Understanding the Risks of Alcohol for Adolescent Girls
This week with Dr. Lisa Rice and Dr. Vince Culotta, I was surprised by how layered our conversation was on alcohol use for moms and daughters. Lisa brought a mom’s dilemma to the group - a mom shared that she was doubting, and maybe a little ashamed, after she and her high-school-aged daughter drank alcohol together on a trip. She asked Lisa if she did the right thing. I realized I needed more information than textbook knowledge and some clinical experience to understand this complex issue for moms and daughters today.
Often, my first step in understanding more is information-gathering. So, in this week’s blog, I’ve summarized three points that stood out to me as I dug into current research on alcohol use in teens1, particularly girls2. I tried connecting the information to real-life moms raising daughters today in each main point.
Here’s what’s ahead. First, I summarized current data on teens who said they had at least one drink in the past month. Second, I expanded on how alcohol affects the teen brain, which Vince referenced in the episode. Third, I highlighted worrying trends in alcohol use among girls and women. Three terms need defining: “binge drinking”, “heavy alcohol use”, and “one drink”. Binge drinking in youth is about three drinks for girls or four drinks for boys in two hours, depending on their age and size. Heavy alcohol use for girls is defined as four or more drinks in a day or eight or more in a week; in boys, it is five or more drinks in a day or 15 or more in a week. One drink is considered a 12-ounce can of beer, a 5-ounce glass of wine, or a 1.5-ounce shot of liquor.
Youth Drinking: The Numbers
Among youth ages 12 to 20, 12.6 million (33.1%) say they have had at least one drink in their lifetime. The survey asked about at least one drink in the past year and month, binge drinking in the past month, and heavy alcohol use in the past month. The number of youth decreased as the time frame decreased and consumption increased. Notably, girls outnumbered boys, which is different than historical trends. Also, there were big differences when looking at the numbers by race and age.
Focusing on the past month only at the time of the survey, 5.6 million youth ages 12 to 20 (14.6%) said they had at least one drink. This was 2.9 million girls (15.6%) and 2.7 million boys (13.7%). Looking at the data by race, this included 3.4 million White youth (17.9%); 223,000 youth of two or more races (16.4%); 1.2 million Hispanic or Latino youth (12.5%); 558,000 Black or African American youth (10.6%); 180,000 Asian youth (7.6%); and 17,000 American Indian or Alaskan Native people (5.8%).
Older youth consume more than younger adolescents. Approximately 1 in 100 youth ages 12-13 reported drinking at least one drink in the past month, compared to approximately 20 in 100 teens ages 16-17. When compared to adults, youth are also more likely to binge drink when they consume alcohol. In the same study, 3.3 million (8.6%) of youth ages 12-20 reported binge drinking in the past month, including 1.7 million girls.
Adolescent Brain + Alcohol
The adolescent brain is wired to explore, take risks, and learn quickly in preparation for independence in adulthood. Some researchers liken the rapid changes happening in the brain at this time to the accelerated growth in the infant brain. Many new neurons develop, making efficient “neural highways” for adaptive thoughts and behaviors, while unnecessary neural pathways die off, called neuroplasticity. At the same time, the prefrontal cortex, the area of the brain that coordinates decision-making, planning, critical thinking, and problem-solving, does not reach full maturity until at least the mid-20s.
Additionally, three processes happen in the brain with alcohol that motivate future drinking. Alcohol activates the brain systems (including opioid receptors) associated with reward and pleasure, producing a pleasurable sensation. It also temporarily diminishes the sensitivity of the stress response system (originating in the amygdala), reducing the release of stress-related neurotransmitters. This gives the sensation of relief from stress or pain. (After this initial response, alcohol triggers processes associated with negative emotional states, which is why exaggerated anxiety and depression come later.) Furthermore, alcohol triggers a neurotransmitter (dopamine) that helps encode cues salient in the moment, such as emotional states, people, places, and things, for powerful memory storage. This contributes to why stopping drinking can be difficult; multiple things cue the positive memories of drinking to motivate further drinking. Taken together, alcohol is twice as rewarding, providing both pleasure and stress relief at the same time, and uniquely effective at coding details of the environment during this state.
Taken together, teen brains are uniquely sensitive to remembering the who, when, where, what, and how of the pleasure-inducing, pain-relieving experience of drinking alcohol without the complete toolkit for sound decision-making. In the podcast episode, this is why Vince and I emphasized delaying alcohol exposure, referencing research that found teens who first consume alcohol after 18 years are statistically no more likely to develop an addiction to alcohol than adults who initially consume after 21 years.
Concerning Trends Among Girls and Women
In recent years, trends in research indicate that girls are more likely to drink alcohol than boys and to drink it more frequently, when the reverse used to be the case. The “why” is not fully understood, so we don’t see girl-specific prevention efforts yet. Researchers are exploring the increase in anxiety and depression in teen girls, so perhaps they are more susceptible to using alcohol as a coping tool. Helping our daughters recognize and effectively manage difficult emotions could help them reduce or avoid drinking as a coping mechanism.
Girls’ bodies are also different from boys’ bodies. At the same weight, a female has less water than a male, so the blood alcohol concentration is higher, increasing the potency of the alcohol’s effects on the brain. In the long run, women also have unique negative consequences of alcohol use. For example, women who have one drink per day are 5%-9% more likely to develop breast cancer compared to women who do not drink alcohol.
What You Can Do
You can be aware of what you and others are modeling for your daughter related to drinking alcohol. Exposure to intoxicated adults, encouraging alcohol use, and telling stories of positive experiences involving alcohol use are all cueing your daughter’s brain for positive associations with alcohol.
You can reduce problems related to drinking alcohol by not making alcohol accessible in your home, facilitating responsible drinking if they choose to do so (such as adult supervision), maintaining communication about everyday life, getting to know your daughter’s friends, and promoting fun activities that do not involve alcohol.
Listen to Episode 016: Drinking With Your Daughter? to hear how Lisa, Vince, and I started to unpack the complex issues in moms and teen daughters drinking together.
All the information summarized here is publicly available from the 1National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the 2Subtance Abuse and Mental Health Services Administration (SAMHSA). Statistics come from the 2023 National Survey on Drug Use and Health (NSDUH), a civilian, non-hospitalized sample of 67,679 people 12 and older from all 50 states and Washington, DC. This large, diverse sample means that results are representative of the U.S. population.
