The leading substance abuse threat to children may be as close as your refrigerator.

“Alcohol is far and away the top drug of abuse by America’s teens,” says Joseph A. Califano Jr., chairman and president of the National Center on Addiction and Substance Abuse at Columbia University. “By any public health standard, America has an epidemic of underage drinking.”

About 10 million adolescents drink alcohol. Nearly half of them binge drink, having five or more drinks at a time. In fact, minors drink 19 percent of the alcohol consumed in the United States.

Flavored alcoholic beverages are popular among underage drinkers, says the National Institute on Drug Abuse. In 2003, 56 percent of high school seniors reported that they had consumed these beverages.

Surveys show boys usually take their first drink at age 11 and girls at age 13. Alcohol offers a fast way to lose inhibitions, fit in and feel good. But alcohol impairs judgment, a big problem for youths who already lack experience, and alcohol intoxication can be fatal. It also can interfere with a girl’s reproductive development in puberty, causing ovarian damage.

“Parents tend to see drinking and occasional bingeing as a rite of passage, rather than a deadly round of Russian roulette,” Mr. Califano says. The toll includes:

  • Health damage. Anyone who drinks a lot faces heart and central nervous system damage, cirrhosis and cancer of the liver, stroke and risk for overdose. Heavy drinking can hamper brain development, memory and learning ability.
  • Alcoholism. People who begin drinking before age 15 are four times more likely to become alcohol-dependent than those who wait until 21.
  • Fatal accidents. Experts blame alcohol for many drownings and traffic deaths involving teens. “Drinking is teen America’s fatal attraction,” Mr. Califano says.
  • Violence. Underage drinkers are more likely to commit or be victims of violent crime.
  • Sexual activity. Adolescents who use alcohol are more likely to be sexually active at an earlier age and have unprotected sex.
  • Suicide. Teen drinking has been linked with contemplating or committing suicide.
  • School performance. High school students who drink are more likely to drop out of school and disdain good grades. Parents who suspect a problem should talk with their child and see a doctor or counselor.

Signs of trouble

  • Odor of alcohol
  • Sudden change in mood or attitude
  • Change in school attendance or performance
  • Loss of interest in school, sports, or other activities
  • Discipline problems
  • Withdrawal from family and friends
  • Secretive behavior

Making a difference

The best way to influence your child to avoid drinking is to have a strong, trusting relationship with him or her, says the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Studies have found that children are less likely to begin drinking if they feel close to their parents. With a strong parental tie, they are less likely to go along with peer pressure to drink, and will strive to meet the parents’ expectations not to drink.

Here are several suggestions from the NIAAA on building a strong relationship:

  • Encourage your teen to talk openly with you. Foster good communication.
  • Show that you care. It’s important that teens know their parents still care about them. Make time to share activities one-on-one with your child.
  • Establish firm, realistic rules for acceptable behavior and follow through with them. Teens need to know there are consequences for their actions.
  • Be accepting. Support your teen’s efforts as well as accomplishments. Avoid teasing that’s hurtful.
  • Don’t forget that your teen is growing up. You need to stay involved in your teen’s life, but still respect his or her growing independence and need for privacy.