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Epidemiology

Alcohol use by adolescents, hazards of alcohol use, factors that contribute to harmful use, genetic, familial, and environmental factors, other factors, adolescent developmental and neurobiological factors, normal adolescent brain development, effect of substances on adolescent brain development, screening and brief interventions, conclusions, lead authors, committee on substance use and prevention, 2018–2019, former committee member, alcohol use by youth.

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

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Sheryl A. Ryan , Patricia Kokotailo , COMMITTEE ON SUBSTANCE USE AND PREVENTION , Deepa R. Camenga , Stephen W. Patrick , Jennifer Plumb , Joanna Quigley , Leslie Walker-Harding; Alcohol Use by Youth. Pediatrics July 2019; 144 (1): e20191357. 10.1542/peds.2019-1357

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Alcohol use continues to be a major concern from preadolescence through young adulthood in the United States. Results of recent neuroscience research have helped to elucidate neurobiological models of addiction, substantiated the deleterious effects of alcohol on adolescent brain development, and added additional evidence to support the call to prevent and reduce underage drinking. This technical report reviews the relevant literature and supports the accompanying policy statement in this issue of Pediatrics .

Alcohol is the substance most widely used by adolescents, often in large volumes, although the minimum legal drinking age across the United States is 21 years. 1 Some people may initiate harmful alcohol consumption in childhood. The prevalence of problematic alcohol use continues to escalate from adolescence into young adulthood. Heavy episodic drinking by students enrolled in college remains a major public health problem. In results of recent research, it has been indicated that brain development continues well into early adulthood 2 and that alcohol consumption can interfere with such development, underscoring concerns that alcohol use by youth is an even greater pediatric health concern than previously thought. 3 , 4 This technical report supports the accompanied policy statement that outlines recommendations from the American Academy of Pediatrics (AAP). 5  

Alcohol, tobacco, and marijuana remain the substances most widely used by youth in the United States. There is both heartening and less heartening news about the use of alcohol by US youth, however. The 2018 Monitoring the Future Study, supported by the National Institute of Drug Abuse and conducted by the University of Michigan, is now in its 44th year of tracking the prevalence of alcohol, tobacco, and other drug use and youth perceptions of such use. A sample of more than 45 000 young people in eighth, 10th, and 12th grade in approximately 380 private and public secondary schools in the United States provides these data. 1 The data include use by youth in all 3 grades in their lifetime, in the past year (annual use), and in the 30 days preceding the survey as well as “binge” drinking, defined as the consumption of 5 or more drinks in a row on at least 1 occasion in the past 2 weeks, and “extreme binge drinking,” defined as the consumption of 10 or more drinks in a row in the previous 2 weeks. The good news is that there has been a long, substantial decline in alcohol use in all of these categories from peaks in the 1990s. For example, in 1997, the highest number of youth reported using alcohol over the previous year (61%); by 2018, 36.1% of youth in the 3 grades surveyed reported use in the 12 months before the survey. Perhaps even more important, the percentage of young people in the 3 grades reporting binge drinking decreased by half or more from peaks in 1997. In 2017, rates of lifetime prevalence, annual prevalence, and 30-day prevalence of alcohol use in all 3 grades showed plateauing, which was interpreted as a sign that the trend of declining rates was at an end. In addition, in 2017, 4% of eighth-graders, 10% of 10th-graders, and 17% of 12th-graders still reported binge drinking in the past 2 weeks, all slightly increased from 2016. 1 However, in 2018, declines in rates of use continued: the 30-day prevalence rates for eighth, 10th, and 12th-graders was 8%, 19%, and 30%, respectively, and the prevalence of binge drinking in the previous 2 weeks in 10th- and 12th-graders declined to 9% and 14%, respectively, although it remained at 4% for eighth-graders. For the 3 grades combined, this survey documented the lowest levels of alcohol use and binge drinking that have been recorded to date. 1 The criterion used for binge drinking as 5 or more drinks in a row has been thought to be too high, especially for younger children and girls, with the literature suggesting that for 9- to 13-year-old children and 14- to 17-year-old girls, binge drinking should be defined as 3 or more drinks. For boys, binge drinking should be defined as 4 or more drinks for those 14 or 15 years old and 5 or more drinks for those 16 or 17 years old. 6  

To examine higher levels of consumption by 12th-graders, the Monitoring the Future study has more recently been tracking 2 levels of extreme binge drinking, defined as having 10 or more or 15 or more drinks in a row on at least 1 occasion in the preceding 2 weeks. These measures have also declined from 11% in 2005 (the first year of this category’s measurement) to 4.6% for the 10 drinks in a row category and from 6% to 2.5% for 15 drinks in a row in 2018. Each of these measures increased slightly from 2016 to 2017 but resumed the decline in 2018. 1 Declines in perceived availability as well as increased peer disapproval of binge drinking may be some of the factors that are contributing to these lower prevalence numbers. 1 These epidemiologic statistics are corroborated by data from 2 other large surveys of youth alcohol use in the United States: the Youth Risk Behavior Survey, conducted biannually by the Centers for Disease Control and Prevention, and the National Survey on Drug Use and Health, conducted annually by the Substance Abuse and Mental Health Services Administration. 7 , 8  

Use of alcohol at an early age is particularly problematic and is associated with future alcohol-related problems. 9 , – 11 Data from the National Longitudinal Alcohol Epidemiologic Study indicate that the prevalence of both lifetime alcohol dependence and alcohol abuse, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria, show a striking decrease with increasing age at the onset of alcohol use. 9 According to the National Longitudinal Alcohol Epidemiologic Study, for people 12 years or younger at first use, the prevalence of lifetime alcohol dependence was 40.6%. In contrast, for people who initiated alcohol consumption at 18 years of age, the prevalence was 16.6%, and for those who initiated drinking at 21 years, the prevalence was 10.6%. Similarly, the prevalence of lifetime alcohol abuse was 8.3% for those who initiated use at 12 years or younger, 7.8% for those who initiated at 18 years, and 4.8% for those who initiated at 21 years. The contribution of age at alcohol use initiation to the odds of lifetime dependence and abuse varied little across sex and racial subgroups in the study. 9 In analyses of data from subsequent surveys, researchers have also illustrated this relationship between early initiation of drinking and subsequent alcohol use disorder (AUD). 12 , – 15  

Adolescent alcohol exposure covers a spectrum, from primary abstinence to alcohol dependence. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) 16 defines AUD as follows:

A problematic pattern of alcohol use leading to clinically significant impairment or distress as manifested by 2 or more of the following, occurring during a 12-month period: 1. Alcohol is often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use. 3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. 4. Craving, or a strong desire or urge to use alcohol. 5. Recurrent alcohol use results in a failure to fulfill major role obligations at work, school, or home. 6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. 7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use. 8. Recurrent alcohol use in situations in which it is physically hazardous. 9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. 10. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of alcohol. 11. Withdrawal, as manifested by either of the following: a. The characteristic withdrawal syndrome for alcohol. b. Alcohol is taken to relieve or avoid withdrawal symptoms. Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (Copyright 2013). American Psychiatric Association. All Rights Reserved.

The disorder is characterized as mild (2–3 symptoms), moderate (4–5 symptoms), or severe (6 or more symptoms). Because these diagnostic criteria were developed largely from research and clinical work with adults, there are limitations to applying these diagnostic criteria to classify alcohol use and associated risks to adolescents. 17 , – 19 As defined by the DSM-5, an adolescent, especially a younger one, may not have had time to develop an AUD, yet the adolescent may be engaging in very risky behavior. Despite being viewed as an improvement in specificity for adolescents, the applicability of these revised criteria may still be limited in that several of the criteria, such as withdrawal, are not typically experienced by adolescents, and other criteria, such as tolerance, have low sensitivity for adolescents. 20 Tolerance can be anticipated as a developmental process that will occur over time in most adolescents who drink. 17 Thus, an adolescent may present with a subsyndromal level of alcohol use that may not meet the formal threshold for addiction or an AUD but that may still be associated with significant impairments in social functioning and well-being. 21 These limitations to applying a diagnostic algorithm designed for adults to children and youth are often cited as a reason for advocating for the development of more age-appropriate criteria.

Alcohol misuse, although not a formal diagnosis, can be defined as “alcohol-related disturbances of behavior, disease, or other consequences that are likely to cause an individual, his/her family, or society harm now or in the future.” 22 Because the term “alcohol misuse” encompasses earlier stages of AUDs that do not meet diagnostic criteria, it may be a more useful concept clinically in pediatrics and when developing alcohol use primary prevention programs for youth.

Underage drinking is associated with wide range of negative consequences for adolescents, including adverse effects on normal brain development and cognitive functioning, risky sexual behavior, physical and sexual assaults, injuries, AUD, blackouts, alcohol overdose, and even death. When compared with use by adults, alcohol use by adolescents is much more likely to be episodic and in larger volumes (binge drinking), which makes alcohol use by those in this age group particularly dangerous. Rapid binge drinking puts the teenager at even higher risk of alcohol overdose or alcohol poisoning, in which suppression of the gag reflex and respiratory drive and hypoglycemia can be fatal. Binge drinking and its sequelae of elevated blood alcohol concentration (BAC) are especially dangerous for young people who, when compared with adults, may be less likely to be sedated and, therefore, more likely to engage in activities such as driving despite impairment in coordination and judgment. 23  

Alcohol use is a major contributor to the leading causes of adolescent death (ie, motor vehicle crashes, homicide, and suicide) in the United States. Motor vehicle crashes rank as the leading cause of death for US teenagers and young adults. Data from the 2017 Youth Risk Behavior Survey found that during the 30 days preceding the survey, 16.5% of high school students nationwide had ridden one or more times in a car or other vehicle driven by someone who had been drinking alcohol. Of the 62.6% of high school students reporting having driven in the 30 days preceding the survey, 5.5% of students had driven a car or other vehicle at least once when they had been drinking alcohol during this time. 7 These data represent a significant linear decline in reports of use while driving after alcohol use or riding with someone who had been drinking since 1991, when rates reported for riding with a drinking driver and driving oneself after drinking were 39.9% and 16.7%, respectively. 7 In further analysis of the Youth Risk Behavior Survey data, it was shown that in 2011, the prevalence of drinking and driving was more than 3 times higher among those youth who binge drank compared with those who reported current alcohol use but not binge drinking (32.1% vs 9.7%). 24  

The important relationship of alcohol use and motor vehicle crashes involving youth is also highlighted by the fact that after the legal drinking age was changed uniformly to 21 years across the United States, the number of motor vehicle fatalities in individuals younger than 21 years decreased significantly. 25 Since 1998, every state has enacted laws establishing a lower BAC for drivers younger than 21 years, referred to as “zero tolerance laws.” These laws are important because young people who drive after consuming any amount of alcohol pose risk to themselves and others. These laws are also estimated to have reduced alcohol-involved fatal crashes among inexperienced drivers by 9% to 24%. 26 Data show that for each 0.02 increase in BAC, the relative risk of a 16- to 20-year-old driver dying in a motor vehicle crash is estimated to be more than double. 27 Graduated driver licensing (GDL) systems have now been adopted in all 50 states and the District of Columbia. 28 These laws indirectly affect drinking and driving by restricting nighttime driving and the transportation of young passengers in the early months after licensure. In a recent national study, it was shown that GDL nighttime driving restrictions were associated with a 13% reduction in fatal drinking driver crashes among drivers 16 to 17 years old compared with drivers 19 to 20 years old who were not under these restrictions. 29 In a Cochrane review, the implementation of GDL was shown to be effective in reducing the crash rates of young drivers and specifically alcohol-related crashes in most studies in the United States and internationally. 30  

Adolescents who report binge drinking violate GDL laws more frequently and engage in more high-risk driving behaviors, such as speeding and using a cell phone while driving. They also received more traffic tickets and reported having more crashes and near crashes. 31 The importance of the additive effect of alcohol with other illicit substances, particularly marijuana, in contributing to motor vehicle crashes should also not be underestimated. Researchers have suggested that the combination of marijuana and alcohol significantly increases the likelihood of a motor vehicle crash, particularly at levels of alcohol that are below legal limits. For example, Dubois et al 32 found that the odds of a motor vehicle crash increased from 66% to 117% with BACs at 0.05 and 0.08, respectively, to 81% and 128% when detectable levels of tetrahydrocannabinol (THC) were present at these same BACs.

Although legislation has greatly improved transportation safety, young people still are involved in a high proportion of fatal motor vehicle accidents involving alcohol. In 2016, the National Highway Traffic Safety Administration reported a 5.6% increase in traffic fatalities from 2015. 33 Although many factors were reported as responsible for this increase, 10 497 people were killed as a direct result of alcohol-impaired driving crashes, accounting for 28% of the total motor vehicle traffic fatalities (37 461 people) in the United States. 33 In fatal crashes in 2016, the second highest percentage of drivers with BACs of 0.08 or higher was for drivers 21 to 24 years old at 26%; the rate for drivers 16 to 20 years old was 15%. 34  

Underage alcohol use and AUD in adolescents are also associated with other mental and physical disorders. AUD is a risk factor for suicide attempts. 35 Miller et al 36 estimated that 9.1% of suicide attempts resulting in hospitalization by people younger than 21 years involved alcohol and that 72% of these cases were attributable to alcohol. Of note, higher minimum legal drinking ages in the United States have been associated with lower youth suicide rates. 37 Psychiatric conditions most likely to co-occur with AUD include mood disorders, particularly depression; anxiety disorders; attention-deficit/hyperactivity disorder; conduct disorders; bulimia; posttraumatic stress disorder; and schizophrenia. 38 Associated physical health problems include trauma sequelae, 39 sleep disturbance, modestly elevated serum liver enzyme concentrations, and dental and other oral abnormalities, 40 despite relatively few abnormalities being evident on physical examination. 40 , 41  

Early alcohol initiation, in particular, has been associated with greater involvement in a number of high-risk behaviors, such as sexual risk-taking (unprotected sexual intercourse, multiple partners, being drunk or high during sexual intercourse, and pregnancy), academic problems, other substance use, and delinquent behavior in mid to later adolescence. 18 , 19 , 38 , 42 , – 45 By young adulthood, early alcohol use is associated with employment problems, other substance abuse, and criminal and violent behavior. 42  

Twin studies in adult populations have consistently demonstrated genetic influences on the use of alcohol, 46 , – 48 but less research has examined genetic influences in the adolescent age range. 49 , – 51 Through a sibling, twin, and adoption study of adolescents, Rhee et al 52 examined the relative contribution of genetics and environment on initiation, use, and problem use of substances. The results of this study demonstrated that for adolescents (compared with adult twin study findings), the magnitude of genetic influences was greater than the effect of shared environmental influences on problem alcohol or drug use. The reverse was true, however, for initiation of use, with shared environmental factors more important than genetic background. In a recent study, Chorlian et al 53 concluded that when alcohol is consumed regularly in the youngest age range, affecting a less-mature brain, the addiction-producing effects in those who have 2 copies of the genetic allele of the cholinergic M2 receptor gene are accelerated, which can lead to rapid transition from regular alcohol use to alcohol dependence. It has been suggested that gene and environmental effects may vary depending on developmental period of the individual and the stage of the problematic use or addiction. 54  

It has been suggested that the progression to heavy or compulsive alcohol or other drug use is strongly influenced by genetics. 54 Specific genetic studies have helped to elucidate the scientific basis for the relationship observed between early initiation of drinking and subsequent AUD. 12 , – 15 A longitudinal study of the genetic and neurophysiologic correlates of AUD in adolescents and young adults has identified neurophysiological endophenotype differences and variants of the cholinergic M2 receptor gene in adolescent brains that have an age-specific influence on the age of onset of such a disorder. 53 The authors reported that among people who became regular users of alcohol before the age of 16 years, a majority of those who became alcohol dependent within 2 years had the risk genotype, whereas the majority of people who became alcohol dependent 4 or more years after the onset of regular drinking did not have the risk genotype. 53 Another study also found an association between a polymorphism of the μ-opioid receptor encoding gene and adolescent alcohol use. 55  

In a number of studies, researchers have demonstrated the importance of family and social factors on the initiation and early use of alcohol and other drugs. Independent of genetic risk, families play an important role in the development of alcohol and other drug problems in youth, and exposure to alcohol or other drug use disorders of parents predicts substance use disorders in children. 56 Generational transmission has been widely hypothesized as a factor shaping the alcohol use patterns of youth. Whether through genetics, social learning, or cultural values and community norms, researchers have repeatedly found a correlation between youth drinking and a number of family factors, such as the drinking practices of parents. 57 , 58 Results of these studies suggest that policies primarily affecting adult drinkers, such as pricing and taxation, hours of sale, and on-premises drink promotions, may also affect underage drinking. Foley et al 59 found in a national sample ( n = 6245) of teenagers 16 to 20 years old whose parents provided alcohol to them and supervised their drinking were less likely to report being regular drinkers or binge drinkers than those who obtained alcohol through friends or nonparent relatives and participated in unsupervised drinking. They also found that teenagers who obtained alcohol from parents for parties that were unsupervised by those parents reported the highest rates of regular and binge drinking. Although the practice of parents buying alcohol for their teenagers and supervising their drinking cannot be recommended, this study highlights the role that parental behaviors toward alcohol can have on an adolescent’s subsequent drinking behaviors. Parental monitoring of children’s use, the convincing conveyance and consistent enforcement of household rules governing use, and perceived consequences of “getting caught” by parents after drinking all protected youth from drinking behaviors. 59 , – 62  

In the United States, approximately 7.5 million children younger than 18 years (10.5% of all children) are reported to live with at least 1 parent who had an AUD in the past year. 63 These children are at increased risk of many behavioral and medical problems, including depression, anxiety disorders, problems with cognitive and verbal skills, and parental abuse or neglect. 64 Children who have a parent with an AUD are also estimated to be 4 times more likely than other children to develop alcohol problems themselves. 65 See the AAP clinical report “ Families Affected by Parental Substance Use ” for further information. 66  

Having friends who use alcohol, tobacco, or other substances is one of the strongest predictors of substance use by youth. 67 Social and physical settings for underage drinking also affect patterns of alcohol consumption. In a special data-analytic study conducted in 2012, the Substance Abuse and Mental Health Services Administration and the Center for Behavioral Health Statistics and Quality, using data from the National Survey on Drug Use and Health, 68 , 69 found that the usual number of drinks consumed by young people is substantially higher when 2 or more other people are present than when drinking by oneself or with 1 other person. Drinking in the presence of others is by far the most common setting for youth, with more than 80% of youth who had consumed alcohol in the past month reporting doing so when at least 2 others were present. 68 , 69 Most young people drink in social contexts that appear to promote heavy consumption. Private residences are the most common setting for youth alcohol consumption, and the majority of underage drinkers report drinking in either someone else’s home or their own. The next most popular drinking locations reported are at a restaurant, bar, or club; at a park, on a beach, or in a parking lot; or in a car or other vehicle. Older youth in the 18- to 20-year-old age group are more likely than younger adolescents to report drinking in restaurants, bars, or clubs, although the absolute rates of such drinking are low compared with drinking in private residences. The data that demonstrate that underage drinking occurs primarily in social settings in groups at a private residence are consistent with previous research findings that underage drinking parties are high-risk settings for binge drinking and associated alcohol problems. 70 Similar findings exist for binge drinking by college students. 71  

Media influences on the use of alcohol by young people are substantial. 72 , 73 Exposure to alcohol marketing increases the likelihood to varying degrees that young people will initiate drinking and drink at higher levels. 74 , 75 Grenard et al 76 have recently demonstrated using prospective data that exposure to alcohol advertising and liking of those ads by adolescents in seventh grade has a significant influence on the severity of alcohol-related problems reported by 10th grade. In 2003, the US alcohol industry voluntarily agreed not to advertise products on television programs for which greater than 30% of the audience is reasonably expected to be younger than 21 years. The National Research Council of the Institute of Medicine (now the National Academy of Medicine) proposed in that same year that the industry standard should move toward a 15% threshold for alcohol advertising on television. A recent evaluation of adherence to these standards conducted in 25 of the largest US television markets revealed that the alcohol industry has not consistently met its self-regulatory standards, indicating the need for continued public health surveillance of youth exposure to alcohol advertising. 77 Young people can be influenced in their alcohol use by other media, including movies, the Internet, and social media. A 2014 study demonstrated that adolescents with exposure to friends’ risky online displays are more likely to use alcohol themselves. 78  

Over the past decade, great strides have been made in understanding the neurobiological basis of addiction. Studies investigating normal brain development have also yielded information that elucidates the effects of alcohol and other drugs on the developing adolescent brain. As summarized by Sowell et al, 79 results of postmortem studies have shown that myelination, a cellular maturational process of the lipid and protein sheath of nerve fibers, begins near the end of the second trimester of fetal development and extends well into the third decade of life and beyond. Autopsy results have revealed both a temporal and spatial systematic sequence of myelination, which progresses from inferior to superior and posterior to anterior regions of the brain. This sequencing results in initial brain myelination occurring in the brainstem and cerebellar regions and myelination of the cerebral hemispheres and frontal lobes occurring last. Converging evidence from electrophysiological and cerebral glucose metabolism studies shows that frontal lobe maturation is a relatively late process, and neuropsychological studies have shown that performance of tasks involving the frontal lobes continues to improve into adolescence and young adulthood.

