Alcohol use disorder, heavy drinking, and binge drinking among adolescents and young adults that are “Not in Employment, Education or Training”: a systematic review and meta-analysis

In 2022, 12.7% of individuals aged 15-to-29 years old in OECD countries were Not in Employment, Education or Training (NEET). Two existing systematic reviews have studied alcohol use in relation to NEET status, with one showing that young people with NEET status (YP-NEET) are at a higher risk of alcohol consumption. However, they did not explore how findings varied based on different NEET subgroups nor the diverse patterns of problematic drinking (e.g. alcohol use disorder (AUD), heavy drinking, binge drinking). Both are essential for understanding consumption behaviours and informing future prevention strategies. This study aimed to analyse problematic drinking among YP-NEET, considering their diverse drinking patterns and group heterogeneity compared to their peers. A systematic review and meta-analysis were conducted following the PRISMA and MOOSE guidelines. The included articles were observational studies examining the associations between different NEET profiles and problematic drinking patterns (i.e. AUD, heavy drinking, and binge drinking) compared to their peers (i.e. students or employed youth). Twenty-three studies were analysed, including a total of 518,533 individuals. The prevalence of each consumption pattern was higher for YP-NEET compared to their peers of the same age. NEET status was significantly associated with AUD (cOR = 1.35, 95%CI = 1.16–1.56) but neither with heavy drinking (cOR = 1.28, 95%CI = 0.74–2.22) nor binge drinking (cOR = 1.19, 95%CI = 0.97–1.48). The most represented NEET profile and the one with the highest level of AUD was the group of unemployed youth. This study highlighted an increased risk of AUD among YP-NEET and high prevalence rates of heavy and binge drinking. However, a critical methodological concern is that standard AUD diagnostic criteria may lack construct validity for YP-NEET, as they include items related to occupational and social dysfunction altered by the NEET status itself. Addressing these measurement challenges, while considering consumption patterns and the diversity of NEET profiles, is crucial for developing effective, adapted, and evidence-based alcohol prevention intervention. CRD42023401994.