Alcohol consumption and its effects on adolescents

Introduction

According to Miller, Naimi and Brewer (2007), the consumption of alcohol is among the core risk behaviours among adolescents. Alcohol can be a part of the adolescents maturing process and also a steppingstone towards harder substance abuse. Alcohol consumption makes adolescents vulnerable to the occurrence of maladaptive behaviour, delinquency, violence, accidents, emotional instability, depression, social exclusion and suicide. Alcohol consumption is not only deleterious to adolescent mental health and safety but also constitute a substantial economic burden to governments. Despite obvious risks and adverse outcomes, alcohol consumption is still increasing among adolescents in some many communities today.

Jarvien and Room (2007) stated that children recognize alcoholic beverages and develop an attitude towards alcohol from as early as pre-school. In 1995 a major international investigation, the European School Survey Project on Alcohol and other Drugs (ESPAD), on potential risk behaviours among adolescents revealed that adolescents in Northern European countries reported the highest levels of heavy drinking and intoxication. Another major international study on the Health Behaviour of Schoolchildren (HBSC) revealed that weekly alcohol use and (early) drunkenness was increasing substantially with age (especially between ages 13 and 15) for boys and girls.

Adolescence, as being a transitional stage from childhood to young adulthood, is accompanied by changes in the biological, psychological and social aspects of life. The change constitutes in the imitation of adult behaviours, emotions and thought processes, new ways of dealing with wins and losses and experimenting with new coping mechanisms, which is only a small part of the internal and external changes of adolescents, which involve their entire identity. Many risk behaviours get their start from such innocent experimentations and imitations thereby innocently exposing the young adult (adolescent) to several problems at the progress to full adult age (Schunk, 2012).

Conceptual framework

Brown and Tapert (2014) defined alcohol as a beverage drink which contains a substantial amount of the psychoactive drug ethanol (informally called alcohol). They further stressed that alcohol has potential for abuse and physical dependence. Alcohol use and heavy drinking are common during adolescence and young adulthood. Some individuals may start hazardous alcohol consumption earlier in childhood. The prevalence of problematic alcohol use continues to escalate into the late adolescent and young adult age range of 18 to 20 years. Drinking by college-aged students remains a major issue.

Results of recent research according to Giedd (2008) have it that the brain development continues well into early adulthood and that alcohol consumption can interfere with such development which indicates that alcohol use by adolescent is an even greater public health concern. Use of alcohol at an early age is associated immediate consequences like risky sexual behaviour, increased suicide rate, violence, juvenile delinquency, familial conflicts, conflicts with friends, a greater risk of accidents and illicit drug use and is therefore considered a serious public health problem and future alcohol-related problems such female breast cancer and other cancers such as colorectum, larynx, liver, oesophagus, oral cavity, and pharynx cancers.

Early alcohol initiation has been associated with greater sexual risk-taking (unprotected sexual intercourse, multiple partners, being drunk or high during sexual intercourse, and pregnancy); academic problems; other substance use; and delinquent behaviour in mid- to later adolescence. By young adulthood, early alcohol use is associated with employment problems, other substance abuse, and criminal and violent behaviour. Independent of genetic risk, exposure to alcohol or other drug use disorders of parents predicts substance use disorders in children (Ellickson, Tucker & Klein, 2009).

Prevalence of alcohol consumption among adolescents

Alcohol is the only psychotropic drug accepted and even encouraged in some society, which allows early contact (even prior to 11 years of age) and increases the risk of future dependence. In a study carried out in Australia, 19.2% of adolescents reported consuming one or more drinks in the previous three months. In Portugal, approximately 50% of adolescents report having experimented with alcohol. In the United States, it is estimated that 4.6% of adolescents between 12 and 17 years of age have a dependence on alcohol. Studies carried out in Brazil report prevalence values of alcohol experimentation ranging from 48.3 to 71.4% in adolescence, as well as a 27.3% frequency of regular use, 22.1% frequency of drunkenness at some time in life and 8.9% frequency of heavy use (Clark, 2007).

