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Keywords:

  • Alcohol;
  • life-span;
  • longitudinal

ABSTRACT

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. LIFE-SPAN DEVELOPMENTAL PERSPECTIVE ON ETIOLOGY OF ALCOHOL USE AND ABUSE
  5. PURPOSES AND COMMON THEMES
  6. Acknowledgements
  7. Conflicts of interest
  8. References

A foundational assumption in the fields of addiction and developmental psychopathology is that child and adolescent experiences set the stage for adult functioning and adjustment. However, the empirical literature documenting life-span linkages with adult alcohol (and other drug) use and abuse is sparse. This gap is due to a slow adoption of life-span developmental conceptualizations and the lack of long-term prospective longitudinal studies. This supplemental issue provides evidence for such linkages from six long-term longitudinal studies, which together follow individuals from birth through to the late 40s. The data sets include national and regional samples from Britain, Finland and the United States. In this introductory paper, we consider conceptual issues concerning linkages across the life-span culminating in adult alcohol use and disorders, and provide a summary of the purposes and common themes.


INTRODUCTION

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. LIFE-SPAN DEVELOPMENTAL PERSPECTIVE ON ETIOLOGY OF ALCOHOL USE AND ABUSE
  5. PURPOSES AND COMMON THEMES
  6. Acknowledgements
  7. Conflicts of interest
  8. References

A fundamental assumption in the fields of developmental psychopathology and addiction is that childhood and adolescence lay a critical foundation for functioning and adjustment in adulthood [1–4]. Considerable empirical literature documents child and adolescent precursors to adult psychopathology [5,6]. Of all the areas of addiction, more is known about alcohol use and abuse in terms of childhood and adolescent roots of adulthood disorder. There has been long-term interest in the topic [7–9], and evidence is mounting regarding genetic and family influences on, and externalizing and internalizing pathways from childhood, to alcohol and other drug use disorders through early adulthood [10–15]. Nevertheless, knowledge remains limited about how the full range of childhood and adolescent characteristics and experiences relate to adult alcohol use and abuse, particularly beyond young adulthood. This gap reflects both conceptual and empirical shortcomings. Conceptually, the substance use and addictions fields have been slow to embrace a life-span developmental perspective [4]. Empirically, relevant long-term high-quality prospective studies following individuals from childhood into adulthood, especially middle adulthood, are still relatively rare.

To help address this gap, this Addiction supplement brings together six long-term prospective national and regional studies from Britain, Finland and the United States that together encompass birth through to the late 40s. Based upon a life-span developmental perspective, the empirical papers identify childhood and adolescent characteristics, relationships and experiences that predict adult alcohol use and abuse [16–21]. In a concluding commentary, Robert Zucker summarizes common and unique findings across the studies, elaborates conceptual considerations regarding the understanding of addiction across the life-span and identifies future directions for research [22]. In this introductory paper, we first discuss briefly relevant life-span developmental conceptual issues as they relate to the etiology of alcohol use and abuse, and then summarize common aims and themes across the studies.

LIFE-SPAN DEVELOPMENTAL PERSPECTIVE ON ETIOLOGY OF ALCOHOL USE AND ABUSE

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. LIFE-SPAN DEVELOPMENTAL PERSPECTIVE ON ETIOLOGY OF ALCOHOL USE AND ABUSE
  5. PURPOSES AND COMMON THEMES
  6. Acknowledgements
  7. Conflicts of interest
  8. References

The perspective we offer is consistent with a broad interdisciplinary developmental science framework that emphasizes multi-dimensional and multi-directional developmental change across life, characterized by successive and dynamic mutual selection and accommodation of individuals and their contexts [23–27]. Through a process of niche selection, individuals select available environments and activities based on personal characteristics, beliefs, interests and competencies; selected ecological niches then provide various opportunities for continued socialization and further selection. This progressive accommodation suggests the qualities of coherence and continuity in development, and a major goal of life-span developmental psychology is to identify the long-term connections—distal developmental influences—across the life course. This emphasis on continuity and distal developmental influences is consistent with the notions of cascading effects and early starter models in the developmental psychopathology literature [28–30], whereby early difficulties and limited opportunities contribute to subsequent escalating and expanding difficulties in multiple domains. As a result, early maladjustment can make later maladjustment almost inescapable. However, consistent with an emphasis on dynamic person–context interactions and multi-directional change, development does not necessarily follow a smooth and progressive function, and early experiences do not always have strong or lasting effects [24,31–36]. In fact, a developmental science perspective also highlights discontinuities over time, showing how long-term developmentally distal effects can become reduced and even reversed by more developmentally proximal effects [37–39]. Thus, both continuity and discontinuity are expected across the life-span. Our goal in this supplement is to consider continuity by examining the extent to which childhood and adolescent experiences and characteristics relate to adult alcohol use and abuse.

