U.S. Department of Justice

Office of Justice Programs

Office of Juvenile Justice and Delinquency Prevention 

Melodee Hanes, Acting Administrator

Ofce of Juvenile Justice and Delinquency Prevention ojjdp.gov

Underage Drinking 

Underage drinking is a widespread 

offense that can have serious physical, 

neurological, and legal consequences. 

Problematically, it has become quite 

commonplace. The Office of Juvenile 

Justice and Delinquency Prevention 

(OJJDP) works to eliminate underage 

consumption of alcohol and provide 

guidance for communities developing 

prevention and treatment programs. 

OJJDP created the underage drinking 

bulletin series to educate practitioners 

and policymakers about the problems 

youth face when they abuse alcohol and 

to provide evidence-based guidelines. 

The series presents findings from a study 

on preventing underage drinking in the 

Air Force as well as a literature review of 

the effects and consequences of underage 

drinking, best practices for community 

supervision of underage drinkers and 

legal issues surrounding underage drinking, and practice guidelines for working 

with underage drinkers. 

The series highlights the dangers of underage drinking. Hopefully, the information it provides will support communities 

in their efforts to reduce alcohol use by 

minors through the use of evidencebased strategies and practices. 

September 2012

Effects and Consequences 

of Underage Drinking 

Highlights

This bulletin presents findings from a literature review that investigated how 

underage drinking can affect a youth’s physical, emotional, and neurological 

health. In it, the authors discuss the legal, neurological, economic, and personal 

consequences youth can face when they make the decision to begin drinking.

The authors highlight the following points:

•	 The human brain continues to develop until a person is around age 

25. Underage drinking may impair this neurological development, 

causing youth to make irresponsible decisions, encounter memory 

lapses, or process and send neural impulses more slowly. 

•	 Underage drinking cost society $68 billion in 2007, or $1 for every 

drink consumed. This includes medical bills, income loss, and costs 

from pain and suffering.

•	 In 2009, 19 percent of drivers ages 16–20 who were involved in 

fatal crashes had a blood alcohol concentration over the legal adult 

limit (0.08). 

•	 Alcohol use encourages risky sexual behavior. Youth who drink may 

be more likely to have sex, become pregnant, or contract sexually 

transmitted diseases.
2 JUVENILE JUSTICE BULLETIN

By raising the drinking age to 21 across the United 

States, Congress has provided a highly effective strategy 

to increase youth health and safety. Tens of thousands of 

lives have been saved in traffic crashes alone. Nonetheless, 

youth and young adults under age 21 often drink alcoholic beverages. Alcohol consumption is often accepted as 

normal adolescent and young adult behavior. According to 

a 2011 report from the National Institute on Drug Abuse, 

by the time teenagers reached grade 12, almost 71 percent 

had used alcohol at least once in their lives and 41.2 percent had drunk alcohol during the past month (National 

Institute on Drug Abuse, 2011). Older adolescents and 

young adults drink at even higher levels, especially those who 

attend college (National Institute on Drug Abuse, 2011). 

Despite the significant progress that has been made in 

reducing adolescent drinking and related problems, when 

a behavior is as pervasive as alcohol use among youth and 

young adults under age 21, the general public may be 

tempted to question the emphasis being placed on it. Alcohol use is often considered a rite of passage, and adults 

who furnish alcohol to minors often abet this use. This 

casual attitude ignores the serious consequences of alcohol 

abuse by minors. This bulletin discusses adolescents’ neurological, social, and emotional development and examines 

why youth begin drinking alcohol. It then reviews literature that addresses the neurological, health, behavioral, 

safety, social, academic, and justice system consequences 

that result when youth and young adults engage in underage drinking.

Adolescent Brain Development 

Scientists once thought that human brains reached their 

maximum growth in childhood; however, recent research 

indicates that brain development continues until about age 

25 (Coalition for Juvenile Justice, 2006). Consumption of 

alcohol during the adolescent years can affect brain development and may result in long-term negative effects, 

including those described below. 

