That it [wine] be not given to Youths, as from 14 years of age unto 25, for wine is unto the most repugnant; because it doth above measure heat their hastie, hot, and agitating nature, and extimulate them (like mad men) unto enormious and outragious actions.

(Rules to live a long and healthy life by Dr Th. Venner, 1650)1

National surveys in Western societies, such as the United States, 2 Great Britain, 3 and the Netherlands 4 have shown that experimentation with potentially risky behaviors, such as cigarette smoking, marijuana use, and alcohol consumption, is usual among adolescents. For example, in these studies, only 10% to 15% of late adolescents reported abstaining from alcohol. Indeed, nonexperimentation, particularly in the older age categories, might be considered statistically deviant. 5 The widespread uptake of alcohol in adolescence focuses attention on the tasks to be realized in the teenage years. One of the most prominent issues in the teenage years concerns the development and maintenance of friendships and romantic relationships. In particular, adolescents seek company with their peers in specific situations outside the parental home. Many leisure-time activities of adolescents take place in alcohol-related settings, such as bars, night clubs, and parties. Furthermore, a part of the normal maturation process consists of adopting adult-like attitudes and behaviors. Because most adults consume alcohol, it is not surprising that young people adopt this habit. In this respect, behaviors such as drinking, smoking, and sexual experiences are "not necessarily irrational, perverse or pathological; for adolescents, such behaviors can fulfill important goals and can be an essential aspect of psychosocial development"6^(p335) Therefore, occasional drinking may be a manifestation of developmentally appropriate experimentation. 7

The view that experimentation with alcohol is a normal phenomenon in adolescence conflicts with earlier research indicating that drinking reflects psychologic maladjustment. 8 In these models, poor functioning in the family or at school is expected to result in low self-worth and distress as well as poor functioning in peer networks. Eventually, these youngsters look for company in which they feel save and secure, which, according to the authors, are also more often deviant youth. These studies assume a linear relation between substance use and psychologic health and suggest that the abstainers are the most well adjusted of adolescents. However, Shedler and Block 7 object to this line of reasoning and postulate that there is a curvilinear relationship between substance use and psychological well-being. In a longitudinal survey of 101 American youngsters, Shedler and Block found that both abstainers and frequent marijuana users report serious difficulties. Children who are under emotional stress and are unable to form satisfying relationships are more likely to be frequent marijuana users as adolescents. On the other hand, the researchers describe an abstainer as "A child which is relatively overcontrolled, timid, fearful and morose . . . and they are not warm and responsive, not curious and open to new experiences, not active, not vital and not cheerful"7^(p620) It is possible that these curves are different for alcohol. However, studies by Jones 9 and Pape and Hammer 10 indicated similar patterns for drinking. For example, in a Norwegian longitudinal survey of 1,462 young adults, both early and late male starters of drinking reported lower levels of self-esteem and more feelings of depression than those who followed the mainstream. 10 An explanation for the deprived position of abstainers is that they are not engaged in behaviors that are rather normative in adolescence and they, therefore, refrain from the positive social features of drinking.

In this article, I examine the functions of drinking for adolescents more closely and discuss a framework of the facilitating functions of drinking by highlighting studies on these issues. Drinking has several functions. First, drinking is related to several characteristics of the intensity and quality of friendships. Second, adolescent alcohol use is related to dating and involvement in romantic relationships. Third, drinking is associated with psychologic developmental tasks in adolescence, such as enhancement of autonomy and formation of identity. Fourth, adolescent alcohol use is associated with the separation process from parents. Fifth, alcohol use may, through its social features, increase feelings of self-esteem and decrease feelings of stress and loneliness among adolescents. Finally, drinking may involve discovering some of the boundaries in life, exemplified by risky behaviors, such as minor delinquent acts, smoking, drinking and use of "soft" drugs. The different perspectives are not entirely mutually exclusive. For instance, an adequate integration in a peer network is, of course, one of the developmental tasks to be accomplished in the adolescent years.

Understanding the causes of adolescent drinking helps to prevent the consequences of alcohol misuse. If, from an adolescent perspective, "pub going" is more than just drinking alcohol, preventive efforts that do not take this into account are likely to have limited effects for two reasons. First, young people will find it hard to believe that drinking is portrayed as something bad that should be prevented at any cost because they have other more positive experiences. Second, young people will find it difficult to identify themselves with advertisements or educational information if drinkers are described as antisocial, criminal, or aggressive. In addition, strategies that reduce the availability of alcoholic beverages, for instance, by raising the minimum age for entering public drinking places, could have negative side effects if drinking, or the setting in which alcohol use takes place, is functional to adolescents.

Friendships

The transition from adolescence to adulthood is accompanied by intensified contacts with peers and an entrance into new social contexts and activities. 11 The concerns that adolescents have to achieve intimacy goals, such as closeness and trust, are redirected from parents toward peers. It is essential for them to come in contact with new friends or strengthen existing bonds. In this way adolescents can reflect their own ideas, opinions, and emotional development. 12,13 When youngsters are asked what motives they have for drinking, they often mention the social aspects of drinking. Adolescents believe drinking makes parties more fun, it makes one more relaxed, and it makes it easier to approach others and to share feelings and experiences. Research on alcohol expectancies has shown that the expected reinforcing social elements of drinking alcohol are related to, and predictive of, frequency and quantity of adolescent alcohol use. 14,15 In the eyes of the beholder, drinking alcohol is related to sociability and connected to social events. Some data support that drinking has a social function. An Australian study 16 reported that moderate drinking was a normative behavior for the well-adjusted and socially integrated young adult. In a study of Swedish conscripts, Leifman et al 17 reported that abstainers were less sociable than drinkers (ie, light, moderate, and heavy drinkers). Pape, 18 Reid, 19 and Silbereisen and Noack 20 reported that abstainers spent less time with their friends and were less likely to have a close friend. Pape also indicated that abstainers had poorer social skills than drinkers. A Dutch study among 16- to 24-year-olds also showed that sociability was positively related to the frequency of drinking. 21 Thus, there is substantial support for the assumption that young people who drink alcohol are more sociable, more integrated in their peer group, have better peer relations, and experience fewer feelings of loneliness.

Dating and Intimate Relationships

Love and romance are of major concerns for young people. In this period of life, they become interested in the opposite sex and have their first dates and sexual encounters. Although sexual experiences go along with associated problems, such as unsafe sex, sexually transmitted diseases, and unwanted pregnancy, the development of intimate relationships has important beneficial aspects for young people. For instance, they discuss their problems and worries with their partners and learn specific communication skills. In addition, young people with romantic experiences are happier, more satisfied, and further along in their emotional development. 22,23 The initiation of intimate relationships can be seen, just like drinking, as one of the behaviors marking the transition from childhood to adolescence. Only a few studies have examined the relations between drinking and involvement in intimate relationships. In longitudinal surveys, Engels and Knibbe 24 and Pape and Hammer 10 have shown that abstainers, or late starters, were less likely to have a steady partner compared with drinkers. It is important to mention that the link between drinking and romantic relationships has to do with the context of use. Pubs, night clubs, and parties are places where young people go to meet the opposite sex and look for opportunities to establish a relationship or have romantic affairs. These are also the settings in which the majority of adolescent alcohol consumption occurs. 25

Relationships With Parents

At approximately the same time as youngsters seek integration in the peer group, they are inclined to distance themselves from the social control of parents and other authorities. Relationships with parents change due to processes of maturation and autonomy. Many researchers have focused on the separation-individuation process of adolescents. 26,27 The general view is that children separate themselves from their parents and search for peer company but, at the same time, are inclined to keep the good relationship with their parents (for instance, they still discuss important career issues with their parents). In this developmental perspective, some separation from parents is an important step in the adolescent maturation process. 28 Changes in orientations and leisure-time expenditure are ways the adolescents distance themselves. Going out with friends without the company of parents or other adults becomes an important way of spending leisure time, particularly during the weekends. Not surprisingly, these are the moments that the adolescents consume alcohol. We know little about the role alcohol plays in changes in parent-child interactions and communication. In a longitudinal study by Jessor and Jessor, 29 young drinkers were less involved with and bonded to their parents and experienced less influence from traditional institutions compared with abstainers. Furthermore, Davies and Stacy 30 reported that young abstainers were more likely to agree with and to be controlled by their parents on topics that potentially were fraught with conflict.

