Complex Factors Drive Underage Alcohol Use

Article excerpt

A complex mixture of biologic, psychological, and social evidence suggests that alcohol consumption in children and adolescents is a developmental issue, based on data from several studies published in a supplement in the journal Pediatrics.

The supplement, sponsored by the National Institute on Alcohol Abuse and Alcoholism, is intended as a clinicians' reference for current research on the developmental factors that may play a role in when and whether children and adolescents use and abuse alcohol. Contributors to the articles include experts in child and adolescent health and development, along with specialists in behavior, prevention research, neuroscience, brain imaging, and genetics.

Studying the developmental components of underage drinking at all developmental stages may help clinicians and public health officials intervene with children, families, and communities to prevent and treat alcohol problems in children and reduce the risk of long-term problems, wrote Ann S. Masten, Ph.D., of the University of Minnesota, Minneapolis, and her colleagues in an article that introduced the concept of a developmental framework for underage drinking (Pediatrics 2008;121:S235-51).

Data from animal studies show that adolescence is a time of particular sensitivity to alcohol, and chronic exposure to alcohol during adolescence promotes cell death and may have negative effects that last into adulthood. Similarly, limited studies in human adolescents suggest that severe alcohol use disorders may be associated with a reduced hippocampal volume, although the results are not definitive, the investigators noted.

Developmental changes throughout childhood and adolescence include changes in form, function, organization, and context, they wrote. Several studies presented in the supplement highlight the connections between these changes and alcohol use and abuse at different developmental stages. Developmental pathways that can steer children toward or away from alcohol appear when they are younger than 10 years old, based on data reported by Robert A. Zucker, Ph.D., of the University of Michigan, Ann Arbor, and his colleagues.

Many factors that have an impact on alcohol use and abuse by children and teens are not specific to alcohol, the investigators noted. Instead, the development of both internalizing and externalizing behaviors can become either risk factors or protective factors with regard to a child's early experiences with alcohol. The nonspecific risk factors are as important as the alcohol-specific factors in affecting how a child responds to alcohol, they explained.

Findings from studies of infants have shown that some infants respond more quickly than others to stimuli. Their abilities to focus on an object or shift focus in response to new stimuli reflect the beginnings of self-regulation and control systems that will ultimately affect how well the individual can plan, reflect, and decide whether to proceed with a particular action. In addition, data from longitudinal studies of young children suggest that externalizing behaviors including aggression, impulsivity, and lack of control, as well as internalizing behaviors including anxiety, sadness, and depression, not only appear in early childhood but predict an increased risk of substance abuse problems. These traits tend to persist throughout childhood and adolescence, Dr. Zucker and his associates noted.

"Despite the preponderance of evidence, it is still rare for clinicians to recognize that drinking problems of youths have their beginnings well before alcohol use is initiated," they said.

More research is needed to understand the factors that influence initial alcohol use in children, and the data are not conclusive as to whether children who first experiment with drinking when they are younger than age 12 years are at greater risk than those who initiate alcohol use at age 13-14 years. Social contexts, including drinking habits in the child's home and the child's exposure to alcohol through mass media, contribute to children's attitudes toward alcohol and expectations of its effects. …