Does Beginning to Drink at an early Age CAUSE Later Alcohol Abuse or Other Problems?

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has warned against assuming that early onset of drinking causes later drinking abuse problems.  It points out that “It is not clear whether starting to drink at an early age actually causes alcoholism or whether it simply indicates an existing vulnerability to alcohol use disorders (26). For example, both early drinking and alcoholism have been linked to personality characteristics such as strong tendencies to act impulsively and to seek out new experiences and sensations (27). Some evidence indicates that genetic factors may contribute to the relationship between early drinking and subsequent alcoholism (28,29).” i

That federal agency’s advice against assuming that early drinking of alcohol causes later alcohol abuse is generally ignored by alcohol activists. For example, Joseph Califano, head of the Center on Addiction and Substance Abuse (CASA) misleadingly asserts that “teen drinking is the number one source of adult alcoholism. Children who begin drinking before age 21 are more than twice as likely to develop alcohol-related problems. Those who begin drinking before age 15 are four times likelier to become alcoholics than those who do not drink before age 21.” ii Similarly, a Drug Abuse Resistance education (DARE) official erroneously asserts that “research tells us if we can keep the kids off cigarettes and alcohol, by the time they graduate there’s almost zero percent chance they will abuse any other type of drug.” iii

However, recent research  strongly suggests that  early onset of drinking may result from pre-existing emotional, behavioral, medical or other problems. For example, new research confirms that children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of heavy drinking and alcohol-related problems diagnosable as alcohol abuse or alcohol dependence. iv

Other  researchers have studied age at first drink and substance use, mental health disorders, education, I.Q., education and personality in a sample of 2,670 adults.  They have also studied whether P3 amblitude (a well-documented psychophysiological marker of alcoholism risk) was associated with age oat first drink in a sample of 1,127 17-year-olds. Finally, they have studied whether indicators of disinhibitory psychopathology assessed at age 11 predicted age at first drink in a sample of 1,343 adolescents.

The researchers have concluded that age at first drink is not causally associated with alcoholism but is associated with a wide range of indicators of disinhibited behavior and psychopathology. Individuals who first drank at an early age exhibited high rates of disinhibitory behavior and psychopathology before they first try alcohol. v

Other researchers have again found that by monitoring young children’s behavior they could predict subsequent alcohol problems long before they took their first drink.

Trained interviewers rated children’s ability to control their impulses and behavior (behavioral control) and to flexibly adapt their self-control to environmental demands (resiliency). This was done from the time children were between three and five years old and every three years thereafter until the children reached the age of 12 to 14. The researchers found that low behavioral control and resiliency predicted the onset of alcohol and illicit drug use in adolescence.

Similarly, in “Age at first drink and risk or alcoholism: a non causal association,”* researchers found that age at first drink is not causally associated with alcoholism but is associated with a wide range of indicators of disinhibited behavior and psychopathology. Individuals who first drank at an early age exhibited high rates of disinhibitory behavior and psychopathology before they first try alcohol. vi

Researcher Helene White explains that

age of onset may simply be a marker of an already existing syndrome of problem behaviors (Glantz & Leshner, 2000). Studies have consistently found that early   disruptive behaviors (e.g., conduct disorder) are related to later substance use and abuse, and that the onset of disruptive behaviors often occurs prior to alcohol use initiation (e.g., Costello et al., 1999). McGue and colleagues (2001b) found that those who first started drinking before age 15 compared to those who started later were at much higher risk for developing alcohol dependence as well as other drug dependence and other externalizing disorders. They argued that all of these outcomes are manifestations of disinhibitory behavior or psychopathology, and that early onset of alcohol use may reflect a vulnerability to disinhibitory behavior. Furthermore, they found that several indicators of disinhibitory behavior actually preceded age of onset. Therefore, their findings refuted a causal path from age of onset to later alcoholism. In a subsequent study, McGue and colleagues (2001a) concluded that a common inherited vulnerability model appears to explain the association of early age of onset and later alcoholism. Prescott and Kendler (1999) also showed that the association between age of onset and later alcoholism was mediated by common genetic factors and, thus, they refuted any causal association. vii

So it would appear that, at best, attempts to raise the age of first drink would be ineffective in reducing alcohol abuse and alcoholism. In fact, attempts to raise age at first drink may very well be counter-productive.

References:

  • i. National Institute on Alcohol Abuse and Alcoholism (NIAAA). Alcohol Alert, #59, April, 2003. The references cited in the NIAAA quote are: (25) Grant, B.F., and Dawson, D.A. Age of onset of alcohol use and its association with DSM–IV alcohol abuse and dependence: Results from the National Longitudinal Alcohol Epidemiological Survey. Journal of Substance Abuse 9:103–110, 1997. (26) Dawson, D.A. The link between family history and early onset alcoholism: Earlier initiation of drinking or more rapid development of dependence? Journal of Studies on Alcoholism 61(5): 637–646, 2000. (27) Rose, R.J. A developmental behavior–genetic perspective on alcoholism risk. Alcohol Health & Research World 22(2): 131–143, 1998. (28) Virkkunen, M., and Linnoila, M. Serotonin in early–onset alcoholism. In: Galanter, M., ed. Recent Developments in Alcoholism. Vol 13: Alcohol and Violence. New York: Plenum Press, 1997. pp. 173–189. (29) Kono, Y.; Yoneda, H.; Sakai, T.; et al. Association between early–onset alcoholism and the dopamine D2 receptor gene. American Journal of Medical Genetics (Neuropsychiatric Genetics) 74(2): 179–182, 1997.
  • ii. Califano, Joseph. Teen Tipplers: America’s Underage Drinking Epidemic. Center on Addiction and Substance Abuse (CASA) pres release, 2-26-02.
  • iii. Schultz, Sean. Alcohol education falls to new generation. Green Bay Press-Gazette, 5-18-04.
  • iv. Molina, Brooke et al. Attention-deficit/hyperactivity disorder risk for heavy drinking and alcohol use disorder is age specific. Alcoholism: Clinical & Experimental Research, 2007,  31(4), 513-715.
  • v. McGue, M. et al. Origins and consequences of age at first drink. I. Associations with substance-use disorders, disinhibitory behavior and psychopathology, and P3 amblitude. Alcoholism: Clinical and Experimental Research, 2001, 8, 1156-1165.
  • vi. Prescott, Carol A., and Kendler, Kenneth S. Age at first drink and risk for alcoholism: A non causal association. Alcoholism: Clinical and Experimental Research, 1999, 23(1), 101-107. (In spite of its title, this report examines alcohol problems in addition to alcoholism.)
  • vii. White, Helene. Age at First Consumption and Future Alcohol- Related Problems. Invited Opinion. International Center for Alcohol Policies, n.d. References cited by Dr. White are Costello, J., Erkanli, A., Federman, E., & Angold, A. (1999). Development of psychiatric comorbidity with substance abuse in adolescents: Effects of timing and sex. Journal of Clinical Child Psychology, 28, 298-311; Glantz, M.D., & Leshner, A.I. (2000) Drug abuse and developmental psychopathology. Development and Psychopathology, 12, 795-814; McGue, M., Iacono, W.G., Legrand, L.N., & Elkins, I. (2001a). Origins and consequences of age at first drink. II. Familial risk and heritability. Alcoholism: Clinical and Experimental Research, 25, 1166-1173; McGue, M., Iacono, W.G., Legrand, L.N., Malone, S., & Elkins, I. (2001b). Origins and consequences of age at first drink. I. Associations with substance-use disorders, disinhibitory behavior and psychopathology, and p3 amplitude. Alcoholism: Clinical and Experimental Research, 25, 1156-1165; and Prescott, C.A., & Kendler, K.S. (1999). Age of first drink and risk for alcoholism: A noncausal association. Alcoholism: Clinical and Experimental Research, 23,101-107.

Readings

  • Dick, D. M., and Foroud, T. Candidate Genes for Alcohol Dependence: A Review of Genetic Evidence From Human Studies. Alcoholism: Clinical & Experimental Research. 27(5): 868-879, May 2003.
  • Dougherty, D. M., et al. Age at First Drink Relates to Behavioral Measures of Impulsivity: The Immediate and Delayed Memory Tasks.
    Alcoholism: Clinical & Experimental Research. 28(3): 408-414, March 2004.
  • Justus, Alicia N., et al. P300, Disinhibited Personality, and Early-Onset Alcohol Problems. Alcoholism: Clinical & Experimental Research. 25(10): 1457-1466, October 2001.
  • McGue, M. et al. Origins and consequences of age at first drink. I. Associations with substance-use disorders, disinhibitory behavior and psychopathology, and P3 amblitude. Alcoholism: Clinical and Experimental Research, 2001, 8, 1156-1165.
  • Wong, P. M., et al. Behavioral control and resiliency in the onset of alcohol and illicit drug use: A prospective study from preschool to adolescence. Child Development, 2006, 77(4), 1016-1033.

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