Developmental timing is an important consideration when understanding the causes and course of alcohol use and abuse. It matters when experiences occur and characteristics become manifest in regard to their meaning and sequelae across the life-span [14,34,36,40,41]. This is true in terms of the timing of both predictors (e.g. childhood versus adolescent onset of aggression) and outcomes (e.g. binge drinking at age 20 versus age 40). Many problem behaviors become normative during adolescence and early adulthood and thus, as risk factors, they may lose some long-term predictive power [42]. Furthermore, as alcohol use, including heavy drinking, becomes normative during late adolescence and early adulthood [43,44], predicting such use on the basis of earlier individual or contextual characteristics becomes more difficult. Moreover, heavy use that continues into middle adulthood may have a different meaning in terms of functioning and adjustment. There has been little systematic concern with timing of predictors and outcomes when examining the etiology of alcohol and other drug use and abuse, but such concern is necessary when attempting to draw linkages across childhood, adolescence and adulthood.

Consistent with life-span developmental conceptual emphasis on social context influences, long-term connections are conditioned upon gender, culture and history, making it important to examine similarities and differences across these dimensions [45]. Clearly, although there are extensive similarities across men and women [46], there are important gender differences in the typical experiences and social role transitions across the life-span which can set the stage for differences in how childhood and adolescent experiences relate to adulthood alcohol use and abuse. Considerable attention has been given to gender differences in the prevalence, course, etiology and consequences of alcohol and other drug use [15,47–50]. To contribute to this literature, each of the empirical papers in this supplemental issue focuses upon gender differences and similarities. Across western cultures, the experiences of adolescence and the transition to adulthood have some similarities as well as important differences [51]; likewise, despite some similarities in terms of alcohol use practices and effects, there are also important cross- and subcultural variations [48]. Recognizing the complexity of cross-cultural research, we focus here upon what might be generalizable across three western countries—Britain, Finland and the United States [16–21]. With regard to historical influences, it is clear that the experience of adolescence and the transition to adulthood vary, sometimes in small ways, across the decades [52,53]. This raises questions about the extent to which risk factors for alcohol and other drug use are consistent across cohorts [54] and the extent to which developmental linkages vary by cohorts. In this supplemental issue, we give this topic some attention, providing evidence to suggest robust developmental linkages as opposed to cohort-specific ones.

PURPOSES AND COMMON THEMES

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. LIFE-SPAN DEVELOPMENTAL PERSPECTIVE ON ETIOLOGY OF ALCOHOL USE AND ABUSE
  5. PURPOSES AND COMMON THEMES
  6. Acknowledgements
  7. Conflicts of interest
  8. References

To what extent can we predict adult alcohol use and abuse based on childhood and adolescent characteristics and experiences? Which characteristics and experiences are most prognostic for long-term use and abuse? To what extent do predictors vary in their relative and absolute effects as a function of the developmental timing of the predictors and the outcomes? These were the key unifying questions that brought the six research teams together. They represent central questions regarding the understanding of alcohol (and other drug) use etiology, and more broadly the study of addictions, across the life-span. The six long-term prospective studies include national and regional samples from Britain, Finland and the United States, which together follow individuals from birth through to the late 40s [16–21]. They vary in methods (e.g. surveys versus clinical interviews), sampling strategies and measures. Through a research network known as the Center for the Analysis of Pathways from Childhood to Adulthood (CAPCA; funded by the US National Science Foundation), we have worked to find common ground regarding the childhood and adolescent antecedents to adulthood heavy drinking and alcohol use disorders. Despite the differences across the studies we identified several similar constructs, along with many constructs unique to each study, which served as the basis of the analyses reported here [16–21].

Based on a broad-based developmental contextual perspective on drug use etiology [4,47,55–60], which is consistent with Problem Behavior Theory [61,62], we identified a common set of predictors in childhood and/or adolescence across the six studies: (i) social address (e.g. parental socio-economic status, education); (ii) family relations; (iii) parental alcohol and other drug use; (iv) parental psychopathology; (v) peer relations and social competence; (vi) academic achievement and functioning; (vii) future aspirations and expectations; (viii) aggression, risk-taking and externalizing disorders; (ix) depression and internalizing disorders; and (x) use of alcohol and other drugs. Each of these construct categories was available in at least three of the six studies [16–21], and many additional predictors were included to bring in the unique strengths of each study. Common drinking outcomes in adulthood included frequency and/or quantity of alcohol use, heavy drinking (also referred to as binge drinking), symptoms of alcohol abuse (e.g. negative consequences such as drunk driving arrests) and symptoms of alcohol dependence. Again, available outcomes and the manner in which they were operationalized varied across studies. Despite these differences, as well as differences in conceptual orientation and analyses (e.g. regression, structural equation modeling, cluster analysis), there were many similarities across the findings [16–21]. The concluding commentary identifies and interprets some of these similarities and differences [22].

