In this longitudinal population‐based sample, binge drinking in adolescence was associated with an increased risk of a wide range of adverse adult outcomes. These included adult alcohol dependence/abuse, regular alcohol consumption higher than recommended levels, illicit drug use and social adversity, including lower social class, history of homelessness, poorer educational outcomes and convictions. These findings were robust to adjustment for socioeconomic status and adult alcohol consumption. US studies have reported that the onset of, or an increase in, binge drinking behaviour during adolescence is associated with an increased risk of alcohol abuse/dependence and other substance use11,13,14
as well as poorer educational attainment11,13,14
and higher involvement in crime13,14
in the transition to adulthood (age 21–23 years). Our findings confirm that later adversity is associated with binge drinking in British young people, with odds ratios suggesting an approximately 1.5‐ to 2‐fold increased risk of adult convictions, school problems and illicit drug use, similar to the findings from US studies.13,14
Our findings are also in agreement with the recent report of an Australian longitudinal study which found that adolescent binge drinking increased the risk of alcohol dependence at 20–21 years.12
As the age of outcome in our study was 30 years, significantly older than in the US or Australian studies mentioned above, our findings suggest that this previously identified adversity associated with binge drinking continues into adult life. These findings suggest that binge drinking in adolescence may contribute, along with other health risk behaviours,29,30,31
to the development of health and social inequalities during the transition from adolescence to adulthood.
We hypothesised that adolescent binge drinking is a separate behavioural pattern from habitual frequent alcohol consumption. We examined this by entering binge drinking and frequent regular drinking as main effects and examining the interaction between the two. Although binge drinking and regular drinking were highly correlated, we found that they appear to have different effects on later adversity. Binge drinking and frequent regular drinking both independently predicted a higher adult risk of alcohol use problems, including both alcohol dependency/abuse and excessive regular alcohol consumption. However, a different pattern was seen for non‐alcohol adult outcomes. Binge drinking also predicted a higher risk of adult convictions, accidents and school exclusion and a lower risk of attaining high adult social class; in contrast, habitual frequent drinking was not associated with these outcomes but was associated with higher adult social class and higher risk of adult illicit drug use.
These different patterns suggest that binge drinking in adolescence may represent a behavioural pattern that increases the risk of later social, educational and socioeconomic adversity.32
These associations may be explained by behaviours or temperamental factors previously reported to be associated with adolescent binge drinking, including impulsive acts and violence.9,33
In contrast, high regular alcohol use, when adjusted for binge drinking, increased the risk of problematic drinking and illicit drug use in adulthood, but was not associated with other poor adult outcomes. Indeed, high regular use was associated with better adult socioeconomic outcomes, whereas binge drinking was associated with poorer socioeconomic outcome. These findings of different patterns of outcomes for binge and high regular drinking are supported by previous work which suggests that intensity of alcohol use and behavioural problems may represent separate dimensions of problem drinking in adolescence,21
and by recent UK evidence from national datasets that frequency of drunkenness is a better predictor of offending behaviour than frequency of drinking per se.9
Our findings may be of policy importance for interventions around drinking in young people. Public health efforts have focused on reducing overall alcohol intake amongst adolescents and young adults through community education programmes around safe drinking, school‐ or college‐based interventions, or higher‐level measures such as increasing the price of alcohol and reducing access to alcohol for young people.5
However, the fact that young people perceive that little risk is associated with binge drinking5
may reduce the effectiveness of targeted interventions to reduce harmful drinking. Indeed, one UK study reported that, although 65% of student binge drinkers were aware that their level of drinking was dangerous, only 5% desired to drink less.34
Our finding that adolescent binge drinking significantly increases the risk of adult adversity and social exclusion supports the consideration of policy interventions specifically targeted at binge drinking, particularly as adolescent drinking patterns are highly influenced by alcohol pricing and access issues.5
Given increasing evidence that health risk behaviours cluster in adolescents,32
and that adolescent smoking and antisocial behaviour predict young adult alcohol dependence,12
we believe that policy around alcohol use in adolescence should also address resiliency and risk factors relating to the co‐occurrence of adolescent health risk behaviours in addition to issues and behaviours specific to alcohol use.