and the Utah Underage Drinking Prevention Workgroup

May 25, 2006

Responses to Frequently Asked Questions

Underage drinking is one of the most serious problems we face in this state, for it can cause brain impairment, increased risk of addiction, and lead to anti-social behavior.

The State’s Underage Drinking Prevention Workgroup, which operates under USAAV (Utah Substance Abuse and Anti-Violence Coordinating Council) seeks to encourage and empower parents to make a positive difference in their children’s lives to help them stay alcohol free. Because there is some discussion currently in the U.S. about lowering the drinking age, and we have received requests for more information, we are providing it in the form of “Frequently Asked Questions.”

QUESTION #1: What documented research did ParentsEmpowered use for their campaign?

RESPONSE: The addiction and alcohol-brain impairment facts on our website came from respected independent scientific researchers (see references). Most of it came through the National Academy of Science, a private, nonprofit society of distinguished scientists and scholars engaged in scientific research, who carefully reviewed all the research studies on alcohol and human brain development (not simply studies on the effects of alcohol on rat brains). They presented their findings on underage drinking to Congress in 2002. Before presenting their 300 page report (which is now in book form, “Reducing Underage Drinking – A Collective Responsibility,” available from the NAS on the web), the report was independently reviewed by the Report Review Committee of the National Research Council “to ascertain that their report was sound and to ensure that it met institutional standards for objectivity and evidence” (“Reducing Underage Drinking – A Collective Responsibility,” pp. iii-viii). We have included excerpts from their report below for easy viewing. All the following quotations in paragraphs ending with (NAS report) came from studies listed in their report.

“Youth who begin drinking before age 15 are four times more likely to develop alcohol dependence than those who begin drinking at or after age 21” (Grant and Dawson, 1997) (NAS report).

“Among adults who developed alcoholism, the average age of first drink was (Schuckit, Anthenelli, Bucholz, Hesselbrock, and Tipp, 1995) (NAS report).

The brain imaging studies on our website which were done by Dr. Susan Tapert, a archer and professor of psychiatry at the University of California, San Diego, “involved teens recruited from local schools. They are typically weekend binge drinkers, consuming about 40 drinks per month on average, and they were not recruited from treatment or rehab programs” (personal correspondence with Dr. Tapert, 2007).

The S.P.E.C.T. brain imaging studies showing decreased functional brain activity levels in teens who regularly consume alcohol were performed on sober young people by Dr. Daniel Amen, a respected neuroscientist and psychiatrist in private practice in Southern California. They are used with his permission and are published on his website,

QUESTION #2: Did use research done on rat—not human—teen brains?

RESPONSE: Because the brains of rats and humans possess similar addiction pathways, early research on alcoholism and the effects of alcohol on the brain involved rats. When it was discovered that alcohol affected teen rat brains much differently than adult rats, research was then directed to that area of focus. This was followed by research on humans, including MRIs and fMRIs (functional MRIs), into how alcohol affects a human teen brain, which corroborated the animal research.1 The alcohol-brain impairment facts presented on our website concern human teen brains.

QUESTION #3: Is there proof that underage drinking can cause brain impairment?

RESPONSE: It is a well-accepted fact that the brain goes through dramatic change and refinement during the ages of 10-25 (Huttenlocher, 1979; Geidd et al., 1999; Silveri and Spear, 2002). Alcohol is a depressant and affects a teen developing brain differently than a mature adult brain. Early and heavy alcohol use has been shown to negatively affect teen brain development. Alcohol use can cause the brains of teen drinkers to respond more positively to alcohol images and cues than non-drinking teens.

“It has recently become clear that there is a tremendous amount of brain development taking place during adolescence. . . . Alcohol, and perhaps other drugs, affect both behavior and brain function differently in adolescents than adults, and adolescents may be more vulnerable to the long-term effects of alcohol abuse.” (White, Duke University) (NAS report).

“Adolescent brain developments are prominent in the prefrontal cortex, an area critical for considering the consequences of actions, and other frontal areas that are important for stress responses and managing drives (Spear, 2002) (NAS report).

