Introduction

Alcohol consumption among minors under 18 represents a serious societal problem in Slovakia that directly threatens the healthy development of the generation. According to Slovak legislation, the sale and serving of alcohol to persons under 18 is strictly prohibited. However, the reality on the streets and on social networks shows that young people obtain it relatively easily, while being unaware of the fatal consequences they risk with every single sip.

Effects of Alcohol on Children and Adolescents

Alcohol is produced by the fermentation of natural sugars found in fruits, vegetables, or grains. The amount of alcohol produced during fermentation varies between products – beer, for example, has a much lower alcohol content than wine or spirits. Although alcohol is considered a drug, its consumption is legal in our country from the age of 18. It is therefore socially accepted, even though it is toxic and highly addictive. Like other drugs, alcohol affects the functions of our body. From a medical perspective, alcohol is classified as a sedative, meaning that in higher doses it depresses the central nervous system. This system controls vital functions such as breathing, digestion, and the pumping of blood from the heart. Alcohol also causes confusion in the messages sent to and from the brain. For this reason, we experience changes in perception, emotions, vision, and hearing when consuming it. And the more alcohol we drink, the more extreme these changes become. What effect does alcohol have on the body? How alcohol affects us depends on many factors, such as gender, age, health status, and body weight. Excessive alcohol consumption can lead to harmful short-term and long-term effects. In the short term, our ability to think, speak, and control our body and reactions may be reduced. Long-term alcohol consumption can very negatively affect our physical and mental health, relationships, family, finances, work, and for young people, school. Alcohol initially has a calming effect, but in excessive amounts it becomes unpleasant and irritating (intoxication). The calming effect on the nervous system can lead us to feel happiness or sadness, relaxation or anger. Alcohol slows our reflexes, impairs coordination, and distorts vision. It also tends to cause memory lapses or even complete blackouts. It can increase blood pressure, speed up the pulse, and cause abnormal heart activity. If we drink alcohol in large quantities over several years, it can lead to an enlarged heart and damage to the liver and other organs. Binge drinking large amounts of alcohol can cause "acute alcohol poisoning," which in some cases can even lead to respiratory arrest and death.

The National Health and Medical Research Council warns that alcohol can have a negative impact on the brain development of a minor child. The earlier a child starts drinking alcohol, the greater the risk of difficulties with memory or learning. Alcohol is the most widespread drug among children and youth. Most of them start consuming it between the ages of 12 and 16, a period when children gain more freedom and become increasingly connected to their peers. At this age, this is also linked to their natural desire to take risks and experience new adventures. Intoxication in adolescents is often associated with a number of serious problems such as injuries, memory loss, suicide attempts, unintended pregnancy, sexually transmitted diseases, poor academic performance, and violence. Its consumption also increases the likelihood of alcoholism and mental disorders later in life. Children under 15 are most at risk – this age group should have no contact with alcohol at all.

Detection in the body depends on weight, height, age, gender, and health status. If we drink a glass of beer, wine, or spirits, the alcohol contained passes through the digestive system into our bloodstream and from there spreads throughout the body, including the brain – all within a few minutes. The body cannot store alcohol, so it breaks it down. The liver breaks down approximately 90-98% of consumed alcohol, with the remaining 2-10% being excreted through urine, breath, and sweat. It can be detected in urine for 6 to 24 hours. First, it converts alcohol into acetaldehyde (a toxic substance) and then into harmless acetate, which is gradually broken down into carbon dioxide and water. As a general rule, we metabolize alcohol at a rate of approximately 10 ml (or one standard alcoholic drink) per hour. Adverse effects occur more quickly in younger and thinner people, or those who drink on an empty stomach or have a lower tolerance for alcohol. Children and adolescents under 18, pregnant women, drivers, former alcoholics, and people taking certain prescription medications should avoid alcohol completely. The state of intoxication manifests differently in each person. During my practice, I have noticed that some people become relaxed and lose their inhibitions, while others become sad, anxious, or aggressive. Generally, however, I can state that alcohol has depressogenic properties. After consuming it, people tend to gravitate towards hopeless, pessimistic topics. While a small amount of alcohol once in a while does not significantly harm adults, it can have fatal consequences for children. Adolescents have a lesser ability to physically and emotionally cope with the effects of alcohol. The same amount of alcohol has a stronger effect on the bodily organs of adolescents than adults, because children and adolescents are still growing and their bodies are developing.

