A Family 

Guide 

Start Talking 

Before They 

Start Drinking 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

www.samhsa.gov
prevention 
 

 

 

 

Table of Contents
 

Introduction 2
 

Surgeon General’s Call to Action 4
 

What You Need to Know 6
 

4A Standard Drink 8
 

4Underage Drinking 10
 

4Alcohol & Judgement 13
 

4Risks 14
 

4The Teen Years 16
 

4Family Influence 18
 

What You Need to Say 20
 

4Alcohol & Underage Drinking 22
 

4Your Family Beliefs & History 24
 

Around Alcohol
 

What You Need to Do 30
 

4Take Action 32
 

4Set Clear Rules 34
 

Activities 36
 

4Play Reporter 37
 

4Think/Say/Feel: Parent 38
 

4Think/Say/Feel: Youth 39
 

4Family Rules 40
 

Conclusion 41
 

Resources 42
 

1 
2 

You Are the 

Most Powerful 

Influence on Your

Child’s Behavior 
 

 

 

 

 

 

 

 -

 

The negative consequences of underage drinking are more 

widespread and serious than previously known. A growing 

body of research shows that alcohol can change the way 

the brain works and the way it’s wired, and may have 

consequences reaching far beyond adolescence. Many more 

dangers of underage drinking are immediate, including 

alcohol poisoning, sexual and physical assault, and motor 

vehicle crashes. Underage drinking is a serious problem, 

with roots deep in our culture. 

You can help protect your children from the risks associated 

with drinking by maintaining open communication and 

expressing a clear, consistent message that underage 

alcohol use is unacceptable. Building a close relationship 

with your children will increase the likelihood they come to 

you for help in making decisions that impact their health 

and well being. 

This guide provides facts and practical advice on how to 

talk with your children about underage drinking. It helps 

you create household rules to support your values. Society 

gives children mixed messages about alcohol. Make sure 

that your children get their information from the best 

resource available you. 

3 
4

The 

Surgeon General’s

Call to Action 

4 
WHAT 

YOU NEED 

TO KNOW

The Surgeon General is the Nation’s top doctor and 

public health officer. The President of the United States 

appoints the Surgeon General to help protect and 

promote the health of the Nation. The Surgeon General 

lets people across the country know the latest news 

on how to get healthy and stay healthy. Because of 

emerging new knowledge about the number of children 

who drink, how much they drink and what happens 

when they drink, the Surgeon General issued a Call 

to Action to Prevent and Reduce Underage Drinking. 

It explains why underage alcohol use is a major 

public health and safety issue. Rates of death and 

injury nearly triple between the early teen years and 

early adult life. Underage drinking contributes to this 

increase and that’s why ending teen alcohol use can 

help save lives. 

This brochure incorporates the latest information 

from the Call to Action, and will give you the 

knowledge and tools you need to take action 

against underage drinking. 

5 
statistic

decis

actions have c

6 
What 


You Need 


to Know
 

cs 

sion making
 

consequences 

7 
What You Need to KNoW 

A Standard Drink
 

8
 
What You Need to KNoW 

A standard drink is any drink that contains about 14 grams 

of pure alcohol. This is the amount usually found in: 

> One 12-ounce beer 

> One 4–5-ounce glass of wine 

> One 1.5-ounce shot of 80 proof liquor 

But not all drinks are standard drinks. Different drinks often 

have different amounts of alcohol. Mixed drinks may contain 

more than one shot of liquor, and different beers or wines may 

not have the same alcohol in them, even when the drinks are 

the same size. For example, some beers and beer products, 

like “ice” beers, and malt liquors, and some wines, have more 

alcohol than others. 

Remember, the legal drinking age is 21 and underage drinking 

can be a threat to health and development. 

