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| Subscribe to Clinical Compass™ | VOLUME 2, ISSUE 4 - FEBRUARY 13, 2007 | |||||||||||||||||||||||||||
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FROM THE CLINICAL KNOWLEDGE CENTER Factors Predicting Age of First Drink and Progression to Alcohol Dependence The week of February 11th-17th has been designated as "Children of Alcoholics Week" by the National Association for Children of Alcoholics (NACOA). According to NACOA, one in four children lives in a family environment where alcohol abuse or alcoholism negatively affects their world and their healthy development. There is growing evidence that living in such families during the crucial developmental years can create lifetime mental and physical health consequences - including the development of alcohol dependence. And in fact, a study published in February 2007 has shed some light on factors that predict the age at which young people begin to consume alcohol, and the time from the first drink to a diagnosis of alcohol dependence (AD). Researchers at the Washington University School of Medicine interviewed 1269 offspring (mean age = 20.1 years) of male twins from the Vietnam Era Twin Registry. Participants ranged in age from 12 to 28 years, with a mean age of 20.10 years (SD = 3.98) at the time of interview. The sample consisted of 48.5% male and 51.5% female offspring. Approximately 95% of participants identified as non-Hispanic white. Sixty-one percent of the offspring's fathers had completed 12 or more years of education; 46.2% of the participants had fathers who were alcohol dependent. DSM-IV psychiatric diagnoses and substance use behaviors were assessed by structured telephone interview, using the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA-II) - a validated measure of psychiatric disorders. Lifetime DSM-IV diagnoses were obtained and detailed accounts of symptoms, frequency, onset and duration of episodes were collected for substance use, mood, anxiety and conduct-related behaviors. Offspring were also queried about the incidence and age of onset of childhood physical and sexual abuse events. In addition, 82% of the participating offspring's mothers were interviewed and provided diagnostic data for the current study. Age of first drink was defined as the age at which the first full alcoholic drink was consumed. Age of onset of AD was defined as the age at which full DSM-IV criteria for AD were first met (i.e., three or more of the seven possible AD symptoms were reported as occurring in the same 12-month period). The researchers found that the first drink occurred on average at 15.7 years, with an onset of AD at 19.1 years. Conduct disorder (CD) was the most potent predictor of early alcohol initiation, with nearly 2.5 times the rate of progression to first drink than that expected for an individual without CD. Attention deficit hyperactivity disorder (ADHD), maternal AD, paternal AD, male gender and parental divorce were also associated with early first use. A Cox proportional hazard regression analysis identified nicotine dependence and generalized anxiety disorder (GAD) as robust predictors of progression to AD. Nicotine dependence was associated with transition to AD at 3.91 times the rate expected in individuals who do not meet criteria for AD; GAD was associated with a nearly 3.5-fold increase in rate of progression from first use to development of AD. Conduct disorder and cannabis abuse were also associated with rapid transition to AD. The researchers note that the study has four limitations. First, investigations conducted with an older sample would reduce the chance of findings being weighted more heavily toward characterizing an early onset variant of the disorder. Second, although reflecting a wide variety of psychiatric and psychosocial risk factors associated with initiation of alcohol use and the development of AD, the current study did not address the full range of risk factors linked to alcohol-related outcomes in young adult populations (e.g., peer relationships). Third, findings may be limited in their generalizability to non-Caucasian young adults. Finally, it is unclear whether the lack of distinctions between genetic and environmental risk groups for risk associated with progression from first drink to AD is because the study sample was too small. In their discussion, the researchers note that this study is a unique opportunity to evaluate a number of factors relative to the course of AD. With the exception of CD, the rate of progression from first drink to AD was modified by different factors than those identified with risk for early first use. Early age of first drink was associated with externalizing disorders with onset in childhood (ADHD and CD), family history of AD, parental divorce, and males rather than females. By contrast, a more rapid transition to AD was predicted by psychiatric and substance use disorders that typically develop in adolescence and young adulthood (nicotine dependence, cannabis abuse and GAD) in addition to CD. The elevated risk associated with comorbid psychiatric disorders at both stages and with substance use disorders at the transition to AD underscores the importance of early detection and treatment of these disorders. Do you have feedback for the author? Click here to send us an email. References
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