Annotated Bibliography

Age of First Drink or Intoxication, & Subsequent Quantity of Drinking

by Thomas E. Radecki, M.D., J.D.

Research has tremendously advanced our ability to answer the question of whether starting drinking at an early age has an adverse effect in the long run. Early studies were usually small studies, having only a few hundred individuals and thus much more subject to errors due to random variations. However, studies by the early 1990s established very solid evidence that early drinking is a major gateway event to alcohol abuse and alcoholism.

Doctors & Lawyers for a Drug Free Youth (DFY) has found 37 studies looking at the age when young people start drinking alcohol and their drinking patterns and/or problems at a later point in time. All 37 studies, covering over 206,000 individuals, show that early drinking increases the likelihood of the amount of later drinking. However, as noted, some of the earlier studies because of their small sample size, disagree on the amount of impact. Now we can say that the research definitively shows that early drinking and/or early heavy drinking increase alcohol-related problems, alcoholism, and/or death in later teenage and adult life. Besides many American studies, parallel findings exist for French, Israeli, British, Swedish, New Zealand, Australia, and, specifically, African-Americans and American Indians.

The studies give powerful evidence of the importance of finding successful ways to delay the onset of drinking until at least the legal drinking age.  While several small studies note considerable variation in drinking levels of individuals over time, the newer, larger studies confirm that the remaining impact of early onset of drinking is still very significant. The percentage of those developing alcohol problems even after starting drinking after the age of 25 is still of concern and gives additional support to the value of lifelong abstinence.

Thirty of the studies specifically linked early onset of drinking or intoxication with the development of alcohol problems or drug abuse or both. Although some studies do show that a fair number of adolescents do stop abusing alcohol as they grow older, every study shows that early drinking and early heavy drinking increases later heavy drinking and/or alcohol problems.

While there are undoubtedly more of these studies that we have not yet located, the evidence appears clear and convincing. The initiation of alcohol drinking at an earlier age increases the risk of alcohol problems at a later age. The conclusion is that parents and society should make considerable effort to help young people understand this danger and to encourage young people, if they ever plan to drink alcohol, to wait at least until the legal age of 21. One large study comparing those starting drinking after age 21 to those starting earlier, found those starting at 16 or before had sixteen times as many drinking problems and those starting between 17 and 20 had four times as many drinking problems! (Barnes, 1992)

While there doesn't appear to be any age after which one can safely say that the dangers of developing a drinking problem can be avoided, those who delay drinking until age 21 will considerably cut their risk of ever developing serious alcohol problems. Delaying to age 36 is even better (Chou, 1992).

At any one point in time, nine percent of American adults have a diagnosable active alcohol dependence (alcoholism), and another 9 or 10% have a less severe alcohol abuse diagnosis. Thirty-eight percent of Americans having a family history of alcoholism in their 1st or 2nd degree relatives and many alcoholics don't have a known family history of alcoholism. Alcohol kills some 100,000 Americans each year and because it is the one of the leading killers of teenagers and young adults, results in 2.6 million years of life lost. It is the second leading preventable cause of death in the U.S. following tobacco abuse.  In years of life lost before age 65, it ties tobacco as being the #1 causes of early death.

Few current courses on alcohol and drug problems aimed at minors stress or even mention that alcoholism is usually developed gradually, is due in large part to the addictive biological nature of alcohol itself, and that the early initiation of drinking makes it more likely that this process will lead to alcohol abuse and alcohol dependence. Research with tobacco actually finds the same pattern, although far fewer studies are available. The earlier tobacco use begins, the more likely the individual will be a heavy user in adulthood. That individual will have a harder time giving up tobacco and will be at a definitely higher risk of developing lung cancer.

Research has shown that most minors consume their first alcohol at home. This is especially true of those starting at an early age. While some of this is consumed without their parents knowledge, considerable research shows that parental approval of underage drinking is linked to heavier teen drinking and the development of alcohol-related problems. Two studies do show that young people of equal ages who start drinking outside the home are more prone to later problems than those who start drinking in the home, the difference is not major. One study showed that those who drink only in the home, the exception, are prone to fewer problems than those who drink outside the home. However, this is a highly select population. The same can be shown of traditional Jewish families where light or very light drinking was a ritualized religious observance.

While the popular media continues to promote underage drinking, e.g. an article in Redbook from November, 1992 encouraging parents to start letting their children drink by age 10, the studies show that this is very poor advice. Complimentary research, reviewed elsewhere on this website, shows that a parental non-drinking role-model results in the fewest children who develop alcohol problems.

