Understanding the risks and effects of alcohol use on adolescents.
Adolescents and alcohol
We all want our rangatahi to grow into happy, healthy young adults ready to live awesome lives and contribute to their communities. Adolescence is an exciting and important time in development; there are many opportunities, and there are also risks. One of the things that can pose a risk for young people is drinking alcohol.
Alcohol can influence how their development unfolds. Having a good understanding of what’s known can help parents, whānau and others guide rangatahi successfully. If rangatahi are parents themselves, their drinking can negatively affect their pēpi too.
Risks of alcohol
Risks that parents and whānau may be less aware of include criminal behaviour,[iii] such as stealing.[iv] Increased mental health difficulties are associated with alcohol use, including depression[v] and alcohol abuse or dependence in adulthood.[vi]
Rangatahi who drink alcohol are at greater risk than their peers. These risks may involve early sexual activity,[vii] unwanted sex, risky sex[viii] including having multiple partners,[ix] sexual abuse, unplanned pregnancy and sexually transmitted infections.[x]
Drinking alcohol increases the risk of deliberate self-harm and suicide.[xi] Alcohol affects neurotransmitters, which are the chemicals used by brain cells to send messages to each other. This can lead to feelings of greater unhappiness, increased aggression, more difficulty finding effective solutions to problems, and more impulsive behaviour. These are some of the ways in which drinking alcohol is linked to suicide attempts by those who are already vulnerable.[xii]
Drinking among school students in New Zealand
A study of New Zealand secondary school students aged 13–18 shows a wide range of behaviours when it comes to alcohol. More than half the students had tried alcohol (57%) and almost half (45%) had further drinks after their first one. Of those who were drinking, over half (56%) had drunk alcohol once or less in the past month. Of concern is that almost a quarter of drinking students (23%) had been binge drinking in the past month, and a small but very worrying group (5%) reported drinking several times each week or on most days.[xiii]
On the other hand, a large group have not tried alcohol (43%). This figure is important; rangatahi who think that many of their friends and schoolmates are drinking are more likely to do so themselves.[xiv] Parents are also influenced by what they think everyone else is doing. While it may feel as though ‘everyone else is drinking’, the reality is a large proportion of under-18s are not.
The age at which tamariki or rangatahi first drink alcohol matters. The younger they are when they start to drink, the greater the chance that they will have alcohol-related problems[xv] or other substance abuse[xvi] in adulthood.
One large study found that those who began drinking before they were 14 had a 40% chance of alcohol dependence, while those who waited until 20 years or older had a 10% chance. Those who started drinking before they were 15 were 2 to 3 times more likely to develop alcohol abuse or dependence than those who began drinking when they were 19 or older.[xvii] Every extra year that rangatahi wait before beginning drinking lessens the chance of later alcohol abuse or dependence.[xviii]
Children don’t have to have a whole drink to be affected. A study found that children who had sipped alcohol before they were 10 years old were almost twice as likely to be drinking by 15 years.[xix]
It’s because of research findings such as these that guidelines in several countries (including Aotearoa) recommend that people under 15 years not drink any alcohol, and those under 18 years delay drinking for as long as possible.[xx]
Unsurprisingly, parents’ attitudes towards alcohol influence their rangatahi. Whether or not young people drink, and if so, how they drink, is influenced by their parents in a significant way.
Many parents wanting to support their rangatahi think that they can teach them to drink safely by giving them alcohol and watching over them.[xxiv] Although this is well-intended and commonly believed, many studies now show that parent approval of any level of drinking, and parents supplying alcohol, is linked to worse, rather than better outcomes.[xxv]
Rangatahi who have parents who usually know where they are, what they’re doing and who they’re with, are likely to drink less.[xxvi]
Rangatahi who may need more support
Sadly, those who’ve experienced maltreatment, including sexual abuse and seeing family violence, are more likely to begin drinking at younger ages and develop alcohol dependence.[xxvii]
Both genes and experiences can contribute to alcohol problems.[xxviii] Family history of alcohol problems does not make alcohol issues inevitable. One study found that a young person’s environment had a bigger impact on whether or not they developed alcohol-related problems.[xxix] Those with a family history of alcohol issues may benefit more by parents and whānau encouraging them to delay beginning to drink alcohol.[xxx]
Studies on the brain are finding that some people who go on to have problems with alcohol had brain differences before they began drinking, which may have made them more prone to developing problems. Of course, we can’t always tell who these young people at greater risk might be, and it’s possible these are the rangatahi who would most benefit from delaying drinking.
What’s different about drinking in adolescence?
While some rangatahi may look like adults, alcohol affects them differently from how it affects adults. Just because they may be towering over their parents in height doesn’t mean they’re adults just yet!
