Alcohol is the most commonly used drug among youth in the United States. Excessive drinking is responsible for more than 4,300 deaths among underage youth each year and cost the U.S. $24 billion annually. In addition to the thousands of deaths each year that result from underage drinking, approximately 200,000 young people visit an emergency room for alcohol-related injuries.
Despite these staggering numbers, 2015 marked the lowest levels for alcohol use recorded by government data among high school youth. This strongly contradicts the common refrains often heard that “all teenagers drink,” or “it is a harmless rite of passage.” Addressing this misperception is important, because otherwise we run the risk of further perpetuating beliefs among young people that underage and binge drinking are the expectation rather the exception.
In fact, most teenagers do not drink regularly. The most recent Centers for Disease Control and Prevention (CDC) [Youth Risk Behavior Survey] data indicate that 35 percent of high school students currently drink alcohol (defined as at least one drink of alcohol on at least one day during the 30 days before the survey), down from 50 percent in the mid-1990s. However, 35 percent is still far too many young people putting their lives and futures at risk.
While there has been success in reducing the number of teens who drink, we cannot afford to let progress stall, particularly in light of more recent research pointing to the long-term harms associated with early use of alcohol and other drugs.
We now know that young people’s brains continue to develop well into their mid-20s, which is a key reason why they are at risk of developing problems with drugs, including alcohol, tobacco, marijuana and prescription drugs. According to the National Institute on Drug Abuse, “because their brain architecture is still not fully developed, adolescents’ brains are more susceptible to being radically changed by drug use — often specifically by impeding the development of the very circuits that enable adults to say ‘later’ … or ‘not at all’ … to dangerous or unhealthy options.”
Young people who start drinking before age 15 are six times more likely to develop an alcohol use disorder than those who begin drinking at or after age 21. Research continues to highlight the fact that alcohol is the substance young people typically initiate first. Moreover, the earlier teens initiate alcohol use, the more likely they are to engage in future illicit substance use. This research highlights an important prevention target — early use of alcohol — and underscores why early identification of substance use is critical to interrupting a trajectory that may lead to a young person developing a substance use disorder.
Another important prevention target in young people is binge drinking (i.e., having five or more drinks in a row on one or more occasions in the prior two weeks). Perhaps one of the most disturbing and lesser-known statistics is that 90 percent of the alcohol consumed by youth under the age of 21 in the United States is in the form of binge drinking, according to the CDC data. Further, 20 percent of young people under the age of 18 who drink are binge drinkers. This information should be cause for concern. Fortunately, increasing focus is being placed on binge drinking as one of the greatest concerns from a public health perspective for both youth and adults.
There are steps communities can take to address underage and binge drinking at both a community and individual level. The Community Preventive Services Task Force highlights each in detail, including electronic alcohol Screening and Brief Intervention (eSBI). More than 30 years of research has shown that alcohol screening and brief intervention (SBI) is effective at reducing risky drinking in adults. It is this body of research that the Conrad N. Hilton Foundation is building upon in its efforts to adapt SBI and Screening, Brief Intervention, and Referral to Treatment (SBIRT) for adolescents.
Through partnerships with national medical and professional associations, medical educators, advocacy organizations, providers and research institutions, we are investing in new SBIRT approaches to prevent and reduce youth substance use, and promote health and well-being. The primary goal of this population-based approach is not to diagnose and treat substance use disorders, but rather to promote prevention messages, address low to moderate risk early on and facilitate effective referrals to treatment for those who may benefit from a diagnostic assessment and/or specialty care. Our learning indicates SBIRT provides a valuable framework for advancing a public health approach to reduce the harms and societal costs associated with substance use disorders.
Our Substance Use Prevention Strategic Initiative is helping to develop knowledge related to screening and early intervention for young people by testing various approaches designed to inform training, delivery and evaluation of youth-related substance use prevention and early intervention activities. Observations from a round of recent interviews with our grantees indicate the initiative is helping address three broad areas of need:
Awareness: building expertise in preventing youth substance use among a broad range of youth-serving organizations, many of which did not have prior work in the area
Adaptation: modifying the traditional SBIRT approach for non-primary care settings so they can develop a fit that can be sustained as part of routine practice
Access: linking young people to community-based services such as job training, mentoring or mental health programs as part of the intervention and referral process.
Through these investments, we hope to continue to advance the progress being made in communities across the country to reduce use of alcohol and other drugs among young people. While we understand we have a long way to go in reducing youth substance use, and that there are many challenges to overcome, there are solutions in prevention, treatment and recovery that work.
We hope that, as organizations and communities across the country convene to recognize Alcohol Awareness Month this April, it is an opportunity to highlight the progress being made in reducing youth alcohol use, and to identify concrete steps that can be taken to target early use and binge drinking in young people to drive down rates even further.
Alexa Eggleston leads implementation of the Conrad N. Hilton Foundation’s youth substance use prevention and early intervention initiative.
Editor’s note: Youth Today’s coverage of substance use and addiction is funded in part by a grant from the Conrad N. Hilton Foundation.
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