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The Georgicks of Virgil, with an English Translation and Notes Virgil, John Martyn Ipsi in defossis specubus secura sub alta Otia agunt terra, congestaque robora, Pierius says it is confecto in the Roman manuscript. And Tacitus also says the Germans used to make caves to defend them from the severity of winter, .

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This study contributes important information for developing alcohol-relevant interventions targeting young Pacific New Zealanders. The study explored the factors that also supported non-binge drinking behaviours and found that modifiable family and community factors were important. This study looked at a particular type of alcohol use called binge drinking 5 or more alcoholic drinks in one session within 4 hours in young Pacific New Zealanders.

Despite being underaged for drinking alcohol, youth have access to alcohol and approximately a third The study compared characteristics that were different between Pacific youth who binge drink and Pacific youth who do not binge drink. Non-binge drinking was more likely in younger students ages 13 , and those students who had strong religious affliations, had a Pacific Island language speaking parent at home, and whose parents monitored their after-school and night-time activities.

Data was available on students of whom Students who were younger and had parental Pacific language use at home were less likely to binge drink than other students. This study indicates the transnational nature of Pacific communities in New Zealand who bring and maintain traditional cultural practices which seem health protective. While participation in sports activities may have health benefits, our findings indicate the need for a more proactive approach on the part of policymakers and the sporting sector to address the associated risk of binge drinking.

Alcohol interventions that de-normalise alcohol overconsumption are warranted for young Pacific New Zealanders. Pacific youth The first national survey of the health and wellbeing of New Zealand youth in , reported that Pacific youth drinking habits were similar to adults, with high proportions of non-drinkers, but also high numbers of youth who were binge drinkers. The participating schools reflected the general characteristics of secondary schools in New Zealand. On the day of the survey, students were asked to come to a designated room.

Upon arrival students were given an anonymous login code to access the survey. The survey included a item multimedia questionnaire administered on a Nokia internet tablet and identification of their census meshblock number based on their residential address to determine the extent of their neighbourhood deprivation. The multimedia nature of the questionnaire meant that all students could read each question and fixed-response options themselves, while listening to the questions and responses being read aloud through headphones.

School principals consented to participation in the survey on behalf of the Boards of Trustees. Students and their parents were provided with information sheets about the survey. Students consented themselves to participate in the study on the day of the survey.

9.2.1 Issues

A more detailed description of the research methodology can be obtained elsewhere. Ethnicity was recorded using New Zealand Census ethnicity question whereby participants select all of the ethnic groups that they identified with from one of 5 major ethnic groups using Statistics New Zealand Ethnic prioritisation method.

Of the Pacific students in the sample, First, students were asked if they had ever drunk alcohol not counting a few sips and continued to drink alcohol by asking the frequency of alcohol consumption in the last 4 weeks. Those who reported drinking 5 or more alcohol drinks in one session at least once in the last 4 weeks were classed as binge drinkers. Chi square tests were used to test for differences between those who reported binge drinking and those who did not.

Chi-square tests were used to investigate the univariate associations between binge drinking and hypothesised demographic, cultural, home and environment factors. Using factors that reached a significance level of 0. All analyses were conducted using the survey procedures in the SAS software v9. Results Information on binge drinking was available for Table 1.

The association of binge drinking with key demographic variables amongst Pacific students Variables. Gender Males Females. Age 13 14 15 16 NZDep low medium high. Table 2. Socioeconomic status SES. Times moved home in the last 12 months. None Once or more. Other rooms used as bedrooms. No Yes. Cultural factors. Parents speak a Pacific language.

Reducing Underage and Young Adult Drinking

How well Students can speak a Pacific language. How well Students can understand a spoken Pacific language. Importance of being recognized as Pacific. Comfortable in Pacific events or gatherings. Attend a place of worship at least once a week. Home and environment factors. Number of parental figures at home. Number of secondary schools attended. Students feeling safe in their neighbourhoods. Table 3. Logistic regression model examining the effect of selected demographics and cultural, home and environment factors on the risk of binge drinking alcohol among Pacific adolescents in New Zealand.

P - value. Gender reference Male. Age reference 17 years. Alternatives used as bedrooms vs no alternative rooms used. Medium vs high deprivation. Parents use of Pacific language vs not being able to speak language. Parents knowing student whereabouts afterschool vs not knowing.

Parents knowing student whereabouts at night vs not knowing. Participating in sports teams or clubs outside of school time vs not participating. Summary This study looked at a particular type of alcohol use called binge drinking 5 or more alcoholic drinks in one session within 4 hours in young Pacific New Zealanders.

Results Data was available on students of whom Conclusion This study indicates the transnational nature of Pacific communities in New Zealand who bring and maintain traditional cultural practices which seem health protective. The opinions and recommendations expressed are those of the authors and do not necessarily reflect the views of study funders.

Correspondence Email t. References Ministry of Health.

New Zealand Child Health Strategy. Wellington: Ministry of Health, Ministry of Health. Am J Public Health ;95 5 Alcohol and injury among attendees at a New Zealand emergency department. New Zealand Medical Journal ; Binge Drinking and Violence. The burden of death, disease and disability due to alcohol in New Zealand. Alcohol-related harm to others: a survey of physical and sexual assault in New Zealand.

Pediatrics ; 1 Alcohol Use Among Adolescents. Auckland: ALAC, Cagney P, Alliston L. Pearls unlimited: Pacific Peoples and alcohol. Gray JL, Nosa V. In summary, extant epidemiologic data indicate that the prevalence of alcohol use begins in early adolescence, steadily increases throughout the high school years, reaches a peak in the mids, and begins to decline thereafter. The findings are consistent across different indicators of drinking e.

These age trends also are evident for AUDs, which peak in late adolescence and early young adulthood. The prevalence data on alcohol use and AUDs clearly illustrate that adolescence and early young adulthood are critical for understanding the occurrence of these conditions. In and of themselves, these findings do not necessarily indicate that alcoholism is a developmental disorder. However, data on age of initiation of alcohol use and its relationship to the subsequent development of alcohol dependence provides a strong indication of the developmental nature of AUDs.

Grant and Dawson reported that people who began drinking before age 15 were four times more likely to subsequently become alcohol dependent than people who did not drink alcohol before age Furthermore, the odds of subsequently developing alcohol dependence were reduced by 14 percent with each increasing year of age at first use. This latter finding is the source of intervention programs targeted at delaying the age of initiation of alcohol use.

The significance of earlier initiation as a risk factor for AUDs, in conjunction with other data based on longitudinal studies, has fostered the notion of the developmental nature of underage and young adult drinking, which has been confirmed by other findings. For example, Greenfield and Rogers reported that adolescents to young adults ages 18—29 were disproportionately represented among the heaviest drinkers. Thus, although this age-group represented only 27 percent of the U.

In an analysis of the commercial value of underage drinking, Foster and colleagues determined that in , the short-term cash value to the alcohol industry from underage drinkers was In a separate study using different data sources, Miller and colleagues estimated that in , underage drinkers accounted for These costs included medical care costs, lost work and other monetary costs, and quality-of-life costs.

Hence, underage and young-adult populations clearly are heavy consumers of alcoholic beverages and result in economic costs that are nearly three times higher than the profits of the alcohol industry. From a public health perspective, it also is important to highlight that the three major causes of death among to year-olds in the United States—unintentional injuries with motor vehicle crashes accounting for the majority of deaths , homicides, and suicides Subramanian —all are associated with alcohol use, especially heavy use.

For example, in , motor vehicle crashes were the leading cause of death among to year-olds. In that same year, a report by the National Highway Traffic Safety Administration Pickrell indicated that among drivers ages 20 years or younger who were involved in fatal traffic crashes, approximately 20 percent had consumed alcohol at the time of the crash. In addition, the median blood alcohol concentration BAC for this age-group ranged from 0.

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Finally, higher levels of alcohol use are associated not only with increased mortality but also with a broad range of other problem behaviors, including cigarette and other drug use, deviant behavior, earlier sexual activity and increased risk for sexually transmitted infections including infection with the human immunodeficiency virus [HIV] , as well as truancy, academic difficulties, and school drop out. These consequences of heavy alcohol use among teenagers and young adults affect not only the drinker but also may adversely impact others via alcohol-related injuries and violence e.

Clearly, the morbidities, mortality, and collateral damage associated with underage and early young adult drinking represent a pervasive public health problem involving the entire population in this age-group. Therefore, appropriate responses also should be targeted at the entire adolescent and young adult population rather than be restricted only to those who meet clinical diagnostic criteria for an AUD. As the findings provided in the previous sections show, drinking behavior and drinking problems change across adolescence and young adulthood, with a clear pattern of age-graded variation.

These differences in course have been demonstrated vividly by Schulenberg and colleagues in their trajectory analysis of a nationally representative sample they had followed through ages 18—22 years. The analysis found that the pattern of binge drinking based on the means of the total sample over the interval does not reflect the pattern for any subset of individuals see figure 6 but is a composite of five starkly different trajectory courses:. Different patterns i. For the studied population as a whole, the overall frequency of binge drinking remained relatively steady at less than one time per 2-week interval.

More detailed analysis, however, identified five subgroups of drinkers that differed in how frequency of binge drinking evolved over time. More recent trajectory studies of this age-group continue to support the validity of these trajectory patterns, although class membership percentages vary somewhat as a function of sample age, number of waves of data available, and trajectory class analytic method Brown et al. It is important to note, however, that this variability is occurring during a developmental period when a great deal of life change is occurring.

This will be discussed further below. A maturational concept of the development of drinking behaviors does not account for these radically different trajectories, nor is it capable of addressing a variety of major public health concerns about drinking in this and younger age-groups, such as the following:. How can we explain the fact that some youth begin drinking in mid-to late adolescence in small amounts at infrequent intervals and without problems, and others begin much earlier, with some drinking at near-alcoholic levels within a short time after they start?

Do factors unrelated to alcohol play any significant role in the development of drinking? To address these questions, researchers have turned to a developmental conceptual model of stability and change that also has served as a powerful guide for investigation in fields as far removed as plant biology, evolutionary biology, and early childhood development. The model emphasizes the importance of studying earlier behaviors and identifying the multilevel processes involved in creating them and the contexts in which they emerge, persist or change, increase or decline Cicchetti ; Masten et al.

Understanding the earlier system of relationships provides clues to continuity, even when no apparent link exists, and discontinuity, even when there appears to be no organismic explanation of it. The developmental framework described above can be used to probe the causes of, and highlight the critical issues associated with, underage and young adult drinking.

This is illustrated here with three examples. One of the major principles of development is that later behavior evolves out of earlier behavior and that the pathway is identifiable, even though the later manifestations may be more differentiated or even changed in structure or appearance i. For example, there is compelling evidence that a developmental connection exists between behavioral undercontrol in early life and problem drinking and AUD outcomes in late adolescence and early adulthood.

In adolescence and young adulthood, one of the most robust correlates of problem alcohol use is behavioral undercontrol Zucker et al. Measures of this construct are subsumed under a number of different labels, such as disinhibition, externalizing behavior, aggressiveness, delinquency, conduct problems, and sensation seeking Brown et al. These measures are positively correlated with one another, tend to operate similarly in their relationships with other variables, and in factor analyses load on the same factor Bogg and Finn, in press; Donovan and Jessor Moreover, longitudinal studies have found that behavioral undercontrol in adolescence is a robust predictor of alcohol problems, AUDs, and other substance use disorders in early adulthood Brown et al.

However, the question is whether this relationship already exists at earlier developmental stages. The evidence for such a connection in fact is quite strong and has been replicated many times. A recent review Zucker identified four longitudinal studies in the general population and two studies with high-risk subjects that found a positive relationship between measures of undercontrol and aggressiveness in early to middle childhood and problem alcohol use in mid-adolescence and severe alcohol problems and AUDs in young adulthood.

Another series of four longitudinal studies Schulenberg and Maggs reported similar relationships. Without the conceptual framework of developmental theory, it is doubtful that this long chain of relationships would have been uncovered. Yet these relationships are highly significant because they indicate that some central etiologic components that contribute to alcohol problems and AUDs are nonspecific to alcohol.

And whatever the underlying predisposition is, it is sufficiently strong to emerge very early in the developmental course. Moreover, the strength of the developmental pathway suggests it should be, to a substantial degree, under genetic control. Home is the primary source of alcohol in childhood and preadolescence Donovan and Molina and one of the primary sources in early adolescence Centers for Substance Abuse Research Similarly, associating with peers who already drink is one of the most important proximal causes of drinking onset and problem use during adolescence Wills and Cleary Differences in level of use in differing contexts, which in turn make alcohol more or less available, are only part of the way that these drinking environments exert their effects.

The presence of alcohol also is a cueing effect, a stimulus for thinking that one could have a drink. Similarly, the fact that someone else already is drinking also acts as a cue because it demonstrates the acceptability of the behavior Bank et al. Lifecycle transitions, such as those occurring during adolescence and young adulthood, also are times of context change, although primarily in relationships and identity rather than in physical contexts.

They are points in the life course where the developmental demand is for changes in age-and gender-specified roles. Some of these changes—such as the onset of puberty and parallel onset of adolescence or the onset of parenthood— primarily are driven by biological events, although they typically also have a strong socially prescribed component. Other context changes, such as moving away to college or starting a full-time job, are dictated more by the role demands of the culture.

Changes in patterns of alcohol use have been linked to all of these context changes. Some of the changes typically involve increases in alcohol use, such as the move away from home Stice et al. Conversely, some changes, such as the onset of parenthood Bachman et al. Thus, these transition times pose a significant challenge to the adolescent or young adult not only with respect to the successful adaptation to new life tasks but also with respect to alcohol use. During transitions to contexts typically associated with increasing alcohol use, the challenge is to resist this demand or at least to moderate it so alcohol use does not become excessive Maggs During transitions where the demand is for decreasing alcohol use, the challenge is to move from a previously unrestrained pattern of use to one of greater restraint.

At the same time, these turning points potentially are useful places for intervention, where a small amount of assistance or guidance can have major impact see Blomberg ; Cunningham et al. One of the most dramatic policy actions of the last generation has been legislation that increased the minimum legal drinking age MLDA from 18 to 21 years.

Recent advocacy efforts to return to an MLDA of 18 years minimum could suggest that the change had been ineffective. However, scientific evidence unequivocally demonstrates that drinking-and-driving crashes and the resulting loss of life among to year-olds have declined as a result of the legislation, even though the size of the effect varies among States Shults et al.

Moreover, the influence of this legislation extends to young adults older than 21 years of age, providing an indication of the long-lasting impact of this change. Recent work also has shown lasting differences in drinking outcomes between those living in the era before the MLDA of 21 years was in effect and those who were exposed to the legislation. Even when in their 40s and 50s, people not exposed to the MLDA legislation had higher rates of both AUDs and other substance use disorders than did people who were affected by the legislation Norberg et al.

Although the effects of changing the MLDA have been studied the longest, analyses of the effects of the more recent policy changes i. All these findings demonstrate that changes in MLDA, lower legal blood alcohol limits, and zero-tolerance laws indeed have had an impact on underage drinking and related problems.

As young people deal with the challenges and opportunities of adolescence and early adulthood, they are exposed to numerous influences that either increase their risk of developing alcohol-related problems and AUDs or reduce that risk. This section highlights some of these risk and protective factors. The inventory of risk factors that increase the likelihood of problem alcohol use in the underage and young adult population is considerable.

A comprehensive review of these factors is beyond the scope of this article for more intensive reviews see Brown et al. Male children of alcoholics COAs are four to nine times more likely to develop alcoholism in adulthood, and female COAs are two to three times more likely than are children without such a family history Russell ; also see figure 3. Approximately 50 percent of that risk is conveyed through genetic factors Dick and Bierut ; McGue There are a number of pathways through which such genetic risk can be transmitted from parent to child, all of which are relevant in the developmental period discussed here i.

Some of the risk is conveyed via direct genetic effect on the offspring—that is, genes responsible for relevant characteristics are passed on from parent to child. The relevant characteristics may include structural and functional differences in brain physiology e. It conveys risk through several pathways:. By leading the youngster into relationships with undercontrolled peers who are more likely to be early and heavier alcohol users;.

By interfering with normal inhibitory mechanisms, thereby allowing alcohol use to continue even when it reaches problem levels; and. By potentially facilitating use even in circumstances that are likely to cause problems e. However, some genetic risk also is conveyed indirectly, through the behavior of alcoholics as parents. Thus, COAs obviously are exposed to greater alcohol consumption in the home, with its attendant context risks of availability and modeling that were described previously.

It is not surprising, therefore, that COAs begin drinking earlier than their non-COA peers, with a small subset beginning even in preadolescence see figure 3. In fact, the greatest differences in prevalence between COAs and non-COAs occur very early, illustrating the effect of some of the family differences described above.

Similarly, COAs are more likely to have been drunk by early adolescence Wong et al. Furthermore, alcoholic homes are more likely to be high in conflict Loukas et al. This difference may be a direct result of parental intoxication or an indirect result of parental conflict over spousal consumption. High levels of conflict, violence, and divorce also are risk factors for earlier use by offspring and more problematic use once drinking has begun. Although the list of apparently consequential risk factors associated with COA status is long, this does not mean that risk automatically is conferred whenever there is a positive history.

Although the relationships between family history and each of these risks are significant, not all alcoholic families share all attributes. Furthermore, some people without a positive family history also may experience early and heavy exposure to alcohol, family conflict, instability, or life stress. Additionally, the genes that put a person at elevated risk are present not only in alcoholic families, and not all risk factors are familial in nature. For example, neighborhood social disorganization is a non—alcohol-specific and nonfamilial factor that has been shown to affect risk development in adolescence and in later adulthood Buu et al.

In recent years, developmental psychopathologists have suggested that a cascade model of risk accumulation may best characterize how this multiplicity of risk factors develops Masten et al. Thus, exposure to a given risk factor at one time period can create elevated risk, whereas exposure to the same factor at another time may have little impact. Furthermore, each step in the cascade of risk increases the predictive value of the preceding step, and moving out of the cascade subsequently decreases prior risk.

A recent cascade analysis by Dodge and colleagues describes the interplay of seven different risk domains involving the child, parents, and peers, in a transactional process over the course of childhood that culminates in substance use onset. The analysis indicated that not only risk accumulation at each new step of the cascade is important but opportunities for risk offset also are critical because they suggest concrete, phase-specific ways in which intervention programs might interrupt what otherwise would be a sequence of risk potentiation or elevation.

A recurring theme of this article is that adolescence is a time of increasing alcohol consumption and that consumption typically peaks during the late adolescent to early adult years. This consumption pattern and the problems associated with excessive alcohol use alone would mark this developmental stage as a period of special risk for adverse consequences.

This risk, however, is further exacerbated by the fact that adolescence also is a time of major changes in brain structure and function. Neural alterations are taking place particularly in brain areas at the front of the brain that are part of executive and reward systems involved in impulse control and emotional regulation.

For example, an area called the dorsolateral prefrontal cortex—which is especially important to decision making and planning—is one of the last brain areas to mature, with structural change continuing through adolescence into early adulthood Gogtay et al. Developmental changes related to increasing the development of myelin sheaths around nerve fibers in the central nervous system i. Findings primarily obtained in animal studies, but to a limited degree also supported by human cross-sectional studies, suggests that high alcohol and other drug consumption during this developmental period may have lasting effects on the maturation of these critical brain areas, inhibiting the development of crucial regulatory and decision-making circuitry Clark et al.

Therefore, it is essential that researchers seek to confirm the findings of animal studies in humans, and indeed much of this work now is in progress. Like risk factors, protective factors can have functional influences at all levels of analysis from the biological to the broader contextual. Furthermore, although perhaps obvious, individuals, circumstances, and contexts associated with no or only low levels of risk by definition also are protective against a problematic outcome. For example, youth with more effective behavioral control capability are less likely to exhibit problem use in adolescence Wong et al.

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Similarly, at the contextual level, social policies e. Even more important, however, are those personal or contextual attributes that can provide active insulation against risk. For instance, positive parenting has been associated with a later onset and lower levels of alcohol use among adolescents Kumpfer and Alvarado Similarly, involvement with low- or nonusing peers, attending a college with no or low levels of alcohol consumption, or living in a dorm committed to nondrinking all have been related to lower levels of use and problem use Wechsler and Nelson Although selection factors are one issue in determining residence i.

Religious involvement is another area where individual choice and context combine to protect against problem alcohol use. Thus, many studies have reported low-order negative relationships between religious involvement and alcohol use, with some of the effect being attributable to the cultivation of self-control and self-regulatory capacities McCullough and Willoughby A few studies have focused on another potentially highly important area—that is, resilience. Resilience is defined as the ability to avoid a pathological outcome, or achieve a successful one, despite the experience of adversity Rutter In theory, biological, psychological, and social characteristics all can contribute to resilience.

Despite the importance of this adaptation, very few studies have investigated this area and followed participants into late adolescence to identify problem outcomes. We are aware of only one study, albeit with a small sample, that has investigated biological factors contributing to resilience using functional magnetic resonance imaging fMRI to assess brain activity Heitzeg et al. The study included COAs ages 16—20 years, who were divided into resilient subjects who had not developed alcohol problems by this time and vulnerable subjects who had developed such problems, as well as non-COA control subjects.

The investigators exposed the participants to emotional stimuli and then measured brain activity in various areas. These analyses detected clear differences between resilient and vulnerable subjects in the activation of various brain areas. In contrast, the vulnerable group displayed a pattern consistent with active suppression of affective responses, suggesting a possible deficit in the ability to engage adaptively with emotional stimuli. Clearly, this work is only a beginning effort at understanding the dynamics of resilient capability. Because of the high rates of alcohol use, binge drinking, and AUDs among underage drinkers and young adults, increasing emphasis has been placed on screening for these difficulties in recent years.

The goals of such screening are both to identify current or potential alcohol use problems and to initiate appropriate referral to prevent and treat these problems. Although the goals of screening appear relatively straightforward, the screening of adolescents and young adults for alcohol and other problem behaviors e. Thus, investigators still need to determine the feasibility of screening for alcohol use in different research settings e.

For instance, primary-care physicians probably would not be receptive to asking a lengthy set of questions during adolescent checkups; likewise, if a screening survey were administered via a computer, the costs for the computer, software, training of participants completing the survey, and analyses of the data collected would have to be considered. These instruments vary in length and have been applied across a variety of adolescent settings.

However, some of the feasibility issues discussed above still remain to be explored further, along with other practical issues e. The health care, educational, and juvenile justice systems in the United States currently are not comprehensively equipped to address the range of adolescent and young adult alcohol use problems. Nevertheless, some recent initial findings from screening and brief intervention studies in hospital emergency rooms Monti et al. The development of successful preventive interventions for underage and early young adult drinking is a challenging task for a variety of reasons, including the multiplicity of risk and protective factors that may vary in their influence across different developmental periods e.

Nevertheless, a broad range of alcohol prevention programs have been developed that target different units or levels of analysis e. For example, some intervention programs are school based and rely on social influences e. Other programs focus on families and rely on strengthening parent—child ties to reduce alcohol use Spoth et al. Still, others are aimed at high-risk youth or focus on social policy interventions e. Because of space constraints, the discussion here only describes some prominent universal preventive intervention programs. Universal programs, which include all individuals in a particular population e.

The most common programs include classroom curricula administered to students within school settings, which may be supplemented with components to change the school-wide climate regarding alcohol use, parent programs, mass media programs, and community-wide interventions.


Accordingly, these programs strive both to help adolescents acquire skills that will enable them to effectively resist social pressures especially peer pressures to use AODs and to promote social attitudes and norms that oppose AOD use. Most AOD prevention curricula for youth are administered during the late elementary and junior high-school years because AOD use often is initiated in this age period.

In a meta-analysis of universal, school-based AOD prevention programs, Tobler and colleagues reported that interactive prevention programs e. Other characteristics of effective programs were a smaller number of participants e. In a major review of extant preventive interventions focused on underage drinking, Spoth and colleagues identified 41 intervention studies that demonstrated some evidence of significant effects, or positive changes, in targeted alcohol use behaviors. Some of the most highly visible universal adolescent alcohol use preventive intervention programs were the community-wide Midwestern Prevention Project Pentz et al.

Although the specific alcohol outcome variables assessed by these programs have differed to some extent e. In addition, for some of these programs there has been evidence of the generalizability of the interventions to different ethnic groups.

Time, please: is drinking becoming as socially unacceptable as smoking? | Society | The Guardian

However, these quite positive and encouraging findings must be tempered by a range of methodological limitations and concerns that have been raised about universal preventive interventions to reduce underage alcohol use. For example, in the review by Spoth and colleagues , only of studies examined provided sufficient data to evaluate the programs, and of these programs, only 41 indicated any evidence of a significant effect. Thus, despite significant advances in the development, implementation, and evaluation of multidomain preventive interventions as well as of policy, legal, and environmentally focused interventions, a number of issues remain to be addressed.

These include additional evaluations of the generalizability of findings to nonwhite populations and of the relative contributions of specific components of multidomain interventions, enhancement of dissemination plans, and quality assurance for the implementation of such evidence-based programs. A review of individual-focused college-based prevention programs from to Larimer and Cronce provided several important conclusions.

Motivational interventions with personalized feedback also yielded positive findings with regard to reductions in alcohol use among college students. Although significant progress has been made in recent years with regard to individual-focused college drinking prevention programs, additional studies are needed with stronger research designs, appropriate control groups, and retention of participants across the course of studies.

In addition to individual-focused college drinking programs, several policy-based prevention activities have been implemented on campuses to reduce alcohol use and associated problems.

9.2 What needs to happen

These include such policies as establishing alcohol-free residences and campuses, prohibiting beer kegs on campus, prohibiting the self-service of alcohol at campus events, and banning the marketing of alcohol on campus. Findings regarding the impact of these policies are limited, although some studies have demonstrated a reduction in binge drinking in AOD-free residences Toomey and Wagenaar Similar to the findings for individual-focused college prevention programs, considerably more research is needed on the impact of university and community policies targeted at reducing alcohol use and alcohol problems among college students.

For more information on college drinking and related problems, see the article by Hingson, pp. A large number of different inpatient and outpatient therapies have been used with underage drinkers, including the step model, behavioral interventions, family therapy, and educational and vocational assistance and rehabilitation. Among the most widely used inpatient approach is the day, group-oriented Minnesota model that uses the step program of recovery Wheeler and Malmquist This program includes different components, such as group meetings, educational presentations about alcoholism and associated health and social problems, group counseling, family therapy, and the completion of workbook assignments to instill personal monitoring of progress in the program.

