Alcohol Abuse

Prevalence of Adolescent Alcohol Abuse

In terms of prevalence, the 1994 national student survey data showed that 25 percent of 8th graders and 50 percent of 12th graders reported consuming alcohol within the previous month (Johnston, O'Malley, and Bachman, 1995). A substantial proportion of those drinkers consumed heavily: 15 percent of 8th graders and 28 percent of 12th graders reported having five or more drinks in a row in the previous two weeks, and just under 3 percent of 12th graders reported daily use of alcohol. The prevalence of adolescent drinking varied along demographic lines. Boys reported more heavy drinking than did girls, and among high school seniors, white adolescents reported more heavy drinking than did Hispanic or African American adolescents. For example, 1994 national data for 12th graders found that 32 percent of non-Hispanic Caucasians, 24 percent of Hispanics, and 14 percent of African Americans reported consuming five or more drinks in a row in the previous two weeks (Johnston et al., 1995). However, the researchers cautioned that ethnic differences could be due to differences in school dropout rates instead of drinking. One needs to remember that inconsistent definitions, as well as inter- and intracultural diversity, make comparisons among ethnic groups especially difficult. In general, however, compared with other ethnic groups, Native American adolescents typically report the highest consumption rates, and Asian American youth report the lowest.

The lack of empirical work on the prevalence of clinical alcohol abuse or dependence among adolescents of high school age or younger is rather shocking. The contrast between the remarkable increase in alcohol-related problems after the high school years and the allegedly low rates before and during high school is likely a product of poor diagnoses in those early years.

[Page 7]To diagnose the drinking patterns and problems that occur during early and middle adolescence, it is essential to use age-relevant criteria instead of applying diagnostic criteria designed for adults. Actually, criteria used tend to vary with the instrument: Different instruments use one or a combination of criteria.

For example, in a study by Rodney and Mupier (1997) on African American male adolescent children of alcoholics (COAs), the instrument used to assess the level of alcohol abuse was the Children's Structured Assessment of the Genetics of Alcoholism (C-SAGA). The C-SAGA uses the standardized diagnostic criteria for alcohol abuse as established in Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) of the American Psychiatric Association. A similar study by Fergusson and Horwood (2000) assessed alcohol-related problems at ages 15 and 16 using the Rutgers Alcohol Problem Index and measured alcohol abuse or dependence using the same DSM-III-R criteria. In both studies, the categorization as an alcohol abuser is rigorous.

For instance, in the C-SAGA, to be classified as an alcohol abuser, the adolescent must use alcohol six times or more during her or his lifetime and exhibit three or more of the symptoms categorized in nine groups. The first group includes the following symptoms: drinking caused others to tell the adolescent respondent that she or he drinks too much, drinking caused respondent to get into physical fights, drinking made respondent feel depressed for more than 24 hours, drinking caused problems with respondent's concentration for more than 24 hours, or respondent drank three or more times knowing a physical condition would be made worse. The second group identified the following symptoms: drinking caused respondent three or more times to miss school, work, or to do chores; respondent's grades went down because of alcohol use; or respondent three times or more accidentally got hurt when drinking. The third group identified the following: respondent quit school, activity, job, or doing things with friends. Increased tolerance by at least 50 percent made up the fourth group, and those who three times or more wanted to drink less made up the fifth group. Those who three times or more drank more than intended, and three times or more drank alcohol to relieve or avoid withdrawal symptoms made up the sixth and seventh groups, respectively. The eighth group consisted of experiencing withdrawal (shakes and at least one other symptom), and the last group consisted of spending a lot of time getting alcohol, drinking, or trying to feel better after using alcohol.

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