9 
 

 

What You Need to KNoW 

Underage Drinking
 

> 	 As they grow older, the chance that young people will use 

alcohol grows. Approximately 22.1 percent of 12–14 year 

olds say they have used alcohol at least once. By age 15–17 

alcohol use more than doubles. And by 18–20 just over 

80 percent have had at least one drink (NSDUH).1 

> 	 A majority of underage drinkers in 2006 reported that when 

they last used alcohol they were either in someone else’s home 

(53.4 percent) or their own home (30.3 percent) (NSDUH).2 

14%

12%

10%

8%

6%

4%

2%

0%

18-2021-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970+

% Population Age 18+

Alcohol Dependence By Age

10 
What You Need to KNoW 

> 	 When young people drink, they tend to drink a lot at one 

time. Past month alcohol users aged 12 to 20 drank on an 

average of 5.9 days in the past month and consumed and 

average of 4.9 drinks per day on the days they drank in the 

past month (NSDUH).3 

> 	 Among all underage current drinkers, 31.0 percent paid 

for the alcohol last time they drank, including 9.3 percent 

who purchased the alcohol themselves and 21.6 percent who 

gave money to someone else to purchase it. The remaining 

69 percent of underage drinkers did not pay for the alcohol 

on their last drinking occasion (NSDUH).4 

3The prevalence of alcohol dependence 

is highest in the 18–20 and 21–24 year 

old groups. These kids don’t just party.5

11 
What You Need to KNoW 

Underage Drinking
 

> 	 Almost 1 in 10 (9.4 percent) of persons aged 12 to 20 met 

the criteria for a diagnosable alcohol use disorder (NSDUH).6 

> 	 Studies show an association between early drinking to 

heavy alcohol consumption and alcohol-related problems in 

adulthood. In fact, individuals who begin drinking alcohol 

before the age of 15 are about 7 times more likely than 

those who start after age 21 to develop alcohol problems 

(NSduh).7 

> 	 More young people use alcohol than use tobacco 

or illicit drugs.8 

> 	 Alcohol use kills more children than all illegal 

drugs combined.9 

12
What You Need to KNoW 

Alcohol and Judgement
 

The teenage brain is still developing. Alcohol can impair the 

parts of the brain that control the following: 

> Motor coordination. This includes the ability to walk 

or drive. 

> Impulse control. Drinking lowers inhibitions and increases 

the chances that a person will do something that they will 

regret when they are sober. 

> Memory. Impaired recollection and even blackouts can occur 

when too much alcohol has been consumed. 

> Judgement and decision making capacity. Drinking may lead 

young people to engage in risky behaviors that can result in 

illness, injury, and even death.10 

13
 

 

 

 

 

What You Need to KNoW 

Risks
 

Alcohol use among youth is strongly correlated with 

violence, risky sexual behavior, poor academic performance 

and other harmful behaviors.11 

VioleNce 

> Children who start drinking before age 15 are 12 times 

more likely to be injured while under the influence of 

alcohol and 10 times more likely to be in a fight after 

drinking, compared with those who wait until they 

are 21.12 

Sexual actiVitY 

> Underage drinking plays a significant role in risky sexual 

behavior, including unwanted, unintended, and unprotected 

sexual activity, and sex with multiple partners. Such 

behavior increases the risk for unplanned pregnancy and 

for contracting sexually transmitted diseases (STDs), 

including infection with HIV, the virus that causes AIDS13,14 

14 
 

 

What You Need to KNoW 

School 

> Teens who use alcohol have higher rates of academic 

problems and poor performance than non-drinkers.15 

> Among eighth-graders, higher truancy rates are associated 

with greater rates of alcohol use in the past month.16 

illicit drug uSe 

> More than 67% of young people who start drinking before 

the age of 15 will try an illicit drug. Children who drink 

are 7.5 times more likely to use any illicit drug, more than 

22 times more likely to use marijuana, and 50 times more 

likely to use cocaine than children who never drink.17 

death aNd iNJur Y 

> Approximately 5,000 people under the age of 21 die as a 

result of underage drinking each year. This includes death 

from car crashes, homicides, suicide, as well as from injuries 

such as falls, burns, and drownings.18 

> When young people drink and get into a car, they tend to 

make poor decisions that impact their safety.19 

> Traffic crashes are the number one killer of teens and over 

one-third of teen traffic deaths are alcohol-related.20 

15 
What You Need to KNoW 

The Teen Years
 

A Time of Many Changes 

The teen years are a time of particular vulnerability to alcohol 

use and its consequences. It is also a time when the developing 

brain may be particularly susceptible to long-term negative 

effects from alcohol use. 

Preventing underage alcohol use must take into account the 

complex forces and factors that shape how an adolescent will 

respond to the availability of alcohol in different situations at 

different times across the span of adolescents. For example: 

> Boys physically become young men and girls become 

young women. 

> Young people move from elementary to middle school 

and then to high school. Academic responsibilities and 

expectations increase. 

> Teens spend less time with their parents. They spend more 

time alone or with friends. They also like to stay up later and 

sleep in. 

> Teens worry more about friendship and social groups. 

And they have growing romantic and sexual interests. 

> The desire for adventure, excitement, and action increases. 

That’s why many young people want to take more chances, 

try new things, and be more independent. 

16 
What You Need to KNoW 

All these things are part of healthy adolescent development; 

they can also increase the risk for alcohol use. Helping your 

child to have the right skills to refuse to do something he 

or she has decided not to do is discussed in the next part 

of this guide. 

Remember, teens with emotional, behavior or family problems 

are at higher risk for alcohol use. And if anyone in the family 

has a drinking problem, it can affect the entire family. It also 

may affect a teen’s choices about drinking. 

17 
 

 

 

 

What You Need to KNoW 

Family Influence
 

“We must create an environment 

that discourages underage 

drinking and supports parents’ 

efforts to provide their children 

with messages about growing 

up safe and healthy.” 

rear admiral Steven K. galson, M.d., M.P.h., 

acting Surgeon general 

Most 6-year-olds know that alcohol is only for adults. 

However, between ages 9 and 13, youth begin to think 

that alcohol use is okay. That’s why it’s never too early 

to start talking with young people about the dangers of 

underage drinking. 

Teens say that they rely on adults in their lives more 

than anyone else to help them make tough decisions 

and to provide good advice. 

18 
 

 

 

 

 

 

What You Need to KNoW 

The US Dietary Guidelines for Americans recommend 

moderate drinking for adults who choose to drink. Moderate 

drinking is defined by the Dietary Guidelines as up to two 

drinks a day for men and one for women. According to 

epidemiologic research, men who drink more than 4 standard 

drinks in a day (or more than 14 per week) and women who 

drink more than 3 in a day (or more than 7 per week) are at 

increased risk for alcohol-related problems. 

You have more influence over your children than you may 

realize. Kids spend a lot of time with friends, television, music 

and magazines. But they are also tuned in to you. Your words 

and actions impact them in many ways every day. 

> Research studies indicate that children are less likely to 

drink when their parents are involved in their lives and when 

they and their parents report feeling close to each other.21 

> You can influence your children’s behavior by observing the 

rules of a moderate drinker or by not drinking.22 

> Your older children also influence their younger brothers and 

sisters. Older siblings’ alcohol use can influence the alcohol 

use of younger siblings in the family, particularly for same 

sex siblings.23 

19 
spell 

thoughts and 

alcoholism 

20 
What 

You Need 

to Say 

it out 

 feelings 

21 
the BodY24 

 

What You Need to SaY 

Alcohol and Underage 

Drinking 

Your children need information to make good decisions. 

Don’t wait until a problem arises to talk to them about 

drinking alcohol. Be sure to tell your child: 

> A single drink of alcohol can affect you. 

> Alcohol passes through the lining of the stomach into the bloodstream. It irritates the stomach lining, which can make a person 

feel sick. If drinking continues, the person may vomit. 

> Alcohol moves through the bloodstream to every organ in the 

body, including the brain. 

> Once alcohol enters the brain, it changes the way a person behaves. 

Alcohol can make people do things they do not want to do. 

> As a person drinks more alcohol, the ability to make decisions is 

affected. The drinker also may lose balance and be unable to see 

or speak clearly. The more alcohol a person drinks, the worse the 

effects can be. 

