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Early drinking linked to risk for alcohol dependence

July 05, 2006

Individuals who are younger when they begin drinking alcohol may face a higher risk of alcohol dependence throughout life, at a younger age and consisting of multiple episodes, according to results of a national survey published in the July issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Approximately 1 million U.S. high school students are frequent heavy drinkers, according to background information in the article. Previous surveys have found that 28 percent of high school students begin drinking before age 13 years, and that those who do are more likely to drink until they are intoxicated than those who wait until age 17 years or older to begin drinking. Heavy drinking places these students at risk for dangerous behaviors, including driving while intoxicated. These students also more often exhibit behaviors including carrying guns; injuring themselves in fights or suicide attempts; having unprotected sex; and earning low grades in school.

Ralph W. Hingson, Sc.D., M.P.H., and colleagues at the Youth Alcohol Prevention Center, Boston University School of Public Health, analyzed results from a national survey of 43,093 adults age 18 years and older conducted in 2001 and 2002. Interviewers asked questions about demographics, behavior, history of depression, drug use, family history of alcohol dependence and the age at which they began drinking. They identified respondents with alcohol dependence based on meeting at least three of seven standard criteria: tolerance for alcohol; withdrawal symptoms; drinking more alcohol or for longer periods of time than intended; willingness but inability to cut down on drinking; spending a great deal of time on alcohol-related behaviors; forgoing important social, work-related or recreational activities in favor of drinking; and continued drinking despite related physical or psychological problems. Individuals who met the criteria for alcohol dependence were asked how old they were when they first began to have several of these experiences at once as well as how many episodes (periods separated by at least one year of not drinking or not having these experiences) they had over their lifetimes.

Overall, 12.5 percent of all the survey respondents and 19 percent of those who had ever drank alcohol met criteria for alcohol dependence at some point in their lives—a figure representing more than 26 million Americans. Forty-seven percent of those who began drinking at a young age (younger than age 14 years) experienced alcohol dependence during their lifetimes, compared with 9 percent of those who began drinking at age 21 years or older. Those who were younger than age 14 when they began drinking were also more likely to be alcohol-dependent within 10 years of beginning drinking (27 percent vs. 4 percent of those starting at age 21 years or older), before age 25 years (33 percent vs. 2 percent) and during the year of the survey (13 percent vs. 2 percent). They also had more than three times the odds of experiencing two or more episodes of alcohol dependence in their lifetimes.

"Usually, each additional year earlier than age 21 years that a respondent began to drink, the greater the odds that he or she would develop the alcohol dependence outcomes examined," the authors write. "This study found that the younger respondents were when they began drinking, the greater their likelihood of experiencing lifetime alcohol dependence after analytically controlling for family history of alcoholism and numerous behavioral and personality characteristics related to the age at drinking onset."

The results highlight the need for pediatricians and other health care professionals to discuss alcohol use with adolescent patients and to implement policies that discourage drinking at younger ages, the authors conclude.

JAMA and Archives Journals