Early Onset of Drinking (Early First Drink of Alcohol) and Later Problems

Drinking at an early age (early onset of drinking) has been associated with later alcoholism and other drinking problems in several western countries that prohibit young people from drinking alcohol legally.

This has led some people to believe that delaying the age at which young people first drink might reduce the later incidence of alcohol abuse and alcoholism. That might work if drinking at an early age actually causes subsequent alcohol problems.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) accurately summarizes the research on the relationship between the onset of drinking at an early age and alcohol dependence later in life.

People who begin drinking before age 15 are four times more likely to develop alcohol dependence at some time in their lives compared with those who have their first drink at age 20 or older (25). 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). 1 (Emphasis added)

The federal agency's warning against assuming that early drinking of alcohol causes later alcohol abuse is routinely ignored. For example, Joseph Califano 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." 2 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." 3

However, there is very strong and growing evidence that early drinking is not the cause, but only a result, of an underlying predisposition to alcoholism and other behavioral problems.

Both early onset of drinking and alcohol dependence may be caused by underlying personality characteristics such as impulsivity or sensation seeking, or from genetic factors.

Federally funded research continues to seriously question whether early age of first drink has any effect upon later alcohol dependence or alcohol-related problems. 4 In one such study, the researchers found that

"AFD (age at first drink) is not specifically associated with alcoholism but rather is correlated with a broad range of indicators of disinhibited behavior and psychopathology. Moreover, individuals who first drink at a relatively early age manifest elevated rates of disinhibitory behavior and psychopathology before they first try alcohol. Taken together, these findings suggest that the association of AFD with alcoholism reflects, at least in part, a common underlying vulnerability to disinhibitory behavior. Whether an early AFD directly influences risk of adult alcoholism remains unclear."

The investigators also report that "problems seen in adulthood among early drinkers existed prior to their taking that first drink, which suggests that developmental processes were already disrupted prior to that first drink. Thus, an early AFD is more likely a 'symptom' of an underlying vulnerability of disinhibitory processes rather than a 'cause' of increased rates of alcoholism." 5 Alcohol researcher Dr. 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. 6

In one study, 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. 7

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. 8

Researchers at the University of Amsterdam in The Netherlands examined the role of both genes and environment on the initiation of drinking alcohol among early adolescents. They used data from the Netherlands Twin Registry to analyze almost 1,400 twins.

Genetic factors were found to be the most important influence in the early initiation of alcohol consumption. 9

Research has found both problem gamblers and alcohol-dependent persons to display impairments in risky decision-making and cognitive impulsivity. More specifically, both share "deficits in tasks linked to ventral prefontal cortical dysfunction."

The findings are consistent with other research studies that have found that that pre-schoolers who display behavioral impulsivity are more likely to become problem drinkers later in life.

Early onset of drinking and later problem drinking both appear to be caused by impulsivity and similar personality factors that preceded them. 10

So it appears 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.

Teaching young people how to drink in moderation may, in fact, reduce drinking problems. In some groups, including Jews, Italians, Greeks, Portuguese, Spaniards, and many others, most people drink but there are few problems. There are three keys to their success.

  1. The substance of alcohol is seen as rather neutral, being inherently neither a magic elixir nor a passport to maturity, success and prosperity. It's how alcohol is used that is all-important.
  2. There are two equally acceptable choices for those legally able to drink: One choice is to drink in moderation, while the other choice is to abstain. What is never acceptable for anyone of any age under any circumstance is to abuse alcohol.
  3. Young people learn about alcohol from an early age within the home by good example. These groups would all agree that it's better to learn about alcohol in the parents' house than in the fraternity house. 11

Nation-wide research in both the U.S. (funded by the federal government) and England has demonstrated that teens who drink with their parents are less likely to experience alcohol-related problems. 12 Note that drinking with your own children at home (and sometimes elsewhere) is legal in most states. 13

But doesn't drinking at an early age damage the brain? Actually, there is no evidence that drinking in moderation at an early age causes any brain damage. 14 In fact, students in these early-drinking groups tend to out-perform U.S. students on standardized tests of math, geography, and other subjects.

Note: This website does not provide health, medical, legal or any other advice and none should be inferred.

References:

  • 1. 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), 1997, 74(2), 179–182.
  • 2. Califano, Joseph. Teen Tipplers: America's Underage Drinking Epidemic. Center on Addiction and Substance Abuse (CASA) press release, 2-26-02.
  • 3. Schultz, Sean. Alcohol education falls to new generation. Green Bay Press-Gazette, 5-18-04.
  • 4. McGue, M., et al. Origins and consequences of age at first drink. I. Associations with substance-use disorders, disinhibitory behavior and psychopathology, and P3 amplitude. Alcoholism: Clinical & Experimental Research, 2001, 25(8), 1156-1165.
  • 5. Age at First Drink: What Does It Really Mean? University of Minnesota/Virginia Commonwealth University press release, 8-14-01.
  • 6. 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.
  • 7. Drinking Alcohol at an Early Age (Early Onset of Drinking) and Later Alcohol Problems: New Research
  • 8. 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.
  • 9. Polen, E., Derks, E., Engels, R., van Leeuwe, J., Scholte, R., Wellemsen, G. and Bloomsma, D. The relative contribution of genes and environment to alcohol use in early adolescence: Are similar factors related to initiation of alcohol use and frequency of drinking? Alcoholism: Clinical & Experimental Research, 2008, 32, 975-982.
  • 10. Lawrence, Andrew J. et al. Problem gamblers share deficits in impulsive decision-making with alcohol-dependent individuals. Addiction, 2009, 104(6),1006-1015.
  • 11. Children, Alcohol and Parenting.
  • 12. Drinking with Parents is "Protective" of Alcohol Abuse; Drinking with Parents Reduces Alcohol Abuse among Teenagers.
  • 13. Minimum Legal Drinking Ages.
  • 14. "Drinking Alcohol Damages Teenagers' Brains."

Readings

  • 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.
  • Dick, D. M., and Foroud, T. Candidate genes for alcohol dependence: A review of genetic evidence from human studies. Alcoholism: Clinical & Experimental Research, 2003, 27(5), 868-879.
  • 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, 2004, 28(3), 408-414.
  • Foley, Kristie Long, et al. Adults' approval and adolescents' alcohol use. Journal of Adolescent Healthy, 2004, 35(4), 345-346.
  • 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, 1997, 9, 103–110.
  • Justus, Alicia N., et al. P300, disinhibited personality, and early-onset alcohol problems. Alcoholism: Clinical & Experimental Research, 2001, 25(10): 1457-1466.
  • Kono, Y., et al. Association between early–onset alcoholism and the dopamine D2 receptor gene. American Journal of Medical Genetics (Neuropsychiatric Genetics), 1997, 74(2): 179–182.
  • 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.
  • O'Neil, Iain. Teenagers who drink with their parents are less likely to binge drink, according to a study of 10,000 children. Morning Advertiser (U.K.), May 11, 2007.
  • Polen, E., et al. The relative contribution of genes and environment to alcohol use in early adolescence: Are similar factors related to initiation of alcohol use and frequency of drinking? Alcoholism: Clinical & Experimental Research, 2008, 32, 975-982.
  • Rose, R.J. A developmental behavior–genetic perspective on alcoholism risk. Alcohol Health & Research World, 1998, 22(2), 131–143.
  • Virkkunen, M., and Linnoila, M. Serotonin in early–onset alcoholism. In: Galanter, M., ed. Recent Developments in Alcoholism. Vol 13.
  • Woodcock, Andrew. Alcohol at home could help cut teenage binge drinking. The Scotsman (U.K.), May 12, 2007
  • 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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