Order Code RS22636
April 2, 2007
Alcohol Use Among Youth
Andrew R. Sommers
Analyst in Chronic Care and Disability
Domestic Social Policy Division
Analyst in Public Health
Domestic Social Policy Division
Alcohol use by persons under age 21 has been identified as a major public health
problem. Studies note that it increases the risks for disability, and may be detrimental
to the developing brain. Minors who drink are more likely to commit suicide, break the
law, or be victims of violence. Alcohol is implicated in nearly one-third of youth traffic
fatalities. The total annual cost of underage drinking is estimated at $62 billion. While
most laws intended to prevent underage drinking are passed at the state level, there has
been legislative activity and interest at the federal level to support states’ efforts to curb
the problem. This report describes the extent of underage alcohol use, recent legislative
activity on this issue, and various policy implications. It will be updated as new data
On March 6, 2007, the U.S. Surgeon General issued an official call to increase
efforts to curb underage drinking.1 “We can no longer ignore what alcohol is doing to our
children,” said Acting Surgeon General Kenneth Moritsugu. “Alcohol,” he continued, “is
the most heavily abused substance by America’s youth.”2
U.S. Department of Health and Human Services, The Surgeon General’s Call to Action to
Prevent and Reduce Underage Drinking, U.S. Department of Health and Human Services,
Office of the Surgeon General, 2007, at [http://www.surgeongeneral.gov/].
U.S. Department of Health and Human Services Press Office, Acting Surgeon General Issues
National Call to Action on Underage Drinking, Office of the Surgeon General, Mar. 6, 2007, at
In light of recent research demonstrating that alcohol may harm the adolescent brain
and that individuals who start drinking before the age of 15 are five times more likely to
have alcohol-related problems later in life, the Surgeon General announced six basic
Fostering changes in American society that facilitate healthy adolescent
development and help prevent and reduce underage drinking.
Engaging youth and all social systems that interface with youth in a
coordinated effort to prevent and reduce drinking and its consequences.
Promoting understanding of underage drinking in the context of
development and maturation that considers individual adolescent
characteristics and environmental, ethnic, cultural, and gender
Conducting additional research on adolescent alcohol use and its
relationship to development.
Improving surveillance on underage drinking and its risk factors.
Ensuring that all policies are consistent with the goal of preventing and
reducing underage alcohol consumption.
Although drinking by persons under the age of 21 is illegal in all states, people age
12-20 drink almost 20% of alcohol consumed in the United States.3 In 2004, there were
more than 142,000 emergency rooms visits by youth age 12-20 as a result of injuries and
other conditions linked to alcohol consumption.4 Each year, approximately 5,000 young
people under the age of 21 die as a result of underage drinking.
The economic toll of underage drinking in the United States in 2001 was an
estimated $61.9 billion.5 It has been reported that medical care, work loss, and pain and
suffering directly associated with underage drinking costs $2,207 annually for each young
person in the United States.6
Low educational achievement and high absenteeism rates are common among
underage students who drink alcohol. These youth often have problems with social
integration, are more prone to fighting, and are often disinclined to participate in healthier
Susan E. Foster, et al. “Alcohol Consumption and Expenditure for Underage Drinking and
Adult Excessive Drinking,” Journal of the American Medical Association, 2003, 289(8): 989-95.
Office of Applied Studies, “Emergency Department Visits involving Underage Drinking,” The
New DAWN Report, Issue 1, Rockville, MD: SAMSHA, 2006, at [https://dawninfo.samhsa.gov/
Excluding pain and suffering from these costs, the direct costs of underage drinking incurred
exceed $20.3 billion each year; Ted R. Miller, David T. Levy, Rebecca S. Spicer, Dexter M.
Taylor, “Societal Costs of Underage Drinking,” Journal of Studies on Alcohol, Vol. 67, 2006, pp.
For alcohol-related fatalities, the costs of pain and suffering were computed based on the
monetary values that people ascribed in experimental settings to not being killed. Similarly, the
pain and suffering costs of nonfatal injuries were based on the values associated with different
dimensions of functioning, cognition, mobility, sensation, and pain. Methodology details are
outlined at [http://www.udetc.org/documents/UnderageMethods.pdf].
activities. They have a higher risk of being engaged in illegal activities and participating
in unprotected sex.7
Although many national surveys collect information about alcohol consumption,
three federally funded studies most comprehensively cover aspects of underage drinking.
National Survey on Drug Use and Health (NSDUH). NSDUH is the primary
source of statistical information on illegal drug use by the U.S. population. Sponsored by
the Substance Abuse and Mental Health Services Administration (SAMHSA), NSDUH
collects data in interviews at each respondent’s place of residence. Survey items aim to
provide the drug prevention, treatment, and research communities with current, relevant
information on the status of the nation’s drug usage, including national and state-level
estimates of the past month, past year, and lifetime use of alcohol. NSDUH tracks trends
in the use of alcohol and helps identify the consequences of underage alcohol use and the
groups who are at greatest risk.
Youth Risk Behavior Survey (YRBS). The YRBS monitors health risk
behaviors, including underage drinking, that contribute to mortality, disability, and social
problems among youth in the United States. The YRBS, which is conducted every two
years, provides data representative of high school students throughout the United States.
The YRBS is a national school-based survey fielded by the Centers for Disease Control
and Prevention (CDC) and supplemented with data collected by state and local education
and health agencies.
Monitoring the Future (MTF). Funded by the National Institute on Drug Abuse,
MTF annually surveys 8th, 10th, and 12th graders about substance use, including alcohol
consumption. Respondents are asked about daily and monthly alcohol use, the quantity
of alcohol consumed, and the number of episodes of heavy drinking in the past month.
Unlike NSDUH or YRBS, MTF also explores issues of risk and ethics by asking, “How
much do you think people risk harming themselves (physically or in other ways)” if they
drink daily or if they drink heavily on the weekends. Similarly, survey participants are
asked whether they “disapprove” of these behaviors. Each year, a random sample of 12thgrade MTF participants is selected for follow-up studies. These individuals are surveyed
by mail every other year until age 30, then every fifth year until age 45. Data from these
follow-up surveys allow researchers to investigate questions about the effects of alcohol
use over time, such as:
How is alcohol use affected by major transitions into and out of social
environments (e.g., military service, civilian employment, college,
unemployment) or social roles (e.g., marriage, pregnancy, parenthood)?
How does the life course of individuals who used alcohol as teens differ
from those who did not?
The consumption of alcohol by youth has dropped steadily over the last decade. In
2005, 74.3% reported having used alcohol on multiple occasions; 43.3% regularly
consumed alcohol; and 25.5% engaged in binge drinking.8 These figures represent
absolute declines of 4.8%, 7.5%, and 7.9%, respectively, since 1997. Still, underage
drinking remains a far more prevalent problem than the use of illicit drugs or tobacco
products. According to Monitoring the Future, U.S. high school seniors are 50% more
likely to have consumed alcohol more than once than to have ever tried illicit drugs or to
have smoked tobacco.9
There are an estimated 11 million underage drinkers in the United States. More than
2 million are classified as heavy drinkers, and nearly 7.2 million are classified as binge
drinkers, meaning that they have had more than five drinks on one occasion.10 Prevalence
rates of alcohol consumption among preteen boys and girls are similar. Among teenagers,
however, males report more current alcohol use (28.9% vs. 27.5%, respectively), and
more frequent binge drinking (21.3% vs. 16.1%) and heavy drinking (7.6% vs. 4.3%) in
2005. Rates of binge drinking are highest among white (22.3%) and American
Indian/Alaskan Native youth (18.1%), followed by Hispanic youth (17.9%), African
American youth (9.1%), and Asian American youth (7.4%).11
Underage drinking varies by geographic region Since 2002, it has been higher in the
Northeast (31.4%) and Midwest (31.0%) than in the South (26.4%) and West (26.0%).12
According to the 2005 NSDUH, underage drinking rates in 2005 were similar in urban
and suburban areas (28.1% and 30.1%, respectively). The rate in rural areas, however,
was markedly lower — 23%.
While NSDUH and YRBS ask many similar questions regarding underage drinking,
the Youth Risk Behavior Survey includes several unique, noteworthy findings. Among
high school students surveyed in 2005, 26% had their first alcoholic drink before age 13,
one in three had ridden with a driver who had been drinking alcohol, 10% had driven
while drinking alcohol at some point in the past month, and 4.3% had consumed alcohol
on school property.13
Centers for Disease Control and Prevention, 2005, Youth Risk Behavior Survey, available at
Lloyd D. Johnston, Patrick M. O’Malley, Jerald G. Bachman, et al., Monitoring the Future
national survey results on drug use, 1975-2005. Volume I: Secondary school students, NIH
Publication No. 06-5883, Bethesda, MD: National Institute on Drug Abuse, 2006.
SAMHSA, Results from the 2005 National Survey on Drug Use and Health: National
Findings, NSDUH Series H - 30, HHS Pub. No. SMA 06 - 4194. Rockville, MD: SAMHSA,
Office of Applied Studies, 2006.
NSDUH, 2005, at [http://oas.samhsa.gov/NSDUH/2k5NSDUH/2k5results.htm#3.2].
U.S. Census regions are defined as follows: Northeast — Maine, New Hampshire, Vermont,
Massachusetts, Rhode Island, Connecticut, New York, New Jersey, Pennsylvania; Midwest —
Ohio, Indiana, Illinois, Michigan, Wisconsin, Minnesota, Iowa, Missouri, North Dakota, South
Dakota, Nebraska, Kansas; South — Delaware, Maryland, District of Columbia, Virginia, West
Virginia, North Carolina, South Carolina, Georgia, Florida, Kentucky, Tennessee, Alabama,
Mississippi, Arkansas, Louisiana, Oklahoma, Texas; West — Montana, Idaho, Wyoming,
Colorado, New Mexico, Arizona, Utah, Nevada, Washington, Oregon, California, Alaska,
Centers for Disease Control and Prevention, 2005 Youth Risk Behavior Survey, 2005, op. cit.
The 21st Amendment to the U.S. Constitution gives states the primary authority to
regulate the sale and distribution of alcohol within their borders. Hence, most underage
drinking prevention laws are passed by states. Today, all states have set the minimum
legal drinking at age 21, and have passed zero-tolerance laws that make it illegal for
people under age 21 to drive after drinking any alcohol. Despite their demonstrated
benefits, legal drinking age laws and zero-tolerance laws generally have not been
vigorously enforced.14 Alcohol purchase laws aimed at sellers and buyers also can be
effective, but experts believe that more resources need to be made available for enforcing
At the federal level, legislative activity has primarily been aimed at coordinating and
supporting the states’ efforts. The following underage drinking prevention laws have
been passed since the 106th Congress (1999-2000):
Sober Truth on Preventing Underage Drinking Act (STOP Act):16
Mandates the Secretary of Health and Human Services to formally
enhance the efforts of the Interagency Coordinating Committee on the
Prevention of Underage Drinking.
Science, State, Justice, Commerce, and Related Agencies Appropriations
Act, 2006:17 Provides $25 million for grants to states to enforce
minimum drinking age laws, and for technical assistance.
Consolidated Appropriations Act, 2005:18 Provides $25 million for
grants to states to enforce minimum drinking age laws, and for technical
No Child Left Behind Act:19 Authorizes the Substance Abuse Mental
Health Services Administration to award grants to local educational
agencies to develop and implement programs to reduce alcohol abuse in
National Police Athletic League Youth Enrichment Act:20 Provides for
expansion of Police Athletic League Chapters to conduct underage
drinking prevention activities in non-school hours.
District of Columbia Appropriations Act, 2001:21 Provides $25 million
for grants to states to enforce minimum drinking age laws, and for
Ralph K. Jones, and John H. Lacey, Alcohol and Highway Safety 2001: A Review of the State
of Knowledge. DOT HS 809 383. Washington, DC: National Highway Traffic Safety
Administration, 2001, at [http://www.nhtsa.dot.gov/people/injury/research/AlcoholHighway].
David F. Preusser, A.F. Williams, H.B. Weinstein, “Policing underage alcohol sales,” Journal
of Safety Research, Vol. 25, pp.127-133, 1994.
P.L.109-422, Sec, 2(c)(1), 120 Stat 2891.
P.L.109-108, Sec. 5(c), 119 Stat 2300.
P.L. 108-447, Sec. 2, Division B, Title I, 118 Stat. 2866.
P.L. 107-110, Title IV, Sec.4129, 115 Stat 1757.
P.L. 106-367, Sec.6(a)(2)(B)(I), 114 Stat 1414.
P.L. 106-553, Appendix B, Title I, 114, Stat. 2762A-65. P.L.106-553.
Missing, Exploited, and Runaway Children Protection Act:22 Provides
funding for community-based alcohol and drug abuse prevention and
education services to street youth.
Institute of Medicine Recommendations
The 2003 Institute of Medicine (IOM) report on reducing underage drinking
concluded that underage drinking cannot be successfully addressed by focusing on youth
alone.23 Since minors “usually obtain alcohol — directly or indirectly — from adults,”
the IOM contended, efforts to reduce drinking among teens should also be aimed at adults
and industry. The IOM’s recommendations, discussed below, included community-based
interventions and policy options to limit or prevent underage alcohol consumption.
Prohibit alcohol advertisements from targeting youth. Long-term
exposure to alcohol advertising and promotion increases the likelihood that children will
drink. The IOM has called on the alcohol and entertainment industries to shield youth
from unsuitable messages about drinking by ensuring that programs do not portray
underage drinking in a favorable light. The IOM also suggested that Congress consider
restrictions on the alcohol industry, analogous to those placed on the tobacco companies,
to prevent marketing practices that disproportionately appeal to minors.
Increasing alcohol prices through excise taxes. The current tax on alcohol
has not kept pace with inflation, thus reducing the real price of alcohol over time. Thus,
alcoholic beverages are cheaper today in real dollars than they were in the 1960s and
1970s. Research indicates that increases in alcohol price are associated with decreased
underage drinking.24 Increasing excise taxes on alcohol, according to the IOM, could
provide revenue for strategies to reduce underage drinking.25
Public awareness. Educating the public about the consequences and the existing
laws regarding underage drinking could curtail access to and consumption of alcohol by
minors. The IOM recommended that the federal government fund and support
development of a national media effort as a major component of an adult-oriented
campaign to reduce underage drinking. For these public education efforts to be effective,
however, they would need to be combined with better enforcement of existing laws.
Enforcement. The IOM suggested that states or the federal government could
consider criminalizing the use of falsified or fraudulent identification in an attempt to
purchase alcoholic beverages, as well as criminalizing the provision of any alcohol to
minors by adults, except to their own children in their own residences.
P.L.106-71, Sec. 3(b)(1), 113 Stat. 1042.
Richard J. Bonnie and Mary Ellen O’Connell (eds.), Reducing Underage Drinking: A
Collective Responsibility, Institute of Medicine, Committee on Developing a Strategy to Reduce
and Prevent Underage Drinking, Washington, DC: National Research Council and the Institute
of Medicine, 2003, available at [http://www.nap.edu/catalog/10729.html].
Frank J. Chaloupka, Michael Grossman, and Henry Saffer, “The effects of price on alcohol
consumption and alcohol-related problems,” Alcohol Research and Health, Vol. 26, No. 1, pp.
If this policy option were pursued, the IOM emphasized that alcohol taxes would have to be
indexed to the consumer price index in order to ensure they keep pace with inflation.