Sowell et al 79 documented reduction in gray matter in the regions of the frontal cortex between adolescence and adulthood, which probably reflects increased myelination in the peripheral regions of the cortex. Gray matter loss, with pruning and elimination of neural connections during normative adolescent development, reflects a sculpting process that progresses in a caudal-to-rostral direction. The prefrontal cortex is the last area to reach adult maturation, and this may not be completed until young adulthood. 80 These changes are thought to improve cognitive processing in adulthood, such as cognitive control (ie, the ability to discount rewards) and executive functioning in risk-reward decision-making. 80 Results of neuropsychological studies have shown that the prefrontal cortex areas are essential for functions such as response inhibition, emotional regulation, planning, and organization, all of which may continue to develop between adolescence and young adulthood. Conversely, parietal, temporal, and occipital lobes show little change in maturation between adolescence and adulthood. Parietal association cortices are involved in spatial relationships and sensory functions, and the lateral temporal lobes are associated with auditory and language processing; these functions are largely mature by adolescence. Hence, the observed patterns of brain maturational changes are consistent with cognitive development. 79 Connections are being fine-tuned in adolescence with the pruning of overabundant synapses and the strengthening of relevant connections with development and experience. It is likely that the further development of the prefrontal cortex aids in the filtering of information and suppression of inappropriate actions. 80  

Our current understanding of the biology of brain development in the adolescent has lent support to several models that explain the vulnerability of the adolescent to AUDs. One of these models posits that because the subcortical systems that are important for incentive and reward mature earlier than the areas responsible for cognitive control, this results in an “imbalance.” Thus, activation and reinforcement of those incentive and reward pathways in response to the substance used may occur. This leaves youth uniquely vulnerable to the motivational aspects of alcohol and other drugs and the development of problematic substance use. 21 Without the modulating effect of cognitive control, an adolescent may be less able to resist the short-term result of using substances, compared with long-term, goal-oriented behaviors, such as abstaining. Given that these maturation imbalances in the development of different brain systems is greatest during adolescence, it is not surprising that teenagers may not be able to regulate the emotional or motivational states experienced with the use of substances as adults. 3 , 21 Researchers studying the role of several neurotransmitters in the development and maintenance of substance use and dependence have elucidated the underlying effects of these neurotransmitters in key areas of the brain involved in substance dependence and addiction.

Alcohol interacts with a number of neurotransmitter systems throughout the brain, including the inhibitory neurotransmitters γ-aminobutyric acid and glutamate, that are responsible for the euphoric as well as sedating effects of alcohol intoxication. In addition, neurons that release the neurotransmitter dopamine are activated by all addictive substances, including alcohol. The activation of dopamine release in the nucleus accumbens subregion of the basal ganglia, the area involved in both reward experiences and motivation, results in the “rewarding effect” experienced by users of alcohol and other drugs. In addition, the brain’s endogenous opioid system and the 3 opioid receptors (μ, κ, and δ) interact with the dopamine system and play a key role in the effect that substances such as alcohol have on “rewards” and incentives to continue use of a substance. Brain imaging studies have demonstrated that both the opioid and the dopamine neurotransmitter systems are activated during alcohol and other substance use. The reader is referred to the comprehensive discussion of this in the Surgeon General’s 2016 report: “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health.” 81  

Determining the specific effect of alcohol exposure or dependence on brain function and structure is challenging given potential biological differences that are normative versus those reflective of recent or past use of substances other than alcohol or of comorbid psychiatric disorders. In several studies, researchers using animal models have demonstrated the inhibition of the growth of adolescent neural progenitor cells with acute alcohol ingestions; similar results were observed with binge alcohol ingestion. 82 , 83 Chronic alcohol ingestion in animal models also disrupts neurogenesis primarily in the hippocampus, an area of the brain especially important for memory. 84  

In adolescents, varying levels of alcohol ingestion ranging from binge-pattern drinking to AUDs have been correlated with both structural and functional brain changes. 21 For example, hippocampal asymmetry was increased and hippocampal volumes were decreased in adolescents with alcohol abuse or dependence patterns compared with both controls who did not use substances and those reporting both alcohol and cannabis use. 85 In another study, adolescents with AUDs had smaller overall and white matter prefrontal cortex volumes compared with nondrinking controls, with girls with AUDs having larger decreases than boys with AUDs. 86 In studies in which researchers used diffusion tensor imaging techniques, which are used to assess white matter architecture, adolescent binge drinking or alcohol use was correlated with reduced factional anisotropy, which is an index that measures neural fiber tract integrity and organization. 87 , – 90 These changes in white matter tract integrity were seen in multiple brain pathways, including those in the corpus callosum as well as limbic, brainstem, and cortical projection fibers. 87 , – 89 It is important to note, however, that all of these studies are correlational and that a true causal relationship between alcohol use in youth and subsequent brain changes has not been demonstrated with this research.

Deficits in neurocognitive function have also been found in adolescents using both alcohol and marijuana compared with controls using no substances. These include deficits in attention, visuospatial processing in teenagers experiencing alcohol withdrawal, poorer performance with verbal and nonverbal retention tasks in adolescents reporting protracted alcohol use, and reduced speed of information processing and overall memory and executive functioning in those reporting alcohol dependence. 4 , 91 , – 93 These abnormalities are postulated to result, in part, from the morphologic and functional changes seen in specific brain areas involved in memory (hippocampus) and executive function and decision-making (prefrontal cortex). In addition, genetic predisposition, such as family history of alcoholism, may enhance the vulnerability of specific brain areas, such as the hippocampus, to the effects of alcohol use in adolescents. 94 These potential genetic factors and epigenetic contributors (the impact of environmental and social factors on gene expression) are areas of active study. 21 The Adolescent Brain and Cognitive Development study, supported by the National Institutes of Health and the National Institute on Drug Abuse, is a 10-year longitudinal study that started in 2015 designed to assess the environmental, social, genetic, and biological factors involved in adolescent brain and cognitive development. The initial year of recruitment and baseline assessment of 11 875 10-year-olds has been completed, and this study holds great promise in terms of informing scientists and clinicians of the effect of licit and illicit substances, among many factors being studied, on the trajectory of brain development and cognitive functioning over the course of adolescent and young adulthood. 95  

Several recent Cochrane reviews have examined the prevention of substance abuse in young people through family-based prevention programs, 96 universal school-based prevention programs, 97 brief school-based interventions, 98 universal multicomponent prevention programs, 99 and mentoring programs. 100 Although there were variations in programs in all of these reviews and generally few high-quality studies, all of these prevention strategies showed some success. Family-based prevention programs typically take the form of supporting the development of parenting skills, including parental support, nurturing behaviors, establishing clear boundaries or rules, and parental monitoring. The development of social and peer resistance skills and the development of positive peer affiliations can also be addressed in these programs. The Cochrane systematic review found that “the effects of family-based prevention are small but generally consistent and persistent into the medium- to longer-term” 96 and are consistent with an earlier systematic review supporting the effectiveness of family-focused prevention programs. 101  

Recognition of the pervasive use of alcohol among young people, the hazards that may be encountered with even low-level use, and the association between early initiation of alcohol use and future alcohol problems underscores the need to integrate our approaches to alcohol and other drug use by youth into pediatric primary care. The AAP recommends that pediatricians screen and discuss substance use as part of anticipatory guidance and preventive care. 102 , – 104 Screening, brief intervention, and referral to treatment (SBIRT) for youth is such an integrated approach that has grown in recent years to bridge the gap between universal prevention programs and specialty substance abuse treatment by pediatric primary care providers. 105 , 106 The reader is referred to the AAP clinical report on SBIRT for pediatricians. 104 The effectiveness of SBIRT is well supported for addressing hazardous use of alcohol by adults in medical settings, but there is less evidence for its effectiveness in adolescents. 107 , – 115  

Several screening strategies have been validated and used to identify youth at risk for or involved in the use of alcohol and other substances that can be incorporated into general psychosocial screening efforts, such as interviewing strategies like HEADSS (home, education, activities, drugs and alcohol, sex, suicidality) 116 and SSHADESS (strengths, school, home, activities, drugs and alcohol, substance use, emotions and depression, sexuality, safety). 117 The CRAFFT is a tool developed for screening adolescents for alcohol and other substance use with 3 introductory questions followed by 6 questions using the CRAFFT mnemonic. 118 It has been well validated and is brief enough for use in busy clinical settings. 119 In 2011, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) collaborated with the AAP to develop a brief screening tool to assist health care providers in identifying alcohol use, AUD, and risk for use in children and adolescents ages 9 to 18 years. 120 This tool includes brief 2-question screeners and support materials about brief intervention and referral to treatment and is designed to help surmount common obstacles to youth alcohol screening in primary care. The screen administration varies by age and grade and focuses on drinking frequency over the previous 12 months to determine level of risk. 121 This tool has been expanded to include tobacco and other substances and is sensitive and specific for identifying substance use disorders in a pediatric clinic population. 122 Although developed for use primarily in the primary care setting, Spirito et al 123 have demonstrated its usefulness in screening for AUDs in pediatric emergency settings.

In several studies, researchers have confirmed the validity of using a single question about the frequency of use of alcohol and other drugs over the previous 12 months to determine level of risk. 124 Studying a population of adolescents and young adults in rural Pennsylvania, Clark et al 124 compared a single question of past-year frequency of alcohol use versus comprehensive diagnostic interviews on the basis of DSM-5 criteria for AUD to determine the validity of this question in identifying problematic alcohol use. They found both high sensitivity and specificity for adolescents ages 12 to 17 years using 3 or more days with 1 or more drinks as a cutoff to identify AUDs. For young adults 18 to 20 years of age, using 12 or more days or 12 or more drinks over the previous year also had excellent ability to identify AUDs. 124 Levy et al 125 have also validated a single-question screen, referred to as the “S2BI”: “In the past year, how many times have you used alcohol?” They have found that responses that include never, once or twice, monthly, weekly, almost daily, or daily can differentiate between those with mild, moderate, and severe AUDs, per DSM-5 criteria, and can indicate those individuals who would benefit from education versus brief intervention or more-specific substance abuse treatment. 125 This screening question has also been shown to identify problematic use of illicit drugs, over-the-counter medications, and tobacco. These screening tools, as well as the NIAAA screening tool, continue to be validated, and the results reported here are promising.

Questions often remain about how to incorporate parents into this screening process and how and when to provide confidentiality for a youth’s report of underage alcohol use. The NIAAA 2-question screening tool recommends that screening begin as early as 9 to 11 years of age, and given that most preteens will be questioned in the presence of a parent or guardian, this offers an opportunity to discuss the parent’s philosophy regarding alcohol use by minors, situations in which they might deem it appropriate (such as at holidays), and their own practices regarding their own drinking and consequences for their child’s drinking. This screening can also be performed routinely for all adolescents during preventive care visits. For the older adolescent, whenever possible, it is preferable to include parents in any discussion with a youth who reports drinking; however, when this is seen by the youth as a major deterrent to his or her alliance with the provider and there are no “red flag” behaviors that are believed to be unsafe, such as the youth riding or driving after drinking, heavy binge drinking, or when an AUD is suspected, maintaining confidentiality and counseling the adolescent is often preferable because this maintains the alliance between the provider and the adolescent. There are no hard and fast rules as to when parents should be included in discussions about their adolescent’s alcohol use; this can be a delicate matter and is generally a judgment call by the primary medical provider, unless the safety of the youth is put in jeopardy by drinking behaviors. Studies have shown that parents tend to underestimate the extent of their teenagers’ drinking behaviors, and including parents in the discussions with their teenagers often serves to highlight a greater amount of use than what is anticipated by parents. Discussions about minimizing risk, such as contracting with the youth to call parents if they are concerned about friends drinking while driving, may also be helpful. Students Against Destructive Decisions is a youth-focused organization promoting healthy and safe decision-making, especially around driving behaviors. The Students Against Destructive Decisions Web site ( https://www.sadd.org/what-we-care-about/ ) provides educational information as well as the “Contract for Life,” which is a contract that teenagers sign along with their parents, promising to avoid alcohol and other substances when driving.

Once screening has been conducted and the level of risk has been determined, the provider can provide anticipatory guidance supporting abstinence, perform brief intervention strategies, or refer the adolescent for further evaluation or to a higher level of treatment. Brief intervention strategies are short, efficient, office-based techniques that health care providers who work with adolescents can use to detect alcohol use and intervene. On the basis of the principles of motivational interviewing, these procedures can be readily performed in the office setting, build on the individual’s readiness to change drinking behaviors, and support the adolescent’s need for involvement in one’s own health care choices and decisions. Harris et al 105 have provided an excellent review of counseling strategies at different levels of risk behaviors of young people, and the NIAAA Alcohol Screening Practitioner Guide provides strategies for brief intervention at different ages. 120 D’Onofrio and colleagues 126 have developed a brief (5- to 7-minute) scripted intervention approach, the Brief Negotiation Interview (BNI), for use with adults reporting harmful and hazardous alcohol use in the emergency setting, and Ryan et al 127 have adapted this BNI for use in a pediatric residency training setting for use with adolescents in a primary care clinic. Pediatrics residents trained in the BNI reported that this intervention was easily learned and highly applicable in clinical settings with teens reporting alcohol and other illicit substance use. 127  

The National Institute on Drug Abuse publication “Principles of Adolescent Substance Use Disorders Treatment: A Research Guide” is a comprehensive guide of evidence-based approaches to treating adolescent substance use disorders and emphasizes that treatment is not “one size fits all” but requires taking into consideration the needs of the individual, including his or her developmental stage; cognitive abilities; the influence of friends, family, and others; and mental and physical health conditions. 128 The AAP clinical report on SBIRT also includes a list of optimal standards for a substance use disorder treatment program. 66 Behavioral therapies are effective in treating alcohol and other substance use disorders as well as multiple substances and include individual therapy, such as cognitive-behavioral therapy and motivational enhancement therapy. Family-based approaches, including multidimensional family therapy and multisystemic therapy, have been proven to be effective. 129 Addiction medications for AUD include acamprosate, disulfiram, and naltrexone. Medication-assisted therapies are not commonly used to treat adolescent AUDs but may be used in specific circumstances. These medications are approved by the US Food and Drug Administration for treatment of people 18 years and older.

In most cases, the primary care pediatrician’s initial role is to identify, through screening, teenagers in need of intervention and referral for further treatment. However, continued involvement by the primary pediatric provider with the teenager and the family, through regular follow-up and care coordination, is essential in any treatment plan after referral.

Although it is heartening that alcohol use among adolescents and youth has decreased over the last several years, researchers have even more clearly elucidated links between alcohol use and deleterious effects on adolescents’ developing brains as well as other aspects of their physical and mental health. Pediatricians are in an excellent position to recognize risk factors for use and screen for hazardous use among youth. Pediatricians can also assess youth whose screening results are positive for alcohol use to determine the level of intervention needed. Brief intervention techniques used by pediatricians have been shown to be effective in a limited number of studies and may be especially helpful in aiding youth and their families to obtain appropriate treatment of AUDs. Pediatricians also have an important advocacy role in health systems’ changes as well as legislative efforts, such as increasing alcohol taxes, resisting efforts to weaken minimum drinking age laws, and supporting GDL programs. 130 , 131  

Drs Ryan and Kokotailo were directly involved in the planning, researching, and writing of this report; and both authors approved the final manuscript as submitted.

This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

Technical reports from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. However, technical reports from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent.

The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

All technical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

FUNDING: No external funding.

American Academy of Pediatrics

alcohol use disorder

blood alcohol concentration

Brief Negotiation Interview

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

graduated driver licensing

National Institute on Alcohol Abuse and Alcoholism

screening, brief intervention, and referral to treatment

Sheryl A. Ryan, MD, FAAP

Patricia Kokotailo, MD, MPH, FAAP

Sheryl A. Ryan, MD, FAAP, Chairperson

Deepa R. Camenga, MD, MHS, FAAP

Stephen W. Patrick, MD, MPH, MS, FAAP

Jennifer Plumb, MD, MPH, FAAP

Joanna Quigley, MD, FAAP

Leslie Walker-Harding, MD, FAAP

Gregory Tau, MD, PhD – American Academy of Child and Adolescent Psychiatry

Renee Jarrett, MPH

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Alcohol’s Impact on Young People

How does alcohol affect the young?

The papers in our collection focus on the relationship between alcohol and young people from childhood to early adulthood .

Research suggests that even moderate drinking by parents may impact children. At the same time, young children’s familiarity with alcohol may put them at risk of early alcohol initiation.

Our collection goes on to explore alcohol use in adolescence , from neurobiological implications to association with sexual identity and STI risk; and considers a cohort of adolescents and young adults when analysing the relationship of drinking behaviours with social media use and risk of violence respectively.

Finally, we follow trajectories of alcohol use in early adulthood , with articles assessing predictors of Alcohol Use Disorder (AUD), considering the role of gender and age on drinking practices, and examining withdrawal-associated muscle pain hypersensitivity in healthy episodic binge drinkers.

All articles will be free to access and share until the 30th of June, with a view to disseminating scientific knowledge on the impact of alcohol on young people.

Alcohol and Children

From age 4 to 8, children become increasingly aware about normative situations for adults to consume alcohol.

Children aged 4–8 become increasingly knowledgeable about drinking norms in specific situations which implies that they know in what kind of situation alcohol consumption is a common human behavior. This knowledge may put them at risk for early alcohol initiation and frequent drinking later in life.

An Exploration of the Impact of Non-Dependent Parental Drinking on Children

Findings suggest levels of and motivations for parental drinking, as well as exposure to a parent tipsy or drunk, all influence children’s likelihood of experiencing negative outcomes.

Alcohol and Adolescents

Lifetime alcohol use influences the association between future-oriented thought and white matter microstructure in adolescents.