Developmental Tasks

The adolescent years are characterized by an increasing attention to adult-like behaviors and opinions. 31 By looking at how adults act and how they are portrayed in the media, teenagers learn about the norms and values of adults. Because drinking is rather normative behavior among adults in most Western societies, youngsters adopt it. In other words, starting to drink is one of the ways they orientate to the adult world. Drinking is not a unique characteristic connected to youth cultures but is a reflection of societal norms and values. In addition, drinking creates an opportunity for adolescents to undertake activities without their parents, and drinking also distinguishes them from the younger generation. Drinking may also be related to other transition behaviors, such as financial independence through a job, an interest in future positions in society, dating, mating, and leaving the parental home. 18,32

Other psychologic changes in adolescent lives involve gaining autonomy, forming identity, and getting a clear self-definition. 33-35 Coming out from under the wings of their parents makes adolescents more independent and mature. In particular, more intensive contacts with friends and partners lead to enhanced feelings of autonomy and the impression that they are able to handle things on their own. Having a job and creating opportunities to fulfill emotional and social needs outside the parental home results in feelings of autonomy. Attendance in alcohol-related settings builds opportunities to fulfill the needs for independence. 36 Regarding identity formation, Jones and Hartman 37 showed that average drinking levels in adolescents are related to a more mature and sophisticated identity statute. Youngsters with low and high consumption levels were more likely to have a "diffused" identity.

Psychologic Well-being

Drinking and pub going by adolescents can be seen as a collectively appreciated time-out situation in which it is legitimate to forget the everyday obligations. Furthermore, it facilitates the sharing of activities, experiences, and emotions with peers. The exchange of common experiences and the knowledge that others are in a similar position positively affects youngsters' well-being. 38 For instance, engagement in social activities with friends is associated with healthier emotional functioning. 39 It follows that if the potential advantages of entrance in alcohol-related settings for this age group are considered, not entering these types of settings might be related to loneliness, isolation, and stress. Perhaps people who do not drink on a regular basis have fewer opportunities to relieve their daily stress or to associate with peers. This point of view is related to the ideas of Pape and Hammer 10 on alcohol abstinence in late adolescence and young adulthood. They emphasize that alcohol use is the norm for people in this period of life. Deviating from the mainstream is associated with negative aspects, such as a lack of social integration as well as low self-esteem and feelings of depression.

Testing the Limits

Shedler and Block 7 found that young Americans who are not curious and open for new experiences are more likely to refrain from substance use in the adolescent years. Because it is atypical and nonnormative for youngsters to remain abstainers, this nondrinking could be perceived as indicative of fear of losing control, being timid, and suffering from a lack of "normal" sensation seeking. Some indirect support for this assumption has been found. It is widely known that certain forms of substance use and delinquent behaviors co-occur. For example, those who abstain from drinking are also less likely to smoke, to experiment with marijuana, to commit minor criminal acts, and to be truants or rebels at school. 2 Thus, in some individuals, abstinence is a sign of a relatively sober and conservative lifestyle without many risk-taking behaviors.

This does not imply that we should ignore adolescent drinking or that we should stimulate youngsters to drink alcohol. First and foremost, our concern should be directed to identify adolescents who do not drink for social reasons but who drink to forget feelings of stress and depression or a lack of self-esteem; who drink heavily and irresponsibly, with accompanying adverse results such as aggression, violent acts, sexual harassment, or drunk driving; or to help those who continue their high levels throughout young adulthood and become problem drinkers. Parents and policy makers should worry less about the majority of adolescents who drink moderately and more about adolescents who do not. Moreover, we stress the need to approach subpopulations of adolescents differently.

Remaining Tasks

CONTEXT OF DRINKING

Much research remains to be done on alcohol and teenagers. First, should the social features of alcohol consumption be attributed to drinking itself or to the situations in which young people use alcohol? From the age of 14 or 15 years onward, the majority of young people go out to bars, night clubs, and parties with their friends and dates. 40,41 The attendance at these settings goes hand-in-hand with alcohol consumption. For example, a Dutch study of 16- to 24-year-olds showed that one of the strongest predictors of adolescent alcohol use was the frequency of pub going. 25 This supports the hypothesis that these functions may be strongly related to the situation. On the other hand, it is common knowledge that after a few drinks, people feel more free and assertive to approach, for instance, potential partners. Perhaps it is a combination of some of the properties of the beverage as well as the specific setting that accounts for the relation between drinking and social benefits.

QUESTIONS OF CAUSALITY

Most studies have used cross-sectional data to examine the correlates of drinking. It is difficult to draw conclusions with respect to the causal nature of different processes. For instance, is the increase of youngsters' social networks a result of drinking and visits to public drinking places, or are those who are well integrated in their peer group more likely to meet each other in social settings such as pubs and night clubs? Furthermore, what are the effects of prolonged abstinence or prolonged drinking. For example, adolescents who do not drink might be late maturers. Thus, some of the differences in social and emotional development may disappear if adolescents were reinterviewed in their mid-20s. 32 On the other hand, some adolescents do not experience important normative changes that occur in most adolescents. They may encounter problems with formation of peer relationships or with detachment from the family. Future research should explore aspects of etiology in more detail before conclusions concerning the relative position of abstainers, moderate drinkers, and heavy drinkers can be made.

