Alcohol is the most commonly used psychoactive drug among adolescents. The 1999 Monitoring the Future national survey of secondary-school students found that approximately 52% of 8th-grade students, 71% of 10th-grade students and 80% of 12th-grade student had used alcohol in their lifetimes (Johnston et al., 2000
). Alcohol consumption and heavy episodic drinking (i.e., having five or more drinks in a row) tend to he higher during young adulthood than at any other period across the lifespan (Hilton, 1991
; Johnston et al., 1998
; Wilsnack et al, 1984
). For some adolescents, moderate alcohol use appears to be positively related to psychosocial functioning and adjustment (Labouvie, 1990
; Maggs, 1997
; Marlatt, 1987
; Silbereisen and Noack, 1988
); for others, however it leads to serious adjustment and alcohol problems later in life (e.g., alcohol abuse and dependence) (Hill et al., 2000
; Kandel, 1980
; Newcomb and Bentler, 1988
; White, 1987
). In fact, alcohol abuse and dependence are most prevalent among young adults, estimated to be at 16% among those aged 18–29 (Grant et al., 1994
It has been suggested that one goal of alcohol research is to adequately map out the developmental courses for different types of drinkers (Zucker, 1979
; Zucker et al., 1995
). Within Zucker’s developmental framework of the course of alcoholism, the onset of “caseness” in alcohol abuse and dependence is best understood as a threshold phenomenon: Alcoholism gradually develops over time through a process in which previous symptomatic manifestations of alcohol problems come to display greater intensity, frequency or regularity, This framework is similar to a hierarchic model of progression. It makes no assumption of an automatic progression from one stage to the next, nor does it assume a particular pathway is irrevocable. However, the particular pathways in alcohol use that lead lo abuse and dependence remain to be detailed.
A number of studies have associated early onset of alcohol use with subsequent misuse of alcohol (Hawkins et al., 1997
; Pedersen and Skrondal, 1998
; Rachal et al., 1982
). Early onset of alcohol use has been found to be associated with the early onset of alcohol abuse and dependence (Andersson and Magnusson, 1988
; von Knorring et al., 1985
) and increased lifetime prevalence of alcohol abuse and dependence (Chou and Pickering, 1992
; Grant and Dawson, 1997
). In addition, early onset of alcohol and tobacco use is a risk factor for the initiation of illicit drug use (Kandel, 1975
; Kandel et al., 1992
; Yamaguchi and Kandel, 1984
Labouvie et al. (1997)
found that age of first alcohol or cigarette use did not predict alcohol use at age 20. They also found that age of onset of alcohol or cigarette use was not a significant predictor of use intensity or use consequences at age 30. Labouvie and White (1998)
concluded from analyses of the same data set that age of onset by itself mid onset sequences by themselves were not predictive of alcohol abuse and dependence in young adulthood. Instead, they found that a model describing both individual trajectories in age of onset and use intensity over time predicted later abuse or dependence.
analyzed retrospective data on lifetime alcohol intake histories among a sample of social drinkers and recovering alcoholics, finding that alcoholics reported drinking regularly earlier than controls and drank more per occasion when they started to drink regularly. Some research shows that frequent heavy episodic drinking during lute adolescence and young adulthood increases the likelihood of concurrent and long-term problems with alcohol (Blane, 1979
; Hill et al., 2000
; Hilton, 1991
; Zucker, 1987
In sum, existing empirical studies have found that earlier age of first use and regular use of alcohol, greater alcohol use intensity in terms of frequency and quantity, and more frequent heavy drinking are associated with later alcohol problems of abuse and dependence. However, information is lacking regarding the time-specific variation in the relationship between adolescent alcohol use and later abuse and dependence. In addition, few studies have examined the question of discontinuity of alcohol use during adolescence and how discontinuity affects risk of later abuse and dependence. Finally, many previously reviewed studies treated alcohol use outcomes as continuous data.
Models featuring stage sequences have some important strengths in cases in which it is appropriate to think of the underlying phenomenon in discrete terms. One strength is that stage sequence models can account for initial status (a problem for many continuous data approaches) by allowing examination of the probability of transitioning to a particular stage conditional upon initial stage membership. Another strength is that examining the prevalence of stages and incidence of stage transitions provides a detailed look at change over time that is difficult to obtain in continuous data analyses, A stage-based approach, in particular, can show very clearly whether a given stage is particularly prevalent at certain times or for certain subgroups, whether individuals in a certain singe are more or less likely to undergo a transition and whether there are qualitative differences between groups. Thus, this stage model provides an excellent tool to examine Zucker’s developmental hypotheses about alcoholism. From a program or policy point of view, a stage-based approach can point very clearly to the developmental periods in which interventions are most likely to be effective, and what behaviors should be the focus of action at which times.
shows four possible stages of alcohol use among adolescents. Between two time points an individual may change from being a nonuser of alcohol to being an initiator (someone who has tried alcohol but is not currently using); an initiator could later become a current user (someone who is currently drinking alcohol, but with no heavy episodic drinking); and a current user could later become a heavy episodic drinker. It is also possible that a heavy episodic drinker may stop and become simply a current drinker. In a similar manner, a current drinker may stop drinking, reverting to the status of an initiator. The possibility of reversals of this type is denoted in by double-headed arrows. This stage model of alcohol use incorporates several important features of alcohol use that have not been included in previous studies. It characterizes patterns of alcohol use in terms of onset of use (initiation or not), how recent the use is (current use or not) and use intensity (heavy episodic drinking or not). It also, importantly, permits the study of developmental patterns of alcohol use in terms of progression, regression and stability.
The present study uses prospectively collected data to compare patterns of alcohol use during adolescence of those who abused or were dependent on alcohol at age 21 (the AAD group) and those who did not meet criteria for alcohol abuse or dependence at age 21 (the non-AAD group). The similarities and differences in the developmental stages of alcohol use, and the transitions between these stages of alcohol use during adolescence are compared for the two groups. This study explores the developmental patterns in alcohol use during adolescence that predict alcohol abuse and dependence in young adulthood.