Youth and Young Adult Alcohol and Other Substance Use

Overview

Adolescence is a time when people may experiment with alcohol, nicotine via cigarettes or vaping, marijuana, and other substances.

Young people who drink alcohol or use drugs face serious risks. They are more likely to be victims of violent crime, have serious problems in school, and be involved in drinking-related traffic crashes.

Exposure to alcohol and other substances may have a significant impact on brain development. Early use of alcohol and other substances can increase the likelihood of going on to use other drugs and of developing a substance use disorder.

Signs of Substance Use in Young People

Pay attention to the signs listed below, particularly when multiple signs are present:

• Mood changes: flare-ups of temper, irritability, and defensiveness, depressive and suicidal symptoms
• School problems: poor attendance, low grades, and recent disciplinary action
• Rebelliousness against family rules
• Switching friends, along with a reluctance to have parents get to know the new friends
• A “nothing matters” attitude: sloppy appearance, lack of involvement in former interests, and general low energy
• Finding alcohol or drugs among a teen’s belongings or smelling alcohol on their breath
• Physical or mental problems: memory lapses, poor concentration, bloodshot eyes, lack of coordination, or slurred speech
• Problems concentrating or remembering
• Coordination problems

Note, however, that some behavioral changes are normal in the teen years and can reflect ordinary growing pains rather than drug or alcohol problems.

See the Alcohol, Nicotine, Cannabis, Opioid, and Psychedelic and Dissociative Drug pages for more information.

Related Health Effects

Alcohol and other drug use may impair judgment and lead to:

• Deaths
• Accidents and injuries
• Physical and sexual assault
• Trouble in school or with the law

Substances also increase the risk of developing mental health disorders and chronic physical health conditions, including substance use disorders.

Drug Use and the Brain

Drugs affect parts of the brain that control reward, mood, and the ability to exert self-control. Repeated drug use can alter the way these circuits function.

Because the teen brain is still developing, it is more vulnerable than the adult brain to changes caused by drug use. For example, the earlier people start drinking alcohol, the more likely they are to experience a measurable impact on cognitive functions, memory, and school performance over time—perhaps even into adulthood. Alcohol misuse has also been linked to changes within and between brain regions. 

Studies show that regular, heavy cannabis use in adolescence is associated with negative effects on memory, processing speed, and academic functioning, and with negative effects on educational attainment, employment, and income in young adulthood. Cannabis use at a young age has also been linked to other mental health conditions, including the likelihood of developing psychosis.

Overdose

Many people have died from a drug overdose in the United States. Opioids are the most common drugs associated with these fatal overdoses.

Alcohol can also cause fatal overdose. The risk of an overdose can increase if alcohol is consumed while taking opioids or sedative hypnotics, such as sleep and anti-anxiety medicines. Additionally, over-the-counter cold and flu medications that include acetaminophen and antihistamines mixed with alcohol can increase risk of overdose.

Substance Use Disorders

A substance use disorder is a medical condition defined by difficulty stopping or controlling drug or alcohol use despite negative consequences. Early substance use can increase risk of a substance use disorder. For example, adults who began drinking before age 15 are more likely to report having alcohol use disorder in the past year than those who waited until age 21 or later to begin drinking.

Causes and Risk Factors

As children mature, it is natural for them to assert their independence, seek new challenges, and engage in risky behavior. The brain continues to develop into the twenties. In some ways, the adolescent brain may be specifically “wired” to help youth navigate adolescence and to take some of the risks necessary to achieve independence from their parents.

This may help explain why teens often seek out new and thrilling, sometimes dangerous, situations, including drinking alcohol and using other substances. They often do not fully recognize its effects on their health and behavior.

A combination of factors influences someone’s risk for using substances early and their risk for addiction:

• Genetics: The genes that people are born with account for about half of a person’s risk for addiction.
• Stressors: Factors such parental relationships, physical and sexual abuse, early exposure to drugs, a family history of substance misuse, childhood trauma, and other stressors can greatly affect a person’s likelihood of drug use and addiction.
• Mental health problems: People with mental disorders like depression, anxiety, and post-traumatic stress disorder are also more likely to use substances and to develop substance use disorders, perhaps initially to cope with the condition.
• Temperament: Impulsive temperaments can increase risk for substance use.
• Peers: Whether an individual’s peers use drugs or disapprove of substance use is a major influence on whether that individual will use substances, particularly during adolescence.

