Alcohol

Basic Data

(Number of Current Users, 2011) "Slightly more than half (51.8 percent) of Americans aged 12 or older reported being current drinkers of alcohol in the 2011 survey, similar to the rate in 2010 (51.8 percent). This translates to an estimated 133.4 million current drinkers in 2011."

("Heavy" Drinkers) "In 2011, heavy drinking was reported by 6.2 percent of the population aged 12 or older, or 15.9 million people. This percentage was lower than the rate of heavy drinking in 2010 (6.7 percent)."

Note: These are the definitions of "current," "binge" and "heavy" alcohol use:
Current (past month) use - At least one drink in the past 30 days.
Binge use - Five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past 30 days.
Heavy use - Five or more drinks on the same occasion on each of 5 or more days in the past 30 days.

(Binge Drinkers) "Nearly one quarter (22.6 percent) of persons aged 12 or older participated in binge drinking at least once in the 30 days prior to the survey in 2011. This translates to about 58.3 million people. The rate in 2011 was similar to the rate in 2010 (23.1 percent)."

(50 Year-Olds) "Alcohol consumption is relatively high among 50-year-olds, with over two thirds (68%) indicating that they consumed at least one alcoholic drink in the prior 30 days, 11% reporting current daily drinking (defined as drinking on 20 or more occasions in the prior 30 days), and 19% indicating recent occasions of heavy drinking (defined as five or more drinks in a row on at least one occasion in the prior two weeks). The rate of recent occasions of heavy drinking is much lower than was exhibited by members of this cohort when they were of high school and college ages."

(Prohibition and Homicide Rates) "The data are quite consistent with the view that Prohibition at the state level inhibited alcohol consumption, and an attempt to explain correlated residuals by including omitted variables revealed that enforcement of Prohibitionist legislation had a significant inhibiting effect as well. Moreover, both hypotheses about the effects of alcohol and Prohibition are supported by the analysis. Despite the fact that alcohol consumption is a positive correlate of homicide (as expected), Prohibition and its enforcement increased the homicide rate."

(Alcohol Mortality) "Excessive alcohol use* accounted for an estimated average of 80,000 deaths and 2.3 million years of potential life lost (YPLL) in the United States each year during 2001–2005, and an estimated $223.5 billion in economic costs in 2006. Binge drinking accounted for more than half of those deaths, two thirds of the YPLL, and three quarters of the economic costs."

* Excessive alcohol use includes binge drinking (defined by CDC as consuming four or more drinks per occasion for women or five or more drinks per occasion for men), heavy drinking (defined as consuming more than one drink per day on average for women or more than two drinks per day on average for men), any alcohol consumption by pregnant women, and any alcohol consumption by youths aged less than 21 years.

(Medications to Treat Alcohol Addiction) "VIVITROL was approved in 2006 by the FDA as an extended-release formulation of naltrexone for the treatment of alcohol dependence in patients who are able to abstain from alcohol in an outpatient setting prior to initiation of treatment. VIVITROL is administered by intramuscular (IM) injection once per month."

(Alcohol-Induced Mortality 2009) "In 2009, a total of 24,518 persons died of alcohol-induced causes in the United States (Tables 10, 12, and 13). This category includes deaths from dependent and nondependent use of alcohol, and also includes accidental poisoning by alcohol. It excludes unintentional injuries, homicides, and other causes indirectly related to alcohol use, as well as deaths due to fetal alcohol syndrome (for a list of alcohol-induced causes, see 'Technical Notes').
"In 2009, the age-adjusted death rate for alcohol-induced causes for males was three times the rate for females. Compared with the rate for the white population, the rate for the black population was 19.5% lower.
"There was no change the age-adjusted death rate for alcohol-induced causes for the total population from 2008 to 2009. The age-adjusted death rate decreased 2.6% for non-Hispanic white males. The rate increased 7.9% for non-Hispanic white females."

(Characteristics of Those Admitted to Treatment for Alcohol Dependence)
"• Admissions for primary abuse of alcohol with secondary abuse of drugs represented 18 percent of TEDS admissions aged 12 and older in 2010 [Table 1.1b].
"• The average age at admission for primary alcohol with secondary drug abuse was lower, at 36 years, than for abuse of alcohol alone (40 years) [Table 2.1a].
"• Non-Hispanic Whites accounted for 59 percent of admissions for primary alcohol with secondary drug abuse (42 percent males and 17 percent females). Non-Hispanic Blacks made up 23 percent³ of admissions (17 percent males and 5 percent females) [Table 2.3a].
"• Almost half (47 percent) of admissions for primary alcohol with secondary drug abuse first became intoxicated by age 14, and 93 percent first became intoxicated before age 21 (the legal drinking age) [Table 2.5]."

(Alcohol Use Disorder by Race/Ethnicity) "The rate of past year alcohol use disorder among persons aged 12 to 20 was higher for American Indians or Alaska Natives (14.9 percent) than for whites (10.9 percent), blacks (4.6 percent), Hispanics (8.7 percent), and Asians (4.9 percent). One in eight Native Hawaiians or Other Pacific Islanders (12.7 percent) met the criteria for an alcohol use disorder."

(Characteristics of Admissions to Treatment for Alcohol Dependence)
"• Admissions for primary alcohol with secondary drug abuse were less likely to be in treatment for the first time than alcohol-only admissions (35 percent vs. 46 percent) [Table 2.5].
"• Among admissions referred to treatment by the criminal justice system, admissions for alcohol with secondary drug abuse were more likely than alcohol-only admissions to have been referred to treatment as a condition of probation/parole (32 percent vs. 19 percent) [Table 2.6].
"• Among admissions for alcohol with secondary drug abuse, marijuana and smoked cocaine were the most frequently reported secondary substances (26 percent and 9 percent, respectively) [Table 3.8]."

(Prevalence of Alcohol Use Disorder) "Combined data from 2002 to 2006 indicated that an annual average of 9.4 percent of persons aged 12 to 20 (3.5 million persons in that age range) met the diagnostic criteria for an alcohol use disorder (dependence or abuse) in the past year."

(Other Substance Use by 'Lifetime' Alcohol Users) "Lifetime alcohol users aged 21 or older had a significantly higher rate of past year illicit drug use (13.7 percent) compared with lifetime nondrinkers (2.7 percent). In addition, lifetime alcohol users had significantly higher rates of past year use across all illicit drug categories, with the exception of inhalants (Table 1). Nonmedical use of pain relievers was the illicit drug used most often by lifetime nondrinkers, whereas lifetime alcohol users reported using marijuana most frequently."

('Lifetime' Alcohol Users) "In 2002 and 2003, an estimated 88.2 percent of persons aged 21 or older (175.6 million) were lifetime alcohol users, whereas an estimated 11.8 percent (23.5 million) were lifetime nondrinkers. Over half of lifetime alcohol users (52.7 percent) had used one or more illicit drugs at some time in their life, compared to 8.0 percent of lifetime nondrinkers. Among persons who had used an illicit drug in their lifetime, the average age at first illicit drug use was 19 years for lifetime alcohol users, versus 23 years for lifetime nondrinkers."

(Prevalence of Use Among African-American Students)
"• African-American students have the lowest 30-day prevalence rate for alcohol use. They also have the lowest rates for self-reports of having been drunk during the prior 30 days.
"• Recent occasions of heavy drinking (having five or more drinks in a row during the prior two weeks) is also lowest among African Americans in all three grades; in 12th grade their rate is 11% versus 26% for Whites and 21% for Hispanics. In 8th grade, Hispanics have the highest rate at 10%, compared to 6% for Whites and 5% for African Americans."

(Alcohol Use by Race/Ethnicity) "Among persons aged 12 or older, whites in 2011 were more likely than other racial/ethnic groups to report current use of alcohol (56.8 percent) (Figure 3.2). The rates were 46.9 percent for persons reporting two or more races, 44.7 percent for American Indians or Alaska Natives, 42.5 percent for Hispanics, 42.1 percent for blacks, and 40.0 percent for Asians.
"• The rate of binge alcohol use was lowest among Asians (11.6 percent). Rates for other racial/ethnic groups were 18.6 percent for persons reporting two or more races, 19.4 percent for blacks, 23.4 percent for Hispanics, 23.9 percent for whites, and 24.3 percent for American Indians or Alaska Natives.
"• Among youths aged 12 to 17 in 2011, Asians had lower rates of current alcohol use than any other racial/ethnic group (7.4 percent), while 10.5 percent of black youths, 12.6 percent of Hispanic youths, 14.6 percent of white youths, 15.2 percent of American Indian or Alaska Native youths, and 17.5 percent of youths reporting two or more races were current drinkers."

(Alcohol Use Among African-Americans) "Past month alcohol use, binge alcohol use, and illicit drug use remained relatively stable among black adults between 2002 and 2008 (Figure1).^4,5
"Combined 2004 to 2008 data indicate that, in the past month, 44.3 percent of black adults used alcohol, 21.7 percent reported binge alcohol use, and 9.5 percent used an illicit drug (Figure 2).
"Rates of past month alcohol use and binge alcohol use were lower among black adults than the national averages. The rate of past month illicit drug use among black adults, however, was higher than the national average.
"Rates of past month and binge alcohol use were considerably lower among young black adults than the national average of young adults (48.6 vs. 61.1 percent and 25.3 vs. 41.6 percent, respectively) (Figure 3). Past month illicit drug use among young black adults was slightly lower than the national average (18.7 vs. 19.7 percent).
"Older black adults had a rate of past month alcohol use that was considerably lower than the national average of older adults (20.3 vs. 38.3 percent) (Figure 4). Their rates of binge alcohol use and past month illicit drug use, however, did not differ significantly from the national averages.
"Compared with the national averages, adult black females had lower rates of past month alcohol use and binge alcohol use and a slightly higher rate of past month illicit drug use (Table 1).
"Compared with the national averages, adult black males had lower rates of past month alcohol use and binge alcohol use and a slightly higher rate of past month illicit drug use (Table 2)."

Physiological and Psychological Effects

(Physiological Effects) "Alcohol is neurotoxic to brain development, leading to structural hippocampal changes in adolescence,¹⁶ and to reduced brain volume in middle age.¹⁷ Alcohol is a dependence-producing drug, similar to other substances under international control, through its reinforcing properties and neuro-adaptation in the brain.¹⁸ It is an immunosuppressant, increasing the risk of communicable diseases,¹⁹ including tuberculosis.²⁰ Alcoholic beverages are classified as carcinogenic by the International Agency for Research on Cancer, increasing the risk of cancers of the oral cavity and pharynx, oesophagus, stomach, colon, rectum, and breast in a linear dose-response relation,²¹ with acetaldehyde as a potential pathway.²² Alcohol has a biform relation with coronary heart disease. In low and apparently regular doses (as little as 10 g every other day), alcohol is cardioprotective,²³ although doubt remains about the effect of confounders.²⁴ At high doses, especially when consumed irregularly, it is cardiotoxic.²⁵

(Alcohol v Marijuana - Displacement Effects) "Note that there is no evidence that the 13-year decline in marijuana use observed between 1979 and 1992 led to any accompanying increase in alcohol use, as many observers suggested would happen. In fact, through 1992 there was some parallel decline in annual, monthly, and daily alcohol use, as well as in occasions of heavy drinking among 12th graders. Earlier, when marijuana use rose in the late 1970s, alcohol use moved up along with it. As marijuana use rose again in the 1990s, alcohol use again rose with it, although certainly not as sharply. In sum, there has been little evidence from MTF over the years that supports what we have termed “the displacement hypothesis,” which asserts that an increase in marijuana use will somehow lead to a decline in alcohol use, or vice versa. Instead, both substances appear to move more in harmony, perhaps both reflecting changes in a more general construct, such as the tendency to use psychoactive substances, whether licit or illicit, or the frequency with which teens “party” or not. However, with alcohol use decreasing and marijuana use increasing over the past few years, it is possible that the displacement hypothesis is gaining support, highlighting the reality of historical change in types as well as causes of substance use. Our continued monitoring will provide the needed evidence about the displacement hypothesis in this current historical period."

"When an alcoholic beverage is consumed, approximately 20% of the alcohol is absorbed in the stomach and 80% is absorbed in the small intestine (Freudenrich, 2001). After absorption, alcohol enters the bloodstream and dissolves in the water of the blood where it is quickly distributed to body tissues. When alcohol reaches the brain, it affects the cerebral cortex first, followed by the limbic system (hippocampus and septal area), cerebellum, hypothalamus, pituitary gland, and lastly, the medulla, or brain stem. Some of these regions are similar to those affected by cannabis, but alcohol also affects sexual arousal/function and increases urinary output. When BAC is near toxic levels, lower order brain regions are affected, which is often followed by sleepiness, lack of consciousness, coma, or death."

"Antidepressants are most commonly in the form of selective serotonin uptake inhibitors (SSRIs), such as fluoxetine (Prozac®) and sertraline (Zoloft®). They can cause impairment, especially in circumstances where extremely high blood concentrations are measured or if they are taken outside of medical need or therapeutic treatment. There is also an additional risk of impairment associated with combined use with alcohol."

(Impairment) "After drinking [alcohol], the brain works inefficiently, taking longer to receive messages from the eye; processing information becomes more difficult and instructions to the muscles are delayed. Alcohol can slow down reaction time by 10 to 30 per cent. It also reduces ability to perform two or more tasks at the same time.

"Alcohol reduces the ability to see distant objects and night vision can be reduced by 25 per cent. Blurred and double vision can also occur. Ability to perceive what is happening at the roadside is weakened. Loss of peripheral vision could be crucial. Alcohol may also create a sense of overconfidence, with the result that people are prepared to take greater risks."

(Lethal Dose vs Other Drugs) "The lethal dose of alcohol divided by a typical recreational dose (safety ratio) is 10, which places it closer to heroin (6), and GHB (8) in terms of danger from overdose, than MDMA (“Ecstasy” – 16), and considerably more dangerous than LSD (1000) or cannabis (>1000)."

(Interactions With Acetaminophen and NSAIDS) "... we [the U.S. Food and Drug Administration, HHS] have recent data suggesting that acetaminophen may be the most common cause of acute liver failure in the United States (Ref. 13). Therefore,we believe that the word "severe" is appropriate in the liver warning. In addition, we agree with the submission that the word "severe" is also appropriate in the stomach bleeding warning on OTC NSAID [nonsteroidal anti-inflammatory drug] products."
The required labeling for acetaminophen and NSAID products in this Federal Register entry was:
"For products containing acetaminophen:

"Alcohol Warning: If you consume 3 or more alcoholic drinks every day, ask a doctor whether you should take acetaminophen or other pain relievers/fever reducers. Acetaminophen may cause liver damage."

"For products containing NSAIDs:

"Alcohol Warning: If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take (name of active ingredient) or other pain relievers/fever reducers. (Name of active ingredient) may cause stomach bleeding."

(Alcohol Toxicity) "Alcohol thus ranks at the dangerous end of the toxicity spectrum. So despite the fact that about 75 percent of all adults in the United States enjoy an occasional drink, it must be remembered that alcohol is quite toxic. Indeed, if alcohol were a newly formulated beverage, its high toxicity and addiction potential would surely prevent it from being marketed as a food or drug."

Alcohol and Driving

(Driving Impairment) "The findings in this report confirm those from the most recent National Roadside Survey, which in 2007 found that only a small percentage of adult drivers are alcohol-impaired. That survey showed that 2.2% of drivers on the road on Friday afternoon or Friday or Saturday night had a BAC of ≥0.08 g/dL (12). Additionally, the findings in this report are consistent with alcohol-impaired driving fatality data. Men accounted for 81% of all alcohol-impaired driving episodes in 2010 and 82% of all alcohol-impaired drivers involved in fatal crashes in 2009 (1). Likewise, men aged 21–34 accounted for 32% of alcohol-impaired driving episodes and 35% of all alcohol-impaired drivers involved in fatal crashes (Tonja Lindsey, National Highway Traffic Safety Administration, personal communication, 2011)."

(Driving Fatalities) "Alcohol-impaired driving fatalities declined 20% from 13,491 to 10,839 from 2006 to 2009, the most recent year for which fatality data are available (7). However, the proportion of all motor vehicle fatalities that involve at least one alcohol-impaired driver has remained stable at about 33%, because non-alcohol-impaired driving fatalities have declined at the same rate as alcohol-impaired fatalities (7). This study indicated that alcohol-impaired driving rates remain disproportionally high among young men, binge drinkers, persons who do not always wear a seatbelt, and persons living in the Midwest."

(Marijuana, Alcohol, and Driving) "As with cannabis, alcohol use increased variability in lane position and headway (Casswell, 1979; Ramaekers et al., 2000; Smiley et al., 1981; Stein et al., 1983) but caused faster speeds (Casswell, 1977; Krueger & Vollrath, 2000; Peck et al., 1986; Smiley et al., 1987; Stein et al., 1983). Some studies also showed that alcohol use alone and in combination with cannabis affected visual search behavior (Lamers & Ramaekers, 2001; Moskowitz, Ziedman, & Sharma, 1976). Alcohol consumption combined with cannabis use also worsened driver performance relative to use of either substance alone. Lane position and headway variability were more exaggerated (Attwood et al., 1981; Ramaekers et al., 2000; Robbe, 1998) and speeds were faster (Peck et al., 1986).
"Both simulator and road studies showed that relative to alcohol use alone, participants who used cannabis alone or in combination with alcohol were more aware of their intoxication. Robbe (1998) found that participants who consumed 100 g/kg of cannabis rated their performance worse and the amount of effort required greater compared to those who consumed alcohol (0.05 BAC). Ramaekers et al. (2000) showed that cannabis use alone and in combination with alcohol consumption increased self-ratings of intoxication and decreased self-ratings of performance. Lamers and Ramaekers (2001) found that cannabis use alone (100 g/kg) and in combination with alcohol consumption resulted in lower ratings of alertness, greater perceptions of effort, and worse ratings of performance."

(Drunk Driving and Students) "During the 30 days before the survey, 24.1% of students nationwide had ridden one or more times in a car or other vehicle driven by someone who had been drinking alcohol (Table 5). The prevalence of having ridden with a driver who had been drinking alcohol was higher among white female (23.8%) than white male (20.5%) students. Overall, the prevalence of having ridden with a driver who had been drinking alcohol was higher among Hispanic (30.7%) than white (22.1%) and black (22.8%) students; higher among Hispanic female (30.7%) than white female (23.8%) and black female (23.2%) students; and higher among Hispanic male (30.7%) than white male (20.5%) and black male (22.5%) students."

(Marijuana, Alcohol, and Driving) "When compared to alcohol, cannabis is detected far less often in accident-involved drivers. Drummer et al. (2003) cited several studies and found that alcohol was detected in 12.5% to 79% of drivers involved in accidents. With regard to crash risk, a large study conducted by Borkenstein, Crowther, Shumate, Zeil and Zylman (1964) compared BAC in approximately 6,000 accident-involved drivers and 7,600 nonaccident controls. They determined the crash risk for each BAC by comparing the number of accident-involved drivers with detected levels of alcohol at each BAC to the number of nonaccident control drivers with the same BAC. They found that crash risk increased sharply as BAC increased. More specifically, at a BAC of 0.10, drivers were approximately five times more likely to be involved in an accident.
"Similar crash risk results were obtained when data for culpable drivers were evaluated. Drummer (1995) found that drivers with detected levels of alcohol were 7.6 times more likely to be culpable. Longo et al. (2000) showed that drivers who tested positive for alcohol were 8.0 times more culpable, and alcohol consumption in combination with cannabis use produced an odds ratio of 5.4. Similar results were also noted by Swann (2000) and Drummer et al. (2003)."

(History of Drunk Driving) "The first discussion of a relationship between alcohol consumption and motor vehicle collisions to be published in an American scientific journal appeared as an editorial in the Quarterly Journal of Inebriation (1904). The editor had received a communication about 25 fatal crashes of automobile wagons in which 23 occupants died and 14 suffered injuries. Nineteen of the drivers had used alcohol within an hour of the crash. The author of the communication commented that driving automobile wagons was a more dangerous activity for drinkers than driving locomotives. Drinking by on-duty railroad employees had been prohibited since 1843 (Borkenstein, 1985)."

