Developmental pathways to alcohol abuse and dependence in young adulthood

Objective: To determine if people who were diagnosed with alcohol abuse or dependence (AAD) at age 21 had different developmental patterns of alcohol use in adolescence than non-AAD individuals. Method: An ethnically diverse urban sample of 808 children was surveyed at age 10 in 1985 and followed prospectively to age 21 in 1996. AAD at age 21 was assessed following DSM-IV criteria. Latent Transition Analysis (LTA) was used to identify four statuses of alcohol use (nonuse, initiation only, current use only, heavy episodic drinking), as well as transition probabilities between these four statuses from elementary school to middle school and from middle school to high school among the AAD and non-AAD group. Results: The prevalence of alcohol use statuses during elementary school was similar in the two groups. Differences in alcohol use emerged in middle school and became more pronounced in high school. In middle school, AAD individuals were more likely to have initiated or been current drinkers than non-AAD individuals. However, the two groups did not differ in the prevalence of heavy episodic drinking in middle school. In high school, most AAD individuals were in the heavy episodic drinking status (54%), while most non-AAD individuals were in the initiation only (33%) or current use only (34%) statuses. Conclusions: These findings suggest preventive intervention targets for different developmental periods. Alcohol abuse and dependence at age 21 may be prevented by delaying alcohol initiation, by reducing current use in middle school and by reducing heavy episodic drinking in high school.