Alcohol is the most common drug used by people younger than 21 in the United States. Despite a minimum legal drinking age of 21, millions of people under that age drink each year, and the Centers for Disease Control and Prevention (CDC) reports that about 4,000 young people under 21 die from excessive alcohol use annually.
This article covers the current statistics, the risks, why young people drink, and what prevention involves.
Current Statistics: How Widespread Is Underage Drinking?
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), drawing on 2024 National Survey on Drug Use and Health data:
- 12.7 million people ages 12 to 20 (32.9% of this age group) reported having had at least one drink in their lifetime
- 10.4 million people ages 12 to 20 (27.0%) reported drinking in the past year
- 5.1 million (13.3%) reported drinking in the past month
- 2.9 million (7.6%) reported binge drinking in the past month
- 576,000 (1.5%) reported heavy alcohol use in the past month
- Past-year drinking was higher among females (28.4%) than males (25.7%), a reversal of the older pattern
Binge drinking is defined by NIAAA as drinking that brings blood alcohol concentration to 0.08% or higher, which for young people takes fewer drinks than it does for adults: about three drinks for girls, and three to five for boys depending on age and size.
The figure rises with age. A SAMHSA state report citing 2022 national survey data notes that 17.9 percent of people ages 18 to 20 reported binge drinking in the past month.
Underage drinking has been trending down. The CDC reports that alcohol use and binge drinking among high school students have generally decreased in recent decades. But the numbers above are still counted in millions, and the decline has not been even. More high school girls now drink than boys, which reverses the pattern of previous generations.
The Consequences of Underage Drinking
Death and Injury
Alcohol is a factor in the deaths of thousands of people younger than 21 in the United States each year. According to the CDC, alcohol use contributes to about 4,000 deaths among people younger than 21 in the United States each year. NIAAA, drawing on the same CDC data, gives the annual average by cause for 2022 to 2023: 1,392 alcohol-attributable deaths in motor vehicle crashes, 978 homicides, 644 from poisoning, overdose and other injuries, and 615 suicides. These are deaths where alcohol was a contributing factor, not the total number of deaths in each category.
Motor Vehicle Crashes
Crashes are the largest single category of those alcohol-attributable deaths. In 2023, about 16 percent of high school students reported riding in the past month with a driver who had been drinking, and about 5 percent of those who had driven said they drove after drinking themselves. Zero-tolerance laws, which outlaw driving after any amount of drinking for people younger than 21, are one of the policy measures NIAAA identifies as helping to prevent these outcomes.
Violence and Sexual Assault
Underage binge drinking is associated with an increased likelihood of being either the victim or the perpetrator of violence. The CDC also links underage drinking to a higher risk of sexually transmitted infections, HIV and unplanned pregnancy, and to increased risk of violence including homicide and suicide.
Academic and Social Consequences
NIAAA notes that drinking may cause young people to have trouble in school or with the law, and that impaired judgment can lead to unsafe sexual behavior, drinking and driving, and aggressive or violent behavior. The effect on school performance is not only behavioral. Research on the adolescent brain has found that the earlier people start drinking, the more likely they are to experience a measurable impact on cognitive function, memory and school performance over time, perhaps even into adulthood.
Brain Development
The brain keeps changing into a person’s mid-20s, and the prefrontal cortex, which handles planning and decision-making, is among the last areas to mature. Alcohol can alter that development. NIAAA reports that heavy drinking during adolescence has been linked to reductions in the size of the frontal lobe (involved in planning and decision-making), the hippocampus (involved in learning and memory), the amygdala (involved in fear-sensing), and the corpus callosum (the band of fibers connecting the brain’s two halves). It also changes the normal developmental patterns in the connections between and within brain regions, and weakens the connections between brain areas that regulate emotional and cognitive functioning.
One consequence shows up immediately. Alcohol temporarily blocks the transfer of memories from short-term to long-term storage in the hippocampus, which is what produces a blackout. One study found that one in five older adolescents who had ever drunk alcohol reported an alcohol-induced blackout in the previous six months.
Long-Term Risk of Alcohol Use Disorder
Alcohol use disorder is a medical diagnosis, not a description of willpower. NIAAA defines it as a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. It is diagnosed on a range rather than as a single threshold. Doctors assess a person against a set of 11 criteria, and how many of them apply determines the severity: two or three is mild, four or five is moderate, six or more is severe.
In plain terms, it means drinking that keeps going even when it is causing problems, that a person has trouble cutting back on when they try, and that takes up more and more room in daily life. It sits on a range. Someone can meet the diagnosis without their life having fallen apart, which is part of why it often goes unrecognized in younger people.
When drinking starts appears to affect the odds of getting there. NIAAA states that research shows people who start drinking before the age of 15 are at a higher risk for developing alcohol use disorder later in life.
