Alcohol Use - Youth in United States

United States

Alcohol is the most commonly used substance among high school students in the United States. In 2024, there were an estimated 42,300 alcohol-related emergency department visits among children under age 18. Each year, approximately 4,000 youth under 21 die from excessive drinking in the U.S. 

Other adverse outcomes associated with underage drinking include:

• Academic issues, such as increased absences and lower grades.
• Legal consequences of actions taken while under the influence.
• Higher risk of developing alcohol use disorder later in life.
• Delayed puberty.
• Depression, anxiety and other mental illnesses.
• Impaired judgment, which can lead to engaging in risky behaviors like violence, driving under the influence and unsafe sexual behavior.

Adolescence is a high-risk period for binge drinking. Most alcohol consumption among underage drinkers occurs in binge episodes, where underage drinkers consume an average of four to five drinks per drinking episode. Binge drinking is more likely to lead to alcohol poisoning and fatal accidents. It has been linked to decreased cognitive functioning in adolescents during a critical, vulnerable period of neurodevelopment. Underage binge drinking also increases the risk of physical and sexual assault.

The economic burden of underage drinking in the U.S. totaled $56.9 billion in 2013, including direct and indirect costs.

The prevalence of alcohol use is higher among:

• Girls compared with boys.
• White, multiracial and Hispanic youth compared with Black or Asian youth.
• Lesbian, gay, bisexual, transgender, questioning, or another nonheterosexual identity (LGBTQ+) than cisgender and heterosexual students.
• Youth ages 16-17 compared with those ages 12-13.

Strategies to prevent underage alcohol use include:

• Increasing alcohol taxes.
• Regulating and restricting the number and concentration of alcohol stores. 
• Enforcing the law against selling alcohol to youth.
• Reducing exposure to alcohol advertising.
• Implementing dram shop liability laws, which hold liquor establishments legally responsible for harm caused by or to minors to whom they have sold alcohol.
• Screening for alcohol use by health practitioners.

According to survey data, 50% of adolescents identified parents as the leading influence on their decision to drink or not. Evidence indicates that parental discussion regarding alcohol risks, modeling moderate alcohol use, and setting clear boundaries regarding alcohol use are recommended prevention strategies. The Substance Abuse and Mental Health Services Administration’s (SAMHSA) “Talk. They Hear You." campaign provides more resources and information to help parents, teachers and community members have conversations about and take action against underage drinking. Additionally, SAMHSA maintains updated, evidence-based community strategies and annual surveillance reports to prevent youth alcohol use. The Community Guide also maintains a list of evidence-based strategies to prevent and reduce excessive alcohol use among youth. 

Healthy People 2030 has a goal to reduce the percentage of adolescents ages 12-17 who reported drinking alcohol in the past month.

Chung, Tammy, Kasey G. Creswell, Rachel Bachrach, Duncan B. Clark, and Christopher S. Martin. “Adolescent Binge Drinking.” Alcohol Research: Current Reviews 39, no. 1 (2018): 5–15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6104966/.

Dees, William L., Jill K. Hiney, and Vinod K. Srivastava. “Alcohol and Puberty: Mechanisms of Delayed Development.” Alcohol Research: Current Reviews 38, no. 2 (2017): 277–82. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513690/.

Hoots, Brooke E., Jingjing Li, Marci Feldman Hertz, Marissa B. Esser, Adriana Rico, Evelyn Y. Zavala, and Christopher M. Jones. “Alcohol and Other Substance Use Before and During the COVID-19 Pandemic Among High School Students — Youth Risk Behavior Survey, United States, 2021.” MMWR Supplements 72, no. 1 (April 28, 2023): 84–92. https://doi.org/10.15585/mmwr.su7201a10.

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Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network (DAWN): National Estimates From Drug-Related Emergency Department Visits, 2024. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Administration, Center for Behavioral Health Statistics and Quality, 2025. https://www.samhsa.gov/data/sites/default/files/reports/rpt56252/dawn-national-estimates-2024.pdf.