Abayomi (2009) stated that the prevalence of adolescents involvement in alcohol consumption is Nigeria do not have a clear cut percentage as it varies from region to region cutting across religious, cultural, social and economic status. But in conclusion Abayomi (2009) stated that the prevalence rate could be as high as 40%. According to him, there are few alcohol prevention programs in Nigeria and rules restricting the advertising of alcoholic beverages are questionable. As in other countries, alcohol use among Nigerian adolescents is an under-explored issue that needs to be discussed. The determination of the epidemiological profile of alcohol use and analysis of behaviours, attitudes and associated factors could contribute toward a better understanding of this complex problem and guide the drafting of health programs aimed at the prevention and combating of alcohol use in adolescence.

Causes of alcohol consumption among adolescents

Greggo, Jones and Kann (2011) identified several reasons that cause alcohol consumption among adolescent which include:

1. Other people: Adolescents see lots of people using various substances. They see their parents and other adults drinking alcohol. Also, the adolescent social scene often revolves around drinking. Sometimes friends urge one another to try a drink something.
2. Popular media: The decision to consume alcohol can be influenced by popular media such as movies and television shows to make it look like there is nothing wrong with the use of alcohol.
3. Escape and self-medication: When adolescents are unhappy and cannot find a healthy outlet for their frustration or a trusted confidant, they may turn to alcohol for solace. Depending on the situation, they may feel blissfully oblivious, wonderfully happy, or energized and confident from the use of alcohol.
4. Boredom: Adolescents who cannot tolerate being alone, have trouble keeping themselves occupied, or crave excitement are prime candidates for alcohol abuse. Not only do alcohol give them something to do, but those substances help fill the internal void they feel. Further, they provide a common ground for interacting with like-minded adolescent, a way to instantly bond with a group of other adolescent.
5. Rebellion: Different rebellious adolescents choose different substances to use based on their personalities. Alcohol is the drug of choice for the angry adolescents because it frees him to behave aggressively often used by adolescents who feel misunderstood and may long to escape to a more idealistic world.
6. Instant gratification: Alcohol work quickly. The initial effects feel really good. Adolescent turn to drug use because they see it as a short-term shortcut to happiness.
7. Lack of confidence: Many shy adolescent who lack confidence feel that they can do things under the influence of alcohol that they might not otherwise. This is part of the appeal of alcohol even for relatively self-confident adolescent; you have the courage to dance if you’re a bad dancer, or sing at the top of your lungs even if you have a terrible voice, or kiss the girl you are attracted to. And alcohol tends not only to loosen inhibitions but to alleviate social anxiety.
8. Misinformation: Perhaps the most avoidable cause of alcohol abuse is inaccurate information about alcohol. Nearly every adolescent has friends who claim to be experts on various recreational substances, and they are happy to assure other adolescents that the risks are minimal.

Effects of alcohol consumption

Brener, Grunbaum, Kann, McMaus and Ross (2014) classified the effects of alcohol consumption into health effects and psychological effects.

Health effects of alcohol consumption

According to Brener et al., (2014), even a small amount of alcohol has an effect on the body. When someone drinks alcohol, it is absorbed into your bloodstream and distributed throughout the body. A tiny amount of alcohol exits the body in through urine and breath.

The body absorbs alcohol more slowly if the individual eats, especially if the food is high in fat. However, if the drink more than the body can process, the drinker gets drunk. How quickly alcohol metabolized depends on the drinker’s size and gender, among other things. Alcohol consumption causes physical and emotional changes that can do great harm to the body. The long-term effects of alcohol abuse are many; it put the drinker’s health in serious jeopardy and endangers life.  Alcohol affects the following systems in the body as stated by Brener et al., (2014).