Animal studies suggest that adolescents are less sensitive to some of alcohol’s short-term negative effects on their movement and sleepiness[xxxi] but more sensitive to some of its positive effects, such as feeling more social[xxxii]. This means adolescents may find it more difficult to recognise signs that they should stop drinking and that may contribute to their drinking more than adults.[xxxiii]
Alcohol and the adolescent brain
A lot of things are changing during adolescence. Along with changing bodies, schools, taste in music, and clothing styles, their brains are changing too. In recent years we’ve realised that there are a lot of changes happening in the brains of young people, much more than was known previously. This is a really important time for rangatahi as they gradually leave childhood behind and move towards becoming adults. What happens during these years affects how well-placed they will be to become the adults in their whānau and wider communities. Positive experiences, chances to practise skills and follow their interests with strong, loving whānau support will set them up to do well.
During times of rapid brain development, the brain is more easily affected by what happens to a young person. If we think of the adult brain as being like a baked clay coffee mug, the adolescent brain is still like a piece of damp clay that hasn’t finished being shaped yet. Because it’s still soft, it can be shaped and changed in many ways, large or small.
In a similar way, the adolescent brain is more open to positive opportunities. It also means they may be more affected by not-so-good things. This is one of the reasons why drinking in adolescence is different from drinking in adulthood. The effects of alcohol are happening when the brain is busy growing, and alcohol can affect how the brain grows.
The ways in which alcohol affects the adolescent brain is complicated; it depends on lots of things, including which area of the brain we’re looking at, and whether rangatahi are male or female. Some studies look at the brain structure, where heavy drinking is linked to some areas of the brain being smaller.[xxxiv] Other studies look at how the brain is working.
Some things are clear though: drinking in adolescence, especially when it’s heavy, can change the brain.[xxxv] If an adolescent and an adult drink the same amount, the adolescent is more likely to be harmed by it.[xxxvi]
While most of us know about the possible short-term effects of drinking too much, such as slurred speech and difficulty taking in information, it’s less widely known that problematic drinking in adolescence can have more lasting effects on the brain and how it works, even after a period of non-drinking[xxxvii]. Drinking can affect adolescents long after their hangover wears off.
Alcohol in pregnancy
Rangatahi who are sexually active may need information and support around the effects of drinking alcohol during pregnancy. Alcohol can have a range of negative effects on pēpi during pregnancy, which last throughout their life. These can include learning, behaviour and attention problems, as well as intellectual disability.[xxxviii]
Many studies agree; there is no known safe amount or safe time to drink during pregnancy.[xxxix]
Younger women are more likely to drink during pregnancy than older women,[xl] so information and support to understand the risks is especially important for young pregnant women. Even if they were drinking before realising they were pregnant, stopping drinking for the rest of their pregnancy lowers the risk for pēpi. The harm from alcohol can be prevented, but cannot be cured.
- Alcohol affects rangatahi differently from how it affects adults.
- Parents and whānau have a very important role in supporting rangatahi.
- Delaying drinking reduces the risk of alcohol-related problems.
- Parents providing alcohol to rangatahi is not found to be helpful — in fact, it’s linked to more likely harm.
- Alcohol drunk in pregnancy can have severe and lasting effects on pēpi.
- There is no safe amount nor safe time in which to drink alcohol when pregnant.
Abar, C., Turrissi, R. J., & Mallett, K. A. (2014). Differential trajectories of alcohol-related behavior across the first year of college by parenting profiles. Psychology of Addictive Behaviors, 28(1), 53–61.
Adolescent Health Research Group. (2013). The health and wellbeing of New Zealand secondary school students in 2012: Youth’12 prevalence tables. Retrieved from https://www.fmhs.auckland.ac.nz/assets/fmhs/faculty/ahrg/docs/2012prevalence-tables-report.pdf(external link)
Anderson, P., de Bruijn, A., Angus, K., Gordon, R., & Hastings, G. (2009). Impact of alcohol advertising and media exposure on adolescent alcohol use: A systematic review of longitudinal studies. Alcohol and Alcoholism, 44(3), 229–243.
Borges, G., Bagge, C. L., Cherpitel, C. J., Conner, K. R., Orozco, R., & Rossow, I. (2016). A meta-analysis of acute use of alcohol and the risk of suicide attempt. Psychological Medicine, 47(5), 949–957.
Brown, S. A., Tapert, S. F., Granholm, E., & Delis, D. C. (2000). Neurocognitive functioning of adolescents: Effects of protracted alcohol use. Alcoholism: Clinical and Experimental Research, 24(2), 164–171.
