Is Underage Drinking the Greatest Risk to Teenagers & Youth?

by Dr. Dale Wisely, All In Mountain Brook

The Big Picture 

Consider the leading causes of death among teenagers: Motor vehicle crashes, suicide, homicide. Close behind these are other unintentional fatal injuries, which are often related to things that happen to youth when they are together in recreational settings (drownings, fall from high places.) And, as we know, far too many teenagers die from unintentional overdoses of drugs and/or alcohol.

Consider now how many of these leading causes of death are often related to mental and behavioral health and/or substance abuse. Motor vehicle crashes are often caused by drinking and driving, being distracted by peers in the vehicle, speeding, and reckless driving. Suicide is obviously related to mental health and, often, substance abuse. Teenagers who are murdered are often caught up in gangs or drug activity. Every major cause of death (and severe injury) among teenagers is highly influenced by mental & behavioral health, including involvement in alcohol and drug abuse.

These top causes account for the overwhelming majority of deaths of young people, who only uncommonly die of diseases. Motor vehicle crashes and substance abuse-related incidents also account for many of the disabling injuries, legal problems, and other associated catastrophic events in the lives of youth.

For good reasons, we have heard much lately about the opioid crisis and about vaping. We have lost and are losing far too many citizens to opioids. Concerns about vaping, which have been articulated by the medical community for years, have become more acute because of cases of severe lung injury, some of which have killed the victims.

With that said, I claim that if we were to take the long and broad view of substance abuse on Earth and ask ourselves what substance of abuse has caused the most death, damage, and misery, it would not be opioids, or vaping, or heroin, or marijuana, or LSD. Not Ecstasy. Not cocaine. Not magic mushrooms. It would be a competition between two legal products: cigarettes and alcohol.

Alcohol abuse is so pervasive and is implicated in so many diseases, injuries, crimes, economic losses, and social problems it is almost impossible to measure. Look at this page for an attempt to do so.

Throughout the USA, it is a crime for a person under the age of 21 to drink alcohol. Yet, it is widely tolerated by parents, who often see underage drinking as inevitable. Some parents passively permit it. Others actively facilitate underage drinking, at the risk of criminal penalties and civil liability, by misguided attempts at “supervised” drinking.

Teenagers should not drink. At all. Parents ought to do everything they reasonably can to prevent it. Parents should be clear and firm in their insistence that their teenagers not drink alcohol. If and when parents learn that their teenagers drink, they should treat as either a serious disciplinary issue or as a potential health problem.

Making the Case

Let’s look at some of the facts. These are taken from the Centers for Disease Control and other official sources.

Underage drinking is responsible for more than 4,300 deaths among youth each year. In 2013, there were about 120,000 emergency rooms visits by persons aged 12 to 21 for injuries and other conditions linked to alcohol.

Here are some of the other consequences of underage drinking. Youth who drink alcohol are more likely to experience—

  • school problems, such as higher absence and poor or failing grades.
  • social problems, such as fighting and lack of participation in youth activities.
  • legal problems, such as arrest for driving or physically hurting someone while drunk.
  • unwanted, unplanned, coerced, and unprotected sexual activity.
  • disruption of normal growth and sexual development.
  • higher risk for suicide and homicide.
  • alcohol-related car crashes and other unintentional injuries, such as burns, falls, and drowning.
  • abuse of other drugs. (Alcohol may be the true “gateway” drug.)
  • changes in brain development that may have life-long effects.
  • death by alcohol poisoning.

Here are some factors that may increase the risk that a teen will use alcohol.
      • Significant social transitions such as graduating to middle or high school;
      • Getting a driver’s license;
      • A history of social and emotional problems;
      • Depression and other serious emotional problems;
      • A family history of alcoholism; and
      • Contact with peers involved in troubling activities.

Source: Julie Baumgardner, “First Things First: Preventing underage drinking starts with dialogue,” Chatanooga Times Free Press, (October 28, 2018


Some of us disapprove of drinking during the high school years and then just accept that college students are inevitably going to drink, even though drinking is still illegal for the majority of college students. The pervasiveness of college-age drinking comes at a terrible price.

  • Nearly 2000 college students between the ages of 18 and 24 die from alcohol-related unintentional injuries, including motor-vehicle crashes.
  • 700,000 students between the ages of 18 and 24 are assaulted by another student who has been drinking.
  • 100,000 students between the ages of 18 and 24 report experiencing alcohol-related sexual assault or date rape.
  • Roughly 20 percent of college students meet the criteria for alcohol use disorders.
  • About 1 in 4 college students report academic consequences from drinking, including missing class, falling behind in class, doing poorly on exams or papers, and getting lower grades overall.
  • For those under 21 who drink, more than 90% of the alcohol is consumed during episodes of binge drinking. On average, underage drinkers consume more drinks per drinking occasion than adult drinkers.

This last one—binge drinking—is a critical point. When teenagers are drinkers, they are almost always binge drinkers. Binge drinking, defined as 5 drinks in a single drinking session, always leads to intoxication, which often leads to terrible things happening.

What Can Parents Do?

Parents should first consider the impact of the wide social acceptability of adult drinking on their attitudes about underage drinking.  Let’s look at some myths & facts.

Myth: Underage drinking is inevitable, so we just need to try to make it safer.
Fact: For many years, surveys indicate that more Mountain Brook teenagers report underage drinking than the national averages. But as is true of the nation, underage drinking in Mountain Brook has actually declined in recent years. However, particularly in the 11th and 12th grades, most students report some use of alcohol.

Myth: As long as they drink responsibly, underage drinking is probably okay.
Fact:  Most underage drinkers are binge-drinking which, by definition is irresponsible.

MythSince I know my kid is going to drink in college, I want them to learn to drink—to practice drinking—under my supervision. That will get them prepared for college drinking.
Facts: (a) It is NOT inevitable that all high school students will drink. A substantial number do not. It is not even inevitable that college students will drink. Many do not. (b) The best data we have indicates that letting teenagers drink alcohol under parental supervision may lead to higher drinking rates, and more alcohol-related problems than a ‘zero tolerance’ approach. (Journal of Studies on Alcohol and Drugs, May 2011). Bottom line: There is NO evidence that being allowed to drink in high school reduces problem drinking in college. The reverse seems to be true. Finally (c) parents who host “supervised” events where teenagers drink are breaking the law AND are subject to civil lawsuits if something bad happens to a teenager during or after such an event.

Here are ways you can prevent / discourage underage drinking:

  1. Stay actively involved in your children’s lives. Cultivate a positive relationship. Seek out conversation.
  2. Know where your children are and what they are doing. Make knowing their friends a priority.
  3. Resist the idea that your teenager cannot have a social life without drinking.
  4. Set and enforce clear standards, including standards about alcohol use. Consistently and proactively, communicate those expectations.
  5. Get help if you think you have an alcohol-related problem or any other person in your household does.
  6. If you keep alcohol in your home, do not make it easily accessible to others.
  7. While there is nothing wrong with adult social drinking, consider what message you send by your patterns of drinking. Do you ALWAYS have alcohol at social gatherings? (Message: Alcohol is necessary when people gather socially.) Do you drink when stressed? (Message: Drinking is a good way to cope with stress.)
  8. Don’t allow underage drinking in your home or on vacation.  Do not provide alcohol for anyone who is under legal drinking age. Do not passively allow underage social drinking by failing to provide rules and supervision when teenagers are gathered under your supervision.