The studies on the impact of the early initiation of alcohol drinking are as follows in chronological order:

Fillmore KM (1974). Drinking and problem drinking in early adulthood and middle age: An exploratory 20-year follow-up study. Q J Stud Alc 35:819-40. A 20-year-follow-up of 206 college students drawn from Straus and Bacon's 1949-52 national sample were studied. Abstaining decreased markedly during this period of time which marked a dramatic increase in the national drinking rate. These percentages decreased for both males (45% to 18%) and females (43% to 16%). Among the drinkers at follow-up, the frequency of drinking had increased considerably. Although the percentage of male problem drinkers decreased considerably, 17% were still problem drinkers at follow-up as well as 12% of females. Being a problem drinker in college was moderately predictive of being a problem drinker 20-years later. Abstainers at Time 1 were much less likely to become moderate or heavy drinkers at follow-up when compared to those who had been light, moderate or heavy drinkers initially. Initial light drinkers had the second lightest drinking pattern at follow-up but contained considerably more heavy drinkers. There was no difference in the percentage of initial abstainers and initial nonproblem drinkers who became problem drinkers at follow-up.

Fillmore KM (1975). Relationships between specific drinking problems in early adulthood and middle age. J Stud Alc 36:882-917. This is a further analysis of the same sample as above. Those who were frequently intoxicated or engaged in binge drinking in college predicted serious alcohol problems 20 years later. Frequency of drinking per se was not a significant predictor but binge drinking was. Half of adult problem drinkers had been problem drinkers in college.

Parfrey PS (1974). Factors associated with undergraduate alcohol use. Brit J Prev Soc Med 28:252-57. Irish undergrads were studied with 444 completing questionnaires. Heavier drinking was strongly associated (p <.001) with age of onset between 13 and 16 rather than age 17 or thereafter for males but for females many more non-drinkers and light drinkers had their first drinks before age 13. This later finding is highly unusual and may be a random anomaly due in part to only 143 females analyzed when compared to larger studies. The heavier drinkers were also more likely to have had their first drink in a bar or hotel although only 23% of the entire sample had their first drinks at home.

Wechsler H, McFadden M (1979) Drinking among college students in New England: Extent, social correlates and consequences of alcohol use. J Stud Alc 40:969-96. 7345 of 10500 students returned a mail questionnaire of 34 New England colleges. Alcohol was consumed alcohol in the past year by 96%. Intoxication at least once a month was reported by 20%. Many undesirable outcomes of drinking were reported. Over 90% of students came from homes with at least one drinking parent. Drinking by male students was increased as parental drinking increased and for females increased as paternal drinking increased. They found that more than half of the men who reported weekly alcohol use in high school were in the frequent-heavy drinking category in college compared with less than 10% of those who either drank infrequently or not at all in high school. In addition, high school females who reported drinking at least once a week were nine times more likely to be frequent-heavy drinkers in college compared with those who drank infrequently or abstained in high school.

Wechsler H, Rohman M (1981). Extensive users of alcohol among college students. J Stud Alcohol 42:149-55. 7083 New England undergrads returned a 15-page mail questionnaire (67%). Beer was the beverage of choice of the heaviest drinkers, more than in other drinking categories. Heavy use of alcohol was strongly associated with a student's drinking patterns in high school with heavy college drinkers being much less likely to have been nondrinkers or infrequent drinkers in high school. The heavy drinkers had many alcohol related problems. Frequent heavy drinking among college students is an extension of students' drinking patterns in high school.

Rachel JV, Guess RL, Hubbard RL, Maisto SA, Cavanaugh ER, Waddel R, Benrud CH (1982). Alcohol misuse by adolescents. Alc Health Res World, pp 61-8. "Misusers" of alcohol start drinking at an earlier age than non-problem drinkers.

Adler I, Kandel DB (1983). Risk periods for drug involvement: Application of survival analysis to cross-sectional data. Soc. Forces 62:375-87. Lifetime prevalence is consistently associated with age of onset for beer, wine, liquor, and cigarettes for 499 French and 609 Israeli 14- to 18-year-olds studied with face-to-face interviews. The higher the prevalence of a given drug, the earlier the age of initiation into use of that drug.

Barnes GM, Welte JW (1983). Predictors of alcohol use among college students in New York State. J Am. Coll. Health 31:150-7. 7,700 New York undergrads were randomly selected from 22 colleges and completed a 10-page questionnaire. Drinkers in the last 30 days included 83% of males and 78% of females. Drinking rates were similar 18 through 21.Upstate and suburban NYC students were more often heavy drinkers (25%) and less often abstainers (14%) than those in New York City (15% and 33%). Abstaining was much higher for blacks (41%) and orientals (65%) and heavy drinking much lower ((5% and 2%) compared to whites (13% and 25%). The earlier the onset of drinking, the higher the total alcohol consumption. Indeed, an earlier age of onset was the most powerful predictor of current consumption and alcohol-related problems. For instance, those starting drinking at 12 were consuming more than four times as much alcohol in college as those waiting until age 18. The most common age of onset for this heavy drinking population was 11 or younger (29%).

