In a special supplement to Pediatrics, edited and sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), physicians will have access in one place to the reviews and analyses of current research on biological, behavioral, and environmental changes during childhood and adolescence that foster the initiation, maintenance, and acceleration of illegal use of alcohol by underage youth.  This is a first time collection of where science is in our understanding of  underage drinking as a developmental issue. NIAAA, one of the institutes of the National Institutes of Health, is committed to moving scientific discovery to strategic prevention and intervention strategies in order to decrease the toll that alcohol is taking on our youth--and as these youth grow--to our society.

“We now recognize that underage drinking must be addressed, not as an isolated phenomenon, but as one fully embedded in the context of child and adolescent development,” said NIAAA Director Ting-Kai Li, M.D.  “From birth through adolescence, a complex cascade of biological, psychological and social development interacts with dynamic environmental influences, leading to behavior that may either move individuals toward or away from underage drinking.”

Looking at developmental perspectives to determine the risk of alcohol dependence is a relatively new scientific approach that is bearing results. For example, according to recent research, binge drinking by young people makes them more vulnerable to the development of alcohol dependence over a lifetime.  Further, risk of an individual’s becoming alcohol dependent is related to how early the young person starts drinking. NIAAA’s Pediatrics supplement includes researchers from a wide range of scientific disciplines.

A sampling of the resources available in the supplement includes:

Ann S. Masten, Ph.D., professor in the Institute of Child Development at the University of Minnesota in   Minneapolis, and colleagues, present a rationale for the developmental approach to alcohol in an article offering age-related data on patterns of onset, prevalence and the course of alcohol use and disorders in young people.

Robert A. Zucker, Ph.D., professor of  psychiatry at the  University of Michigan, Ann Arbor, and his team looked the relationship between early developmental processes and the continuity of risk for underage and problem drinking by summarizing the evidence on early pathways toward and away from underage drinking.  This article has a particular focus on the risk and protective factors, mediators, and moderators of risk for underage drinking that become evident during the preschool and early school years.

In “ Transitions into Underage Drinking and Problem Drinking: Developmental Processes and Mechanisms between Ages 10-15” - Michael Windle, Ph.D., professor and chair, Department of Behavioral Sciences and Health Education at Emory University in Atlanta,  and his group examined pre- and mid-teen groups during the time when the initial initiation and escalation of alcohol use commonly occurs, in relation to puberty, structural and functional maturation of the brain, and changes in social contexts.

Looking at the next age group, youth aged 16-20, Sandra Brown, Ph.D.,  professor of psychology at the University of California, San Diego, and colleagues review the normative neurological, cognitive, and social changes that typically occur in late adolescence. Their report discusses evidence for the impact of these transitions on individual drinking trajectories. The team also describes evidence linking heavy alcohol use in late adolescence with neurological and social impairments.

“Ensuring that pediatricians have access to this new data and a comprehensive view of how alcoholism affects our youth, matched to their developmental processes, will help physicians take a new look at these issues and the impact that early alcohol consumption can have on the life of not only the child, and teenager, but for the life of the individual,’’ said Elias A. Zerhouni, M.D., director of the NIH.

Examining prevention strategies, Richard Spoth, Ph.D., director of the Partnerships in Prevention Science Institute at Iowa State University, and his team reviewed the current evidence base for preventive interventions addressing underage drinking. They recommend applying emerging consumer-oriented and community-participatory models for intervention development and research as a strategy.

In an article called, "Developmentally Informed Research on the Effectiveness of Clinical Trials (DIRECT): A Primer for Directly Assessing How Developmental Issues May Influence Treatment Response among Adolescents with Alcohol Problems" Eric F. Wagner, Ph.D., associate professor in the Community-Based Intervention Research Group at FloridaInternationalUniversity, reviews the degree to which developmental processes have been considered in adolescent alcohol treatment research and discusses promising concepts and methodologies from applied developmental science.

Alcohol treatment outcome studies discussed by Deborah Deas, M.D., M.P.H., professor of psychiatry at the Medical University of South Carolina in Charleston, include family-based interventions, motivational interviewing, behavioral therapy, cognitive behavioral therapy, and limited pharmacotherapy studies.

“These papers comprehensively address the complex relationship between development and underage drinking,” noted Vivian B. Faden, Ph.D. deputy director of NIAAA’s Division of Epidemiology and Prevention Research and co-editor of the Pediatrics supplement.  By providing clinicians with this information, we anticipate that this supplement will advance the goals set forth in the U.S. Surgeon General's recent Call to Action to Prevent and Reduce Underage Drinking.”

Released in March of 2007, the Surgeon General’s first Call to Action on underage drinking appealed to Americans to do more to stop America’s 11 million current underage drinkers from using alcohol, and to keep other young people from starting.