“Brain size was compared between youth with adolescent-onset alcohol use disorders and healthy matched comparison youth using magnetic resonance imaging (MRI). Youth with alcohol use disorders had significantly smaller left and right hippocampi, central brain regions critical for the formation of new memories” (De Bellis et al., 2000) (NAS report).

Researcher Aaron White at Duke University describes in his website how alcohol negatively affects the formation of long-term memories in the hippocampus, noting that alcohol “severely disrupts brain cells’ ability to establish long-lasting, heightened responsiveness to signals from other cells (Bliss and Collinridge 1993).”

“Although some studies have found that [drinking teens] perform reasonably well on tests of language, intellect, and reasoning, other studies have found that young heavy drinkers perform more poorly on tests of planning and executive functioning (Giancola and Mezzich, 2000), memory (Brown et al.,2000a), spatial operations (Tapert and Brown, 1999; Tapert et al., 2002), and attention tasks” (Tapert et al., 2001a; Tapert and Brown, 1999) (NAS report).

“In one study, alcohol-use disordered adolescents who were detoxified in a long-term treatment program demonstrated a 10 percent deficit in their ability to recall both verbal and nonverbal information that had been previously presented to them” (Brown et al., 2000a) (NAS report).

“A large college survey reported that youth with grade point averages at the Dor F level drink three times as much as those who earn A grades” (Presley, Meilman, and Lyerla, 1994) (NAS report).

“For youth being treated for alcohol problems, those who continue to drink and those who experience any alcohol withdrawal appear most likely to exhibit continued deterioration in cognitive functioning” (Tapert and Brown, 1999; Tapert et al., 2002) (NAS report).

In a study comparing (1) individuals who were treated at inpatient rehab programs during adolescence then relapsed to (2) those who had successful treatment outcomes, and to (3) individuals with no history of substance problems, those who continued to use alcohol and drugs heavily performed progressively more poorly than those who stopped use and those with no history of substance problems. There was some evidence for continued modestly poorer performance in those who stopped using, as compared to non-problem users” (personal correspondence, Tapert, 2007).

“Tapert and colleagues (2002) assessed neuropsychological functioning and substance use involvement at seven time points during an eight year period in subjects beginning, on average, at the age of 16 and ending at 24…. The heavier one was involved in substance use during adolescence, the lower their scores on tests of learning and memory at year eight, when subjects were in their early twenties. Heavier drinking alone was associated with lower scores on tests of attention, and experiencing withdrawal symptoms from alcohol predicted additional deficits in visuospatial abilities. These studies suggest that heavy use of alcohol and other drugs during the teenage years predicts lower scores on test of memory and attention when one is in their early-mid twenties.” (White, Duke University)

“A study with alcohol-dependent young women showed that alcohol-related cues (e.g., words associated with drinking) elicited craving and led to greater increases in brain activity in a variety of regions relative to controls (Tapert et al., 2004), thus establishing a link between craving for alcohol and brain function in key areas and indicating that the brains of alcohol-dependent young women function differently than their peers.” (White, Duke University).

QUESTION #4: Can drinking underage “trash” a teen’s brain?

RESPONSE: While the word “trash” was used figuratively, as a play-on-words in wrapping Salt Lake City and County garbage trucks, our use of the term “brain impairment” is accurate, for it refers not only to cognitive impairment, but also to the increased risk of addiction (which is a mal-adaptation of the brain’s pleasure-reward system to alcohol), as well as to the increased risk of mental health problems among teens who use alcohol.

”Teen alcohol use is associated with a wide variety of mental health concerns, ranging from low self-esteem and deviant behaviors to depression and suicide. Mental health problems and disorders occur significantly more frequently among youth with alcohol use disorders than in the general population and substantially more often than can be accounted for by the base rates of these individual disorders” (Lilienfeld, Waldman, and Isreal, 1994).

“Early [alcohol] use also elevates risk for a multitude of mental health and social problems” (McGee, Williams, Poulton, and Moffitt, 2000).