Donovan JE, Jessor R, Jessor SL (1983). Problem drinking in adolescence and young adulthood: A follow-up study. J Stud Alcohol 44:109-137. Most college drinkers "matured out" of their problem drinking, although marriage appears to be linked to this reduced drinking. College problem drink was still significantly related to problem drinking 7 years later at least somewhat. A total of 595 high school seniors and college seniors were followed up 6-7 years after being followed for four years during school (a 94% retention rate). Of male college senior problem drinkers, 50% were still college drinkers 6 years later.

Gonzalez GM (1983). Time and place of first drinking experience and parental knowledge as predictors of alcohol use and misuse in college. J Alc & Drug Ed 28:24-33. University students who retrospectively reported that they started to drink at a younger age tended to consume more alcohol than those who began drinking when older. Those introduced to alcohol by parents or with their parents' approval were somewhat less likely to experience alcohol-related problems later in life than those whose parents did not know of their first drink.

Hughes SP, Dodder RA (1983) Alcohol-related problems and collegiate drinking patterns. J Youth Adolesc 12:65-76. He reported that the most important predictor of the extent of collegiate drinking is the amount of alcohol consumed in precollege years.

Schuckit (1983) also found that the earlier that university men begin to drink, the greater the frequency and quantity of subsequent drinking, and the greater the incidence of alcohol-related problems.

Holland SJ, Griffin A (1984). Adolescent and adult drug treatment clients: Patterns and consequences of use. J Psychoactive Drugs 16:79-89. This study found that the age of onset of alcohol use behavior predicts the number of alcohol-related problems later in life.

Morgan MC, Wingard, DL, Felice ME (1984). Subcultural differences in alcohol use among youth. A Acol Health Care 5:191-5. Black youth had their first social drink between the ages of 12 and 15 years as opposed to white students who initiation into alcohol use began around 11 years of age. Many studies have found black youth to have lower rates of alcohol use.

Friedman J, Humphrey JA (1985). Antecedents of collegiate drinking. J Youth & Adolescence 14:11-21. A 10% random anonymous sample totalling 856 nonmarried undergrads were surveyed (95% of a larger sample with 5% of survey unusable although the characteristics of this 5% did not differ). They who started to drink at a younger age tended to consume more alcohol than those who began drinking when older. Those who report drinking large amounts of alcohol when young are more likely to be heavy drinkers when older than those who had reported drinking small amounts when young. Race (three times as many whites were in the heaviest drinking category), degree of closeness to a problem-drinking (closeness tends to decrease drinking), age of onset of drinking, and the extent of drinking at onset markedly influenced collegiate alcohol consumption. The strongest predictor was the extent of adolescent consumption.

Robins LN, Przybeck TR (1985). Age of onset of drug use as a factor in drug and other disorders. In CL Jones, and RJ Battjes (eds.), Etiology of Drug Abuse: Implications for Prevention. Rockville, Maryland: National Institute on Drug Abuse, pp. 178-92. One of the most powerful predictors of illicit drug abuse in early adulthood is the onset of alcohol use prior to the age of 15.

Barnes GM, Welte JW (1986). Patterns and predictors of alcohol use among 7-12th grade students in New York State. J Stud Alc 47:53-62. A 1983 random sample of New York 7-12th graders totalling 27,335 surveyed found those who report drinking large amounts of alcohol when young are more likely to be heavy drinkers when older than those who had reported drinking small amounts when young. Children whose age of first drunk was 11 or younger, 15% of the study, were consuming an average of 2 ounces of alcohol or four drinks per day at the time of the study. Those with first intoxication at 12 or 13, 28% of the study, were consuming 0.9 ounces per day. Children with first intoxication at 14 or later, 35% of the study, were consuming 0.6 ounces per day. The 24% of children who had never gotten intoxicated were consuming only 0.09 ounces per day. Children who said that their parents approved of their drinking beer or were neutral were more likely to consume greater amounts and be heavy drinkers than those who said their parents disapproved of drinking. Parents strongly opposed to children drinking had children who consumed the least.

Humphrey J & Friedman, J (1986). The onset of drinking and intoxication among university students. J Stud Alc 47:455-8. 856 undergrad were studied in North Carolina. Individuals who begin to drink at or before age fifteen (compared with those age sixteen or older) are twice as likely to get drunk four or more times a month when they are university students.