Risks of Particular Substances

Alcohol

While many teens don't binge drink, they tend to consume alcohol consistently. They also tend to increase their consumption over time, potentially leading to health and social consequences and to problematic use for some. 

Many others do engage in binge drinking when they drink alcohol. When teens and young adults drink alcohol, they often binge drink. NIH defines binge drinking as a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08% — or 0.08 grams of alcohol per deciliter — or higher. This generally takes three drinks for girls, and three to five drinks for boys, depending on their age and size —in about 2 hours. In the United States, a “standard drink” is defined as any beverage containing 0.6 fl oz or 14 grams of pure alcohol (such as a 12-oz regular beer).

As blood alcohol level rises, the effects on the body multiply. Although drinking any amount of alcohol can carry certain risks, crossing the binge threshold increases the risk of acute harm, such as blackouts and overdoses. Binge drinking also increases the likelihood of unsafe behaviors, accidents, and injuries, property damage, drunk-driving arrests, violence, academic problems, and death. Long-term, binge drinking and other forms of alcohol misuse increase risk for many chronic health disorders.

Cannabis

Studies show that regular, heavy cannabis use in adolescence is associated with negative effects on working memory, processing speed, verbal memory, and academic functioning. It is also associated with negative effects on educational attainment, employment, and income in young adulthood. Cannabis use at a young age has also been linked to other mental health conditions, including the likelihood of developing psychosis and to developing cannabis use disorder later in life.

Nicotine

Research shows that many teens and young adults do not realize that the flavors they use in vaping products can actually contain nicotine, an addictive compound found in tobacco. Recent studies showed that students who had already used any type of e-cigarette by the time they started 9th grade were more likely than others to start smoking cigarettes and other smokable tobacco products within the next year.

Prevention Guidance

Parent-Child Communication

Research strongly shows that active, supportive involvement by parents and guardians can help teens avoid drug and alcohol use.

Studies have shown that it is important to:

• Establish a loving, trusting relationship with your child.
• Talk early and often, in developmentally appropriate ways, with children and teens about your concerns — and theirs — regarding alcohol and drugs.
• Establish policies early on and be consistent in setting expectations and enforcing rules.
• Work with other parents to monitor where kids are gathering and what they are doing.
• Work in and with the community to promote dialogue about alcohol and drugs.
• Encourage your child to develop healthy friendships and fun alternatives to drinking and other drug use.
• Know whether your child is at high risk for a substance use problem; if so, take steps to lessen that risk.
• Know the warning signs of a teen drug use and act promptly to get help for your child.
• Be aware of your state’s laws about possession and use of substances.
• Never provide substances to your or someone else’s child.

Your child can learn to resist alcohol and other substances. Let them know that the best way to say “no” is to be assertive — say no and mean it. Strategies include:

• Stand up straight.
• Make eye contact.
• Say how you feel.
• Don’t make excuses.
• Stand up for yourself.

Parents and guardians are important role models for their children. Suggestions include:

• If you choose to drink, use alcohol in moderation. Don’t misuse drugs.
• Don’t communicate to your child that using alcohol or drugs is a good way to handle problems.
• Let your child see that you have other, healthier ways to cope with stress, such as exercise, listening to music, or talking things over with a partner or friend.
• Never drink or use other drugs while driving or ride in a car with a driver who has been drinking or using drugs.

Healthy Coping Strategies

Learning healthy ways to cope with stress — that don’t involve alcohol or other substances— can reduce the risk of use and its consequences. Here are some ways to build healthy coping strategies:

• Take breaks from watching, reading, or listening to news stories, including those on social media.
• Connect with others and talk with people you trust about your concerns and how you are feeling.
• Take deep breaths, stretch, or meditate — and build this into your everyday routine.
• Make time to unwind and try to do some healthy activities you enjoy.
• Stay healthy by getting plenty of sleep, exercising, and eating healthy, well-balanced meals.
• Know where and how to get treatment and other support services, including counseling or therapy.
• Connect with community- or faith-based organizations.

