Background and aims: Adolescent alcohol consumption decreased in high-income countries during the 2000s and 2010s. While evidence for declining consumption is clear, there has been less research tracking trends in alcohol-related harms. This article reviewed trends in adolescent alcohol-related harms in high-income countries where a decline in consumption had occurred and investigated sex-based differences in trends.

Methods: The databases Medline, CINAHL, Scopus and PubMed were systematically searched, with grey literature searches also conducted. Studies were included if they reported on harm rates between 2005 and 2019 for adolescents (10-19 years) from countries where a reduction in adolescent drinking occurred. Health-system based measures of alcohol-related harm were used (e.g. hospital admissions or mortality data). Search terms included alcohol, adolescents, alcohol-related harms, trends or synonyms. Risk of bias was assessed, primary screening was conducted by one author with checks by another, and data extraction was completed by three authors with accuracy checks conducted. The results are presented via narrative synthesis.

Results: Systematic searches resulted in 1311 results. A total of 18 systematic search and 23 grey literature sources were included. For many countries, alcohol-related harms have decreased since 2005, following trends in declining consumption. This evidence was strongest in Anglosphere countries, where eight of thirteen records (62%) indicated declines, followed by North America, where declines were present in four of eleven records (36%). Trends from mainland Europe were contradictory, with only four of thirteen (31%) indicating decreases in harms. Increases in harms for some female and student populations were reported in some jurisdictions.

Conclusions: Alcohol-related harms for young people have generally declined in countries where youth drinking has fallen, although the declines in harm have been smaller than the declines in drinking. Declines in alcohol-related harm were strongest in the United Kingdom, Australia, New Zealand and Ireland, followed by North America.

Keywords: adolescents; alcohol; alcohol‐related harm; sex‐based differences; systematic review; trends.

© 2025 The Author(s). Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.