Why Does Teen Alcohol Abuse Happen? And What Can Parents Do?

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Although the legal age for purchasing and consuming alcohol is 21 in the United States, teen alcohol abuse is prevalent. Results of the 2019 Youth Risk Behavior Survey, a nationwide assessment of substance use among middle school and high school students, indicated that 29% of high school students drank alcohol in the month before the survey.¹ Further results showed that 14% of high school respondents engaged in binge drinking, 5% drove while under the influence, and 17% rode with someone who had been drinking.¹

As a parent, you may have a teen who has tried alcohol, considered trying it, or who may be misusing alcohol. You are not alone, and there are many things you can do to help your teen, whether they have never used alcohol or need alcohol use disorder treatment.

In this article:

• Why Teens Drink
• Teen Risk Factors for Alcohol Misuse
• Dangers of Underage Drinking
• Signs of Teen Alcohol Misuse
• Teen Alcohol Use Disorder
• Teen Treatment Options

Why Teens Drink

The 2019 National Survey on Drug Use and Health, which estimates substance abuse in teenagers and adults, found that 7 million youth between the ages of 12 and 20 reported drinking alcohol in the month before the survey.² Of those respondents, 4.2 million admitted to binge drinking at least once in the prior month and 825,000 reported binge drinking five or more days in the preceding month.²

The Surgeon General report on underage drinking lists common reasons for teen alcohol misuse, some of which relate to the changes in adolescence and young adulthood. Teenagers and young adults are changing and growing physically and hormonally; they take on more responsibilities that can create both positive and negative stress; and they are trying to find themselves, their identity, and independence. For some, this means taking risks and trying new things, like alcohol.³

Teens change socially. Friendships, romantic relationships, and sexual interests can influence a teen’s decisions and behaviors. Sleep habits, family dynamics, and social media can all also play a role in a teen’s decision-making about underage alcohol use.³

Some researchers went directly to teens to find out why they drink. The reasons include to:⁴

• Fit in socially
• Relax or reduce tension
• Foster courage
• Reduce worry
• Feel more powerful
• Feel impaired cognitively and uninhibited behaviorally

Some teenagers also experiment with legal non-alcohol substances, such as over-the-counter cold medicine, or substances with less attached social stigma, such as weed, for these same reasons. Typically, teens choose these alcohol alternatives because they believe they are safer, more readily available, or less likely to be detected than alcohol.

If you are wondering how your teen would answer the question of why they drink, or even why they would consider drinking, it’s okay to go ahead and start a conversation with them. Their reason may be on the above list or be specific to the circumstances they’re experiencing at this stage in their life. If you think your child would respond better to the question coming from someone else, therapists, peer mentors, school counselors, credentialed interventionists, or other trained individuals can facilitate the conversation.

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Teen Risk Factors for Alcohol Misuse

Researchers have learned that some teens are more likely to misuse alcohol than others. Risk factors for repeated alcohol misuse include living with a parent or family member who misuses alcohol, underlying mental illness, and previous trauma, like sexual or physical abuse.⁵

Teens who haven’t learned how to regulate their emotions or who are encouraged to use substances may also be more likely to misuse alcohol. A crucial risk factor is the nature of the relationship between teens and their parents or guardians. Behavioral modeling, the home environment, and parental supervision influence risk for teen drinking. Studies also indicate potential genetic influences that, while they do not predict substance abuse in teenagers, increase your teenager’s risk factors for misusing mind-altering substances or becoming addicted to them.⁵

Teenagers are resilient, though, and with the right help, protective factors can replace risk factors. Family, school, and community support can provide protective factors for teens. Examples include family therapy to improve family dynamics, life skills training, counseling, and drug education programs.⁶

Think of protective factors like barriers between your teen and alcohol. Just as risk factors don’t predict misuse, you can’t predict which protective factors will be most impactful for your teen, but you can provide these resources.

