Early Drinking Linked To Higher Lifetime Alcoholism Risk

Local, National Authorities Call For Newtown Parents To Play Roles In Education, Prevention

By John Voket

Representatives from Newtown’s Family Counseling Center as well as a national authority who appeared here recently speaking about substance abuse are pointing to a recent study that further confirms the notion that underage drinking leads to permanent health and substance abuse issues.

Data from a recently released survey of 43,000 American 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.

Isabel Burk, a substance abuse prevention expert and certified health education specialist who spoke recently at local schools about inhalants, believes while some parents remember drinking during their teen years, today’s drinking patterns are quite different.

“Today’s youth start drinking at earlier ages and drink more at one sitting, faster,” Ms Burk said. “Parents might have had a couple of beers to get buzzed; today’s teens drink five or six beers in a single sitting and drink to get totally drunk.”

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.

Elias A. Zerhouni, MD, 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.”

Adult Standards Differ

Ms Burk reminds parents, and those who are asked to provide alcohol to underage drinkers, that even though alcoholic beverages are legal for adults, that does not make them safe for youth.

“Researchers have found that the developing brains of youth and teens are more susceptible to cell damage and functional deficiency after drinking alcohol,” she said.

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 US 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, versus nine 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 ten 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.

Education, Prevention Critical

According to Cher Shannon of the Family Counseling Center of Newtown, evidence-based prevention programs such as the Center’s Strengthening Families Program (SFP) for youths age 10–14, are designed with the express purpose of preventing youth problem behaviors.

“The Strengthening Families Program is providing effective intervention in the lives of young people before they engage in behavior that is likely to have serious long-term consequences for them,” Ms Shannon said. “This particular program is focused on fifth and sixth graders and their parents because during periods of transition — going from elementary to middle school or junior high — children are most vulnerable and at high risk for drug use.”

Youth in the SFP intervention group are less likely to have ever used alcohol without parental permission. At tenth grade, SFP students exhibited a 32 percent relative reduction in alcohol use compared to control group students. In addition, SFP students’ age of first use was later than that of the control group. This is absolutely critical in terms of the link to higher lifetime alcoholism risk.

“Prevention programs, by their very nature, are universal programs, i.e., they are appropriate and helpful for all children and their families and not specifically targeted to high risk or families experiencing problems with problematic use of alcohol or drugs,” Ms Shannon said.

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. A 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.

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.”

“There is no known threshold of alcohol that is considered safe for youth,” Ms Burk said. “Brain issues aren’t the only reason alcohol is risky for underage drinkers. Alcohol use makes inappropriate behavior more likely. Alcohol impairs decisions and judgment, planning and coordination, so young people might say and do things that are risky or dangerous. Your teen on alcohol is not the same as your teen stone sober.”

Additional alcohol research information and publications are available at www.niaaa.nih.gov. For more information about NIH and its programs, visit www.nih.gov.

*Dr Hingson is now Director of NIAAA’s Division of Epidemiology and Prevention Branch.