Younger people are at greater risk for alcohol problems

December 13, 1999

A recent study looking at three different age groups that spanned two generations found that the youngest age group began regular use of alcohol at an earlier age than the other two groups. Among those individuals who were alcohol dependent, those in the youngest age group were more likely to have developed alcohol problems before the age of 25. What this means is that people are starting to drink at an earlier age and, as a direct consequence, developing alcohol problems at an earlier age.

"A lot of studies have shown that the earlier people start to drink regularly," said lead author Scott F. Stoltenberg, assistant research scientist at the Department of Psychiatry, University of Michigan Alcohol Research Center, "the more likely it is that they will eventually develop alcohol problems. So if you can put off a person's initiation into regular drinking into their 20s or so, they're a lot less likely to develop these kinds of problems."

It's no secret that early use of alcohol, cigarettes and other drugs can 'set the stage' for long-term health and behavioral problems. Although alcohol is thought to be the most commonly used psychoactive substance during adolescence, its use has a complicated relationship with the use of other substances such as tobacco and illegal drugs. Furthermore, numerous studies have found a strong association between early use of these substances and later-in-life alcohol-use disorders, depression, and multiple health-risk behaviors that include violence and suicide plans.

Why does this happen? "There are probably two answers," said Victor Hesselbrock, professor of psychiatry at the University of Connecticut School of Medicine. "First, developing a substance-use disorder requires a certain amount of exposure to the substance. You can't become an alcoholic, a heroin addict, a cocaine addict, or addicted to cigarettes unless you use that substance a significant amount. The earlier you start, the more exposure you have to the drug. Second, there are problem-behavior children. They have what we call conduct disorder; these are the kids who have trouble with their parents, they're unresponsive to discipline, they're a problem in school, they're unruly, they get into trouble in the neighborhood--and for whatever reason, they start using these substances at an early age."

The generational study, published in the December issue of Alcoholism: Clinical & Experimental Research, looked at three "cohorts" or groups of people: those born before 1930 (referred to as "old); those born between 1930 and 1949 (referred to as "middle"); and those born after 1949 (referred to as "young"). Those considered "young" began regular use of alcohol at an earlier age than the other two groups. They were also more likely to develop drinking problems before the age of 25, called "early-onset alcoholism." In addition, this same group was more likely to exhibit elements of what is called "anti-social alcoholism," such as fighting while drinking, involvement with the police and drunk driving. Another finding of interest concerned women: age of first regular alcohol use among women declined more dramatically than it did among men, suggesting a related increase in problem drinking among women. Finally, the study found that a strong family history of alcohol problems was highly correlated with younger ages of regular drinking, early-onset alcoholism and alcohol-related antisocial behavior.

"In the study of alcoholism and other disorders," explained Hesselbrock, "you find something called a 'secular trend.' When people about 15 years ago spoke of early-onset alcoholism, it meant before the age of 25. The more we study this, the more we see that age march down. Right now, early-onset alcoholism probably begins before the age of 21."

Early-onset alcoholism is one of the defining features of anti-social alcoholism. "Generally these are the people that you would have met in high school," said Stoltenberg, "probably not in college because a lot of these folks don't go to college. They get arrested, they drive while drunk; generally they're thought to be very impulsive. 'Impulsivity,' or the lack of impulse control, has a lot to do with whether or not a person can keep themselves from doing whatever comes into their head." In other words, anti-social behavior involves a range of behaviors that tend to get people into trouble; early-onset alcoholism facilitates anti-social behavior in those individuals who already have impulse-control problems, most likely by further weakening impulse control.

"This paper not only confirms that the age of onset for alcohol problems and alcoholism is marching down, getting younger and younger," said Hesselbrock. "It also shows that the risk for women of developing these disorders, particularly women who are problem-behavior oriented, is probably not that different from men's."

The study, funded by the National Institute of Alcohol Abuse and Alcoholism, also found support for a genetic tendency for alcoholism. Both Hesselbrock and Stoltenberg spoke of an unknown number of genes -- six to eight, 10 or more -- that each has an influence vis-à-vis vulnerability or susceptibility to alcohol disorders that can be 'shared' with other disorders such as depression and nicotine dependence.

"No single gene causes alcoholism," noted Stoltenberg.

Hesselbrock added that "genes do not predetermine, they only increase risk."

Yet not even a body of genes, let alone a solitary gene, entirely explains the conundrum. "When you talk about these cohort effects," explained Stoltenberg, "you're talking about social changes rather than genetic changes. Clearly an individual with a dense family history of alcoholism has a much greater risk for alcohol problems than an individual without that history. In the couple of generations involved in this study, however, there's no genetic change going on, so the effects have to be due to social or environmental changes."

The prevalence of drinking and age of first regular alcohol use among women are prime examples of social changes, noted Stoltenberg. "Maybe men and women have the same biological predisposition to behave this way," he said, "but 50 years ago it wasn't socially acceptable for women to go into bars and drink. Certainly they weren't considered 'good girls.' Now it's a lot more acceptable for women to go out and drink like men."

Those considered "young" in the study would be almost 50 years old today. Stoltenberg said that even though "it's hard to extrapolate from one cohort to another, I wouldn't be surprised if the rates of these kinds of behaviors are going to be even higher in groups in their 20s and 30s right now."

Co-authors of the Alcoholism: Clinical & Experimental Research paper included: E.M. Hill, S.A. Mudd, F.C. Blow and R.A. Zucker of the University of Michigan Alcohol Research Center. The study was funded by the National Institute of Alcohol Abuse and Alcoholism.
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Alcoholism: Clinical & Experimental Research

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