Younger drinkers more likely to avoid treatment

Most people’s stereotype of an alcoholic is likely to be a middle-aged drunk slumped on a barstool, not a teenager whooping it up at a keg party. But a recent School of Public Health study shows that alcohol dependence often starts in adolescence — and the younger a person becomes addicted, the less likely he or she is to seek help as an adult.

“What we found is contrary to conventional wisdom that alcoholism begins later in life,” says Ralph Hingson, a School of Public Health professor of social and behavioral sciences. He says his findings are especially relevant for National Collegiate Alcohol Awareness Week, which this year is October 15 to 21. “Our study showed that 47 percent of people who suffered from alcohol dependence at some point in their lives were diagnosable before the age of 21 and two-thirds became dependent before the age of 25. It’s clear that early onset of drinking predicts early onset of dependence.”

Hingson found, moreover, that those addicted to alcohol before age 18 were three times as likely to wait 10 or more years to seek treatment and were 7 percent less likely to ever seek treatment than those who did not become dependent until age 30.

Hingson collaborated on the study with Tim Heeren, an SPH biostatistics professor, and Michael Winter, assistant director of the SPH Data Coordinating Center’s Statistical Program. All three are part of the SPH Youth Alcohol Prevention Center, the first research center at a school of public health funded by the National Institutes of Health’s National Institute on Alcohol Abuse and Alcoholism (NIAAA). The study was published in the September issue of Pediatrics, the official journal of the American Academy of Pediatrics.

Hingson and his colleagues analyzed data from a 2001-2002 survey of 43,093 U.S. adults aged 18 and older conducted by NIAAA researchers for the National Epidemiologic Survey on Alcohol and Related Conditions. The SPH researchers focused on the 4,778 participants whose survey responses indicated they had been alcohol-dependent at one point in their lives.

Some of the results were “both startling and revealing,” says Hingson. For example, among the 3.8 percent of the participants who were alcohol-dependent during the survey year, more than half of those who reported drinking problems by age 18 were drunk at least once a week, compared to 19 percent of those first dependent at age 30 or older.

“The results underscore the need for prevention efforts to reduce underage drinking,” says Hingson. “Most college students with alcohol use disorders don’t think they have an alcohol problem, but they aren’t being screened for potential substance abuse. If more of them are asked about their drinking practices by their health-care providers, more interventions can be targeted toward the very people who are at the highest risk for long-term alcohol dependency as adults.”

He cites college-community programs such as SPH’s Join Together — along with the school’s ongoing research projects, including a recent study on the aftereffects of heavy drinking on the academic performance of college students — as effective ways to publicize the dire consequences of alcohol abuse among the nation’s youth.

Hingson’s prolific research on alcohol-related traffic accidents among young people has been credited with helping to change drunk driving laws. According to the organization Mothers Against Drunk Driving, his 1993 study on the success of so-called zero-tolerance blood-alcohol limits in 12 states — .00 and .02 for underage drivers — led to a similar law in Massachusetts.

Aside from young drinkers facing a faster slide toward dependence on alcohol than their adult counterparts — and a longer and tougher struggle with alcohol throughout their lives — the problem has a more immediate and deadly severity, Hingson points out, which was revealed in his 2002 study The Magnitude of Alcohol-Related Mortality and Morbidity Among U.S. College Students Ages 18-24. 

“We’re legitimately concerned about losing more than 3,000 U.S. troops in Iraq,” says Hingson, “but every year more than 5,000 college-age students die from causes related to alcohol, including drunken driving, alcohol poisoning, accidental falls, and fires. We simply can’t be complacent about this.”