Effects and Consequences of Underage Drinking

September 2012

•	 In a study comparing the brains of youth ages 14 to 

21 who did and did not abuse alcohol, researchers 

found that the hippocampi of drinkers were about 10 

percent smaller than in those who did not drink. Not 

only is this finding significant, since the hippocampus 

is a part of the brain that handles memory and learning, but such effects may be irreversible (American 

Medical Association, 2010). Alcohol can interfere with 

adolescents’ ability to form new, lasting, and explicit 

memories of facts and events (Hiller-Sturmhofel and 

Swartzwelder, n.d.). This has obvious implications for 

learning and academic performance.

•	 Alcohol has toxic effects on the myelination process in 

adolescents (Medical News Today, 2005). Myelination 

helps stabilize and speed brain processes. Disruption of 

the myelination process can lead to cognitive deficiencies (Lewohl et al., 2000).

•	 The pharmacological effects of alcohol and other chemical substances most immediately interfere with optimal 

brain functioning. Continued use of alcohol and other 

drugs over time may keep youth from advancing to 

more complex stages of thinking and social interaction. 

Youth with alcohol use disorders often perform worse 

on memory tests and have diminished abilities to plan 

(Bonnie and O’Connell, 2004). 

Adolescent Social and 

Emotional Development 

Adolescents have unique social and emotional characteristics and undergo physical and cognitive changes that can 

affect their social and emotional development. Some of 

these characteristics and changes can increase the likelihood that youth will find themselves in dangerous and 

risky situations when using alcohol at a time when they are 

particularly vulnerable to negative outcomes from drinking. Understanding adolescents’ social and emotional 

development can provide greater insight into underage 

drinking, its dangers, and ways to prevent it.
JUVENILE JUSTICE BULLETIN 3

As adolescents struggle for independence and create a 

personal identity, relationships with their family and peers 

change. Peer groups may become more important to 

youth than their families, and peers often provide some of 

the same functions that family did earlier. Peers become 

the bridge between the family and the adult social roles 

the young person must assume (Berk, 2009). Youth look 

to their peers for support, approval, and belonging. They 

tend to choose peers who are similar to themselves 

(Vernon, 2002). 

To gain acceptance from their peers, youth tend to dress 

alike, use similar speech patterns, be enamored of the 

same heroes, and listen to the same music. They want to 

steer clear of humiliation, so they try to look and act like 

their peers to avoid disapproval and negative judgments 

(Vernon, 2002). Peer pressure often convinces youth to 

engage in activities to gain one another’s approval. This 

tendency may lead to alcohol use.

On the other hand, some youth face social rejection or 

neglect and have few peer relationships. These youth are 

at higher risk for a variety of problems, such as social 

isolation or withdrawal, lack of appropriate social skills 

development, and low self-esteem (Holmes, 1995). 

Furthermore, rejection or neglect may contribute to 

these youth joining together in antisocial groups.

Whether their peers accept or reject them, youth develop 

new behavior patterns during adolescence. Caissy (1994) 

describes a variety of adolescent behavioral characteristics 

that guide social development:

•	 Experimentation. Youth try different social roles and 

identities to discover who they are. This may include 

harmless experiments such as new hairstyles, makeup, 

dress, and music, or more harmful experimentation 

such as alcohol and drug use. 

•	 Rebellion. Youth rebel against adult authority as a 

means of learning to make decisions. They often do 

exactly the opposite of what adults want them to do. 

Sources of conflict may include curfews, smoking, 

drinking alcohol, the use of other psychoactive substances, or academic performance. 

•	 Talking and socializing. Youth may talk on the telephone, send text messages, interact on social media sites 

(e.g., MySpace, Facebook, Twitter), or hang out with 

friends at the mall to socialize. The peer group provides 

a social form of self-evaluation, and youth need feedback from their peers (Newton, 1995).

•	 Preoccupation with themselves. Youth tend to focus 

on their needs. They feel they are the topic of others’ 

conversations and others are watching them constantly. 

They may spend long periods of time self-grooming, 

monopolizing the telephone or computer, or engaging 

in other self-centered activities. 

•	 Risk taking. Youth often do not realize the consequences that their behavior will have and may take risks 

because they believe nothing bad will happen to them.

Adolescents undergo many physical and mental changes 

before they become adults. In addition to their predisposition to peer pressure and social experimentation, 

adolescents’ brains continue to develop through their 

midtwenties and may be highly vulnerable to the effects of 

alcohol and other substances. 

Factors Contributing to 

Underage Drinking

Youth and young adults begin to drink alcohol for a 

variety of reasons. Resource and treatment providers must 

understand these motives when working with underage 

drinking offenders and targeting issues. These factors are 

discussed below. 

Emotional Satisfaction From Drinking 

Young drinkers want to feel different when they drink. 

Some of the reasons youth drink include (Johnson, 2004; 

Bonnie and O’Connell, 2004):

•	 To relax and lower their inhibitions in social situations. 

•	 To reduce stress, tension, and worries.

•	 To increase courage and feelings of power.

•	 To enhance sexual attractiveness and performance.

•	 To satisfy their curiosity about the feelings that alcohol 

produces or feel more grown up.

Personal Characteristics 

of Underage Drinkers 

Many studies have identified personal characteristics that 

may increase the likelihood that a youth will engage in 

underage drinking. Impulsive or excitement-seeking youth 

and young adults are more likely to drink alcohol (von 

Diemen et al., 2008). Rebellious youth may also drink 

because they do not feel that they are part of society, think 

they are not bound by rules, and may not want success 

or responsibility. 

Additionally, youth with mental health issues, such as 

depression or attention deficit hyperactivity disorder, may 

be at higher risk for substance abuse (Alcoholism: Clinical 

and Experimental Research, 2007). Similarly, youth who 

face mental health problems because of physical or sexual 

abuse may turn to alcohol and drugs as a solution to their 

trauma (Brannigan et al., 2004). 
4 JUVENILE JUSTICE BULLETIN

Family Inuence 

Parents and siblings can influence a youth’s propensity to 

start drinking. For instance, studies have shown that youth 

are more likely to drink alcohol when at least one of their 

parents has a history of alcoholism and alcohol use (King and 

Chassin, 2004; Essau and Hutchinson, 2008). If parents do 

not set clear behavioral expectations or monitor their children’s behavior, children may be more likely to participate in 

underage drinking (Bonnie and O’Connell, 2004). 

Research has found that family conflict is associated with 

increases in adolescent alcohol use (Bray et al., 2001). 

Youth may turn to alcohol (or to peer groups who consume alcohol) in middle adolescence to cope with family 

conflict. Therefore, alcohol use should not be considered 

simply a normal stage of adolescent development. Instead, 

prevention and intervention workers should look deeper 

into the causes of initial alcohol use.

Peer and School Inuences 

During adolescence, youth strive for acceptance by their 

peers. They want to fit in and often choose peer groups 

whose values and behaviors are similar to their own. If 

drinking is a typical activity for these groups, they are 

much more likely to drink. Underage drinking often 

occurs at social events that peer groups attend, such as 

sports events, concerts, and parties.

Numerous studies have shown that youth who demonstrate a high involvement in their school, as evidenced by 

good grades or participation in extracurricular and/or 

academic activities, are less likely to engage in underage 

drinking (Pacific Institute for Research and Evaluation, 

n.d.; Catalano et al., 2004; Henry, Swaim, and Slater, 

2005). Youth with poor grades or those who frequently 

exhibit behavioral problems at school are more likely to 

drink alcohol, especially if they associate with peers who 

drink (Mason and Windle, 2001). 

Advertising and Media Inuences

In today’s culture, youth and young adults are bombarded 

with media and advertisements about drinking. Often, the

media make drinking appear sexy and fun. Advertising 

may include items with alcohol brand names, and alcohol 

companies may sponsor popular events or give free products to young people (Jernigan and O’Hara, 2004).

Few empirical studies have examined the effects of alcohol 

advertising in the media. However, some evidence suggests that alcohol advertising may influence the beliefs and 

behaviors of young people, causing them to drink illegally 

(Grube, 2004).

Youth Access to Alcohol 

Not all merchants are vigilant about preventing underage 

youth from buying alcohol. Some youth use false identification to buy alcohol; persuade adults to buy it for them; 

and/or steal alcohol from parents, friends, and commercial 

establishments. Adults often purchase alcohol and provide 

it to underage drinkers at parties and events, sometimes 

with the permission or collusion of parents (Bonnie and 

O’Connell, 2004).