Temple MT, Fillmore KM (1985-6). The variability of drinking patterns and problems among young men, age 16-31: A longitudinal study. Int J Addict 20:1595-1620. In a small study, 240 Oregon high school students were followed from age 18 to 31 with drinking behavior briefly measured at 12 points in time. Although the authors stress how many abstainers in senior year of high school still end up drinking and "regularly got high" as young adults (34%), those already "getting high" from alcohol in senior year were still worse at age 31 (51%). Their research has been interpreted by others as supporting the concept of the harmful effects of early drinking although the authors stress that problem drinking at age 31 was most unrelated to levels of drinking at age 18. Drinking to the point of feeling high rapidly increases during ages 16 and 21 and falls off somewhat thereafter.

Ghodsian M, Power C (1987). Alcohol consumption between the ages of 16 and 23 in Britain: a longitudinal study. Brit J Addict 82:175-80. The age at which people first start drinking has been declining the Britain and Scotland. A large national representative sample of young people in Britain at age 16 and again at age 23 from the National Child Development Study of children born in March, 1958. The 17,000 children were surveyed at ages 7, 11, 16, 23. 9,337 were used for this study, those giving the necessary information at both ages 16 and 23. At age 23, 28% of women and 9% of men were abstainers. Of men 50% were moderate and 12% heavy (over 50 drinks in the month). Although there was considerable movement between drinking categories, the likelihood of heavier consumption at 23 was much greater for those with early heavier drinking. Those who drank most and more frequently at 16 were most likely to drink heavily at 23. Those illegally drinking in taverns at 16 were more likely than those drinking only at home to be heavy drinkers at age 23 although the difference wasn't large.

Gold, M.S. (1988). The facts about drugs and alcohol. (3rd ed.). New York: Bantam. The earlier drinking begins, the more likely problem drinking will exist.

Fleming R, Leventhal H, Glynn K, Ershler J (1989). The role of cigarettes in the initiation and progression of early substance use. Add Behav 14:261-72. Interviews of 1007 students grades 6 through 10 in Milwaukee were followed two years later with 89% reinterviewed. Cigarettes were the first gateway drug used for most students. Use of cigarettes, marijuana and beer at Time 1 was linked to at least monthly liquor use at Time 2. Use of either cigarettes alone or marijuana alone at Time 1 was linked to greater initiation of monthly beer use at Time 2. Daily or any coffee or tea use was not linked to other substance use.

Gonzalez GM (1989). Early onset of drinking as a predictor of alcohol consumption and alcohol-related problems in college. J Drug Educ 19:225-30. 4,202 Florida college students showed 14% started drinking in elementary school, 34% middle school, 45% high school and 7% college. Time of first drink predicted the quantity-frequency of consumption and alcohol problems in college (p<.0001). Those not starting drinking until in college had the lowest consumption (12.33) and lowest frequency of alcohol problems (6.79) by a large margin while those starting in elementary and middle school had the highest rates (28.25 & 16.85).

Weber MD, Graham JW, Hansen WB, Flay BR, Anderson-Johnson C (1989). Evidence for two paths of alcohol onset in adolescents. Addict Behav 14:399-408. 2188 7th and 8th graders were surveyed twice one year apart. Adolescents who used more often and who had the greatest increase in use were those who started drinking the earliest. Problem drinking was related to the age teens started drinking.

Alterman AI, Hall JG, Portill JJ, Searles JS, Holohan JM, McLellen AT (1990). Heavy drinking and its correlates in young men. Addict Behav 15:95-103. In a study of 98 college men, the consuming alcohol or drugs before the age of 15 was highly correlated with increased drinking behaviors and adverse consequences when in college. Drinking problems were very common among the Philadelphia college students (40%). Being a fraternity member, a heavy drug user, a smokers, and having a family member who had received alcoholism treatment were also significant factors in drinking and alcohol problems. Fathers who had at least one serious drinking related problem, e.g. fired, divorces, DUIs, were reported by 29%. Only 39% did not have alcohol problems in 1st or 2nd degree relatives.

Barnes GM, Welte JW (1990). Prediction of adults' drinking patterns from the drinking of their parents. J Stud Alcohol 51:523-7. In a study of 6,364 randomly selected New York young adults, abstaining by fathers and abstaining by mothers each had a positive effect. Each was linked to less heavy drinking and fewer alcohol-related problems in the adult lives of their children. This effect was true for both sons and daughters. Growing up in a family where the father was absent had an additional negative effect over and above the drinking pattern of the mother. Also, the earlier the first drink and the first time drunk, the more likely that drinking problems later developed.