Excretory system

The excretory system is responsible for processing and eliminating waste products like alcohol from the body. As part of that process, the pancreas secretes digestive enzymes that combine with bile from the gallbladder to help digest food. The pancreas also helps regulate insulin and glucose. Excessive alcohol use can cause the pancreas to produce toxic substances that interfere with proper functioning. The resulting inflammation is called pancreatitis, a serious problem that can destroy the pancreas. One of the most frequent causes of chronic pancreatitis is alcohol abuse.

The liver’s job is to break down harmful substances, including alcohol. Excessive drinking can cause alcoholic hepatitis which can lead to the development of jaundice (yellowing of the skin and eyes). Chronic liver inflammation can lead to severe scarring known as cirrhosis. This formation of scar tissue can destroy the liver. When the liver fails to perform, toxic substances remain in your body. Liver disease is life threatening. Women are at higher risk for alcoholic liver disease than men, because women’s bodies tend to absorb more alcohol and take longer to process it.

When the pancreas and liver are not functioning properly, the risk of hypoglycaemia (low blood sugar) rises. A damaged pancreas can cause the body to be unable to utilize sugar due to a lack of insulin, which can lead to hyperglycaemia. Unbalanced blood sugar levels can be a dangerous problem, especially for people with diabetes. Alcohol abuse also raises your risk of liver cancer.

Central nervous system

One of the first signs of alcohol in the body system is a change in behaviour. Alcohol travels through the body easily. It can quickly reach many parts of the body, including the brain and other parts of the central nervous system. That can make it harder to talk, causing slurred speech, the telltale signs that someone who has had too much to drink. It can also affect coordination, interfering with balance and the ability to walk. Drink too much, and the ability to think clearly is affect, as are the impulse control and ability to form memories. Over the long term, drinking can actually shrink the frontal lobes of the brain. Acute alcoholic withdrawal can lead to seizures and delirium. And severe alcoholism can progress to permanent brain damage, causing dementia.

Damage to your nervous system can result in pain, numbness, or abnormal sensations in your feet and hands. Alcoholism can cause a thiamine (vitamin B₁) deficiency, which can result in involuntary rapid eye movements, weakness, or paralysis of the eye muscles. Men and women metabolize alcohol differently. It generally takes less alcohol to affect women.

Over time, a heavy drinker can become physically and emotionally dependent on alcohol. It may be very difficult to gain control. Unlike most other common addictions, acute alcohol withdrawal can be life threatening. Cases of severe, chronic alcohol addiction often require medical detoxification. When an alcoholic stops drinking abruptly, they’re likely to experience symptoms of withdrawal, such as nausea, anxiety, nervousness and tremors. In severe cases, it may lead to confusion, hallucinations (delirium tremens), and seizures.

1. Digestive system

Alcohol can wreak havoc on the digestive system, from the mouth all the way to the colon. Even a single incidence of heavy drinking can injure parts of the digestive tract. Alcohol abuse can damage the salivary glands and irritate the mouth and tongue, leading to gum disease, tooth decay, and even tooth loss. Heavy drinking can cause ulcers in the oesophagus, acid reflux, and heartburn. Stomach ulcers and inflammation of the stomach lining (gastritis) can occur. Inflammation of the pancreas interferes with its ability to aid digestion and regulate metabolism. Damage to the digestive system can cause gassiness, abdominal fullness, and diarrhoea. It can also lead to dangerous internal bleeding, which may be due to ulcers, haemorrhoids, or oesophageal varices caused by cirrhosis.

Alcohol makes it harder for the digestive tract to absorb nutrients and B vitamins or control bacteria. Alcoholics often suffer from malnutrition. Heavy drinkers face higher risk of mouth, throat, and oesophagus cancers. Moderate drinking in the presence of tobacco use can raise the risk of these upper-gastrointestinal cancers. Colon cancer is also a risk.

