Age At First Drink Research Articles

Age at first drink and its influence on alcohol use behaviours in young adulthood: Evidence from an Australian household-based panel study

BackgroundPublic health guidelines recommend delaying the initiation age for alcohol. However, the causal link between age-at-first-drink (AFD) and future alcohol use in young adulthood is uncertain. This study examined the association between AFD and alcohol-related outcomes at age 20 years using an Australian sample. MethodsData were obtained from Waves 1–19 (years 2001–2019) of the Household, Income and Labour Dynamics in Australia Survey on 20-year-olds with responses across ≥3 consecutive waves (n = 2278). The AFD for each respondent (between 15 and 20 years) was analysed relative to Australian legal drinking age (18 years). Inverse probability treatment weighting was used to evaluate associations between AFD and four outcomes at age 20 years: risk of current alcohol use; quantity of weekly alcohol consumption; risk of binge drinking; and frequency of binge drinking. Adjustments were made for confounders (e.g., heavy drinking by parents). Robustness of study findings was evaluated using several diagnostic tests/sensitivity analyses. ResultsAmong 20-year-olds, those with an AFD of 15–16 years consumed significantly more alcohol per week compared to an AFD of 18 years. Additionally, 20-year-old drinkers with an AFD of 16 years were significantly more likely to binge drink (though this association was likely confounded). An inverse dose-response relationship was observed between AFD and weekly alcohol consumption at 20 years, where a higher AFD led to lower alcohol consumption. ConclusionStudy findings indicate an association between a higher AFD and consuming less alcohol in young adulthood, which could potentially support the scale-up of prevention programs to delay AFD among Australian adolescents.

Adolescent alcohol and cannabis use and early adulthood educational attainment in the 1986 Northern Finland birth cohort study

BackgroundHeavy alcohol and cannabis use during adolescence have been previously described as risk factors not only for morbidity in adulthood, but also social problems including adversities in educational attainment. Attempts to consider overlapping risk factors and confounders for these associations are needed.MethodsUsing weighted multivariable models, we examined prospective associations between age at first drink (AFD), age at first intoxication (AFI), frequency of alcohol intoxication, as well as self-reported alcohol tolerance (i.e., number of drinks needed for the subjective experience of intoxication), and lifetime cannabis use at age 15/16 years with subsequent educational attainment obtained from comprehensive registers until age 33 in the Northern Finland Birth Cohort 1986 (6,564 individuals, 49.1% male). Confounding variables including sex, family structure (intact vs. non-intact), maternal and paternal education level, behavioural/emotional problems in school at age 7/8 years, having a history of illicit substance use in adolescence, having any psychiatric diagnosis before age 16, and parental psychiatric diagnoses, were adjusted for.ResultsIn this large birth cohort study with a 17-year follow-up, younger age at first intoxication, higher frequency of alcohol intoxication, and high self-reported alcohol tolerance at age 15/16 years were associated with poorer educational outcomes by the age of 33 years. These associations were evident regardless of potential confounders, including parental education and childhood behavioural/emotional problems. The association between adolescent cannabis use and educational attainment in adulthood was no longer statistically significant after adjusting for confounders including frequency of alcohol intoxication at age 15/16.ConclusionsAssessments of age of first alcohol intoxication, high self-reported alcohol tolerance and frequency of intoxication during adolescence should be included when implementing screening strategies aimed at identifying adolescents at risk for subsequent social problems.

Associations of Adolescent Alcohol Use and Self-Reported Alcohol Tolerance With Risk of Self-Harm and Suicide in Early Adulthood: A Birth-Cohort Study.

We aimed to assess the predictive associations of age at first drink (AFD), age at first intoxication (AFI), frequency of intoxication, and self-reported alcohol tolerance at ages 15-16 with self-harm requiring medical attention or suicide death by age 33. In an ongoing follow-up study, the Northern Finland Birth Cohort 1986, a total of 7,735 individuals were included at ages 15-16. Information on alcohol and other substance use was assessed via questionnaires. Information on self-harm or suicide was collected from national registers until the participants were 33 years of age. Baseline psychiatric symptomatology measured with the Youth Self-Report questionnaire and sociodemographic background variables were controlled for in multivariable analyses using Cox regression analyses. Male gender and psychiatric symptoms at ages 15-16 were consistently associated with greater risk of self-harm and suicide death. When baseline psychiatric symptomatology and other background variables were adjusted for, younger AFI (hazard ratio [HR] = 2.28, 95% CI [1.16, 4.47]) and high inherent alcohol tolerance (HR = 3.76, 95% CI [1.55, 9.08]) were associated with self-harm. Furthermore, frequent alcohol intoxication (HR = 5.39, 95% CI [1.44, 20.23]) and high inherent alcohol tolerance (HR = 6.20, 95% CI [1.18, 32.45]) were associated with suicide death by age 33. High alcohol tolerance, age at onset of intoxication, and frequency of alcohol intoxication in adolescence appear to be significant predictors of self-harm and suicide in early adulthood. Self-reported alcohol tolerance in adolescence is a novel empirical approach to assess adolescent alcohol use associating with subsequent harms.

Age at first drink and severity of alcohol dependence

BackgroundEarly age at first drink (AFD) has been linked to early onset and increased severity of alcohol dependence in various studies. Few Indian studies on AFD have shown a negative correlation between AFD and severity of alcohol dependence. Our study aimed to explore this relationship in patients with alcohol dependence syndrome (ADS) diagnosed using ICD-10 criteria. MethodsOne hundred fifty-one consecutive patients freshly diagnosed with ADS were included in the study, which was conducted at the psychiatry unit of a tertiary care, multispecialty hospital. The Addiction Severity Index (ASI) was used to assess severity of alcohol dependence. ResultsMean AFD was 24.85 years (range = 13–40 years). Median ASI score was 36 (range = 21 to 57). The study yielded a weak negative correlation (ρ = −.105) between AFD and ASI, which was statistically not significant. ConclusionsWe found no correlation between AFD and severity of alcohol dependence at detection in Indian Armed Forces personnel, which is contrary to what has been reported worldwide and in previous Indian studies. Delayed initiation of alcohol use among those enrolling in the Indian Armed Forces and early detection of alcohol dependence within the military environment are possible explanations.

