Underage Drinking Risk Factors and Consequences

Drunken teenage girls dozing together
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Fortunately, underage drinking has actually been steadily declining for decades in the United States. However, it is still prevalent enough to be a major public health concern.


Underage drinking began a steep decline back in the 1980s when Congress passed the National Minimum Drinking Age Act, which required states to raise the age for legal purchase and possession of alcohol to 21 by October 1986 or lose 10% of their federal highway funds.

By 1988, all 50 states and the District of Columbia had adopted 21 as the minimum drinking age, setting off a steady decline in underage drinking rates among 8th, 10th and 12th-grade students that continues today.


However, according to the 2014 National Survey on Drug Use and Health (NSDUH), an estimated 8.65 million Americans age 12 to 20 reported that they were current drinkers, meaning they had at least one drink in the past 30 days.

Males still binge drink and drink daily more than underage females, but the differences are diminishing. White students report the highest levels of drinking, Hispanics are next and Blacks report the lowest rates.

Of those students who have problems or who drop out, 80% report having gotten drunk in the past month, or reported binge drinking, or reported drinking and driving in the past 30 days.

Teen Drinking Defined

According to SAMSHA, teen drinking is defined in terms of non-drinkers, light, binge, and heavy drinkers.

  • Non-drinkers: Did not drink alcohol in the previous 30 days.
  • Light drinkers: Consumed at least one, but fewer than five drinks on any occasion during the previous 30 days
  • Binge drinkers: Consumed five or more drinks on at least one occasion, but no more than four occasions during the previous 30 days.
  • Heavy drinkers: Consumed five or more drinks per occasion on five or more days in the previous 30 days.

Drinking and Teen Development

For some students, drinking alcohol is their only behavioral problem, but for others, drinking goes along with other problem behaviors linked to unconventionality, impulsiveness, and sensation seeking, according to research.

Adolescents age 12 to 17 who use alcohol are more likely to report behavioral issues, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Especially behavior that is aggressive, delinquent, or criminal.

Typically, binge drinking among students begins around age 13, increases during adolescence, peaks in young adulthood (ages 18-22), and then gradually decreases.

However, studies have found that young people who increase their binge drinking between ages 18 and 24 or who consistently binge drink at least once a week during those years may having problems in the following areas:

  • Educational attainment
  • Employment
  • Financial independence
  • Marriage

Risk Factors

There are many reasons why some adolescents begin a pattern of alcohol abuse and develop alcohol use disorders while others do not. Here are some of the key risk factors.


Research has shown that genetic factors play a role in a person's vulnerability to developing alcohol problems.

We know for certain that children of parents with an alcohol use disorder are significantly more likely to have a problem with drinking themselves compared to children of parents who do not have an alcohol use disorder. But, a family history of alcohol misuse is not the only determining factor.

Environmental influences also play a role in whether someone develops an alcohol use disorder and can vary widely from person to person. We also know that environmental influences can mitigate some of the genetic influences, leading those with genetic vulnerabilities to not develop issues with alcohol.

Biological Markers

Studies have revealed that brain waves caused by a response to specific stimuli can provide measurable brain activity that can predict some risk of alcoholism. P300, a specific brain wave that occurs about 300 milliseconds following a stimulus of light or sound, is one of the brain waves used in these studies.

Scientists were able to predict alcohol use in preadolescent boys four years later at the average age of 16 by measuring their P300 brain waves.

Childhood Behavior

Behavior patterns in early childhood have also be found to be predictors of later drinking problems. At age 3, children who were classified as "under controlled"—impulsive, restless, or distractible—were twice as likely to be diagnosed with alcohol use disorders at age 21 compared to 3-year-olds classified as "inhibited" or "well-adjusted."

Children who exhibit aggressiveness as early as ages 5 to 10 years old are more likely to use alcohol and other drugs during adolescence.

Children who exhibit antisocial behavior are more likely to have alcohol-related problems during adolescence and severe alcohol use disorders in adulthood, research shows.

Psychiatric Disorders

Alcohol consumption and a variety of psychiatric disorders have been linked in adolescents and young adults in several research studies:

  • Adolescents who are heavy drinkers are more likely to have conduct disorders.
  • Boys from 6 to 17 with attention deficit hyperactivity disorder (ADHD) and who had weak social relationships were significantly more likely to have severe alcohol use disorders four years later.
  • College freshmen with anxiety disorders were twice as likely to have severe alcohol use disorders compared to those without anxiety disorders.
  • College students with drinking problems were four times as likely to have a major depressive disorder.

Psychosocial Factors

Along with the factors listed above, there are a number of psychosocial factors that increase the risk of underage youth making a decision to begin early-onset alcohol consumption.

Family Dynamics

Parents are the single most important influence on their children's decision to become involved in substance use or not. Studies show that parents who drink or express favorable attitudes about drinking are linked to their children initiating alcohol consumption and continuing to drink.

