Relationship between drinking early in adolescence and later negative outcomes

Alcohol experimentation in late childhood or early adolescence is a common event. An early age of first drink (AFD), however, is associated with a variety of negative outcomes.

A study in the October issue of Alcoholism: Clinical & Experimental Research looks at variables that may precede or predict AFD, with a focus on four areas: child characteristics, family demographics, family psychopathology, and child behavior problems. Surprisingly, aspects of the child and the child's environment seemed to affect their AFD more than family history of alcohol dependence.

"A number of studies have demonstrated that an early AFD is associated with increased rates of childhood psychiatric disorders, lowered success in school and extracurricular activities, increased criminal behavior, and lowered overall life satisfaction and productivity," said Samuel Kuperman, director of the division of child psychiatry at the University of Iowa Hospitals and Clinics and corresponding author for the study. "These problematic outcomes continue into adulthood, with reported increases in both alcohol-related diagnoses as well as non alcohol-related problems of increased rates of psychiatric diagnoses, poorer physical health, less stability of employment and committed relationships, and increased criminal behavior."

Yet the relationship between an early AFD and later problems is not one of "cause and effect," said Stephan Arndt, a professor in psychiatry at the Carver College of Medicine at the University of Iowa.

"The relationship between drinking early in adolescence and later negative outcomes in drinking is a simple observed correlation," observed Arndt, also with the Iowa Consortium for Substance Abuse Research. "It does not mean that an adolescent who has their first drink early will necessarily have a negative outcome and, as Dr. Kuperman and his colleagues point out, many adolescents who drink early will drink normally in later years. So while AFD seems to be correlated with problem drinking, we do not know how it fits into the process that leads to problem drinking."

"Complicating the relationship of early AFD to later negative outcomes is the fact that many of the risk factors for early AFD may themselves be directly related to these same negative outcomes," added Kuperman. "The goal of this study is to begin to untangle the complicated relationships between these risk factors, which we have grouped together into four domains, and early AFD. Specifically, we examined whether AFD can be predicted better by the total number of risk factors or by the existence of a specific type of risk factor."

Using data collected through the ongoing Collaborative Study on the Genetics of Alcoholism, study authors looked at two groups of children (all ages 7 to 17): those from families with a high occurrence of alcohol dependence, and those from families without that familial history (otherwise called "controls"). Multiple regression analyses were performed to determine which variables contributed the most to predicted AFD.

Results indicate that child and environmental factors are stronger predictors of AFD than family history of alcohol dependence.

"Three variables explained 45 percent of the model variance," said Kuperman. "Age at interview accounted for 38.3 percent, conduct scale score accounted for 6.2 percent, and the number of alcohol-dependent adult siblings accounted for 0.5 percent. No family history measures of alcohol dependence or antisocial personality disorder were contributory to the prediction model for AFD."

"I was not surprised to see that the child and environmental factors were stronger predictors of AFD than family history," said Arndt. "Environment and how the child reacts to his/her environment are clearly more important determinants of age of first drink and, possibly, negative outcomes from alcohol. Culture also plays a large role. While there may be genetic components operating on drinking behavior, these seem to only be related to level of risk and ultimately must interact with the environment."

"While there is a small contribution to the prediction of AFD based on the number of adult siblings with alcohol dependence," agreed Kuperman, "I believe this actually supports the belief that genetic loading for alcohol dependence does not per se contribute to early AFD. Having many siblings with alcohol dependence may somehow represent an environment conducive to early drinking."

"These findings will hopefully lead us to a deeper understanding of the path involved towards negative outcomes in later life and the role that AFD plays or does not play in this path," added Arndt. "It looks like the child and his/her environment starts the path towards age at first drink, and possibly eventually to problems with alcohol. Effective prevention may need to focus on aspects of the child, the family, and the home environment. A simple fix, like delaying the age of first drink, may not be effective since the groundwork for the problems may have already been laid."

Kuperman agrees. "Early alcohol use seems to reflect a number of adverse effects in a child's life: effects that may be internal to the child such as having a significant number of disruptive behavioral symptoms, as well as effects that may be in the child's environment." The next step, he said, is to examine the unique contributions of early AFD to later negative outcomes. "In particular, I believe that we will demonstrate that a strong family history of alcohol dependence or antisocial personality disorder does in fact contribute to an increased risk for the occurrence of negative life outcomes, but that this is not directly influenced by an early onset of AFD."

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