Part of the reason has to do with what the brain is doing at that age. NIAAA describes the adolescent brain as having an increased ability to change in response to experience, known as brain plasticity. That capacity is what makes adolescence such a formative stretch of life, and it is also what leaves the brain open to both the short-term and long-term effects of alcohol during the years when patterns are being set.
Why Young People Drink
Prevention works better when it starts from the real reasons rather than treating underage drinking as simple defiance. The NIAAA fact sheet identifies several.
The Legal Framework: Minimum Drinking Age
Before the National Minimum Drinking Age Act of 1984, the minimum legal drinking age could differ by state. It is now 21 nationwide, which means alcohol cannot be sold to people younger than 21.
The CDC points to measurable results. States that raised their minimum age to 21 before the national law had a 16 percent drop in motor vehicle crashes. Between 1985 and 1991, the share of 18 to 20 year olds who reported drinking in the past month fell from 59 percent to 40 percent, and among 21 to 25 year olds it fell from 70 percent to 56 percent.
Every state and the District of Columbia also has a zero-tolerance law, which makes it illegal for anyone under 21 to drive with any measurable amount of alcohol in their system. The CDC notes that these laws, together with the minimum drinking age of 21, are in place in all 50 states and D.C. and have saved tens of thousands of lives.
The SAMHSA STOP Act state reports track each state’s performance in enacting, enforcing and implementing laws, regulations and programs to prevent or reduce underage drinking, giving an annual picture of where each state stands.
Prevention Strategies: What Works
NIAAA calls preventing underage drinking a complex challenge, and says any successful approach has to account for genetics, personality, rate of maturation and development, level of risk, and social and environmental factors. With that in mind, it describes five approaches that have been found to be successful.
Individual-Level Interventions
Approaches that change how young people think about alcohol, so they are better able to resist pressure to drink.
Family-Based Interventions
Programs that empower parents to set and enforce clear rules against drinking and improve communication between children and parents about alcohol. SAMHSA’s Talk. They Hear You. campaign provides resources for parents and caregivers on starting conversations, answering difficult questions, and defining conversation goals.
School-Based Interventions
Programs providing students with knowledge, skills, motivation, and opportunities to remain alcohol-free.
Community-Based Interventions
Local coalitions working to reduce risk factors for alcohol misuse in given areas.
Policy-Level Interventions
Measures making alcohol harder to obtain, such as raising its price and maintaining the minimum legal drinking age of 21, along with zero-tolerance driving laws for those under 21. This is the tier with the clearest evidence behind it. The CDC describes the strategies it lists for reducing alcohol-impaired driving as effective, and as recommended by The Guide to Community Preventive Services, the National Highway Traffic Safety Administration, or the National Academies of Sciences, Engineering, and Medicine. The drop in crashes and in past-month drinking that followed the move to 21, covered earlier in this article, comes out of that tier.
Success depends on the specific program and how well it is delivered, not on the category it belongs to. A parent, school, or coalition weighing a particular program is fair to ask what results it has actually produced.
When Prevention Isn’t Enough: Getting Help
Not every young person who drinks needs treatment, but some do, and it is better looked at early than late. NIAAA lists warning signs that parents, families and teachers should pay attention to:
- Changes in mood, including anger and irritability
- Academic or behavioral problems in school
- Rebelliousness
- Changing groups of friends
- Low energy level
- Less interest in activities or care in appearance
- Finding alcohol among an adolescent’s belongings
- Smelling alcohol on an adolescent’s breath
- Problems concentrating or remembering
- Slurred speech
- Coordination problems
Any one of these on its own can mean a dozen things, most of them ordinary. A cluster of them is worth acting on.
The usual first step is the young person’s own doctor. NIAAA and the American Academy of Pediatrics both recommend that all youth be regularly screened for alcohol use, and NIAAA notes that screening by a primary care provider or other health practitioner, such as a pediatrician, is an opportunity to identify problems early.
Where treatment is needed, NIAAA describes options including individual or group counseling sessions one or more times per week, family therapy to build a supportive foundation for recovery, and, for those 18 and older, medication prescribed by a physician to help reduce alcohol cravings.
Where the Leverage Is
Underage drinking is not inevitable, and the long-term trend has been downward. That is the result of the combination this page has covered: laws that make alcohol harder to get, schools that do more than list consequences, communities that pay attention, and adults at home who set clear rules and keep talking.
The point worth holding onto is that when a young person has a first drink matters, and the adults around them have real influence over when that is. Delaying it is not a small win.
If you are already past that question and wondering whether what you are seeing at home is a problem, that is worth putting to a physician or a counselor rather than sitting with on your own.