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Alcohol's Effects on Health

Research-based information on drinking and its impact.

Get the Facts About Underage Drinking

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Underage drinking is a serious public health problem in the United States. Many youth drink, and when the do, they often binge drink (see the Underage Drinking Facts and Statistics page for more information about the prevalence and scope of the problem).

Underage Drinking Is Dangerous

Underage drinking poses a range of risks and negative consequences. It is dangerous because it:

  • Causes many deaths. Alcohol is a significant factor in the deaths of people younger than age 21 in the United States each year. This includes deaths from motor vehicle crashes, homicides, alcohol overdoses, falls, burns, drowning, and suicides.
  • Causes many injuries. Drinking alcohol can cause youth to have accidents and get hurt.1
  • Impairs judgment. Drinking can lead to poor decisions about taking risks, including unsafe sexual behavior, drinking and driving, and aggressive or violent behavior.
  • Increases the risk of physical and sexual assault. Underage binge drinking is associated with an increased likelihood of being the victim or perpetrator of interpersonal violence.2
  • Can lead to other problems. Drinking may cause youth to have trouble in school or with the law. Drinking alcohol is also associated with the use of other substances.
  • Increases the risk of alcohol problems later in life. Research shows that people who start drinking before the age of 15 are at a higher risk for developing alcohol use disorder (AUD) later in life.3
  • Interferes with brain development. Research shows that people’s brains keep developing well into their 20s. Alcohol can alter this development, potentially affected structure and function. See the Alcohol and the Adolescent Brain fact sheet for more information.

Why Do So Many Youth Drink?

As children mature, it is natural for them to assert their independence, seek new challenges, and engage in risky behavior. Underage drinking is one such behavior that attracts many adolescents. They may want to try alcohol but often do not fully recognize its effects on their health and behavior. Other reasons youth drink alcohol include:

  • Peer pressure
  • Increased independence or the desire for it
  • Stress

In addition, many youth have easy access to alcohol. In many cases, adolescents have access to alcohol through family members or find it at home.

What Is Binge Drinking?

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08%—or 0.08 grams of alcohol per deciliter—or higher. For a typical adult, this pattern corresponds to consuming five or more drinks (male), or four or more drinks (female), in about two hours.4 Research shows that fewer drinks in the same timeframe result in the same BAC in youth: only three drinks for girls, and three to five drinks for boys, depending on their age and size.5 In the United States, a "standard drink" is defined as any beverage containing 0.6 fl oz or 14 grams of pure alcohol.

Preventing Underage Drinking

Preventing underage drinking is a complex challenge. Any successful approach must consider many factors, including:

  • Genetics
  • Personality
  • Rate of maturation and development
  • Level of risk
  • Social factors
  • Environmental factors

Several key approaches have been found to be successful. They are:

  • Individual-level interventions. This approach seeks to change the way youth think about alcohol so they are better able to resist pressures to drink.
  • School-based interventions. These are programs that provide students with the knowledge, skills, motivation, and opportunities they need to remain alcohol-free.
  • Family-based interventions. These are efforts to empower parents to set and enforce clear rules against drinking, as well as improve communication between children and parents about alcohol.
  • Community-based interventions. Community-based interventions are often coordinated by local coalitions working to mitigate risk factors for alcohol misuse.
  • Policy-level interventions. This approach makes alcohol harder to get—for example, by raising the price of alcohol and keeping the U.S. Minimum Legal Drinking Age at 21. Enacting zero-tolerance laws that outlaw driving after any amount of drinking for people younger than 21 can also help prevent problems.

Warning Signs of Underage Drinking

Adolescence is a time of change and growth, including behavior changes. These changes usually are a normal part of growing up but sometimes can point to an alcohol problem. Parents play a key role in shaping their kids’ attitudes toward alcohol and alcohol behaviors (See the Parenting to Prevent Alcohol Use fact sheet). Parents, families, and teachers should pay close attention to the following warning signs that may indicate underage drinking:6,7

  • Changes in mood, including anger and irritability
  • Academic or behavioral problems in school
  • Rebelliousness
  • Changing groups of friends
  • Low energy level
  • Less interest in activities or care in appearance
  • Finding alcohol among an adolescent's belongings
  • Smelling alcohol on an adolescent's breath
  • Problems concentrating or remembering
  • Slurred speech
  • Coordination problems

Treating Underage Drinking Problems

Screening youth for alcohol use and AUD is very important and may prevent problems down the road. Screening by a primary care provider or other health practitioner (e.g., pediatrician) provides an opportunity to identify problems early and address them before they escalate. It also allows adolescents to ask questions of a knowledgeable adult. NIAAA and the American Academy of Pediatrics both recommend that all youth be regularly screened for alcohol use.

Some youth can experience serious problems because of drinking, including AUD, which require intervention by trained professionals. Professional treatment options include:

  • Attending individual or group counseling sessions one or more times per week
  • Receiving a prescription from a primary care provider or psychiatrist to help reduce alcohol cravings
  • Participating in family therapy to build a supportive foundation for recovery

For more information, visit the Underage Drinking landing page.

References


1. Substance Abuse and Mental Health Services Agency (SAMHSA), Center for Behavioral Health Statistics and Quality. The DAWN Report: Alcohol and drug combinations are more likely to have a serious outcome than alcohol alone in emergency department visits involving underage drinking. Rockville, MD: SAMHSA; 2014 [cited 2023 Feb 20]. Available from: https://www.samhsa.gov/data/sites/default/files/spot143-underage-drinking-2014/spot143-underage-drinking-2014/spot143-underage-drinking-2014.pdf

2. Waterman EA, Lee KDM, Edwards KM. Longitudinal associations of binge drinking with interpersonal violence among adolescents. J Youth Adolesc. 2019 Jul;48:1342–52, 2019. PubMed PMID: 31079263

3. Age at drinking onset: age when first drank a beverage containing alcohol (a can or bottle of beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with liquor in it), not counting a sip or two from a drink. AUD: having met two or more of the 11 AUD diagnostic criteria according to the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). AUD risk across different ages at drinking onset is compared using the prevalence ratio weighted by the person-level analysis weight. Derived from the CBHSQ 2023 National Survey on Drug Use and Health (NSDUH-2023-DS0001) public-use file. [cited 2025 Jan 2]. Available from: https://www.samhsa.gov/data/data-we-collect/nsduh/datafiles

4. NIAAA. Defining binge drinking. What colleges need to know now: an update on college drinking. Bethesda (MD): National Institutes of Health; 2007 Nov. Defining binge drinking, p. 2. [cited 2023 Feb 20]. Available from: https://www.collegedrinkingprevention.gov/media/1College_Bulletin-508_361C4E.pdf

5. Chung T, Creswell KG, Bachrach R, Clark DB, Martin CS. Adolescent binge drinking: developmental context and opportunities for prevention. Alcohol Res. 2018;39(1):5–15. PubMed PMID: 30557142

6. Rusby JC, Light JM, Crowley R, Westling E. Influence of parent-youth relationship, parental monitoring, and parent substance use on adolescent substance use onset. J Fam Psychol. 2018 Apr;32(3):310–20. PubMed PMID: 29300096

7. SAMHSA [Internet]. How to tell if your child is drinking alcohol. Rockville (MD): SAMHSA; [updated 2022 Apr 14; cited 2023 Feb 20]. Available from: https://www.samhsa.gov/underage-drinking/parent-resources/how-tell-if-your-child-drinking-alcohol

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