Alcohol Misuse and Abuse Nationwide

The Consequences and Costs of Underage Drinking

Underage drinking can have numerous consequences, including damage to the human brain, which continues to develop until around age 25:6

  • The hippocampi (a part of the brain that handles memory and learning) of youth ages 14–21 who abuse alcohol has been found to be about 10% smaller than in those who did not drink—and such effects may be irreversible.7
  • Alcohol can interfere with youth’s ability to form new and lasting memories of facts and events, which has implications for their learning and academic performance.8
  • Youth with alcohol use disorders often perform worse on memory tests and have diminished ability to plan.9
  • Alcohol use by youth is associated with abnormalities in the volume of the prefrontal cortex, which may lead to deficiencies in reasoning and to impulsive behavior.10

Underage drinking is also expensive. The problems associated with underage drinking—including youth violence, property damage, high-risk sex, fetal alcohol syndrome, and alcohol dependence and treatment—all pose a cost to our society and to taxpayers. The Underage Drinking Enforcement Training Center at the Pacific Institute for Research and Evaluation, funded by the OJJDP, studies the consequences of underage drinking and reports on its associated costs every year):2

  • In 2013, underage drinking cost the United States $56.9 billion, which includes medical care, work loss, treatment costs, and property crime.
  • This breaks down to a cost of $1,903 per year for each youth in the United States, or $3.75 per drink consumed underage.
  • Even if only tangible costs (i.e., medical care and work loss, rather than pain and suffering) are considered, the cost of underage drinking totals $20.01 billion each year, or $1.32 per drink.

The most costly problems related to underage drinking were youth violence and car crashes:

National Cost of Underage Drinking

Read more on the costs and consequences of underage drinking:

  • Excerpt from the Surgeon General’s Report: Adverse Consequences of Underage Drinking
  • Selected Research on Underage Drinking

Underage Drinking and Violence

Drinking is implicated in many deaths, injuries, and crimes:9

  • Homicide and suicide are the second- and third-leading cause of death for those ages 15–24.12 Research shows a causal link between alcohol and suicide, and alcohol is also linked to other mental health disorders, such as depression.
  • Alcohol has been reported to be involved in 36% of homicides, 12% of male suicides, and 8% of female suicides involving people under 21.
  • The Bureau of Justice Statistics13 found that close to one-third of violent crime is alcohol-related.
  • Some researchers estimate that individuals under age 21 commit 45% of rapes, 44% of robberies, and 37% of other assaults.14

Frequent heavy drinkers also carry a weapon and engage in fights more frequently than nondrinkers:9

  • Underage drinkers are more likely than their nondrinking peers to carry a weapon—44% of frequent heavy drinkers had carried a weapon, and 22% had carried a gun in the past 30 days, compared with 10% and 3%, respectively, of nondrinkers.
  • Carrying a weapon increases the dangers associated with drinking; not surprisingly, injuries due to a physical fight were more common among frequent heavy drinkers (13%) than nondrinkers (about 2%).

Alcohol use is also heavily implicated in crimes reported on college campuses:9

  • Ninety-five percent of all violent crime on campus involves the use of alcohol by the assailant, the victim, or both.15
  • At least 50% of college student sexual assaults are associated with alcohol.15
  • Of the reported incidents of sexual victimization, 43% involve alcohol consumption by victims, and 69% involve alcohol consumption by the perpetrators).15

Given that many sexual assaults—especially acquaintance rape—are believed to be unreported, it is possible that alcohol figures into many more assaults than these studies indicate. (p. 62)9

In addition, the OJJDP6 reports that in 2001, 696,000 college students were hit or assaulted by another college student who had been drinking.

Underage Drinking and Driving

Research has found that the earlier age at drinking onset, the greater the likelihood of being in a drinking-involved motor-vehicle accident, and that those who drink at earlier ages are more likely to have alcohol-related driving offenses before age 21.17

The 2013 National Youth Risk Behavior Surveillance (YRBS)14 noted the following:

  • 1 in 10 youth had driven a car or other vehicle one or more times when they had been drinking alcohol during the past 30 days
  • The rates for male students were higher than for female students (12% and 7.8%, respectively)

Grunbaum et al. break down these numbers by race and ethnicity: In 2000, 14.7% of white youth (ages 15–20), 13.1% of Latino youth, and 7.7% of African American youth drove a car after drinking alcohol.19\

Although alcohol-related youth motor vehicle fatalities have decreased substantially over the past decade or so, “youth are still overrepresented in alcohol-related fatal crashes compared with the older population” (p. 60).9 Underage drinking and driving is a serious issue with dire consequences:

  • In 2000, 69% of alcohol-related traffic fatalities among youth involved underage drinking drivers.
  • Almost 40% of youth traffic fatalities are alcohol-related.20
  • In 2009, 19% of drivers ages 16–20 who were involved in fatal crashes had a blood alcohol concentration over the legal limit.6
  • While youth ages 15–20 comprise only 7% of licensed drivers, in 2000 they represented approximately 13% of the drivers involved in fatal crashes after drinking.20

Underage drinkers make other poor driving decisions that affect their well-being:9

  • They are less likely to wear a seat belt. Alcohol-related traffic crashes are three times more likely to be fatal for youth who are not wearing a seat belt.
  • They are more likely to allow an intoxicated driver to drive them: 38.3% of Latino youth (ages 15–20), 30.3% of white youth, and 27.6% of African American youth have ridden with a driver who had been drinking alcohol.

Use of Alcohol by Underage Youth

Lifetime and Current Use of Alcohol

The 2013 National YRBS found that underage drinking rates are decreasing:18

  • Lifetime use of alcohol by underage youth was 66.2%, which has fallen significantly over the past few decades (i.e., from 81.6% in 1991)
  • Current use of alcohol among underage youth was 34.9%, which has also fallen since 1991 (50.8%)

Note: A new report from SAMHSA21 offers even more promising numbers: In 2013, current use of alcohol among those ages 12–20 was 22.7%, down from 28.8% in 2002.

  • Rates of current alcohol use (i.e., use of alcohol within the past 30 days) were higher among white (36.3%) and Hispanic (37.5%) students than black (29.6) students, higher among Hispanic female (39.7%) than black female (31.3%) students, and higher among white male (36.9%) and Hispanic male (35.2%) than black male (27.7%) students
  • The percentage of youth using alcohol before age 13 (the age of onset) is now 18.6%, another significant decrease from 1991 (32.7%)

Note: Age of onset is the age at which an individual first acquires or experiences the symptoms of a disease or disorder; for underage alcohol use, the average age of onset is 13. According to the Surgeon General, “Delaying the age of onset of first alcohol use as long as possible would ameliorate some of the negative consequences associated with underage alcohol consumption” (p. 12).22

Findings from the 2013 National Survey of Drug Use and Health (NSDUH):1

  • Current use rates for Asian youth ages 12–20 are 15.2%; for American Indians and Alaska Natives, 17.8%
  • As expected, current use rates are higher for 10th- (30.9%), 11th- (39.2%), and 12th-graders (46.8%) than for 9th-graders (24.4%)

Alcohol and Other Illicit Drug Use

The 2013 National YRBS noted a relationship between alcohol and illicit drug use:18

  • Approximately one in five youth (19.9%) who currently use alcohol have also used illicit drugs within two hours of alcohol use
  • The most commonly reported illicit drug used by underage drinkers in combination with alcohol was marijuana, which was used within two hours of alcohol use by 19.5% of current underage drinkers (1.6 million persons) on their last drinking occasion

Age of onset was found to be a strong predictor of use of other illicit drugs. The National Longitudinal Alcohol Epidemiologic Survey found that “approximately one-half of persons who began drinking at age 14 or younger had also used other drugs illicitly in their lifetime, compared to around one-tenth of those who began drinking at age 20 or older” (p. 1).23 The younger a person is when he or she begins using alcohol, the more likely he or she is to use other drugs and to do so at an earlier age.17

Drinking and Other Drug Use - Age of Onset

The OJJDP reports that while “many factors can affect whether youth progress to the use of other drugs and which ones they choose to use,24,25,26 alcohol is frequently followed by tobacco, then marijuana, and then other illicit hard drugs” (p. 6).6

See Early Drinking Initiation and Illicit Drug Use: CESAR Fax for more on the relationship between alcohol and other illicit drug use.

