• Alcohol use disorders;
  • drinking onset;
  • epidemiology;
  • latent variable modeling


Aims  This study investigates the occurrence of clinical features of alcohol dependence and socially maladaptive drinking during the first 24 months after the onset of alcohol use.

Design  Data for this study are from the nationally representative 2004–07 National Surveys on Drug Use and Health (NSDUH).

Setting  General population of the United States, aged 12 years and older.

Participants  New-onset alcohol users (NOAUs) were drinkers who started to drink alcohol within 24 months of the NSDUH assessment and consumed alcohol during the last 12 months.

Measurements  The NSDUH assessed for clinical features of alcohol dependence and socially maladaptive drinking, consistent with the DSM-IV.

Findings  NOAUs frequently experienced problems relating to self-reported tolerance, spending a great deal of time recovering from the effects of alcohol and unsuccessful attempts at cutting down on drinking. The likelihood of experiencing the clinical features increased steadily in the first 9 months after use, but appeared to plateau or only gradually increase thereafter. Strong evidence emerged that the clinical features measured a single latent dimensional of ‘alcohol use disorder’ (AUD) in this sample. The majority of the clinical features were good indicators of the underlying AUD continuum in the 2 years after first drinking onset.

Conclusions  There may be a period of time during the second year of alcohol use, when level of alcohol use disorder fluctuates rather than increases. Public health and safety efforts designed to target problematic alcohol use in the earliest stages of alcohol involvement could be useful in preventing the escalation of alcohol problems in this group of drinkers.