HETEROGENEITY OF ABSTAINERS

The category of abstainers is probably heterogeneous. Abstainers comprise isolated youngsters with few peer contacts outside the parental home who are unsatisfied because they want to spend time with others and belong to a peer group. However, people may not consume alcohol for several reasons. For example, young athletes might be abstaining because they want to continue their healthy lifestyle but could have a good social life as well. In addition, abstinence could be a feature of a lifestyle that is labeled as positive in certain subpopulations. 42 For instance, certain religious movements have regulations that do not allow alcohol consumption. Therefore, those who participate in these movements may not drink but may indeed be adequately integrated in a social network. They are not considered deviant by not drinking. In contrast, problems may occur if individuals do not follow the rules and start drinking. Another reason for not drinking is related to physical health. It is possible that young people with, for instance, a chronic disease are more often abstaining and also score higher on psychologic maladjustment assessments. 43 In this group, the relation between abstinence and maladjustment cannot be attributed to the deprived social situation of these youngsters. Until recently, most studies did not pay much attention to the heterogeneity of the category of abstainers.

The shortcomings in the studies on beneficial aspects of drinking are evident. Nonetheless, so far the research findings underscore the social and developmental aspects of adolescent drinking. Prevention efforts that ignore the positive aspects of drinking are likely to fail.

Implications for Prevention

Although research on the beneficial functions of drinking is considered preliminary, it is relevant to raise a few issues regarding the prevention of alcohol misuse and its consequences. First, the majority of late adolescents consume alcohol in Western societies, implying that drinking is not only a socially acceptable behavior but also normative. Youngsters who do not drink are exceptional. Therefore, health education that aims to discourage adolescents from drinking will have limited effects. Furthermore, insights in the positive aspects of drinking emphasizes that prevention focusing on the negative effects of alcohol and neglecting some beneficial functions are not convincing for the target group. Therefore, if one would plan to lower the prevalence of binge drinking or drunk driving, it is essential to think more thoroughly about how to deal with different motives of people for their going-out and drinking behavior.

Many alcohol-prevention programs in the United States and Europe aim to teach secondary school students social skills to resist peer pressure. 44 Basically, these programs assume that people use and misuse alcohol because they lack social competence. However, the recent findings that are depicted suggest that sociable and well socially integrated youngsters in particular drink alcohol, countering these assumptions. Still, these programs may be helpful in targeting youngsters who are prone to drink heavily under the strong influence of friends. It is, however, not likely that social skill-enhancing programs will have significant effects on the reduction of overall drinking levels because they are not based on the correct premises. 45

Legislation to discourage adolescent drinking by, for example, raising the minimum age for access to public drinking places, could even have some negative consequences. Young people will still seek opportunities to meet each other and may end up in places (in the street, shopping centers, at a friend's home without the company of adults) in which alcohol consumption is even less controllable than in pubs and night clubs. Although it is paradoxical, the drinking habits of adolescents are concentrated in specific public settings, which may be encouraging. One strategy to reduce levels of alcohol use could be to change aspects of the drinking situation while maintaining the purpose of the setting.

Young people have different reasons for alcohol use. A large portion of the adolescents visit pubs, night clubs, and parties and, subsequently, drink alcohol for social reasons. 41,46 They are in control of their drinking behavior and are not at risk for any acute or chronic health consequences. Teenagers who view drinking places as primarily related to alcohol and who also have robust and positive (mis)beliefs about the effects of alcohol, may be those with high consumption patterns and problems later in life. A second group at risk is youngsters who drink for nonsocial reasons. It is well known that some youngsters use alcohol to alleviate feelings of anxiety, depression, loneliness, or stress. 47 In particular, when adolescents adopt the idea that a solution to their problems can be found in a bottle, they could be at risk for developing alcohol problems later in life. 48 A third group of risk-prone adolescents are those who drink heavily, particularly in large male groups, and become violent and aggressive after a night of drinking. With respects to the negative aspects of drinking, health-education interventions that concentrate on risk-prone categories of youngsters are more effective in the prevention of certain side effects than school-based programs, which only concentrate on youngsters in general.

REFERENCES