Adolescents and alcohol. Some people argue they’re an inevitable combination. Others argue they don’t have to be. We understand that teens are likely to experiment with alcohol in some form during their teen years. Some teens try it once or twice and then stop. Others try it and go on to consume alcohol on a semi-regular basis throughout adolescence. Still, others try it, and what begins as experimentation gradually increases until their alcohol consumption crosses the threshold to addiction.

Many parents of teens choose to ignore the red flags of their teenager’s alcohol misuse or regard it as an adolescent rite of passage instead of a serious problem.

“Teens will be teens,” they say, chalking underage drinking up to typical adolescent behavior.

This laissez-faire mindset can result in tragic outcomes. It can be hard to accept the possibility that your teen – especially an early adolescent who’s 12 to 14 years old – is drinking alcohol without your knowledge.

However, it’s imperative for you to consider the probability they are.

Consider this fact:

Alcohol is the most widely abused substance among adolescents in the U.S.

This brief guide is designed to help you know what to look for if you think your teen is using, misusing, or abusing alcohol, and what to do if your teen is misusing or abusing alcohol.

Adolescents: Alcohol Addiction and Abuse

 First, we want to clarify the terminology around alcohol use. The clinical term for alcohol abuse or alcohol addiction – formerly known as alcoholism – is alcohol use disorder, often written with the acronym AUD. This terminology reflects a change in the way we talk about alcohol and substance use disorder in general. To reduce stigma and misunderstanding around the misuse and/or disordered use of alcohol and substances, we now refer to and individual diagnosed with AUD as a person with an alcohol use disorder rather than an alcoholic or an alcohol abuser.

This change in terminology reflects the change in addiction treatment away from the old model that held that alcohol addiction is a character flaw or moral failing, toward the disease model of addiction, which asserts that alcohol use disorder is a chronic, relapsing disease that responds to treatment, much the same way that chronic medical conditions like diabetes or hypertension are chronic relapsing diseases that respond positively to treatment.

What is Alcohol Use Disorder (AUD)?

The National Institute on Alcohol Abuse and Alcoholism (NIAA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) have clear criteria that help addiction professionals and laypeople alike determine specific categories and levels of alcohol consumption. Please keep in mind these definitions are designed for adults, and that the minimum legal drinking age in the U.S. is 21 years old. This means that by definition – and with very few exceptions – adolescents who consume alcohol are engaging in illegal activity.

With that in mind, here’s how the experts define the various levels of drinking, up to and including the disordered use of alcohol, a.k.a. addiction, alcoholism, or alcohol use disorder (AUD).

Moderate Alcohol Consumption

• SAMSHA and NIAA define moderate consumption as 1 drink a day for women and 2 drinks a day for men.

Binge Drinking

• NIAAA defines binge drinking as a pattern of consumption that brings blood alcohol concentration (BAC) up to 0.08 g/dl. That means:
  • Around 4 drinks in about 2 hours for women
  • Around 5 drinks in about 2 hours for men
• SAMHSA defines binge drinking as drinking 5 or more alcoholic beverages on the same occasion on at least 1 day in the past 30 days.

Heavy Drinking

• SAMHSA defines heavy drinking as binge drinking on each of 5 or more days in the past 30 days

Risk of Developing an Alcohol Use Disorder

Data from the NIAA shows that people who have low risk for developing an AUD consume alcohol within the following limits:

• 3 drinks on any single day and no more than 7 drinks per week (women)
• 4 drinks on any single day and no more than 14 drinks per week (men)

We’ll repeat the statement above:

The minimum legal drinking age in the U.S. is 21 years old.

This means that by definition – and with very few exceptions – adolescents who consume alcohol are engaging in illegal activity.

Now let’s look at the prevalence of alcohol use among adolescents in the U.S.

Alcohol Use Among Adolescents: The Statistics

The following facts and figures show important information for parents regarding alcohol use among adolescents. The complete data sets are published by the Centers for Disease Control (CDC) as part of the annual Youth Risk Behavior Survey (YRBS). Parents can find these statistics online in the 2019 YRBS.

