Developmental Risk Factors for Underage Drinking

¶ … Drinking in Australia

Skeleton Brief

Trends in Underage Drinking

As children age the risk of alcohol use increases dramatically and by 16-years of age most have consumed alcohol within the last 30 days (Figure 1; Rowland et al., 2014).

Percentage of school-aged children in the state of Victoria who consumed alcohol within the last 30 days (adapted from Rowland et al., 2014).

Dangers of Underage Risky Drinking

The Australian Institute of Health and Welfare (AIHW, 2011) has defined risky drinking as the consumption of large amounts of alcohol within a short period of time (p. 75). The risks associated with risky drinking include damage to the gut and brain, cancer, psychological problems, physical injury, unsafe sex, illicit drug use, addiction, and legal problems.

Risk Factors

Pitkanen (2006) reviewed the research literature concerning risk factors for underage drinking and found that most fit into two categories: (1) Family and (2) socio-emotional (Table 1).

Table 1.

Risk factors for underage drinking (Pitkanen, 2006).

Category

Risk Factors

Family

Parental substance use disorder

Socio-economic status

Parental/family dysfunction

Domestic violence

Genetic predisposition

Socio-Emotional

Antisocial behavior

Impulsivity/poor emotional control

Poor academic performance

Social influences

Neighborhood characteristics

Stress

Conceptualizing the Problem

Human brains develop in important ways throughout childhood and during the first years of adulthood (AACAP, 2011). For example, the part of the brain responsible for generating instinct-driven, fear-based, aggressive behaviors (amygdala) matures earlier than the part of the brain responsible for controlling these behaviors in a socially responsible way (frontal cortex). This explains why parents have a hard time understanding teen tendencies to be impulsive, irrational, and engage in risky behaviors, since the adult frontal cortex is fully developed. Teenagers therefore react to the world in ways that seem foreign to parents.

During adolescence neuronal connections are being made and pruned, while the white matter is increasing in size, resulting in an increased risk of social and emotional problems, aggressive behavior, taking irrational risks, and physical injury (AACAP, 2011). Accordingly, the risk of alcohol use and abuse peaks during adolescence and early adulthood.

Unfortunately, habitual heavy alcohol use will result in significant changes in an adolescent's brain. The hippocampus and prefrontal cortex are both smaller in size, while the local integrity of the white matter is compromised in eight brain regions (Squeglia, Jacobus, & Tapert, 2009). The hippocampus, prefrontal cortex, and white matter are critical for memory formation, modulating fear and aggression, and facilitating neuronal communications between different regions of the brain, respectively. The brains of adolescent heavy drinkers will therefore be developmentally delayed and remain prone to impulsive, irrational, and risky behaviors.

The formation of identity during adolescence is one of the most important tasks that a teenager must undertake, according to Erik Erikson (ACT for Youth, 2002). The coincident emergence of risk-taking behavior and identity exploration is probably linked, since experimenting with new social roles and increased autonomy is inherently risky (Brown et al., 2008, p. S296). When alcohol is involved, however, it can be very difficult to discriminate between contributions from alcohol or the family to the social development process.

Another major influence on adolescent social development is peers. The nature of this influence can be positive, negative, or both, but for most adolescents the importance of peers to identity exploration and behavioral choices cannot be overestimated (Brechwald & Prinstein, 2011). Common attributes associated with transitioning through adolescence is a significant increase in peer interactions, more complex social behaviors, role experimentation, novel experiences, peer-pressure to develop a stable identity, and reliance on peer feedback. These factors paint a picture of adolescent social success that depends on the ability to secure positive regard and a sense of belonging from peers. Using the lens of social learning theory the risk of underage drinking will depend to a large extent on modeling peer behaviors, vicarious reinforcement, and rewards and punishments meted out by valued peers (Brechwald & Prinstein, 2011, p. 169). Identity-based theories suggest that the most important peer influence will come from a peer or peer group that has been idealized by an adolescent. Emulation and membership, respectively, will in turn foster an intrinsically rewarding self-identity. Accordingly, if peer influences promote alcohol consumption or abuse the risk of underage drinking would increase dramatically.

Recommendations

The identification of risk factors for underage drinking provides an opportunity to intervene. In terms of prevention, education of both adolescents and parents would be essential. Although adolescents may be prone to impulsive, irrational, and risky behaviors, this does not negate the fact that most teens are intelligent and caring individuals capable of making well-considered decisions. For this reason, the information discussed above about brain development and peer influences should be explained in detail to adolescents, possibly through an academic course taught in middle school. If successful, the decrease in medical, legal, and economic costs associated with underage drinking would probably more than compensate for the cost of the course. The same information could be presented to parents in the form of a brochure or flyer. Prevention strategies will not work for all adolescents and for this reason alcohol abuse treatment would represent the second arm of the recommendations. School nurses would be trained to recognize the signs and symptoms of underage drinking and a mental health referral system instituted within schools.

Reflection

A recent advertisement for a paediatric clinical psychologist in Melton, Australia stated that the ideal applicant would "possess exceptional report writing skills and the ability to generate effective recommendations for teachers, parents and allied health professionals" (PsychXchange, 2014). In response I would offer the following: