Updated guidance shows how parent attitudes, behaviors and boundaries -- as well as a teen's circle of friends – can influence alcohol use.
As growing evidence shows how alcohol can interfere with brain development and function, the American Academy of Pediatrics urges parents to talk with their teens about the risks and set firm rules against its use.
The AAP strengthens its call to prevent and reduce underage drinking in an updated policy statement, "Alcohol Use by Youth," published in the July issue of Pediatrics. An accompanying technical report outlines the evidence for AAP recommendations and states that alcohol remains the most common substance used by teens.
"The teen years are a critical time for brain growth, when connections responsible for emotional regulation, planning and organization are being formed and fine-tuned," said Joanna Quigley, MD, FAAP, lead author of the policy statement.
"Alcohol paves a pathway for addiction when the brain is still maturing, affecting the area that governs decision-making. As parents, we don't want to downplay those risks, but keep the conversations open and model healthy habits."
Genetic, environmental and social factors contribute to alcohol use and behaviors. People who begin drinking at a younger age are more likely to have an alcohol use disorder later in life, regardless of their gender or race, studies have found.
"Binge drinking is especially dangerous and is known to lead to other risky behaviors, such as drinking and driving," said Sheryl Ryan, MD, FAAP, who chairs the AAP Committee on Substance Use and Prevention and is lead author of the technical report. "Pediatricians should screen their patients for alcohol use and help them understand the impact on the brain and behaviors."
The good news is, teen alcohol use has gradually declined overall since the 1990s. In 2018, more than 36% of students surveyed in 8th, 10th and 12 grades reported using alcohol in the prior 12 months before the survey, according to the 2018 Monitoring the Future Study by the National Institute of Drug Abuse and University of Michigan. That compares to 1997, when the percentage of teens who reported using alcohol over the prior year reached 61 percent, the highest level recorded during the survey's 44-year history.
The AAP recommends that pediatricians screen for alcohol use and provide education to teens and their families about hazards, consequences and potential interventions.
Other recommendations include:
Send a clear message against the use of alcohol under age 21.
Support existing state laws for a minimum purchase age of 21 for alcohol and advocate for taxes on alcohol products.
Support strengthening graduated driver licensing programs, which have been adopted in all 50 states and the District of Columbia. The laws indirectly affect drinking and driving by restricting nighttime driving and the transportation of younger passengers.
Advocate for more research on the impact of alcohol use on the developing brain.
Support the role of schools in screening for underage alcohol use and providing general health education and community programs.
Ban the sale and distribution of powdered alcohol.
Motor vehicle crashes are the leading cause of death for U.S. teens and young adults, and alcohol plays a major role in many of those crashes.
"Even as we see progress -- with fewer kids drinking overall than 20 years ago -- not everyone is getting the message," Dr. Quigley said. "We can't be complacent now. Families and pediatricians can work together.
Additional Information from HealthyChildren.org: