The Toll of Underage Drinking
Drunk Driving, Alcohol Dependence, Risky Sexual Behavior, and Health Consequences.
- The Centers for Disease Control and Prevention (CDC) estimates that 4,358 deaths of person under age 21 each year are caused by alcohol use.1
- 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.2
- Youth who begin drinking before the age of 14 have 5 times greater odds of being injured while under the influence of alcohol, 6.3 times greater odds of ever being in a motor vehicle crash, and 6 times greater odds of ever being in a fight as compared to than youth who begin drinking after the age of 21.3
- A National Trauma Data Bank analysis of over 30,000 injured youth age 12-18 who were screened for alcohol use from 2009-2012 found the mortality rate for youth under the influence of alcohol was significantly higher when compared to youth who had not drank prior to injury.4
- As compared to underage youth who do not drink flavored alcoholic beverages (FABs), underage youth who drink alcopops (e.g., Smirnoff Ice, Mike’s Hard Lemonade) had 6 times greater odds of reporting an alcohol-related injury in the previous 12 months.5
Suicide and Self-Harm:
- Youth who drink heavily have 23.6 times greater odds of intentionally injuring themselves by means such as self-cutting, attempted hanging, or self-poisoning as compared to youth who don’t drink heavily.6
- Among young people, drinkers and binge drinkers are more likely than non-drinkers to contemplate or attempt suicide:7
- 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.8
- A longitudinal study showed heavy underage drinkers had reduced volume in three brain regions (rostral anterior cingulate, left cingulate, and pars triangularis) as compared to nondrinkers, and the gaps between the two groups widened over the next 3 years as the underage drinkers showed greater volume reductions.9 The surface area of the anterior cingulate is associated with executive control, including inhibitory functioning, attention, impulsivity, and self-regulation.10
- Evidence suggests alcohol use prior to age 21 impairs crucial aspects of youthful brain development. 11 One study found heavy-drinking adolescents who had been sober for 3 weeks still scored 10% lower than non-drinking peers on tests requiring verbal and nonverbal recall and skills needed for map reading, geometry, and science. 12
- Drivers age 16-20 have the largest risk for fatal car crashes; they are 17 times more likely to get in a car crash when they are legally drunk than when they are sober.13
- In 2013, 3,883 young people ages 16-20 died in motor vehicle crashes. Seventeen percent of these drivers were legally drunk at the time of the crash.14
- A longitudinal study of 1,124 youth in Los Angeles found 14 year olds who drank alcohol but did not smoke marijuana in the past month had a three-fold greater odds of driving under the influence or riding with a driver who was under the influence 2 years later.15
- The severity of underage motor vehicle crashes increases with alcohol involvement:16
- In 2013, 1 in 10 (10.0%) high school students drove a car after drinking alcohol in the past month.17 However, 1 in 5 (21.9%) high school students reported riding in the car with a driver who had been drinking in the past month.18
Alcohol Abuse or Dependence:
- Americans who began drinking before the age of 15 are five times more likely to develop alcohol dependence than those who wait until the age of 21.19
- In 2014, approximately 4.3 million young adults aged 18 to 25 (12.3% of this age group) had an alcohol use disorder (alcohol abuse or dependence) in the past year.20
- The incidence of onset of alcohol dependence peaks by 18 years of age.21
- The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has concluded that alcohol abuse and dependence are "developmental disorders."22
Risky Sexual Behavior:
- 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.23
- Young adult drinkers are twice as likely as non-drinkers to have had 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.24
- In 2013, 1 in 10 (11.4%) current high school drinkers, and 1 in 8 (13.6%) high school binge drinkers reported being physically forced to have sexual intercourse. Drinkers are more than twice as likely to report this as non-drinkers.7
- First year college students are 13% more likely to experience negative sexual consequences like unplanned/unprotected sex, regretted sex, or unwanted sexual attention on heavier drinking occasions, that is on occasions when they drink higher than their own self-reported average alcohol consumption.25
- In 2010, underage drinking cost approximately $24.3 billion in the United States. Of this, $3.8 billion was healthcare costs, $13.7 billion was lost labor/productivity, and $6.8 billion was other costs such as alcohol-related crime, motor vehicle crashes, and fetal alcohol syndrome costs.26
Updated March 2016
The Toll of Underage Drinking (printer-friendly version)
1. Centers for Disease Control and Prevention (CDC). Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI) Application, 2013. Accessed October 7, 2015 at: http://nccd.cdc.gov/DPH_ARDI/Default/Default.aspx
2. Heron M. Deaths: Leading causes for 2010. National vital statistics reports; vol 62 no 6. Hyattsville, MD: National Center for Health Statistics. 2013. Accessed October 6, 2015 at http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_06.pdf
3. Hingson RW, Edwards EM, Heeren T, & Rosenbloom D. (2009). Age of Drinking Onset and Injuries, Motor Vehicle Crashes, and Physical Fights After Drinking and When Not Drinking. Alcoholism: Clinical & Experimental Research, 33(5): 783-790. Accessed October 12, 2015 at: http://www.ncbi.nlm.nih.gov/pubmed/19298330
4. Aziz, H., Siordia, J.A., Rhee, P., Pandit, V., O’Keeffe, T., Kulvatunyou, N., & Joseph, B. (2015). Analyzing the effects of alcohol on adolescent trauma using the National Trauma Data Bank. The Journal of Trauma and Acute Care Surgery, 79(3):463-467.