> Alcohol can have lasting effects on the brain, impairing how a 

person learns, thinks, and remembers. 

> Alcohol can kill. When a person drinks too much alcohol in a 

very short period, alcohol poisoning can occur. Breathing gets 

difficult. A person can vomit, pass out, or even die. 

> Some people get addicted to alcohol. They drink more and more 

as they get used to the alcohol. But they can stop and recover. 

22 
PeerS 

the laW 

What You Need to SaY 

> Children often think that other people their age are drinking 

regularly, but most are not.25 

> Alcohol can hurt your child—even if he or she is not the one 

drinking. If your child is around people who are drinking, he or 

she has an increased risk of being seriously injured or affected 

by violence. At the very least, your child may have to deal with 

someone who is sick, out of control, or unable to take care of 

themselves.26 

> As children get older, some of their friends may start drinking, 

and may get into trouble from drinking too much. Tell your child 

that there is help for people who have alcohol problems. It is OK 

to get help. 

> It is illegal for anyone to buy alcohol until 21 years of age. 

> Even one drink can cause a person to fail a breath test. In some 

states, people under age 21 who have been drinking can have 

their driver’s license suspended, be subject to a heavy fine, or 

have their car permanently taken away.27 

23 
 

 

 

 

 

What You Need to SaY 

Your Family Beliefs & 


History Around Alcohol
 

Discuss your personal beliefs with your child. Sharing your 

values and family history around alcohol will create an 

environment of trust and understanding. 

if You driNK 

> Explain your reasons for drinking responsibly and 

in moderation. 

> Tell your children that some people should not drink 

alcoholic beverages at all. These include:28 

• Children and adolescents. 

• Individuals of any age who cannot restrict their drinking 

to moderate levels. This is a special concern for recovering 

alcoholics and people whose family members have 

alcohol problems. 

• Women who are trying to conceive or who are pregnant. 

• People who plan to drive or take part in activities that 


require attention or skill. 


• People using prescription and/or over-the counter 


medications that should not be used in combination 


with alcohol.
 

24
What You Need to SaY 

> Be clear that you do not want your children to drink alcohol 

until they are 21 years old. 

> When they are 21, if they decide to drink, they should do in 

moderation. 

if You doN’t driNK 

> Explain your reasons for not drinking, whether they are 

religious, health related, or due to family history. 

> Encourage your children to talk with you if they have 

questions about why you choose not to drink. 

> Be clear that you do not want them to drink alcohol. 

> Explain that when they are 21, if they should decide to 

drink, they should do so in moderation. 

25
 

 

What You Need to SaY 

Your Family Beliefs & 


History Around Alcohol
 

if You draNK uNderage 

Parents need to think carefully about how to answer their 


children’s questions about their own alcohol use as teens. 


If a parent was an underage drinker, be honest. 


Don’t let your past stop you from conversing with your 


child about underage alcohol use. The value of face-to-face 


discussions with your child cannot be overestimated.
 

Acknowledge that it was risky. Make a distinction between 


adolescent use and adult use and emphasize that we know 


even more now about the risks than ever before.
 

Explain how and why your opinions of underage drinking 


have changed. 


if SoMeoNe iN the faMilY driNKS too Much 

or iS iN recoVerY 

If your family has a history of alcoholism, your children need 

to know that they are at a greater risk for problem drinking. 

> Discuss what drinking responsibly means, and that some 

people are unable to drink alcohol at all without drinking 

to excess. 

26 
 

 

 

What You Need to SaY 

> Explain that alcoholism is a progressive disease that is 

a combination of physical addiction and mental obsession 

with drinking. 

> Communicate the importance of abstaining from alcohol. Tell 

your children that they need to delay drinking for as long as 

possible and recommend that they not drink at all. Explain 

that the older they are before they take a drink, the lower 

the chances that they will have problems with alcohol. 

> Let your children know that drinking under the legal age of 

21 is a major risk for people with a family history of alcohol. 

> Inform them that there are successful treatment options for 

people who drink and develop problems with alcohol, and 

that you support family members who are in recovery. 

