When Teen Drinking Becomes a Disorder

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It’s a pretty safe bet that most of our children, in high school and in college, will be in social situations in which people drink in unwise and sometimes downright dangerous ways.

Even if they don’t drink, they will at least be exposed to friends and classmates and roommates who do.

What makes alcohol more problematic for some kids — and some adults? There’s been a good deal of research on the development of what is now called alcohol use disorder, and its precursors — what do we now understand, and can that understanding help us as parents to worry less, or at least, to direct our worries in the right directions?

Frances Wang, a postdoctoral scholar at the University of Pittsburgh who studies genetic and environmental causes of alcohol use disorders, said that often people blame only the home environment — that is to say, the parenting. But there are genetic risk factors that seem to be common across a number of disorders, she said, including alcohol use disorder, but also depression and conduct problems, like aggression and antisocial behavior, which can be predecessors of alcohol problems.

Dr. Wang was the first author on a study published in 2018 in the journal Development and Psychopathology, which looks at a particular biological attribute — the functioning of serotonin, a neurotransmitter — determined by a combination of genetic factors. Investigating these common genetic risk factors might help us understand the connections. But bear in mind that there are no simple cause-and-effect stories here.

And while there may be times when the home environment really is the driving force, Dr. Wang said, “for most people it’s the interaction between already having that genetic risk and an environment that increases genetic risk or makes genetic risk come out.”

In this research, Dr. Wang and her colleagues looked to see if the serotonin functioning was tied to self-regulation, but did not find that self-regulation was the common trait connecting these different disorders. They did find — as earlier studies have suggested — that genetic risk of poor serotonin function predicted depression and aggression or antisociality, and that the conduct issues in turn predicted alcohol use.

In another study they found that the serotonin function may be related to a tendency to become impulsive in the face of negative emotion, a trait called negative urgency. It may be, Dr. Wang said, that a common underlying issue for many of these kids is this negative urgency, which manifests itself differently in a young child and in an adolescent. Again, there are no simple cause-and-effect stories here; these are complex patterns of heredity and environment.

Another study, published in 2018 in the Journal of Research on Adolescence, examined social influences on adolescent alcohol use. Rose Wesche, an assistant professor in the department of human development and family science at Virginia Tech, who was the first author on the study, said that alcohol use in adolescence and young adulthood, although it can be very risky, is also “very normative — which points to how difficult it is to prevent it if you are a parent, despite your best intentions and best efforts.”

In the 2018 study, she and her colleagues looked at how the frequency of adolescent drunkenness changed as a function of the frequency of peer drunkenness, in a sample of 1,439 adolescents. They found that the adolescents reported being drunk more frequently when their friends, and their romantic partners’ friends, were drunk more frequently.

Adolescents also reported getting drunk more often when their romantic partners had more positive attitudes toward alcohol. And the researchers found an association between more frequent drunkenness and “unstructured socializing,” that is, hanging out without adult supervision, an association that was stronger as the adolescents got older.

“Peers’ attitude and behavior matters,” Dr. Wesche said. “The social contexts of our lives can create opportunities for alcohol use.”

When we say that peers have important influences on adolescent decision making, we are not necessarily talking about what parents tend to think of as peer pressure. “Peers, friends and romantic partners — those people become much more influential on our behavior during adolescence,” Dr. Wesche said. “People discuss peer pressure, but it goes beyond peer pressure — it can be just the perception that a peer is watching you.” Recent neurodevelopmental thinking about the adolescent brain incorporates the idea that adolescent risk-taking is particularly tied to peer influences.

Adolescent drinking is also related to what kids believe about how much their peers are drinking (studies show they tend to overestimate it, and that interventions to correct those assumptions can help moderate college student drinking) and what they believe about alcohol and its effects.

[If you need help finding resources for yourself or someone else, try the National Institute on Alcohol Abuse and Alcoholism’s Treatment Navigator.]

So if you are a parent, you need to keep talking, asking questions, providing information, letting your kids know what your standards and your values are. First of all, of course, you make sure you are drumming in the message about drinking and driving: don’t ever get in a car with a driver who may have been drinking (or doing anything else that may impair driving skills); make sure there’s always a safe alternative, whether it be calling a ride-share service or calling home, and make sure it’s clear that there will never be disciplinary consequences.

Use that conversation as you use other possible opportunities to keep talking about this subject, about what their peers are doing, about what they themselves think and believe and feel. “You want to have a relationship where they can talk to you about what they’re doing,” Dr. Wesche said, “so if they’re getting into behaviors you don’t want, you can intervene.”

Of course, intervening isn’t always easy. And it’s one thing to say, promote the healthy friendships, discourage the ones that seem to be pulling your child in more problematic directions, but we all know that except perhaps in extreme circumstances, this is highly problematic for most parents.

So yes, there is such a thing as genetic risk, and your family history matters. And yes, the peer group is extremely important in adolescence, and your friends and romantic partners and their attitudes and practices around alcohol matter. And yes, the home environment matters.

“I think we know that there are internal, social and environmental reasons why some adolescents are more vulnerable to excessive alcohol use and risky alcohol use,” Dr. Wesche said. “Everything from your genes to your relationships with parents and peers to things in your environment like the availability of alcohol.”

“Just because you have these risk factors does not mean that you are going to become an alcoholic,” Dr. Wang said. But knowing about some of the risk factors may help with prevention; adolescents should get the help they need when they are struggling. “If kids are showing conduct problems and/or depression, we know there are treatments available to help kids alleviate the distress in their own lives,” which in turn may help to prevent problems further ahead. “Adolescence is a pretty critical period for helping kids achieve well-being,” she said.