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The Dangers of Underage Alcohol Abuse

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In the United States, the National Minimum Drinking Age Act prevents anyone under 21 from purchasing or possessing alcoholic beverages.1 Although many legal measures exist to stop underage drinking, it is still a nationwide problem among teenagers and young adults. You may be wondering, what are the consequences of drinking under 21? And why do teens take such risks?

Why Do Teenagers Use Alcohol?

Teens may use alcohol for a myriad of reasons. Misusing alcohol is a risk-taking behavior, but so are other experiences in the teenage years. Positive risks help a teen grow and mature, while negative risks slow growth and development. These formative years bring numerous internal and external changes that affect decision-making, including alcohol abuse.

The Brain

Brains do not stop developing until a person is in their mid-twenties. The pre-frontal cortex in the brain is responsible for making decisions and making judgments by thinking of the potential for consequences. In the teenage years, the pre-frontal cortex is still developing. Teens are likely to make impulsive and risky decisions, especially when influenced by other factors.3

Peer Influence

Teenagers spend a lot of time with peers. Some spend more time with peers than their families. If adolescents surround themselves with peers who misuse alcohol, they may be encouraged to engage in underage drinking. Teens who give in to peer pressure are more likely to have low self-esteem, seek high-sensation activities, and have genetic sensitivity involving dopamine receptors in the brain.4

Social influences may also play a role in drinking before 21. Those in a gang may feel the need to drink alcohol or misuse substances. Some teens who are bullied or have deviant peer relationships may be more likely to consume alcohol to escape mentally.5


Non-nurturing environments don’t supply teens with the coping skills or guidance needed to help them avoid risky behaviors. Some environments even encourage risk-taking behaviors. For example, teens with parents who have alcohol use disorder or parents who promote underage drinking in the home environment are more likely to engage in underage drinking in high school.

Other environmental influences include:6

  • Sibling alcohol misuse
  • Availability and access to alcohol
  • Adverse life events contributing to adolescent risk-taking behaviors

Adverse events can include childhood physical or sexual abuse, poverty, racism, and other traumatic experiences, such as bullying, discrimination, and harassment.6

Mental Health

Teens with diagnosed or undiagnosed mental health conditions may be more likely to engage in drinking before 21. Disorders like attention-deficit/hyperactivity disorder (ADHD), depression, and anxiety may increase an adolescent’s risk of underage drinking. Some teens may use alcohol as a form of self-medicating troubling symptoms, although alcohol only provides temporary relief and only contributes to further complications down the road.5

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How Many Teenagers Use Alcohol?

The number of teens participating in underage drinking in high school is alarming. Recent research shows nearly 30% of teens have had at least one drink by the age of 15.7

Also, 11% of all alcohol consumed in America is done so by teens, who are more likely to binge drink, consuming much more alcohol at one time. For example, binge drinking for teen girls means having four or more alcoholic beverages within a few hours and five or more drinks for boys.7

A recent study found that over 800,000 adolescents reported binge drinking at least four days in the previous month.7 According to the National Institute on Alcohol Abuse and Alcoholism, over 400,000 youth between the ages of 12 and 17 have alcohol use disorder. Among college students under the age of 22, an estimated 20% met the criteria for alcohol use disorder.8

What Are the Risks of Teenage Alcohol Use?

Consequences and risks of underage drinking can affect all areas of a teen’s life, including their physical and mental health, academic performance, social life, and more. Some risks may even be life-threatening.

Drinking and Driving

Adolescents are at a much higher risk for car crashes, including fatal collisions. The Insurance Institute for Highway Safety reports 16– to 19-year-olds driving under the influence are three times more likely to experience a fatal car crash than those above the age of 20.9 Reasons, other than the misuse of substances, include risky behaviors such as:9

  • Speeding
  • Passing cars when it is not safe
  • Texting while driving
  • Sensation seeking
  • Peer pressure
  • Inexperience

Alcohol Poisoning

Teens may be at an increased risk for alcohol poisoning or alcohol overdose. This is because adolescents and young adults tend to engage in frequent binge drinking. Drinking large amounts of alcohol in a relatively short period of time can interfere with the body’s ability to metabolize alcohol, leading to a build-up of alcohol in the system and a rapidly increasing blood alcohol concentration (BAC). And as BAC increases, so do the risks of experiencing potentially life-threatening consequences.11

Altered Brain Development

Since the teenage brain is still in development, a substance like alcohol can alter the brain’s structure and function. Teens who misuse alcohol may experience numerous brain-related consequences, including:12

  • Short-term and long-term memory recall problems
  • Learning difficulties
  • Cognitive function declines
  • Reading ability declines
  • Psychomotor speed reduction
  • Attention difficulties
  • Gray and white matter growth slows
  • Brain is less sensitive to reward
  • Impulsive reactions increase

Mental Health Disorders

Much evidence exists supporting the connection between mental health and alcohol use disorders. One study in particular examined anxiety, depression, post-traumatic stress disorder (PTSD), and underage drinking. Results show that the earlier a person starts misusing alcohol, the more likely they are to develop a mental health disorder. This is found to be true among more people who were assigned female at birth than assigned male at birth.13

Alcohol Use Disorder

The younger a person starts drinking, the higher the risk of developing alcohol use disorder at some point in their life. Research indicates that adolescents who started drinking prior to age 15 are four times more likely to develop alcohol dependence or alcohol addiction than those who begin drinking at age 21.14

Who Is Most at Risk for Underage Alcohol Use?

Adolescents who are most at risk of consuming alcohol at an early age seem to share characteristics, like the following:15

  • Novelty-seeking temperament
  • Temperamental disinhibition
  • Observation of parental alcohol misuse

Other studies confirm that the less parental supervision a teen has, the more likely they are to misuse alcohol. Additional factors include:16

  • Transitioning from one grade to another in school, or from middle school to high school
  • Gaining more independence, such as driving, staying home alone, and earning money on their own
  • Changing peer groups, specifically hanging out more with peers who misuse alcohol
  • Increasing stress in a teen’s life or exposure to a traumatic event
  • Changing family dynamics through divorce, separation, remarriage

Gender makes a difference in underage alcohol misuse. Boys are more likely to binge drink at an earlier age than girls. However, both boys and girls drink for similar reasons, such as wanting to feel better, relaxing and reducing stress, and feeling more powerful. Teens are also curious and will take risks to find out how alcohol affects them physically and mentally.17

Race and ethnicity differences exist among high school students misusing alcohol. Those who are white have the highest prevalence of underage drinking in high school, and the group with the lowest sense of a need to stop. Hispanic results were similar to whites except that Hispanic-Whites had higher levels of risk. Native Americans were the second-highest level. However, they also have the highest desire to stop misusing alcohol. African Americans and Asian Americans presented as groups with the lowest risk of misusing alcohol in high school.18

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Treatment for Underage Alcohol Misuse

Treatment options for underage drinking include the following:

  • Inpatient medical detox
  • Specialized inpatient teen rehab
  • Residential care
  • Partial hospitalization
  • Intensive outpatient
  • Individual outpatient counseling

Adolescents can learn the skills necessary to avoid the dangers of drinking before 21, like developing alcohol use disorder. If you are struggling to control your alcohol use, this is one of the clinical criteria for alcohol use disorder. The next step should be to seek a professional assessment.

We can connect you to a treatment facility that provides assessments and comprehensive alcohol addiction treatment. Call us at 800-948-8417 Question iconCalls are forwarded to these paid advertisers . We are here 24/7.


  1. National Institute on Alcohol Abuse and Alcoholism. Underage Drinking. Alcohol Policy Information System.
  2. Balogh, K. N., Mayes, L. C., & Potenza, M. N. (2013). Risk-Taking and Decision-Making in Youth: Relationships to Addiction Vulnerability. Journal of Behavioral Addictions, 2(1), 10.1556/JBA.2.2013.1.1.
  3. Squeglia L. M. (2020). Alcohol and the Developing Adolescent Brain. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 19(3), 393-394.
  4. Griffin, A. M., Cleveland, H. H., Schlomer, G. L., Vandenbergh, D. J., & Feinberg, M. E. (2015). Differential Susceptibility: The Genetic Moderation of Peer Pressure on Alcohol Use. Journal of Youth and Adolescence, 44(10), 1841-1853.
  5. Whitesell, M., Bachand, A., Peel, J., & Brown, M. (2013). Familial, Social, and Individual Factors Contributing to Risk for Adolescent Substance Use. Journal of Addiction, 2013, 579310.
  6. Chartier, K. G., Karriker-Jaffe, K. J., Cummings, C. R., & Kendler, K. S. (2017). Review: Environmental Influences on Alcohol Use: Informing Research on the Joint Effects of Genes and the Environment in Diverse U.S. Populations.The American Journal on Addictions, 26(5), 446-460.
  7. National Institute on Alcohol Abuse and Alcoholism. (2020). Underage Drinking.
  8. National Institute on Alcohol Abuse and Alcoholism. (2020). Alcohol Facts and Statistics.
  9. Osilla, K. C., Seelam, R., Parast, L., & D’Amico, E. J. (2019). Associations Between Driving Under the Influence or Riding With an Impaired Driver and Future Substance Use Among Adolescents. Traffic Injury Prevention, 20(6), 563-569.
  10. Chikritzhs, T., & Livingston, M. (2021). Alcohol and the Risk of Injury. Nutrients, 13(8), 2777.
  11. National Institute on Alcohol Abuse and Alcoholism. (2021). Understanding the Dangers of Alcohol Overdose.
  12. Lees, B., Meredith, L. R., Kirkland, A. E., Bryant, B. E., & Squeglia, L. M. (2020). Effect of Alcohol Use on the Adolescent Brain and Behavior. Pharmacology, Biochemistry, and Behavior, 192, 172906.
  13. Berenz, E. C., McNett, S., Rappaport, L. M., Vujanovic, A. A., Viana, A. G., Dick, D., & Amstadter, A. B. (2019). Age of Alcohol Use Initiation and Psychiatric Symptoms Among Young Adult Trauma Survivors. Addictive Behaviors, 88, 150-156.
  14. National Institute on Alcohol Abuse and Alcoholism. (1998). Age of Drinking Onset Predicts Future Alcohol Abuse and Dependence.
  15. Armstrong, J. M., Ruttle, P. L., Burk, L. R., Costanzo, P. R., Strauman, T. J., & Essex, M. J. (2013). Early Risk Factors for Alcohol Use Across High School and Its Covariation with Deviant Friends. Journal of Studies on Alcohol and Drugs, 74(5), 746-756.
  16. Chung, T., Creswell, K. G., Bachrach, R., Clark, D. B., & Martin, C. S. (2018). Adolescent Binge Drinking. Alcohol Research: Current Reviews, 39(1), 5-15.
  17. U.S. Department of Justice. (2012). Effects and Consequences of Underage Drinking.
  18. Terry-McElrath, Y. M., & Patrick, M. E. (2020). U.S. Adolescent Alcohol Use by Race/Ethnicity: Consumption and Perceived Need to Reduce/Stop Use. Journal of Ethnicity in Substance Abuse, 19(1), 3-27.
  19. Saloner, B., Carson, N., & Lê Cook, B. (2014). Explaining Racial/Ethnic Differences in Adolescent Substance Abuse Treatment Completion in the United States: A Decomposition Analysis. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 54(6), 646-653.
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