Early Alcohol Dependence Linked to Reduced Treatment Seeking and Chronic Relapse
Individuals who become alcohol dependent before age 25 are less likely to ever seek treatment than those who become alcohol dependent at age 30 or older, according to a new study supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH). They also are more likely to have multiple dependence episodes, of longer duration, and to meet more dependence diagnostic criteria than those who become alcohol dependent later in life. The study appears in the September 1, 2006 issue of Pediatrics.
“Young people who misuse alcohol are experiencing life long consequences of this abuse, and this study underscores the need for research that focuses on prevention and treatment efforts for this vulnerable population,” notes NIH Director Elias A. Zerhouni, M.D.
“The treatment-seeking and dependence severity aspects of this study add important dimensions to previous findings that have shown increased risk of developing future alcohol problems with early alcohol use,” adds NIAAA Director Ting-Kai Li, M.D.
In the current study, Ralph W. Hingson, Sc.D. * and colleagues from the Youth Alcohol Prevention Center at Boston University School of Public Health, analyzed data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a representative survey of the U.S. adult population that involved face-to-face interviews with more than 43,000 U.S. civilians ages 18 and older. The survey included numerous questions based on diagnostic criteria for alcohol abuse and alcohol dependence. Survey respondents also were asked about any help or treatment they had sought for their drinking. The researchers focused on the 4,778 NESARC participants – representing 12.5 percent of the U.S. adult population -- whose survey responses indicated that they had been alcohol dependent at some point in their lives.
“Our analyses found that almost half of these individuals became alcohol dependent before age 21 and about two-thirds before age 25, while about 20 percent became alcohol dependent at age 30 or older,” says Dr. Hingson. “The odds of ever seeking help were lower among those first dependent before ages 18, 20, and 25 compared with those who first became alcohol dependent at age 30 and above, regardless of the number of dependence criteria they met. Yet individuals who were first dependent before age 25 had significantly greater odds of experiencing multiple dependence episodes, episodes exceeding one year, and more dependence symptoms, even after controlling for numerous demographic and behavioral characteristics associated with early onset of alcohol dependence.”
The researchers speculate that fewer marital, family, or work responsibilities among younger persons may help explain why persons diagnosable with alcohol dependence at early ages are less likely to recognize and seek treatment for their drinking-related problems. They also note that, because episodes of heavy drinking are more common among youth in general, those with early dependence onset may be less likely to recognize their dependence.
Dr. Hingson and colleagues call for systematically counseling adolescent patients about their drinking, noting that a recent study found that pediatric medical care providers under-diagnose alcohol use, abuse, and dependence among patients 14 to 18.
“Early onset of drinking predicts early onset of dependence, which in turn is associated with chronic, relapsing dependence,” says Dr. Hingson. “Screening and brief motivational counseling can reduce alcohol-related problems among adolescents and college students who are heavy drinkers and needs to be expanded.”
*Dr. Hingson is now Director of NIAAA's Division of Epidemiology and Prevention Research.