Evidence-Based Prevention Approaches

Preventing youth and young adult drinking and drug use is a complex challenge, and any successful approach must consider many factors, including genetics, personality, rate of maturation and development, level of risk, and social and environmental factors. Several key approaches have been found to be successful:

• Individual-level interventions seek to change the way youth think about drugs and alcohol, so they are better able to resist pressures to drink or use drugs.
• School-based interventions provide students with the knowledge, skills, motivation, and opportunities they need to remain drug- and alcohol-free.
• Family-based interventions empower parents to set and enforce clear rules against substance use and improve communication between children and parents about alcohol.
• Community-based interventions are often coordinated by local coalitions working to mitigate risk factors for substance misuse.
• Policy-level interventions work by shaping the environment to make substance use less likely. For example, through making prices of alcohol and tobacco products high and through strict age limits on purchasing.

Evidence-based prevention programs are designed to prevent substance use and related negative outcomes, and may aim to reduce risk factors and enhance protective factors, help people avoid or delay the onset of drug use, stop substance use from progressing into higher-risk use or a substance use disorder, and reduce harms related to substance use and misuse.

Studies have shown that evidence-based prevention strategies have long-term, cost-saving benefits for both personal and public health, with positive effects, even for the children of the people who received the intervention.

Delaying the Start of Drinking and the Use of Other Drugs

It is important that, if young people ultimately choose to use a substance, they delay first use. Research shows that people who start drinking and using substances later have a lower chance of developing a substance use disorder compared with people who start earlier.

Screening for Alcohol and Other Drug Use and Substance Use Disorders

Screening youth for alcohol and other substance use disorders is important and may may prevent future problems. Screening by a primary care provider such as a pediatrician, or another healthcare provider, offers an opportunity to identify problems early and address them before they escalate.

Treatment and Management

Some youth can experience serious problems because of drinking and other drug use, including substance use disorders, which require intervention by trained professionals. See the Substance Use Disorders page for more information.

Find Treatment

If you think you or someone close to you might have an alcohol or drug problem, several several tools can help you find treatment options:

• NIAAA Alcohol Treatment Navigator® helps you search for alcohol treatment options
• SAMHSA Treatment Locator or call 1-800-662-HELP (4357)
• Behavioral Health Treatment Services Locator: Locate substance use treatment centers in your area

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on youth drinking or clinical trials on youth drug use.

Community Support

• College Drinking Prevention: Resources for college students, parents, and educators
• CollegeAIM — the College Alcohol Intervention Matrix: Research-based information for colleges
• National Association for Children of Addiction: Helps children hurt by a parent’s alcohol use. Call 301-468-0985
• Just4Teens: Resources specifically for teens
• Partnership to End Addiction: A national resource working to reduce teen substance use and support families impacted by addiction. See personalized support and resources for families
• SAMHSA “Talk. They Hear You.” campaign: Helps parents and caregivers start talking to their children early about the dangers of alcohol and other drugs
• SAMHSA Helping Families Cope: Resources for families coping with mental and substance use disorders
• SAMHSA Parent Resources
• Drug Enforcement Administration (DEA): Campus Drug Prevention
• The Center on Young Adult Health and Development at the University of Maryland aims to understand the health-related behaviors of young adults during a critical life transition
• Call the Childhelp National Child Abuse Hotline at 1-800-4-A-CHILD (1-800-422-4453).

Mutual Support Groups For Young People With Alcohol Use Disorder

• Narcotics Anonymous
• Smart Recovery
• Alcoholics Anonymous (AA)
• Secular AA
• Young People in AA

Living With a Person With a Substance Use Disorder as a Young Person

Living with a person who has a substance use disorder can be especially difficult for young people. Supporting a loved one through a struggle with substance use can be difficult for adults and teens alike, and this process can be especially complicated when someone is resistant to getting help. While you may not have control over someone else’s substance use, support is available to cope with how that substance use may affect you.

• Al-Anon helps family and friends of people who are worried about someone’s drinking.
• Alateen

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH.

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

NIH supports research to understand, prevent, and treating youth and young adult drug use and its consequences.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.