“Studies indicate that heavy adolescent alcohol use is associated with psychological distress, anxiety, and depression” (Mazaira Castro, Dominguez Santos, and Rodriguez Lopez, 1993).

In a survey of high school students binge drinking was a key predictor of actual suicide attempts, compared to suicidal thoughts, even after factoring in high levels of depression and stress. Michael Windle, Ph.D., lead author of the study, said binge drinking may be a good predictor “because binge drinking episodes frequently precede serious suicide attempts.” (Alcoholism: Clinical and Experimental Research, May, 2004; read summary of article at Join Together.

“Suicide is the third leading cause of death for youth (National Center for Health Statistics, 1999) and is consistently related to alcohol use across studies” (e.g., Preuss et al., 2002).

“Alcohol use interacts with conditions such as depression and stress to contribute to suicide, the third leading cause of death among people between the ages of 14 and 25.” (Anderson, 2001; Garlow, 2002).

In one study, 37% of 8th grade females who drank heavily reported attempting suicide, compared with 11 percent who did not drink (Windle, Miller-Tutzauer, Domenico).

“Rates of conduct disorder, antisocial personality disorder, nicotine dependence, and illicit drug abuse and dependence are significantly higher among youth who drink early” (McGue, Iacona, Legrand, Malone, and Elkins, 2001).

QUESTION #5: Can failure to drink before age 21 cause problems later in life?

RESPONSE: For youth to mature into successful adults, they need to be emotionally stable and become successful in areas essential for their roles as adults, such as school, work, and interpersonal relationships. There is substantial evidence that alcohol abuse and dependence creates problems in these areas; but even modest involvement during high school may create significant problems. Because teen drinking impairs good judgment, and most teens have not yet developed the brain mechanism that makes them sedated during heavy drinking, they are less likely to pass-out than adults who have drunk the same number of drinks, permitting teens to continue engaging in risky or harmful behaviors in which they might not otherwise participate.

In a well-designed national survey, Monitoring the Future 2003 (MTF), “53 percent of twelfth graders had consumed alcohol on at least 10 occasions and two-thirds of these youth indicated they had one or more problems because of their drinking.

“One-third of the high school seniors with drinking experience reported 3 or more alcohol-related problems. The most commonly reported alcohol-related problems included behavior they later regretted (52 percent) and interference with the ability to think clearly (30 percent).

“One in five students reported damage to their relationship with their significant other and/or driving unsafely.

“One of every six students indicated they became involved with people who were a bad influence on them and damaged their relationship with their parents.

“10 percent of high school seniors with alcohol experience said alcohol damaged friendships, hurt them emotionally, got them in trouble with police, and hurt their performance in school.” (O’Malley, Johnston, and Bachman, 1998) (NAS report).

“Youth who use alcohol are at an increased risk for other drug involvement, failure to develop emotionally and cognitively, and criminal involvement” (Newcomb and Bentler, 1988) (NAS report).

“Alcohol use also influences the mental health and social functioning of teens. Youth drinking is associated with nicotine and marijuana use, fighting, early intercourse, school dropout, and suicidal ideation/attempts” (National Center for Health Statistics, 1999; Preuss et al., 2002) (NAS report).

In a new study published in the Journal of Epidemiology and Community Health, the U.K.’s Institute of Child Health reported a study of 11,000 children which compared the drinking habits of 16-year-olds in 1986 to a variety of outcomes when they hit age 30. Those classified as binge drinkers in their teens were:

  • 60% more likely to become alcoholics by age 30
  • 40% more likely to use illegal drugs and have mental health problems
  • 60% more likely to be homeless and ran almost double the risk for criminal convictions
  • 40 percent more likely to have suffered serious accidents.
  • Adjusting for other factors likely to influence findings, the results remained unchanged.

“Youth who drink heavily are three times less likely to use condoms than nondrinkers or infrequent drinkers (Tapert, Aarons, Sedlar, and Brown, 2001b), and heavy drinking is associated with unprotected intercourse and sexual activity before age 16 (Fergusson and Lynskey, 1996). Forty-four percent of sexually active teenagers report they are more likely to have intercourse if they have been drinking