Power C, Estaugh V (1990). The role of family formation and dissolution in shaping drinking behavior in early adulthood. Brit J Addict 85:521-30. This study of 9,337 British youths surveyed periodically since birth in 1958 found that non-drinking or lighter drinking at age 16 tended to persist at age 23 although there was some decrease in drinking overall and a majority of both non-drinking and light drinking 16-year-old had become frequent-moderate or heavy drinkers by age 23. The best predictor of maintaining or reducing levels of drinking to a low level was marriage and parenthood. Partnership breakdown was associated with heavier drinking established at age 16 and increasing consumption between adolescence and early adulthood no matter what the age 16 consumption level was.

Andreasson S, Allebeck P (1991). Alcohol and psychiatric illness: Longitudinal study of psychiatric admissions in a cohort of Swedish conscripts. Internatl J Add 26:713-28. A 20-year follow-up of 49,464 Swedish draftees found high levels drinking (17 drinks or 8.8 ounces per week) at conscription was associated with a 180% increased risk of death during follow-up compared to moderate drinkers (less than seven drinks or 3.5 ounces per week). Those consuming an intermediate moderate to high level had a 60% increased death rate. Deaths dues to direct toxic effects of alcohol were less than 5%. Instead suicides and accidents predominated. Abstainers had a 20% lower risk of mortality than moderate consumers, due to significantly fewer traffic deaths. Social risk factors added little to the already increased risk of death among high consumers.

Casswell S, Stewart J, Connolly G, Silva P (1991). A longitudinal study of New Zealand Children's experience with alcohol. Brit J Addict 86:277-85. Children, 632 in all, were followed and surveyed at ages 9, 11, 13, and 15. New Zealand's traditional pattern of drinking is said to be periodic spree use. A period of prohibition in the early 20th century has been followed by liberalization with a high average consumption of 11 liters of absolute alcohol per year per adult. The legal drinking age is between 18 and 20. Already at age 9, over 25% of boys and 10% of girls were drinkers and only 15% reported being total abstainers, i.e. not even drinking a sip. Those told of the bad effects of alcohol were more likely to be an abstainer than those given a liberal message. By age 15, over 80% were drinkers and 10% total abstainers. Children of moderately consuming fathers consumed the most. The frequency of mother's and father's drinking had a strong effect on the frequency of their children's drinking with children of non-drinkers or infrequent drinkers drinking least often. Almost all children have been introduced to alcohol in the home by age 9, most by sips out of their parents glasses. There was a small positive relationship between the amounts consumed at younger and older ages.

Ellickson PL, Hays RD, Bell RM (1991). Stepping through the drug use sequence: Longitudinal scalogram analysis of initiation and regular use. J Abn Psychol 101:441-51. Tracing the sequence of drug use over time for 4145 West Coast 7-10th graders over a 4-year span. Alcohol initiation was the most common first drug of use with 76% of the students had already trying alcohol by 7th grade. The most standard drug use sequence went from alcohol initiation to cigarettes to marijuana to weekly alcohol use to pills and regular cigarette smoking then cocaine, regular marijuana, and other illicit drugs. Alcohol initiation and regular use of alcohol are each steps along the drug involvement pathway except for Asian-Americans were regular alcohol use is last in the drug sequence. Numerous other studies have established with fairly invariable sequence which starts with alcohol or cigarettes or both, followed by cannabis and then other drugs. Ten such studies are referenced in this paper.

GM Barnes, Welte JW, Dintcheff B (1992). Alcohol misuse among college students and other young adults: Findings from a general population study in New York State. Interntl J Addictions 27:917-34. Parents, dorms lead to drinking: Beginning drinking at an early age and growing up with a heavy drinking father are strong predictors of heavy drinking and alcohol problems according to a large representative survey of young adults. Living in a dorm as a college student makes a unique contribution to alcohol misuse. The study covered phone interviews with 1,934 adults 18 to 25 in New York State. Of those who started drinking at 21 or after only 2% consumed 2 or more drinks per day and markedly fewer alcohol problems (0.5) compared to those starting drinking at 16 or younger (30% over 2 drinks/day and 8.0 problems) or even 17 to 20 (14% over 2 drinks/day and 2.2 problems).

Beauvais F (1992). Characteristics of Indian youth and drug use. Amer Indian Alaska Native Mental Health Res 5:51-67. High rates of drug abuse exist among Indian youth. Age of first intoxication, low family caring, weak family sanctions against drugs, positive attitudes toward alcohol use, father not at home, and poor religious identification were linked to increased drug use.

Blazetemple D, Lo SK (1992). Stages of drug use: A community survey of Perth teenagers. Brit J Add 87:215-25. A study of 1093 13-17-year-olds found that underage drinking and smoking each function as gateway drugs to illicit drugs. Although tobacco was worse in this regard, alcohol had its own independent gateway drug effect.

