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Who Is at Risk?

Researchers estimate that people who begin drinking before the age of 15 are four times more likely to develop an serious alcohol problem later in life than those who wait until they are 21. 5 Less well understood, however, is the issue of who will develop an alcohol problem while they are still in adolescence, although scientists have identified several risk factors.

Many young people with alcohol problems also have a mental health, or co-occurring, disorder. According to the American Academy of Pediatrics, estimates range from 41 to 65 percent.6 As a result, these young people are at especially high risk for two of the most serious problems associated with drinking during adolescence: violence and suicide. 7

Children with conduct disorders — also known as antisocial disorders and characterized by rule-breaking behavior and a disregard for the rights of others — are at extremely high risk for developing an serious alcohol problem during adolescence. Thrill-seeking is common among children with conduct disorder and may explain why they begin drinking at an early age. Researchers also believe that alcohol's role in loosening inhibitions may encourage such adolescents to "act out" and get them in more serious trouble because of their drinking. Other researchers suggest serious alcohol problems and conduct disorders co-occur because of shared risk factors, not because one influences the other.8

Depression and post-traumatic stress disorder — also known as negative-affect disorders — are also common among adolescents with serious alcohol problems, especially young women. Researchers believe that both of these conditions often occur as a result of physical or sexual abuse during childhood and that young people who have been (or are being) victimized drink to self-medicate.9 As with conduct disorders, however, exactly how one influences the other isn't known. Because alcohol is a depressant, its use can contribute to depression. Studies also have shown drinking can increase the likelihood of sexual victimization that, in turn, can lead to a negative-affect disorder.

Other Characteristics Linked to Alcohol Problems

The link between attention deficit/hyperactivity disorder (ADHD) and adolescent alcohol problems has not been as strongly established. Recent research, however, suggests that children who are diagnosed with severe inattention problems also face an increased risk for drug use disorders during their teen years.10

Experts have identified a number of other risk factors for serious alcohol problems, most of which have to do with a young person's environment. Young people who have strong relationships with their parents are less likely to have serious alcohol problems than those who don't. Poor parenting skills and parental problems with mental health and alcohol or other drug use are other contributing factors. 11 Unstable living arrangements and the influence of siblings and other family members or friends who may drink heavily and use drugs also can increase the risk.

Just as important as risk factors are protective factors - variables that have been identified by researchers that can be strengthened during treatment to prevent relapse. These include: 12

  • success in school or work
  • friendships with peers who don't drink or use other drugs
  • healthy family relationships
  • involvement in positive recreational activities


5 National Institute on Alcohol Abuse and Alcoholism. 1998 news release.

6 American Academy of Pediatrics. 2001. Improving Substance Abuse Prevention, Assessment, and Treatment Financing for Children and Adolescents. Policy Statement.

7 Physician Leadership for National Drug Policy. 2002.

8 Clark, D.B. and Bukstein, O.G. 1998. Psychopathology in Adolescent Alcohol Abuse and Dependence. National Institute on Alcohol Abuse and Alcoholism. Alcohol Health & Research World (22) 2: 117-121.

9 Clark, D.B. and Bukstein, O.G. 1998.

10 National Institute on Alcohol Abuse and Alcoholism. 2003 news release.

11 Liddle, HA. 2002. The Research Renaissance in Adolescent Substance Abuse Treatment. Connection, a publication of the Academy for Health Services Research and Health Policy.

12 Liddle, H.A. 2002.