A key aspect of this supplemental issue is the emphasis on age variation in predictors and outcomes; each study focused upon such variation to the extent permitted in the given data sets. Across the papers, there were four common themes. First, we examined the extent to which both child and adolescent variables predict adult alcohol use and abuse rather than, for example, adolescent predictors completely mediating childhood predictors. Secondly, we contrasted the predictability of alcohol use and abuse outcomes in the more developmentally proximal period of early adulthood with the more distal period of middle adulthood, considering whether predictability decreases with the passage of time or, rather, whether the normative excesses of early adulthood make this period less predictable than middle adulthood. Thirdly, we examined various alcohol involvement outcomes, ranging from alcohol use to alcohol abuse and dependence, permitting consideration of variation in predictors based on severity of involvement with alcohol. Finally, we focused upon gender differences and similarities, testing for gender differences in levels of variables (which tend to be common) and in relationships among variables reflecting process and mechanisms (which are observed less commonly) [16–21].

It is worth noting briefly how our group evolved. We began by trying to find the least common denominator across the studies and using similar analytical techniques to facilitate more fine-grained and direct comparisons; but we learned quickly that this obstructed progress and resulted in some important methodological compromises. Thus, we chose a broader perspective on cross-study comparisons, with each study utilizing the best strategy available given its strengths, to best address the overarching questions. Our understanding is greatly enhanced by taking multiple and divergent looks at a given phenomenon—no study is perfect, and with variations in samples and methods, conclusions can be stronger if similar findings span across the studies. Future efforts, building upon those here, can provide more fine-grained comparisons, including cross-cultural ones.

As a group, our aims for this set of papers were to document long-term connections, focus upon developmentally distal influences and identify their conditions and limits. The six long-term prospective studies were well suited to address these gaps in the literature. None the less, we have not attended well to the processes and pathways that underlie the long-term connections. Continued research should address these important issues [63], as well as the complex topics of genetic influences and gene by context interactions.

This supplemental issue represents an important step in the understanding of life-span linkages regarding alcohol use disorders and, more generally, addictions. As the papers show, childhood and adolescent characteristics and experiences do reverberate across the life-span, showing some lasting connection to adulthood alcohol use and disorders; but these effects are typically small [16–21]. This is not surprising, for long-term connections, when present, are likely to be rather small [34,35], and the life-span is full of opportunities for discontinuities and divergences in course [36]. It is therefore of great theoretical and applied interest that linkages do remain across decades of life; with these linkages as a foundation, greater attention can be given to processes of mediated effects and to divergent pathways.

A final word about the title is in order. We selected the phrase ‘Destiny matters’ purposely because destiny has a double meaning. It can reflect preordained fate, thus highlighting the effects of early characteristics and experiences (along with genetic interactions) on eventual adulthood alcohol use and abuse. Destiny can also reflect luck and external influences, highlighting the impact of social contexts, developmental transitions and life events on the course of alcohol use and abuse across the life-span. We hope that this supplemental issue serves to highlight long-term linkages between childhood/adolescence and adulthood, including the limits on such long-term linkages, and to help set that stage for future integrative work on understanding the interweaving of developmentally distal and proximal influences on the course of substance use and abuse, and addiction in general, across the life-span.

Acknowledgements

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. LIFE-SPAN DEVELOPMENTAL PERSPECTIVE ON ETIOLOGY OF ALCOHOL USE AND ABUSE
  5. PURPOSES AND COMMON THEMES
  6. Acknowledgements
  7. Conflicts of interest
  8. References

Preparation of this manuscript was supported in part by grants from the National Institute of Drug Abuse (DA-01411, Principle Investigator: L. Johnston) and the National Institute on Alcohol Abuse and Alcoholism (AA-015535, Principle Investigator: J. Maggs). The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institutes of Health. Collaboration on the supplemental issue was supported by National Science Foundation Grant no. 0322356 to the Center for the Analysis of Pathways from Childhood to Adulthood. Support for this supplemental issue was provided by the Society for the Study of Addiction through Graham Hunt, for which the authors of this and all other papers in this issue are grateful. As co-editors of this supplement, the authors appreciate the thoughtful and helpful comments of 11 peer reviewers (listed elsewhere in this issue) and those of Dr Robert West and Louisa Strain. Finally, the authors appreciate the help of Kathryn Johnson on this paper.

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  4. LIFE-SPAN DEVELOPMENTAL PERSPECTIVE ON ETIOLOGY OF ALCOHOL USE AND ABUSE
  5. PURPOSES AND COMMON THEMES
  6. Acknowledgements
  7. Conflicts of interest
  8. References
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