SP Chou, RP Pickering (1992). Early onset of drinking as a risk factor for lifetime alcohol-related problems. Brit J Addiction 87:1199-2104. Using the 1988 National Health Interview Survey data, Chou of NIAAA calculated the results of 29,950 drinking or formerly drinking adults 18 and older and the frequency of alcohol dependence symptoms as defined by DSM-III-R. The risk of ever developing any symptoms of alcohol dependence is highest for those whose first drink is before 13 and drops rapidly until age 21 and slowly after age 25. Even waiting until age 36 vs 26 cuts in half the chance of developing 3 or more lifetime symptoms of alcohol dependence (8% vs. 20%). Overall, 42% of drinkers experienced 3 or more symptoms of alcohol dependence at some time during their lives. For those having their first drink at 12-13, 67% had experienced 3 or more symptoms. The authors conclude, "A delay in drinking until 20-21 years-old reduces significantly the risk of developing alcohol-related problems...." The high level of alcohol problems at some time during one's life closely fits a previous report that 40% of all drinkers will suffer some serious consequence to his or her drinking at some time during his life. Chou's study has a beautiful graph of age of onset vs. development of at least one symptom of alcohol dependence. Besides being a powerful argument for delaying the onset of drinking, it is a powerful argument of livelong abstinence.

Crum RM, Bucholz KK, Helzer JE, Anthony JC (1992). The risk of alcohol abuse and dependence in adulthood: The association with educational level. Am J Epidem 135:989-99. An analysis of two interviews with 11,871 people separated by one year has found that compared to adults who had earned a college degree, those who had attended high school without completion were at a 523% increased risk of developing alcohol abuse or dependence (alcoholism) during the year of follow-up. 1,802 (13%) individuals had been excluded from the study because they already had active or former alcohol abuse or dependence at the time of the initial interview. The surveys were done in New Haven, Baltimore, St Louis, Durham, and Los Angeles, as part of the Epidemiologic Catchment Area Study. Adults who had attended college without earning a degree at a 225% increased risk compared to those finishing college. Those finishing high school but not going on to college had only an 88% increase compared to those finishing college, which was not statistically significant. Individuals who had their first alcohol intoxication before age 18 were 600% more likely to develop new alcohol abuse or dependence during the year of follow-up than those who did not get intoxicated before age 18. Males were 425% more likely to develop alcohol problems during the year of follow-up than females. Being black was not associated with an increased rate of alcohol problems

Wilmes, D (1992). Parental Permissiveness: Who wants to Admit it? The Observer: News from The Johnson Institute 14(4). A survey of 6--12 grade students found children allowed to drink alcohol at home are more likely to use alcohol and other drugs outside the home and also more likely to develop serious problems related to their use of alcohol or other drugs.

Yu J, Williford WR (1992). The age of alcohol onset and alcohol, cigarette, and marijuana use patterns: An analysis of drug use progression of young adults in New York State. Internl J Add 27:1313-23. 3000 New Yorkers 16- to 24-years-old were interviewed . The early onset of alcohol use increases that chance of using cigarettes, marijuana, and the continuing use of alcohol with the strongest impact between ages 13 and 16.

Dana RQ, Pratt PA, Kochis RA, Andrews WW (1993). Problematic college drinking behaviors as a function of first intoxication. J Alc Drug Educ 38(2):92-99. 300 University of Maine students in 1990 completed anonymous surveys. The age of first intoxication was highly related to the intensity of current drinking, and the number of problems caused by drinking. Those with their first intoxication at 18 years of older reported the least drinking and fewest alcohol-related problems. This group was followed by the 16-17-year-old age of first intoxication group, then the 14-15-year-old group and finally the 13 or younger group who had three times as many alcohol-related problems and the most drinking (p = .0001). 51% returned the surveys. All but 8 were 21 or younger. First intoxication was 13 or younger in 18%, 14-15 in 33%, 16-17 in 24% and 18 or older in 24%. An additional 10% of the sample had never gotten intoxicated.

© 1993 Thomas Radecki, M.D. May be copied or republished as long as DFY and Dr Radecki are acknowledged

Additional Studies to Review:

Calahan D (1970). Problem Drinkers. San Francisco: Jossey-Bass.

Fillmore KM, Midanik L (1983). The chronicity of drinking problems among men: A longitudinal study. Alcohol Research Group Working Paper.

Calahan D, Room R (1974). Problem Drinking among American Men. New Brunswick, NJ: Rutgers Center of Alcohol Studies, Monograph 7.