The multiple components of this approach are designed to increase personal resources and resolve family problems to increase the prospects of recovery. Whereas the Minnesota model is based on an inpatient program, most of the existing research on treatment for underage drinkers has been conducted on outpatient programs.

Some therapies and approaches, such as cognitive—behavior therapy, have been used with some success to foster recovery among adolescents in treatment Deas and Clark However, across these different treatment modalities, effect sizes i. Finally, although several medications have been approved by the U. Food and Drug Administration for the treatment of alcohol dependence in adults, there have been few applications of these medications to adolescents. Thus, despite the very high rates of alcohol use, binge drinking, and AUDs among underage drinkers, the service delivery system has been lacking in addressing this serious public health issue.

Research in the areas of service delivery and treatment has lagged and is compounded by difficulties in addressing the multiple problems e. Future research in adolescent treatment would benefit from a model that incorporates an understanding of developmental features of adolescence e. In the 40 years since NIAAA began, the attention to the interval prior to adulthood has steadily increased.

Thus, this developmental period has become recognized as an interval during which much of the risk for later alcohol problems and alcoholism begins to emerge, and when the developmental patterning for later disorder begins to consolidate. At the same time, appreciation has deepened about the significance of adolescence and young adulthood as a major playing field in its own right, within which heavy consumption occurs and where great immediate risk exists for damage to self and others.

As described in this overview, over the past 40 years substantial progress has been made in the areas of etiology, screening, preventive interventions, and treatment regarding underage and young adult drinking. The increasing maturity of the field is evidenced by the current interdisciplinary, multilevel research integrating social, behavioral, and biological levels of analysis to understand mechanisms of risk and protection.

Furthermore, sophisticated methods of applied research are being used to develop new screening methods for early identification of risk as well as more effective, multisystemic programs for prevention and intervention. In contrast, the vulnerable group exhibited greater activation of dorsomedial prefrontal cortex and less activation of ventral striatum and extended amygdala, bilaterally, than did either control or resilient groups; moreover, these subjects exhibited more externalizing behavior.

F inancial D isclosure. National Center for Biotechnology Information , U. Journal List Alcohol Res Health v. Alcohol Res Health. Michael Windle , Ph. Zucker , Ph. Author information Copyright and License information Disclaimer. M ichael W indle , P h.

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R obert A. Copyright notice. This article has been cited by other articles in PMC. Keywords: Underage drinking, drinking in young adulthood, psychosocial development, development of alcohol disorders, risk factors, protective factors, alcohol effects on brain development, screening among youth, preventive interventions, college drinking, treatment for adolescents and young adults. Department of Health and Human Services. Rockville, MD: U. Epidemiology of Underage and Young Adult Drinking National, large-scale surveys conducted over the past 20 years have provided new insights into the prevalence of alcohol consumption, binge drinking, and AUDs, which have altered the manner in which alcohol use and AUDs are viewed by professionals and lay people alike.

Open in a separate window. Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. The Developmental Nature of Underage and Young Adult Drinking The prevalence data on alcohol use and AUDs clearly illustrate that adolescence and early young adulthood are critical for understanding the occurrence of these conditions. Developmental Framework for Understanding Underage and Young Adult Drinking As the findings provided in the previous sections show, drinking behavior and drinking problems change across adolescence and young adulthood, with a clear pattern of age-graded variation.

Figure 6. Examples of the Utility of the Developmental Framework The developmental framework described above can be used to probe the causes of, and highlight the critical issues associated with, underage and young adult drinking. Exploring the Salience of Earlier Behavior for Later Outcomes One of the major principles of development is that later behavior evolves out of earlier behavior and that the pathway is identifiable, even though the later manifestations may be more differentiated or even changed in structure or appearance i.

Contexts of Alcohol Use and Life Cycle Transitions Home is the primary source of alcohol in childhood and preadolescence Donovan and Molina and one of the primary sources in early adolescence Centers for Substance Abuse Research