Neurological Consequences 

of Underage Drinking

As discussed above, if youth experiment with alcohol, this 

use may have negative effects on the brain, which continues to develop until the midtwenties. Psychoactive substances such as alcohol produce pleasurable feelings and 

may diminish stress and emotional pain. These chemicals 

can turn on the brain’s reward system, which makes people 

want to repeat the use of substances to obtain the same 

feelings. Eventually, substance use can alter the structure and chemical makeup of the brain, leading to brain 

disorders (Society for Neuroscience, 2008). In addition, 

adolescents have a diminished sensitivity to intoxication, 

making it possible for them to drink more alcohol without 

feeling very intoxicated. This may be because they have 

higher metabolic rates (Winters, 2009).

Alcohol use by adolescents is associated with abnormalities in the volume of the prefrontal cortex, the part of the 

brain that controls reasoning and impulse (Medina et al., 

2008). In particular, females are vulnerable to the effects 

of alcohol on this part of the brain. Severe or chronic 

alcohol use among female adolescents may limit the 

development of their prefrontal cortex more than it does 

for males. Low prefrontal cortex development may lead to 

deficiencies in reasoning and impulsive behavior.

Alcohol can activate the pleasure-producing chemistry of 

the brain and release a pleasure-enhancing chemical called 

dopamine. Dopamine is released in the brain when an action satisfies a basic need or desire. With repeated alcohol 

use, the brain’s natural capacity to produce dopamine is 

reduced. This leads to feelings of depression, anger, boredom, anxiety, and frustration (O’Connell, 2009).

With the use of alcohol and other drugs over time, youth 

may fail to advance to more complex stages of thinking 

and social interaction. Youth with alcohol-use disorders 

often perform worse on memory tests and have diminished abilities to plan (Bonnie and O’Connell, 2004). 

Effects may also include hallucinations, psychotic episodes, 

changes in sleep patterns, and changes in the ability to 

concentrate. 
JUVENILE JUSTICE BULLETIN 5

Health Consequences of 

Underage Drinking 

Underage drinking can lead to behaviors with serious 

health consequences in both the short and long term. 

These behaviors are discussed in detail below. 

Risky Sexual Behavior 

The ramifications of underage drinking and risky sexual 

behavior are immense. Youth who drink alcohol more 

commonly engage in sexual intercourse when drinking, 

have sexual experiences at an earlier age, have sex with 

multiple partners, engage in unprotected or unplanned sex, 

experience unexpected pregnancies, have babies with Fetal 

Alcohol Spectrum (FAS) disorders, and contract sexually 

transmitted diseases (STDs) than youth who do not drink. 

According to the Youth Risk Behavior Survey (Grunbaum 

et al., 2002), frequent heavy drinkers were more likely than 

nondrinkers to have had sexual intercourse (87 percent 

versus 34 percent), sex before age 13 (18 percent versus 5 

percent), sex with at least six different partners (31 percent 

versus 4 percent), and sex with at least three partners in the 

past month (20 percent versus 2 percent). Frequent heavy 

drinkers were more likely than nondrinkers to have used 

alcohol or drugs prior to their most recent sexual activity 

(52 percent versus 3 percent). Many who engage in sexual 

activity while drinking report having unprotected sex. 

Nearly 30 percent of 15- to 17-year-olds and 37 percent of 

18- to 24-year-olds say they drink even though they know 

they may have sex when they are intoxicated and would 

not when sober (Bonnie and O’Connell, 2004). Another 

study showed that 31 percent of youth who engaged in 

frequent heavy drinking reported having at least six different partners, compared with only 4 percent of youth who 

do not drink (Hingson and Kenkel, 2004).

Youth and young adults who begin drinking early are 

more likely to have unplanned and unprotected sex 

(Hingson and Kenkel, 2004), which sometimes results 

in unwanted pregnancies. Youth who drink alcohol while 

pregnant face the risk of delivering babies with FAS disorders. Children born with FAS disorders often experience 

developmental delays and have other birth defects, including abnormal facial features, growth deficiencies, and central nervous system problems (Centers for Disease Control 

and Prevention, 2006).

Adolescents now represent half of all new cases of HIV/

AIDS (Centers for Disease Control and Prevention, 2005). 

Underage drinking is considered a major contributor to 

the likelihood that those who engage in sexual activity 

after consuming alcohol will be more likely to contract 

an STD because of impaired decisionmaking capabilities. 

While intoxicated, youth and young adults are more likely 

to engage in risky sexual behavior, including having sex at 

a younger age, having unprotected sex, or having sex with 

multiple partners (Lopez, 2003). Youth themselves seem 

aware of this risk; one survey found that 52 percent of 

girls ages 13–18 who were surveyed listed STDs as a major 

health risk associated with drinking alcohol (Tildon and 

Kimball, 2005). 

Alcohol Poisoning 

Alcohol poisoning can occur when a person drinks a large 

amount of alcohol in a short period of time. About 50,000 

people suffer from alcohol poisoning each year, and some 

die as a result (Alcoholism Information Web Site, n.d.). 

One of the most dangerous causes of alcohol poisoning is 

binge drinking (Mayo Clinic, 2008), or imbibing five or 

more drinks in a short period of time. Teens and college 

students, most of whom are first-time or inexperienced 

drinkers, are most likely to binge drink. 

Alcohol-Related Mental Health Disorders 

Early alcohol use has been shown to increase risk for 

chronic alcohol addiction and other alcohol problems in 

later life (Hingson, Heeren, and Winter, 2006; Masten 

et al., 2009). The American Psychiatric Association, in its 

Diagnostic and Statistical Manual of Mental Disorders, 4th 

ed. (DSM–IV), established two diagnoses of alcohol use 

disorders: alcohol abuse and alcohol dependence (American Psychiatric Association, 1994). To be diagnosed with 

alcohol abuse, at least one of four symptoms1 must be 

present within a 1-year period, and to be diagnosed with 

alcohol dependence, at least three of seven possible symptoms2

 must be present within a 1-year period.

Some researchers and clinicians do not believe that this 

diagnostic system is adequate for youth. Adolescents tend 

to experience additional symptoms of problem alcohol use 

that are not included in these diagnostic criteria, such as 

blackouts, passing out, risky sexual behavior, craving, and a 

drop in school grades (Martin et al., 1995). On the other 

hand, some of the symptoms used in the DSM–IV do not 

occur frequently among adolescents, including withdrawal 

and medical problems, both of which usually appear after 

years of heavy drinking. Hazardous use is frequently associated with driving while intoxicated, which rarely occurs 

in younger adolescents who cannot drive (Martin and 

Winters, 1998). Martin and associates (1996) found that, 

as opposed to the DSM–IV diagnostic criteria, adolescent alcohol symptoms developed in three stages. Some 

symptoms of dependence typically occurred before abuse 

symptoms. Their proposed stages are shown in table 1 

(page 6). More recent analyses have suggested other ways 

of making the DSM–IV criteria more useful and accurate 

for adolescents (Hasin et al., 2003).
6 JUVENILE JUSTICE BULLETIN

Other Drug Use 

The younger a person is when he or she begins using 

alcohol, the more likely he or she is to use other drugs 

(Hingson, Heeren, and Edwards, 2008). Although many 

factors can affect whether youth progress to the use of 

other drugs and which ones they choose to use, alcohol is 

frequently followed by tobacco, then marijuana, and then 

other illicit hard drugs (Degenhardt et al., 2009; Gfroerer, 

Wu, and Penne, 2002; Welte and Barnes, 1985). 

Safety Consequences of 

Underage Drinking 

Youth in the United States use alcohol more frequently 

than any other mood-altering substance. The immediate 

results of alcohol consumption often include impaired 

decisionmaking, risky behavior, and poor coordination. 

This section describes safety problems youth may encounter if they choose to abuse alcohol. 

Driving While Impaired 

Adolescents and young adults are the least experienced 

drivers on the road. When they consume alcohol, which 

impairs their judgment and coordination and makes them 

more likely to take risks, they cause crashes. In 2009, 

according to the National Highway Traffic Safety Administration (2010), 5,051 drivers ages 16–20 were involved 

in fatal motor vehicle crashes. Of those, 19 percent (951) 

had a blood alcohol concentration over the legal adult 

limit of 0.08. Of those killed in motor vehicle crashes who 

had been drinking, 74 percent were not wearing seatbelts. Youth are also more likely to ride in vehicles driven 

by peers who have been drinking. In 2001, 80 percent of 

youth who frequently drank alcohol reported they had 

ridden with a driver who had been drinking (Grunbaum et 

al., 2002).