Room R (1977). Areas for Development in NIAAA Prevention Programs. Working Paper F70. Berkeley: Social Research Group.

Blane HT (1978). Middle-aged alcoholics and young drinkers. In HT Blane and ME Chafetz (eds), Youth, Alcohol, and Social Policy. New York: Plenum Press.

Fillmore KM, Bacon S, Hyman M (1979). The 27 Year Longitudinal Panel Study of Drinking by Students in College, 1949-1976. Final Report to NIAAA. Berkeley: Social Research Group.

Kandel DB, Logan JA (1984). Patterns of drug use from adolescence to young adulthood: Periods of risk for initiation, continued use, and discontinuation. Amer J Publ Health 74:660-666.

Tobacco smoking age of onset research suggests that the same is true for addictive drugs in general. These studies are also reviewed below. They suggest that at least part of the effect may be biological, not entirely environmental.

latnot the entire sample had their 1A parents did not know of their 1TeenThey also had the most alcohol-related problems. 87:1199-2104.

Tobacco Age of Onset Studies:

Ershler J, Leventhal H, Fleming R, Glynn K (1989). The quitting experience for smokers in sixth through twelfth grades. Addict Behav 14:365-78. Smoking during childhood decreased the likelihood of quitting.

Chassin L, Presson CC (1990). The natural history of cigarette smoking: Predicting young-adult smoking outcomes from adolescent adolescent smoking patterns. Health Psychol 9:701-16. Any smoking during adolescence increased the likelihood of smoking during young adulthood.

Taioli E, Wynder EL (1991). Effect of the age at which smoking begins on frequency of smoking in adulthood. N Engl J Med 325:968-9. Smokers beginning before 14 were more likely to be heavy smokers than those who began age l20 or older. They also had a greater difficulty stopping smoking.

Escobedo LG, Marcus SE, Holtzman D, Giovina GA (1993). Sports participation, age of smoking initiation, and the risk of smoking among US high school students. J Amer Med Ass 269:1392-5. The CDC reports a national survey of 11,248 9th-12th graders found white students and those with law grades were at highest risk of becoming heavy smokers and blacks least likely by a wide margin.Of all, 72% had experimented at some time and 32% had smoker within the past 30 days. Students who began smoking at age 12 or younger were more likely to be regular and heavy smokers. somewhat smaller or less detailed, but already presented strong evidence that the earlier a person starts drinking, the more likely that the person will develop alcohol-related problems DFY has found 35at a later point in time. All 35174smaller,ican studies, the studies reviewed here note parallel findings exist for the French, Israelis,ersnsTwenty-eight The above North Carolina ie university students. In another report on the same study, it notes 14(4). A survey of 6< examining the issue (alcoholism), and another 9 to. The difference, however, does not appear teensa minority in the studyresearch suggestsalso e of being a problem drinker 20 ue in part to only 143 females in the relatively small study &much lower (&&Tseerly1900sdramatic increase in consumption to 27:917-34. Parents and dormitory living leads to drinking.y caring, weak family sanctionss findingssupport (1992). Parental permissiveness: Who wants to ao 24-years-old were interviewedE. ed or republished as long asis (705 W. Oregon, Urbana, IL 61801, 217-328-3349).Still by Thomas E. Radecki, M.D., May, 1993

.

Marijuana Age of Onset Studies:

Robins & Przybeck (1985). Adolescents who use marijuana before age 15 are at a higher risk of alcohol and other drug problems than those who begin to use marijuana at a later age. DFY has found 36ime. All 36

Donnermeyer JF (1993). Rural youth usage of alcohol, marijuana, and "hard" drugs." Interntl J Add 28:249-55. 197 11th graders from four rural schools in north-central Illinois completed questionnaires. The age of first use of alcohol predicted current use of alcohol as well as first use of marijuana, which in turn was ralted to first use of hard drugs. Current use of hard drugs also predicted current use of marijuana, which in turn predicted current use of alcohol. There has not been enough research on the impact of starting drinking in the home at the approval of the parents vs. seeking the alcohol vs. abstinence vs. starting drinking with friends. Since some research suggests a large percentage of children who start drinking before age 13 do so at home and much research shows that children starting drinking before age 13 have a high risk of alcoholism, at least in the U.S., advocating underage drinking in the home is highly questionable.Parents Magazine in November, 1993 also appeared to advocate permitting 11- to 13-year-old children to drink in the home, although less explicitly. okers than those who began age Irish, school Some rfounddrinking under age 13 earlier, especially, appears seriously misguided

