Alcohol Use - Youth in United States

United States

Alcohol is the most commonly used substance among high school students in the United States. In 2014, there were more than 57,000 alcohol-related emergency department visits among children ages 12-17. Each year, approximately 4,000 youth under 21 die from excessive drinking. 

Risks associated with underage drinking include:

• Academic issues, such as increased absences and lower grades.
• Higher risk of developing an alcohol use disorder later in life.
• Depression, anxiety and other mental illnesses.
• Impaired judgment, which can lead to engaging in risky behaviors like violence, driving under the influence or unsafe sexual behavior.
• Legal consequences of actions taken while under the influence.
• Delayed puberty. 

Adolescence is a high-risk period for binge drinking. Most alcohol consumption among underage drinkers occurs in binge episodes (4 to 5 drinks per drinking episode). Binge drinking is more likely to lead to alcohol poisoning and fatal accidents, and has been linked to decreased cognitive functioning among adolescents during a critical and vulnerable time in their neurodevelopment. Underage binge drinking also increases the risk of physical and sexual assault.

In 2013, underage drinking cost the U.S. $59.6 billion in direct and indirect costs.

The prevalence of alcohol use is higher among:

• Girls compared with boys.
• Non-Hispanic white and Hispanic youth compared with non-Hispanic Black youth.
• Lesbian, gay and bisexual students compared with students who identify as heterosexual, questioning or other.
• Youth ages 16-17 compared with those ages 12-13.

Strategies to prevent excessive drinking, including underage alcohol use, include:

• Increasing alcohol taxes.
• Regulating and restricting the number and concentration of alcohol stores. 
• Enforcing the law against selling alcohol to youth.
• Implementing dram shop liability laws, which hold liquor establishments legally responsible for harm caused by or to minors to whom they have sold alcohol.
• Reducing exposure to alcohol advertising.

Parents have a strong influence on a child’s attitude toward alcohol. Communicating the dangers of alcohol to children, setting a good example and deglamorizing alcohol can help children make good decisions about alcohol. Parents should also monitor the alcohol supply in their homes and ensure children can’t access it without permission. The Substance Abuse and Mental Health Services Administration provides resources and information through their “Talk. They Hear You.” campaign to help parents, teachers and community members have conversations about and take action against underage drinking.

The Community Guide provides additional evidence-based strategies to prevent and reduce excessive alcohol use among youth. The Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking also offers tips on how to combat underage drinking at the community and individual levels. 

Healthy People 2030 has a goal to reduce the number of adolescents ages 12-17 who reported drinking alcohol in the past month.

Chung, Tammy, Kasey G. Creswell, Rachel Bachrach, Duncan B. Clark, and Christopher S. Martin. “Adolescent Binge Drinking.” Alcohol Research: Current Reviews 39, no. 1 (2018): 5–15.

Dees, William L., Jill K. Hiney, and Vinod K. Srivastava. “Alcohol and Puberty: Mechanisms of Delayed Development.” Alcohol Research: Current Reviews 38, no. 2 (2017): 277–82.

Hoots, Brooke E., Jingjing Li, Marci Feldman Hertz, Marissa B. Esser, Adriana Rico, Evelyn Y. Zavala, and Christopher M. Jones. “Alcohol and Other Substance Use Before and During the COVID-19 Pandemic Among High School Students — Youth Risk Behavior Survey, United States, 2021.” MMWR Supplements 72, no. 1 (April 28, 2023): 84–92. https://doi.org/10.15585/mmwr.su7201a10.

Lees, Briana, Lindsay R. Meredith, Anna E. Kirkland, Brittany E. Bryant, and Lindsay M. Squeglia. “Effect of Alcohol Use on the Adolescent Brain and Behavior.” Pharmacology Biochemistry and Behavior 192 (May 2020): 172906. https://doi.org/10.1016/j.pbb.2020.172906.

U.S. Department of Health and Human Services. “The Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking: A Guide to Action for Communities.” Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General, 2007. https://www.hhs.gov/sites/default/files/underage-drinking-community-guide.pdf.

White, Aaron M., Megan E. Slater, Grace Ng, Ralph Hingson, and Rosalind Breslow. “Trends in Alcohol-Related Emergency Department Visits in the United States: Results from the Nationwide Emergency Department Sample, 2006 to 2014.” Alcoholism: Clinical and Experimental Research 42, no. 2 (February 2018): 352–59. https://doi.org/10.1111/acer.13559.