Alcohol and Teens: Key Facts

• Teens consume alcohol more than marijuana or cigarettes*:
  • 29.2% of teens reported current alcohol use in 2019
  • 21.7% of teens reported current marijuana use in 2019
  • 6.0% of teens reported current cigarette smoking in 2019
• Nearly 20% of ninth graders reported they had consumed alcohol within the previous month
• Almost 25% of eighth graders reported they have tried alcohol at least once
• Exactly 15.0% of high school students said they first drank “more than a few sips” of alcohol before the age of 13.
• 3.8% of 8^th graders, 8.5% of 10^th graders, and 14.4% of seniors engaged in binge drinking in 2019.
• 16.7% of high school students reported riding in an automobile with a driver who had consumed alcohol
• 5.4% of high school students reported driving an automobile after consuming alcohol
• Teens who start drinking alcohol prior to age 14 have an increased likelihood of developing AUD later in life.

*Teen vaping is on the rise: 32.7% of teens report current electronic vapor product use (tobacco)

These statistics present a clear picture of how prevalent underage drinking is among teenagers in the U.S. They also indicate the dangers associated with alcohol consumption, from acute risks like drinking and driving, riding in an automobile with someone who has consumed alcohol, and developing AUD later as an adult.

Looking for and Recognizing the Signs of Alcohol Abuse

No responsible parent wants their teen drinking alcohol, developing problem alcohol use, or developing an alcohol use disorder. The temptation for teens, however, is great. Alcohol is easily accessible – often through a friend or right from home – and that increases both temptation and risk. If you accept the possibility that your teen experiments with alcohol or consumes alcohol regularly, you’re more likely to notice the warning signs. Once you do, you can take the necessary steps to help your teen.

One of the most important things to remember when looking for signs of alcohol use and misuse is this:

Watch for and pay close attention to any changes from your teen’s usual behavior, mood, or personality.

Signs of adolescent alcohol abuse include:

• Bloodshot eyes
• Glassy eyes
• Slurred or incoherent speech
• Poor coordination
• Shaking or tremors
• Changes in sleep or appetite
• Alcohol odor on clothing, body, or breath
• Frequent or excessive use of mouthwash, gum, or breath fresheners
• Secretive behavior
• Locking their bedroom door/spending lots of time alone in room
• Drastic decline in academic performance
• Frequently missing or being late to school or work
• Alcohol hidden in belongings, bedroom, or car
• Alcohol missing from your home
• Decline in personal hygiene, grooming, and appearance
• Increased need for money / borrowing or stealing money or selling valuables to get it
• Moodiness
• Irritability
• Change in friends or peer group
• Withdrawal from family
• Trouble with the law or school staff
• Decreased interest in activities once enjoyed, such as sports, clubs, and/or extracurricular activities
• Argumentativeness
• Lying
• Avoiding eye contact

Keep in mind that some of these warning signs can be due to other things, such as high stress or an underlying mental health issue. Some are signs of typical adolescent behavior and what’s called differentiation, or the process of defining a new, individual identity separate from parents and siblings.

If you suspect your teen uses, misuses, or abuses alcohol – after recognizing the signs – then it’s important to arrange a full assessment and evaluation with a healthcare professional. This is more than important: it’s essential. If you see the signs, don’t ignore them or assume your child is just going through a phase.

Knowing the First Steps to Take

If you know for a fact your teen uses, misuses, or abuses alcohol, it’s time to be proactive. Don’t hope or assume the issue will go away by itself over time. If they begin experimenting with alcohol as an early adolescent, they have an increased risk of developing AUD later in adolescence or as an adult. That’s why, though many teens do use alcohol while their parents either consent to the use or ignore it altogether, chalking it up to typical teenage behavior is a mistake.

Here are three initial steps you can take to address the issue:

1. Talk to your teen.

An open, honest, and calm conversation with your teen is the best place to start. Strive to keep any negative emotions, such as disappointment, anger, or fear at bay as you express your concerns. Avoid lecturing, scolding, or confronting your teen. Those behaviors almost always backfire, and rather than facilitating communication, they increase the chance your teen will shut down and tune you out completely. Instead of anger or confrontation, let your teen know you genuinely want to understand and listen to whatever they have to say. Understand that your teen may not be willing to talk, especially if the lines of communication have been damaged or strained for some time. That’s okay: this conversation won’t instantly restore those lines of communication, but it is the first step.

2. Set up an appointment for an evaluation.

One option for an evaluation is with your family doctor or your child’s pediatrician. Their doctor can do a physical examination including lab tests to check for alcohol in their system, unless too much time has passed. A physical exam can also rule out any underlying medical issues that could be causing some of the signs you’ve noticed. Also, your doctor can give you a referral or recommendation for treatment.

Another option is to have your child evaluated by a psychologist, psychiatrist, or other mental health professional – preferably one who specializes in or has experience with treating AUD in the adolescent population. A mental health evaluation can help determine if your teen has any emotional issues or an undiagnosed mental health disorder, such as anxiety or bipolar disorder, that may the root cause of the alcohol use, misuse, or abuse. Many teens use alcohol to cope with stress, alleviate troubling mental health symptoms, or numb negative emotions.

A third option for an evaluation is an adolescent drug and alcohol treatment center: they’re the most likely place to find psychiatrists, therapists, or counselors with experience treating adolescent AUD.

3. Seek appropriate treatment and support.

 Once your child receives a professional evaluation and assessment, the assessing provider will offer treatment recommendations. These recommendations will be determined by your teen’s specific needs, the severity of the alcohol abuse, and the length of the alcohol abuse.

Recommended treatment may include:

• Individual or group therapy or alcohol and drug counseling. This level of treatment usually involves weekly sessions lasting one to two hours. These sessions may be incorporated into a more intensive level of treatment – discussed below – as needed.
• Dual-diagnosis treatment. This treatment is recommended if your teen has a co-occurring mental health disorder in addition to their alcohol use disorder. Treatment focuses on treating both rather than focusing on only one or the other.
• Alcohol and drug rehabilitation. Rehab is offered at various levels of intensity depending on your child’s needs and severity of the problem. We offer details about levels of care below.
• Medication. Medication may be prescribed for teens to help alleviate serious alcohol withdrawal symptoms, reduce agitation or psychotic symptoms, or to help treat a co-occurring mental health disorder.
• Family therapy. Alcohol abuse impacts the entire family. Also, many teens use alcohol to cope with family conflict, abuse in the home, or other problems going on at home. Family therapy can help address these issues.

Supporting and Encouraging Your Child

The two most important things you can do to help your teen recover from the disordered use of alcohol is to offer genuine and consistent support and encouragement. The road to recovery can be a rocky one, and can seriously strain any parent-child relationship. Here are some things you can do to help your teen and minimize the challenges of recovery:

• Strive to get and keep the doors of communication open.
• Be respectful in your interactions with your teen.
• Avoid criticizing, talking over, or talking down to them.
• Educate yourself about adolescent alcohol use disorder.
• Educate yourself about any other substances your teen may be using.
• Actively participate in their treatment and recovery.
• Spend quality time with your teen and take a genuine interest in their life.
• Be available and willing to really listen.
• If your teen isn’t ready or willing to open up to you, be patient.
• Keep your negative emotions in check and try to see things from their perspective.
• Create a home environment that supports recovery. If you have a liquor cabinet or bar, keep it locked. Making alcohol in the home readily accessible sets them up for potential relapse.
• Consider the impact any alcohol use by family members may have on your teen.
• Be a good role model for your teen: practice what you preach.
• If your teen relapses, be patient and understanding. Avoid judging, ridiculing, or over-reacting.
• Understand that alcohol addiction can be very difficult to overcome. If your teen struggles, it doesn’t mean there’s something wrong with them: it means they’re having a challenge overcoming a chronic, relapsing medical condition.
• Stay calm even when you’re anxious or scared.
• Be willing to address your own issues that may create conflict or stress in your relationship with your teen or negatively impact your overall family dynamic.

What to Do When Things Escalate

Alcohol addiction can cause erratic behavior, mood swings, and even suicidal thoughts and behavior in teens. The unpredictability of addiction can cause circumstances to escalate quickly, leading to a precarious or outright dangerous situation. As a parent, you need to have a plan in place and take quick action to ensure the safety of your entire family.

If things do escalate there are several things you can do:

• Contact your child’s primary care provider
• If they have a mental health provider, such as a therapist or counselor, contact them
• Enlist the help of a close family member or friend for support or assistance
• In case of accidental overdose – also known as alcohol poisoning – take your teen to the nearest hospital emergency room. Signs of alcohol overdose/poisoning include:
  • Confusion
  • Vomiting
  • Seizures
  • Slow breathing (less than eight breaths per minute)
  • Erratic breathing (gaps of more than ten seconds between breaths)
  • Abnormally pale skin
  • Blue tinged skin
  • Low body temperature
  • Unconsciousness/unresponsiveness

If your teen is unconscious or unresponsive, call 911 immediately.

DO NOT WAIT.

When Individual Therapy Isn’t Enough

When a teenager has an alcohol use disorder, weekly individual therapy and counseling may not be sufficient to get and keep them sober and on a stable road to recovery.

A more intensive level of treatment may be necessary if your teen:

• Continues to use, misuse, or abuse alcohol
• Lacks a stable support system
• Has a co-occurring mental health disorder
• Actively contemplates suicide or attempts suicide
• Is psychotic or manic
• Is unable to function or carry out the typical responsibilities and activities of day-to-day life, such as getting out of bed, eating, dressing themselves, and going to school

More intensive levels of treatment may include:

• Intensive Outpatient Programs (IOP)
• Partial Hospitalization Programs (PHP)
• Residential Treatment Centers (RTC)
• Inpatient Hospitalization

Here’s a description of these levels of care:

Intensive Outpatient Programs (IOP)

This level of treatment is a step above weekly therapy or weekly alcohol counseling. The amount and timing of treatment depends on the program. Teens typically participate in treatment 3 times a week for 3 hours per session, live at home, and attend school during an intensive outpatient program.

Partial Hospitalization Programs (PHP)

This level of treatment is a is a step up from intensive outpatient treatment. As with IOP treatment, the amount and timing of treatment depends on the specific program. Adolescents go to treatment daily, usually for 4 hours per day, and attend school at least part time. They live at home or, if additional support is needed, in a sober living facility.

Residential Treatment Centers (RTC)

Residential alcohol treatment, also often referred to as inpatient alcohol treatment, involves having your son or daughter live ‘round the clock at a non-hospital treatment facility. This intensive level of treatment may last anywhere from 28 to 120 days, depending on your child’s treatment needs and progress. In addition to receiving full-time alcohol treatment, one of the greatest advantages of residential alcohol rehab is being in an environment that is free from alcohol and drugs. This enables your child to focus on recovery without having to deal with the temptation to drink.

IOP, PHP, and RTC programs can be beneficial for adolescents who have a mental health disorder in addition to an alcohol use disorder.

Inpatient Psychiatric Hospitalization

Hospitalization may be necessary if your teen is a danger to themself or others (suicidal or psychotic), or in need of 24/7 medical monitoring due to excessive alcohol use. Medical monitoring may be recommended in association heavy binge drinking, which is an increasing and dangerous trend amongst adolescents and young adults. Abrupt cessation of alcohol use (going cold turkey) can cause dangerous and potentially life-threatening withdrawal symptoms, which is why medical monitoring may be necessary.

These levels of care – excluding psychiatric hospitalization, during which immediate safety and psychiatric stability are the primary goals –  typically involve some combination of the following therapeutic approaches:

• Individual therapy and counseling
• Group therapy and counseling
• Family therapy and counseling
• Experiential activities such as exercise and mindfulness
• Community support (Alcoholics Anonymous or SMART Recovery)

The exact combination of treatment depends on the treatment center and the level of care your teen needs.

Take Care of Yourself

This process will probably be challenging. Helping your child is your highest priority, but do not neglect your own self-care along the way. You’ll be more available and effective if you bolster your own emotional, physical, and mental well-being while your teenager is in treatment.

Here are some steps you can take:

• Surround yourself with support by joining a support group (local or online), seeing with a therapist, and reaching out to family and friends – there’s no reason to go through this alone.
• Make sure you get eat three healthy meals a day and get plenty of sleep and rest
• Find healthy ways to manage your stress, such as yoga, meditation, and exercise
• Make time for yourself so you can relax, recharge, and restore life balance.

The road to recovery is rarely linear. There will be successes and setbacks. There will be tough days and wonderful days – but whatever you do, don’t lose hope. Thousands of teens recover from the disordered use of alcohol, even when things look bleak at first.

Your teen can recover too!