27 
 

 

What You Need to SaY 

Your Family Beliefs & 

History Around Alcohol 

helP iS aVailaBle 

>	 SaMhSa National drug information treatment 

and referral hotline 

800-662-helP (4357) • www.findtreatment.samhsa.gov 

Information, support, treatment options, and referrals to local rehab centers 


for any drug or alcohol problem. Operates 24 hours, seven days a week.
 

>	 alateen 

800-344-2666 • al-anon.alateen.org 

Alateen is a recovery program for young people which helps families and friends of 

alcoholics recover from the effects of living with a problem drinker. 

>	 National association for children of alcoholics (Nacoa) 

888-554-coaS • nacoa.org 

NACoA’s mission is to advocate for all children and families affected by alcoholism 

and other drug dependencies. 

28 
What You Need to SaY 

29
 
be consistent
 

get in

30
 
i

What 

You Need 

to Do 

nvolved
 

31 
 

 

 

 

 

 

What You Need to do 

Take Action
 

There are six actions you can take today to help keep your 

child alcohol free. 

talK earlY aNd ofteN With Your child 

> Establish and maintain an open line of communication. 

> Get into the habit of talking with your child every day. This 

will make it easier for you to have conversations about 

serious subjects when necessary. 

get iNVolVed 

> Talking with your child about his or her activities opens up 

an opportunity for you to share your interests and values. 

> Young people are much less likely to have mental health and 

substance abuse problems when they have positive activities 

to do and when caring adults are involved in their lives. 

Be a good role Model 

> Think about what you say and how you act in front of 

your child. Your own actions are the most powerful indicator 

to your children of what is appropriate and acceptable in 

your family. 

> Do not take part in illegal, unhealthy, or dangerous practices 

related to alcohol, tobacco, or drugs or your child may 

believe that these practices are OK no matter what you say. 

32 
 

 

 

 

 

What You Need to do 

Be aware of what is going on in your 

home. Two out of three teens aged 13–18 

said it is easy to get alcohol from their own 

homes without their parents knowing it.29 

teach KidS to chooSe frieNdS WiSelY 

> Teach your child how to form positive relationships. 

> Help your child to understand what qualities to look for 

in a friend. 

MoNitor Your child’S actiVitieS 

> Know where your children are and get acquainted with 

their friends. 

> Limit the amount of time your children spend without 

an adult being present. Unsupervised children have more 

opportunities to experiment with risky behaviors, including 

the use of alcohol, tobacco, and illegal drugs, and they may 

start substance abuse at earlier ages. 

Set ruleS 

> Make clear, sensible rules for your child and enforce them 

with consistency and appropriate consequences. 

> Following these rules can help protect your child’s physical 

safety and mental well-being, which can lower his or her risk 

for substance abuse problems. 

33 
 

 

 

 

What You Need to do 

Set Clear Rules 


About Alcohol
 

Set clear rules about alcohol. 

Be SPecific 

> Tell your children what the law is, what your household 

rules are, and what behavior you expect. For example, 

“Alcohol is for adults. Do not drink alcohol until you 

are 21. Our family follows the law.” 

Be coNSiSteNt 

> Be sure your children understand that the rules are 

maintained at all times, and that the rules hold true 

even at other people’s houses. Follow your own rules. 

Be reaSoNaBle 

> Don’t change the rules in mid-stream or add new 

consequences without talking to your children. Avoid 

unrealistic threats. 

34 
 

 

What You Need to do 

recogNize good BehaVior 

> Always let your children know how pleased you are when 

they respect the rules of the household. 

Put it iNto Practice 

> Write out your most important family rules and post them 

clearly where they are seen often by everyone in the family. 

Then review the rules regularly with your family on your 

child’s birthday or at the beginning of the school year. 

35 
Activities
 

discuss 

write it down 

share 

36 
 

 

 

 

 

actiVitieS 

Play Reporter
 

Use these questions to interview your child and then let your child interview you. 

Let your child’s questions and answers lead you into a longer conversation. 

Remember to change the questions as needed based on your child’s age. 

