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The Toll of Underage Drinking

Drunk driving, alcohol dependence, risky sexual behavior, and health consequences.

Drunk Driving:

• Motor vehicle crashes are the leading cause of death for young people ages 15-20. In 2008, 5,864 young people ages 15-20 died in motor vehicle crashes. Alcohol was involved in 31 percent of these deaths and 25 percent of these drivers were legally drunk at the time of the crash.¹
• Drivers are less likely to use restraints when they have been drinking. In 2008, 63 percent of the young drivers of passenger vehicles involved in fatal crashes who had been drinking were unrestrained. Of the young drivers who had been drinking and were killed in crashes, 73 percent were unrestrained.²
  
• The severity of a motor vehicle crash increases with alcohol involvement. In 2008, 2 percent of drivers ages 15 to 20 involved in property damage-only crashes had been drinking, 4 percent of those involved in crashes resulting in injury had been drinking, and 22 percent of those involved in fatal crashes had been drinking.³
• In the year 2007, only 6.4% of licensed drivers were ages 15 to 20. However, in that same year, they represented approximately 12% of drivers who had been drinking and were involved in fatal crashes.⁴

Alcohol Dependence:

• Americans who began drinking before the age of 15 are four times more likely to develop alcohol dependence than those who wait until the age of 21.⁵
• In November 2004, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) concluded that alcohol abuse and dependence are "developmental disorders."⁶
• An analysis published in the November 15, 2004 issue of Biological Psychiatry stated that the onset of alcohol dependence peaks by 18 years of age.⁷

Risky Sexual Behavior:

• In 2003, 1 in 12 (8.2%) current high school drinkers, and 1 in 8 (13.7%) high school binge drinkers reported being physically forced to have sexual intercourse. Drinkers are twice as likely to report this as non-drinkers.⁸
• In a study of 1,034 students from Brooklyn, NY, females who reported alcohol use by the fall of seventh grade were almost twice as likely as their alcohol-delaying peers to have initiated sexual intercourse or engaged in recent sexual intercourse by the tenth grade.⁹
• In a poll of more than 11,700 college students from 128 colleges in the United States, researchers found that, compared to those who waited to drink until they were 19 or older, college students who got drunk for the first time before age 13 were twice as likely to say they had had unplanned sex because of drinking. They were more than twice as likely to say they had had unprotected sex because of drinking.¹⁰
• Young adult drinkers are twice as likely as non-drinkers to have a sexually-transmitted disease during the past year. Heavy drinking males are almost four times as likely, and heavy drinking females are three and a half times as likely.¹¹

Health Consequences:

• The Centers for Disease Control and Prevention (CDC) estimates that 4,554 underage deaths each year are due to excessive alcohol use.¹²
• Alcohol use plays a substantial role in all three leading causes of death among youth - unintentional injuries (including motor vehicle fatalities and drownings), suicides, and homicides.¹³
• Those who begin drinking before the age of 14 are five times more likely than those who begin drinking after the age of 21 to be injured while under the influence of alcohol at some point during their lives.¹⁴
• Among young people, binge drinkers and heavy drinkers are more than twice as likely as non-drinkers to report having attempted to injure themselves or having contemplated or attempted to commit suicide.^15,16,17
• Research has also shown another specific link between heavy alcohol use and youth suicides. States that passed "zero tolerance" laws to reduce youth drinking-driving also experienced statistically significant reductions in suicide deaths among 15- to 20-year-olds, compared to states that did not pass such laws.¹⁸
• There is growing evidence to suggest that alcohol use prior to age 21 impairs crucial aspects of youthful brain development. In one recent study, heavy-drinking adolescents who had been sober for three weeks still scored 10 percent lower than non-drinking peers on tests requiring verbal and nonverbal recall and skills needed for map reading, geometry, and science.^{19, 20}
  
• A CDC study of 4,131 seventh, ninth, and eleventh graders in a high-risk U.S. school district found that 35 percent of students had started drinking prior to age 13. These preteen alcohol use initiators were more likely than non-drinkers to be victims of dating violence and to have imagined or attempted suicide, even after controlling for demographic factors as well as peer and parental influences.²¹

Social Consequences:

• The costs of youth drinking are an estimated $62 billion annually, and include costs to society such as medical care costs and lost productivity, as well as costs to the young drinker such as pain and suffering and loss of income.^{22, 23}
  
• A study that followed over 6,500 individuals found that, by the age of 23, those who were drinkers by seventh grade were:
  • more likely than non-drinkers to have "missed work for no good reason,"
  • more likely to be substance-users,
  • more likely to engage in criminal and violent behavior, and
  • between 1.7 and 2.3 times more likely to be weekly or binge drinkers, exhibit signs of alcohol dependence, and experience multiple alcohol problems.²⁴

