Issue 1, 2006R

Emergency Department Visits Involving Underage Drinking

All 50 States have a legal drinking age of 21; however, many underage people obtain and use alcohol. In 2004, 10.8 million persons aged 12 to 20 (29%) used alcohol in the past month, according to the National Survey on Drug Use and Health (NSDUH).¹

Underage use of alcohol can have both immediate and long-term consequences. According to the National Highway Traffic Safety Administration, nearly 25 percent of drivers aged 16 to 20 who were involved in fatal motor vehicle crashes in 2003 had been drinking alcohol.² Among 14 million adults who could be classified as dependent on or abusing alcohol in the past year, 95 percent started drinking alcohol before age 21.³

The Drug Abuse Warning Network (DAWN) collects data from a national sample of hospitals on emergency department (ED) visits related to recent drug use. Since 2003, DAWN has included ED visits involving alcohol alone or in combination with other drug(s) for patients younger than age 21. This report presents findings on these alcohol-related ED visits for patients aged 12 to 20.

During 2004, an estimated 451,909 drug-related ED visits were made by patients aged 12 to 20. Nearly half of these visits (45%) involved alcohol. Of the alcohol-related ED visits, nearly three quarters (74%) were for alcohol and no other drugs (Figure 1).

Figure 1. Underage alcohol-related ED visits
Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (03/2008 update).

As patient age increases, the rate of ED visits due to alcohol-related problems increases. Patients aged 18 to 20 were approximately 4 times more likely than patients aged 12 to 17 to have an alcohol-related ED visit. This difference by age was more than 4 times higher for alcohol alone and 3 times higher for alcohol with other drugs (Figure 2).

Figure 2. ED visit rates for alcohol alone and alcohol with other drug(s), by age
Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (03/2008 update).

While other studies have found binge or heavy drinking behavior to be more common among underage males than underage females,⁴ the differences in the rates of alcohol-related ED visits for males and females were not significant (Figure 3).

Figure 3. ED visit rates for alcohol alone and alcohol with other drug(s), by gender
Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (03/2008 update).

The disposition of the underage drinkers from the ED appeared to be related to whether the alcohol was used alone or with other drugs. When the ED visits involved alcohol alone, 76 percent were treated and released, usually to home (Figure 4). Nineteen percent were admitted for inpatient care, and among those, 16 percent required intensive or critical care.

When the visits involved alcohol with other drugs, just over half (58%) of the patients were treated and released (Figure 5). Thirty percent were admitted as inpatients, and among those, 21 percent required intensive or critical care and 46 percent were admitted to psychiatric units.

Figure 4. Discharge status of alcohol-related ED visits involving alcohol alone
Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (03/2008 update).

Figure 5. Discharge status of alcohol-related ED visits involving alcohol with other drug(s)
Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (03/2008 update).

Of the 53,481 alcohol-related ED visits by patients aged 12 to 20 where alcohol was combined with another drug, 69 percent involved an illicit drug. Marijuana and cocaine (in 47% and 19% of visits, respectively) were the most frequent illicit drugs in alcohol polydrug ED visits, followed by stimulants, including amphetamine and methamphetamine, in 10 percent of visits. However, not all of the drugs found in combination with alcohol were illicit substances: 44 percent involved a prescription or over-the-counter medication, and 13 percent involved both an illicit drug and a medication. Medications such as alprazolam (5%), acetaminophen (3%), and ibuprofen (2%) were found in underage alcohol-related ED visits (Table 1).