When Alcohol Abuse Starts Early, Course Often More Severe

Individuals who become alcohol dependent before age 25 are less likely to seek treatment than are those who become alcohol dependent at age 30 or older, researchers have found.

Younger people who are dependent on alcohol are also more likely on average to have multiple drinking episodes of longer duration and to meet more alcohol-dependence diagnostic criteria than are those who become alcohol dependent later in life.

The study appears in the September Pediatrics. The research was funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

“Young people who misuse alcohol are experiencing lifelong consequences of this abuse, and this study underscores the need for research that focuses on prevention and treatment efforts for this vulnerable population,” said National Institutes of Health Director Elias Zerhouni, M.D., in a written statement.

“The treatment-seeking and dependence-severity aspects of this study add important dimensions to previous findings that have shown increased risk of developing future alcohol problems with early alcohol use,” added NIAAA Director Ting-Kai Li, M.D.

The research was conducted by Ralph Hingson, Sc.D., and colleagues from the Youth Alcohol Prevention Center at Boston University School of Public Health. Hingson is now director of NIAAA's Division of Epidemiology and Prevention Research.

The team analyzed data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a representative survey of the U.S. adult population. NESARC involved face-to-face interviews with more than 43,000 individuals aged 18 or older across the United States. The researchers focused on a subset of 4,778 NESARC participants whose survey responses indicated that they had been alcohol dependent at some point in their lives.

The survey included numerous questions based on DSM-IV diagnostic criteria for alcohol abuse and alcohol dependence. The individuals surveyed were also asked about any help or treatment they had sought for their drinking.

“Our analyses found that almost half of these individuals became alcohol dependent before age 21 and about two-thirds before age 25, while about 20 percent became alcohol dependent at age 30 or older,” Hingson explained in a NIAAA press release.

“The odds of ever seeking help were lower among those first dependent before ages 18, 20, and 25 compared with those who first became alcohol dependent at age 30 and above, regardless of the number of dependence criteria they met,” Hingson pointed out. “Yet individuals who were first dependent before age 25 had significantly greater odds of experiencing multiple dependence episodes, episodes exceeding one year, and more dependence symptoms, even after controlling for numerous demographic and behavioral characteristics associated with early onset of alcohol dependence.”

The researchers speculated that the need to deal with fewer marital, family, or work responsibilities among younger persons may help explain why persons diagnosable with alcohol dependence at early ages are less likely to recognize and seek treatment for their drinking-related problems.

They also noted that because episodes of heavy drinking are more common among youth in general than among older adults, those with early dependence onset may be less likely to recognize that they are dependent and have a problem for which they need to seek help.

“Early onset of drinking predicts early onset of dependence, which in turn is associated with chronic, relapsing dependence,” Hingson said.“ Screening and brief motivational counseling can reduce alcohol-related problems among adolescents and college students who are heavy drinkers, and [those efforts need] to be expanded.”

“Age of Alcohol-Dependence Onset: Associations With Severity of Dependence and Seeking Treatment” is posted at<http://pediatrics.aappublications.org/cgi/content/abstract/118/3/e755>.▪