Dangers of Underage Drinking

Substance misuse in teenagers can have harmful effects. One study found that nearly 40% of patients treated for substance-related injuries in hospital emergency rooms were aged between 12 and 20 years old and had experienced harm due to alcohol misuse.⁷

Underage alcohol-only misuse accounts for 78.8% of emergency room visits. Teens who combine alcohol with drugs account for 21.2% of underage alcohol misuse–related emergency room visits. ⁷

Substance abuse in teenagers can lead to permanent injury, coma, and be life-threatening. Drinking too much can lead to alcohol poisoning and overdose. Because drinking affects decision-making and motor functions, life-threatening or permanent injury can also happen due accidents that occur while operating vehicles, swimming, hiking and climbing, or even performing household tasks like cooking. ⁸

When drinking, teens are more likely to engage in high-risk behavior when intoxicated. They may be more likely to combine alcohol with other substances or put themselves in locations or situations that they would avoid when sober. People who use alcohol while underage may be more vulnerable to alcohol use disorders later in life. One theory researchers have for this increased risk of future addiction is that the brain does not stop developing until the mid-twenties. Any trauma to the brain, such as alcohol misuse, can alter the structure of the brain. Studies of underage alcohol misuse indicate a link with learning problems and developmental delays.⁸

Signs of Teen Alcohol Misuse

Teens exhibit patterns of behavior some think are “typical teen behaviors.” However, the following signs may also suggest alcohol misuse:⁹

• Changes in mood—One minute your teen may be happy and calm and the next minute they may seem irritable and defensive or have a temper outburst. This volatility can be related to the “high” and “crash” of substance use.
• Changes in performance at school—Teens who misuse alcohol may not be able to maintain their grade point average, may face disciplinary action for tardiness and truancy, or they may butt heads with teachers or other students.
• Changes in attitude—Teens may lose interest in activities they once enjoyed or exhibit an attitude of not caring, whether for themselves or others. This is one of the clinical criteria for an alcohol use disorder.
• Changes in energy and motivation—Teens who misuse alcohol may lack the energy to participate in activities. They seem more sluggish than usual. This can be related to patterns of behavior around alcohol (e.g., late-night parties) or the physical aftereffects of using alcohol.
• Changes in physical abilities—If your teen shows a lack of coordination, slurred speech, or is involved in an abnormal amount of falls, trips, or accidents, it could be due to alcohol misuse.
• Changes in mental health—Memory lapses, poor concentration, increased depression or anxiety, crying spells, and conversations that imply they feel hopeless are signs of alcohol misuse, especially because alcohol is a depressant.
• Changes in personal appearance and environment—Teens who misuse alcohol may stop caring about personal hygiene and the clothes they wear, or they may become unable to complete personal care tasks and household chores. Your teen may become more resistant to you entering their room or looking at their social media.
• Changes in friends—If your teen starts hanging out with a new group of, it could be due to alcohol misuse.

Immediate signs of alcohol intoxication to watch for include slurred speech, restlessness, euphoria, sedation, loss of balance, slowed breathing, fatigue, dizziness, and agitation.¹⁰

Teen Alcohol Use Disorder

Alcohol misuse among teenagers can lead to tolerance or dependence. They may drink more than intended or need to drink more alcohol to achieve the same effects. They may also experience negative symptoms of withdrawal when trying to stop.¹⁰

Withdrawal symptoms may include nausea, vomiting, tremors, or shaking, and an increase in heart rate, blood pressure, and body temperature. Other symptoms may include diarrhea, confusion, anxiety, depression, cravings, and insomnia. Severe psychiatric symptoms include hallucinations, delirium, and psychosis.¹⁰

The type and severity of withdrawal correlate with how long, how often, and how much alcohol your teen consumes.¹⁰

