The physiological changes of adolescence, including the marked sculpting of the brain during adolescence, have roots that appear deeply embedded in our evolutionary past. Evidence is discussed that adolescent sensitivity to alcohol use is in part biologically based and related to adolescent-typical neural characteristics that result in a relative insensitivity to intoxicating and aversive effects of alcohol and likely other drugs of potential abuse. These adolescent-typical alcohol insensitivities may combine with genetic and environmental risk or protective factors to influence the likelihood of adolescents’ drinking heavily and developing a pattern of elevated alcohol use that may set the stage for later alcohol use disorders. Additional basic research and human studies are needed to explore how these adolescent-typical alcohol sensitivities may be modulated by various risk and protective factors, determine the implications of these developmental insensitivities for elevated alcohol exposure during adolescence, and assess whether there are lasting, developmentally specific consequences of that exposure.
