Adolescents and Alcohol

Adolescents who begin drinking alcohol before age 14 have a nearly 50% risk of becoming alcohol dependent in adulthood. A study published July, 2006, by the Archives of Pediatrics and Adolescent Medicine, a specialty journal of the American Medical Association, regards early drinking as a predictor of alcohol dependence in adulthood.

The Centers for Disease Control and Prevention find that more than 75,000 deaths annually are attributable to excessive alcohol consumption; the third leading preventable cause of death in the U.S. Alcohol is involved in 50% of accidental trauma and 30% to 40% of emergency department visits.

The study surveyed over 43,000 adults in 2001-2002, and found that 47% of those who began drinking before age 14 later became alcohol dependent vs. 9% of those who started drinking at age 21 or older. Of this early age drinking group, most individuals who later became alcohol dependent did so within 10 years, that is, by their mid-20’s.

The important point this study makes is that an adolescent or young adult patient entering treatment for Substance Use Disorder, who gives a history of drinking more than a few sips of alcohol before age 14, is much more likely to struggle with a lifetime of alcohol dependence than one who begins drinking at a later age. One could also conclude that if an “at-risk” adolescent can be identified and treated aggressively early on, their chance of not developing adult alcohol dependence should significantly increase.

Prevention and Intervention

What other researchers have learned about the different path that drinkers follow as they progress through young adulthood has important implications for prevention. Other studies have shown that people follow a variety of pathways across the adolescent and young adult years, alcohol use behaviors change differently for different people, and factors that predict alcohol use patterns emerge and disappear at different ages.

One approach to prevention simply will not fit every need. Another way to prevent alcohol-related problems, among young people or the population as a whole, is to establish policies that reduce overall alcohol consumption rates or reduce the rates of high-risk drinking. Alcohol guidelines and information can influence the availability of alcohol.  Comprehensive community-based programs have reduced past month alcohol consumption among underage youth by 7%, All states and the District of Columbia have enforced 21-year-old minimum drinking age laws. In 2002, an estimated 917 lives saved in traffic crashes as a result of the age 21 minimum drinking age laws (NHTSA, 2002).. the social messages about drinking that are conveyed by advertising and other marketing approaches, and the enforcement of existing alcohol laws.

Choosing Sides: Should States Lower the
Legal Drinking Age?

By Hugh C. McBride

The war on terrorism has opened up a new front in the United States – but instead of focusing on
bombs and bullets, this battle involves beers and ballots.

With thousands of Americans under the age of 21 deployed in Iraq, Afghanistan, and other hot
spots around the world, several states are taking a second look at laws that bar these service
members from being able to legally take a drink of alcohol once they return from combat.


Seven states are currently considering proposals to lower the legal drinking age from 21 to 18:

  • If enacted, bills currently in the Kentucky, Wisconsin, and South Carolina legislatures
    would lower the legal age only for military personnel.
  • Missouri citizens are working on a ballot initiative that would apply to all individuals age
    18 and above.
  • A lawyer in South Dakota is working on a campaign to allow 19- and 20-year-olds to buy
    “low alcohol” beer (containing no more than 3.2% alcohol by weight).
  • Minnesota is considering a bill that would allow bars and restaurants to sell alcohol to
    anyone age 18 or older, but would limit liquor store sales to customers age 21 and up.
  • In February 2008, the Vermont legislature authorized a task force to explore the potential
    ramifications of lowering the state’s legal drinking age to 18.

In addition to the increased attention given to under-21s in the military, some who support
lowering the drinking age say they are motivated by the perceived failures in the existing laws
that regulate alcohol consumption.

“Our laws aren’t working. They’re not preventing underage drinking. What they’re doing is
putting it outside the public eye,” Vermont state Sen. Hinda Miller said in USA Today. “So you
have a lot of kids binge drinking. They get sick, they get scared, and they get into trouble, and
they can’t call because they know it’s illegal.”

David J. Hanson, an alcohol policy expert with the State University of New York-Potsdam, told
MSNBC reporter Alex Johnson that “raising the drinking age to 21 was passed with the very best
of intentions, but it’s had the very worst of outcomes. Just like during national Prohibition, the
law has pushed and forced underage drinking and youthful drinking underground, where we have
no control over it.”