These findings replicate reports of reduced future orientation as a function of greater lifetime alcohol use and demonstrate an association between future orientation and white matter microstructure, in the PCR, a region containing afferent and efferent fibers connecting the cortex to the brain stem, which depends upon lifetime alcohol use.

Differential Alcohol Use Disparities by Sexual Identity and Behavior Among High School Students

Results highlight the need to incorporate multiple methods of sexual orientation measurement into substance use research.

What a Difference a Drink Makes: Determining Associations Between Alcohol-Use Patterns and Condom Utilization Among Adolescents

Results suggest significant increased risk of condomless sex among binge drinking youth. Surprisingly, no significant difference in condom utilization was identified between non-drinkers and only moderate drinkers.

Alcohol and Adolescents and Young Adults

The association between social media use and hazardous alcohol use among youths: a four-country study.

Certain social media platforms might inspire and/or attract hazardously drinking youths, contributing to the growing opportunities for social media interventions.

Change in the Relationship Between Drinking Alcohol and Risk of Violence Among Adolescents and Young Adults: A Nationally Representative Longitudinal Study

Alcohol is most strongly linked to violence among adolescents, so programmes for primary prevention of alcohol-related violence are best targeted towards this age group, particularly males who engage in heavy episodic drinking.

Alcohol and Young Adults

Predictors of alcohol use disorders among young adults: a systematic review of longitudinal studies.

This review suggests that externalizing behaviour is a strong predictor of AUD. The risk of AUD is also high when illicit drug use co-occurs with externalizing behaviour. Environmental factors were influential but changed over time.More evidence is needed to assess the roles of early internalizing behaviour, early drinking onset and other distinctive factors on the development of AUD in young adulthood

Gender-Specific Drinking Contexts Are Associated With Social Harms Resulting From Drinking Among Australian Young Adults at 30 Years

We found that experiences of social harms from drinking at 30 years differ depending on the drinker’s gender and context. Our findings suggest that risky contexts and associated harms are still significant among 30-year-old adults, indicating that a range of gender-specific drinking contexts should be represented in harm reduction campaigns. The current findings also highlight the need to consider gender to inform context-based harm reduction measures and to widen the age target for these beyond emerging adults.

The Role of Sex and Age on Pre-drinking: An Exploratory International Comparison of 27 Countries

This exploratory study aims to model the impact of sex and age on the percentage of pre-drinking in 27 countries, presenting a single model of pre-drinking behaviour for all countries and then comparing the role of sex and age on pre-drinking behaviour between countries. Using data from the Global Drug Survey, the percentages of pre-drinkers were estimated for 27 countries from 64,485 respondents. Bivariate and multivariate multilevel models were used to investigate and compare the percentage of pre-drinking by sex (male and female) and age (16–35 years) between countries.

Hyperalgesia after a Drinking Episode in Young Adult Binge Drinkers: A Cross-Sectional Study

This is the first study to show that alcohol withdrawal-associated muscle hyperalgesia may occur in healthy episodic binge drinkers with only 2–3 years of drinking history, and epinephrine may play a role in binge drinking-associated hyperalgesia.

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• Open access
• Published: 07 November 2021

How to prevent alcohol and illicit drug use among students in affluent areas: a qualitative study on motivation and attitudes towards prevention

• Pia Kvillemo   ORCID: orcid.org/0000-0002-9706-4902 1 ,
• Linda Hiltunen 2 ,
• Youstina Demetry 3 ,
• Anna-Karin Carlander 4 ,
• Tim Hansson 5 ,
• Johanna Gripenberg 1 ,
• Tobias H. Elgán 1 ,
• Kim Einhorn 4 &
• Charlotte Skoglund 1 , 4  

Substance Abuse Treatment, Prevention, and Policy volume  16 , Article number:  83 ( 2021 ) Cite this article

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The use of alcohol and illicit drugs during adolescence can lead to serious short- and long-term health related consequences. Despite a global trend of decreased substance use, in particular alcohol, among adolescents, evidence suggests excessive use of substances by young people in socioeconomically affluent areas. To prevent substance use-related harm, we need in-depth knowledge about the reasons for substance use in this group and how they perceive various prevention interventions. The aim of the current study was to explore motives for using or abstaining from using substances among students in affluent areas as well as their attitudes to, and suggestions for, substance use prevention.

Twenty high school students (age 15–19 years) in a Swedish affluent municipality were recruited through purposive sampling to take part in semi-structured interviews. Qualitative content analysis of transcribed interviews was performed.

The most prominent motive for substance use appears to be a desire to feel a part of the social milieu and to have high social status within the peer group. Motives for abstaining included academic ambitions, activities requiring sobriety and parental influence. Students reported universal information-based prevention to be irrelevant and hesitation to use selective prevention interventions due to fear of being reported to authorities. Suggested universal prevention concerned reliable information from credible sources, stricter substance control measures for those providing substances, parental involvement, and social leisure activities without substance use. Suggested selective prevention included guaranteed confidentiality and non-judging encounters when seeking help.

Conclusions

Future research on substance use prevention targeting students in affluent areas should take into account the social milieu and with advantage pay attention to students’ suggestions on credible prevention information, stricter control measures for substance providers, parental involvement, substance-free leisure, and confidential ways to seek help with a non-judging approach from adults.

Alcohol consumption and illicit drug use are major public health concerns causing great individual suffering as well as substantial societal costs [ 1 , 2 ]. Early onset of substance use is especially problematic since the developing brain is vulnerable to the effects of alcohol and drugs, increasing the risk of long-term negative effects, such as harmful use, addiction, and mental health problems [ 3 , 4 , 5 , 6 ]. Short-term consequences of substance use include intoxication [ 5 , 7 ], accidents [ 8 [, academic failure [ 9 ], and interaction with legal authorities [ 10 ], which calls for effective substance use prevention in adolescents and young adults. Such prevention interventions may be universal, targeting the general population, e.g., legal measures and school based programs, or selective, targeting certain vulnerable at-risk groups, i.e., subsections of the population [ 11 ]. Selective prevention can be carried out within a universal prevention setting, such as health care or school, but also be delivered directly to the group which it aims to target, face-to-face or digitally [ 12 , 13 , 14 , 15 ].

The motives to use substances are governed by a number of personal, social and environmental factors [ 16 ], ranging from personal knowledge, abilities, beliefs and attitudes, to the influence of family, friends and society [ 17 , 18 , 19 , 20 ]. Cooper and colleagues [ 21 ] have previously identified a number of motives for drinking, i.e., 1) enhancement (drinking to maintain or amplify positive affect), 2) coping (drinking to avoid or dull negative affect), 3) social (drinking to improve parties or gatherings), and 4) conformity (drinking due to social pressure or a need to fit in). Similar motives for illicit drug use have been found by e.g. Kettner and colleagues, who highlighted the attainment of euphoria and enhancement of activities as prominent motives for use of psychoactive substances among people using psychedelics in parallel with other substances [ 22 ], along with Boys and colleagues [ 23 , 24 , 25 ], who reported on changing mood (e.g., to stop worrying about a problem) and social purposes (e.g., to enjoy the company of friends) as motives for using illicit drugs among young people. Additionally, the authors found that the facilitation of activities (e.g., to concentrate, to work/study), physical effects (e.g., to lose weight), and the managing of the effects of other substances (e.g., to ease or improve) motivated young people to use illicit drugs.

Prior research has repeatedly shown that low socioeconomic status is a risk factor for substance use and related problems [ 26 , 27 , 28 ]. However, recent research from Canada [ 29 ], the United States [ 30 , 31 , 32 ], Serbia [ 33 ], Switzerland [ 34 ], and Sweden [ 35 ] suggest that high socioeconomic status too is associated with excessive substance use among young people, although for other reasons [ 29 , 30 , 31 , 32 , 33 , 34 ]. Previous research has highlighted two main explanations for excessive substance use among young people in families with high socioeconomic status; i) exceptionally high requirements to perform in both school and leisure activities and ii) absence of adult contact, emotionally and physically, due to parents in resourceful and affluent areas spending a lot of time on their work and careers [ 36 , 37 ]. In addition to these explanations, high physical and social availability due to substantial economic resources and a social milieu were substance use is a natural element, may enable extensive substance use among economically privileged young people [ 30 , 38 , 39 ].

In parallel with identification of various groups at risk for extensive substance use, a growing number of young people globally abstain from using substances [ 1 , 40 , 41 ]. By analyzing data derived from a nationally representative sample of American high school students, Levy and colleagues [ 40 ] found an increasing percentage of 12th-graders reporting no current (past 30 days) substance use between 1976 and 2014, showing that a growing proportion of high school students are motivated to abstain from substance use. However, while this global decrease in substance use among adolescents is mirrored in Swedish youths, in particular alcohol use, a more detailed investigation shows large discrepancies across different socioeconomic and geographic areas. Affluent areas in Sweden stand out as breaking the trend, showing increasing alcohol and illicit drug use among adolescents [ 42 , 43 ].

To date, we lack in-depth knowledge of why youths in affluent areas keep using alcohol and illicit drugs excessively. Furthermore, despite implementation of various strategies and interventions over the last decades [ 14 , 44 , 45 , 46 , 47 , 48 ], we have yet no clear guidelines on how to effectively prevent substance use in this specific group, although the importance of parents’ role for preventing substance use in privileged adolescents has been highlighted in a recent study [ 29 ]. Moreover, despite the fact that attitudes are assumed to guide behavior [ 49 , 50 ] and consequently the reception and effects (behavior change) of prevention interventions, the knowledge about affluent adolescents’ attitudes toward current substance use prevention interventions remains limited. To our knowledge, the only study exploring adolescents’ attitudes to substance use prevention was carried out among Spanish adolescents who participated in “open-air gatherings of binge drinkers”. The study concerned adolescents irrespective of their economic background and revealed positive attitudes to restrictions for drunk people [ 19 ]. Thus, extended knowledge on what motivates young people in affluent areas to excessively use substances, or abstaining from using, as well as their attitudes to prevention is warranted.

In the current study, we aim to explore motives for using, or abstaining from using, substances among students in affluent areas. In addition, we aim to explore their attitudes to and suggestions for substance use prevention. The findings may make a valuable contribution to the research on tailored substance use prevention for groups of adolescents that may not be sufficiently supported by current prevention strategies.

A qualitative interview study was performed among high school students in one of Stockholm county’s most affluent municipalities. The research team developed a semi-structured interview guide (supplementary Interview guide) covering issues regarding the individual’s physical and mental health, extent of alcohol and illicit drug use, motives for use or abstinence, relationships with peers and family, alcohol and drug related norms among peers, family and in the society, and attitudes towards strategies to prevent substance use. Examples of interview questions are: How would you describe your health? Which are the main reasons why young people drink, do you think? How do you get hold of alcohol as a teenager?

What do you know about drug use among young people in Municipality X? How would you describe your social relationships with peers in and outside Municipality X?

The study was approved by the Swedish Ethical Review Authority (dnr. 2019–02646).

Study setting

Sweden has strict regulations of alcohol and illicit drugs compared to many other countries [ 45 , 46 ]. Alcohol beverages (> 3.5% alcohol content by volume) can only be bought at the Swedish Alcohol Retailing Monopoly “Systembolaget” by people 20 years of age or older, or at licensed premises (e.g., bars, restaurants, clubs), at the minimum age of 18 years. The use of illicit drugs is criminalized. The study was carried out in a municipality with 45% higher annual median income than the corresponding figure for all of Sweden, along with the highest educational level among all Swedish municipalities, i.e., 58% of the population (25 years and over) having graduated from university and hold professional degrees, as compared with the national average of 26%. Furthermore, only 6.1% of the inhabitants receive public assistance, compared to a national average of 13.4% [ 51 ].

Recruitment

Purposive sampling was used to recruit students from the three high schools located in the selected municipality. Contact was established by the research team with the principals of the high schools that agreed to participate in the study. Information and invitation to participate in the study was published on the schools’ online platforms, visible for parents and students. Students communicated their initial interest in participating to the assistant principal. Upon consent from the students, the assistant principal forwarded mobile phone numbers of eligible students to the research team. Also, students from other schools in the selected municipality were asked by friends to participate and upon contact with the research team were invited to participate. Forty students signed up to take part in the study, of which 20 were finally interviewed, representing four schools (three in the selected municipality and one in a neighbor municipality). Before the interview, informed consent was obtained by informing the students about confidentiality arrangements, their right to withdraw their participation and subsequently asking them about their consent to participate. The consent was recorded and transcribed along with the following interview. Twenty students who had initially signed up were excluded after initial consent due to incorrect phone numbers or if the potential participants were not reachable on the agreed time for participation. The reason for terminating the recruitment after 20 interviewees was based on the fact that little or no new information was considered to occur by including additional participants.

Participants

The final sample consisted of 20 students. Background information of the participants is presented in Table  1 . The group included eleven girls and nine boys between 15 and 19 years of age. Seven participants attended natural sciences/technology/mathematic programs and 13 attended social sciences/humanities programs. Twelve participants lived in the socioeconomically affluent municipality where the schools were located and eight in neighboring municipalities. The sample included three abstainers and 17 informants who were using substances, the latter referring to self-reported present use of alcohol and/or illicit drugs (without further specification). Additionally, 18 of the participants reported that at least one of their parents had a university education.

During April–May 2020, semi-structured telephone interviews with the students were conducted by five of the authors (PK, YD, AKC, TH, CS). The interviewers had continuous contact during the interview process, exchanging their experiences from the interviews and also the content of the interviews. After 20 interviews had been conducted, it was assessed that no or little new information could be obtained by additional interviews and the interview process was terminated. The interviews, on average around 60 min long, were recorded on audio files and transcribed verbatim.

Qualitative content analysis, informed by Hsieh & Shannon [ 52 ] and Granheim & Lundman [ 53 ], was used to analyze the interview material. To increase reliability of the analytic process, a team based approach was employed [ 54 ], utilizing the broad expertise represented in the research team and the direct experience of information collected from the five interviewers.

The software NVivo 12 was utilized for structuring the interview data. Initially, one of the researchers (PK) read all the interviews repeatedly, searching for meaningful units which could be grouped into preliminary categories and codes, as exemplified in Table 2 . During the process, a preliminary coding scheme was developed and presented to the whole research team. After discussion, the coding scheme was slightly revised. Following this procedure, a second coder (CS) applied the updated coding scheme along with definitions (codebook) [ 54 ], coding all the interviews independently. Subsequent discussions between PK, YD and CS, resulted in an additionally revised coding scheme. This scheme was utilized by PK and another researcher (LH), who had not been involved in the interviewing or coding, coding all of the interviews independently. The agreement between the coders PK and LH was high and a few disagreements solved through discussion. No change in the codes was necessary and the research team agreed on the coding scheme as outlined in Fig.  1 .

Final coding scheme

The interview material generated three main categories, six subcategories and 27 codes. The results are presented under headings corresponding to the identified subcategories, since they are directly connected to the aim of the study. Content from the main category “External factors” is initially presented to illustrate the context in which the students form their motivation to use or abstain from using substances, as well as their attitudes towards prevention.

External factors

The external factors found in the interview material concerned wealth, availability of alcohol and other substances, parental norms and peer norms. Informants living in the affluent municipality described an expensive lifestyle with boats, ski trips, summer vacations abroad, and frequent restaurant visits, in contrast to informants from other areas who described a more modest lifestyle. These differences were further accentuated by informants’ descriptions of large villas in the affluent municipality, where students can arrange parties while the parents go to their holiday homes. Some informants further pointed to the fact that people in this municipality easily can afford to buy illicit drugs, increasing the availability.

The reason why they do it [use illicit drugs] in [the affluent municipality] is because the parents go away, which make it easier to have parties and be able to smoke grass at home, and also because they can afford it .

Parents’ alcohol norms seemed to vary between families, but most informants described modest drinking at home, with parents consuming alcohol on certain occasions and sometimes when having dinner. However, several informants described that they as minors/children were offered to taste alcohol from the parents’ glasses. Most of the informants meant that their parents trust them not to drink too much when partying.

They [my parents] have said to me that drinking is not good, but that they understand if I drink, sort of.

Both parents’ and peers’ norms appear to influence substance use among the students, The impression is that there is an alcohol liberal norm in the local society among adults as well as among adolescents.

If you want to have a social life in community X, then it is very difficult … you almost cannot have it if you don’t drink at parties.

Motives for using substances

Confirming that both alcohol and illicit drugs are frequently used among students in the current municipality, a number of motives for substance use were expressed by the participants. The most prominent motive appeared to be a desire to feel a part of the social milieu and to attain or maintain high social status, with fear of being excluded from attractive social activities and parties if abstaining from substance use. The participants indicated that you are expected to drink alcohol to be included in the local community social life, claiming that this applied to the adult population as well. Alcohol consumption and even intoxication are perceived to be the norm in the students’ social life and several of the participants noted that abstainers risk being considered too boring to be invited to parties.

The view is that you cannot have fun without alcohol and therefore, you don’t invite sober people.

There seemed to be a high awareness of one’s own as well as peers’ popularity and social status. Participants evaluated peers as high or low status, fun or boring, claiming that trying to be cool and facilitate contact with others motivates people to use substances. High status students are, according to some participants, frequently invited to parties where alcohol and other substances are easily accessible.

I would say that our group of friends has more status. [… ] You know quite a few [people] and you are invited to quite a lot of parties. You can often evaluate the group of friends, i.e. their status, based on which parties they are invited to. […] Some [groups of friends] only drink alcohol and some even take drugs and drink alcohol.

Some differences in traditions and norms between schools was discerned, with certain schools being especially known for high alcohol consumption and drug use procedures when including new students in the school-community. One of the participants described fairly extensive norm violations, with respect to the law, on these occasions, e.g., strong peer pressure to drink alcohol and use illicit drugs, combined with humiliation of new students, careless driving under the influence of substances with other students in the car, and “punishment” by future exclusion from social events of those who don’t participate at these occasions. On the other hand, already popular, or more senior students, appear to be able to abstain from substance use on occasions without being questioned or risk social exclusion. High self-esteem and a firm approach when occasionally saying no to substances is often respected according to the participants. To avoid peer pressure to use alcohol or illicit drugs, the participants suggested acceptable excuses, such as school duties, bringing your moped or car to the party, having a sports activity or work the day after, or having plans with your parents or extended family during the weekend.

Apart from peer influence, several students expressed hedonistic motives, such as enjoying a nice event or simply to have fun.

If you want a little extra fun, then you take drugs.

Apart from social enhancement motives for using substances, some students reported that relaxing from academic pressure or rewarding oneself after an intense period of studying motivates them to use substances. Almost every participant expressed high academic ambitions. One participant who claimed to be very motivated to study expressed drinking due to stress, as illustrated in the extract below:

You study a lot and you are stressed over school. Then it can be very nice to go out and drink and you can forget everything else for a few hours. […] So it can be a “stress reliever” in that way.

Yet another participant explained that academic failure had previously made her use substances to comfort herself. Coping with mental health problems, such as depression, was also stated as a reason for substance use. Moreover, some participants reported that they use ADHD (Attention Deficit Hyperactivity Disorder) medication to be able to study more intensively.

Motives for abstaining from using substances

A number of motives for totally or temporarily abstain from substance use were put forward by the students, such as a wish to be healthy, keep control and avoid embarrassment, influence of parents, academic pressure, sports ambitions or simply lack of interest. Lack of interest in alcohol and drugs was expressed foremost by those attending natural sciences programs and those who totally abstained from substance use.

