Alcohol Alert Alcohol Alert
Centers for Disease Control and Prevention
Too often today’s headlines bring news of yet another alcohol-related tragedy involving a young person—a case of fatal alcohol poisoning on a college campus or a late-night drinking–driving crash. People ages 18 to 25 often are in the news, but are they really at higher risk than anyone else for problems involving alcohol?
Some of the most important new data to emerge on young adult drinking were collected through a recent nationwide survey, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). According to these data, in 2001–2002 about 70 percent of young adults in the United States, or about 19 million people, consumed alcohol in the year preceding the survey.
It’s not only that young people are drinking but the way they drink that puts them at such high risk for alcohol-related problems. Research consistently shows that people tend to drink the heaviest in their late teens and early to mid-twenties (1,2). Young adults are especially likely to binge drink and to drink heavily1 (3). (1 In this study, binge drinking was defined as consuming five or more drinks in a row at least once in the past month. Drinking heavily was defined as consuming five or more drinks in a row on at least five occasions in the past month .) According to NESARC data, about 46 percent of young adults (12.4 million) engaged in drinking that exceeded the recommended daily limits2 at least once in the past year, and 14.5 percent (3.9 million) had an average consumption that exceeded the recommended weekly limits.3 (2 The recommended daily limits for moderate alcohol consumption are no more than two drinks for men or one drink for women per day .) (3 According to the National Institute on Alcohol Abuse and Alcoholism [NIAAA], men may be at risk for alcohol-related problems if their alcohol consumption exceeds 14 standard drinks per week or 4 drinks per day, and women may be at risk if they have more than 7 standard drinks per week or 3 drinks per day. A standard drink is defined as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits.)
Such risky drinking often leads to tragic consequences (5)—most notably alcohol-related traffic fatalities (6). Thirty-two percent of drivers ages 16–20 who died in traffic crashes in 2003 had measurable alcohol in their blood, and 51 percent of drivers ages 21–24 who died tested positive for alcohol (7). Clearly, then, young adult drinkers pose a serious public health threat, putting themselves and others at risk.
AN AGE OF EXPLORATION
Young adulthood is a stage of life marked by change and exploration. People move out of their parents’ homes and into dormitories or houses with peers. They go to college, begin to work full-time, and form serious relationships. They explore their own identities and how they fit in the world. The roles of parents weaken and the influences of peers gain greater strength. Young adults are on their own for the first time, free to make their own decisions, including the decision to drink alcohol.
Young adulthood also is the time during which young people obtain the education and training they need for future careers. Mastery of these endeavors is vital to future success; problems with school and work can produce frustration and stress, which can lead to a variety of unhealthy behaviors, including increased drinking. Conversely, alcohol use during this important time of transition can impede the successful mastery of these developmental tasks (8), also increasing stress.
ALCOHOL AND THE MATURING BRAIN
Research shows that the brain continues to develop throughout adolescence and well into young adulthood. Many scientists are concerned that drinking during this critical developmental period may lead to lifelong impairments in brain function, particularly as it relates to memory, motor skills, and coordination (9). Young adults are particularly likely to binge drink4 and to suffer repeated bouts of withdrawal from alcohol. (4 NIAAA defines binge drinking as consuming about four drinks for men or three drinks for women in about 2 hours.) This repeated withdrawal may be a key reason for alcohol’s harmful effects on the brain (10).
Even though research shows that drinking early in life can lead to impairment of brain function in adulthood, findings also show that not all young people who drink heavily or become alcohol dependent will experience the same level of impairment, and some may not show any damage at all (11). This is because factors such as genetics, drinking patterns, and the use of other drugs also influence risk.
FACTORS THAT INFLUENCE USE
Outside influences as well as individual characteristics help determine whether a person will begin drinking and how much he or she will consume. Some of these factors increase a person’s risk for problems with alcohol, whereas others serve to protect him or her from harm, as outlined below.
Gender—Men are much more likely than women to drink in ways that are harmful. As shown in a recent national survey of 19- to 30-year-olds, 45 percent of men and 26.7 percent of women reported heavy drinking (defined in that study as five or more drinks on one occasion) in the past 2 weeks, and 7.4 percent of men and 3 percent of women reported daily drinking (12).