Clark, T. C., Fleming, T., Bullen, P., Denny, S., Crengle, S., Dyson, B., . . . Utter, J. (2013). Youth’12 overview: The health and wellbeing of New Zealand secondary school students in 2012. Retrieved from https://www.fmhs.auckland.ac.nz/assets/fmhs/faculty/ahrg/docs/2012-overview.pdf(external link)
Dawson, D. A., Goldstein, R. B., Chou, S. P., Ruan, W. J., & Grant, B. F. (2008). Age at first drink and the first incidence of adult-onset DSM-IV alcohol use disorders. Alcoholism: Clinical and Experimental Research, 32(12), 2149–2160.
Donovan, J. E., & Molina, B. S. G. (2014). Antecedent predictors of children’s initiation of sipping/tasting alcohol. Alcoholism: Clinical and Experimental Research, 38(9), 2488–2495.
Fergusson, D. M., & Boden, J. M. (2011). Alcohol use in adolescence. In P. Gluckman & H. Hayne (Eds.), Improving the transition: Reducing social and psychological morbidity during adolescence (pp. 235–256). Auckland, New Zealand: Office of the Prime Minister’s Science Advisory Committee.
Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2009). Tests of causal links between alcohol abuse or dependence and major depression. Archives of General Psychiatry, 66(3), 260–266.
Grant, B. F., & Dawson, D. A. (1997). Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: Results from the National Longitudinal Epidemiologic Survey. Journal of Substance Abuse, 9, 103–110.
Jones, S. C. (2016). Parental provision of alcohol: A TPB-framed review of the literature. Health Promotion International, 31, 562–571.
Jones, S. C., Magee, C., & Andrews, K. (2015). ‘I think other parents might…’: Using a projective technique to explore parental supply of alcohol. Drug and Alcohol Review, 34(5), 531–539.
Kelly, A. B., Chan, G. C. K., Weier, M., Quinn, C., Gullo, M. J., Connor, J. P., & Hall, W. D. (2016). Parental supply of alcohol to Australian minors: An analysis of six nationally representative surveys spanning 15 years. BMC Public Health, 16(1), 325.
Lyons, A. C., McCreanor, T., Hutton, F., Goodwin, I., Barnes, M., Griffin, C., . . . Samu, L. (2014). Flaunting it on Facebook: Young adults, drinking cultures and the cult of celebrity. Retrieved from http://mro.massey.ac.nz/handle/10179/5187(external link)
Matua Raki. (2017). Bridging the gap: Young people and substance use. Retrieved from https://www.matuaraki.org.nz/resources/bridging-the-gap-young-people-and-substance-use/711(external link)
McDonough, M. H., Jose, P. E., & Stuart, J. (2016). Bi-directional effects of peer relationships and adolescent substance use: A longitudinal study. Journal of Youth and Adolescence, 45, 1652–1663.
Ministry of Health. (2010). Alcohol and pregnancy: A practical guide for health professionals. Wellington, New Zealand: Ministry of Health, Retrieved from https://www.health.govt.nz/publication/alcohol-and-pregnancy-practical-guide-health-professionals(external link)
Ministry of Health. (2015). Alcohol use 2012/13: New Zealand health survey. Retrieved from https://www.health.govt.nz/publication/alcohol-use-2012-13-new-zealand-health-survey(external link)
National Scientific Council on the Developing Child. (2006). Early exposure to toxic substances damages brain architecture: Working paper #4. Retrieved from https://developingchild.harvard.edu/resources/early-exposure-to-toxic-substances-damages-brain-architecture/
Newton-Howes, G., & Boden, J. M. (2016). Relation between age of first drinking and mental health and alcohol and drug disorders in adulthood: Evidence from a 35-year cohort study. Addiction, 111(4), 637–644.
Norstrom, T., & Rossow, I. (2016). Alcohol consumption as a risk factor for suicidal behavior: A systematic review of associations at the individual and at the population level. Archives of Suicide Research, 20(4), 489–506.
Oberleitner, L. M., Smith, P. H., Weinberger, A. H., Mazure, C. M., & McKee, S. A. (2015). Impact of exposure to childhood maltreatment on transitions to alcohol dependence in women and men. Child Maltreatment, 20(4), 301–308.
Palmer, R. H., Young, S. E., Hopfer, C. J., Corley, R. P., Stallings, M. C., Crowley, T. J., & Hewitt, J. K. (2009). Developmental epidemiology of drug use and abuse in adolescence and young adulthood: Evidence of generalized risks. Drug & Alcohol Dependence, 102(1–3), 78–87.
Park, A., Sher, K. J., Todorov, A., & Heath, A. C. (2011). Interaction between the DRD4VNTR polymorphism and proximal and distal environments in alcohol dependence during emerging and young adulthood. Journal of Abnormal Psychology, 120, 585–595.