I attend the engineering program and I don’t think the interest in alcohol and parties is as present as it might be on social sciences programs.

Fear of health consequences was predominantly related to abstaining from illicit drugs, but also alcohol. Motives for abstaining from alcohol included perceived risk of being addicted, due to relatives having alcohol problems (heredity), and taking medicine, for example ADHD medicine, since combining alcohol and medication was perceived as risky. Some students had observed friends getting “weird” or “laze” after using illicit drugs, which made them hesitant to use such substances themselves. With regard to parental norms, most parents were by the participants reported to be “normal drinkers” themselves and quite relaxed about their teens’ alcohol consumption. This applied to both the parents of older teens and minors. However, many of the participants reported that their parents would be upset and disappointed if they found out that their child used illicit substances, which motivated some of them to abstain. Reasons for abstaining from substance use included academic strivings, sports performance ambitions, driving, or other activities requiring sobriety, which the students referred to as socially acceptable reason to abstain from substance use. Prioritizing studies over partying was explicitly expressed as the primary motive to abstain by some of the participants.

We are a group of five or six who come from other municipalities. […] We don’t party and such things and we may be seen as a bit boring. But we are a little more responsible and we are more motivated to study than the others in the class.

A wish to save money and reluctance to support the illegal drug production were also mentioned as reasons to abstain from substance use, however to a lesser extent.

Universal prevention viewed as attractive or feasible

With regard to substance information interventions, some students wanted detailed information about different substances’ physical and psychological effects. The participants emphasized the importance of credible sources or persons providing the information, mentioning researchers, young medical students and even parents as credible sources of information. Individuals who had experience of substance use were also suggested.

You have to tell the facts in a way that makes us want to listen. With the help of various spokespersons who have been involved in it, for example.

Several students stressed the importance of being able to identify with the person sending the message and suggested influencers as plausible sources. Someone who is difficult to relate to was given as an example of a non-credible, as the following excerpt shows:

They shouldn’t take a heroin addicts who talk about having found Jesus, because I do not think it would touch the children or touch the young. You have to somehow find … someone that can relate to the young people.

As for universal prevention, the students also suggested intensified legal measures for companies and people providing young people with alcohol or drugs.

For example, make it difficult for young people to have access to alcohol [...], allocate more time as a police officer to catch the drug dealers.

Both alcohol and illicit drugs were reported as easily accessible. Students can obtain alcohol via social media platforms, such as Instagram and Snapchat, where “liquor cars” market themselves and offer home delivery. In addition, older siblings or peers and even some parents were, according to the informants, providing minor students with alcohol. The main way to access illicit drugs is via parties where older students offer drugs to younger peers. Access to prescription drugs was also reported.

Several of the participants agreed that parental involvement is constructive for substance use prevention. Many of them reported having supportive and caring parents involved in their lives, but at the same time referring to friends’ parents as being more absent, resulting in extensive partying in large homes without parental control. Some students reported that parents don’t realize to what extent youths are using substances and that the parents should pay even more attention to what their children do.

I think [parents should be] keeping track, good track of the kids […] . Keeping track of what they are doing and ask them how they feel and things, I think that helps.

In line with leisure activities as a reason to abstain from substance use, some participants suggested that social activities other than partying could be a way of preventing substance use, as expressed by one participant when asked about plausible ways to prevent substance use.

Find a sport or friend that you train with […] instead of going to a party,

Talking about their leisure activities, the participants expressed joy and that these activities made them relax while being social.

The leisure interests, like working out and hanging out with friends, is relaxing and in contrast to the everyday in some way .

Universal prevention viewed as inappropriate

Several of the participants expressed great skepticism towards traditional universal preventive strategies, such as lectures by teachers, social workers or researchers. Some teachers were perceived as ignorant and unengaged, lecturing about substances only by duty.

The teachers have been a bit like ‘now we’re going to talk about drugs […] and then you have fifteen minutes and they say something like ‘here we are a drug free and smoke and tobacco free school’, and no one obeys.

Some students also doubted that the information provided from school and society is true, suspecting exaggerated report on harm, and that they prefer information from social media platforms such as Youtube or other online sources.

It feels like the information we get in school is a bit exaggerated, a bit made up for us […] A bit like this, ‘now we’ll get the young people to stop’.

Selective prevention viewed as attractive or feasible

In circumstances where students are worried about their own or peers’ substance use, participants stressed the need for a way to connect with local authority, health care or other support anonymously, without being registered in medical records or being reported to the authorities. Moreover, the participants emphasized the importance of a non-judging approach from professionals when they reach out to students at risk of excessive substance use.

If you wonder about something or if you are worried about something, then you should be able to turn to adults without being yelled at and know that you are getting positive feedback like ‘I understand you’ and ‘how can we fix this?’

Selective prevention viewed as inappropriate

As indicated above, help-seeking seemed to be counteracted by fear of being recorded in medical records or in the criminal registries. One participant mentioned an incident where a student, caught smoking marijuana, was prosecuted and that this student’s life had been severely affected with cancellation of planned studies abroad and rejection of driving license application. These consequences had, according to the participant, resulted in the student “giving up” and selling illicit alcohol to other students instead of trying to strive for a good future life. Admitting that such an incident can serve as a warning to other students, the fear of consequences is, according to the participant, still an obstacle to seeking help.

People don’t really know what to do when they see their friends do it [use substances]. You don’t want to tell on them, because they are afraid that if it is written down somewhere, then everything can be ruined.

Also, parents were by the participants reported as being reluctant to seek help for their children, because of fear of the reporting of their child’s behavior or crime to authorities, with subsequent negative consequences.

Parents do not dare either because they don’t want it to be about their children. I know some parents who have found drugs in their children’s rooms, but do not want to ruin [future prospects] for them.

The current study aimed to explore motives for using or abstaining from using substances, including alcohol, among students in affluent areas, as well as their attitudes to and suggestions for substance use prevention.

Summary of results

The motives for using substances among the students are associated with social aspects as.

well as own pleasure and coping with stressful situations. The most prominent motive appears to be a desire to feel a part of the current social milieu and to attain or maintain high social status within the peer group. Several of the students expressed fear of being excluded from attractive social activities if abstaining from substance use, although some meant that they were not interested in substances and didn’t care if they were perceived as boring, and also had found a small group of friends with whom they socialized. Motives for abstaining, apart from lack of interest, included academic ambitions, activities requiring sobriety, parental influence, and a wish to stay healthy. The students expressed negative attitudes towards current information-based prevention as well as problems with using selective prevention interventions due to fear of being registered or reported to the authorities. Students’ suggestions for feasible universal prevention concerned reliable information from credible sources, stricter substance control measures, extended parental involvement, and social leisure activities without substance use. Suggestions regarding selective prevention were guaranteed confidentiality and non-judging encounters when seeking help due to substance use problems.

Comparison with previous research

Children of affluence are generally presumed to be at low risk for negative health outcomes. However, the current study, in accordance with other recent studies [ 29 , 55 ], suggest problems in several domains including alcohol and drug use and stress related problems, even if the cause of these problems cannot be determined based on our interview study. Previous explanations for extensive substance use among affluent young people have been exceptionally high-performance requirements in both school and in leisure activities, and absence of emotional and physical adult contact, resulting from parents in affluent areas spending a lot of time on their jobs and careers [ 30 , 56 , 57 , 58 ]. These explanations can be viewed in the light of Cooper and colleagues’ [ 21 ] as well as Boys and colleagues’ [ 23 , 24 , 25 ] previously identified coping motive for substance use. Coping appears among affluent young people as a central motive for substance use, i.e., coping with performance requirements and perhaps with negative affects due to parents’ absence. In the current study, however, social motives, including conformity, i.e., using substances due to social pressure and a need to fit in [ 21 , 23 , 24 , 25 ] appears to be the most prominent motive, supporting the social learning theory which proposes that behavior can be acquired by observing and imitating others and by rewards connected to the behavior [ 16 , 59 ]. Interestingly, a small group of participants, especially from natural sciences programs, resisted the general pressure to use substances and found a social context of a few friends with whom they socialized without striving for high social status in the larger social context. The wish to be included in the social life and achieve high social status within the peer group was described as a central motive for substance use among a majority of the students, along with fear of being excluded if abstaining. Previous research show that high socioeconomic status is a protective factor for substance use disorder among adults [ 60 ], but among young people it may be the opposite. High status appears to be an important risk factor for the use of substances, at least among those striving for higher status. The students report that they, to achieve high status, must attend parties and at least drink alcohol. After achieving high status, which has resulted in frequent invitations to parties, students then may pose an even higher risk of excessive alcohol and drug use. In line with previous studies, results show that individuals with larger social networks, which has shown to be an indicator for social status among young, also drink more [ 35 , 61 ]. However, status can also act as a protective factor. Individuals with higher status have, according to the interviewees, slightly more room for maneuver to temporarily say no to substances at a party, without being pressured or ashamed. Nevertheless, several of the interviewees reported that they have to choose between using substances or being excluded from desirable social activities, as abstainers are considered “boring”. The results further show that alcohol and other drugs are popular among affluent youth and the information from the participants indicate that the students perceive substance use to be under control. One possible explanation is that high affluence can contribute to a sense of control over one’s life [ 62 ]. Although previous studies show that young people from affluent areas drink more, the risk of developing alcohol problems is still greater among young people who grow up in more disadvantaged areas [ 57 ]. Why this is the case is unclear. There is a widespread belief that affluent youngsters have plenty of social and financial resources in the family and thus receive the right help (e.g., psychotherapy) when they have problems [ 62 ], which could explain why they do not develop alcohol problems. However, research also shows that parents in affluent areas seek less help than others when their children are troubled [ 30 , 63 ], partly due to difficulties in accepting and revealing problems within the family [ 62 ]. In the current study, the informants expressed doubts about the possibility to be guaranteed confidentiality when seeking help, which may mean that there are concerns among both children and parents about the risk of losing status and a good reputation if seeking help for substance use problems. Consequently, there is a risk that any substance use problems will not be noticed in this group [ 62 ].

Previous research indicates that academic pressure may promote substance use [ 56 , 64 ]. However, in the current study academic pressure, due to high ambitions, was reported both as a reason for using substances and abstaining, the former to cope with stress or relax, the latter to maintain a sharp intellect and receive high grades. Moreover, previous research has demonstrated an association between pressure from extracurricular activities or “over scheduling” and negative outcomes among affluent students ( 39 ). In the current study, this did not stand out as a critical vulnerability factor. Instead, students reported extracurricular and leisure activities as relaxing and fun and an accepted reason to abstain from substance use while still attending activities where peers were using substances.

With regard to adult or parental contact, previous research shows that mental health and substance use among adolescents in socioeconomic affluent areas are associated with parents’ lack of reaction to teenage substance use (i.e. liberal, allowing attitudes and minor or no repercussions on discovering use) and parents’ lack of knowledge of their teens’ activities [ 30 ]. In our study, the students reported that their parents do not generally react with punishment due to their child’s alcohol consumption. However, the participants thought that parents probably should react more condemningly due to illicit drug use, if revealed. The Swedish criminalization of illicit substance use [ 46 ] may influence parents to adopt stricter norms with regard to their children’s illicit substance, because of the consequences for revealed substance use that may occur in the Swedish context. Also, parents in the current study were reported as being reluctant to seek help for their children out of fear of negative consequences that may affect their children. This result is in line with previous research, showing that concern about admitting problems in their children is elevated among affluent parents [ 30 ], mentioned above. In the current study, the participants further reported closeness to their parents and that their parents cared about how they spent their time. That said, some parents of wealthy peers were reported as being more absent, resulting in extensive partying in large homes without parental control. Previous research has shown the nature of family relationships and perceptions of closeness to be important protective factors for adolescent mental health [ 56 ], and this seems to apply to the students in the current study.

The students’ attitudes to current substance use prevention, aimed to increase students’ knowledge, are to a large extent negative. Information provided in school were reported as exaggerated and uninteresting. Instead, students suggested interventions focusing on credible sources of reliable information, such as from people with personal adverse experiences of substance use and people whom they can identify with. Whether people with own experience of substance use are credible or helpful in a more objective way can be disputed, but the students seem to put their trust in them rather than other persons. This result is partly in line with previous research on school-based programs in general, suggesting that the role of the teacher (the one who deliver the information) is central and that the use of peer leaders can be successful in engaging the students who receive the message [ 65 , 66 ]. Some informants in the current study meant that the teachers in school were ignorant and unengaged, lecturing about substances only by duty, which of course can be problematic for the sense of credibility among those receiving the information. Previous research has demonstrated that for older adolescents, a social influence approach can increase the effectiveness of alcohol and drug prevention interventions, as can health education, basic skills training and the inclusion of parental support [ 67 ]. Again, this research applies to adolescents in general and not to affluent youth specifically.

Interestingly, the students also suggested stricter regulations on substances with intensified legal measures for those providing substances. Positive attitudes to limiting access of alcohol for drunk people have previously been shown in a Spanish study among adolescents participating in an open-air gatherings of binge drinkers [ 19 ]. The positive attitude to stricter regulations for those providing substances is interesting in the light of the students’ desire for a non-judging approach when having to seek help for own substance use, as described below. Previous research, however, supports strict policy measures to decrease availability as an effective measure for substance use prevention in the general population [ 68 ]. The students further suggested increased parental control and activities and venues which can be attended without using substances, for example sporting/training with friends. Leisure activities without substance use have recently been offered to e.g., adolescents in general in an Icelandic prevention strategy [ 69 ], however more research is needed to see if this kind of prevention is attractive also for large groups of affluent students as an alternative to parties and whether it also appears to be effective in reducing substance use in this group. Clearly, some affluent students without ambitions to receive high social status do find socialization without using substances attractive, as shown in the current study. With regard to selective prevention, the students were critical of the current risk of being reported to parents, registered within medical records or reported to the authorities if turning to professionals for support for substance use problems. They claimed that this circumstance serves as a massive counteracting force to seek help at an early stage for oneself or for peers and that the possibility of reaching out anonymously is essential for taking the first step in seeking help. Moreover, the adolescents in this study call for an open and non-judging approach when turning to health care staff, parents or other adults, which is in line with so called Motivational Interviewing, a non-judging approach aimed to enhance motivation to change by exploring and resolving ambivalence about e.g., substance-related behaviors [ 70 ], which has shown promising results with regard to reduction of alcohol consumption among young people [ 71 ].

Strengths and limitations

The current study has a number of strengths. Firstly, we were able to recruit both male and female students between 15 and 19 years of age, living inside the affluent community as well as in neighboring municipalities, which provided us with a broad base of the students’ social context. Secondly, we included informants using substances as well as abstainers, increasing the possibility to get a broad view of motives to use or abstain from using substances among affluent youth. Thirdly, the research group has extensive experience in qualitative analysis as well as working with adolescents and young adults with mental health problems, including alcohol and drug consumption or abuse. However, our study must also be viewed in the context of some limitations. Students with more severe health or psychosocial problems may have refrained from participating, biasing the results towards adolescents of more stable psychosocial functioning. Moreover, interview studies are always vulnerable for social desirability bias due to a potential desire to give socially acceptable answers [ 72 ]. However, the possibility to terminate participation at any time, along with the circumstance that most of the interviewers are health care professionals, thereby used to handle secrecy in consultation situations, may have decreased the risk of desirability bias in the current study.

Several of the motives guiding substance use behavior among young people in general also seem to apply to affluent youth. A desire to feel a part of the current social milieu and to attain or maintain high social status within the peer group were reported as prominent motives for substance use among affluent students in the current study. Given that the social milieu is crucial for the substance use behavior in this context, future research on substance use prevention targeting this group could with advantage pay attention to suggestions on prevention strategies given by the students. Students’ suggestions include reliable prevention information from credible sources, stricter substance control measures targeting those providing substances, parental involvement, leisure activities without substance use, and confidential ways to seek help, involving a non-judging approach from professionals and other adults.

Availability of data and materials

Collected data will be available from the Centre for Psychiatry Research, a collaboration between Karolinska Institutet and Region Stockholm, but restrictions apply to their availability, as they were used under ethical permission for the current study, and so are not publicly available. However, data are available from the authors upon reasonable request and with permission from the Centre for Psychiatry Research.

Abbreviations

attention deficit hyperactivity disorder

natural sciences/technology/mathematic programs

social sciences/humanities programs

Stockholm prevents alcohol and drug problems

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Acknowledgements

We would like to thank all the participating students for making this study possible.

The work was funded by the Alcohol Research Council of the Swedish Alcohol Retailing Monopoly (grant no. 2018–0010). The funding body had no role in study design, data collection, analysis, data interpretation or writing the manuscript. Open Access funding provided by Karolinska Institute.

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Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Liljeholmstorget 7, 117 63, Stockholm, Sweden

Youstina Demetry

Department of Neuroscience, Uppsala University, Uppsala, Sweden

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PK contributed to conceptualization, methodology, investigation (data collection), data curation, formal analysis, writing original draft, review & editing, funding acquisition. LH contributed to conceptualization, methodology, data curation, formal analysis, validation, review & editing. YD contributed to project administration, methodology, investigation (data collection), data curation, formal analysis, validation, review & editing. AC contributed to investigation (data collection), review & editing. TH contributed to investigation (data collection), review & editing. JG contributed to conceptualization, methodology, review & editing, funding acquisition. TE contributed to conceptualization, methodology, review & editing. KE contributed to review & editing. CS contributed to conceptualization, methodology, investigation (data collection), data curation, formal analysis, review & editing, funding acquisition, supervision. All authors approved the submitted manuscript version.

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Kvillemo, P., Hiltunen, L., Demetry, Y. et al. How to prevent alcohol and illicit drug use among students in affluent areas: a qualitative study on motivation and attitudes towards prevention. Subst Abuse Treat Prev Policy 16 , 83 (2021). https://doi.org/10.1186/s13011-021-00420-8

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• Underage Drinking

Underage alcohol consumption is common in the United States and can have harmful outcomes. A comprehensive approach that includes effective policy strategies can prevent underage drinking and related harms.

Underage drinking is a significant public health problem in the U.S. Excessive drinking is responsible for about 4,000 deaths and more than 220,000 years of potential life lost among people under age 21 each year. 1 Underage drinking cost the U.S. $24 billion in 2010. 2

Underage Drinking is Common

Learn about the Minimum Legal Drinking Age laws

Alcohol is the most commonly used substance among young people in the U.S. 3

The 2021 Youth Risk Behavior Survey 3  found that among high school students, during the past 30 days

• 23% drank alcohol.
• 11% binge drank .
• 5% of drivers drove after drinking alcohol.
• 14% rode with a driver who had been drinking alcohol.

Rates of current and binge drinking among high school students have generally been declining in recent decades. Although males historically had higher rates, in 2019 and 2021, female high school students were more likely to drink alcohol and binge drink than male high school students. 3,4

Underage Drinking is Dangerous

Youth who drink alcohol are more likely to experience 4-7

• School problems, such as higher rates of absences or lower grades.
• Social problems, such as fighting or lack of participation in youth activities.
• Legal problems, such as arrest for driving or physically hurting someone while drunk.
• Physical problems, such as hangovers or illnesses.
• Unwanted, unplanned, and unprotected sexual activity.
• Disruption of normal growth or sexual development.
• Physical and sexual violence .
• Increased risk of suicide  and homicide.
• Alcohol-related motor vehicle crashes  and other unintentional injuries, such as burns, falls, or drowning.
• Memory problems.
• Misuse of other substances.
• Changes in brain development that may have life-long effects.
• Alcohol poisoning.

