Reducing Underage and Young Adult Drinking How to Address Critical Drinking Problems During This Developmental Period Michael Windle, Ph.D., and Robert A. Zucker, Ph.D. Forty years ago, when the National Institute on Alcohol Abuse and Alcoholism (NIAAA) was founded, alcoholism was considered an adult disease driven principally by physiological determinants. As NIAAA expanded its research portfolio, new data and insights were obtained that led to an increased focus on underage and young adult drinking. Fostered by interdisciplinary research, etiologic models were developed that recognized the multiplicity of relevant genetic and environmental influences. This shift in conceptualizing alcohol use disorders also was based on findings from large-scale, national studies indicating that late adolescence and early young adulthood were peak periods for the development of alcohol dependence and that early initiation of alcohol use (i.e., before age 15) was associated with a fourfold increase in the probability of subsequently developing alcohol dependence. In recent years, developmental studies and models of the initiation, escalation, and adverse consequences of underage and early young adult drinking have helped us to understand how alcohol use may influence, and be influenced by, developmental transitions or turning points. Major risk and protective factors are being identified and integrated into screening, prevention, and treatment programs to optimize interventions designed to reduce drinking problems among adolescents and young adults. In addition, regulatory policies, such as the minimum drinking age and zero-tolerance laws, are being implemented and evaluated for their impact on public health. KEY WORDS: Underage drinking; drinking in young adulthood; psychosocial development; development of alcohol disorders; risk factors; protective factors; alcohol effects on brain development; screening among youth; preventive interventions; college drinking; treatment for adolescents and young adults n 1970, the National Institutes Simultaneously, but unrelated to tion. At that time, NIAAA’s Division of Health (NIH) established the the research on the adult psychopathol- of Epidemiology and Prevention INational Institute on Alcohol Abuse ogy, a separate scientific community increasingly began to support research and Alcoholism (NIAAA). At that time, was sensitized to the public concern addressing these issues, and an impor­ both the general public and the scientific about an illegal activity—underage tant body of theory and research community predominantly regarded drinking—that potentially could began to articulate the developmental alcoholism as a disorder of adulthood, result in great personal and societal nature of drinking behavior and to and the major focus of NIH-funded cost in the form of accidents and loss scientific work was on understanding of life. By the late 1970s, a significant MICHAEL WINDLE, PH.D., is a professor its etiology and finding new treatments body of research was addressing the in, and chair of, the Department of for it. Most of the etiological research critical issue of why most youth only Behavioral Sciences and Health Education, focused on physiological and clinical begin drinking in mid- to late adoles- Emory University, Atlanta, Georgia. analyses in adults, and the drinking cence and consume alcohol in small behavior of adolescents only appeared amounts at infrequent intervals and ROBERT A. ZUCKER, PH.D., is a professor in discussions of the epidemiology and without problems, whereas others in the Departments of Psychiatry and sociology of drinking patterns (e.g., begin much earlier, and in some cases Psychology and director of the Addiction Kissin and Begleiter 1972, 1976; progress to consuming near-alcoholic Research Center, University of Michigan, Popham 1970). levels within a short time after initia- Ann Arbor, Michigan. Vol. 33, Nos. 1 and 2, 2010 29 identify individual and social contex­ developmentally because they origi­ College Drinking (NIAAA 2002; tual factors that regulate it (Blane and nate before adulthood; moreover, the also see the article by Hingson, pp. Chafetz 1979; Jessor and Jessor 1977; highest prevalence of alcohol depen­ 45–54), which was charged with Kandel 1978). This research also start­ dence occurs in youth ages 18–20 reviewing the existing research on col­ ed to investigate how the initiation of (Grant et al. 2004). Since then, research lege drinking as a basis for implement­ drinking could be delayed and how the on underage drinking has increasingly ing and evaluating alcohol prevention occurrence of problems could be reduced crossed disciplines and now involves programs. The other is the Underage once drinking had begun (Kandel integrative work on the genetics