Typically, motor vehicle crashes occur while youth are in 

cars and trucks, but youth may also be impaired on bicycles, motorcycles, or any other type of vehicle. The Youth 

Risk Behavior Survey (Grunbaum et al., 2002) found that, 

of the youth who identified themselves as frequent heavy 

drinkers, almost half (45 percent) never wore motorcycle 

helmets and a majority (92 percent) never wore bicycle 

helmets. Vehicle crashes can result in many kinds of injuries, including minor wounds, lifetime disabilities, and 

death. Injury rates remain unacceptably high. 

Other Accidental Injuries and Deaths

Alcohol-related injuries and deaths of youth and young 

adults from other types of accidents are just as prevalent 

as alcohol deaths from motor vehicles. In 2000, 6,936 

persons younger than age 21 died from alcohol-related 

accidents, including drowning, burns, and falls. This represented 44 percent of all unintentional injury deaths linked 

to alcohol among persons younger than age 21 (Hingson 

and Kenkel, 2004).

 Table 1. Stages of Youth Alcohol Involvement

Stage Symptoms

Stage 1 •	 Tolerance.

•	 Drinking larger amounts or for a longer 

period than intended.

•	 Large amounts of time spent using alcohol.

•	 Failure to fulfill major role obligations at work, 

school, or home. 

•	 Social problems.

Stage 2 •	 Unsuccessful attempts or a persistent desire 

to quit or cut down on drinking.

•	 Reduced activities because of alcohol use.

•	 Continued use despite physical or 

psychological problems.

•	 Hazardous use.

•	 Alcohol-related legal problems.

Stage 3 •	 Withdrawal.

Source: Martin et al., 1996.
JUVENILE JUSTICE BULLETIN 7

Homicides, Suicides, and Other Violence

Alcohol drinkers engage in more violent acts than nondrinkers. Many such acts are described below.

Homicide. According to Bonnie and O’Connell (2004), 

about 1,500 (36 percent) of homicides committed in 

2000 by someone younger than age 21 involved alcohol 

consumption. Homicide is the second leading cause of 

death for youth between ages 15 and 24. 

Physical violence. In 2001, the Youth Risk Behavior 

Survey (Grunbaum et al., 2002) reported that, of youth 

who drank four or more drinks on at least one occasion 

during the past 30 days, 44 percent carried a weapon and 

22 percent carried a gun, as compared with 10 percent and 

3 percent, respectively, of those who never drank. Frequent heavy drinkers became engaged in fights (both in 

general and at school) more frequently than nondrinkers 

(Hingson and Kenkel, 2004). In 2001, 696,000 college 

students were hit or assaulted by another college student 

who had been drinking (Hingson, Zha, and Weitzman, 

2009).

Sexual assault. Dating violence also occurs much more 

frequently among underage drinkers than nondrinkers. 

Those who drank heavily and frequently were much more 

likely to have been hit or slapped by a boyfriend or girlfriend and to have been forced to have sex (Hingson and 

Kenkel, 2004). More than 70,000 students between ages 

18 and 24 are victims of alcohol-related sexual assaults 

(National Institute on Alcohol Abuse and Alcoholism, 

2007). Alcohol is often a factor for both assailants and 

victims in these assaults. As many sexual assaults are never 

reported, the actual rates of alcohol-related attacks may be 

much higher (Bonnie and O’Connell, 2004).

Suicide. Frequent, heavy alcohol use is linked to feelings 

of depression, hopelessness, and suicide ideation as well 

as suicide attempts (Dahl and Hariri, 2004). In 2000, approximately 300 alcohol-related youth suicides occurred 

(Bonnie and O’Connell, 2004). 