The first signs of intoxication appear when alcohol enters our bloodstream and from there reaches the brain. A person becomes more talkative, confident, and prone to taking risks; their motor skills slow down, and concentration and short-term memory worsen. It is at this point that they are at risk of injury. Men typically feel such symptoms after two to three drinks per hour, women after just one or two. When a person drinks more, symptoms such as dizziness, vertigo, blurred vision, or coordination errors begin to appear. A "blackout," or short-term loss of consciousness, is also common. Alcohol poisoning in adults usually occurs when the blood alcohol level exceeds three parts per thousand. Four or more parts per thousand in most cases lead to the death of the intoxicated person. Typical symptoms of alcohol overdose (see figures 1 and 2) include:

  • pale face,
  • blue discoloration of lips and nails,
  • vomiting,
  • limpness of the body ("ragdoll body"),
  • gasping for breath or slow breathing,
  • slowed heart activity,
  • unconsciousness.

During adolescence, significant changes can occur mainly in two parts of the brain:

  • the so-called hippocampus, the part of the brain responsible for learning and memory. Studies have shown that increased alcohol use can shrink this part of the brain by up to 10%. This brain area is particularly sensitive to alcohol during the teenage years. Alcohol acts as a poison on the nerve cells of the hippocampus, causing their irreversible damage or destruction.

  • In the frontal lobe, which enables us to plan, reason, make decisions, and speak. During adolescence, this part of the brain changes the most. NHMRC research revealed that adolescents who drank alcohol in larger quantities had smaller frontal lobes than their peers who did not drink alcohol.

Alcohol acts as a dangerous poison on a child's body. Since it depresses the nervous system and lowers blood sugar levels, children can fall into a coma or have seizures after consuming it. If blood sugar levels drop to dangerously low levels, they are even at risk of death. When intoxicated, children react the same way as adults – they stagger, talk nonsense, appear tired, or may vomit. Therefore, always watch for similar signs and never leave alcoholic beverages within their immediate reach. Young people not only have little information about the effects of alcohol but also an insufficiently developed ability to assess risks. This is mainly due to two significant changes occurring in their brain:

  • Due to emotional immaturity, children and young people develop a habit of alcohol very quickly. Puberty forces a person to behave impulsively, intensifying their emotional expressions and desire for excitement. Consequently, although young people know about the harmful effects of alcohol and drugs, it does not deter them from experimenting, because the part of the brain that seeks excitement suppresses rational thinking.

  • The part of the brain that assesses risks and controls self-control is not fully developed until the age of 17, and its fine-tuning sometimes lasts until the twenties. For this reason, teenagers need your help until their intellectual abilities are fully developed.

Alcohol and Legislation

According to § 2 para. 2 of Act No. 219/1996 Coll. of the National Council of the Slovak Republic (on Protection against the Abuse of Alcoholic Beverages), minors (up to 15 years) and adolescents (up to 18 years) must not consume alcoholic beverages or other addictive substances. They are also obliged to undergo an examination to determine alcohol or the presence of narcotic drugs or psychotropic substances if there is a reasonable suspicion that they have consumed alcoholic beverages or other addictive substances. For minors, it also applies that they must not stay without the supervision of their legal representatives after 9:00 PM in publicly accessible places where alcoholic beverages are served. According to the law, not only members of the Police Force but also employees of the municipal and city police are authorized to call upon minors and adolescents for an examination to determine alcohol or other addictive substances (other persons are named by law). The examination to determine alcohol is carried out by a breath test using a device that determines the volume percentage of alcohol in the blood (in the breath). If the person refuses to undergo such an examination, a medical examination can be performed by taking and laboratory testing of blood or other biological material. If the person refuses such a medical examination, the degree of intoxication is determined by a doctor based on medical clinical signs. The Police Force shall notify the relevant administrative authority (the municipality according to the adolescent's permanent residence) of the result of the examination to determine alcohol, or the presence of narcotic drugs or psychotropic substances, if it proves positive. Subsequently, the relevant municipality or city district shall notify by letter the adolescent, their legal representatives, and the relevant department of social-legal protection and social curatorship of the Office of Labour, Social Affairs and Family, about the initiation of proceedings regarding the violation of the prohibition on drinking alcoholic beverages and summons the affected persons for a discussion of the offense. The offense is discussed at an oral hearing. The adolescent acts as the accused in the proceedings, and their legal representatives (parents) are also parties to the proceedings. After legal instruction and familiarization with the case file, all parties comment on the offense. At the end, the relevant authority adopts measures arising from the law. For a violation of the prohibition on drinking alcohol by a minor, the municipality may impose a fine on the minor's legal representative of up to 33 euros. The fine may be imposed within one year from the day the prohibition, restriction, or obligation was violated. If it concerns an adolescent under 18 years of age, the municipality shall impose a reprimand on them. In justified cases, it may also impose a ban on visiting publicly accessible places and rooms where alcoholic beverages are served. The municipality also informs the relevant Office of Labour, Social Affairs and Family about the imposition of a fine or reprimand, which subsequently stops the child allowance for a period of 3 months. The office determines a so-called special recipient (which is the municipality according to the minor's or adolescent's permanent residence) and for three consecutive calendar months, the parent will not receive the child allowance, but the municipality will.