and Drinking Research Initiative (National 1989; Robins and Przybeck 1985). neurophysiology of risk that is being Academy of Sciences 2004; also see As the developmental window from tied to behavioral and social environ­ sidebar), which was formed in 2004 childhood to early adulthood has mental science (Clark et al. 2008; to intensify research, evaluation, and been studied over the years, research Kendler and Prescott 2006; McGue outreach efforts on the underage drink­ on early drinking origins to adoles­ et al. 2001). ing problem. This initiative is ongoing cent problems on the one hand and Two initiatives in the past decade and has led to the development of on the origins of alcoholism on the underscore NIAAA’s recognition of the committee on Assessment and other hand has begun to converge. the importance of underage and early Screening for Underage Drinking Risk. An NIAAA news release in 2004 (Li adult drinking as a problem area of This article provides a brief snapshot 2004) articulates this integration, national significance and also have of the current scientific knowledge stating that both alcohol-related led directly to the work summarized about these earliest drinking years. It problems and alcohol use disorders in this article. One initiative, kicked summarizes the epidemiologic evidence (AUDs) needed to be understood off in 1998, was the Task Force on that documents the importance of the NIAAA’s Underage Drinking Research Initiative he National Institute tee. The mission of the steering multimedia resources; and other on Alcohol Abuse and committee is to stimulate research NIAAA-sponsored sites relevant to TAlcoholism’s (NIAAA’s) on underage drinking by drawing underage drinking. Other NIAAA- upon multiple disciplines (e.g., ado­ Underage Drinking Research Initiative sponsored sites include The Cool was undertaken in response to the lescent development, genetics, neu­ Spot (http://www.thecoolspot.gov), convergence of recent scientific roscience, prevention, and social advances and the increased public policy) to advise NIAAA on future an interactive site designed for concern about the seriousness of research to improve the prevention young people that features FAQs, underage drinking and its personal and treatment of underage drinking. statistics, and other information and societal costs. These concerns Thus far, goals identified by the about underage drinking, and The were expressed cogently both in the steering committee have yielded Leadership to Keep Children Alcohol 2007 Surgeon General’s Call to Action numerous products, including two Free (http://www.alcoholfree To Prevent and Reduce Underage special issues in scientific journals children.org), a unique coalition of Drinking (U.S. Department of (i.e., the April 2008 issue of Pediatrics Governors’ spouses, Federal agencies, Health and Human Services 2007) [Suppl. 4] and a 2009 issue of and public and private organizations and by the 2004 report Reducing Alcohol Research & Health [Vol. 32]) whose focus is on preventing the use Underage Drinking: A Collective that summarized existing research of alcohol by children. ■ Responsibility (Bonnie and O’Connell and identified important gaps. NIAAA also has established a Web 2004), which was sponsored by the References National Research Council and the site for the Underage Drinking Institute of Medicine. The focus of Initiative (http://www.niaaa.nih BONNIE, R.J., AND O’CONNELL, M.E., EDS. this NIAAA initiative is to intensify .gov/AboutNIAAA/NIAAASponsor Reducing Underage Drinking: A Collective edPrograms/underage.htm) that Responsibility. Washington, DC: National research, evaluation, and outreach Academies Press, 2004. efforts regarding underage drinking. contains updated statistics on To accomplish this, NIAAA formed underage drinking; updates from U.S. Department of Health and Human an interdisciplinary working group the Steering Committee; print pub­ Services. The Surgeon General’s Call to Action To Prevent and Reduce Underage Drinking. on underage drinking that consisted lications for parents, teachers, and Rockville, MD: U.S. Department of Health of NIAAA staff members and a young people, such as “Keep Kids and Human Services, Office of the Surgeon multidisciplinary steering commit­ Alcohol Free: Strategies for Action;” General, 2007. 30 Alcohol Research & Health Reducing Underage and Young Adult Drinking adolescent and young adult periods in new insights into the prevalence of tant because an earlier age at onset determining level of alcohol con­ alcohol consumption, binge drinking, has been associated with a more sumption. The article then examines and AUDs, which have altered the man­ severe course of alcoholism, poorer the developmental nature of problem ner in which alcohol use and AUDs are