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Colin MacKenzie M.D.
December 26, 2020

Age at first alcohol use: A risk factor for the development of alcohol disorders?

Introduction

In many communities, the use of liquor during adolescence and youth is a familiar or cultural event. For large numbers of adolescents, it can represent nothing more than healthy psychological experimentation.  Many people who begin to use alcohol on a regular basis in adolescence stop drinking in early adulthood to meet the expectations and obligations of adult social roles such as marriage, motherhood, and employment.  However, studies have shown that a substantial minority of lifetime alcohol users eventually progress to one or more problems with alcohol or become dependent on alcohol. 

A powerful predictor of progression to alcohol-related problems is the age at which a person first begins the consumption of alcohol. The earlier the age at which people take their first drink of alcohol, the greater the risk of abuse and serious problems later in life. The National Longitudinal Epidemiological Survey of Alcohol found that more than 40% of all people who report drinking alcohol before age 14 become dependent on alcohol, four times the rate (10%) seen for those who report their first drink at age 20 or older.

In this blog, we will review the study by DeWit and colleagues who report their results in the article titled, “Age at First Alcohol Use: A Risk Factor for the Development of Alcohol Disorders” published in the American Journal of Psychiatry, regarding the association between the age of first alcohol use and the development of alcohol-related problems later in life. 

Methods

For this study, DeWit et al used data obtained from a community sample of 5856 lifetime drinkers who participated in the Mental Health Supplement of the Ontario Health Survey in 1990-1991. 

Results

Alcohol use during the preadolescent and early adolescent years are highly vulnerable risk periods for the development of alcohol-related harm.  DeWit and Colleagues report in their article titled, “Age at First Alcohol Use: A Risk Factor for the Development of Alcohol Disorders” published in the American Journal of Psychiatry, that people who start using alcohol from ages 11 to 14 years are more vulnerable to the risk of developing alcohol-related disorders later in life.  In fact, those who have their first use at ages 11 to 12 have a 20% probability of life-time alcohol dependence, while those who wait until age 15 to 16 see their probability drop to about 8%, and those not starting until age 19 or later had only 1/10th the probability of those age 11 to 12 of progressing to alcohol dependence after 10 years. Interestingly, those who start drinking before age 11 demonstrate a delayed onset of alcohol use problems for about 10 years before their rates of alcohol use problems escalate rapidly to approach levels similar to those who start at age 11 to 12 years.   

Explanations for why early drinking increases the risk of later alcohol problems are varied. Characteristics such as gender, racial or ethnic affiliation, biological factors (eg, early puberty), involvement with delinquent peers, behavior problems in childhood, as well as adverse events or circumstances early in life not only influence the age at which young people have their first drink, but also increase the risk of developing alcohol problems in adulthood.

In addition, between the ages of 11 and 14, children experience a variety of social and psychological changes (for example, the formation of self-concept and the acquisition of learned social skills) that are important to healthy social functioning at a later age. The initiation of alcohol consumption during this critical period can interfere with these developmental processes, possibly causing an escalation towards more intense and frequent consumption later.  Additionally, this age cohort experiences unique stressors, such as puberty and entrance into high school.  An adolescent may find alcohol to be a means to cope with these stressors laying down a foundation of maladaptive coping mechanisms that escalate with stressors later in life.  The study also points out that children who begin to use drugs to cope with their problems in life become more frequent and habitual users of alcohol. 

Conclusion

The study results support the notion that prevention programs that are effective in delaying alcohol use in adolescents, even just a couple of years, could profoundly impact the prevalence of alcohol-related harm in the future.  Likewise, such programs could avoid social, economic, and health-related costs at the societal level. The urgency of implementing effective programs is underscored by recent trends that indicate a steady decline in the average age at first alcohol consumption.

DeWit DJ, Adlaf EM, Offord DR, Ogborne AC. Age at first alcohol use: a risk factor for the development of alcohol disorders. Am J Psychiatry. 2000 May;157(5):745-50. doi: 10.1176/appi.ajp.157.5.745. PMID: 10784467