Acute Intoxication from the Perspective of Emergency Medical Care

Alcohol intoxication becomes a medical problem when it is no longer a state of drunkenness, but a disorder of consciousness and a threat to basic life functions. It is at this stage that the emergency medical service arrives at the affected person, and such a patient ends up in the emergency department. From a clinical perspective, the depth of central nervous system depression is decisive: with rising ethanol levels, the level of consciousness decreases, and the risk of aspiration of vomit, airway obstruction, respiratory depression, and hypothermia increases. In severe intoxication, autonomic dysfunction, coma, and even circulatory arrest can occur (Mirijello et al., 2022).

In adolescents, intoxication has a different course than in adults. In a European cross-sectional study from a pediatric emergency department, 126 patients under 16 years of age had an average ethanol level of 195.7 mg/dl, with potentially severe values above 300 mg/dl occurring in 3.6% of them, and hospitalization was required in 10.3% of cases. The most common finding was impaired consciousness, which directly correlated with alcohol level, and hypokalemia; seizures and hypoglycemia did not occur in this cohort (Castro-Rodríguez et al., 2022). Hypoglycemia, which is classically cited as the main risk in children, is thus more typical for young children than for adolescents – in the latter, the depth of unconsciousness and the complications arising from it dominate.

The most serious mistake in the care of an intoxicated patient is attributing the disorder of consciousness solely to alcohol. A Dutch multicenter cohort study demonstrated that suspicion of intoxication is associated with a higher, not lower, probability of severe head injury (odds ratio 1.42; 95% confidence interval 1.22 – 1.65), and such injuries are difficult to recognize in the field (Lokerman et al., 2023). The British NICE guideline therefore explicitly requests that a reduced level of consciousness should not be attributed to intoxication until significant brain injury has been ruled out (NICE, 2023). In practice, this means that an intoxicated patient requires as thorough an examination as any other – not less thorough.

In adults, a chronic dimension is added to acute intoxication. In up to half of individuals with long-term excessive consumption, a withdrawal state develops after cessation or significant reduction of alcohol intake, which in its most severe form can be life-threatening (Day – Daly, 2022). Thus, in a dependent adult, alcohol withdrawal is often more dangerous than intoxication itself. Acute intoxication should also be understood as a signal event indicating a chronic problem: the patient should be examined for the presence of alcohol use disorder and referred for follow-up specialist care (Mirijello et al., 2022). The scope of the phenomenon in Slovakia is illustrated by data from the National Health Information Center, according to which 14,136 hospitalizations for alcohol-related diseases were recorded in 2023, of which 175 were for the toxic effect of ethanol (NCZI, 2025). Since no detoxification center has been operating in Slovakia since 2004 and the legal regulation for their establishment was repealed by Act No. 321/2024 Coll., effective from January 1, 2025, this entire burden now falls on emergency departments and emergency medical service crews.

Conclusion

It is very challenging for parents when they find out that their child might have a problem with alcohol and needs professional help. Do not feel bad if you did not notice the warning signs in time. Most parents remain in shock and start blaming themselves or their child. The most important thing is to seek help as soon as possible, because the longer alcohol problems are ignored, the greater the likelihood of permanent physical and also psychological consequences. Do not be afraid to talk about the problem with your family and loved ones, and ask them for help in an emergency. If a parent discovers any addiction in their child, they can contact the Department of Social and Legal Protection of Children and Social Curatorship of the Office of Labour, Social Affairs and Family, where a social curator will provide them with counseling and recommend the most appropriate procedure for resolving the situation. You can also contact helplines that provide anonymous telephone assistance. The staff of these helplines are usually also informed about medical and psychological services in their area and are able to arrange them.

Authors:
Capt. PhDr. Ľudmila Húsková, PhD.
District Police Directorate, Martin

Ing. Bc. Vladimír Pustay, MPH
University of Žilina

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