Race/EthnicityRacial, ethnic, and cultural differences in drinking and alcohol-related problems also have been documented. In general, White and Native American young adults drink more than African Americans and Asians, and drinking rates for Hispanics fall in the middle. In addition, while drinking among Whites tends to peak around ages 19–22, heavy drinking among African Americans and Hispanics peaks later and persists longer into adulthood (13). Researchers suggest that these ethnic differences result, in part, from the fact that Whites see heavy drinking as part of a youthful lifestyle, whereas Hispanics tend to see heavy drinking as a “right” they earn when they reach maturity.
College vs. Noncollege StatusMany people think that the college campus environment itself encourages heavy drinking (14). Alcohol use is present at most college social functions, and many students view college as a place to drink excessively. Yet several studies have found that heavy drinking and related problems are pervasive among people in their early twenties, regardless of whether they attend college or not (15,16). In fact, a recent survey shows that college students drink less frequently than their noncollege peers (that is, 3.7 percent of students report daily drinking vs. 4.5 percent of nonstudents). However, when students do drink, such as at parties on the weekends, they tend to drink in greater quantities than nonstudents5 (17). (5 In this study, 41.7 percent of college students vs. 37.1 percent of young adults reported drinking five or more drinks during the last 2 weeks .)
On the other hand, students tend to stop these drinking practices more quickly than nonstudents—perhaps “maturing out” of harmful alcohol use before it becomes a long-term problem (16). Rates of alcohol dependence diagnosis appear lower for college students than for 18- to 24-year-olds in the general population (15). And people in their thirties who did not go to college reported a higher prevalence of heavy drinking than people who did go to college (18).
EmploymentBeing employed full-time after high school was associated with a slight increase in current drinking and a slight decrease in heavy drinking. Unemployed men, but not women, especially tended to reduce their drinking. Homemakers reduced both their current and heavy drinking, but this may have been because of increasing responsibilities stemming from marital and parental roles rather than the result of being a homemaker (19).
Military ServiceYoung adults in the military are more likely to drink heavily (i.e., consume five or more drinks per typical drinking occasion at least once a week) than older enlistees. In 2002, 27 percent of adults ages 18 to 25 in the military reported heavy drinking, compared with only 8.9 percent of those ages 26 to 55 (20). The reasons for heavy drinking rates in the military include a workplace culture that supports alcohol use and the increased availability of alcohol both in and around military bases (21).
Peer InfluencesPeople entering college or the workforce may be especially vulnerable to the influence of peers because of their need to make new friendships. And they may increase their drinking in order to gain acceptance by peers. Borsari and Carey (22) contend that peer influence is exerted directly (in the form of drink offers or urges to drink) and indirectly (by modeling perceived social norms).
The phenomenon of perceived social norms—or the belief that “everyone” is drinking and drinking is acceptable—is one of the strongest correlates of drinking among young adults, and the subject of considerable research (15). Many college students think campus attitudes are much more permissive toward drinking than they really are and believe other students drink much more than they actually do (22–24). Recent research has shown that addressing these misperceptions can help reduce drinking (24). Then again, the relationship between drinking practices and peer groups may not be so clear. That is, a young person may opt to join a peer group based on that group’s drinking practices rather than change his or her drinking behavior to fit in with a particular peer group (25).
Marriage and ParenthoodJust as the move to adulthood leads to greater exploration of the world and experimentation with alcohol, assuming adult roles and responsibilities consistently curbs alcohol use. This reduction in drinking may be a result of limitations that adult roles place on social activities in general or may reflect a change in these young adults’ attitudes toward drinking.
Young married women have the greatest decreases in drinking behavior, and married men, compared with men in all other categories of living arrangements (i.e., living with parents, in a dormitory, alone, or in other arrangements) have the fewest increases. The data also indicate that becoming engaged (i.e., making a commitment to a relationship) has a similar but less powerful effect on drinking compared with marriage, whereas becoming divorced leads to increased drinking behavior (19).
Being a parent also is related to lower alcohol use for both men and women, although a large part of this effect may simply be a result of getting married. Most women who became pregnant eliminate their alcohol use, although most of their husbands do not (19).
Young adults with serious alcohol problems—that is, who fit the diagnostic criteria for alcohol dependence—may not be as likely to choose stable roles such as marriage and parenthood, or these milestones may not affect their drinking behavior to the same extent that they affect people with less problematic drinking practices (26).
Personality CharacteristicsA number of personality traits have been associated with drinking greater amounts of alcohol and drinking more often, including impulsivity, risk-taking, and sensation-seeking—or the tendency to seek out new and exciting experiences (27). Sensation-seeking and impulsivity also have been linked to deviant behavior and nonconformity, both of which are predictors of heavy drinking and related problems among youth (28).
Then there are other personality traits, such as a feeling of invincibility, that are common among young adults (27) and which can influence drinking. Many young people simply do not see themselves as vulnerable to any negative consequences that might occur because of drinking, such as having an accident or becoming dependent on alcohol. This optimistic bias makes young adults more likely to take risks and perhaps to drink excessively, although risk-taking may not be a direct cause of drinking. That is, research shows that the decision to drink is influenced more by the perceived benefits of drinking than by the perceived risks (29).
Negative moods, feelings of depression, and anxiety disorders also may influence alcohol use (15). Research has suggested that some people drink to relieve feelings of stress. In support of this, Cooper and colleagues (30) found that drinking to cope with negative feelings was a good predictor of heavy drinking as well as drinking problems in 19- to 25-year-olds. Again, though, research also shows that young adults are more likely to drink for “positive” or celebratory reasons than to drink to cope with negative feelings (31).
Alcohol ExpectanciesPositive alcohol expectancies, or the belief that drinking will lead to positive, pleasurable experiences, play a key role in the drinking behavior of young adults. What a person expects from drinking not only predicts when he or she will begin drinking but also how much he or she will drink throughout young adulthood. As people age through adolescence and into young adulthood, they increasingly expect benefits from drinking and become less convinced of the risks (32,33).
Family InfluencesDuring young adulthood parents may have less direct influence on their children’s drinking behavior, but they still play a major protective role (32). The example set by parents with their own drinking has been shown to affect their children’s drinking throughout their lifetime (34). Young people model their behavior after their parents’ patterns of consumption (including quantity and frequency), situations and contexts of use, attitudes regarding use, and expectancies. The family’s structure and aspects of the parent–child relationship (e.g., parenting style, attachment and bonding, nurturance, abuse or neglect, conflict, discipline, and monitoring) also have been linked to young people’s alcohol use (34).
GeneticsAlcohol problems seem to “run” in some families (34). This family connection to alcoholism may be the result of a genetic link and/or may reflect the child’s modeling of drinking behavior. Siblings also can influence drinking through modeling and by providing access to alcohol (32). It’s unclear whether children of alcoholics have different drinking patterns and problems in young adulthood than those who do not have a family history of alcoholism (15). Research does show, however, that people with a family history of alcoholism are less likely than those with no family history to mature out of heavy drinking as they approach young adulthood (35).
To better understand the role of genetics in alcohol abuse and alcoholism, scientists are looking at differences (or variants) in particular genes to see if they can be linked to drinking behavior. One study examined how gene variants linked to the regulation of serotonin—a key brain chemical involved in mood, appetite, emotion, and addiction, among other processes—influenced drinking behavior in college students. This study found that White students with a particular version of this gene engaged in binge drinking more often, drank to intoxication more often, and consumed more alcoholic drinks per drinking occasion than did students with other variants of the gene (36).
Another study focused on the gene that helps to form an enzyme (aldehyde dehydrogenase or ALDH) that is important for breaking down alcohol in the body. This study reported that Asian American college students who carried a particular version of the ALDH gene which results in less efficient alcohol breakdown were less likely to be regular drinkers and engage in binge-drinking episodes; they also reported a lower number of maximum drinks consumed in a 24-hour period than Asian students with other ALDH variants (37).