Social and Emotional 

Consequences of Underage 

Drinking 

Underage drinking has serious social consequences for 

youth and young adults. During adolescence, youth shift 

from being more involved with their families to socializing 

more with peers. In turn, their peers influence their values 

and norms, particularly in late adolescence (Bonnie and 

O’Connell, 2004). If alcohol use is common among their 

friends, youth may begin drinking. 

Heavy and frequent alcohol use may interfere with 

a young person’s capacity to make prosocial choices. 

Frequent, heavy use of alcohol has been associated with 

low self-esteem, depression, conduct disorders, antisocial 

behavior, and anxiety in adolescents (Brown and Tapert, 

2004). Developing self-control during adolescence is a 

major task, but alcohol use may create a dependency that 

defeats attempts at self-control. Moreover, alcohol use may 

lead to alienation and stigmatization by peers (Crowe and 

Schaefer, 1992).

Academic Consequences 

of Underage Drinking 

Alcohol use can impact youth’s academic performance. 

Underage drinkers may miss classes, fall behind in their 

schoolwork, earn lower grades, and perform poorly on 

examinations and assignments (Wechsler et al., 2002; 

Johnson, 2004). They may also drop out, fail classes, or be 

expelled from school. 

Nondrinking youth also can experience negative consequences when other youth drink, including (Johnson, 

2004):

•	 Sleep or study time disruptions.

•	 Insults or humiliation from drinkers.

•	 Unwanted sexual advances.

•	 Time spent taking care of an intoxicated friend.

“Youth in the United States use alcohol more 

frequently than any other mood-altering substance.”
8 JUVENILE JUSTICE BULLETIN

•	 Arguments with intoxicated peers.

•	 Assaults by intoxicated peers.

•	 Personal property damage.

Family Consequences 

of Underage Drinking 

Families can contribute to underage drinking or can experience the negative consequences of a youth’s drinking 

behavior. The consequences of underage drinking—such 

as health problems, social difficulties, dropping out of 

school, or legal consequences—may precipitate a family 

crisis. While the youth becomes preoccupied with obtaining and drinking alcohol, the family may focus on how 

to stop the youth’s behavior, jeopardizing other family 

members’ relationships and needs. Family members may 

struggle to control the situation, become resentful, feel 

guilty, and blame themselves and other family members for 

the problems that occur. Moreover, family members may 

try to protect the underage drinker from consequences by 

compensating and taking up the slack or drawing attention 

to another problem (Crowe and Schaefer, 1992). 

Economic Consequences 

of Underage Drinking 

Underage drinking has both immediate and long-term 

economic consequences. Recent estimates calculated by the 

Pacific Institute for Research and Evaluation (n.d.) put the 

total cost of underage drinking at $68 billion in 2007, as 

shown in table 2. According to this analysis, underage drinking costs $1 (e.g., rebuilding property damage or vehicles 

after traffic crashes, medical care, or legal fees for violent 

acts) for every drink that an underage drinker consumes.

The immediate costs of underage drinking include personal costs and costs to a drinker’s family, community, and 

legal system. Personal costs may include payment for alcohol treatment, medical services (e.g., for injuries in traffic 

accidents), and insurance (e.g., higher premiums from 

traffic accidents or convictions for driving under the influence). Parents may lose money driving underage drinkers to appointments and treatment or taking off work to 

accompany the youth on court dates. The community pays 

for providing enforcement, supervision, and treatment 

services to youth and young adults charged with underage 

drinking (Bonnie and O’Connell, 2004).

Long-term costs are many and varied. One example of a 

long-term cost is the future potential earnings or contributions a youth will make to the workforce (Bonnie and 

O’Connell, 2004). This projection assumes that underage drinkers who do not receive treatment services have a 

greater risk of developing alcoholism or problems associated with alcohol use in adulthood. Although the individual 

may absorb some of these costs, society also pays because 

the individual may have difficulty finding and sustaining a 

good job. Moreover, students who binge drink in college 

may experience problems with regard to their grades, social life, and employment, which may eventually negatively 

affect their productivity at work. In the end, the actions of 

these individuals affect society at the broader level. 

Another lifelong cost comes from unwanted pregnancies 

due to alcohol use. Youth who have children may require 

welfare for medical care. If their children have FAS disorders, treatment costs may contribute to further community 

costs. 

