Alcohol consumption among young people raises concern among health professionals

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The Brazilian Institute of Geography and Statistics (IBGE), a major research organization in the country, released a new report with unprecedented analyzes on experimentation and consumption of alcohol among adolescents in the 9th grade of elementary school (14 to 15 years-old).

Deepening the analysis of the 2019 Brazilian National Health Survey (PNS), a new study investigated alcohol abuse by young people and the factors related to this pattern.

Global Burden of Alcohol-Related Diseases Among Youth

Alcohol consumption among adolescents has been a persistent public health concern worldwide. Recently, a comprehensive study published in BMJ Open offered important insights into the global burden of alcohol-related diseases among youth aged 10 to 24. This study, combined with other recent research, provides a detailed picture of how alcohol consumption affects adolescent and young adult health globally.

Alcohol consumption among adolescents is one of the leading global public health concerns. A recent study published in the prestigious journal BMJ Open revealed alarming data on how alcohol affects youth health worldwide, analyzing information from 204 countries between 1990 and 2019 (1).

Key Findings from the Study

A 2019 analysis found that alcohol was responsible for 59,855 deaths among youth aged 10 to 24, while other drugs caused 16,391 deaths. Alcohol accounted for 5.9 million years of life lost due to premature death or lived with disability, compared to 4.1 million related to other drugs.

Gender Disparities

The study revealed a troubling disparity: young men are significantly more affected by alcohol-related issues than young women. While alcohol-related problems have declined for both sexes since 1990, drug-related issues among young men are on the rise.

Regional Overview: A Divided World

• Eastern Europe: Leads in alcohol-related problems
• North America: Highest rates of drug-related issues
• High-income countries: Paradoxically show higher burdens of substance-related disease

This relationship between economic development and alcohol problems suggests that greater access and purchasing power may inadvertently increase risk.

Behavioral Profiles Among European Adolescents

Complementing the global data, an analysis of 15-year-olds in five European countries (England, Italy, the Netherlands, Hungary, and Finland) identified four behavioral profiles (2):

1. Generally unhealthy (multiple risk behaviors)
2. Generally healthy (low risk overall)
3. Moderately healthy
4. Abstainers with other risks (avoid substances but face other challenges)

The Good News are: there has been a significant reduction in the proportion of youth in the “generally unhealthy” group in all countries—especially in England, where it dropped by 22.8 percentage points.

Evidence of Declining Alcohol Use

A systematic review (rated low to moderate in methodological quality by JBI criteria) analyzed trends in alcohol-related harm in high-income countries where adolescent alcohol use has declined. The findings:

• 62% of records from Anglophone countries reported declines in alcohol-related harm
• 36% in North America showed declines
• 31% in continental Europe indicated decreases

Gender Differences in Harm Trends

• Men: Consistently showed decreases or stabilization in alcohol-related harm
• Women: Some populations—especially in university settings—showed increased alcohol-related harm

Major Health Consequences of Alcohol Use in Adolescents

Alcohol use among teens is linked to:

• Alcohol use disorders
• Self-harm and interpersonal violence
• Traffic injuries
• Tuberculosis (particularly in low-income regions)
• Brain development issues

Signs of Progress

Despite the concerning numbers, there are reasons for optimism:

• Global decline in adolescent alcohol use since 1990
• Reduction in alcohol-related deaths in various regions
• Greater awareness of alcohol risks among youth

Improvements in adolescent health indicators are largely due to simultaneous declines in alcohol, tobacco, cannabis use, and sexual activity. However, these positive trends are not always linked to broader improvements in other health domains.

Ongoing Challenges

Vulnerable Populations

The systematic review found that although harm has decreased in most countries, some female and student populations have experienced increased alcohol-related harm—highlighting the need for targeted interventions.

Regional Differences

No one-size-fits-all solution exists. Evidence is strongest in Anglophone countries, followed by North America. In continental Europe, findings are more mixed and contradictory.

What Needs to Be Done: Evidence-Based Recommendations

• Targeted prevention programs for vulnerable groups, especially young women and university students
• Region-specific policies considering cultural and socioeconomic contexts
• Ongoing monitoring of consumption patterns and harm indicators
• Integrated approaches addressing multiple risk behaviors

Conclusion

The BMJ Open study paints a complex picture: while global adolescent alcohol use is declining, it remains one of the leading causes of death and disability among young people. The situation is particularly severe for young men and varies greatly by region.