Of course, not all experts agree that lowering the legal drinking age is the ideal, or even an
advisable, approach. In a press release announcing the formation of the Support 21 Coalition,
Glynn Birch, the national president of Mothers Against Drunk Driving, said, “Science speaks for
itself. When the legal drinking age is 21, lives are saved and injuries are prevented. The 21 Law
saves lives on the road and keeps countless youth from starting to drink at early ages. The earlier
a youth begins drinking alcohol, the more likely they are to become alcohol dependent, binge
drink and to drive drunk later in life.”


Though drinking laws in the United States technically fall under the control of the individual
states, the National Minimum Drinking Age Act of 1984 and the Federal Highway Act tied
states’ passage of 21-and-older laws to their continued receipt of federal funding. States that
failed to raise the legal age for the purchase and public possession of alcohol faced a 10-percent
decrease in the annual amount of federal money they received for highway construction and

Prior to the passage of the federal drinking age act, 30 states allowed 18-year-olds to drink some
form of alcohol. Some states set the limit at 18 for beer and wine and 21 for all other alcohol,
some authorized 18-year-olds to drink 3.2% beer, and some simply lowered the age for all
alcohol to 18.

Within four years of the enacting of the national law, though, all 50 states had established 21 as
the minimum legal drinking age. Wyoming became the final state to do this when, on March 12,
2008, then-Gov. Mike Sullivan signed 21-and-above legislation into law to avoid losing $8.2
million in federal highway funds.

The effort to raise the drinking age resulted in the United States having one of the most age-
restrictive alcohol policies among all countries where alcohol is not banned for religious reasons.
Various sources note that the majority of nations (including the U.S.’s closest neighbors, Mexico
and Canada) allow citizens to drink at age 18, with many European countries (such as France,
Germany, Italy, and Spain) granting at least some alcohol-consumption rights to 16-year-olds.


According to a fact sheet posted on the National Highway Transportation Safety Agency’s
website, the “NHTSA estimates that minimum drinking age laws have saved 18,220 lives of all
ages since 1975. … These laws have had greater impact over the years as the drinking ages in the
states have increased, affecting more drivers age 18 to 20.”

In September 2001, the NHTSA released a report entitled “Determine Why There Are Fewer
Young Alcohol-Impaired Drivers.” Statistics cited in that report include the following:

  • In the United States in 1982, there were 10,270 drivers under the age of 21 involved in
    fatal crashes. Forty-three percent (4,393) of these drivers were deemed to have been
    drinking prior to their crashes.
  • In 1998, the number of drivers age 21 and under who were in fatal crashes was 8,128,
    with 21 percent (1,714) of these determined to have been drinking.
  • Comparing 1998 with 1982, the number of youthful drivers involved in fatal crashes
    declined by 21 percent, and the number who had been drinking declined by 61 percent.

The National Youth Rights Organization, a youth-led nonprofit organization dedicated to the
repeal of age-restrictive drinking, curfew, and other laws and the protection of student rights,
argues that statistics like the ones cited by the NHTSA are based on faulty logic. A frequently
asked questions section on the NYRO website counters that “in an in-depth and unrefuted study
[Peter Asch] and [David] Levy prove that raising the drinking age merely transferred lost lives
from the 18-20 bracket to the 21-24 age group.”

The NYRO also argues that 21-and-over drinking laws are inconsistent with the nation’s
standard policy of granting adult rights at age 18. “When you are 18 you are judged mature
enough to vote, hold public office, serve on juries, serve in the military, fly airplanes, sign
contracts and so on,” the group writes. “Why is drinking a beer an act of greater responsibility
and maturity than flying an airplane or serving your country at war?”

Support for this position isn’t limited to individuals who are directly affected by the laws in
question. In her article in the March 20, 1998, edition of CQ Researcher, Indiana University
professor Ruth C. Engs advocated a lowering of the drinking age as a means of encouraging
“mature and sensible drinking behavior” through role modeling in controlled public settings.
Engs cited increases in binge drinking and other unhealthy alcohol-related behaviors among the
reasons for revisiting minimum drinking age legislation.