Inadequate information is available on early onset of drinking in other cultures, including European cultures which are often held up as examples of the benefits of family drinking. However, the European research available strongly suggests that an early onset of drinking in other cultures is also harmful. Certainly, the rates of alcoholism in Europe are quite high. While American youth culture has a tradition of heavy, excessive drinking, there is no evidence that this tradition is an outgrowth of early abstinence or prohibition traditions in our country. Indeed, it i smore likely due to Hollywood role-models, and the greater American youth access to automobiles, independent living, college education, and financial resources typical of our country. Even today, relatively little is done to discourage underage drinking and advertising is often aimed specifically at this age groups. Abstinence, even abstinence for minors is rarely advocated. BACCHUS, by far the biggest college-based alcohol program refuses to advocate abstinence. High school programs usually do not give good reasons to abstain at least until age 21. This review highlights some of the reasons for strongly advocating abstinence at least until age 21.Australian oldly link thefind DFY has found 37. All 37

Lo CC, Globetti G (1993). Black college students drinking patterns Ñ the roles of family, religious affiliation, and parental guidance during the 1st drinking experience. Sociol Spectrum 13:343-63. Lo did a small study of 160 students at a black Alabama university and reports that students who take their first drink at a lower age are more likely to drink at a high level and to experience a high number of alcohol-related problems in college. However, the negative relationship between age at the time of the first drink and college drinking patterns is attenuated if these young onset drinkers start their drinking in the presence of adults or with the knowledge of their parents.

Hirschman RS, Laventhal H, Glynn K (1984). The development of smoking behavior: Conceptualization and supportive cross-sectional survey data. J Appl Soc Psychol 14:184-206.

à Breslau N, Fenn N, Peterson E (1993). Early smoking initiaion and nicotine dependence in a cohort of young adults. Drug & Alc Dep 33:129-37. 1007 HMO members 21-30 from Detroit were studied. Controlling for sex and race, persons who smoked their first cigarette at 14 to 16 were 1.6 times more likely to become dependent than those initiating at an older age. Conduct problems, elgl fights, truancy, running away, school troubles, and expulsion before age 16 were all strongly related to early smoking, especially for those starting smoking before age 13. Although those starting smoking 13 or young were much more likely to be nicotine dependent later in life compared to those 17 or later (28% vs 15%), the effect disappeared when controlling for race since whites started earlier.

& Other Illicit Drug Robins LN, Murphy GE (1967). Drug use in a normal population of young negro men. Am J Publ Health 57:1580-96.

Yamaguchi L, Kandel DB (1984). Patterns of drug use from adolescence to young adulthood Ñ III. Predictors of progression. Am J Public Health 74:673-681.

Robins LN,TR Age of onset of drug use as a factor in drug and other disorders. In: Etiology of Drug Abuse: Implications for Prevention. (Jones CL and Battjes RJ eds), pp 178-92. NIDA Reseach Monograph 56. US GPO, Waashington, DC, DHHS Publication No (ADM) 85-1335.

Kandel DB (1989). Issues of sequencing of adolescent drug use and other problem behaviors. Drugs Soc 3:55-767.

Surgeon General (1989). Reducing the Health Consequences of Smoking: 25 years of Progress: A Report of the Surgeon General. Atlanta, GA: Centers for Disease Control; 1989. US Dept of Health and Human Services publication CDC 89-8411. p. 406. Delayed onset of smoking is associated with decreased mortality as well as increased attempts to quit and smoking cessation druing the school years. DFY has found 39. All 39,

McKenna T, Pickens R (1981). Alcoholic children of alcoholics. J Stud Alcohol 42:1021-29Early initiation of alcohol use linked to later alcohol-related problems.

Samson HH, Maxwell CO, Doyle TF (1989). The relation of initial aclohol experiences to current alcohol consumption in a college population. J Stud Alcohol 50:254-60. Early use linked to later consumption. Russell M (1990). Prevalence of alcoholism among children of alcoholics. In M. Windle, and J.S.Searles (Eds.), Children of Alcoholics: Critical Perspectives. New York: Guilford Press, p. 9-38. Russell reports finding that the early onset of drinking was linked to later alcohol-related problems.

4040216nine Grant B, Gordis E (1998).

Interviews in 1992 with 42,000 adults asked when they began drinking, excluding experimental sips. More than 43% who began before age 14 developed alcohol later in life and another 10% abused alcohol. The percentage is higher for teens in families with a history of alcoholism. For those who waited until age 21, the chance of developing into an alcoholic was about 10%. Overall, the chances of developing alcoholism drops by 14% each year a person delays drinking. Three-quarters of the drinkers began before age 21. The researchers speculated that younger brains are more sensitive to alcohol. USA Today 1/15/98

Thomas E. Radecki, M.D., J.D.

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