Pfefferbaum, A., Kwon, D., Brumback, T., Thompson, W. K., Cummins, K., Tapert, S. F., . . . Sullivan, E. V. (2017). Altered brain developmental trajectories in adolescents after initiating drinking. American Journal of Psychiatry, 175(4), 370–380. https://doi.org/10.1176/appi.ajp.2017.17040469(external link)
Rothman, E. F., Wise, L. A., Bernstein, E., & Bernstein, J. (2009). The timing of alcohol use and sexual initiation among a sample of Black, Hispanic and White adolescents. Journal of Ethnic Substance Abuse, 8(2), 129–145.
Ryan, S. M., Jorm, A. F., Kelly, C. M., Hart, L. M., Morgan, A. J., & Lubman, D. I. (2011). Parenting strategies for reducing adolescent alcohol use: A Delphi consensus study. BMC Public Health,11(1), 13.
Savage, J. E., Rose, R. J., Pulkkinen, L., Silventoinen, K., Korhonen, T., Kaprio, J., . . . Dick, D. M. (2017). Early maturation and substance use across adolescence and young adulthood: A longitudinal study of Finnish twins. Development and Psychopathology, 30(1), 79–92. https://doi.org/10.1017/S0954579417000487(external link)
Seglem, K. B., Waaktaar, T., Ask, H., & Torgersen, S. (2016). Sex differences in genetic and environmental contributions to alcohol consumption from early adolescence to young adulthood. Addiction, 111, 1188–1195.
Spear, L. P. (2014). Adolescents and alcohol: Acute sensitivities, enhanced intake, and later consequences. Neurotoxicology and Teratology, 41(Supplement C), 51–59.
Squeglia, L. M., Rinker, D. A., Bartsch, H., Castro, N., Chung, Y., Dale, A. M., . . . Tapert, S. F. (2014). Brain volume reductions in adolescent heavy drinkers. Developmental Cognitive Neuroscience, 9, 117–125.
White, V., & Bariola, E. (2006). Australian secondary school students’ use of alcohol in 2005. Retrieved from http://webarchive.nla.gov.au/gov/20110309153937/http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/mono58(external link)
WHO. (2015). Young people and alcohol.A resource book. Retrieved from http://iris.wpro.who.int/bitstream/handle/10665.1/10929/9789290616849_eng.pdf(external link)
Windle, M., Spear, L. P., Fuligni, A. J., Angold, A., Brown, J. D., Pine, D., . . . Dahl, R. E. (2009). Transitions into underage and problem drinking.Alcohol Research & Health, 32(1), 30–40.
[i] Fergusson & Boden, 2011
[ii] White & Bariola, 2006
[iii] Fergusson & Boden, 2011, cited by Matua Raki, 2017
[iv] Clark et al., 2013
[v] Fergusson, Boden, & Horwood, 2009
[vi] Palmer et al., 2009
[vii] Rothman, Wise, Bernstein, & Bernstein, 2009
[viii] Clark et al., 2013
[ix] Windle et al., 2009
[x] Matua Raki, 2017
[xi] Norstrom & Rossow, 2016
[xii] Borges et al., 2016
[xiii] Adolescent Health Research Group, 2013
[xiv] Gazis et al., 2010, cited by McDonough, Jose, & Stuart, 2016
[xv] Ministry of Health, 2015
[xvi] Windle et al., 2009
[xvii] Dawson, Goldstein, Chou, Ruan, & Grant, 2008
[xviii] Grant & Dawson, 1997
[xix] Donovan & Molina, 2011, cited by Donovan & Molina, 2014
[xx] Ryan et al., 2011
[xxi] Anderson, de Bruijn, Angus, Gordon, & Hastings, 2009
[xxii] Kelly et al., 2016
[xxiii] Lyons et al., 2014
[xxiv] Jones, Magee, & Andrews, 2015
[xxv] Abar, Turrissi, & Mallett, 2014; Jones, 2016
[xxvi] Savage et al., 2017
[xxvii] Newton-Howes & Boden, 2016; Oberleitner, Smith, Weinberger, Mazure, & McKee, 2015;
[xxviii] Park, Sher, Todorov, & Heath, 2011
[xxix] Seglem, Waaktaar, Ask, & Torgersen, 2016
[xxx] Park, Sher, Todorov, & Heath, 2011
[xxxi] Windle et al., 2009
[xxxii] Spear, 2014
[xxxiii] Spear, 2014
[xxxiv] Squeglia et al., 2014
[xxxv] Pfefferbaum et al., 2017
[xxxvi] Spear, 2014
[xxxvii] Brown, Tapert, Granholm, & Delis, 2000
[xxxviii] National Scientific Council on the Developing Child, 2006
[xxxix] Minstry of Health, 2010
[xl] Ministry of Health, 2015