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Age at Onset, Duration, and Severity

Ralph W. Hingson, ScD, MPH; Timothy Heeren, PhD; Michael R. Winter, MPH

Arch Pediatr Adolesc Med. 2006;160:739-746.

Objective  To examine whether starting to drink at an early age is associated with developing alcohol dependence at a younger age and chronic relapsing dependence, controlling for respondent demographics, smoking and illicit drug use, childhood antisocial behavior and depression, and family alcoholism history.

Design  Cross-sectional survey.

Setting  Nationwide face-to-face survey with a multistage probability sample.

Participants  A total of 43 093 adults were surveyed in 2001-2002.

Main Outcome Measures  Based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria, lifetime alcohol dependence, dependence within 10 years of starting drinking, multiple episodes, an alcohol dependence episode in the past year, episodes exceeding 1 year, and meeting 6 or 7 dependence criteria.

Results  Relative to respondents who began drinking at 21 years or older, those who began drinking before age 14 years were more likely to experience alcohol dependence ever and within 10 years of first drinking (adjusted hazard ratios and 95% confidence intervals [CIs], 1.78 [1.51-2.11] and 1.69 [1.38-2.07], respectively). They also more often experienced past-year dependence and multiple dependence episodes (adjusted odds ratios, 1.93 [95% CI, 1.40-2.64] and 3.09 [95% CI, 2.19-4.35], respectively). Among alcohol-dependent persons, the odds were 2.62 (95% CI, 1.79-3.84) for having at least 1 episode exceeding 1 year and 2.89 (95% CI, 1.97-4.23) for meeting 6 or 7 dependence diagnostic criteria.

Conclusion  There is a need to screen and counsel adolescents about alcohol use and to implement policies and programs that delay alcohol consumption.

Author Affiliations: Youth Alcohol Prevention Center, Boston University School of Public Health, Boston, Mass.

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