For example, you might ask a teenager about his or her future goals, but you 

might ask a younger child, “What do you want to be when you grow up? Why?” 

Be sure to practice active listening by showing interest in what your child 

says; this will validate your child’s feelings. If your child says something 

you don’t agree with, respond positively and try to find a constructive answer. 

Make sure your child knows your beliefs. 

SaMPle iNterVieW QueStioNS 

1. What three words would you use to describe yourself? To describe me? 

2. Who are some of your role models? What do you admire about these people? 

3. What scares or concerns you? What makes you happy? 

4. What are your future goals? 

5. How would drinking alcohol get in the way of your future goals? 

6. What would you do if you were offered alcohol at a party? 

7. What would you do if the person responsible for driving you has been 

drinking alcohol? 

8. What would you really like to ask me but are too afraid to talk about? 

37 
 

 

 

actiVitieS 

Think/Say/Feel
 

PareNtS 

Use the enclosed pages to imagine that you are having a dialog 

with your child. This exercise will prepare you to speak openly 

with your child and will help you to anticipate his or her reaction 

to your ideas. Be as realistic as possible. 

> Write down what you would think, say, and feel while having 

a conversation about underage drinking with your child. 

> Now write down what you imagine your child is going to 

think, say and feel. 

> Share your answers with your child. 

Activity Inside Flap4

38 
 

 

 

actiVitieS 

Think/Say/Feel
 

childreN 

Talking with your parents about underage drinking can be 

challenging. This exercise will prepare you to speak openly to 

your mom or dad about underage drinking and will help you to 

anticipate what your parent’s reaction might be. Be as realistic 

as possible. 

> Write down what you would think, say, and feel while having 

a conversation about underage drinking with your parent. 

> Now write down what you imagine your mom or dad is going 

to think, say and feel. 

> Share your answers with your parent. 

3Activity Inside Flap 

39 
 

 

 

actiVitieS 

Family Rules
 

Many families give mixed messages to their children about underage 

drinking. This exercise will help you share your beliefs and family values 

about alcohol use and allow you to create a set of rules. Are there differences 

between your spoken and unspoken rules about underage drinking? Are 

there differences between your perception of these rules and your child’s 

perception? How can you eliminate any inconsistencies? Write out your 

answers to these questions independently and then discuss them together. 

What the PareNt thiNKS: 

Spoken Rule: 

Unspoken Rule: 

What the child thiNKS: 

Spoken Rule: 

Unspoken Rule: 

NoW Write a clear Set of faMilY ruleS aBout alcohol coNSuMPtioN. 

What the law is: 

What our family’s rule is on the use of alcohol: 

What behavior we expect: 

40 
 

 

—

Conclusion
 

By learning more about how underage drinking affects 

a teen’s growing body and brain, family and other 

adults in the community can better help protect youth 

from the dangers of underage drinking. Family and 

caring adults in the community can help teens choose 

not to drink. 

Let your children know how important they are to 

you. Be honest with them about the facts and 

consequences of underage drinking. Your ongoing 

involvement, care, and concern will help your 

children to stay safe. 

Support your children’s future keep them 

alcohol free. 

future 

41 
 

 

 

Resources
 

www.stopalcoholabuse.gov 

A comprehensive portal of Federal 

resources for information on underage 

drinking and ideas for combating this 

issue. People interested in underage 

drinking prevention—including 

parents, educators, community-based 

organizations, and youth—will find a 

wealth of valuable information here. 

stopalcoholabuse.gov is supported by 

the Federal Interagency Coordinating 

Committee on the Prevention of 

Underage Drinking (ICCPUD). 

www.whitehousedrugpolicy.gov 

Substance Abuse and Mental Health 

Human Services Administration 

(SAMHSA) 

Family.samhsa.gov 

A public education Web site, developed 

to support the efforts of parents and 

other caring adults to promote mental 

health and prevent the use of alcohol, 

tobacco, and illegal drugs among 

7– to 18-year-olds. 