5. Albers, A. B., Siegel, M., Ramirez, R. L., Ross, C., DeJong, W. & Jernigan, D. H. (2015). Flavored Alcoholic Beverage Use, Risky Drinking Behaviors, and Adverse Outcomes among Underage Drinkers: Results from the ABRAND Study. American Journal of Public Health, 105(4):810-815. Accessed November 20, 2015 at: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2014.302349?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&
6. Martiniuk AL, Chen HY, Glozier N, Patton G, Senserrick T, Williamson A, Woodward M, & Ivers R. (2015). High alcohol use a strong and significant risk factor for repetitive self-harm in female and male youth: a prospective cohort study. American Journal of Drug and Alcohol Abuse, 41(5):465-73.
7. Calculated from the Youth Risk Behavior Survey public use dataset available at: http://www.cdc.gov/healthyyouth/data/yrbs/data.htm
8. Carpenter, C. (2004). Heavy Alcohol Use and Youth Suicide: Evidence from Tougher Drunk Driving Laws. Journal of Policy Analysis and Management, 23(4):831-842.
9. Squeglia LM, Rinker DA, Bartsch H, Castro N, Chung Y, Dale AM, Jernigan TL, & Tapert SF. (2014). Brain volume reductions in adolescent heavy drinkers. Developmental Cognitive Neuroscience, 9:117–125. Accessed October 11, 2015 at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061267/
10. Fjell AM, Walhovd KB, Brown TT, et al. (2012). Pediatric Imaging, Neurocognition, and Genetics Study. Multimodal imaging of the self-regulating developing brain. Proceedings of the National Academy of Sciences, 109(48):19620–19625. Accessed October 11, 2015 at: http://www.pnas.org/content/109/48/19620.full.pdf
11. Wuethrich B. (2001). Getting Stupid. Discover, 22(3). Available at: http://discovermagazine.com/2001/mar/featstupid
12. Brown SA, Tapert SF, Granholm E, & Delis DC. (2000). “Neurocognitive Functioning of Adolescents: Effects of Protracted Alcohol Use.” Alcoholism: Clinical and Experimental Research, 24 (2): 164-171.
13. National Center for Injury Prevention and Control (2012). Teen Drinking and Driving: A Dangerous Mix. Accessed October 6, 2015 at: http://www.cdc.gov/vitalsigns/teendrinkinganddriving/index.html
14. National Highway Traffic Safety Administration, (2014). Traffic Safety Facts 2013, Washington, DC: National Center for Statistics and Analysis, U.S. Department of Transportation. Available at http://www-nrd.nhtsa.dot.gov/Pubs/812102.pdf
15. Ewing, B. A., Tucker, J. S., Miles, J. N., Shih, R. A., Kulesza, M., Pedersen, E. R., & D’Amico, E. J. (2015). Early Substance Use and Subsequent DUI in Adolescents. Pediatrics, 136(5):868-875.
16. Among persons with reported age, police-reported alcohol involvement, and classified injury severity. Calculated from the National Highway Transportation Safety Administration public use dataset available at: ftp://ftp.nhtsa.dot.gov/fars/
17. Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014. Accessed October 2, 2015 at http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf
18. Kann L, Kinchen S, Shanklin SL et al. (2014). Youth Risk Behavior Surveillance — United States, 2013. Morbidity and Mortality Weekly Report, 63(No. SS-4). Accessed October 2, 2015 at http://www.cdc.gov/mmwr/pdf/ss/ss6304.pdf
19. U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking: A Guide to Action for Educators. U.S. Department of Health and Human Services, Office of the Surgeon General, 2007. Accessed October 12, 2015 at: http://www.surgeongeneral.gov/library/calls/underage-drinking-educator-guide.pdf
20. Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Accessed October 19, 2015 at: http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf
21. Li TK, Hewitt BG, & Grant BF. (2004). Alcohol Use Disorders and Mood Disorders: A National Institute on Alcohol Abuse and Alcoholism Perspective. Biological Psychiatry, 56(10): 718-720. Available at: http://dx.doi.org/10.1016/j.biopsych.2004.03.006
22. Team on Underage Drinking, National Institute on Alcohol Abuse and Alcoholism. (2004). Alcohol Consumption by Children and Adolescents: An Interdisciplinary Overview. Bethesda, MD: NIAAA.
23. Stueve A & O'Donnell LN (2005). Early Alcohol Initiation and Subsequent Sexual and Alcohol Risk Behaviors among Urban Youths. American Journal of Public Health, 95 (5):887-893. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449273/
24. 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.
25. Scaglione NM, Turrisi R, Mallett KA, Ray AE, Hultgren BA, & Cleveland MJ. (2014). How Much Does One More Drink Matter? Examining Effects of Event-Level Alcohol Use and Previous Sexual Victimization on Sex-Related Consequences. Journal of Studies on Alcohol and Drugs, 75(2): 241–248. Accessed October 11, 2015 at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3965678/pdf/jsad241.pdf
26. Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, & Brewer RD. (2015). 2010 National and state costs of excessive alcohol consumption. American Journal of Preventive Medicine, 49(5):e73–e79. Accessed October 17, 2015 at: http://www.ajpmonline.org/article/S0749-3797(15)00354-2/pdf