Risks of underage drinking

Puberty and the teenage years are a time of change. Your child may have just started high school or just gotten a driver's license. They may have a sense of freedom they never had before.

Teenagers are curious. They want to explore and do things their own way. But pressure to fit in might make it hard to resist alcohol if it seems like everyone else is trying it.

When a child begins drinking before age 15, they are much more likely to become a long-term drinker, or problem drinker. About 1 in 5 teens are considered problem drinkers. This means they:

• Get drunk
• Have accidents related to drinking
• Get into trouble with the law, their families, friends, schools, or the people they date

The best time to begin talking with your teen about drugs and alcohol is now. Children as young as 9 years old may become curious about drinking and they may even try alcohol.

Drinking can lead to making decisions that cause harm. Alcohol use means any of the following are more likely to occur:

• Car crashes
• Falls, drowning, and other accidents
• Suicide
• Violence and homicide
• Being a victim of violent crime

Alcohol use can lead to risky sexual behavior. This increases the risk for:

• Sexually transmitted infections
• Unwanted pregnancy
• Sexual assault or rape

Over time, too much alcohol damages brain cells. This can lead to behavior problems and lasting damage to memory, thinking, and judgment. Teens who drink tend to do poorly in school and their behaviors may get them into trouble.

The effects of long-term alcohol use on the brain may be lifelong. Drinking also creates a higher risk for depression, anxiety, and low self-esteem.

Drinking during puberty can also change hormones in the body. This can disrupt growth and puberty.

Too much alcohol at one time can cause serious injury or death from alcohol poisoning. This can occur with having as few as 4 to 5 drinks within 2 hours.

If you think your child is drinking but will not talk with you about it, get help. Your child's health care provider may be a good place to start. Other resources include:

• Local hospitals
• Public or private mental health agencies
• Counselors at your child's school
• Student health centers
• Programs such as SMART Recovery Help for Teens and Young Adults or Alateen, part of the Al-Anon program

Risky drinking - teen; Alcohol - underage drinking; Problem underage drinking; Underage drinking - risks

Gilligan C, Wolfenden L, Foxcroft DR, et al. Family-based prevention programmes for alcohol use in young people. Cochrane Database Syst Rev. 2019;3(3):CD012287. PMID: 30888061 pubmed.ncbi.nlm.nih.gov/30888061/.

National Institute on Alcohol Abuse and Alcoholism website. Alcohol screening and brief intervention for youth: a practitioner's guide. www.niaaa.nih.gov/sites/default/files/publications/NIAAA_AlcoholScreening_Youth_Guide.pdf. Updated August 2021. Accessed May 1, 2024.

National Institute on Alcohol Abuse and Alcoholism website. Make a difference: talk to your child about alcohol - parents. www.niaaa.nih.gov/publications/brochures-and-fact-sheets/make-a-difference-child-alcohol. Updated August 2023. Accessed June 10, 2024.

National Institute on Alcohol Abuse and Alcoholism website. Underage drinking. www.niaaa.nih.gov/publications/brochures-and-fact-sheets/underage-drinking. Updated February 2024. Accessed May 1, 2024.

Quigley J, Committee on Substance Use and Prevention. Alcohol use by youth. Pediatrics. 2019;144 (1): e20191356. PMID: 31235610 pubmed.ncbi.nlm.nih.gov/31235610/.

Updated by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.