Early Drinking Linked to Higher Lifetime Alcoholism Risk
Data from a survey of 43,000 U.S. adults heighten concerns that
early alcohol use, independent of other risk factors, may contribute
to the risk of developing future alcohol problems. Those who began
drinking in their early teens were not only at greater risk of
developing alcohol dependence at some point in their lives, they
were also at greater risk of developing dependence more quickly and
at younger ages, and of developing chronic, relapsing dependence.
Among all respondents who developed alcoholism at some point,
almost half (47 percent) met the diagnostic criteria for alcohol
dependence (alcoholism) by age 21.
The associations between early drinking and later problems held even after investigators controlled for other risk
factors for dependence, adding to concerns that drinking at a young age might raise the risk of future alcohol
problems rather than being an identifying feature of young people predisposed to risky behavior. The study
appears in the July issue of Archives of Pediatrics & Adolescent Medicine, Volume 160, pages 739-746.
Elias Zerhouni, M.D., director of the NIH, said, "This is a very good example of how insights gained from health
research can inform public policy. Converging research suggests that youthful drinking is associated with an
increased risk of long-term, not just acute, health consequences."
Scientists at the Boston University School of Public Health and Youth Alcohol Prevention Center, led by Dr.
Ralph Hingson, carried out the analysis using data from the 2001-2002 National Epidemiologic Survey on
Alcohol and Related Conditions (NESARC), a representative survey of the U.S. civilian noninstitutionalized
population aged 18 years and older.
NESARC involved face-to-face interviews with adults ages 18 and older. The survey used questions based on
diagnostic criteria for alcohol abuse and alcohol dependence from the American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV). In the study, "starting to drink"
meant the age when respondents first drank alcohol, not counting tastes or sips.
NIAAA Director Dr. Ting-Kai Li said, "This work underscores the need
for research to clarify how early drinking relates to the risk of lifetime
alcohol problems. In particular, it is important to learn whether early
alcohol use may affect the developing brain in ways that increase
vulnerability to dependence."
In results that echo earlier studies, of those individuals who began
drinking before age 14, 47 percent experienced dependence at some
point, vs. 9 percent of those who began drinking at age 21 or older. In
general, each additional year earlier than 21 that a respondent began
to drink, the greater the odds that he or she would develop alcohol
dependence at some point in life. While one quarter of all drinkers in the survey started drinking by age 16,
nearly half (46 percent) of drinkers who developed alcohol dependence began drinking at age 16 or younger.
New findings showed that among all drinkers, early drinking was associated not only with a higher risk of
developing alcoholism at some point, but also within 10 years of first starting to drink, before age 25, and within
any year of adult life. Early drinking was also associated with increased risk of having multiple episodes of
alcoholism. Further, among respondents who had had alcohol dependence at some point, those who began
drinking young had episodes of longer duration and with a wider range of symptoms than those who started later.
Previous research has established the link between early onset of drinking and lifetime diagnosis of alcoholism.
Key to understanding the relationship between early drinking and alcoholism risk is whether the act of drinking
while young raises lifetime risk, or whether early drinking reflects an underlying predisposition for risky behavior
in particular young people. In the latter case, early drinking would be considered a marker identifying individuals
already at risk for developing alcoholism. In this study, investigators attempted to account for factors - such as
family history of alcoholism, childhood antisocial behavior and depression and smoking and drug use - known to
be associated with higher risk. Even controlling for a number of risk factors and the effects of age differences
among respondents, early drinking was associated with an increased risk of lifetime alcohol diagnosis.
In calculating the impact of early drinking on the risk of experiencing alcoholism, the study used statistical
methods that account for the fact that older respondents have had a longer window of opportunity to develop
alcoholism than younger respondents. The risk of those who began drinking before age 14 was multiplied by a
factor (or "hazard ratio") of 1.78 relative to those who started drinking at age 21 or older.
The recently released 2005 Youth Risk Behavior Survey - conducted by the Centers for Disease Control and
Prevention - found that among high school students nationwide, 26 percent had drunk alcohol (other than a few
sips) for the first time before age 13.
The authors conclude that the results of both studies support the need to take measures to delay alcohol
consumption by underage youth. Dr. Hingson said, "This analysis suggests that interventions that delay drinking
onset may not only reduce the acute consequences of drinking among youth, but may help reduce alcohol
dependence among adolescents and adults. It's an important public health issue for longitudinal research
to resolve."
