Alcoholism Health Article

Risk factors (predictors) of alcohol use and abuse

As the preceding sections have demonstrated, alcohol-related behaviors among children and adolescents occur at a relatively high frequency and can contribute to a host of quite serious health-related outcomes. Given this descriptive information on patterns of alcohol use and the number alcohol-related problems, much attention has been directed toward an understanding of what factors predict alcohol use among children and adolescents. Factors that increase the expectation (or probability) that children or adolescents will use or abuse alcohol are referred to as risk factors. Risk factors have been categorized into several useful groups and examples from each of these groups is presented subsequently.

Some societal-community factors have been identified as increasing risk for adolescent alcohol use and abuse. For instance, youthful drinking behavior may be fostered via media sources (e.g., television and magazine commercials, movies) and adolescent societal heroes (e.g., athletes, rock stars) that explicitly or implicitly convey the message that alcohol consumption is associated with positively valued characteristics (e.g., popularity with friends). Such societal media images are further fostered by the absence of serious enforcement of established legal standards for underage drinking. Stiff legal penalties for adolescents are often associated with the use, and especially the selling, of substances identified as illegal for adult use (e.g., marijuana, cocaine). Nonetheless, alcohol (which is a legal substance for adults but illegal for adolescents) use by teenagers is not likely to meet with legal enforcement unless there are extenuating circumstances such as a DWI or automobile crash. The absence of legal enforcement of underage drinking may contribute to an atmosphere of implicit tolerance of alcohol use by adolescents. An additional community level factor associated with risk for adolescent drinking is the relative ease of availability of alcoholic beverages. Easy access may occur within the home (e.g., a fully stocked liquor cabinet, refrigerator, or basement supply), or via liquor outlets where minors may either be directly served, or easily request others (e.g., siblings) to purchase alcoholic beverages.

Several aspects of school functioning have also been associated with increased risk for adolescent drinking. Early onset, persistent behavior problems including attentional problems, high activity levels, and aggression within the school context have been consistent predictors of high levels of teenage alcohol use. Similar findings have been reported for a low commitment to school achievement and career expectations by adolescents; children and adolescents who do not believe that their educational and career futures are bright tend to associate more with deviant peers and to consume more alcohol. Finally, academic failure (e.g., poor attendance, poor grades, underachievement) is associated with increased risk for heavier alcohol use.

Family factors associated with increased risk for adolescent alcohol use include the drinking practices of other family members (e.g., parents, or sibs' drinking practices), marital conflict, poor family management practices (e.g., failure to monitor children as to where they are, who they are with, etc.), harsh (physically abusive) discipline, physical or sexual abuse, and the lack of a warm, open, nurturing relationship with parents. In brief, highly troubled family relations serve as a spring-board for children and adolescents to engage in higher levels of alcohol use and other problem behaviors (e.g., delinquency). Without the emotional warmth and guidance provided by parents and other family members, adolescents from highly troubled families often seek some level of comfort and support with other, often deviant prone, adolescents who are also from troubled family backgrounds. This process of selective association among teenagers from troubled families often results in a progression toward higher levels of alcohol use and other deviant behaviors by these adolescents.

Peer factors are perhaps the single most highly associated risk factor for adolescent alcohol use. Peer selection processes are not random, but rather reflect a tendency for adolescents to select friends and peers according to similarities regarding attitudes, values, and behaviors. Peer groups are frequently identifiable contingent on the shared orientation of constituent members. Thus, peer groups of athletes are often referred to as "jocks" and those peer groups engaged in alcohol and drug use as "heads." The friend and peer context is especially important during adolescence to foster a personal identity or sense of self, and to learn behaviors (e.g., prosocial skills) that are important in young adulthood. The engagement by some adolescents in deviant peer networks may undermine important prosocial skill training and contribute to an alienated sense of self, as well as foster more serious involvement in alcohol use and other deviant behaviors.

Several individual factors have also been identified as increasing risk for adolescent drinking behavior. Research on children of alcoholics (COAs) has consistently supported a genetic susceptibility to alcohol among the offspring of alcoholics. COA boys are at four times the risk of an alcohol disorder in adulthood than boys of non-COAs. COAs are also more likely to experience a disrupted family environment and to have more internalizing problems (e.g., depression, anxiety) and externalizing problems (e.g., aggression, truancy), and to perform more poorly in school. The personality factors of alienation and rebelliousness have also been associated with higher levels of alcohol use. These personality factors are reflected in adolescents being psychologically removed from the normative attitudes and values of society, and not embracing societal values such as educational achievement or law abidance. Poor problem-solving coping skills have also been associated with increases in adolescent alcohol use. Skill deficits in the coping domain may contribute to the adoption of escapist drinking coping motives, or to strategies (e.g., interpersonal aggression) that may foster negative outcomes.

The National Institute on Alcohol Abuse and Alcoholism estimates that 6.6 million children under age 18 live in households with at least one alcoholic parent.

These risk factors for adolescent drinking behavior do not occur in a vacuum, but are often highly interrelated. That is, often adolescents may be at risk not simply because of one factor, but due to the co-occurrence of several of these factors. The engagement by adolescents in consuming alcohol may also maintain or increase the level of risk associated with these factors (e.g., increase academic failure) and contribute to a negative spiraling process toward more serious alcohol problems and alcoholism.