Tolerance, dependence and withdrawal symptoms are signs your teen may have an alcohol use disorder. However, only a psychiatrist or physician can give a diagnosis. They base their diagnosis on specific criteria, such as if their alcohol use interferes with their abilities to perform at school, work, and other activities. They also assess if your teen is putting themselves in harmful situations while drinking, has encountered legal or school-related punishments due to drinking, and continues drinking despite negative consequences.^10,11

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Teen Treatment Options

Alcohol treatment exists for all teens, including those with and without addiction. Examples of treatment programs with positive outcomes include:⁴

• 12-step facilitation groups, including the best known Alateen, where teens study and work through the 12 Steps of Alcoholic Anonymous. Most 12-step programs are one element of a more extensive treatment plan that may also include detox, inpatient rehab, individual and group therapy, and family therapy.
• Therapeutic communities (TC) are long-term residential facilities where peers and staff serve as support. Teens continue their education while also receiving individual and group counseling. The goal is to treat all areas of the teen’s life that need improvement, not just alcohol misuse.
• Cognitive-behavioral therapy (CBT) is a form of talk therapy that can be used in individual and group therapies. The idea is to help your teen become aware of how they think so that they become empowered to change behavioral patterns.
• Family therapy provided by a licensed marriage and family therapist teaches all family members how to support a teen in recovery. It also helps family members work through their issues and learn to implement positive boundaries.

Brief interventions, intensive outpatient, outpatient, day treatment, or partial hospitalization are additional options.⁴

The most crucial part of a treatment program is the initial assessment to determine which type of treatment can benefit your teen. Some consider the assessment to be the process of matching your teen with the right program. Things like your teen’s age, gender, the severity of the problem, co-occurring disorders, cognitive functioning, educational level, medical needs, and legal mandates help in the creation a treatment plan.⁴

If you think your teen may be misusing alcohol, call 800-948-8417 Who Answers? . If your teen is drinking, we can guide you in getting them the help they need. To find out how to start the treatment process, call 800-948-8417 Who Answers? .

Resources

1. Centers for Disease Control and Prevention. (2020). 2019 YRBS Results and Data Available Now. Youth Risk Behavior Surveillance System (YRBSS).
2. Substance Abuse and Mental Health Services Administration. (2020). 2019 National Survey on Drug Use and Health Table 7.16A— Alcohol Use in Lifetime, Past Year, and Past Month among Persons Aged 12 to 20, by Gender: Numbers in Thousands, 2002-2019.
3. S. Department of Health and Human Services. (2007). The Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking – What It Means to You: A Guide to Action for Families.
4. Bonnie, R.J. & O’Connel, M.D. (Eds.) (2004) Reducing Underage Drinking: A Collective Responsibility. National Research Council (US) and Institute of Medicine (US) Committee on Developing a Strategy to Reduce and Prevent Underage Drinking. Washington (DC): National Academies Press (US).
5. Brown, S. A., McGue, M., Maggs, J., Schulenberg, J., Hingson, R., Swartzwelder, S., Martin, C., Chung, T., Tapert, S. F., Sher, K., Winters, K. C., Lowman, C., & Murphy, S. (2009). Underage Alcohol Use: Summary of Developmental Processes and Mechanisms: Ages 16-20. Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism, 32(1), 41–52.
6. Komro, K.A., & Toomey, T.L. (2002). Strategies to Prevent Underage Drinking. Alcohol Research & Health, 26(1), 5-14.
7. Naeger, S. (2017). Emergency Department Visits Involving Underage Alcohol Misuse: 2010 to 2013. The CBHSQ Report: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
8. National Institute on Alcohol Abuse and Alcoholism. (2021). Underage Drinking.
9. gov. (2021). Warning Signs. Substance Abuse Prevention.
10. Adger, H., Jr, & Saha, S. (2013). Alcohol Use Disorders in Adolescents. Pediatrics in Review, 34(3), 103–114.
11. S. National Library of Medicine. (2021). Alcohol Use Disorder (AUD). Medline Plus.