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Alcohol Issues and Adolescence

By:  Christopher M. Weed--M.A.T, M.S.W. 

Definitions

A Drink-- A "drink" refers to half an ounce of alcohol (e.g., one 12oz. beer, one 5oz. glass of wine, or one 1.5oz. shot of distilled spirits). ³

Binge Drinking (episodic heavy drinking)— according to the NIAA….A "binge" is a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08 gram percent or above. For the typical adult, this pattern corresponds to consuming 5 or more drinks (male), or 4 or more drinks (female), in about 2 hours.³

Health risks associated with adolescent alcohol use
Recent research shows that adolescent alcohol use has the potential to trigger long-term biological changes that may alter an adolescent's development as well as affect the adolescent's immediate behavior. The resulting adverse outcomes may include:

• mental disorders such as anxiety and depressive disorders. ^{(p.25-26)11, 8}
• neurocognitive impairment ^{(p.25-26)11, 8}
• impaired memory ^(p.25-26)11
• altered sensitivity to motor impairment ^(p.25-26)11
• damage to the frontal anterior cortical regions (i.e. the development of self-regulation, judgment, reasoning, problem solving, and impulse control) ^(p.25-26)11
• possible disruption in normal growth ^(p.25-26)11
• effects on liver, bone, and endocrine development ^(p.25-26)11
• disrupted developmental changes in hormones associated with puberty in both males and females⁸

Factors that increase risk of adolescent alcohol dependence
Parents and other caregivers should be aware of specific factors that may increase the risk of their adolescent becoming involved with alcohol or experiencing an adverse alcohol related consequence. Typically, adolescents develop alcohol expectancies and patterns by observing drinking behavior at home or among their peers. Children with alcohol-dependant parents appear to develop 'alcohol schema' at an early age.^(p.426)3 Studies have shown that early onset of alcohol or other drug use is one of the strongest predictors of later alcohol dependence.⁸
Other factors that increase risk for adolescent alcohol issues include:

• A history of conduct problems. ^{(p.50)11, 8}
• Depression and other mental disorders. ^(p.50)11
• A family history of alcohol dependence, which raises the risk of problematic alcohol involvement. ^(p.50)11
• Significant stress inducing or opportunity increasing transitions (such as acquisition of a driver's license, a parental divorce, graduation from middle school to high school, or the move from high school to college or the workforce)^(p.50)11
• Interaction with peers involved in deviant activities. ^(p.50)11
• Less parental supervision ^{(p.1738 & 1747)1}
• Compared with adolescents from two-parent households, adolescents in single-parent families have been reported to show higher levels of alcohol involvement ^(p.1738)1

Adolescent Alcohol Use Statistics

Earlier Adolescence
           
Among the 8th graders surveyed ina 2005 study⁴ :

• 41% reported having tried alcohol (more than just a few sips)
• 20% said they have already been drunk at least once in their lifetime
• 5.4% reported first having been drunk by the end of 6th grade
• 11% reported binge drinking This year females actually had a slightly higher binge drinking rate in 8th grade than did males—10.6% vs. 10.2%.
• 83% disapprove of weekend binge drinking
• 18% said that most or all of their friends drink
• 7% said that most or all of their friends get drunk at least once a week
•  64% see alcohol as fairly easy or very easy to get

Among the 10th graders surveyed ina 2005 study⁴:

• 63% reported they had tried alcohol
• 42% said they had been drunk at least once in their lifetime
• 21% reported binge drinking
• 74% disapprove of weekend binge drinking
• 44% said that most or all of their friends drink
• 18% said that most or all of their friends get drunk at least once a week
• 84% see alcohol as fairly easy or very easy to get

Among the 12th graders surveyed ina 2005 study⁴:

• 75% reported they had tried alcohol and of that, 69% of them reported they continue to use it
• 58% said they have been drunk at least once in their lifetime
• 4.4% of males reported using alcohol daily
• 1.6% of females reported using alcohol daily
• 5.6% of the non-college-bound students report using alcohol daily versus 2.3% of the college-bound.
• 27% reported binge drinking (22% of females report binge drinking versus 33% of males)
• 67% said they disapprove of weekend binge drinking
• 36% of the non-college-bound report binge drinking versus 26% of the college-bound
• For high school aged people, binge drinkingis lowest in large metropolitan areas.
• 24% of all 12th graders associate great risk of harm with having one or two drinks nearly every day
• 45% of all 12th graders think there is great risk involved in having five or more drinks once or twice each weekend
• 38% do not view heavy daily drinking as entailing great risk.
• 49% said they have "often" been around people using alcohol to get high
• 29% said that most or all of their friends get drunk at least once a week
• 93% see alcohol as fairly easy or very easy to get

Later Adolescence (after high school years)

A 2002 review of combined national studies on college-age drinking revealed¹⁰:

• Of the 7,444 U.S. traffic fatalities in the age group from 18-24 years old, 49% (3,674) were alcohol related. Of that 49%, 31% (1,138) were students in college*
• 38.9% of college students* ages 18-24 reported riding with a drinking driver during month prior to answering the study questions. This translates to roughly 3.1 million  2- and 4-year college students
• the number of unintentional alcohol-related injury deaths among 18-24 year-olds attending 2- and 4-year colleges probably exceeds 1,400 annually
• the number of 4-year college students* that are unintentionally hurt or injured under the influence each year may reach 500,000
• the number of 4-year college students* hit or assaulted by drinking college students is over 600,000

* only 60% of 4-year college students and 48% of students at either 2- or 4-year colleges are ages 18-24,  these estimates do not reflect all college students, but rather those in the age group at highest risk of  alcohol-related problems.

A 2006 National Study reports⁴:

• 40% of college-aged students reported occasions of heavy drinking—five or more drinks in a row at least once in the two-week period prior to the study ^(p.25)
• 87% of college students reported trying alcohol ^(p.25)
• Adolescents not in college tend to have a higher rate of daily drinking (5.1% in 2005) than adolescents who are in college (4.6% in 2005) ^(p25-26)
• 8.6% of men in college report daily drinking ^(p25-26)
• 2.3% of women in college report daily drinking ^(p25-26)
• 9.0% of men not in college (college-age) report daily drinking ^(p25-26)
• 2.3% women not in college (college-age) report daily drinking ^(p25-26)
• 50% of males in college reported binge drinking ^(p25-26)
• 34% of females in college reported binge drinking ^(p25-26)
• Among sexually active college students age 18-24, 19.3 percent used alcohol or other drugs during their last sexual intercourse¹²

Intervention
Based on their responses to a survey conducted in 2004, approximately 3.7 million or 9.8 percent of American youth ages 12–20 met criteria for Alcohol Use Disorders (AUDs) and/or received treatment at a specialty facility for an alcohol problem. Of the 3.7 million, only 232,000 (about 6%) received treatment in a specialty facility. Another study in 2005 found that although admissions to treatment have increased over 50% over the past decade, less than 10% of adolescents with substance dependence problems receive treatment. (p.1664)2  This same study suggests that adolescents (like adults) with concurring psychiatric issues receive more treatment and other services for their issues with alcohol. ^(p.1670)2 Statistics such as these suggest that there is an unmet need for better screening, referral, and treatment of adolescent AUDs and associated behavioral problems.

Some of the common barriers to effective intervention include:

• The cost of intervention
• Lack of insurance coverage
• Limited access to care or treatment facilities
• Lack of awareness of the problem
• Limited availability of developmentally and culturally appropriate treatment
• The need to travel long distances to receive care
• Inadequate screening by primary care physicians
• Difficulty diagnosing AUDs among adolescents

Types of Intervention
Early evidence from studies indicates that brief motivational interventions may be effective in reducing or eliminating alcohol related problems in adolescents. Some other promising interventions for adolescents with AUDs are family-based intervention, group or individual cognitive–behavioral therapy, and therapeutic community interventions.  Regardless of the type of intervention used, treatment for adolescents frequently involves combining interventions for alcohol use with interventions for co-occurring drug use, mental disorders, and family problems. ^(p.55-56)11 There is a significant need for more evidence-based information focused on effective treatments for adolescents with alcohol use issues.  

FOR THOSE IN TREATMENT^(p.1664)2

• Pre-treatment factors associated with poorer treatment outcomes (usually substance use and relapse to use) are non-Caucasian race, increased severity of substance use at baseline, criminality, and lower educational status. ^(p.1664)2
• The in-treatment factors predictive of outcome are time in treatment, involvement of family, use of practical problem-solving, and provision of comprehensive services such as housing, academic assistance, and recreation. ^(p.1664)2
• Post-treatment variables that are thought to be the most important determinants of successful treatment outcome include:
• association with non-using peers
• involvement in leisure time activities, work, and school.
• treatment completion
• low pretreatment use
• adequate parental supervision
• peer and parent social support