In general, the risk of youth experiencing these problems is greater for those who binge drink than for those who do not binge drink. 6,7

Early initiation of drinking is associated with development of an alcohol use disorder  later in life. 8

Underage Drinking is Associated with Adult Drinking

Studies show a relationship between underage drinking behaviors and the drinking behaviors of adult relatives, adults in the same household, and adults in the same community and state.

• There is a relationship between youth and adult drinking, including binge drinking, in states and communities. 9-11  A 5% increase in binge drinking among adults in a community is associated with a 12% increase in the chance of underage drinking. 10
• Among adolescents whose peers drink alcohol, those whose parents binge drink are more likely to drink alcohol than those whose parents do not. 12

Underage Drinking is Preventable

State alcohol policy environments influence underage drinking, as well as excessive drinking among adults. Comprehensive approaches that include effective population-level policy strategies can reduce underage drinking. 10,13,14  The Community Preventive Services Task Force recommends several effective strategies for preventing excessive drinking, 15  including:

• Increasing alcohol taxes.
• Having commercial host (“dram shop”) liability laws.
• Regulating the number and concentration of alcohol outlets.
• Enforcing laws prohibiting alcohol sales to minors.

The Surgeon General’s Report on Alcohol, Drugs, and Health describes other strategies that can complement effective alcohol policies, such as national media campaigns targeting youth and adults, reducing youth exposure to alcohol advertising, and the development of comprehensive community-based programs. 5 Read more about the prevention of excessive alcohol use , including underage drinking.

• Centers for Disease Control and Prevention. Alcohol-Related Disease Impact Application website . Accessed February 29, 2024.
• Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. 2010 national and state costs of excessive alcohol consumption. Am J Prev Med 2015; 49:e73–e79.
• Centers for Disease Control and Prevention. 2021 Youth Risk Behavior Survey Data. Available at: https://www.cdc.gov/healthyyouth/data/yrbs/index.htm . Accessed on September 13, 2023.
• Jones CM, Clayton HB, Deputy NP, Roehler, DR, Ko JY, Esser MB, Brookmeyer KA, Hertz MF. Prescription opioid misuse and use of alcohol and other substances among high school students — Youth Risk Behavior Survey, United States, 2019 . MMWR Suppl 2020;69(Suppl-1):38–46.
• U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health . Washington, DC: HHS, 2016.
• Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics 2007;119:76–85.
• Esser MB, Guy GP, Zhang K, Brewer RD. Binge drinking and prescription opioid misuse in the U.S., 2012-2014 . Am J Prev Med 2019;57,197-208.
• Buchmann AF, Schmid B, Blomeyer D, et al. Impact of age at first drink on vulnerability to alcohol-related problems: Testing the marker hypothesis in a prospective study of young adults . J Psychiatr Res 2009;43:1205–1212.
• Nelson DE, Naimi TS, Brewer RD, Nelson HA. State alcohol-use estimates among youth and adults, 1993–2005 . Am J Prev Med 2009;36:218–224
• Xuan Z, Nelson TF, Heeren T, et al. Tax policy, adult binge drinking, and youth alcohol consumption in the United States . Alcohol Clin Exp Res 2013;37:1713–1719.
• Paschall MJ, Lipperman-Kreda S, Grube JW. Effects of the local alcohol environment on adolescents’ drinking behaviors and beliefs . Addiction 2014;109:407–416.
• Olson JS, Crosnoe R. The interplay of peer, parent, and adolescent drinking . Soc Sci Q 2018;99:1349–1362.
• Xuan Z, Blanchette JG, Nelson TF, et al. Youth drinking in the United States: Relationships with alcohol policies and adult drinking . Pediatrics 2015;136:18–27.
• Blanchette JG, Lira MC, Heeren TC, Naimi TS. Alcohol policies in U.S. states, 1999–2018 . J Stud Alcohol Drugs . 2020;81:58–67.
• Excessive Alcohol Consumption. The Guide to Community Preventive Services website . Accessed September 16, 2022.
• The Community Guide: Enhanced Enforcement of Laws Prohibiting Sales to Minors
• Youth Risk Behavior Surveillance System Findings
• Monitoring the Future Findings
• National Survey on Drug Use and Health Findings
• Age 21 Minimum Legal Drinking Age

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Alcohol Awareness Month: Raising Awareness about the Dangers of Alcohol Use Among Teens

March 27, 2024

April is Alcohol Awareness Month, an opportunity to update your knowledge about the adverse effects of alcohol misuse on health and society. It is also a good time to talk to teens about drinking and to equip them with the knowledge to handle situations involving alcohol. Even teens who would not normally be tempted to drink alcohol may be drawn in by certain social situations, so don’t assume they have all the facts they need to resist peer pressure. Parents and trusted adults can play a meaningful role in shaping youth’s attitudes toward drinking.

Alcohol-related problems continue to take a heavy toll on individuals, families, and communities. Researchers estimate that each year there are more than 178,000 alcohol-related deaths, making alcohol a leading preventable cause of death in the United States. Alcohol is a significant factor in the deaths of people younger than age 21 in the United States. This includes deaths from motor vehicle crashes, homicides, alcohol overdoses, falls, burns, drownings, and suicides. Research indicates that alcohol misuse during the teenage years can interfere with normal adolescent brain development. Alcohol use during adolescence also significantly increases the risk of developing alcohol use disorder later in life, and the earlier a teen starts, the higher the risk. In addition, more than 200 disease and injury-related conditions are associated with alcohol misuse.

Here are some resources from NIAAA to inform teens and their parents—as well as people such as educators, coaches, and faith group leaders who work with teens—about the detrimental health effects of underage alcohol use:

• Facts About Teen Drinking : Designed for teens, this website contains in-depth information about how alcohol affects health, how to identify signs of an alcohol problem, and how to get help.
• NIAAA for Middle School : This website contains interactive activities to help parents, caregivers, and teachers introduce and reinforce key messages about peer pressure, resistance skills, and other important topics related to underage drinking.
• Alcohol and Your Brain: A Virtual Reality Experience : This educational experience shares age-appropriate messages through engaging visuals, informative billboards, and narration.
• Kahoot! quiz about underage drinking : This quiz can be taken at home or in the classroom to help teens gain a better understanding of underage drinking. Topics covered in the quiz are negative health consequences associated with drinking, signs of an alcohol problem, and how to find support.

More NIAAA resources about drinking during adolescence are available on our underage drinking landing page , including resources for talking to kids about alcohol. Parents and other adults can make a difference in helping teens make the right decisions when it comes to alcohol and preventing underage drinking. Having conversations with them about alcohol is a strong start. Another strong start is to understand your key function as a role model when it comes to alcohol. Adolescents are less likely to drink heavily when the adults in their life demonstrate responsible behavior regarding their own alcohol use and when they live in homes where parents/guardians have specific rules against drinking at a young age.

In addition, for adults, the Rethinking Drinking website features interactive calculators as well as tips and strategies to cut down or quit drinking. The Alcohol Treatment Navigator walks individuals through the process of finding treatment options and recovery resources. Whether you are seeking more information about what alcohol use disorder is, are thinking about cutting back on alcohol, are a parent looking for information about how to talk to your child about alcohol, or a health care professional looking for how to help patients with alcohol-related problems, NIAAA can help.

Best wishes, George F. Koob, Ph.D. NIAAA Director

Need Help for an Alcohol Problem?

If you’re having an emergency, call 911. If you are having suicidal thoughts, call 911, go to the nearest emergency room or call the toll-free, 24-hour  National Suicide Prevention Lifeline  at 1-800-273-TALK (8255) to help you through this difficult time.

The  NIAAA Alcohol Treatment Navigator  can help you recognize and find high quality treatment for alcohol use disorder. If you drink excessively, seek medical help to plan a safe recovery as sudden abstinence can be life threatening. NIAAA’s  Rethinking Drinking  can help you assess your drinking habits and provides information to help you cut back or stop drinking.

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Prevention of Alcohol Consumption Programs for Children and Youth: A Narrative and Critical Review of Recent Publications

Rafael sánchez-puertas.

1 Department of Health Sciences, Public University of Navarre, Pamplona, Spain

2 Department of Psychology, Particular Technical University of Loja, Loja, Ecuador

Silvia Vaca-Gallegos

Carla lópez-núñez.

3 Department of Personality, Assessment and Psychological Treatments, School of Psychology, University of Seville, Seville, Spain

Pablo Ruisoto

Associated data.

Youth substance use is a public health problem globally, where alcohol is one of the drugs most consumed by children, and youth prevention is the best intervention for drug abuse.

Review the latest evidence of alcohol use prevention programs in empirical research, oriented to all fields of action among children and youth.

A narrative and critical review was carried out within international databases (PsychInfo, Pubmed, Web of Science, and Scopus) in August 2021 and was limited to empirical studies that appeared in the last five years (2017–2021). A flow diagram was used according to the PRISMA statements. Empirical research articles in English with RCTs and quasi-experimental design that included alcohol, children, and young people up to 19 years of age (universal, selective, or indicated programs) were included. The authors examined the results and conceptual frameworks of the Prevention programs by fields of action.

Twenty-two articles were found from four fields of action: school (16), family (2), community (2), and web-based (2), representing 16 alcohol prevention programs. School-based alcohol prevention programs are clinically relevant [ Theory of Planned Behavior , Refuse , Remove, Reasons, Preventure , The GOOD Life , Mantente REAL , Motivational Interviewing (BIMI), Primavera , Fresh Start , Bridges/Puentes ], they are effective in increasing attitudes and intentions toward alcohol prevention behavior, while decreasing social norms and acceptance of alcohol, reducing intoxication, and increasing perceptions with regards to the negative consequences of drinking.

This narrative and critical review provides an updated synthesis of the evidence for prevention programs in the school, family, community, and web-based fields of action, where a more significant number of programs exist that are applied within schools and for which would have greater clinical relevance. However, the prevention programs utilized in the other fields of action require further investigation.

Introduction

Youth substance use represents a public health problem globally ( Somani and Meghani, 2016 ; Stevens et al., 2020 ). The neurological development that occurs during childhood and adolescence combined with the onset of substance use (between the ages 15 and 19) ( Blanco et al., 2018 ) becomes a particularly vulnerable stage that must be studied ( Thorpe et al., 2020 ). Alcohol is one of the drugs most consumed by adolescents and young adults ( Johnston et al., 2020 ). Particularly in the United States, 62.5% of underage alcohol users are binge alcohol users ( Substance Abuse and Mental Health Services Administration [SAMHSA], 2018 ). Use and misuse of alcohol are associated with poor cognitive and executive functioning ( Lees et al., 2020 ), increased risk of injury, death, and physical and sexual violence ( Centers for Disease Control and Prevention [CDC], 2020 ), poor academic performance ( Bugbee et al., 2019 ; Chai et al., 2020 ), and increased exposure to social risks and early sexual activity ( Boisvert et al., 2017 ). Moreover, young people who drink alcoholic beverages are more likely to use tobacco and other drugs and develop risky sexual behaviors ( Lee et al., 2018 ).

Currently, alcohol abuse is characterized by high relapse rates, around 70–80% within a year ( Dousset et al., 2020 ). In 2017, a systematic review found that children are aware of and able to recognize alcohol and its effects, suggesting the importance of starting prevention as soon as possible ( Jones and Gordon, 2017 ). For this reason, the National Institute on Drug Abuse ( National Institute on Drug Abuse [NIDA], 2020a ) considers prevention the most cost-effective intervention for drug abuse. Unfortunately, there is no single accepted concept to define “drug use prevention”.

The European Monitoring Center for Drugs and Drug Addiction ( European Monitoring Centre for Drugs and Drug Addiction [EMCDDA], 2015 ) defines “prevention” as any policy, program, or activity to (at least partially) delay or, directly or indirectly reduce drug use, including the possibility of minimizing drug use, limiting the negative consequences for health and social development or the progression of problematic drug use. As well it states that preventive actions among young people should be initiated early in their lives ( European Monitoring Centre for Drugs and Drug Addiction [EMCDDA], 2021 ). In addition, substance use prevention also emphasizes protection against the initiation, progression, and maintenance of drug use, training in healthier coping strategies and social skills, or the development of social policies that reduce the availability and accessibility (such as prices) of alcohol ( Becoña, 2007 ; Caywood et al., 2015 ). Overall, evidence-based prevention programs are encouraged ( Harrop and Catalano, 2016 ; Funk et al., 2020 ).

Drug Use Prevention Programs

Most prevention programs seek to reduce the number and type of drugs consumed, delay the age of onset of drug use, eradicate the impact of negative consequences among those who already use drugs or have abuse/dependence problems, as well as reduce risk factors and enhance protective factors by providing healthy alternatives to consumption ( Becoña and Cortés, 2011 ; National Institute on Drug Abuse [NIDA], 2020b ). Most programs are based on three essential components ( Reno et al., 2000 ; Tobler et al., 2000 ): reducing supply (reducing access and availability of drugs), reducing or delaying drug demand, and limiting health and social consequences.

Prevention, conceptualized as an intervention that occurs before the onset of the disorder, is usually classified into three types: universal, selective, or indicated ( Griffin and Botvin, 2010 ). Universal prevention programs are aimed at the general population. These are less intense and expensive than the other two types (for example, this would include school-level preventive activities that promote skills to refuse drug offers, improve self-esteem, and other factors that protect against substance abuse) ( Espada et al., 2003 ; Griffin and Botvin, 2010 ). Selective prevention programs are aimed at high-risk groups within the general population and indicated prevention strategies are aimed at a specific subgroup of the community, which are usually consumers who show premature signs of danger for the development of addictive disorders ( Griffin and Botvin, 2010 ; Becoña and Cortés, 2011 ). That is, indicated prevention targets those who already show early signs of substance use problems, engage in substance abuse, or other high-risk behaviors associated with drug consumption ( Griffin and Botvin, 2010 ).

In addition, prevention programs can be developed in different fields of action, such as family-based, that encourage positive interaction between parents and children in connection with different developmental milestones ( Van Ryzin et al., 2016 ); school-based, that provide a safe space for children and adolescents to discuss their problems with their friends and peers, and allow for regular supervision, as children spend a significant amount of time each day at school ( Spanemberg et al., 2020 ); community-based, that refers to the community’s efforts to prevent consumption by its members ( Hafford-Letchfield et al., 2020 ); and recently, mindfulness-based intervention (MBI), that includes paying attention in the present moment in a particular way: on purpose and without judgment ( Korecki et al., 2020 ).

Recent systematic reviews of prevention programs have focused solely on either family-based ( Van Ryzin et al., 2016 ; Ballester et al., 2020 ), school-based ( Tremblay et al., 2020 ), or community-based fields of action ( Melendez-Torres et al., 2016 ; Hafford-Letchfield et al., 2020 ). However, most programs are included within other broader programs whose objective is to improve the school climate and prevent bullying ( Spanemberg et al., 2020 ) or are specific micro-interventions, such as interventions based on mindfulness ( Korecki et al., 2020 ). This study aims to critically review the latest empirical evidence of alcohol prevention programs in children and youth.

Materials and Methods

A narrative and critical review was carried out in international databases (PsychInfo, Pubmed, Web of Science, and Scopus) in August 2021 and was limited to empirical studies that appeared in the last five years (2017–2021). The keywords used were: “alcohol”, “child*”, “young adults”, and “prevent*”. The Boolean connector used was AND.

The criteria to carry out the selection process were the following: empirical research articles with randomized controlled trials (RCTs) and quasi-experimental design that included alcohol as a variable, that the target group constituted children and young people up to 19 years of age (universal, selective or indicated programs), and that the studies had been published in English journals of high quality and impact factor. Although this is not a systematic review, a flow chart according to the PRISMA statements ( Moher et al., 2009 ; Page et al., 2021 ) was used for this narrative and critical review ( Figure 1 ). The records were removed before screening in the identification stage because they were duplicates or unrelated to the intervention. In contrast, the papers were eliminated in the first stage of the screening (records screened) because the prevention was not in substance use.

Flow diagram of search and selection of articles according to PRISMA statements.

The authors examined the results and conceptual frameworks of the prevention programs by fields of action in children and young people up to 19 years: Do these interventions reduce the amount and/or frequency of use? Does the intervention influence other variables such as attitudes, intentions, perceptions, or social norms about alcohol consumption? The evidence reviewed along with the conceptual frameworks and key results of the reviewed articles are described in Supplementary Table 1 .

Characteristics of Included Studies

Of the 22 included studies, 16 were randomized controlled trials (72.73%), and 6 (27.27%) were quasi-experimental (see Supplementary Table 1 ).

Description of the Programs

Supplementary Table 1 summarizes basic information of the 16 prevention programs reviewed, the intervention, the conceptual framework, and their results. The school prevention programs found were: the Triad ; Primavera ; Bridges / Puentes ; Mantente REAL ; Preventure ; Refuse, Remove, Reasons program ( RRR ); Fresh Start ; based in Motivational Interviewing program ( BIMI ), Unplugged ( Tamojunto ); The GOOD Life ; pragmatic prevention, and a program based in Theory of Planned Behavior. The family prevention programs found were Media Detective Family and Effekt . The community prevention programs found were Öckerö Method and a program based on the Theory of Planned Behavior. Finally, the web-based prevention program was RealTeen .

Almost all reviewed alcohol prevention programs were universal; that is, they intervened before the initiation stage, except one ( Lammers et al., 2017 ), which was a selective prevention program. The fields of action ranged from school (16 studies, 72.7%), family (2 studies, 9.1%), community (2 studies, 9.1%), to web-based (2 studies, 9.1%) prevention programs. Some of these programs were aimed at preventing the use of other drugs in addition to alcohol. All studies explicitly explained subject randomization and pooling in their analyses, mainly involving subjects, groups, or clusters (classes or schools). The studies showed heterogeneous sample sizes, ranging from N = 45 to 6,658; and n = 23 to 3,340 participants in the experimental group. Two studies ( Schwinn et al., 2017 ; Park et al., 2021 ) applied their programs exclusively to girls, while the remaining investigations were developed for both boys and girls. The age of the children and youth ranged from 10 to 19 years old. Outcomes ranged from immediately post prevention to 5-year assessment period follow-ups.

Prevention Programs by Fields of Action

Conceptual framework of school-based prevention programs.

All the programs were universal programs (except Lammers et al., 2017 , who studied adolescents with previous drinking experience) applied to students in a longitudinal design, regardless of their risk of alcohol consumption. The programs focused on social skills, intention and motivation, personality traits, and risk and protective factors for alcohol use. Considering the stage of development, children and young people begin to consume alcohol due to social and psychological pressure from peers, family, culture, and the media, since they lack or do not yet have all the skills and knowledge to recognize and resist such pressure. In other words, the programs seek to avoid alcohol consumption by resisting external pressure and increasing coping skills, considering their personality traits, and also by allowing children and young people to analyze their negative emotional reactions, irrational thoughts and behavioral intention while maintaining a negative attitude toward alcohol consumption to promote healthy behavior.

Several programs seek to develop social skills to reduce the effects of the social influence of alcohol consumption. Sanchez et al. (2017 , 2018 , 2019) ; Valente et al. (2019) , and Vigna-Taglianti et al. (2021) applied the Unplugged program, based on the social influence model, supporting the development of general social skills that are thought to reduce the effects of social influence by modifying attitudes, beliefs, and normative perception ( Kreeft et al., 2009 ). The GOOD Life program [applied by Vallentin-Holbech et al. (2019) ] is based on the social norms approach and aims to change the overestimation of peer use. The Refuse, Remove, Reasons ( Mogro-Wilson et al., 2017 ) program (RRR) uses social learning theory and the mutual aid model that combines social resistance skills training and normative education. Beckman et al. (2017) focused on one of the three components of the Triad program, namely, the alcohol use prevention component (called Fighting Drugs ). Primavera ( Diaz et al., 2021 ) uses health promotion as a reference basis ( Dudley et al., 2015 ) and is mainly based on experiential learning ( Potvin and Jones, 2011 ) via the development of psychosocial skills for preventing adolescent alcohol and tobacco use.

Among the programs that are based on behavioral intention are Kim et al. (2021) (web-based) and Onrust et al. (2017) ( Fresh Start program), based on the Theory of Planned Behaviour which states that behavioral intention is the direct determinant of changing to healthy behavior and that people with solid intentions strive to achieve the goal of not drinking and are more easily motivated to change their behavior ( Ajzen and Madden, 1986 ). Mantente REAL ( Kulis et al., 2020 ) (uses ecological risk and Resiliency Theory , Communication Competence Theory , and Narrative Theory ), a Spanish language version of keepin’ it REAL (kiREAL), increases the use of culturally accepted drug resistance skills and promotes non-permissive norms and attitudes about substance use ( Gosin et al., 2003 ). Motivational Interviewing (BIMI) ( Reyes-Rodríguez et al., 2019 ) seeks to identify a present or latent problem about consumption and from there motivate the person to carry out a change ( Pilowsky and Wu, 2013 ).

Bridges/Puentes ( Gonzales et al., 2018 ) emphasizes risk reduction (prevention) as well as positive youth development (promotion) in multiple domains (family, school, and peers) ( Koning et al., 2013 ); Hodder et al. (2017a) used a pragmatic intervention to implement available programs and resources targeting individual and environmental ‘resilience’ protective factors.

Finally, Preventure is a selective prevention program based on Cognitive Behavioural Therapy with a personality-targeted approach ( Lammers et al., 2015 ).

Outcomes of School-Based Prevention Programs

Sanchez et al. (2017) found that the Unplugged program (culturally adapted to Brazil) seemed to increase alcohol use initiation (9 months follow-up). Three studies based their results on the intervention performed by Sanchez et al. (2017 , 2018) did a 21-month follow-up and found an increase in alcohol use in intervention and control groups. Sanchez et al. (2019) showed that the program’s effect on drug use via normative beliefs was not statistically significant. Valente et al. (2019) found that the impact of the intervention is unlikely to be conditioned to parenting style dimensions. Moreover, Vigna-Taglianti et al. (2021) applied Unplugged in Nigeria (culturally adapted) and found that the program significantly reduced the prevalence of recent alcohol use; furthermore, the program prevented regress across stages of alcohol use.

Several programs made it possible to reduce alcohol consumption. Diaz et al. (2021) used the Primavera prevention program and showed that children from the control group were less likely to report current alcohol use at the end of the first year of the intervention. Gonzales et al. (2018) used the Bridges/Puentes program, which significantly reduced the likelihood of developing an alcohol use disorder five years later. The results of Kulis et al. (2020) ( Mantente REAL prevention program) showed relatively less frequent use of alcohol, and higher risk students reported relative reductions in the frequency of alcohol use, especially males. Mogro-Wilson et al. (2017) , using the RRR, found significantly reduced inebrity from alcohol use, decreased social norms and acceptance of alcohol, and increased perceptions about negative perceptions and consequences of alcohol use. A brief intervention (based on Motivational Interviewing ) was applied by Reyes-Rodríguez et al. (2019) , showing a significant reduction of risk levels of alcohol consumption six months later.

Three investigations found no positive effect of the interventions. The Triad prevention program was applied by Beckman et al. (2017) , who did not see an impact on the likelihood of drinking alcohol or drinking to intoxication. Hodder et al. (2017a) used a pragmatic intervention . There was no difference in the prevalence of any measure of substance use between intervention and control students, nor was there any difference for an aggregate or individual measure of personal and environmental protective factors. Vallentin-Holbech et al. (2019) applied to The GOOD Life program. The outcome shows that the intervention effect was insignificant for the frequency of binge drinking, and with regards to overestimated peer drinking, higher preventive effect sizes were observed for higher levels of exposure, satisfaction, and recall.

Finally, Park et al. (2021) ( Theory of Planned Behavior ) applied the program to girls. They found improved alcohol-related knowledge and converted individuals’ positive expectations of alcohol to negative ones. On the other hand, Kim et al. (2021) found significant improvements in attitudes and intention toward alcohol drinking prevention behavior. The results observed by Onrust et al. (2017) ( Fresh Start ) were minimal but significant effects on attitudes toward alcohol were seen. The Preventure program ( Lammers et al., 2017 ) found significant intervention effects on reducing alcohol use within the anxiety sensitivity group and reducing binge drinking and binge drinking frequency within the sensation-seeking group.

Conceptual Framework of Family-Based Prevention Programs

Two universal family-based prevention programs ( Scull et al., 2017 ; Tael-Öeren et al., 2019 ) focused on parent-child dyads. They seek the development of parental control skills, parenting behaviors, and the establishment of clear limits or rules, as well as their children’s peer and social resilience skills, and maintaining parental restrictive attitudes toward adolescents’ alcohol use over time.

Tael-Öeren et al. (2019) applied Effekt (previously known as the Örebro Prevention Program ) sought to delay and reduce adolescents’ alcohol use by maintaining parental restrictive attitudes toward adolescents’ alcohol use over time ( Koutakis et al., 2008 ). The Media Detective Family was an online media literacy education substance abuse prevention program that parents and their children complete together, whose goals are to enhance the message interpretation process skills of both parents and children and reduce children’s use of alcohol and tobacco ( Scull et al., 2017 ).

Outcomes of Family-Based Prevention Programs

The Effekt prevention program ( Tael-Öeren et al., 2019 ) positively affected parental attitudes, but it failed to delay or reduce adolescents’ alcohol consumption. The Media Detective Family prevention program, applied by Scull et al. (2017) , found that children reported a significant reduction in their use of substances over time.

Conceptual Framework of Community-Based Prevention Programs

Two universal community-based prevention programs ( Park et al., 2021 ; Svensson et al., 2021 ) focused on strengthening the community as a more protective environment from alcohol use for children and youth. They provided information and offered education about alcohol and its associated risks, reduced access to alcohol, promoted health, improved advocacy for the media, strengthened restrictions, attitudes, and approaches to youth alcohol use among parents, other adults, and the community.

The study carried out by Park et al. (2021) used the Theory of Planned Behavior explained above. Öckerö Method was a program whose goal was delaying the onset of alcohol use and reducing alcohol consumption among youths by strengthening restrictive attitudes and approaches to youth alcohol consumption among parents and other adults ( Svensson et al., 2021 ).

Outcomes of Community-Based Prevention Programs

The results of both studies were heterogeneous. Svensson et al. (2021) ( Öckerö Method ) did not show empirical evidence that the intervention affected adolescents’ drinking habits or their perceptions of their parents’ attitudes toward adolescent drinking. On the other hand, Park et al. (2021) improved alcohol-related knowledge and converted individuals’ positive expectations of alcohol to negative ones.

Conceptual Framework of Web-Based Prevention Programs

Although some programs from different fields of action use the web as a tool (online), two studies have been found that do not fit into any of these fields and are described simply as web-based and gender-specific interventions (girls). RealTeen prevention program [used by Schwinn et al. (2017) and Schwinn et al. (2019) ] is based on Social Learning Theory . It is aimed at helping girls navigate the risks associated with peer and social influences to use alcohol. This intervention focuses on goal setting, decision making, puberty, body image, coping, drug knowledge, and refusal skills.

Outcomes of Web-Based Prevention Programs

Schwinn et al. (2017) found that girls reported less binge drinking, higher alcohol refusal skills, coping skills, and lower peer drug use rates at one-year follow-up. On the other hand, Schwinn et al. (2019) [based on data from Schwinn et al. (2017) ] didn’t find reductions in binge drinking at 2-and 3-years follow-up.

In this research, the latest evidence of alcohol use prevention programs in empirical research oriented to all fields of action in children and youth has been reviewed, utilizing data from the last five years (2017–2021). Programs aimed at children and young people were reviewed due to the importance of prevention in these stages of development. Twenty-two studies were identified representing 16 prevention programs. The fields of action ranged from school (16 studies), community (2 studies), family (2 studies) to web-based (2 studies) prevention programs. Despite the significant heterogeneity of programs (both in sample size and follow-ups) and the difference in the number of studies for each field of action, most prevention programs are clinically relevant, given their results. The effects of universal prevention programs are generally miminal ( Onrust et al., 2016 ), and may be attributed to the inconsistency of program content and the diversity of the theoretical frameworks, as well as the boomerang effect (whereby trying to correct exaggerated perceptions of overall prevalence, consumption increases rather than protects against alcohol consumption ( Hopfer et al., 2010 )).

School-Based Prevention Programs

Beginning with school-based prevention programs based in Theory of Planned Behavior ( Kim et al., 2021 ), Refuse, Remove, Reasons ( Mogro-Wilson et al., 2017 ), Preventure ( Lammers et al., 2017 ), The GOOD Life ( Vallentin-Holbech et al., 2019 ), Mantente REAL ( Kulis et al., 2020 ), Motivational Interviewing ( Reyes-Rodríguez et al., 2019 ), Primavera ( Diaz et al., 2021 ), Fresh Start ( Onrust et al., 2017 ), and Bridges/Puentes ( Gonzales et al., 2018 ), all are effective in increasing attitudes and intention toward alcohol prevention behavior, decreasing social norms and acceptance of alcohol, reducing insobriety, and increasing perceptions about negative consequences of drinking. In contrast to this, the prevention program called Unplugged not only did not show effectiveness in the study by Valente et al. (2019) , but even seemed to increase alcohol use initiation in the studies by Sanchez et al. (2017) and Sanchez et al. (2018) . However, it was effective in Nigeria ( Vigna-Taglianti et al., 2021 ). The “ pragmatic prevention ” ( Hodder et al., 2017a ) was not effective either, possibly because the school staff selected the type, manner, and order of implementation of curriculum resources and programs; such interventions are less likely to be effective than non-pragmatic approaches ( Yoong et al., 2014 ). The Triad ( Beckman et al., 2017 ) did not affect the likelihood of drinking alcohol, applying only one of the program’s three components.

Other systematic reviews and meta-analyses have found similar results on school-based prevention programs. For example, the systematic review by Tremblay et al. (2020) found that 70% of the programs demonstrated reductions in the use of substances, including both alcohol and drugs; and the systematic review and meta-analysis by Melendez-Torres et al. (2018) concludes that this type of intervention was broadly effective for reducing specific alcohol and drug use. However, opposite results have also been found. The systematic review conducted by Hodder et al. (2017b) found that the universal school-based interventions that address adolescent ‘resilience’ protective factors as part of any intervention approach are ineffective for reducing adolescent alcohol use.

The school-based prevention programs that are most likely to be successful are those that combine the practice of social skills and the transmission of educational knowledge ( Tobler et al., 2000 ; Botvin and Griffin, 2007 ) but also those programs that target their interventions at more than one risk factor ( Griffin and Botvin, 2010 ; Hale et al., 2014 ). Among the components that increase the effectiveness of the programs are: the strengthening of social, emotional, behavioral, cognitive, and moral competencies; the increase in self-efficacy; improving social relationships with adults, peers, and younger children; and longer interventions ( Catalano et al., 2004 ; Cairns et al., 2014 ). However, research is lacking in universal alcohol prevention programs with primary and lower grade students that promote personal and social life skills ( Onrust et al., 2016 ), including self-control, promotion of self-esteem, and problem-solving skills ( Onrust et al., 2016 ), supplemented with the offer of healthy alternatives, work with parents and peer education ( MacArthur et al., 2016 ; Onrust et al., 2016 ).

Kim et al. (2021) ; Onrust et al. (2017) ( Fresh Start ), and Mogro-Wilson et al. (2017) ( RRR ) found improvements in attitudes and intention toward alcohol consumption, decreased social norms and acceptance of alcohol, and increased perceptions about negative consequences of alcohol use. According to a systematic review ( Jones and Gordon, 2017 ), children’s attitudes toward alcohol become more positive as they get older. For this reason, early interventions must be applied to delay or prevent the formation of positive attitudes, perceptions, and social norms toward alcohol and follow alcohol consumption prevention guidelines that allow students to control the pressures of alcohol consumption ( Kim et al., 2021 ), delaying consumption.

Among the programs that target their intervention at more risk factors is Unplugged , which supports the development of life skills (communication, assertiveness, critical thinking, coping strategies, goal setting, decision making, and problem-solving) and skills to resist the pressure to use drugs ( Kreeft et al., 2009 ). The program seeks to strengthen adolescents’ personal and interpersonal skills that reduce the effects of social influence by modifying attitudes, beliefs, and normative perceptions ( Sussman et al., 2004 ; Giannotta et al., 2014 ). The change in drinking behavior, which did not decrease but rather increased after nine months ( Sanchez et al., 2017 ) and at the 21-month follow-up ( Sanchez et al., 2017 ) in Brazil, could be due to the context and probably influenced by many factors, such as the age of the pupils, prevalence of use, social pressure, and, not last, fidelity of implementation. In addition, adaptations have to ensure that the intervention content, language, examples, and delivery methods are culturally appropriate, relevant, and acceptable to the new population ( Castro et al., 2004 ).

Some research has found that the effectiveness of preventive interventions in schools may depend on implementation parameters such as acceptance of the building blocks, the scope of intervention, and mode of delivery ( Cuijpers, 2002 ; Perkins and Craig, 2006 ; Domitrovich et al., 2008 ). In other words, the students’ attention would increase if the intervention is attractive to them, facilitating their ability to retain the central messages ( Domitrovich et al., 2008 ; Durlak and DuPre, 2008 ); Vallentin-Holbech et al. (2019) ( The GOOD Life ) studied these variables, finding that no significant effects for any level of exposure were found, neither for satisfaction, nor recall for binge drinking. Further research is required to determine the impact of these variables on other prevention programs.

Students with anxiety sensitive traits have shown higher levels of alcohol use and drinking problems in previous research ( Sher et al., 2000 ; Krank et al., 2011 ), and Lammers et al. (2017) ( Preventure ) found significant intervention effects on reducing alcohol use within the anxiety sensitivity group, reducing binge drinking and binge drinking frequency. This is one of four personality profiles at higher risk of developing alcohol problems (sensation seeking, impulsivity, anxiety sensitivity, and negative thinking) ( Comeau et al., 2001 ).

The application design of the programs must be taken into account. Although most were randomized controlled trials, three were quasi-experimental ( Beckman et al., 2017 ; Mogro-Wilson et al., 2017 ; Kim et al., 2021 ). A limitation of the quasi-experimental studies is that the program’s identification of a causal effect is based on the assumption that the intervention and control schools would have had the same trend in alcohol consumption without the intervention, which is impossible to test.

Family, Community, and Web-Based Prevention Programs

Similarly, prevention programs based on the family and the community do not allow conclusions to be reached on their effectiveness, since only Scull et al. (2017) (family-based) found a reduction in alcohol consumption among children. Park et al. (2021) (community-based) found that the program improved alcohol-related knowledge and converted individuals’ positive expectations of alcohol to negative ones.

Two systematic reviews ( Allen et al., 2016 ; Kuntsche and Kuntsche, 2016 ) and a meta-analysis ( Van Ryzin et al., 2016 ) analyzed the effectiveness of family-oriented alcohol prevention offerings, allowing for the conclusion that these programs may have preventive effects on alcohol consumption in young people. For the most part, they aimed to strengthen parental behavior and self-efficacy to improve alcohol-related family communication. Both parents and youth worked on their life skills and leisure activities in family programs. Van Ryzin et al. (2016) found that the overall impact across different programs was small to moderate.

Moreover, two systematic reviews of community programs of mentoring to prevent or reduce alcohol found a significant overall effect on alcohol consumption ( Thomas et al., 2013 ; Tolan et al., 2014 ); Toomey and Lenk (2011) found that programs that change the community environment can reduce alcohol use and related problems among youth. Strategies that lead to a general increase in the price of alcoholic products, increased regulation, control, and penalties for providing alcohol to minors, and restricting alcohol advertising could be recommended ( Paschall et al., 2009 ).

On the other hand, two web-based prevention programs ( Schwinn et al., 2017 , 2019 ) applied to girls showed, in the same way, their clinical importance as gender-specific prevention, since they reported less binge drinking and higher alcohol avoidance skills and coping skills, even at 1-year follow-up. From these only two results, no general conclusions can be reached, apart from the fact that it is a gender-specific prevention program; however, a web-based prevention program applied to first-year college students showed a reduction in alcohol consumption ( Gilbertson et al., 2017 ), so more research is required on this type of program.

The results obtained by Tael-Öeren et al. (2019) using Effekt are possibly due to it being an adaptation aimed at 11-year-old children, while additional versions were designed for 13-year-old children ( Koutakis et al., 2008 ), which resulted in the choice of different measures to address the initiation of alcohol consumption. Beckman et al. (2017) applied only the intervention “Fight against drugs” of The Triad , not the other interventions associated with other behavioral issues. It may be that using all the themes is more effective, as the entire program addresses various risk behaviors.

Limitations

Among the limitations of this research are studying alcohol consumption in populations that include young age groups which still do not drink or are starting to do so, so the evaluation and the results should be analyzed with caution. Furthermore, this is not a systematic review, which is restricted to the findings of the last five years. Knowing the most current evidence of prevention programs in children and youth in the different fields of action implies comparing varying program interventions, conceptual frameworks, and results, which limits the generalization of results and conclusions.

Individual studies are certainly not sufficient to conclude for or against the large-scale implementation of, for example, family, community, or web-based alcohol prevention programs in the clinical setting. In light of how alcohol use can be countered in the population, prevention science can support practice and policy by providing reliable knowledge for children, adolescents, and youth-oriented addiction prevention. Research and clinical practice must be evidence-based. Its implementation must take into consideration accumulated practical knowledge and the particularities of the target group and the local context. In only this way can a consensus be reached on the methods by which causality of the connection between alcohol-related issues and consumer behavior be established.

Future research should continue to seek evidence of the most effective programs but also expand into new, under-studied fields, such as technology-based substance use prevention programs ( Stinson et al., 2020 ) and mindfulness-based programs (MBP), which should be systematically tested in this population ( Riggs and Greenberg, 2019 ). In addition, studies are needed to assess the quality of investigations and reviews that employ prevention programs to reach more effective conclusions ( Shea et al., 2017 ), such as standardizing follow-ups.

Given the individual and social costs of alcohol use in youth, and increasingly in children, as a public health problem, it is the responsibility of the family, the school, the community, and the state to know the most current evidence of alcohol prevention programs. To this end, this narrative and critical review provides an updated synthesis of the evidence for prevention programs in the school, family, community, and web-based fields of action, where a greater number of programs applied in the school which ultimately carry greater clinical relevance. However, the prevention programs used in the other fields of action require further investigation.

Author Contributions

PR, CL-Z, and RS-P: record review, evaluation of full-text studies for inclusion, and data extraction. RS-P: writing—original draft preparation. PR, CL-Z, and SV-G: writing—review and editing the final version. All authors have read and agreed to the published version of the manuscript.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

The publication of this research was funded by the Particular Technical University of Loja (Ecuador). Additional funding was provided by the European Union—Next Generation EU through the Grant for the Requalification of the Spanish University System for 2021–2023 at the Public University of Navarra (Resolution 1402/2021). The funders had no role in the study design, data collection, analysis, decision to publish, or manuscript preparation.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2022.821867/full#supplementary-material

Supplementary Table 1

Studies of alcohol use prevention programs for children and youth.

