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Objectives: This study aimed to examine the longitudinal effects of regional alcohol accessibility factors on adolescent drinking rates in Korea. Specifically, it analyzed how entertainment business density, perceived ease of purchasing alcohol, and stress recognition rates influenced changes in adolescent drinking behavior from 2010 to 2023. Methods: This research utilized data from the Korea Youth Risk Behavior Web-based Survey (KYRBS) conducted by the Korea Disease Control and Prevention Agency and the National Business Survey by Statistics Korea. The data were aggregated at the level of 17 metropolitan cities and provinces, producing 231 valid observations after excluding missing and extreme values. A longitudinal multilevel model was employed to assess the effects of time, entertainment business rate, stress recognition rate, and perceived ease of alcohol purchase on adolescent drinking rates, as well as their interaction effects with time. Results: Between 2010 and 2023, the adolescent drinking rate decreased significantly from 21.1% to 11.4%. Stress recognition rate and perceived ease of alcohol purchase both showed significant positive effects on drinking rates (p<.001 and p<.05, respectively), indicating that higher stress and easier alcohol access were associated with increased adolescent drinking. While the entertainment business rate alone was not statistically significant, its interaction with time was (p<.05), suggesting that regions with higher densities of entertainment establishments exhibited a slower decline in drinking rates over time. Overall, the decreasing trend in adolescent drinking appeared moderated by environmental accessibility factors. Conclusions: Adolescent drinking in Korea has declined over the past decade; however, environmental accessibility—particularly the prevalence of entertainment businesses—continues to influence this trend. Stress levels and perceived alcohol availability remain consistent risk factors. These findings highlight the need for sustained, community-level interventions focused on regulating alcohol access, managing adolescent stress, and addressing environmental risk factors through long-term public health strategies.