Evidence shows that alcohol-related harm is declining in many high-income countries, especially Anglophone nations. However, rising trends among certain female and student populations underscore the need for continued vigilance.

Analyses of European countries demonstrate that change is possible through well-designed policies, with significant reductions in risk behaviors among teens. Moving forward requires tailored approaches that account for gender, age, and socioeconomic differences.

References:

1. Li, J., Li, X., Shen, Y., Yang, X., & Liu, T. (2025). Global burden attributed to alcohol and drug use among adolescents and young adults, 1990–2019: results from the Global Burden of Disease Study 2019. BMJ Open, 15, e093412. doi:10.1136/bmjopen-2024-093412.
2. Stevely, A. K., Gray, L. A., Fairbrother, H., Fenton, L., Henney, M., Kersbergen, I., & Holmes, J. (2024). A latent class analysis of international change and continuity in adolescent health and wellbeing: A repeat cross-sectional study. PLoS ONE, 19(6), e0305124. https://doi.org/10.1371/journal.pone.0305124
3. Miziara, I. D., & Miziara, C. S. M. G. (2023). Suicide victims and alcohol-related consumption in Brazil: An observational study and a narrative review of the literature. Forensic Science, Medicine and Pathology. https://doi.org/10.1007/s12024-023-00766-

LGBTQIAPN+ Youth and Psychoactive Substance Use: What Brazilian Data Reveal

From adolescence onward, LGBTQIAPN+ youth often face experiences marked by rejection, discrimination, invisibility, and a lack of support in environments that should provide safety and acceptance. These experiences can have lasting consequences, one of which—documented by decades of international research—is an increased vulnerability to substance use. Until recently, however, Brazil lacked national data demonstrating how this reality unfolds within its own unique social, cultural, and structural context. A study published in 2025 has begun to fill this gap, providing important new evidence on an issue that affects the health and well-being of millions of Brazilian adolescents and young adults.

Substance use during adolescence is one of the most important public health concerns worldwide. Adolescence is a developmental period characterized by profound neurological, emotional, and social changes that make the brain particularly vulnerable to the effects of psychoactive substances and to the development of problematic patterns of use that may persist into adulthood. Among sexual and gender minority youth, this vulnerability is even greater. Previous research has consistently shown that adolescents who identify as lesbian, gay, bisexual, transgender, queer, and other sexual and gender minorities are at increased risk for substance use. Specifically, queer adolescents are approximately 190% more likely to use illicit drugs than their heterosexual peers.²˒³

Most of the available evidence has come from high-income countries, particularly the United States and Europe. A study published in 2025 in the International Review of Psychiatry helps address this knowledge gap by providing Brazilian data, and its findings deserve careful attention.¹ Researchers analyzed data from 1,492 participants between 12 and 21 years of age. Of these, 247 (16.6%) identified as LGBTQIAPN+, while 1,245 (83.4%) identified as cisgender heterosexual. The study compared lifetime prevalence and age at first use of alcohol, tobacco, cannabis, and cocaine between the two groups.

Lifetime Prevalence of Substance Use

The findings revealed important differences between the groups. Lifetime alcohol use was similar, reported by approximately 84% of cisgender heterosexual participants and 86% of LGBTQIAPN+ participants. Marked differences emerged, however, for other substances:

• Tobacco: Lifetime use was reported by 48% of LGBTQIAPN+ youth, compared with 36.8% of cisgender heterosexual youth.
• Cannabis: Lifetime use was reported by 40.4% of LGBTQIAPN+ participants, compared with 27% of cisgender heterosexual participants.
• Cocaine: Lifetime use was reported by 7.4% of LGBTQIAPN+ youth, compared with 3.6% of cisgender heterosexual youth—more than twice the prevalence observed in the comparison group.

These differences are already substantial when considering the LGBTQIAPN+ population as a whole. However, the findings become even more informative when participants are analyzed according to their sex assigned at birth.

What Changes Among Individuals Assigned Female at Birth?