Children who are warned about the dangers of alcohol by their parents are less likely to start drinking underage. The same is true for children who report being close to their parents.

A lack of parental communication, support, and monitoring have been linked by researchers to the frequency of drinking, heavy drinking, and drunkenness among adolescents. Studies have also linked parental hostility, rejection, and harsh, inconsistent discipline to childhood drinking and alcohol-related problems.

Adolescents are more likely to drink if their peers drink, but beyond that, even if their peers exhibit an acceptance of drinking it can influence a child's decision to initiate alcohol consumption.

Positive Expectancies

Research shows that adolescents are more likely to begin drinking if they have developed a positive expectancy about drinking. These positive expectancies generally increase with age and can predict both the onset of drinking and problem drinking among young people.

Childhood Trauma

Child abuse and other traumatic events are also risk factors for later alcohol problems among youth. Of those adolescents who end up in treatment for alcohol use disorders rates of physical abuse, sexual abuse, violent victimization, and witnessing violence are much higher than the general population of adolescents.

Compared to study controls, adolescents in alcohol treatment programs were:

  • Six times more likely to have been abused physically
  • 18 times more likely to have been sexually abused
  • More likely to have experienced post-traumatic stress disorder (PTSD)

Those adolescents treated for alcohol abuse were 10 times more likely to have had PTSD while those treated for alcohol dependence were 13 times more likely.

Alcohol Advertising

Studies of the effects of alcohol advertising on children have found that alcohol ads can significantly increase positive expectancies about alcohol. Alcohol advertising targeted at adolescents has been found to influence alcohol brand preferences and increase the adolescent's intention to drink as adults.


In the late 1960s and early 1970s, in the Vietnam war era, many states dropped their legal drinking age to 18. The political thinking was, "if they are old enough to get drafted and fight for their country, they are old enough to drink."

The effect was almost immediate. Alcohol-related traffic fatalities increased dramatically. Highway deaths not only increased in the states where the drinking age was lower but also in the states that bordered those states.

That's when Congress stepped in and mandated nationwide legal drinking age of 21 by threatening to withhold federal highway funding to those states that did not increase the drinking age.

The higher legal drinking age immediately prompted a decrease in underage drinking and a decrease in drinking and driving as well as alcohol-related highway fatalities.

The legal drinking age no doubt had an effect in other areas where underage drinking can result in problems, including:

Sexual Behavior

Underage drinking is linked not only to increased risky sexual behavior but also increased vulnerability to coerced sex. Adolescents who drink are more likely to have sex before age 16, more likely to have sex while they are drinking and less likely to practice safe sex after drinking.

Risky Behavior and Victimization

Alcohol use among eighth and 10th graders have been found to increase both risky behavior and victimization. This is particularly true for eighth-grade students.

Here are some sobering statistics about crime, violence, and suicide based on self-reporting from teens who claimed they were heavy drinkers. In this comparison with adolescent non-drinkers these teens were:

  • 16 times more likely to have used an illicit drug in the past month (heavy drinkers); eight times more likely to have used an illicit drug in the past month (light drinkers)
  • Four times more likely to steal something outside the home
  • Four times more likely to report that they had gotten behind the wheel under the influence of drugs
  • Five times more likely to run away from home
  • Five times more likely to say that they had driven under the influence of alcohol in the past year
  • More than seven times more likely to have been arrested and charged with breaking the law
  • Six times as likely to report skipping school
  • Three times more likely to report deliberately trying to hurt or kill themselves
  • Three times more likely to report having gotten into a physical fight
  • Three times as likely to report engaging in destruction of property belonging to others

Puberty and Bone Growth

If studies conducted with laboratory animals are an indication, heavy alcohol consumption in adolescents may delay puberty, slow bone growth, and result in weaker bones.

Emotional and Behavioral Problems

There is also a strong relationship, based on adolescent self-reporting, between teen alcohol use and emotional and behavioral problems, including:

  • Driving under the influence of alcohol and/or drugs
  • Feeling depressed
  • Fighting
  • Skipping school
  • Stealing


Several studies have found that early-onset drinking is linked to the risk of greater substance abuse problems later in life. The earlier a child begins to drink alcohol, the greater the problems they will face in adulthood, not only with substance abuse but with meeting important life goals such as education and careers.

Therefore, it is important for parents and for society to do everything possible to prevent the initiation of childhood drinking.

Laws and policies will only work so far, the real work begins in the home within the family.

A Word From Verywell

Parents need to know that alcohol use can also be a warning sign or a cry for help that something is seriously wrong in a child's life. If parents, counselors, teachers, and other caring adults reach children early enough, they can intervene before troubling behaviors lead to serious emotional disturbances, including:

If your child is struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

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Additional Reading

By Buddy T
Buddy T is an anonymous writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism.