to peer pressure.
• Teen risk factors for alcoholism differ a bit between the 14- to 16-year-old and 16- to 18-year-old age groups, in that 16- to 18-year-olds tend to be less likely to drink in excess when they have a close relationship with their mothers.

Facts about the societal risk factors for adolescent alcoholism include peer pressure and the portrayal of teen drinking in the media. For example, research demonstrates that the Internet and advertising, including that which occurs on social media, promote drinking behaviors in teenagers.

Some of the most common symptoms of alcohol abuse in teenagers:

• Changes in behavior: Teens who abuse alcohol may experience changes in mood, behavior, and personality. They may become more irritable, aggressive, or anxious, or they may withdraw from friends and family.
• Academic problems: Alcohol abuse can interfere with school performance and lead to poor grades, absenteeism, and disciplinary problems.
• Changes in social activities: Teens who abuse alcohol may start to spend more time with peers who also drink, or they may start to withdraw from social activities altogether.
• Physical symptoms: Teens who abuse alcohol may experience physical symptoms such as headaches, nausea, and vomiting, as well as blackouts or memory lapses.
• Risky behavior: Teens who abuse alcohol are more likely to engage in risky behaviors, such as driving under the influence, having unprotected sex, lying, breaking curfew, becoming verbally or physically abusive toward others, having items in their possession that are connected to alcohol use (paraphernalia), or using other drugs.
• Legal problems: Alcohol abuse can lead to legal problems, such as arrests for underage drinking, stealing, or driving under the influence.
• Family problems: Alcohol abuse can also lead to family conflicts and problems, including arguments, fights, and other forms of domestic violence.

Replacing fluids that are lost due to the increased urination associated with drinking is often used to treat alcohol intoxication. Doctors frequently use fluids that contain sugars for that purpose.

Alcohol poisoning is the potentially fatal result of drinking excessive amounts of alcohol in a short period. It is caused by alcohol slowing down the body's functions (for example, breathing, heart rate, and gag reflex), thereby potentially leading to choking, coma, stopped breathing, stopped heart, and death. Treatment involves getting the person to the hospital immediately so medical professionals can watch the person closely, give the person oxygen and fluids, and take other measures in order to prevent choking, as well as stopped breathing or heartbeat.

Few medications are effective in treating alcoholism.

• Ondansetron (Zofran) is effective in treating alcoholism in people whose problem drinking began before they were 25 years old.
• Naltrexone (Trexan, ReVia, Vivitrol) has also been found effective in managing alcohol addiction.
• Naltrexone is the most frequently used medication in treating alcoholism. It decreases the alcoholic's cravings for alcohol by blocking the body's euphoric ("high") response to it.
  • People take naltrexone either by mouth on a daily basis or through monthly injections.
• Physicians prescribe disulfiram (Antabuse) for about 9% of alcoholics. It decreases the alcoholic's craving for the substance by producing a negative reaction to drinking.
• Acamprosate (Campral) works by decreasing cravings for alcohol in those who have stopped drinking.

However, medical professionals have not approved any of these medications to treat alcoholism in people less than 18 years of age. There are studies to indicate that medications that treat seizures, like gabapentin (Neurontin) and topiramate (Topamax), can help reduce drinking in individuals with alcoholism. However, there is little data about the use of these medications for the treatment of alcoholism in people under 18 years of age.

Some research indicates that psychiatric medications like lithium (Lithobid), fluoxetine (Prozac), and sertraline (Zoloft) may be useful in decreasing alcohol use in teens who have another mental health disorder in addition to alcohol abuse. Ondansetron (Zofran) is effective in treating alcoholism in people whose problem drinking began before they were 25 years old.

There are numerous individual treatments for alcoholism in teens.

• Relapse prevention uses methods for recognizing and amending problem behaviors.
• Individualized drug counseling specifically emphasizes short-term behavioral goals in an attempt to help the individual reduce or stop the use of alcohol altogether.
• Healthcare professionals use cognitive therapy techniques, like helping the teen recognize what tends to precede and follow their episodes of alcohol use, to address alcohol abuse in teens.
• Some treatment programs include drug testing.
• Twelve-step programs like Alcoholics Anonymous are individualized drug-counseling methods.
• Motivational enhancement therapy encourages teens to increase their desire to participate in therapy.
• Stimulus control refers to a treatment method that teaches the person to stay away from situations that are associated with alcohol use and to replace those situations with activities that are contrary to using drugs.
• Urge control is an approach to changing patterns that lead to drug use.
• Social control involves family members and other significant others of the alcoholic in treatment.

While group therapy can be helpful in decreasing alcohol use in teens,

• groups that include a number of teens who also engage in disordered behaviors can actually tend to increase alcohol use in this age group.
• Family interventions for alcoholism that tend to be effective for teens include multidimensional family therapy (MDFT), group therapy, and multifamily educational intervention (MFE).
• MDFT is quite effective. Longer-term residential treatment of three to five months that addresses peer relationships, educational problems, and family issues often treats alcoholism in teens.

For youth in the first stage of alcohol use (having access but not having yet used alcohol), preventive measures are used. Therefore, healthcare professionals recommend limiting access to alcohol or other drugs, addressing any risk factors of the youth or family, as well as optimal parental supervision and expression regarding expectations.

Mental-health professionals should not minimize the approach to those who have experimented with alcohol, since infrequent use can progress to the more serious stages of alcohol use if not addressed. Therefore, professionals recommend that the youth be thoroughly educated about the effects and risks of alcohol, that fair but firm limits be set on the use of alcohol, and that the user attend brief counseling, a self-help group, and/or a family support group.

Teens who have progressed to the more advanced stages of alcoholism are typically treated intensively, using a combination of the medical, individual, and familial interventions already described.

Without treatment, youth who drink excessively as teenagers are more likely to become problem drinkers than adults. Depending on the severity of alcohol misuse, the youth's prognosis can be significantly improved by interventions ranging from involving the teen's parents to having the teen participate in Alcoholics Anonymous (AA) or more intensive treatments.

Overall, the prognosis for alcoholism can be positive with early intervention, effective treatment, and ongoing support. It is important for individuals with alcoholism to seek help and work with healthcare professionals and loved ones to develop a personalized treatment plan that meets their unique needs and goals.

• Al-Anon-Alateen: 888-4AL-ANON
• Alcoholics Anonymous World Services: 212-870-3400
• American Council on Alcoholism treatment referral line: 800-527-5344
• Mothers Against Drunk Driving: 800-GET-MADD
• National Council on Alcoholism and Drug Dependence: 800-NCA-CALL
• National Institute on Alcohol Abuse and Alcoholism: 301-443-3860
• National Resource Center: 866-870-4979