Law and Policies

(Alcohol Industry) "Since there are substantial commercial interests involved in promotion of alcohol’s manufacture, distribution, pricing, and sale,² the alcohol industry has become increasingly involved in the policy arena to protect its commercial interests, leading to a common claim among public health professionals that the industry is influential in setting the policy agenda, shaping the perspectives of legislators on policy issues, and determining the outcome of policy debates towards self-regulation.²"

(History of Alcohol Prohibition) "By all estimates, the Eighteenth Amendment was a costly blunder. Between 1920 and 1930, the federal government spent an average of twenty-one million dollars enforcing the Volstead Act.¹² [the National Prohibition Act - enabling legislation for the 18th Amendment] During the same period, the United States lost an estimated $1.25 billion in potential tax revenues annually.¹³ In spite of the resources consumed by Alcohol Prohibition, it affected only one segment of the nation. National Prohibition cut in half the consumption of spirits by the poor and working classes, but the “consumption of alcoholic beverages by the business, professional and salaried class [was] fully as great . . . as it was prior to prohibition.”¹⁴ While National Prohibition kept the poor dry, it made local organized crime groups wealthy enough to extend their control over entire cities.¹⁵ This success further reflected mainstream America’s implicit rejection of temperance morality. As Al Capone himself so pointedly remarked:

"I make my money by supplying a public demand. If I break the law, my customers, who number hundreds of the best people in Chicago, are as guilty as I am. The only difference between us is that I sell and they buy. Everybody calls me a racketeer. I call myself a business man. When I sell liquor, it’s bootlegging. When my patrons serve it on a silver tray on Lake Shore Drive, it’s hospitality."

(Heavy Alcohol Use Among Military Personnel) "Heavy alcohol use in the past 30 days decreased between 1980 and 1988, remained relatively stable with some fluctuations between 1988 and 1998, showed a significant increase from 1998 to 2002, and remained at that same level in 2005 (19%) and 2008 (20%). However, taken together, heavy alcohol use over the decade from 1998 to 2008 showed an increasing pattern (15% to 20%). The heavy drinking rate for 2008 (20%) was not significantly different from when the survey series began in 1980 (21%)."

Adolescents and Alcohol

(Widespread Availability) "The presence of alcohol in almost all of the polydrug-use repertoires and among all of the different populations addressed is one of the key findings of this ‘Selected issue’. Alcohol is almost always the first drug with strong psychoactive and mind-altering effects used by young people, and its widespread availability makes it the ever-present drug in substance combinations among young adults, particularly in recreational settings."

(Alcohol Use Among 12th graders) "Frequent alcohol use is also considerably more prevalent among the non-college-bound. For example, daily drinking is reported by 4.1% of the non-college-bound 12th graders versus 1.6% of the college-bound. Binge drinking (five or more drinks in a row at least once during the preceding two weeks) is reported by 27% of the non-college-bound 12th graders versus 20% of the college-bound. There are also modest differences between the non-college-bound and college-bound 12th graders in lifetime (75% vs. 69%), annual (69% vs. 62%), and 30-day (45% vs. 39%) prevalence of alcohol use."

(Alcohol Use and Socioeconomic Status) "The picture for alcohol use among 12th graders is similar to the one described earlier for marijuana use: that is, little difference in 30-day prevalence rates across the SES [socioeconomic status] strata, except that the lowest stratum has fairly consistently had a lower prevalence than all the others, and all strata have moved approximately in parallel. The story for 12th-grade binge drinking is similar."

(Lifetime Prevalence of Alcohol Use by Students) "Nationwide, 70.8% of students had had at least one drink of alcohol on at least 1 day during their life (i.e., ever drank alcohol) (Table 41). The prevalence of having ever drunk alcohol was higher among black female (66.1%) than black male (60.9%) students. Overall, the prevalence of having ever drunk alcohol was higher among white (71.7%) and Hispanic (73.2%) than black (63.5%) students; higher among Hispanic female (74.1%) than black female (66.1%) students; and higher among white male (72.3%) and Hispanic male (72.4%) than black male (60.9%) students."

(Alcohol Prevalence Among Adolescents) "Alcohol use is more widespread than use of illicit drugs. Seven out of ten 12th-grade students (70%) have at least tried alcohol, and four out of ten (40%) are current drinkers—that is, they reported consuming some alcohol in the 30 days prior to the survey (Table 4-2). Even among 8th graders, the proportion of students reporting any alcohol use in their lifetime is one third (33%), and about one eighth (13%) are current (past 30-day) drinkers.⁴⁷
"• Of greater concern than just any use of alcohol is its use to the point of inebriation: in 2011, 15% of 8th graders, 36% of 10th graders, and 51% of 12th graders said they have been drunk at least once in their lifetime. The prevalence rates of self-reported drunkenness during the 30 days immediately preceding the survey are strikingly high — 4%, 14%, and 25%, respectively, for grades 8, 10, and 12.
"• Another measure of heavy drinking asks respondents to report how many occasions during the previous two-week period they had consumed five or more drinks in a row. Prevalence rates for this behavior, which is also referred to as binge drinking or episodic heavy drinking, are 6%, 15%, and 22% for the three grades, respectively.⁴⁸"

(Under-Age Use of Alcohol and Other Drugs) "In 2006, more than one third (35.8 percent) of persons aged 12 to 20 who used alcohol in the past month also had used an illicit drug in the past month, and 16.0 percent of underage drinkers used an illicit drug within 2 hours of using alcohol on their last occasion of alcohol use.
"Marijuana was the illicit drug most used by underage drinkers, with nearly one third (30.0 percent) having used marijuana in the past month, and 15.0 percent having used marijuana within 2 hours of their last alcohol use."

(Payment for Alcohol) "Among all underage current drinkers, 31.0 percent paid for the alcohol the last time they drank, including 9.3 percent who purchased the alcohol themselves and 21.6 percent who gave money to someone else to purchase it. Underage persons who paid for alcohol themselves consumed more drinks on their last drinking occasion (average of 5.9 drinks) than did those who did not pay for the alcohol themselves (average of 3.9 drinks).
"More than one in four underage drinkers (25.8 percent) indicated that on their last drinking occasion they were given alcohol for free by an unrelated person aged 21 or older. One in sixteen (6.4 percent) got the alcohol from a parent or guardian, 8.3 percent got it from another family member aged 21 or older, and 3.9 percent took it from their own home."

(Youth Exposure to Prevention Messages) "In 2011, approximately one in eight youths aged 12 to 17 (11.7 percent) reported that they had participated in drug, tobacco, or alcohol prevention programs outside of school in the past year. This rate was similar to the 11.5 percent reported in 2010, but was lower than the rate reported in 2002 (12.7 percent). In 2011, the prevalence of past month use did not differ significantly between those who did or did not participate in these programs for illicit drugs (10.8 and 9.9 percent, respectively), marijuana (7.5 and 7.9 percent), cigarettes (6.8 and 7.8 percent), or binge alcohol use (6.9 and 7.5 percent).
"• In 2011, 75.1 percent of youths aged 12 to 17 reported having seen or heard drug or alcohol prevention messages in the past year from sources outside of school, which was similar to the 75.9 percent reported in 2010, but was lower than the 83.2 percent reported in 2002 (Figure 6.6). In 2011, the prevalence of past month use of illicit drugs among those who reported having such exposure (10.0 percent) was not significantly different from the prevalence among those who reported having no such exposure (10.2 percent)."

(Alcohol and Other Drug Involvement in Criminal Offenses at Schools and Colleges) "Table 9 provides the reported instances in each offense record in which the offenders were suspected of using alcohol, computers, and/or drugs.²² The data show that such use was minimal in situations occurring at schools during the 5-year study period. Of the 589,534 offense records, reports of offenders suspected of using drugs totaled 32,366, while reports of alcohol use totaled 5,844."