Age at onset of alcohol use and DSM-IV alcohol abuse and dependence: A 12-year follow-up
Introduction
The relationship between age at onset of drinking and alcohol problems has been extensively studied in the alcohol field Barnes & Welte, 1986, Grant & Dawson, 1997, Hasin & Glick, 1992, Humphrey & Friedman, 1986, Jessor & Jessor, 1975, Kandel, 1975, Labouvie et al., 1997, Margulies et al., 1977, Parker et al., 1996, Robins & Przybeck, 1985, Samson et al., 1989, Wechsler & McFadden, 1979, Windle, 1991, Yamaguchi & Kandel, 1984. The results of these studies indicate a strong association between age at onset of drinking and both patterns of drinking and alcohol-related problems. The Barnes and Welte (1986) cross-sectional analysis of secondary school students in New York State reported that the mean ounces of ethanol consumed per day was greater as the age at first intoxication decreased. Drawing upon longitudinal data from the Rutgers Health and Human Development Project, Labouvie et al. (1997) found that age at first use of alcohol predicted alcohol use at age 20 but was unrelated to alcohol use and alcohol use consequences 10 years later. When age at first use of any illicit substance was included in the regression model, the relationship between age at first use of alcohol and alcohol use at age 20 was no longer statistically significant.
Other studies have indicated that the earlier the onset of drinking, the more problematic will be subsequent use of alcohol. Humphrey and Friedman (1986) found that respondents who began to drink prior to age 16 were twice as likely to report frequent intoxication as college students. Drawing upon the 1988 National Health Interview Survey (NHIS), Hasin and Glick (1992) categorized the severity of alcohol dependence classified according to the Diagnostic and Statistical Manual of Mental Disorders—Third Edition—Revised (DSM-III-R: American Psychiatric Association, 1987) as mild (three to four positive criteria), moderate (five to six positive criteria), and severe (seven to nine positive criteria) and found a strong, positive association between severity and earlier onset of drinking (less than 15 years vs. 15 years and older). In a national sample of more than 27,000 US adults, 18 years of age and older, Grant and Dawson (1997) reported that the odds of alcohol dependence decreased by 14% with each increasing year of age at onset of use, and the odds of alcohol abuse decreased by 8%. These estimates controlled for the effects of sex, race, age, duration of drinking, current drinking status, and family history of alcoholism.
Robins and Przybeck (1985) concluded that early users have greater potential for problems, but Robins (1984) also cautioned that early initiation may be an indicator of other psychiatric disorders and, hence, not a direct factor in subsequent problem manifestation. There are substantial lines of evidence that link the onset of some forms of alcohol abuse and dependence to an earlier history of antisocial behavior Cloninger et al., 1981, Zucker et al., 1996. Several studies have implicated both peer drug use and antisocial behaviors in the initiation of alcohol use among adolescents (Adler & Kandel, 1982, Alexander & Campbell, 1967, Biddle et al., 1980, Kandel, 1975, Margulies et al., 1977).
More recently, Prescott and Kendler (1999) have offered evidence suggesting that early onset and alcoholism are both manifestations of a general vulnerability to problem behavior. On the other hand, Grant and Dawson (1997) found separate and independent effects of family history of alcoholism and age at onset of alcohol use on alcohol use disorders defined by the Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition (DSM-IV: American Psychiatric Association, 1994). Parker et al. (1996), in an analysis of Russian high schools and technical schools in the Moscow region, found separate and independent effects of antisocial orientation and early age at first drink on the frequency of alcohol use during the past year. Findings from this study further indicated that the relationship between early onset and alcohol frequency was moderated by antisocial orientation.
The purpose of the present study is to examine the relationship between age at onset of regular drinking, measured in 1982, and subsequent estimates of DSM-IV alcohol abuse and dependence for the same respondents, measured 7 and 12 years later. The relationship between age at onset of alcohol use and alcohol use disorders is extended by the present study in several ways. First, the bulk of the evidence cited is based on cross-sectional studies, and the associations between age at drinking onset and other indicators of alcohol use may suffer from recall bias. Second, while longitudinal studies have replicated findings from cross-sectional analyses, the follow-up periods tend to be of short duration or based on specific study populations, including large proportions of respondents who have not passed through the risk period for developing alcohol use disorders. Third, the inclusion of several problem behavior indicators in the present study (e.g., antisocial behaviors, use of marijuana, school dropout status, and parental education) provides more extensive control for factors that may confound the association between onset and outcomes. And fourth, the vast majority of studies relating the onset of drinking to problem behavior rely on the age of first drink and, occasionally, age at first intoxication Barnes & Welte, 1986, Humphrey & Friedman, 1986. In the US, the first exposure to alcohol often occurs prior to age 15, frequently in the form of an “occasional sip” or a “first drink” in the context of family celebrations or religious activity. Findings from annual surveys of high school seniors indicate that the peak school grades for the “first use of an alcoholic beverage—more than just a few sips” are from the seventh through ninth grades, when students are 13 through 15 years of age (Johnston, O'Malley, & Bachman, 1994). The age at first drink, however, may not necessarily signal the onset of a pattern of regular use of alcohol. In contrast, the definition of age at onset of drinking used in the present study attempts to capture the onset of a pattern of the regular use of alcohol.
Section snippets
Methods
The National Longitudinal Survey of Labor Market Experience in Youth (NLSY) is an ongoing survey with annual follow-up of young people throughout the US. The NLSY was initiated in 1979 and included a representative sample of 12,686 males and females ages 14 through 21 on January 1, 1979. The procedures and methods of the survey were designed to create a database representative of the entire population born from 1957 through 1964 and included the following three independent probability samples:
Statistical analysis
The analysis consisted of two parts. First, an item nonresponse analysis was conducted that examined the distribution of predictor and outcome variables in the study sample and among those respondents excluded from the analyses due to missing values. Second, two linear logistic regression analyses were used to assess the relationship between age at drinking onset and the odds of alcohol abuse and dependence, controlling for the effects of demographic factors and problem indicators. Linear
Results
Table 1 shows the distribution of predictor and outcome variables among the study sample and that portion of the sample excluded from the present analyses due to missing values on one or more predictor or outcome variables. When compared to those respondents excluded, the respondents in the study sample were more likely to be dependent in 1989 and 1994 and to be abusers in 1989. Respondents in the study sample were also more likely to be married and have a family history of alcoholism, but less
Discussion
Consistent with the literature, the present study found significant associations between age at drinking onset and DSM-IV alcohol dependence 7 to 12 years later. In 1989 and 1994, the odds of alcohol dependence were reduced by 5.0% and 9.0% for each year that drinking onset had been delayed, respectively. In 1994, the odds of alcohol abuse were reduced by 7.0% for each year that drinking onset had been delayed. In 1989, age at drinking onset was not significantly related to the development of
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