Underage Drinking – How Teens Can Develop an Alcohol Use Disorder Before Age 21
Underage drinking is one of the key risk factors for developing an alcohol use disorder. Alcohol use disorder is the umbrella term for drinking patterns that include binge drinking, heavy drinking, alcohol abuse and alcoholism.
It is often considered a right of passage; something most teens and young adults under 21 go through. As such, the focus is often on keeping young people safe, whether that be parents hosting a party with alcohol and taking away all car keys or offering to drive, no questions asked. Yet in 2019, “of those who drink underage, 15 percent began using alcohol before they were 13 years old,” and “over 7 million 12-to 20-year-olds reported past month alcohol use,” according to SAMHSA. (Source: SAMHSA March 2021 “FACTS on Underage Drinking,” www.store.SAMHSA.gov, fact sheet PEP21-03-10-008 | Released 2021, accessed 5.28.21.)
Brain Research Sheds Light on Impacts of Underage Drinking
New and/or advances in brain imaging technologies (e.g., fMRI, SPECT, PET) of the past 10 – 15 – 20 years and the resulting research is shedding new light on this issue. Neuroscientists, doctors and other medical professionals are now able to observe how the brain develops and the impact of alcohol (and other drugs — illegal or prescription) on the developing brain.
The image below is a 10-year time-lapse of brain imaging study reprinted with permission from Dr. Paul Thompson of UCLA’s Laboratory of Neuro Imaging.
The above time-lapse study was conducted over 10 years. The darker colors represent brain maturity (brain development). I have added the approximate ages to the original image to give readers an idea of how much change occurs from ages 12 – 20 (it’s now understood it continues developmental changes through age 22 on average for girls/women and 24 on average for boys/men). How these changes are affected and affect underage drinking are described in the remainder of this post.
This image study shows brain development, ages 5 through 20. It’s now understood to continue developing until around age 22 for girls/women and 24 for boys/men. The significant brain changes we see by the darker color changes in the time lapse study above are related to:
- Puberty. Puberty triggers new hormonal and physical changes, as well as new neural networks instinctually wired into the species to encourage the species to take risk and turn to their peers. See video, “Thanks to Puberty, Just Say ‘No’ Can be Difficult for Tweens and Teens‘” for a more full explanation.
- Development of the cerebral cortex (front area) — the “thinking” part of the brain. This involves neural networks wiring within the Cerebral Cortex — the idea of learning calculus vs. memorizing multiplication tables, for example. It also involves neural networks in the Cerebral Cortex wiring to those in other areas of the brain — the idea of controlling emotions, which originate in the Limbic System, with logical thought, which originates in the Cerebral Cortex, for example.
- “Pruning” and “strengthening” of neural networks. Pruning is when neural connections (explained below) that are not used or are redundant fall away (get “pruned”), and those that are used get strengthened, which makes the remaining neural connections more efficient (similar to the way an insulted cable wire works more efficiently than a non-insulated one). This concept is explained in more detail in The Partnership to End Addiction’s website section, Brain Development, Teen Behavior and Preventing Drug Use.
About Neural Connections
The brain controls everything we think, feel, say and do. It does this through an electro-chemical signaling process, which is how neurons in the brain (aka brain cells) “talk” to one another and to and from others via the nervous system. This “talking” is also referred to as neural connections, brain wiring, neural networks and neural circuitry.
Of the approximately 100 billion brain cells we are born with, only a relatively small fraction are ‘wired.’ From birth to around age 25, our brains are ‘wiring’ neural networks like crazy. This image shows the basics the electro-chemical signaling process.
Basic components of the brain’s communication system – neural connections.
Over the course of our lives, we create neural connections (that eventually become brain maps when repeatedly activated) for all the functions our bodies and brains do. In other words, we create neural connections for riding a bike or typing on a computer or talking on the phone or reading a book or running, breathing, reciting multiplication tables, eating, talking with our hands — everything!
There is an expression to describe this process — “neurons that fire together, wire together“ to create “embedded brain maps.” (Norman Doidge, M.D. The Brain That Changes Itself)
How Drinking Changes Neural Connections
Alcoholic beverages contain the chemical, ethyl alcohol. Ethyl alcohol chemicals initially work on the brain’s pleasure/reward neural networks. These pleasure/reward neural networks rely on the neurotransmitter, dopamine, to convert the electrical signal into something that can cross the synapse and bind to receptors. Receptors convert the message back into an electrical signal so the message can be carried along the branchlike extension to the next neuron.
Dopamine is our “feel good” neurotransmitter — without it, we have a hard time feeling pleasure. Thus, when we drink, it’s these neural networks that “tell” the brain that drinking makes us feel good. If we repeatedly drink, we develop a memory of that feeling (thanks to other neural networks), which is why people want to drink, again. Think about it — if there were no feel good feelings from drinking alcohol, we likely wouldn’t drink it.
The Impact of Underage Drinking on the Developing Brain
As you look at the time-lapse image, again, notice how the brain develops from back to front (yellow/green to purple/fuchsia). This means that the portions of the brain that deal with emotion, memory, learning, motivation and judgment are the last to develop and, as such, are the most deeply affected by alcohol (or drug abuse) during ages 12 through 20, often through age 25.
For example, if a young person repeatedly abuses alcohol (or drugs), the neural connections associated with memories and experiences related to alcohol abuse are the ones that are strengthened and thus embedded. By the same token, neural connections damaged by or not used because of alcohol abuse (those related to learning or judgment, for example) are pruned or not strengthened (pruned does not mean death, it means missed neural connection opportunities).
Understanding the impact of alcohol on the brain — especially during its critical developmental stage of ages 12 through 20 and beyond — is shedding new light on the issue of underage drinking.
For a short video on this, check out BrainFacts.org’s “The Workings of the Adolescent Brain,” which provides overview of brain development during the first 2.5 decades and why substance use during that time is such a problem.
For a More Complete Summary
…of the brain, check out this PDF Chapter excerpt, “Basic Brain Facts.” from my latest book. And for a greater understanding of how a person develops an alcohol use disorder – especially during adolescence or young adulthood – check out my latest book, 10th Anniversary Edition If You Loved Me, You’d Stop!
And as always, if you have further questions, feel free to contact me at lisaf@breakingthecycles.com to schedule a phone call. There is no charge.
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Note: This post originally appeared under this title on May 28, 2009. It was revised October 14, 2009, March 4, 2011, May 30, 2013 and May 28, 2021.
Lisa Frederiksen
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