Alcoholism Health Article

Alcohol-related problems

In addition to knowledge about the number of adolescents who consume alcoholic beverages, a second area of importance pertains to alcohol-related problems, that is, major social and personal difficulties that may be associated with the use of alcohol. Three major problem areas have been consistently identified among adolescents who drink alcohol. The first area refers to adverse social consequences associated with consuming alcohol and identifies problems in the home, at school, with peers, or with legal authorities. Problems in the home include events such as fighting with parents about drinking or breaking curfew because of drinking. Problems at school include drinking before or during school, or missing school because of drinking. Problems with peers include events such as having a fight with girlfriend or boyfriend about one's drinking. And problems with legal authorities include events such as getting into trouble with the police for fighting or for driving while drinking. Not surprisingly, higher levels of alcohol consumption are associated with higher levels of alcohol problems.

The second alcohol-related problem area refers to dependency symptoms. These symptoms refer to behaviors that we often identify with the progressive disease process of alcoholism: doing things while one is drinking and regretting it the next day, thinking about cutting down on drinking, passing out from drinking, getting drunk several days in a row, drinking alcohol to get rid of a hangover, and drinking to forget one's troubles. These behaviors reflect more serious involvement with alcohol to the point that it may severely impact other aspects of daily functioning, including school performance and social interaction. The persistent manifestation of these behaviors suggests that professional assistance is advisable.

The third alcohol-related problem area refers to escapist drinking coping motives. That is, when some adolescents feel distressed, due, for example, to conflict with parents or peers, or to an upcoming school exam, they may elect to drink alcohol to relieve (i.e., to escape from) stress associated with these events. This is often referred to as "self-medicating" depressed feelings and often creates problems for two reasons. First, the drinking behavior, in and of itself, does not facilitate problem-solving or other positive coping strategies to ameliorate or eliminate the perceived Stressor. Second, if the alcohol consumption is at high levels, it may actually undermine the successful resolution of the conflict by increasing negative mood states and undermining constructive and thoughtful alternatives.

Pharmacologically, alcohol is a central nervous system depressant that is experienced psychologically as a biphasic effect. The initial consumption of alcohol contributes to the suppression, or disinhibition, of some behaviors, and this disinhibition is often experienced positively with regard to mood, that is, it is experienced as the "freeing up" of felt tensions. However, after a period of time (when the alcohol is diluted via metabolic processes), the second phase emerges which consists of a downward spiraling associated with more negative mood states.

Hence, alcohol use may provide temporary relief from the stresses of adolescence, but it does little to resolve Stressors and may, in fact, contribute to dysfunctional (avoidance) coping processes. To the extent that this method of (mal)adaption to stress becomes persistent across situations and time, adolescents are at risk for a range of problematic behaviors, including serious alcohol problems or "full-blown" alcoholism.

The three alcohol-related problem areas of adverse social consequences, dependency symptoms, and escapist drinking coping motives are of importance in signifying current major problems, as well as posing potential serious risk for alcoholism and other problem behaviors among children and adolescents as they develop toward young adulthood. Children and adolescents with persistent and pervasive difficulties in these domains are in need of professional assistance, as these are behaviors that portend more dire consequences.

Higher levels of alcohol use and alcohol-related problems among children and adolescents are also associated with a range of other deleterious behaviors that are hazardous to the health and well-being of youngsters. The three major causes of adolescent mortality—accidents (e.g., automobile, boating), homicide, and suicide—are highly associated with the use of alcohol among adolescents. Almost 9 out of 10 teenage automobile accidents involve the use of alcohol. Higher levels of alcohol and other substance use have been associated with higher levels of adolescent suicidal ideation (i.e., thinking about committing suicide) and suicide attempts, and alcohol has been found in high concentrations among adolescents who have completed suicide. Higher levels of adolescent alcohol use have also been associated with a number of other adverse health-related outcomes, including sexual precocity, teenage pregnancy, sexually transmitted diseases, human immunodeficiency virus (HIV) infection, poor school performance, and school dropout. Alcohol use has often been referred to as the "gateway" substance, preceding the use of marijuana and then other illegal substances (e.g., cocaine, heroin). Thus, heavier alcohol use during adolescence may be symptomatic, or even prognostic, of a range of current and potential future hazardous behaviors among adolescents.

The previous information in this essay has focused on several indicators of alcohol behaviors (e.g., alcohol use, alcohol problems, alcohol expectancies) to address broader societal concerns with child and adolescent alcohol use in the general population. It is important to also recognize that there is a small, but significant, number of adolescents who have quite severe problems with alcohol use and meet clinical criteria for an alcohol disorder. The children and adolescents who meet the clinical criteria for an alcohol disorder typically manifest persistent, high-volume drinking and pervasive adverse social consequences and dependency symptoms. Further, these children typically have a history of childhood behavior problems (e.g., conduct disordered difficulties, attentional deficits), long-term troubled family relations, and a pattern of coexisting substance abuse (e.g., marijuana or cocaine abuse). Prevalence estimates of the number of children and adolescents meeting clinical criteria for an alcohol disorder are not known, though some have speculated that the number may exceed two million.