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Essay: Impact of Alcohol, Tobacco And Drug Abuse on Youth

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Impact of Alcohol, Tobacco And Drug Abuse on Youth

Alcohol, tobacco and other drugs are affect youth negatively. Youth especially student’s e.g. secondary and tertiary students abuse alcohol, tobacco and other Drugs. Drugs such as tobacco, cocaine and marijuana are the major drugs which students abuse or use. Youth may end up drinking alcohol and using drugs because of various situations or reasons e.g. youth especially school going drink alcohol, use tobacco and other drug as a result of peer pressure because they may want to feel grown up among their peers, some youth use drugs to relieve boredom and give themselves personal excitement, some use drugs to rebel and get violent without any fear of people or authority, some use drugs to experiment, some use drugs and drink alcohol because their parents also drink alcohol so they end up indulging in the practise as well, social background may also influence youths to use drugs and to drink alcohol e.g. if they are many drug dealers and bottle stores around its easier for youths to indulge in the use of this drugs and lastly some youth may drink alcohol and abuse drugs to feel pleasure and escape the pressures of life or to alter their view of reality. Youth who get into drugs may get it from a friend’s friend, who also got it from his friend’s friend and so on this is to say that drugs are not of easy access because they are illegal. At the end of this long line of friends is a dealer who is making money out of destroying young people futures. The use of alcohol, tobacco and other drugs has negative impacts amongst the students who abuse this substances e.g. excessive alcohol consumption and the abuse of drugs are dangerous because alcohol and drug abuse can affect health and ability to function and think properly, almost every system in the body can be negatively affected by use of drugs and drinking of alcohol. Alcohol can cause cancer, liver disease, heart attacks and brain damage, to mention a few. Alcohol, tobacco and other drug use does not only affect youth especially students’ health wise it also affects their academic performance, it also affect them financially, psychologically, physically and ultimately students may suffer some legal consequences. Youth more so teens, who engage in sexual intercourse and drug abuse including abuse of alcohol and tobacco, are more likely than youth who abstain from such activities to become depressed, have suicidal thoughts and or even attempt suicide.

HEALTH EFFECTS OF ALCOHOL, TOBACCO AND DIFFERENT DRUG USE The use of alcohol, tobacco and other drugs has detrimental effects on health of the youth which may turn out to be fatal. The type of drugs which students commonly use are Stimulants (drugs that produce alertness, high energy, more awake and confident e.g. cocaine, amphetamines, caffeine) and Hallucinogens (give strange and intense visions called hallucinations) ALCOHOL

The scientific name for alcohol that people drink is ethyl alcohol or ethanol. Beer, wine, and liquor all contain ethyl alcohol. Other types of alcohol, like rubbing alcohol are poisonous if ingested. . Excess alcohol is the most common cause of preventable death. Alcohol is highly toxic to almost every organ in the body but when alcohol is taken in allowed limits amounts it is detoxified by the liver and therefore does little or no harm to the body. Alcoholic drinks contain ethyl alcohol and it is metabolized in the body to acetaldehyde. Both ethanol and acetaldehyde interfere with normal functioning of organs in the body including the heart and the liver and therefore if the liver and the heart get damaged disease occur which may eventually kill, teenagers maybe more prone to this effects in the youth as their organs are still developing thus toxic substances from alcohol damage their body organs. When people drink too much, with time they risk becoming addicted to alcohol. This is called alcoholism, or alcohol dependence. It’s a disease, and it can happen at any age, Common signs include, loss of control not being able to stop or cut down drinking, not feeling well after heavy drinking (upset stomach, sweating, shakiness, or nervousness), neglecting activities giving up or cutting back on other activities. Binge drinking happens when someone drinks more than four (for women) or five (for men) alcoholic drinks in about two hours, with the intention to getting drunk. Binge drinking is the most harmful type of drinking. It usually happens at teen or student parties TOBACCO The dangers of smoking are so great, but because of it governments get a lot of tax money from tobacco and cigarettes manufacturers, they are less hesitant to ban it totally. Government and society is aware of the danger that is why they made it illegal for teens to possess and use cigarettes. Smoking of tobacco can cause many with many diseases like respiratory and heart disease including, respiratory infections, lung cancer as well as cancer of the larynx, pancreas, stomach, & uterine cervix, bronchitis, emphysema and stillborn or premature children ().Smoking causes surges in the concentrations of catecholamine’s (the stimulator chemical messengers of the autonomic nervous system) as well as increases in carbon monoxide in the blood. Both of these short- term effects can exacerbate existing heart disease, resulting, for instance, in attacks of angina (chest pain). Nicotine raises blood pressure and heart rate, requiring the heart to work harder. It also constricts the coronary arteries, thereby lessening the supply of blood and oxygen to the heart muscle. It also promotes irregular heartbeats (cardiac arrhythmias). Smokers are not the only people harmed by tobacco. Toxic fumes from cigarettes pose a health threat to all those around smoker’s family, friends, and. Because the organic material in tobacco does not burn completely, smoke contains many toxic chemicals, including carbon monoxide, nicotine, and tar. As a result of this exposure, smokers’ children have more colds and flu, and they are more likely to take up smoking themselves when they grow up. Smokers also affect other people as well e.g. passive smoking. This is the involuntary inhaling of smoke from other people cigarettes and we all suffer when we have people smoking around us. It is called second-hand smoking and it is known to be even more dangerous than smoking itself COCAINE

Use of cocaine has increased among youth over the years, along with the myth that the drug is relatively safe, especially when it is sniffed rather than injected or smoked as ‘crack.’ In fact, no matter how it is used, cocaine can kill. It can disturb the heart’s rhythm and cause chest pain, heart attacks, and even sudden death. These effects on the heart can cause death even in the absence of any seizures. Even in the absence of underlying heart disease, a single use of only a small amount of the drug has been known to be fatal. Cocaine use is not healthful for anyone, but especially for certain groups like the youth. Although the drug has been shown to impair the function of normal hearts, it seems even more likely to cause death in people with any underlying heart disease. When pregnant women use cocaine, they not only raise the likelihood of having a miscarriage, a premature delivery, or a low-birth-weight baby, but also of having a baby with a congenital heart abnormality, especially an atrial-septal or ventricular-septal defect.

Use of cocaine raises blood pressure, constricts blood vessels, and speeds up heart rate. It may also make blood cells called platelets more likely to clump and form the blood clots that provoke many heart attacks. In addition, cocaine’s effects on the nervous system disrupt the normal rhythm of the heart, causing arrhythmias (irregular heartbeats). Recently, scientists have established that cocaine binds directly to heart muscle cells, slowing the passage of sodium ions into the cells. Cocaine also causes the release of the neurotransmitter nor epinephrine (nor adrenaline), a chemical messenger that stimulates the autonomic nervous system. Both changes can lead to arrhythmias. Heart attacks in young people are rare. However, when they do occur, cocaine is frequently the cause.

Cocaine is a highly addictive substance, and crack cocaine is substantially more addicting, as the drug is far more potent and is smoked. Users quickly develop a tolerance to crack cocaine, needing more of the substance to achieve the desired effects. Because the high from crack cocaine is so short-lived, users commonly smoke it repeatedly in order to sustain the high. This can lead to an even faster onset of addiction. Also, because crack cocaine works on the brain’s system of reward and punishment, withdrawal symptoms occur when the drug’s effects wear off. These symptoms can include depression, irritability, and extreme fatigue, anxiety, an intense craving for the drug, and sometimes even psychosis. Users will often keep using crack cocaine simply to avoid the negative effects of withdrawal

Marijuana harms in many ways, and kids are the most vulnerable to its damaging effects. Use of the drug can lead to significant health, safety, social, and learning or behavioural problems, especially for young users. Making matters worse is the fact that the marijuana available today is more potent than ever. Short term effects of marijuana use include memory loss, distorted perception, trouble with thinking and problem solving, and anxiety. Students who use marijuana may find it hard to learn, thus jeopardizing their ability to achieve their full potential. Long term effects include reduced resistance to common illnesses (colds, bronchitis, etc.), suppression of the immune system, growth disorders, increase of abnormally structured cells in the body, reduction of male sex hormones, rapid destruction of lung fibre’s and lesions (injuries) to the brain could be permanent, Study difficulties: reduced ability to learn and retain information, apathy, drowsiness, lack of motivation, personality and mood changes, inability to understand things clearly.

ACADEMIC EFFECTS OF ALCOHOL, TOBACCO AND DIFFERENT DRUG USE Heavy drinking by students can lead to positive blood alcohol levels the next day, affecting whether or not they even get up for class and, if they do, the quality of how information is processed and ultimately stored. Sleeping off a buzz, a common practice, can interfere with the sleep cycle, resulting in an increase in anxiety, jumpiness, and irritability the next day, and fatigue the day after that With evening use, marijuana has the same impact on sleep that alcohol has, throwing off the sleep cycle and impacting how a person feels for at least two additional days. Marijuana suppresses neuronal activity in the hippocampus, resulting in problems with attention, memory, and concentration. There is increasing evidence that there is an impact to motivation following marijuana use. This could be due to the effect of THC in the body blocking the passage of nutrients through cells, the neuronal suppression in the hippocampus, or the decrease in energy accompanying the fatigue that follows night time use. Marijuana significantly increases heart rate, weakens the heart muscle, and affects blood pressure- the increase in heart rate can be a concern for someone already dealing with anxiety ( and particularly panic). College students often forget why they are supposed to be in school. Is the purpose of university life to party all the time or to get the most out of the learning environment? Substance abuse can seriously affect academic performance. Aside from long-term addiction (or possible emptying you bank account) it can cause grades to plummet. How? Substance use affects you entire body, including your brain, in a variety of ways. Judgment is often the first attribute to be affected. You may find it difficult to make good decisions, to make them quickly or to be realistic when you make them. Suddenly, it becomes much easier to wait until the last minute to cram for that exam or to crank.

First of all, drugs and alcohol are a drain on people’s finances. We have all experienced the stress associated with money at one time or another. For those who abuse drugs or alcohol, financial issues are further compounded by their need to feed their habit. They frequently accumulate debt, borrow or steal money from others, or choose their substance of choice over more important things like food for their family or utility bills. While no one wants to be homeless, in debt, or engaging in criminal activities, the financial impact of drug and alcohol abuse risks not only your ability to support yourself, but it can also destroy relationships. When you abuse drugs or alcohol, you are choosing that substance over everything else, including your loved ones. Whether they are suffering from your financial choices or have become mistrustful of you, you have placed a strain on your relationships, which can ultimately ruin those connections for good. Families and others that rely on a sufferer of alcoholism are likely to experience problems related to financial troubles caused by drinking habits. The costs of alcohol increase as the alcoholic person builds tolerance to the drug in his or her system. This requires the person to take in ever-greater amounts of alcohol in order to feel the same effects. The psychological effects of this alcohol tolerance and dependency may cause the sufferer to become withdrawn and less supportive of colleagues, friends and family members. Sufferers may no longer attend social functions that do not allow drinking and may not be fully aware of their behaviour if attending functions where their drug of choice is allowed. A lack of networking and communication with peers may cause further financial problems if the sufferer loses promotion opportunities. Greater drains on income and lessened opportunities may cause undue troubles for others financially dependent on the sufferer, requiring a spouse or roommate to pick up extra hours or a second job to keep bills at a manageable level.

SOCIAL EFFECTS OF ALCOHOL, TOBACCO AND DIFFERENT DRUG USE Excessive alcohol use can affect all areas of a person’s life, including family, work and personal relationships. Family problems: Arguments over someone’s drinking can cause family and relationship problems that may lead to break up. Work problems: Drinking alcohol at work and hangovers can lead to poor performance and accidents at work, while illness can result in absenteeism. Legal problems: Drink-driving may lead to fines, loss of license and even imprisonment Misbehaviour caused by alcohol can also have disastrous effects on a pupil’s educational attainment, as well on performance in tests of intellect in later life. Compared with those pupils who have never truanted, pupils who had ever truanted from school had increased odds of having drunk alcohol in the last week (odds ratios of 2.24 for those who had truanted in the last year, 1.69 who had truanted previously). 6.5% of permanent exclusions of children from English state-funded secondary schools in 2010/11 were due to alcohol. Women, especially young women, encounter special risks in groups of drinking friends and acquaintances. In many societies, a woman who drinks seems to signal that she is at least approachable, and to some men an intoxicated woman is by definition sexually available. Such concepts as ‘acquaintance rape’ and ‘date rape’ bear witness to recent concern with this problem. A large proportion of unwanted sexual advances are mediated by alcohol. Initiation into certain groups, such as military units or college fraternities, sometimes includes drinking very large amounts of alcohol, so-called ‘binge drinking’. This pattern of drinking entails high risks of accidental injury, violence and acute alcohol-poisoning. It has long been known that a heavy-drinking lifestyle in groups of friends is relatively common in the armed forces. More recently, the focus has been on such drinking patterns on college and university campuses and what they mean for the development of problem drinking patterns later in life. INTERVENTIONS

A drug intervention is a structured, solution-oriented process undertaken to persuade someone who is abusing drugs to seek help in overcoming the addiction. Family, friends, and others involved in the person’s life use the intervention to demonstrate the extent of the effects of drinking and related behaviours. A successful intervention is not a confrontation but an opportunity for an addicted individual to accept help in taking the first step toward recovery. Often, an interventionist is invited to serve as a guide and educator before, during, and after the intervention. Some drug addicts can and do recognize the extent of the problems stemming from drug abuse and seek treatment without the need for an intervention. Most, however, are reluctant or unable to realize that drugs are responsible for the problems in their relationships, health, or work. They ignore the safety issues related to drinking and driving and other high-risk behaviours. It is common for addicts to deny that drugs are the source of the difficulties they face. They may instead blame other people or circumstances in their lives. When that happens, an intervention can break through the denial and help these individuals clearly see the effects of their drug abuse on the people who matter most to them.

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Community Partnership of the Ozarks working with local businesses to keep alcohol, tobacco out of minors' possession

SPRINGFIELD, Mo. (KY3) - Community Partnership of the Ozarks is working with local businesses and retailers to keep tobacco and alcohol out of the hands of youth in the community.

The organization says that it’s seen compliance as low as 12% in different communities around the Ozarks. That’s why leaders host programs at least once a month to teach retailers about how not to sell to minors. The program goes over things like checking IDs, identifying minors, state laws, and more.

“We work with local retailers to provide responsible retailer training to help them identify what the local, state, and federal laws are related to alcohol sales and tobacco sales. We also work with local law enforcement as they conduct alcohol and tobacco compliance checks. So we share that information with the retailers to help them be prepared and know what to do so that they can pass the checks and more importantly, not sell to minors,” said Chris Davis, vice president of CPO’s Prevention and Youth Support Division.

The program is free and open to anyone with a liquor or tobacco license, including bars and restaurants, grocery stores, gas stations, and more.

The program also goes over the downsides to youth being in possession of alcohol or tobacco, to encourage retailers to do the right thing on the front end.

“It’s illegal for minors to be in possession of alcohol or consume alcohol so they can have criminal consequences as well. In some ways, and sometimes can impact some of their future decisions. For example, if there’s underage drinking offenses on someone’s record, it could impact possibly what credentials or certifications or licenses that individual wants to do as an adult,” said Davis. “The retailer’s, by and large, they want to be part of the solution to do the right thing. So we just want to provide them the tools to do so.”

The benefit of these programs are two-fold. On one hand, it benefits the retailers and keeps their licenses and sales in tact. On the other, it helps benefit youth in the community.

“We found that it’s a point of pride when they have their employees go through the training, and then they pass compliance checks and things like that. The owners and the managers can just support the staff who did the right thing, and build that up as a success.,” said Davis. “It also sends a message to youth and others in the community that the retailers are doing their part that decreases the community norms that are favorable towards underage drinking.”

Davis says that by reducing ways youth can access alcohol and tobacco, it decreases risk factors.

“Accessibility and availability to substances is one of the key risk factors. If we can help retailers and others decrease youth access to substances, it decreases the likelihood that they will engage in substance misuse and have those other negative consequences,” said Davis.

Davis also noted that by doing these trainings, CPO has seen compliance increase around the communities it serves.

“What we found over time is communities that are implementing regular responsible retail or training with us or other organizations tend to start seeing those failed compliance check rates going down. The compliance checks have consequences for those which can be warning letters, fines, even suspension of their license to be able to sell so. So that’s an important carrot and stick that goes along with this,” said Davis.

CPO also partners with the Springfield Police Department and other local law enforcement to host compliance checks to keep up with retailers selling tobacco and alcohol.

CPO serves 21 counties in the Ozarks, and these trainings are available to any retailer with a liquor or tobacco license who’s interested. If your business is interested in participating in these trainings, you can reach out to CPO here .

To report a correction or typo, please email [email protected]

Copyright 2024 KY3. All rights reserved.

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303 Alcohol Essay Topic Ideas & Examples

🏆 best alcohol topics for essays, 👍 good topics for alcoholism essays, 🎓 simple & easy alcohol research titles, 💡 most interesting alcohol topics to write about, 📌 interesting topics to write about alcohol, 📑 good research topics about alcohol, ❓ research questions about alcohol.