Binge Drinking

SAMHSA defines binge drinking as having five or more alcoholic drinks within a couple of hours on at least 1 day in the past 30 days. The National Institute on Alcohol Abuse and Alcoholism is even more specific, defining it as a pattern of drinking that brings blood alcohol concentration levels to 0.08 g/dL, which typically occurs after four drinks for women and five drinks for men within two hours.

Findings from the 2013 National YRBS:18

  • More than one-fifth of youth (20.8%) were currently engaging in binge drinking, which is down by more than 10% since 1991 (31.3%)
  • The prevalence of binge drinking was higher among white (23.2%) and Hispanic (22.6%) students than black (12.4%) students, higher among white female (21.1%) and Hispanic female (22.6%) students than black female (11.5%) students, and higher among white male (25.3%) and Hispanic male (22.7%) students than black male (13.1%) students

The 2013 NSDUH found that 7.6% of Asian youth and 13.9% of American Indian and Alaskan Native youth, ages 12–20, currently engage in binge drinking.1

Access to Alcohol by Underage Youth

Findings from the 2013 National YRBS:18

  • Among the youth who had a drink in the 30 days before the survey, 41.8% obtained the alcohol by having someone give it to them
  • Female students were more likely than male students to have someone give alcohol to them (46.7% and 36.7%, respectively)

Underage youth obtain alcohol from a variety of sources, according to the 2013 NSDUH:1

  • Among underage current drinkers who did not pay for the alcohol the last time they drank, the most common source (36.6%) was an unrelated person age 21 or older
  • Parents, guardians, or other adult family members provided the last alcohol to 24.5% of nonpaying underage drinkers
  • Other underage persons provided the alcohol on the last occasion for 16.4% of nonpaying underage drinkers
  • The majority of underage current drinkers reported that their last use of alcohol in the past month occurred in a home setting, either in someone else’s home (52.2%) or their own home (34.2%); the rate for drinking at home has increased from 2012 (31.4%)
  • Underage females were more likely than males to have been in a restaurant, bar, or club on their last drinking occasion (8.8% and 4.5%, respectively)
  • 28.7% of youth paid for the alcohol the last time they drank, including 7.8% who purchased the alcohol themselves and 20.5% who gave money to someone else to purchase it; these rates are similar to 2012 (28.2%, 7.6%, and 20.4%, respectively)

Perception of the Harm or Risk of Alcohol Use by Underage Youth

The NSDUH looked at data from 2002 to 2013 regarding perceptions of the risk of alcohol use among youth ages 12–17.

National Perceived Risk
  • Youth who perceived great risk in having four or five drinks of an alcoholic beverage nearly every day increased from 62.2% in 2002 to 65.6% in 2008, but the rate then declined between 2009 (64.1%) and 2013 (62.5%), bringing the 2013 rate almost back to the 2002 rate.
  • The percentage of youth who perceived great risk in having five or more drinks of an alcoholic beverage once or twice a week increased from 38.2% in 2002 to 40.7% in 2011; the rate then decreased 2% between 2011 and 2013 and went back down to 39%.
  • The rate of binge alcohol use and heavy alcohol use also decreased, from 10.7% and 2.5% to 8.9% and 2%, respectively.
  • Although perceived risk of alcohol use peaked in 2008 for each measure of perceived risk, the rate of adolescent alcohol use continued to decline between 2008 and 2013 for both binge alcohol use (6.2% in 2013) and heavy alcohol use (1.2% in 2013).