Drinking characteristics in adolescence predict alcohol behaviors in early adulthood

 1. In a retrospective cohort study, initiating high-intensity drinking (HID) by 11^th grade was associated with an increased risk of alcohol use disorders at 20 years of age.

2. Escalation from first binge (≥5 drinks) to HID (≥10 drinks) in the same year in adolescence was associated with an increased risk of HID behaviors at 20 years of age.

Evidence Rating Level: 2 (Good)

Study Rundown: High-intensity drinking (HID, ≥10 drinks) is common amongst adolescents and leads to negative acute and long-term consequences. The pattern of behavior and implications related to adolescent HID have not been well-studied. In this retrospective cohort study of 451 participants, researchers investigated whether the timing and characteristics of drinking events in adolescence are correlated with behaviors and frequency of drinking in early adulthood. Binge drinking and HID occurred mostly between grades 9 to 12 with a mean of 2 years to escalate from first drink to first HID episode. Initiating HID before Grade 11 (compared to after) was associated with increased HID behaviors and alcohol use disorder (AUD) scores at 20 years of age. In addition, the escalation from first binge (≥5 drinks) to first HID in the same year in adolescence led to an increased rate of HID at 20 years old. A major limitation of this study is that it only assessed drinking behaviors at 20 years old, limiting generalizability to other ages. Overall, this study suggests that early initiation and quick escalation of drinking behaviors in adolescence may increase the risk of negative drinking behaviors and misuse in early adulthood. This information may be helpful to incorporate into counseling discussions between clinicians, adolescents, and parents.

Click here to read the article in JAMA Pediatrics

Relevant Reading: High-intensity drinking versus heavy episodic drinking: prevalence rates and relative odds of alcohol use disorder across adulthood

In-Depth [retrospective cohort]: This study screened 14,502 Grade 12 student participants in the United States from the Monitoring the Future study in 2018, that were re-surveyed in 2020 in the online Young Adult Daily Life (YADL) study in 2020. Eligible participants included Grade 12 students who reported past 30-day drinking and reported HID by age 20 years. Binge drinking was defined as ≥5 drinks and HID was defined as ≥10 drinks. Following screening, 451 participants were eligible for data analysis. At the age of 20 years old, participants were asked questions about (1) escalation and initiation of drinking, (2) current alcohol behaviors, (3) family history of alcohol issues, and (4) college status. Alcohol use measures included average weekly consumption, current HID frequency, and Alcohol Use Disorders Identification Test (AUDIT) scores. Results suggest that drinking initiation including first drink, first binge, and first HID occurred predominantly between grades 9 and 12. It took 1.9 (SE 0.1 years) mean years to escalate from first drink to first HID and 0.7 (SE 0.1 years) mean years to escalate from first binge to first HID. Initiating HID by 11^th grade compared to later was associated with a greater number of average drinks (aIRR 1.40, 95%CI 1.10-1.79), greater expected rate of past 2-week HID occasions (aIRR 2.01, 95% CI 1.25-3.22), and greater expected AUDIT score (aIRR 1.17, 95% CI 1.02-1.34) at 20 years old. Escalation from the first binge to HID in the same year was associated with a greater expected rate of past 2-week HID occasions (aIRR 1.66, 95% CI 1.06-2.61) at 20 years old.

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