2. Circulatory system

In some cases, a single episode of heavy drinking can cause trouble for your heart. It is even more likely that the heart will suffer if the individual is a chronic drinker. Women who drink are at even higher risk of heart damage than men. Circulatory system complications include poisoning of the heart muscle cells (cardiomyopathy), irregular heartbeat (arrhythmia), high blood pressure, stroke, heart attack and heart failure. People with diabetes have an increased risk of low blood sugar levels, especially if they use insulin. Deficiencies in vitamin B₆, vitamin B₁₂, thiamine, and folic acid can cause lowered blood counts.

3. Sexual and reproductive health

Erectile dysfunction is a common side effect of alcohol abuse in men. It can also inhibit hormone production, affect testicular function, and cause infertility. Excessive drinking can cause a woman to stop menstruating and become infertile. It also can increase her risk of miscarriage, premature delivery, and stillbirth. Alcohol has a huge effect on foetal development. A range of problems, called foetal alcohol spectrum disorders (FASD), can occur. FASD symptoms, which include physical abnormalities, learning difficulties, and emotional problems, can last a lifetime.

4. Skeletal and muscle systems

Long-term alcohol use makes it harder for the body to produce new bone. Drinking puts an individual at increased risk of osteoporosis (thinning bones) and bone fractures. Muscles become prone to weakness, cramps, and even atrophy.

5. Immune system

An immune system weakened by alcohol abuse has a hard time fighting off viruses, germs, and all types of illness. Heavy drinkers are more likely to get pneumonia or tuberculosis than the general population. Chronic alcohol use increases the risk of many forms of cancer.

Psychological effects of alcohol consumption

Farkr and Anderson (2007) stated that alcohol affects the brain and lead to varying mental health side effects due to excessive drinking. People often reach for a drink because they want to change the way they feel. Maybe they want to relax, to celebrate or simply forget the day at work. More concerning is that many people drink to try and mask anxiety or depression, or other mental health problems. While alcohol can have a very temporary positive impact on the drinker’s mood, in the long term it can cause big problems for mental health. Farkr and Anderson (2007) highlight the various way alcohol affects mental health of the drinker.

1. Alteration of brain chemistry

The brain relies on a delicate balance of chemicals and processes. Alcohol is a depressant, which means it can disrupt that balance, affecting the thoughts, feelings and actions, and sometimes long-term mental health. This is partly down to ‘neurotransmitters’, chemicals that help to transmit signals from one nerve (or neuron) in the brain to another.

The relaxed feeling an individual can get when they have that first drink is due to the chemical changes alcohol has caused in the brain. For many, a drink can help feel more confident and less anxious. That is because it is starting to depress the part of the brain we associate with inhibition. But as the individual drinks more, more of the brain starts to be affected. It does not matter what mood the individual is to start with, when high levels of alcohol are involved, instead of pleasurable effects increasing, it is possible that a negative emotional response will take over. They could become angry, aggressive, anxious or depressed.

2. Increase in anxiety and stress

While a glass of wine after a hard day might help an individual to relax, in the long run it can contribute to feelings of depression and anxiety and make stress harder to deal with. This is because regular, heavy drinking interferes with neurotransmitters in our brains that are needed for good mental health.

When an individual drinks, it narrows the perception of a situation and do not always respond to all the cues around them. If the individual is prone to anxiety and notice something that could be interpreted as threatening in the environment, the individual will hone in on that and miss the other less threatening or neutral information.  For example, one might focus on a partner talking to someone he or she is jealous of, rather than notice all the other people they have been chatting to that evening.

3. Risk of depression

If an individual drinks heavily and regularly they are likely to develop some symptoms of depression. It is that good old brain chemistry at work again. Regular drinking lowers the levels of serotonin in the brain – a chemical that helps to regulate mood. People who experience anxiety or depression are twice as likely to be heavy or problem drinkers. For some people, the anxiety or depression came first and they have reached for alcohol to try to relieve it. For others, drinking came first, so it may be a root cause of their anxieties. Drinking heavily can also affect relationships with partners, family and friends. It can impact on performance at work. These issues can also contribute to depression.