Updated July 2011

Notes

1. National Highway Traffic Safety Administration, (2008). Traffic Safety Facts 2008, Washington, DC: National Center for Statistics and Analysis, U.S. Department of Transportation. Available at www.nrd.nhtsa.dot.gov/pubs/811169.pdf.
2. Ibid.
3. Ibid.
4. Ibid.
5. Grant, B.F. and Dawson, D.A. (1997). “Age at Onset of Alcohol Use and Its Association with DSM-IV Alcohol Abuse and Dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey.” Journal of Substance Abuse, 9: 103-110.
6. Team on Underage Drinking, National Institute on Alcohol Abuse and Alcoholism. (2004). Alcohol Consumption by Children and Adolescents: An Interdisciplinary Overview. Bethesda, MD: NIAAA.
7. Lei, T.K., Hewitt, B.G., and Grant, B.F. (Nov. 15, 2004). “Alcohol Use Disorders and Mood Disorders: A National Institute on Alcohol Abuse and Alcoholism Perspective.” Biological Psychiatry, 56(10): 718-720.
8. Miller, J.W., Naimi, T.S., Brewer, R.D., and Jones, S.E. (2007). “Binge Drinking and Associated Health Risk Behaviors among High School Students.” Pediatrics, 119 (1):76-85.
9. Stueve, A. and O'Donnell, L.N. (2005). “Early Alcohol Initiation and Subsequent Sexual and Alcohol Risk Behaviors among Urban Youths.” Am J Public Health, 95 (5):887-893.
10. Hingson, R., Heeren, T., Winter, M.R., and Wechsler, H. (2003). “Early Age of First Drunkenness as a Factor in College Students’ Unplanned and Unprotected Sex Attributable to Drinking,” Pediatrics, 111:34-41.
11. Substance Abuse and Mental Health Services Administration. (Mar. 20, 2007). The NSDUH Report: Sexually Transmitted Diseases and Substance Use. Rockville, MD: Office of Applied Studies.
12. Midanik, L.T., et al. (Sept. 24, 2004).  “Alcohol-Attributable Deaths and Years of Potential Life Lost-United States, 2001,” MMWR Weekly 53, 37:866-870.
13. National Center for Injury Prevention and Control. (2007). “10 Leading Causes of Death, United States, 2007, All Races, Both Sexes.” In WISQARS Leading Causes of Death Reports, 1999-2007. Accessed July 12, 2011 at: http://webapp.cdc.gov/sasweb/ncipc/leadcaus10.html .
14. Hingson, R., Heeren, T., Jamanka, T., and Howland, J. (2001). Age of Drinking Onset and Unintentional Injury Involvement After Drinking. Washington, DC: National Highway Traffic Safety Administration.
15. J.C. Greenblatt. (2002). Patterns of Alcohol Use Among Adolescents and Associations with Emotional and Behavioral Problems. Rockville, MD: Office of Applied Studies, SAMSHSA.
16. For this study, binge drinkers were defined as those who "consumed 5 or more drinks on at least one, but no more than 4 occasions," and "heavy drinkers" were defined as "those who consumed 5 or more drinks per occasion on 5 or more days" during the past month.
17. Swahn, M.H., Bossarte, R.M., Gender, P. (Aug., 2007). “Early Alcohol Use, and Suicide Ideation and Attempts:  Findings from the 2005 Youth Risk Behavior Survey.” J Adolesc Health, 41(2):175-81.
18. Carpenter, C. (2004). “Heavy Alcohol Use and Youth Suicide: Evidence from Tougher Drunk Driving Laws.” Journal of Policy Analysis and Managemen,t 23(4):831-842.
19. Bernice Wuethrich. (Mar., 2001). “Getting Stupid.” Discover, 22(3).
20. Brown, S.A., Tapert, S.F., Granholm, E.,  Delis, D.C. (Feb., 2000). “Neurocognitive Functioning of Adolescents: Effects of Protracted Alcohol Use.” Alcoholism: Clinical and Experimental Research, 24 (2): 164-171.
21. Swahn, M.H., Bossarte, R.M., Sullivent, E.E. (2008). “Age of Alcohol Use Initiation, Suicidal Behavior, and Peer and Dating Violence Victimization and Perpetration Among High-Risk, Seventh-Grade Adolescents.” Pediatrics, 121(2):297-305.
22. Levy, D.T., Miller, T., and Cox, K.C., Costs of Underage Drinking. (1999). Calverton, MD: Pacific Institute for Research and Evaluation.
23. National Research Council and Institute of Medicine. (2006). Reducing Underage Drinking: A Collective Responsibility. Washington, DC: National Academies Press, (xv) 13.
24. Ellickson, P.L., Tucker, J.S., and Klein, D.J. (May, 2003). “Ten-Year Prospective Study of Public Health Problems Associated With Early Drinking.” Pediatrics, 111(5):949-955.