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.
References:
Fishman M, Bruner A, Adger H Jr. Substance abuse among children and
adolescents. Pediatr Rev. 1997;18:394-403
Schwartz B, Alderman EM. Substances of abuse. Pediatr Rev.
1997;18:204-215
State and Local Youth Risk Behavior Surveillance System Coordinators.
Youth risk behavior surveillance-United States, l999. MMWR Morb Mortal
Wkly Rep. 2000;49(SS-5):13-14, 17-18, 38, 60
Takahashi A, Franklin J. Alcohol abuse. Pediatr Rev. 1996;17:39-45