• Alcoholism Causes and Curing In addition, professional counseling is equally important as the specialist can be able to access the level of alcoholism in the patient, how dependant that person is on alcohol and such information which would help […]
• Drug and Alcohol Abuse For along time now, drug and alcohol abuse in the society has been a problem that affects the youth and the society at large. This paper highlights the problems of drug abuse and alcohol drinking […] We will write a custom essay specifically for you by our professional experts 808 writers online Learn More
• Alcoholism and Sociological Imagination In the context of the alcoholism social problem, it is possible to use the concept of sociological imagination to unify individual characteristics of the alcoholic and historical contexts of the problem to illuminate the dynamics […]
• Drug and Alcohol Rehabilitation Therefore, the development of interpersonal relations that foster the development of social networks and social identity is critical in the rehabilitation of the drug and alcohol addicts.
• Alcohol and Drugs Effects on High School Students According to Martin, “society also advertises the image of individual and social happiness for alcohol and drug users; this misconception results in the societal decrease of achievement, especially, of high school age students”.
• Alcoholism as a Social Problem The first attempt to tackle the problem was in the 1920s when the government passed the prohibition Act. This may cause them to turn to alcohol as a way of neutralizing the problem.
• Underage Drinking and Teen Alcohol Abuse However, due to low legal driving age in America, many teenagers are prone to the risk of driving under the influence of alcohol than in other countries.
• Without Alcohol, The World Would Be a Better Place While the author accomplishes the ultimate goal of persuading the readers, the extensive use of Pathos harms the cohesion of the text as well as the credibility of the argumentation.
• Reaction to Attending Alcoholics Anonymous Meeting The mentor and organizer started the meeting with a short introduction, greeting and thanking the participants for their persistence to inspire the conversation that followed.
• Alcoholic Anonymous: Advantages and Disadvantages of the Programs In addition to this, the merits and demerits of AA in the fight against alcohol abuse will be articulated so as to demonstrate the effectiveness of AA in helping Alcoholics recover.
• Drugs and Alcohol Effects and Behaviorism Help The problem of alcohol and drug dependency has increased over the years, fueled by factors such as easy accessibility of drugs, high cost of living, poverty, financial instability, and laxity on the part of authorities […]
• Non-Alcoholic Beverage Company’ SWOT Analysis For instance, recent data on the progress of Coca-Cola shows that the organization gained the total of $67,749,000,000 in the target market.
• Alcohol, Violence, and Sex Content in Salinger’s “The Catcher in the Rye” For example, The Catcher in the Rye is a book that appeals to the majority of adults while the representatives of the younger generation often turn out to be not able to come to the […]
• Alcohol Abuse by Quentin McCarthy The aim of MAST is to determine the extent of alcohol consumption based on responses provided and formulate strategies of helping the agent with regard to excess consumption of alcohol.
• The Effects of Alcohol Use on Academic Achievement in High School In examining the outcome of teenage alcohol misuse on quality of students’ academic grades, the author of this article applied a fixed-impact estimation model in assessing the grade point average derived from various high schools. […]
• Fetal Alcohol Syndrome: Causes and Consequences Scientists have not yet found out, if the volume of alcohol taken, the frequency of taking, or the time the alcohol is taken during pregnancy, is connected to a variation in the degree of injury […]
• Cigarette and Alcohol Consumption Alcohol and smoking have changed the way people act, and this reflects the behaviors of all characters in the three videos.
• Ban on All Advertising of Alcohol To make matters even worse, most of the alcohol adverts tend to neglect references to the bad effects associated with the consumption making it look like an alternative to soft drinks.
• Effects of Alcohol Consumption The duration in which a person consumes alcohol determines the intensity of the negative effects of alcohol on the person. Alcohol consumption is regarded as a risk factor in causing colon cancer because it causes […]
• Alcohol and Domestic Violence in Day-To-Day Social Life My paper will have a comprehensive literature review that will seek to analyze the above topic in order to assist the reader understand the alcohol contributions in the domestic and social violence in our society.
• Alcoholic Anonymous Organization Fighting Addiction By accepting the problem and causes, a participant can try to resolve. In the program, participants have to admit their past wrongs and errors to a group and receive support to change.
• Driving Under the Influence of Alcohol One of the implications of the adolescent and adult driving while intoxicated is enduring the life after the occurrence of breaking the law.
• Impaired Control and Alcohol Consumption The study will focus on the relationship between mood/attitude and impaired control in the context of alcohol consumption. The purpose of the study is to identify whether certain moods or attitudes result in a greater […]
• Alcohol Usage Should Be Controlled As such, the current landscape of alcohol production and marketing requires heavier regulation in the form of a number of policy changes.
• Managing Business Ethics: Alcohol and Marketing The promotion of alcoholic beverages is one of the “highly regulated” form of marketing, and in some countries of the World the direct marketing of alcoholic beverages are completely banned.
• Alcohol and Tobacco Advertising History in the American Media This is the promotion of tobacco products by the tobacco industry in the media. In the 1970s the development of color lithography was a boost to the tobacco advisement in the U.S.media.
• Alcohol Addiction and Psychological Assistance Smith is a supporter of the Democratic Party like most people in her family and among her friends and colleagues. Smith was asked what goals she wanted to achieve in the course of her treatment.
• Alcohol Industry and Business Ethics At the same time, Crane and Matten state that alcohol companies can be ethical citizens as they use numerous methods to make people aware of the harm associated with the use of alcohol.
• Concept and Treatment of Alcohol Abuse Alcoholism is the taking of alcoholic beverages to an extent that it can interfere with the physical behavior and activities of the alcoholic person.
• Ethical and Social Responsibility of the Alcohol Industry in the UK? The continuous public scrutiny measures the extent of social responsibility and accountability that the alcohol industry has on the consumption of alcohol. The CSR approach asserts that the sole responsibility of the firm is to […]
• Motivational Program and Alcoholics Anonymous The success or failure of AA recovery program can arguably be attributed to the strength of an individual to undergo total change in the way of thinking.
• Alcoholics Anonymous Program Evaluation Program evaluation also assesses the organization’s quality, the efficiency of its methods and identifies aspects of the procedures that can be improved.
• Alcoholism, Domestic Violence and Drug Abuse Kaur and Ajinkya researched to investigate the “psychological impact of adult alcoholism on spouses and children”. The work of Kaur and Ajinkya, reveals a link between chronic alcoholism and emotional problems on the spouse and […]
• Single Parents in the Alcoholic Classification In this category, the single parent, either the father or the mother is a chronic alcoholic and heavily uses alcohol and other substances.
• Stereotype of Aboriginals and Alcohol in Canada Therefore, it is necessary to research whether the given prejudice has certain grounds to base on, track the measures that are being currently undertaken to eliminate the stereotype and offer other efficient ideas that will […]
• Alcohol as the Most Common Depressant on Earth While alcohol has medicinal properties and can potentially improve the mood, it has many unwanted side effects and causes more damage around the world than the rest of the drugs combined. The failures of anti-alcohol […]
• Alcoholic Anonymous Meeting as Group Therapy The AA meeting allows the participants to feel a sense of belonging. Describe the observations of the social milieu in an AA meeting.
• Alcoholic Anonymous Reaction Essay The understanding of alcohol abuse and the current resources that exist to curb it, such as AA, is fundamental to understanding the challenge on a medical level.
• Alcoholism and Treatment Options Even though alcohol has been inappropriately abused recently, it is safe to say that the consumption of alcohol is both a tonic and poison, depending on the dose. In India, several states prohibit the sale […]
• Alcohol Use Disorder: Addictive Behaviors Alcohol use disorder is a chronic relapsing brain disease characterized by the following: Compulsive alcohol use Loss of control over alcohol intake Negative emotional state when not using alcohol.
• Understanding and Addressing Alcohol Dependence Alcohol dependence is a chronic condition involving a past or present record of excessive drinking, unending craving for alcohol, and persistent, recurring problems associated with the inability to decide when to use the chemical.
• Pathophysiology of Stress, Processed Foods, and Risky Alcohol Consumption The body starts to see the fats, sugars, and salt in ultra-processed foods as rewards, which leads to increased cravings and overeating.
• Drug and Alcohol Abuse Among Teenagers The thesis statement is: “Conviction is a better way to reduce drug and alcohol addiction among teenagers in the United States”.
• Alcohol and Drug Abuse in Canada Therefore, it contributes as a central factor in the essence of the character, and it is crucial to understand the core definition and the elements that foster the ideology.
• Alcohol Use Disorder: Andrea’s Case Her drinking habit has compromised her ability to be responsible and even has led to her losing her job. Andrea’s drinking habit has led to the worsening of her relationship with her co-habiting girlfriend, Ashleigh.
• When Alcohol Use Becomes Substance Use Disorder Patients suffering from AUD believe they cannot restrict their alcohol use; however, others who consume alcohol may alter the limit since they are not addicted to the drug.
• Prohibiting Alcohol and Tobacco Use at the Workplace The alcohol and tobacco policy has been selected due to the challenges that make it a failure in the workplace. Ensures the health, safety, and welfare of employees.
• Awareness on Alcoholism: What Is It and How to Cope? The availability of these products is a major driver of individual and family problems that many people face. Alcoholism is a form of physical and mental addiction to drinks containing alcohol.
• Comorbid Gambling Disorder and Alcohol Dependence The patient was alert and oriented to the event, time, and place and appropriately dressed for the occasion, season, and weather.
• Alcohol Abuse: Causes, Symptoms, Prevention, and Treatment Alcohol can additionally be the cause of brain damage manifested in the form of impairments in executive functioning, for example, weakening of visuospatial function and working memory.
• Alcohol-Based Sanitizers Preventing Nosocomial Infections Namely, the research papers examine the most prominent strains in the healthcare setting, compare alcohol-based and alcohol-free sanitizers, and prove the effectiveness of the intervention.
• Alcohol Consumption Impact on Graduation Rates One of the most acute problems of our time is the increasingly frequent use of alcohol by minors. Alcohol consumption by school students refers to deviant behavior, and this type of behavior of adolescents is […]
• Alcohol Misuse and Its Impact on Young Drinkers The impact of alcohol use can range from severe and rapid results of a single incident of alcohol impairment, including unexpected accidents and deaths, to cumulative and varied implications of a persistent pattern of drinking, […]
• Alcohol and Aggression: Annotated Bibliography The authors conduct an experiment to examine the alcohol-related cues to aggressive thoughts and violent perceptions in the absence of alcohol or using a placebo.
• Screening Alcoholism With AUDIT Evaluation Method This tool, in turn, could provide some extra explanations for Brian’s drinking and help determine whether he was genetically predisposed to the condition. Thus, AUDIT happens to be the most suitable tool for reviewing Johnson’s […]
• Isopropyl Alcohol in Cosmetics and Medicine Isopropyl is synthesized in two steps: through the reaction of propylene with sulfuric acid and the consequent hydrolysis. In the context of isopropyl alternatives as sanitizers, ethyl alcohol serves as a solid option.
• Drug and Alcohol Addiction: Abby’s Case The amounts of money Abby spends weekly on fulfilling her addictive desires and her long history of drug usage imply that she has an addiction problem.
• Alcohol Consumption: The Key Aspects The quantity of alcohol a person’s body can handle is determined by the type of drink, the person’s weight, and the drink’s serving size.
• Aspects of the Fetal Alcohol Syndrome It is not known when alcohol is most harmful to the fetus during pregnancy and whether there is a safe lower limit for alcohol consumption.
• Alcohol-Induced Chronic Pancreatitis: Population Affected, Side Effects, and Treatment The recurrence of acute pancreatitis is linked to the development of chronic pancreatitis, and it is more prevalent in alcoholics who use alcohol often.
• Evidence of the Success of Alcohol Prohibition in the United States in 1920 Consumption of alcoholic beverages considerably declined as a result of the enactment of prohibition in the United States. As a result, there was a considerable decrease in the number of alcohol-related diseases.
• Drug and Alcohol Addiction in Atlantic City The prevalent part of the population of Atlantic City consists of African-Americans and Caucasians. Because of this, alcohol and drugs are very popular among residents, which may pose a community health issue and is applicable […]
• Alcohol Consumption Among Students: Linear Regression and Correlation 0, the p-value is 0. From the correlations results in table 3.
• Alcohol Consumption Among Students However, the study examines the prevalence of alcohol among college students and the neighborhood surrounding since many studies have not focused on the impact of the environment on alcohol consumption among college students.
• Narcotic Anonymous and Alcoholics Anonymous Groups The desire to change one’s life for the better and look at the world soberly is what many people come to with time, and all of them are united by the desire to return to […]
• Alcohol and Narcotic Anonymous’ Recovery I was impressed by the fact that at the beginning of the meetings the group finds a volunteer who reads an excerpt from the book as a prayer, and the discussion of personal experiences begins.
• Substance Abuse: Drug and Alcohol Treatment National Association of Addiction Treatment Providers: Concentrates on ethical interventions Provides integrated treatment approach Offers cognitive-behavioral methods Reinforces the value of family support Recognizes addiction as a complex issue Prohibits discrimination
• The Alcohol Consumption Issue in the United States The consumption of alcohol and drugs in the United States is often influenced by underlying sociodemographic conditions of individuals. The pervasiveness of this use is fueled, in part, by the lack of clarity in distinguishing […]
• Alcoholism Issue in Miami Gardens The new data also matches tendencies from the summer of 2020, when the coronavirus struck, when many Floridians resorted to alcohol and other narcotics in the face of unpredictable circumstances.
• The Need for Government Control of Alcohol and Cigarettes The production and distribution of cigarettes should be criminalized due to the fact that smoking influences various diseases. It should be remarked that the reasonable use of alcohol can help protect against diabetes and promotes […]
• The Effects of Drinking Alcohol While Pregnant However, the study revealed an unexpected association between the two conditions and improved awareness of the devastating impact of protean on development and health. The study evaluated the neuropsychological and alcohol exposure parameter as well […]
• Effectiveness of SBIRT for Alcohol Use Disorders in the Emergency Department In this stage, the health practitioner asks the patient three questions regarding the quantity and frequency of alcohol use by employing the AUDIT-C tool.
• Alcoholism Causes: Where Science and Religion Converge Although it is difficult to pinpoint a single cause of alcoholism, it is clear that many internal and external factors serve as raw material in the making of an alcoholic.
• The Cost-Effectiveness of Alcohol Screening, and Brief Intervention Miami is a highly-populated area; According to statistics, 463,347 people reside in it; Approximately 25% of the population suffer from different forms of addiction and alcohol abuse is one of the leading problems on […]
• Alcohol Abuse and Effective Prevention Technique The original presentation and this extended exploration for it discuss the community structure, the essence of the problem and the theory and practice behind the SBIRT approach.
• Media Influence on Alcohol Abuse Consequently, many people are likely to watch the advert, and the ad can increase consumption of the product and limit the fight against alcohol problems.
• Alcohol Addiction: Biological & Social Perspective At the same time, the UK is one of the most drinking countries, as the average number of liters of alcohol per person there was 11. In addition, taking acetaldehyde dehydrogenase inhibitors allows to break […]
• Alcoholics Anonymous Overview When I attended the third meeting, I was among the people who largely contributed to how it is easy to stop taking alcohol.
• Researching the Issues of Alcohol in Colleges Lowering the age limit will allow the students to try out alcohol earlier and will reduce the popularity of drinking in college.
• Drug and Alcohol Addiction Crisis Among Adults in Baltimore While a lot of the violence in Baltimore is related to the drug trade, the drugs themselves killed at least 180 more people than homicides in the city as of 2019.
• Alcohol Addiction and the Role of a Community New Horizons Group of Alcoholics Anonymous is a local fellowship to support men and women with alcoholic problems in Miami Springs.
• The Research in the Field of Alcohol Consumption by Adolescents Therefore, at this stage of the discussion, it is important to consider the role of the theory in the five approaches to qualitative research with the purpose to underline the role of theory in our […]
• Alcoholic Anonymous Meeting and Impact on Treatment As the name suggests, the meeting was open to alcohol addicts and those who have recovered, members of the public, media, and professionals in different fields.
• Alcohol Addiction Among Women Women are a population of interest because of the increased mortality rates from alcohol-related health complications and the effect of this substance on childbearing. Similarly, to the previous organization, Alcove is a recovery facility that […]
• Alcoholism Problem Overview Alcoholism is one of the major factors affecting the health of individuals and family relations due to the repercussions of the dependence.
• Nuances of Alcohol Using Addiction Despite the traced co-occurrence of criminal activities and alcohol consumption, people argue that there are many positive aspects of drinking moderately, such as relaxation that is useful in many social environments. Goode argues that “for […]
• Alcohol Use Disorder: SBIRT Alcohol is widely known to be a harmful substance, but many people tend to underestimate its dangers due to the slow and incremental nature of its effects.
• Social Work Related to Alcohol and Substance Abuse The social work of this setting offers services to understand the current point of clients and identify the directions to improve their behaviors.
• Predicting Medium-Term Success Among Alcohol and Opiate Dependents The purpose of this project: to establish establish whether the detoxification facility is an important inclusion in the process of getting addicts off drugs.
• The Alcohol Consumption Relapse Issues In the case of my patient, she is highly willing to improve her life, and she understands that it is the only path to happiness.
• Moderate Alcohol Use Disorder: Treatment Plan The primary tool to help determine the disease’s presence are surveys – CAGE-test, Alcohol Use Disorders Identification Test, usage of DSM 5 criteria, and others.
• Effects of Alcohol. Alcohol-Related Statistics It is also a leading cause of death including both for the chronic drinker and the innocent victims of alcohol-related accidents.
• Pinacol Rearrangement and Alcohol Reactions Lab The purpose of this experiment is to use the researcher’s background knowledge on alcohol reactions to explain more complex reactions. The objective of this reorganization is to generate a ketone.
• Alcoholism: A Female Patient’s Drinking Profile It had changed her perspective of reality and destroyed her family in a way that each of her children had a health problem leading to death of one child at the age of 10 years.
• Moderate Alcohol Abuse as DSM–IV–TR Diagnosis The DSM-IV-TR diagnosis in this case is a moderate alcohol abuse ), which requires a minimum of four symptoms as specified in the DSM.
• The Problem of Co-Morbidity: Alcohol and Tuberculosis The problem of alcohol abuse as one of the main factors for the emergence and amplification of tuberculosis is widely discussed in medical circles and social organizations as well.
• The Use of Alcohol During Pregnancy Since you would like to understand if it is important for you to stop drinking alcohol, I would say that in case you want to prevent the emergence of any complications for the baby, it […]
• Reasons of Alcohol Addiction in Teenagers Given the clinical diagnoses, the wide-spread nature of the problem, and the severe consequences impacting the life and health of millions of people, the in-depth investigation of the causes of the disorder is of critical […]
• Alcohol and Substance Abuse There has been “no definitive treatment strategy for alcohol-related intervention with homeless individuals”. Some of the most successful interventions or programs to help homeless individuals with alcohol and substance abuse include the following: Providing both […]
• Alcoholic Anonymous: Its Purposes and General Topics Another primary objective of AA groups is for the members to provide support to each other in the process of healing from alcoholism.
• Alcoholism in Native Americans Theories suggest that the rate at which alcohol is absorbed in the body of a Native American is different from that of the rest of the U.S.population.
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Gov issues proclamation for National Alcohol Awareness Month

The West Virginia Alcohol Beverage Control Administration (WVABCA) was pleased to report that Gov. Jim Justice officially recognized April as Alcohol Awareness Month in West Virginia.

In issuing a proclamation, the governor emphasized the need to increase public awareness and understanding about the dangers associated with underage alcohol use and adult alcohol misuse.

Since 1987, the National Council on Alcoholism and Drug Dependence has recognized April as Alcohol Awareness Month. According to the Center for Disease Control and Prevention, every year in the United States approximately 95,000 people die from alcohol-related causes. Alcohol Use Disorder affects about 15 million adults in the United States, (National Institute for Alcohol Abuse and Alcoholism-NIAAA). The Substance Abuse and Mental Health Services Administration reports that about 2.3 million adolescents aged 12-17 in 2019 drank alcohol in the past month, and about 1.2 million of these adolescents binge drank in the last month.

WVABCA Commissioner Fred Wooton said, “We are grateful for Gov. Justice’s proclamation,” adding, “the WVABCA is committed to addressing the dangers associated with alcohol misuse by working with community leaders and law enforcement on a local, county and state level as we strengthen our collective ability to protect our youth and families.”

To address these issues, the WVABCA has a DUI Simulator that has traveled to high schools across the state and attended safety type events. Since 2010, 72,000 have experienced this life-saving program.

Additionally, the WVABCA’s NO School Spirits Public Service Announcement contest has reached tens of thousands of students. This program is in its 10th year and encourages and empowers youth to develop and produce meaningful educational and prevention messaging aimed at preventing underage drinking. The WVABCA licensing and enforcement efforts are also geared to protect the public. New carding posters are available for businesses to ensure compliance and help avoid underage alcohol sales. In addition, the WVABCA is creating a new server/seller carding video that will be available in the coming weeks.

WVABCA educational information can be found at abca.wv.gov.

The West Virginia Legislature created the West Virginia Alcohol Beverage Control Administration in 1935. The WVABCA was organized to give effect to the mandate of the people expressed in the repeal of the state prohibition amendment and to assure the greatest degree of freedom that is consistent with the health, safety and good morals of the people of West Virginia. The Mission of the WVABCA is to regulate, enforce and control the sales and distribution, transportation, storage and consumption of alcoholic liquors and nonintoxicating beer as mandated by the West Virginia Liquor Control and Nonintoxicating Beer Act.

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