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How do you get a teenager to care about the damage alcohol might do to her body when the part of the brain responsible for this kind of thinking hasn’t developed yet?
That’s a tough one, as experts on the human brain and behavior have known for years. The prefrontal cortex, which helps us make rational choices, is the last part of the brain to develop, around age 25.
The second-to-last section to develop? The limbic system, the one that directs a teenager’s decision-making processes — the one that’s more involved in controlling emotions, being impulsive, being irrational.
“Put alcohol use in context with adolescence,” said Aaron White, senior scientific adviser to the director at the National Institute on Alcohol Abuse and Alcoholism. “Teenagers are supposed “to push away [authority] and explore.”
Plus, White said, “Alcohol dampens stress and anxiety.” If the brain finds something it likes, it will want to repeat it, he said. Substance use “taps into our natural reinforcement systems, especially when we are young.”
But binge drinking, especially, can have permanent effects, research is showing: brain deterioration and issues with memory, motor skills and problem-solving skills, even increased anxiety issues in adulthood.
And there is unsettling evidence that, for some preteens and teens, binge drinking is not just a once-in-a-while thing.
Findings from the Substance Abuse and Mental Health Services Administration’s annual National Survey on Drug Use and Health show some scary statistics. The survey respondents are among about 70,000 people ages 12 and up randomly selected each year who answer questions related to use of tobacco, alcohol, illicit drugs (including non-medical use of prescription drugs) and mental health. The data is then extrapolated to represent the U.S. population.
In 2016, the survey showed 26,000 12- and 13-year-olds said they had drunk at least four alcoholic drinks over a two-hour period at least once in the previous month. In 2017, 51,000 12- and 13-year-olds admitted the same behavior, a nearly 100% increase. In 2018, it was the 14- and 15-year-olds who said they were bingeing more, up to 212,7000 from 209,0000 the previous year.
The survey data also showed increased cases of depression among young people who sought mental health services, and those patients’ accompanying suicidal thoughts fueled by alcohol or another substance.
(In adults, bingeing means becoming legally drunk in two hours. How many drinks that requires depends on body weight, so a lot of alcohol in a short period can hit kids hard. The Centers for Disease Control and Prevention says both 13-year-old boys and girls in the 50th percentile for weight are about 100 pounds. The average adult male over 20 weighs almost 100 pounds more; the average adult woman over 20, about 70 pounds more, the CDC says.)
Knowing your Blood Alcohol Content (BAC)
Understanding BAC is key to understanding how alcohol affects your body and the serious danger zones of alcohol poisoning. BAC measures the ratio of alcohol in the blood. So, a BAC of .10 means one part alcohol for every 1000 parts of blood.
To calculate your BAC, select the appropriate chart–for males or for females–then find the row with your approximate weight. Then select the number of drinks consumed. This BAC figure would result if the total number of drinks were consumed in one hour. The Time Factor table can be used to calculate BAC over more than one hour.
BAC Chart for Men
BAC Chart for Women
‘I was so depressed, I really didn’t care’
Damaging her brain? When Maria DeCesare was drinking shots of cheap vodka in her bedroom closet before high school, that wasn’t what she was thinking about.
“I knew the damage was a possibility,” said DeCesare, now 19, a freshman majoring in biophysics at Augsburg University, a small private school in Minneapolis. “In all honesty, I was so depressed, I really didn’t care.”
What she cared about was eliminating the pain she had lived with since early grade school. Her mother, a recovering alcoholic, wasn’t able to be there for her. “If I went to her with a problem, she couldn’t [respond].”
So DeCesare tried self-comfort: “I sucked my thumb until I was 10. My one thumb is smaller than the other.”
And cognitive therapy. “It didn’t click.”
She drank bourbon with friends at 16, gulping while they sipped. The bourbon gave her what the other things couldn’t — a way to escape. So she started drinking on a more regular basis. But after her grandmother died suddenly, DeCesare’s bedroom closet became her private bar. She’d drink, and then she would drive herself to school. She either got the alcohol from an older ex-coworker, bought the liquor herself or stole from her boyfriend.
She said her mother caught her in the closet three months into her nearly-every-morning routine. Her parents sent her for treatment at a Hazelden Betty Ford addiction center in suburban Minneapolis, but she relapsed after nine months.
“I was an outpatient … and I went back to the same lifestyle. I tried to live normally,” but she began smoking highly-concentrated marijuana. Eventually, she got sober. She has stayed sober for more than a year now.
How would DeCesare convince a young person not to drink?
“The best way is from a loving standpoint: ‘If you want to feel better, this is not going to help you. It might for a short time, but you will always sober up, and always feel worse than before you took the drink.’”
Kids, surviving in a kids’ world
Young people need to see who is looking out for them, several experts in the field say, from municipalities raising taxes on liquor and instituting zoning that prohibits liquor stores in child-friendly areas, to liquor advertisers exercising restraint on billboards and social media.
David Jernigan, a professor at Boston University who studies the influences of alcohol advertising and its promotion on young people, cited Philadelphia’s ban on advertising in bus shelters and New York City’s ban of it on most city property.
“Kids drink the way they drink because they can,” said Jernigan. “We need to think about the environments we put them in. Yes, there are recovery houses, but what about the liquor stores surrounding them?”
There is a segment of the wine industry, he said, making a concerted effort to reach out to young women. “Drinking has become normalized as a stress release, and kids are influenced by the adult world.”
But they must survive in their own world.
Data from the 2018 National Survey on Drug Use and Health showed an increase in parents and family members buying alcohol for adolescents. For example, parents of 15- to-17-year-olds said that in 2017 they furnished alcohol for 4,000 youngsters; that number increased to 7,000 the following year. Family members chipped in as well: 22,000 in 2017; 32,000 in 2018, according to the surveys’ findings.
“They don’t buy it by themselves,” said Gene-Jack Wang, a physician-researcher with the National Institute of Alcohol Abuse and Alcoholism.
How do you keep children from drinking in their teens? Lay the groundwork much earlier.
Start at 2 years old, said White, from the National Institute on Alcohol Abuse and Alcoholism. Teach them how important their brains are, that they don’t want to hurt their heads.
Joseph Lee, medical director of Hazelden Betty Ford’s Youth Services, said first grade is probably early enough.
“You aren’t talking about the dangers of alcohol,” Lee said — what needs to be discussed, emphasized and reinforced are friendships. How to make friends; anxiety and how to manage it; and empathy and how to develop it.
“[Empathy] can’t come on its own … If you don’t think you are the same as others, how can you walk in their shoes?” Lee said.
Social media shows young people very quickly that being able to cope is an important skill.
“They need to prove that they are relevant,” said Charles Mendez, founder of the Tampa, Florida-based Mendez Foundation. Its educational program for elementary and middle schools, “Too Good for Drugs,” is used in about 3,000 school districts in 48 states and is designed to help youngsters avoid alcohol and drugs. At its core, the program reminds children who they are and teaches them to reject what they don’t want and to seek out those who have the same values.
Foundation staff members visit schools in the Tampa area to interview kids and find out what is going on in their lives. With regard to alcohol and drugs, Mendez said, “When I talk to teens, they are direct, [they say], ‘It’s part of our lives, we have to deal with it.’”
Families and drinking
Lee, of Hazelden Betty Ford Youth Services, worries about the kids who come from homes where heavy drinking is a constant, curfews don’t exist, imbibing starts early and risk-taking is routine. If family members drink heavily, pay attention to the kids — they take risks, he said.
“They see the upside but not the downside. The highest-risk kids have behavioral attitudinal trends that you can identify,” Lee said.
Family psychologist and WHYY contributor Dan Gottlieb said every member of a child’s family has to buy into the child’s welfare. Kids must “feel felt,” he said.
Jernigan, of Boston University, said there are about 106,000 drinking deaths in the United States each year. Of those, about 4,350 involve people under 21. “It is under-recognized,” he said.
Convincing teens that drinking is harmful “is what I struggled with” as a predoctoral fellow,” said Christopher Cutter, an assistant professor at Yale School of Medicine and chief of adolescent psychology at Turnbridge, and addiction treatment center. He added that he sees quite a few detached parents and depressed kids coming into Turnbridge.
In families that drink, the experts noted, it’s more difficult to say to a teen, “Don’t follow in your father’s footsteps.” Detached parents and kids left on their own are high-risk factors for dangerous drinking — multiple episodes of binge drinking in one month’s time.
“If we aren’t convincing them, we have to engage them in protective factors,” Cutter said. “It’s the long game. Can we keep them engaged in therapy? Before it’s too late?”
In 2006, National Institute of Alcohol Abuse and Alcoholism physician-researcher Gene-Jack Wang and his colleagues did a small study on the children of alcoholics. The aim: to take a look at brain function, specifically dopamine receptors, using positron emission tomography (PET).
PET scans allow a look at tissue and organ function. Dopamine is a chemical that’s vital for sending signals in the brain and is involved in regulating pleasure and reward.
The people in the study were given a personality questionnaire to answer. Wang and his colleagues found that the children of alcoholics who had not become drinkers themselves had more dopamine receptors — their brains were protecting them.
The researchers didn’t see that coming.
“Their brain adapted,” he said, “… If you are born with [the genetic disposition to drink], you aren’t doomed.”
This article has been updated to correct the figures for drinking deaths in the United States.