I’ve always believed that I was a responsible drinker in college because my parents allowed me to have sips of their alcoholic drinks here and there, that drinking was no big deal for me because my parents made it no big deal when I was growing up. When I went on a high school trip to Italy, nearly everyone on the trip took advantage of the lower drinking age and got fall-down drunk every night, whereas I was bright-eyed and bushy-tailed each morning, ready to sightsee and learn.
And then, in my 40s, I became a full-blown, fall-down, daily-drinking alcoholic, and my theory fell apart.
Now that I have two older adolescents of my own, am six years sober, and have spent the past five years teaching teens in a substance abuse rehab, I am desperate for some evidence-based messaging that really works to keep kids sober until they are old enough to responsibly forge their own relationships with alcohol.
Thanks to a newly released policy statement on Alcohol Use by Youth from the American Academy of Pediatrics, I found it.
Alcohol is the addictive substance most widely used by adolescents, and its use is associated with the leading causes of death for teens, including suicide, car accidents and homicides. The National Institute of Drug Abuse just released its 2018 report, Monitoring the Future: National Survey Results on Drug Use, 1975-2018, that combines data gathered from about 45,000 eighth-, 10th- and 12th-graders in public and private schools across the United States on their drug and alcohol consumption. The good news is that alcohol use by older adolescents is in decline, and in some age groups, it’s at the lowest rates ever reported.
That said, the number of teens who engage in underage drinking remains concerning. Nearly 60 percent of 12th-graders and one-quarter of eighth-graders report having drunk alcohol.
When teens do drink, they drink differently than adults. Teens are more likely than adults to binge drink, defined as four or more drinks on one occasion for women and five or more drinks over two hours for men. However, the American Academy of Pediatrics (AAP) disputes this standard, indicating that these numbers are based on adult consumption and do not take adolescents’ smaller physical size and neurological immaturity into account. The AAP recommends the definition for adolescent binge drinking be reduced to three or more drinks for children ages 9-13 and girls under 17, four or more drinks for boys 14-15, and five or more drinks for boys 16 and older.
Whatever the measure, any binge drinking is dangerous, but it’s even more perilous for adolescents. Teens who binge drink report higher rates of driving while intoxicated, speeding, risky driving, and are at higher risk of alcohol poisoning and death. Greater alcohol intake has also been associated with increased rates of smoking, illicit drug use, risky sexual behaviors, hazardous driving and accidents, physical fighting, fewer hours of sleep and lower grades.
By the time kids hit puberty, their brains are nearly the same size as adults’, but they are profoundly dissimilar on a structural and cellular level. Adults have fully formed brains, complete with mature frontal lobes, but adolescents do not. The frontal lobe and prefrontal cortex, the origin of all that adult, higher-order thinking, are the final parts of the brain to mature and connect. These areas won’t be fully online until the mid-20s, and in the meantime, the lower, more primitive structures in the brain that trade in emotion, rewards and novelty are in charge. As a result, teens tend to gravitate toward emotional and psychological highs, risks and new, exciting experiences before they have the cognitive ability to check those impulses.
The adolescent brain is capable of incredible learning and cognitive resilience during this phase of development, but it is also acutely vulnerable, and alcohol can do serious, permanent damage. Several studies show that frequent drinkers don’t perform as well as nondrinkers on tests of memory, verbal learning and attention.
An adolescent’s hippocampus, where memories are formed in the brain, is acutely sensitive to damage due to alcohol consumption. This may be why adolescents are more prone to alcohol-induced memory blackouts than adults, and why this heightened tendency to blackout can persist into adulthood.
Although teens may be more prone to experiencing blackouts, they are less likely to suffer the negative effects of drinking, such as sedation, loss of motor control and balance. Because of this developmental quirk, teens may drink more while feeling less intoxicated than a similarly sized adult would, putting themselves at higher risk for alcohol poisoning, driving while intoxicated, accidental injuries, sexual assault and even death.
The younger adolescents are when they start drinking, the more damage they do to their developing brains, and the more likely they are to develop alcohol dependence over their lifetimes. Half the 12th-graders who report using alcohol started drinking by ninth grade. For adolescents who start drinking at 12 or younger, their lifetime risk of alcohol dependence is 41 percent, whereas if they wait until 18 or 21, their risk is 17 percent and 11 percent, respectively.
The good news is that clear parental disapproval of underage drinking and pediatric care that includes substance abuse screening are effective in preventing underage drinking.
When parents send permissive messages around underage drinking, whether due to the misapprehension that it’s simply what teenagers do, that it will reduce later misuse in college or that it’s safer for kids to drink at home, children drink significantly greater amounts and end up experiencing more negative consequences due to their alcohol consumption than the children of parents who communicate consistent and clear disapproval of underage drinking.
Pediatricians can serve as essential allies by reinforcing parental disapproval and providing early intervention for risky behaviors through tools such as screening, brief intervention and referral to treatment (SBIRT). The American Academy of Pediatrics recommends “pediatricians screen and discuss substance abuse as part of anticipatory guidance and preventative care.”
While we celebrate the declining prevalence of adolescent alcohol use, it’s important to remember that alcohol is more dangerous for kids than adults, and it presents a significant risk to their health, safety and learning. Underage drinking does not have to be a cultural or developmental inevitability, and with proper messaging and role modeling, we have the power to keep the rates of adolescent alcohol use moving in the right direction.
Jessica Lahey, author of “The Gift of Failure” and a forthcoming book about preventing childhood addiction.
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