“While there has been a decrease in per capita consumption and motor vehicle crashes,
unfortunately, during this same time period there has been an increase in other problems related
to heavy and irresponsible drinking among college age youth.” Eng wrote. “Most of these
reported behaviors showed little change until after the 21 year old law in 1987. … This increase
in abusive drinking behavior is due to ‘underground drinking’ outside of adult supervision in
student rooms and apartments where same age individuals congregate.”


In addition to the all-or-nothing “18 or 21″ options being debated by various experts and
advocates, other groups have taken advantage of the renewed attention to alcohol age limits to
propose alternative approaches to controlling the consumption of “adult beverages” by younger

In 2007, John M. McCardell Jr., the former president of Middlebury College, founded Choose
Responsibility, a nonprofit organization that champions a series of changes to existing laws and
policies. McCardell’s group has put forth a proposal that its website describes as “a multi-faceted
approach that combines education, certification, and provisional licensing for 18-20 year-old
high school graduates who choose to consume alcohol.”

The Choose Responsibility plan is similar to the approach used by many states to educate and
license young drivers. The organization is in favor of state-issued “drinking licenses” that would
be granted to students who successfully complete at least 40 hours of instruction in the legal,
ethical, health, and safety issues related to alcohol consumption, all taught by a certified alcohol

McCardell, who told National Review Online, “I’m not going to claim that legal-age 21 has
saved no lives at all, but it’s just one factor among many and it’s not anywhere near the most
important factor,” has been a major figure in the drinking-age debate since The New York Times
published his opinion piece, “What Your College President Didn’t Tell You,” in 2004. In that
op-ed, McCardell termed the 21-year-old drinking limit “bad social policy and terrible law.”

Though he emphasized his opposition to drunk driving and cited his charter membership in the
group Presidents Against Drunk Driving in his Times article, McCardell also noted that “No
college president will say that drinking has become less of a problem in the years since the age
was raised. Would we expect a student who has been denied access to oil paint to graduate with
an ability to paint a portrait in oil? Colleges should be given the chance to educate students, who
in all other respects are adults, in the appropriate use of alcohol, within campus boundaries and
out in the open.”


With passionate advocates on both sides of the issue, the effort to revise existing drinking-age
laws in the United States is moving slowly yet deliberately. No states have yet risked the
reduction in federal finances – and the predicted rise in drinking-and-driving-related deaths – by
lowering their legal ages for alcohol consumption, but calls to do so continue to come. At the
same time, individuals and organizations such as MADD and the Insurance Institute for Highway
safety argue for maintaining and enforcing the existing laws.

IIHS President Adrian Lund expressed his and others’ opposition to lowering the drinking age in
the Support 21 Coalition’s inaugural press release. “Study after study has found that when the
drinking age was lowered, nighttime fatal crashes for young drivers went up. When the drinking
age was raised, crashes went down almost 30 percent. It’s irresponsible to assert that untested
educational programs could alter these results,” Lund wrote. “If we allow states to lower the
drinking age again, more teens will drink and drive and more will die.”


Curran, John. “Vermont latest to eye lower drinking age.” USA Today. Feb. 29, 2008.

Engs, Ruth C. “Why the drinking age should be lowered: An opinion based upon research.” CG
Researcher. March 20, 1998. (

Johnson, Alex. “Debate on lower drinking age bubbling up.” MSNBC. Aug. 14, 2007

Miller, John J. “The Case Against 21.” National Review Online. April 19, 2007.

Mothers Against Drunk Driving. “MADD, AMA, NTSB, IIHS and Others Launch Support 21
Coalition.” Sept. 29, 2007. (

National Highway Transportation Safety Administration. “Determine Why There Are Fewer
Young Alcohol-Impaired Drivers.” September 2001.

National Highway Transportation Safety Administration. “Fact Sheet: Minimum Drinking Age
Laws.” Accessed May 30, 2008.

National Youth Rights Organization. “Frequently Asked Questions.” Accessed May 30, 2008.

Recognizing the varied and ever-changing directions that alcohol use can take offers scientists and healthcare professionals a solid developmental foundation on which to build effective interventions.