|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
“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.”
The National Institute on Alcohol Abuse and Alcoholism, part
of the National Institutes of Health, is the primary U.S. agency
for conducting and supporting research on the causes, consequences,
prevention, and treatment of alcohol abuse, alcoholism, and alcohol
problems and disseminates research findings to general, professional,
and academic audiences. Additional alcohol research information
and publications are available at www.niaaa.nih.gov.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov.