Alcohol Abuse

Alcohol is the most common substance abused by young people in the United States. According to the Centers for Disease Control and Prevention 1999 Youth Risk Behavior Surveillance, more than 80% of high school students had ever used alcohol compared with 70% who had ever tried cigarettes and 47% who had ever used marijuana. Current alcohol use, defined as one or more drinks in the preceding month, was reported by 50% of the students, including 40% of 9th graders and 60% of l2th graders. Episodic heavy drinking, defined as five or more drinks on one or more occasions in the preceding month, was reported by 31% of the students, including 20% of 9th grade females and almost 22% of 9th grade males and 28% of females and 35% of males in the 12th grade. One third of the students reported that in the preceding month they had ridden  with a driver who had been drinking alcohol, and 14% of females and 31% of males in the 12th grade reported driving in the preceding month after drinking alcohol.

Acute alcohol ingestion affects motor coordination and causes visual disturbances. The speech may become slurred and the gait ataxic. Although alcohol is a depressant, it also causes disinhibition, manifesting as giddiness, talkativeness, or belligerence and aggression. An idiosyncratic intoxication, most common in young males, presents as a sudden behavioral change of marked aggression, impulsiveness, and assaultive behavior associated with the consumption of relatively small amounts of alcohol. Occasionally an adolescent may present with confusion and stupor, symptoms of severe intoxication. Very high alcohol levels are associated with respiratory depression, coma, and death.

Signs of physiologic addiction (eg, withdrawal seizures and delirium tremens) are seen infrequently in adolescents. Although many adolescents are binge drinkers, drinking to become intoxicated, the majority do not become alcoholics. Patients who have conduct disorders and those who have a strong family history of alcoholism are especially at risk for alcoholism. Adolescents who are problem drinkers often have an antecedent comorbid depression. Indicators of a developing substance abuse or drinking problem include labile moods, withdrawal, irritability, irresponsibility, decline in school performance, and a shift in friends to peers who are also substance users.

The primary consequences of alcohol use in adolescents are injuries or death due to associated trauma and violence. Alcohol is a frequent contributing factor in motor vehicle accidents, drownings, homicides, and suicides as well as premature sexual activity and date rape.

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