The role of childhood risk factors in initiation of alcohol use and progression to alcohol dependence
Article first published online: 28 NOV 2006
Volume 102, Issue 2, pages 216–225, February 2007
How to Cite
Sartor, C. E., Lynskey, M. T., Heath, A. C., Jacob, T. and True, W. (2007), The role of childhood risk factors in initiation of alcohol use and progression to alcohol dependence. Addiction, 102: 216–225. doi: 10.1111/j.1360-0443.2006.01661.x
- Issue published online: 28 NOV 2006
- Article first published online: 28 NOV 2006
- Submitted 13 February 2006; initial review completed 15 May 2006; final version accepted 24 July 2006
- age of first drink;
- alcohol dependence
Aims To identify childhood risk factors that predict (a) age of first drink and (b) time from first use to alcohol dependence (AD) onset, using survival analysis.
Participants The sample consisted of 1269 offspring (mean age = 20.1 years) of male twins from the Vietnam Era Twin Registry; 46.2% were offspring of alcohol-dependent fathers.
Measurements DSM-IV psychiatric diagnoses and substance use behaviors were assessed by structured telephone interview.
Findings First drink occurred on average at 15.7 years; AD onset at 19.1 years. A Cox proportional hazard regression analysis revealed conduct disorder (CD) as the most potent predictor of early alcohol initiation (HR 2.48; CI 1.85–3.32). Attention deficit hyperactivity disorder (ADHD), maternal AD, paternal AD, male gender and parental divorce were also associated with early first use (HR 1.20–1.52; CI 1.04–1.39–1.18–1.96). A Cox proportional hazard regression analysis modeling first drink to AD identified nicotine dependence (HR 3.91; CI 2.48–6.17) and generalized anxiety disorder (GAD) (HR 3.45; CI 2.08–5.72) as robust predictors of progression to AD. CD (HR 1.75; CI 1.10–2.77) and cannabis abuse (HR 1.88; CI 1.22–2.90) were also associated with rapid transition to AD.
Conclusions Results highlight the role of psychiatric and substance use disorders in progression from first drink to AD, underscore the continuity of risk associated with CD and indicate that (with the exception of CD) different factors play a role in transition to AD than in initiation of alcohol use. Distinctions between stages are interpreted in a developmental framework.