Youth Drinking: Risk Factors and Consequences Despite a minimum legal drinking age of 21, many young people in the United States consume alcohol. Some abuse alcohol by drinking frequently or by binge drinking--often defined as having five or more drinks* in a row. A minority of youth may meet the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for alcohol dependence (1,2). The progression of drinking from use to abuse to dependence is associated with biological and psychosocial factors. This Alcohol Alert examines some of these factors that put youth at risk for drinking and for alcohol-related problems and considers some of the consequences of their drinking. Prevalence of Youth Drinking Thirteen- to fifteen-year-olds are at high risk to begin drinking (3). According to results of an annual survey of students in 8th, 10th, and 12th grades, 26 percent of 8th graders, 40 percent of 10th graders, and 51 percent of 12th graders reported drinking alcohol within the past month (4). Binge drinking at least once during the 2 weeks before the survey was reported by 16 percent of 8th graders, 25 percent of 10th graders, and 30 percent of 12th graders. Males report higher rates of daily drinking and binge drinking than females, but these differences are diminishing (3). White students report the highest levels of drinking, blacks report the lowest, and Hispanics fall between the two (3). A survey focusing on the alcohol-related problems experienced by 4,390 high school seniors and dropouts found that within the preceding year, approximately 80 percent reported either getting "drunk," binge drinking, or drinking and driving. More than half said that drinking had caused them to feel sick, miss school or work, get arrested, or have a car crash (5). Some adolescents who drink later abuse alcohol and may develop alcoholism. Although these conditions are defined for adults in the DSM, research suggests that separate diagnostic criteria may be needed for youth (6). Drinking and Adolescent Development While drinking may be a singular problem behavior for some, research suggests that for others it may be an expression of general adolescent turmoil that includes other problem behaviors and that these behaviors are linked to unconventionality, impulsiveness, and sensation seeking (7-11). Binge drinking, often beginning around age 13, tends to increase during adolescence, peak in young adulthood (ages 18-22), then gradually decrease. In a 1994 national survey, binge drinking was reported by 28 percent of high school seniors, 41 percent of 21- to 22-year-olds, but only 25 percent of 31- to 32-year-olds (3,12). Individuals who increase their binge drinking from age 18 to 24 and those who consistently binge drink at least once a week during this period may have problems attaining the goals typical of the transition from adolescence to young adulthood (e.g., marriage, educational attainment, employment, and financial independence) (13). Risk Factors for Adolescent Alcohol Use, Abuse, and Dependence Genetic Risk Factors. Animal studies (14) and studies of twins and adoptees demonstrate that genetic factors influence an individual's vulnerability to alcoholism (15,16). Children of alcoholics are significantly more likely than children of nonalcoholics to initiate drinking during adolescence (17) and to develop alcoholism (18), but the relative influences of environment and genetics have not been determined and vary among people. Biological Markers. Brain waves elicited in response to specific stimuli (e.g., a light or sound) provide measures of brain activity that predict risk for alcoholism. P300, a wave that occurs about 300 milliseconds after a stimulus, is most frequently used in this research. A low P300 amplitude has been demonstrated in individuals with increased risk for alcoholism, especially sons of alcoholic fathers (19,20). P300 measures among 36 preadolescent boys were able to predict alcohol and other drug (AOD) use 4 years later, at an average age of 16 (21). Childhood Behavior. Children classified as "undercontrolled" (i.e., impulsive, restless, and distractible) at age 3 were twice as likely as those who were "inhibited" or "well-adjusted" to be diagnosed with alcohol dependence at age 21 (22). Aggressiveness in children as young as ages 5-10 has been found to predict AOD use in adolescence (23,24). Childhood antisocial behavior is associated with alcohol-related problems in adolescence (24-27) and alcohol abuse or dependence in adulthood (28,29). Psychiatric Disorders. Among 12- to 16-year-olds, regular alcohol use has been significantly associated with conduct disorder; in one study, adolescents who reported higher levels of drinking were more likely to have conduct disorder (30,31). Six-year-old to seventeen-year-old boys with attention deficit hyperactivity disorder (ADHD) who were also found to have weak social relationships had significantly higher rates of alcohol abuse and dependence 4 years later, compared with ADHD boys without social deficiencies and boys without ADHD (32). Whether anxiety and depression lead to or are consequences of alcohol abuse is unresolved. In a study of college freshmen, a DSM-III (33) diagnosis of alcohol abuse or dependence was twice as likely among those with anxiety disorder as those without this disorder (34). In another study, college students diagnosed with alcohol abuse were almost four times as likely as students without alcohol abuse to have a major depressive disorder (35). In most of these cases, depression preceded alcohol abuse. In a study of adolescents in residential treatment for AOD dependence, 25 percent met the DSM-III-R criteria for depression, three times the rate reported for controls. In 43 percent of these cases, the onset of AOD dependence preceded the depression; in 35 percent, the depression occurred first; and in 22 percent, the disorders occurred simultaneously (36). ............