The aim of this study was to investigate the prevalence of alcohol consumption and its related factors in adolescents aged 13 to 17 years living in the Eastern Mediterranean. Analysis of the findings showed that alcohol consumption is common in adolescents, which was also found in the studies of Benjet et al. (10), Kittipichai et al. (11), and Getachew et al. (12). In a study of Thai adolescents, Luecha et al. (9) found that 31.01% of adolescents aged 10 to 14 had consumed alcohol at least once. In a study by Ting et al. (22) on 11 to 12-year-old Taiwanese adolescents, alcohol consumption was reported at 48% in this group. Explaining this finding, it can be said that seeking diversity, curiosity, easy access, misconceptions about alcohol, being influenced by friends and imitating them are among the most important causes of adolescents’ tendency to consume alcohol (10–12). It can also be stated that adolescents are exposed to high-risk behaviors such as alcohol consumption due to special conditions in this age group (23). Adolescence is a period of changes in physical, sexual, psychological, cognitive development, as well as changes in social needs, lack of appropriate conditions for passing this critical stage can lead to a tendency to consume alcohol (24).
Another finding of the present study was that the prevalence of alcohol consumption in boys is higher than girls, this finding was consistent with the findings of Alex-Hart et al. (24), Assanangkornchai et al. (25), Chaveepojnkamjorn et al. (26), Georgie et al. (27), Pengpid & Peltzer (28). Explaining this finding, we can point to the biological differences in alcohol consumption between men and women. Compared to men, women generally have less water in their body, which is why women reach the peak with less consumption, even if they consume the same amount as men, and this causes men to consume more (29, 30). We can also point to cultural differences, because in most societies drinking alcohol is masculine, and some men are better accepted by drinking alcohol in the company of their friends and have stronger personal relationships (31, 32). Social control is greater for women, and women are concerned that alcohol consumption may affect their family relationships and general behavior or make them sexually vulnerable (33, 34).
The study also found that marijuana use in adolescents greatly increases the chances of alcohol consumption. In a study conducted by Sokolovsky et al., (35) 341 young university students were surveyed. In this study, it was found that marijuana and alcohol are often used simultaneously and their simultaneous use has more negative consequences. There is a two-way relationship between alcohol consumption and marijuana use, adolescents who use marijuana may also use more alcohol, and vice versa, usually marijuana and alcohol are consumed simultaneously. In general, it can be said that performing a high-risk behavior in adolescence can lead to different behaviors (36–38).
Another finding of the present study was that smoking increases the likelihood of alcohol consumption. The same finding was found in the studies of Thrul et al. (39), McKee et al. (40), Piasecki et al. (41). In this regard, Thrul et al. (39) in a study showed that the simultaneous consumption of cigarette and alcohol increases the perception of rewards for consumption (39). On the other hand, some studies have shown that the simultaneous consumption of alcohol and cigarette may have a greater effect on the mesolimbic system, which in turn stimulates the reward system in the brain, and further stimulation of this system leads to increased adolescent desire to consume these two simultaneously (42, 43).
Having sex was another factor that increased the chances of consuming alcohol, alcohol consumption can be associated with engaging in sexual experiences (44). In a study, Dogan et al. (45) showed that alcohol consumption in adolescents affects the number of sexual partners. Explaining this finding, it can be said that having a positive attitude towards a behavior affects the likelihood of doing that behavior. In some adolescents, there is a view that alcohol consumption has a positive effect on sexual experiences and this view leads to alcohol consumption among them (46). Some people also believe that alcohol consumption causes a pleasurable sexual relationship and increases sexual attraction and the positive aspects of sexual behavior, all of these factors affect the increase in alcohol consumption (38, 47).
Being alone also increased alcohol consumption. Consistent with this finding, McKay et al. (48), in a study showed that being alone is effective in alcohol consumption. In addition, loneliness and gender are associated with alcohol consumption, so that being a woman and experiencing loneliness put a person at greater risk for drinking alcohol. For example, several studies have shown that alone adolescents may use alcohol, cigarette, and illegal drugs, probably Adolescents use alcohol as a form of self-medication to reduce loneliness (49, 50).
Another factor that was shown to be effective in alcohol consumption was insomnia. This finding is consistent with Barrow’s research (50, 51) which showed that insomnia creates a vicious circle with alcohol consumption. As insomnia increases the risk of alcohol consumption, alcohol consumption can become problematic as well, which exacerbates insomnia. The same finding was found in the research of Rohers et al. (52) Their study found that people who experience insomnia use alcohol to improve sleep quality. On the other hand, it has been found that a history of committing suicide increases the chances of alcohol consumption. This finding is consistent with the research of Pompili et al. (53) who showed in their research that there is a two-way relationship between alcohol consumption and suicide. Explaining this finding, it can be stated that according to studies, suicide is directly related to anxiety and depression, and many people with a history of suicide use alcohol as self-medication, and when they suffer from anxiety, low mood or life problems, they turn to alcohol to forget their problems. However, constant use of alcohol can cause tolerance, dependence and ultimately addiction in the individual (54). Although alcohol consumption can temporarily reduce suicidal ideation, in fact it makes the problem worse. In most cases, long-term alcohol abuse makes the suicidal ideation more frequent and powerful and increases the likelihood of attempting suicide (55, 56). In addition, alcohol abuse generally exacerbates the other factors influencing suicide. For example, alcohol exacerbates the symptoms of many disorders, such as bipolar disorder, borderline personality disorder, and depression, all of which can contribute to suicide. Alcoholism can also cause problems at work, within the family, interpersonal relationships, and the legal system, these problems affect suicide (55).
On the other hand, the effect of daily activity on alcohol consumption cannot be ignored. In this regard, in a study Conroy et al. (57) showed that after controlling age and gender, daily physical activity was associated with alcohol consumption. If a curious and energetic teenager does not have good entertainment and it is not possible for him/her to have proper daily activities, he/she will be drawn to activities and entertainment that are not good. Therefore, addressing the issue of alcohol consumption in adolescents and young people and preventing it by emphasizing the role of daily activities is very necessary and important.
It has also been found that a history of being beaten increases the chances of alcohol consumption in adolescents. Studying the research related to the long-term effects of child abuse has shown that most adolescents and adults who have had traumatic events as children are more likely to consume alcohol than others. Research shows that childhood abuse experiences can have long-term effects on all aspects of health, development, and well-being (58), and can lead to impaired performance and high-risk behaviors such as alcohol consumption (59). Waner et al. (60) believe that prolonged exposure to bullying predisposes the child to violence and high-risk behaviors in the future. Children who have been abused have also been found to be more aggressive and delinquent than their peers. These children are pessimistic on their social networks. These signs may be influential in shaping the tendency to consume alcohol (61).
It was also found that parental supervision is a deterrent and effective factor in reducing alcohol consumption in adolescents. The same finding was obtained in the study of Benjet et al. (10). A study by Strunin et al. (62) also found that parental supervision was effective in limiting alcohol consumption in adolescents. Parental supervision has a significant effect on delaying the tendency to consume alcohol. Adolescents and young people who have less family support and supervision show self-destructive behaviors. The higher the level of family support in adolescents is, the less they are exposed to alcohol. In fact, parental supervision is a protective factor against alcohol consumption (63, 64).