SAMHSA’s National Clearinghouse 

for Alcohol and Drug Information 

www.ncadi.samhsa.gov 

NCADI is the Nation’s one-stop resource 

for information about substance abuse 

prevention and addiction treatment. 

The Anti-Drug 

www.theantidrug.com 

TheAntiDrug.com serves as a drug 

prevention information center, and a 

supportive community for parents to 

interact and learn from each other. 

National Institute on Alcohol Abuse 

and Alcoholism 

www.niaaa.nih.gov 

NIAAA provides leadership in the 

national effort to reduce alcohol-related 

problems by conducting and supporting 

research; coordinating and collaborating 

with other research institutes and 

Federal Programs; and translating 

and disseminating research findings 

to health care providers, researchers, 

policymakers, and the public on alcoholrelated issues 

Sites for Kids 

www.freevibe.com 

www.nacoa.org 

www.al-anon.alateen.org 

www.thecoolspot.gov 

42 
 

 

 

 

 

 

 

 

 

 

CITeD SourCeS 

1,2,4,6,7. Pemberton, M. R., Colliver, 

J. D., Robbins, T. M., & Gfroerer, J. C. (2008). 

Underage alcohol use: Findings from the 

2002–2006 National Surveys on Drug Use 

and Health (DHHS Publication No. SMA 

08-4333, Analytic Series A-30). Rockville, MD: 

Substance Abuse and Mental Health Services 

Administration, Office of Applied Studies. 

3. Substance Abuse and Mental Health 

Services Administration, Office of Applied 

Studies. (March 31, 2008). The NSDUH Report: 

Quantity and Frequency of Alcohol Use among 

Underage Drinkers. Rockville, MD. 

5,10,11,15,19. Institute of Medicine National 

Research Council, Reducing Underage 

Drinking A Collective Responsibility, 2003. 

8,9. EIC and NIAAA, Spotlight on ... Underage 

Drinking, No 22. 

12. Hingson, R.; Heeren, T.; and Zakocs, R. Age of 

drinking onset and involvement in physical fights 

after drinking. Pediatrics 108:872–877, 2001. 

13. Cooper, M.L., and Orcutt, H.K. Drinking 

and sexual experience on first dates among 

adolescents. Journal of Abnormal Psychology 

106:191–202, 1997. 

14. Cooper, M.L.; Pierce, R.S.; and Huselid, R.F. 

Substance use and sexual risk taking among 

black adolescents and white adolescents. 

Health Psychology 13:251–262, 1994. 

16. O’Malley PM, Johnston LD, Bachman JG. 

1998. Alcohol use among adolescents. Alcohol 

Health & Research World 22(20):85–93. 

17. Cigarettes, Alcohol, Marijuana: Gateways 

to Illicit Drug Use, Center on Addiction and 

Substance Abuse, Columbia University, 1994. 

18. Centers for Disease Control and Prevention 

[CDC] 2004; Hingson and Kenkel 2004; Levy 

et al. 1999; National Highway Traffic Safety 

Administration [NHTSA] 2003; Smith et al. 1999). 

20. NHTSA, Traffic Safety Facts, 2003. 

21. Hawkins JD, Graham JW, Maguin E, et al. 

1997. Exploring the effects of age of alcohol 

use initiation and psychosocial risk factors on 

subsequent alcohol misuse. Journal of Studies 

on Alcohol 58(3):280–290. 

22. Ibid. 

23. McGue M, Sharma A, Benson P. 1996. 

Parent and sibling influences on adolescent 

alcohol use and misuse: Evidence from a 

U.S. adoption cohort. Journal of Studies on 

Alcohol 57(1):8–18. 

24. DHHS, Too Smart to Start SmartSTATS: 

a Data Book, 2003. 

25, 26, 27. SAMHSA, Tips for Teens: The Truth 

About Alcohol, 2004. 

28. USDA, 

www.nal.usda.gov/fnic/dga/dga95/alcohol.html. 
What you’re...
 

thiNKiNg: 

SaYiNg: 

feeliNg: 
What your child is...
 

thiNKiNg: 

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What you’re...
 

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What your parent is... 

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