Alcohol in Children and Adolescents

• Alcohol is often consumed in larger amounts or over a longer period than was intended
• There is persistent desire or unsuccessful efforts to cut down or control alcohol use
• A great deal of time is spent in activities necessary to obtain or use alcohol
• Craving, or a strong desire to use alcohol
• Recurrent alcohol use resulting in failure to fulfill major role obligations
• Continued alcohol use despite persistent social or interpersonal problems
• Important social or recreational activities are reduced or ceased because of the use
• Recurrent alcohol use in hazardous situations
• Alcohol use is continued despite knowledge of having a problem
• Tolerance and/or withdrawal symptoms

When we consider substance use disorder, we often talk about substance dependence. Individuals are considered dependent on a substance when symptoms of tolerance and withdrawal are present:

1. Tolerance is a need for markedly increased amounts of a substance to achieve its desire effect.
2. Withdrawal is the development of substance-specific maladaptive behavioral changes, with physiological and cognitive concomitants, that is due to the cessation or reduction of substance use.

Many factors influence whether children and adolescents try alcohol, including whether their friends or family members use alcohol, cultural beliefs about use of alcohol, and the ease of access/availability of alcohol within the neighborhood, community, and school. Additionally, factors within the family environment may be particularly important, as the presence of violence, physical or emotional abuse, mental illness, or drug use in the household can increase the likelihood the likelihood of children and adolescents using alcohol.

The American Psychiatric Association has found there is a genetic component to alcohol use disorder. Children and adolescents’ inherited genetic vulnerability (e.g. personality traits like poor impulse control or a high need for excitement; mental health conditions such as depression or anxiety) make it more likely that they will try alcohol. 

The following treatments have been proposed to be most effective:

• Counseling, using one or more the following approaches:
• Cognitive-behavioral therapy consists of gradually exposing the person to the substance (alcohol) while simultaneously refraining from compulsive behavior (using the substance).
• Motivational counseling focuses on decreasing ambivalence toward change
• Contingency management uses immediate and tangible reinforcements for positive behaviors to modify problematic behaviors such as alcohol use
• Adolescent community reinforcement approach (A-CRA) focuses on replacing influences that reinforced alcohol use with healthier family, social, educational, or vocational reinforcers
• Family based approaches [Brief strategic family therapy (BSFT) and family based therapy (FBT)] highlight the need to engage the family in treatment and may focus on communication and conflict, problems with school, and other co-occurring behavioral or mental health problems.
• Pharmacological Interventions (addiction medications including acamprosate, disulfiram, and naltrexone) are available for treatment of alcohol use disorder in adults, but have not been approved by the FDA for use with children and adolescents. Despite lack of evidence, some health care providers do use medications “off-label” to treat children and adolescents for alcohol use problems.

Research additionally suggests that the following treatments are promising:

• Short term tangible reinforcement (e.g. collecting money that would normally be used to purchase alcohol or alcohol related products, and saving it to purchase a reward for quitting).
• Hypnosis
• Social support through alcoholics anonymous (AA) or other self-help groups

• Exercise as an adjunct to relieve alcohol cravings