4. Increased risk of suicide, self-harm and psychosis

Alcohol can make people lose their inhibitions and behave impulsively, so it can lead to actions they might not otherwise have taken including self-harm and suicide. More than half of people who ended up in hospital because they had deliberately injured themselves said they have drunk alcohol immediately before or while doing it.  27% of men and 19% of women gave alcohol as the reason for self-harming (Brener, et al, 2014). Extreme levels of drinking (such as more than 30 units per day for several weeks) can occasionally cause ‘psychosis’. It is a severe mental illness where hallucinations and delusions of persecution develop. Psychotic symptoms can also occur when very heavy drinkers suddenly stop drinking and develop a condition known as ‘delirium tremens’ (symptoms include body tremors and confusion).

5. Memory damage

Soon after drinking alcohol, the brain processes slow down and memory can be impaired. After large quantities of alcohol, the brain can stop recording into the ‘memory store’. That is why drinkers can wake up the next day with a ‘blank’ about what they said or did and even where they were. This short-term memory failure or ‘black out’ does not mean that brain cells have been damaged, but frequent heavy sessions can damage the brain because of alcohol’s effect on brain chemistry and processes. Drinking heavily over a long period of time can also have long-term effects on memory. Even on days when the individual did not  drink any alcohol, recalling what he or she did yesterday, or even where he or she have been earlier that day, becomes difficult.

Solutions to problems associated with alcohol consumption among adolescents

According to Brener, et al,(2014), the following are measures that can be used to reduce the problems associated with alcohol consumption:

• The government should invent measures to foster changes in the society that facilitate healthy adolescent development and that help prevent and reduce adolescent drinking.
• Parents and other caregivers, schools, communities, all levels of government, all social systems that interface with adolescents, and adolescents themselves should work together in a coordinated national effort to prevent and reduce adolescent drinking and its consequences.
• The government and all stakeholders should be understanding of adolescent alcohol consumption in the context of human development and maturation that takes into account individual adolescent characteristics as well as environmental, ethnic, cultural, and gender differences.
• The society at large should show interest on research into on adolescent alcohol use and its relationship to development.
• The government, community and parents should explore all available measures to improve public health surveillance on adolescent drinking and on population-based risk factors for this behaviour.
• Efforts should be made to ensure that policies at all levels are consistent with the national goal of preventing and reducing adolescent alcohol consumption.

References

Abayomi, N. (2009). Really underage drinkers: Alcohol use among elementary students. Clinical and Experimental Research, 3: 255-268.

Brener, N., Grunbaum, J.,  Kann, L.,  McMaus, T. & Ross, J. (2014). Assessing health risk behaviors among adolescents: The effect of question wording and appeals for honesty. J. Adolesc. Health 35: 91–100.

Brown, S.A. & Tapert, S.F. (2014). Adolescence and the trajectory of alcohol use: basic to clinical studies. Ann N Y Acad Sci. 1021: 234 –244.

Clark, D. B. (2007). The natural history of adolescent alcohol use disorders. Addiction. 99(suppl 2):5–22.

Ellickson, P. L.,Tucker, J. S. & Klein, D. J. (2009). Ten-year prospective study of public health problems associated with early drinking. Paediatrics. 111(5 pt 1):949 –955

Giedd, J. N. (2008). The teen brain: insights from neuroimaging. J Adolesc Health. 42(4): 335–343.

Greggo, J., Jones, S. & Kann, L. (2011). Population density and alcohol-related risk behaviors among US high school students. J. Health Educ. 36:148–154.

Farkr, W. & Anderson, P. (2007). Binge drinking and Europe. Addictions 19: 333–339.

Jarvien, M. & Room, R. (2007). Youth Drinking Cultures: European Experiences; Surrey, UK: Ashgate Publishing

Miller, J.W., Naimi, T.S. & Brewer, R.D. (2007). Binge drinking and associated health risk behaviours among high school students. Pediatrics 119: 76–85.

Schunk, D.H.  (2012). Peer models and children’s behavioral change. Rev. Educ. Res. 57: 149–174.