This study sought to examine percentages of youth who use alcohol with and/or without parental permission and associations with symptoms of depression and anxiety. At least one in four youth indicated use with parental permission, with approximately 12.7% of youth indicating that they use alcohol both with and without parental permission. Those who used alcohol without parental permission, regardless of use with parental permission, reported higher levels of both depression and anxiety symptoms than those who did not use alcohol. Those who reported only using alcohol with parental permission did not differ on levels of depression symptoms from any other group of youth and did not differ on levels of anxiety symptoms with youth did not use alcohol or who only used alcohol without parental permission. These findings suggest that alcohol use with parental permission may not reduce more risky alcohol use and can be associated with internalizing difficulties.