Underage Drinking – How Teens Can Become Alcoholics Before Age 21

Underage drinking – as in repeated binge drinking – is one of the key risk factors for developing a long-term problem with drinking.

It is often considered a right of passage; something most teens and young adults under 21 go through. As such, the focus is often on keeping young people safe, whether that be parents hosting a party with alcohol and taking away all car keys or offering to drive, no questions asked. Yet, young adults, ages 18-20, have the highest rate of alcohol dependence (alcoholism) in the United States, according to the U.S. Surgeon General’s “2007 Call to Action to Prevent and Reduce Underage Drinking” report.

New and/or advances in brain imaging technologies (e.g., fMRI, SPECT, PET) of the past 10 – 15 years and the resulting research is shedding new light on this issue. Neuroscientists, doctors and other medical professionals are now able to observe how the brain develops and the impact of alcohol (and other drugs — illegal or prescription) on the developing brain.

The image below is a time-lapse of brain imaging studies reprinted with permission from Dr. Paul Thompson of UCLA’s Laboratory of Neuro Imaging.

10-year Time Lapse Study Showing Brain Development - darker colors represent brain maturity (i.e.., wiring of neural networks)

10-year Time Lapse Study Showing Brain Development – darker colors represent brain maturity (i.e.., wiring of neural networks)

This image study shows brain development, ages 5 through 20 and beyond. It was thought (until these new brain imaging capabilities) that the brain was fully developed by adolescence. We now know it’s not. There is a great deal of brain development — brain changes — occurring between ages 12-20, often through age 25. These brain changes are related to:

1) Puberty. Puberty triggers new hormonal and physical changes, as well as new neural networks instinctually wired into the species to encourage the species to take risk and turn to their peers. See video, “It’s Time We Tell The Whole Truth About Puberty” for a more full explanation.

2) Development of the cerebral cortex (front area) — the “thinking” part of the brain. This involves neural networks wiring within the Cerebral Cortex — the idea of learning calculus vs. memorizing multiplication tables, for example. It also involves neural networks in the Cerebral Cortex writing to those in other areas of the brain — the idea of controlling emotions, which originate in the Limbic System, with logical thought, which originates in the Cerebral Cortex, for example.

3) “Pruning” and “strengthening” of neural networks. Pruning is when neural connections (explained below) that are not used or are redundant fall away (get “pruned”), and those that are used get strengthened, which makes the remaining neural connections more efficient (similar to the way an insulted cable wire works more efficiently than a non-insulated one). This concept is explained in more detail at The Partnership at Drug Free.org website, A Parent’s Guide to the Teen Brain.

About Neural Connections

We are born with about 100 billion brain cells — billions of them — also known as neurons but only a relatively small fraction are ‘wired.’ From birth to around puberty, our brains are ‘wiring’ neural networks like crazy — a wiring process that allows neurons to “talk” to one another via neural connections. Neural connections in the brain control everything we think, feel, say and do.

A neural connection requires brain cells (neurons), synapses (the gap between the branchlike extensions of a brain cell) and neurotransmitters (the chemical messenger that takes a message from one brain cell’s branchlike extension, across the synapse, to receptors on the receiving brain cell’s branchlike extension). There is an expression sometimes used to describe this process — “neurons that fire together, wire together“ and this wiring together is sometimes called a “brain map.”  (Norman Doidge, M.D. The Brain That Changes Itself)

Over the course of our lives, we create neural connections (brain maps) for all of the functions our bodies and brains do. In other words, we create neural connections for riding a bike or typing on a computer or talking on the phone or reading a book or running, breathing, reciting multiplication tables, eating, talking with our hands — everything!

Alcohol works on neural connections in many parts of the brain, but the neural connections initially most affected are those in the Limbic System (the pleasure/reward/pain center of the brain) because those connections require the neurotransmitter, dopamine. Dopamine is our “feel good” neurotransmitter — without it, we have a hard time feeling pleasure. Thus, when we drink, it’s these neural networks that “tell” the brain that drinking makes us feel good. We develop a memory of that feeling (thanks to other neural networks), which is why people want to drink, again. Think about it — if there were no feel good feelings from drinking alcohol, we likely wouldn’t drink it.

About Alcohol Use / Abuse / Addiction — Why It Matters How Much A Person Drinks

It’s important to understand there are three stages of drinking — use / abuse / addiction. It’s common to assume that drinking is either normal or alcoholic. With this assumption, it’s common to excuse some rotten drinking behaviors (e.g., fights, DUIs, arguments) because we don’t want to think of our loved one as an alcoholic. Understanding the differences and the consequences can help us want to intervene earlier rather than later in order to help young people stop their abusive drinking before they cross the invisible line to addiction.

  • Alcohol use is defined as moderate drinking — 7 standard drinks per week, with no more than 3 of those 7 drinks in a day, for women, and 14 standard drinks per week, with no more than 4 of those drinks in a day, for men. A standard drink is either 5 ounces of wine OR 12 ounces of beer OR 1.5 ounces of spirits (vodka, for example). [Note: 35% of American adults do not drink any alcohol — none.]
  • Alcohol abuse is when a person exceeds these drinking limits and has problems related to their drinking, such as arguments with family and friends about their drinking, binge drinking (defined as 4 or more drinks for women and 5 or more drinks for men), blackouts, lying about how much they’re drinking, driving while under the influence, work or school performance problems, arrests, unplanned or unprotected sex — in other words, doing things they just would not do if they hadn’t been drinking.
  • Alcohol addiction (aka alcoholism) is a chronic, relapsing brain disease caused by biological, environmental and developmental factors. It occurs when a person’s alcohol abuse causes chemical and structural changes in their brain (by interrupting normal neural connections), which sets up the characteristics of alcoholism:  tolerance, cravings, loss of control and physical dependence, in addition to the behaviors just described under alcohol abuse.

According to the World Health Organization’s AUDIT, all alcoholics go through the alcohol abuse stage but not all alcohol abusers become alcoholics. Alcoholism cannot be cured (meaning you can not go back to drinking after a period of time of abstinence), but it can be treated. Alcohol abuse drinking patterns, on the other hand, can be changed.

The Impact of Underage Drinking on the Developing Brain

As you look at the time-lapse image, again, notice how the brain develops from back to front (yellow/green to purple/fushia). This means that the portions of the brain that deal with emotion, memory, learning, motivation and judgment are the last to develop and, as such, are the most deeply affected by alcohol (or drug abuse) during ages 12 through 20, often through age 25.

For example, if a young adult repeatedly abuses alcohol (or drugs), the neural connections associated with memories and experiences related to alcohol abuse are the ones that are strengthened and thus embedded. By the same token, neural connections damaged by or not used because of alcohol abuse (those related to learning or judgment, for example) are pruned or not strengthened. This late stage brain development also explains why teens don’t know why they do some of the things they do, and why they take risks they likely would not engage in if they had a fully developed brain and the hindsight (memories and experiences) that go with it. Because the brain is NOT fully developed, adolescents are more vulnerable than adults to many of the effects of alcohol (e.g., memory, long-term cognitive deficits), and less vulnerable to others (e.g., sleepiness, loss of balance).

The Addiction Project’s section, Adolescent Addiction, explains these concepts further, as does this section, “Five Things to Know About Adolescent’s Brain Development and Use.”

Facts About Alcohol Abuse During Brain Developmental Ages 12 – 25

  • According to NIAAA, nearly half of all people who ever met the diagnostic criteria for alcoholism in their lifetime were addicted (aka alcoholics) by age 21 and two-thirds were addicted by age 25. Thus, alcoholism is really a young person’s disease, but it often takes a person another 10 – 15 years before they seek treatment, which is why we generally think of alcoholism as something that happens to older adults.
  • Age of first use is the most significant risk factor for a person becoming alcohol dependent (an alcoholic).
  • Teens who start drinking before age 15 are 5 times more likely to develop alcohol problems as adults.

Understanding the impact of alcohol on the brain — especially during its critical developmental stage of ages 12 through 20 and beyond — is shedding a whole new light on the issue of underage drinking. In closing, it may also be helpful to know that the BRAIN CAN CHANGE and go back to “normal” if alcohol abuse is stopped.

For article sources and additional information:

NOTE: This post was revised October 14, 2009, March 4, 2011 and May 30, 2013.


Lisa Frederiksen

Lisa Frederiksen

Author | Speaker | Consultant | Founder at BreakingTheCycles.com
Lisa is the author of hundreds of articles and 11 books, including "If You Loved Me, You'd Stop!," "Addiction Recovery: What Helps, What Doesn't," and "Secondhand Drinking: the Phenomenon That Affects Millions." She is a national keynote speaker with over 25 years speaking experience, consultant, and founder of BreakingTheCycles.com. She has spent more than 13 years studying 21st century brain research in order to write, speak, and consult on substance use disorders prevention, intervention and treatment; mental disorders; addiction (aka substance use disorders) as a brain disease; adolescent addiction treatment vs adult addiction treatment; effective treatment for co-occurring disorders (having both a substance use and mental disorder); secondhand drinking | drugging; help for the family; and related subjects. In 2015, she founded SHD Prevention, providing training and consulting to companies, public agencies, unions, nonprofits and other entities to address the workplace impacts of employee secondhand drinking and alcohol misuse.
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