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Chronic health problems resulting from heavy alcohol use are generally not observed in adolescents because such effects take longer to accumulate. However, heavy drinking during adolescence, especially if this behavior is continued in adulthood, places a person at risk of such health problems as pancreatitis, hepatitis, liver cirrhosis, hypertension, and anemia. Chronic liver disease and cirrhosis among Latinos and American Indian and Alaskan natives are the sixth leading cause of death among these groups (Anderson, 2002). Recent research suggests that drinking during puberty may have deleterious effects on bone density development: for young women, failing to develop maximal bone density during adolescence puts them at risk later in life for osteoporosis.

Effects on the Adolescent Brain

New research on adolescent brain development suggests that early heavy alcohol use may also have negative effects on the actual physical development of brain structure (Brown and Tapert, 2004). Contrary to earlier beliefs, the brain continues to change physiologically well beyond childhood. Brain growth among infants and children is focused essentially on volume—creating as many brain cells with as many connections to other brain cells as possible. During adolescence, development shifts from producing a great number of neurons to creating efficient neural pathways, which occurs in two ways. First, the structure of neurons changes as they become encased by an insulating tissue (myelin) that helps to speed the movement of the electric impulses carried by brain cells. This change means that adults can relay information from one part of the brain to another more rapidly than can children. In adolescence, this myelination occurs predominantly in the frontal and prefrontal lobes, the part of the brain responsible for important functions such as planning, organization, and halting an impulse. The second change in brain development has to do with synaptic refinement, the process by which connections between brain cells are pruned and eliminated so that only the most efficient connections are used and maintained. Like myelination, synaptic refinement also contributes to increasing the speed and efficiency of transmitting information from one part of the brain to another, which in turn improves reaction time. Adolescent brain developments occur in areas of the brain critical for considering the consequences of actions and important for stress responses and managing drives (Spear, 2002).

Recent studies based on animal models suggest that alcohol use during adolescence may have deleterious effects on myelination and synaptic refinement. Rats that were given doses of alcohol in quantities and frequency that mimic the use of frequent heavy adolescent drinkers had problems with memory tasks (White et al., 2000). Another study showed that heavy alco-

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