Conclusion 

Raising the minimum age to purchase alcohol to 21 in the 

United States has had an exceptionally positive effect on 

the health and safety of youth. Unfortunately, underage 

 Table 2. Costs of Underage Drinking

Expense Cost (in billions)

Medical costs 7.4

Work loss costs 14.9

Lost quality of life costs 45.7

Total $68.0

Source: Pacific Institute for Research and Evaluation, n.d.

“Consumption of alcohol during the adolescent years can affect 

brain development and may result in long-term negative effects.”
JUVENILE JUSTICE BULLETIN 9

drinking is still common and can have tragic consequences. 

Many people view drinking alcohol as a fairly typical activity for youth and young adults, and young people often 

find it relatively easy to obtain alcoholic beverages. However, the psychoactive properties of alcohol cause impaired 

decisionmaking, poor coordination, and engagement in 

risky behaviors. Alcohol use can damage the brain and 

other body systems and organs. 

Underage drinkers often face legal consequences for their 

actions. When establishing penalties for youth, justice 

system professionals must work on changing the attitudes 

and behaviors of underage drinkers to avert further consequences for the youth and their families. Communities and 

the justice system must provide prevention, intervention, 

and treatment services early so that youth stop drinking, 

start living productive lives, and contribute to their 

communities. 

For More Information

This bulletin was adapted from Underage Drinking: Intervention Principles and Practice Guidelines for Community 

Corrections (Crowe et al., 2011). The bulletin highlights 

the importance of preventing and reducing the consumption of alcohol by youth younger than age 21 and is the 

second in an OJJDP series on underage drinking. The goal 

of the series is to better inform practitioners, policymakers, and judges on the effects of underage drinking in the 

hope that this information will support the development 

of more effective policy and practice guidelines to combat 

the problem. 

Other bulletins in the series provide guidelines, culled 

from evidence-based practice literature, to aid community supervision professionals in their work with underage 

drinkers, outline some of the legal issues that these professionals may encounter when working with underage drinkers, and present findings from an evaluation of OJJDP’s 

Enforcing Underage Drinking Laws initiative implemented 

in five communities with local Air Force bases. 

The bulletins can be accessed from OJJDP’s Web site, 

ojjdp.gov. Underage Drinking: Intervention Principles and 

Practice Guidelines for Community Corrections is available 

online at www.appa-net.org/eweb/docs/appa/pubs/

UDIPPGCC.pdf.

Endnotes 

1. These symptoms include role impairment (i.e., frequent 

intoxication at work, home, or school), hazardous use, 

legal problems, and social problems. 

2. These symptoms include gaining tolerance (i.e., the 

need to consume more to become intoxicated), going 

through withdrawal, drinking more or for longer than intended, making unsuccessful attempts to quit, spending a 

lot of time drinking, reducing social or recreational activities, and developing psychological or physical problems. 

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Acknowledgments

This bulletin was adapted from Underage Drinking: Intervention Principles and Practice Guidelines for 

Community Corrections, authored by Ann H. Crowe with Tracy G. Mullins, Kimberly A. Cobb, and 

Nathan C. Lowe. Ann Crowe, M.S.S.W., Ed.D., was a project director and senior research associate 

at the American Probation and Parole Association (APPA) before her retirement in December 2006. 

Tracy Mullins is a deputy director of the APPA in Lexington, KY. Kimberly Cobb is a research associate with the APPA. Nathan Lowe is a research associate with the APPA. The authors would like to 

acknowledge the Underage Drinking Enforcement Training Center at the Pacific Institute for Research 

and Evaluation (PIRE) in Calverton, MD, and the American Probation and Parole Association in Lexington, KY. The authors would also like to thank Kathryn Stewart, M.S., director of the Dissemination 

and Diffusion of Science-Based Prevention Component of the Prevention Research Center Grant at 

PIRE and founding partner of Safety and Policy Analysis, International.

This bulletin was prepared under grant number 

2007–AH–FX–K003 from the Office of Juvenile 

Justice and Delinquency Prevention (OJJDP), 

U.S. Department of Justice.

Points of view or opinions expressed in this document are those of the authors and do not necessarily represent the official position or policies of 

OJJDP or the U.S. Department of Justice.

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