One of the study's most important findings is that the observed disparities were driven primarily by participants assigned female at birth. Among those assigned male at birth, differences between LGBTQIAPN+ and cisgender heterosexual participants were not statistically significant. In contrast, among those assigned female at birth, the disparities were pronounced:

• Tobacco: Lifetime use was reported by 49% of LGBTQIAPN+ participants, compared with 34.2% of cisgender heterosexual participants.
• Cannabis: Lifetime use was reported by 44.3% of LGBTQIAPN+ participants, compared with 23.3% of cisgender heterosexual participants—nearly twice the prevalence.
• Cocaine: Lifetime use was reported by 7.4% of LGBTQIAPN+ participants, compared with 2.4% of cisgender heterosexual participants, representing more than a threefold higher prevalence.

When participants were further classified according to sexual orientation, bisexual individuals assigned female at birth exhibited the highest lifetime prevalence of alcohol, tobacco, cannabis, and cocaine use compared with heterosexual women. No statistically significant differences were observed among lesbian participants or other sexual minority subgroups.

Earlier Initiation of Substance Use

The study also found that lifetime prevalence of substance use increased progressively with age in both LGBTQIAPN+ and cisgender heterosexual participants. However, LGBTQIAPN+ youth reported initiating alcohol use at younger ages. Among LGBTQIAPN+ participants, 8.7% reported consuming alcohol by age 10, compared with only 1.9% of cisgender heterosexual participants.

Cannabis use was particularly higher among LGBTQIAPN+ participants between 14 and 18 years of age, with 26.5% reporting use compared with 7.5% among cisgender heterosexual youth. Cocaine use remained uncommon during early adolescence but increased considerably among older LGBTQIAPN+ participants.

Why is this important? Because age at first substance use is one of the strongest predictors of future risk. The earlier an individual begins using psychoactive substances, the greater the likelihood of developing substance use disorders, psychiatric comorbidities, and persistent patterns of problematic use later in life.

Implications for Prevention and Public Health

The study's findings highlight the need for prevention strategies that recognize the specific experiences and vulnerabilities of LGBTQIAPN+ youth. The evidence reinforces previous research showing that LGBTQIAPN+ adolescents who experience discrimination related to their sexual orientation or gender identity report higher rates of substance use. Addressing stigma, discrimination, and structural exclusion should therefore be viewed not only as a matter of social justice but also as a public health priority. Experiences from other vulnerable populations similarly demonstrate that, when individuals are unable to access appropriate support and acceptance, psychoactive substances may become a means of coping.

Within the Brazilian context, this study makes an important contribution by providing longitudinal evidence from a middle-income country on a topic that has received relatively little investigation. Its findings confirm patterns previously observed in international studies and demonstrate that disparities in substance use among LGBTQIAPN+ youth are not unique to particular cultural settings.

Importantly, the purpose of these findings is not to stigmatize LGBTQIAPN+ adolescents or reinforce prejudice of any kind. Health disparities do not arise from sexual orientation or gender identity themselves; rather, they reflect the consequences of exclusion, violence, discrimination, and inadequate social support. Robust evidence such as that presented in this study underscores the importance of ensuring equitable access to evidence-based public policies and high-quality healthcare services designed to reduce the health disparities experienced by LGBTQIAPN+ populations.

References:

1. Figueiredo CPM, Bezerra HA, Miguel EC, Rohde LA, Salum GA, Pan PM, Caye A. Patterns of substance use and initiation among LGBTQIAPN+ youth in Brazil: Evidence from a population-based cohort. Int Rev Psychiatry. 2025;37(6–7):639–650. doi:10.1080/09540261.2025.2573758
2. Brown E, Abdelmassih E, Hanna F. Avaliando os determinantes do uso de substâncias em adolescentes LGBTQIA+: uma revisão de escopo. International Journal of Environmental Research and Public Health . 2024; 21(12):1579. doi.org/10.3390/ijerph21121579
3. Marshal MP, Friedman MS, Stall R, King KM, Miles J, Gold MA, Bukstein OG, Morse JQ. Sexual orientation and adolescent substance use: a meta-analysis and methodological review. Addiction. 2008;103(4):546–556.