Age at First Drink, Experiences of Drunkenness, and Alcohol-Related Problems in Canadian Youth: Is Early Onset Bad If You Are a Moderate Drinker?

This article examines early age at first drink (AFD) (14 years and younger) and alcohol-related problems, with a focus on experiences of drunkenness. It challenges the assumption that all early AFD is harmful by investigating whether early drinkers who typically consume alcohol in moderation experience minimal problems or harms. Participants were drawn from the 2012 Student Drug Use Survey in Canada's Atlantic Provinces of New Brunswick, Nova Scotia, and Newfoundland and Labrador, an anonymous cross-sectional survey of high school students (ages 15-19 years). Negative binomial regression techniques were used to assess alcohol problems and harms (12-item scale) in association with early-onset drinking. Among ever-drinking high school students (n = 4,752), 65% had their first drink before age 15, 73% reported having ever been drunk, and 55% indicated at least one alcohol-related problem in the past 12 months, with a mean of 1.39 problems. Analyses revealed that experiencing an alcohol-related problem was more strongly associated with ever being drunk than with early AFD. Modeled together, individuals who reported early AFD and who had never been drunk reported significantly fewer problems relative to individuals who reported early AFD and late AFD but had been drunk. Early AFD is commonly linked to alcohol-related problems in youth and is predictive of future alcohol-related harms in adulthood. However, considerable heterogeneity in the likelihood of suffering alcohol-related problems exists, contextualized by individual drinking patterns. Given the high prevalence of early AFD, harm minimization efforts could achieve greater success by directing youth to consume alcohol in moderation, rather than focusing solely on abstinence.

The blind men and the elephant-response to commentaries.

Different definitions of age at first drink (AFD) tend to result in different conclusions about its harmfulness. Agreeing on one definition appears difficult due to the variety of dimensions involved. This impairs the value of AFD for alcohol research and prevention. It is obvious that the earlier and therefore the longer a human being is exposed to a toxic substance, the greater the adverse health consequences will be. Postponing this exposure therefore means prevention. There is striking simplicity and truth in this argument, which may explain why the concept of age at first drink (AFD) became so popular 1. However, the situation for alcohol use is different. Not all quantities consumed are toxic (children's cough medicines still contain alcohol to this day, for example) and exposure is usually not constant, especially at an early age when people commonly take their first sip of alcohol. Unfortunately there is insufficient space to respond to all the thoughtful comments made on our paper 2. However, all commentators share a concern about the definition and measurement of AFD, and two 3, 4 call for more work and consensus in this respect. Interestingly, they do not generally comment on AFD as the age at which the first gram of alcohol was digested, referring instead to ‘age of drinking onset’ 4, 5, ‘early drinking’ 1, 3, 4 and so on. It appears to us that they are asking implicitly for more work and a greater consensus on the definition and measurement of the early onset of harmful drinking. However, this is not the same as AFD—the age at first alcohol consumption, even just a sip. In most cases, AFD is not even a proximal precursor of harmful drinking onset. Moreover, even if we set out to define such an onset, it remains unclear what kind of behaviour is ‘switched on’ or ‘starts’ and what qualifies as ‘early drinking’. Drinking behaviour varies along several dimensions, all of which are important for its potential to cause harm: (a) the amount consumed per occasion (ranging from several sips to five or more drinks), (b) the frequency of drinking occasions (e.g. yearly or daily), (c) the regularity of drinking occasions and (d) the cultural, physical and psychosocial circumstances in which the consumption occurs (e.g. during a religious ceremony, in the presence of parents or peers, or before a risky activity). Furthermore, it is unclear what qualifies as early—before the age of 6, before the age of 21, or any year in between? Depending on which corner of the four-dimensional cube we look at, conclusions about the harmfulness of the early onset of drinking and their implications for research and prevention may be as divergent as the description the six blind men gave of the elephant in the well-known Hindu tale 6. At the extremes, consensus among scholars appears evident. A 6-year-old consuming several full drinks a day or before riding a skateboard on a steep slope is clearly harmful, and a 20-year-old taking a sip of alcohol once a year or during a religious ceremony is obviously harmless. Unfortunately, as we know from Carl Friedrich Gauss, such extremes are rare and in between there are so many shades of grey in the four-dimensional cube as to make an exact and reliable definition of when and what kind of ‘onset’ or ‘early drinking’ is harmful 1, 3, 4 extremely difficult, if not impossible. The aim of this ‘For Debate’ paper 2 was to sound a note of caution about the way AFD and early onset is used and to remind researchers, prevention specialists and policymakers not to be seduced by the simplicity of the argumentation mentioned at the beginning. None.

Is 'age at first drink' a useful concept in alcohol research and prevention? We doubt that.

To address and discuss the weaknesses of age at first drink (AFD) as a concept in alcohol research and prevention. Narrative literature review. Varying from one sip to the consumption of several full drinks, and sometimes including the specification of particular conditions (e.g. without parental consent), no exact definition and operationalization of AFD was found. Evidence reveals poor test-retest reliability when the same individuals report their AFD two or more times. Theoretical arguments and empirical evidence fail to explain why having one sip or one drink earlier than peers should cause heavier drinking and related problems later in life. Alternative explanations such as self-selection, third variable effects and systematic report bias are not considered in most studies. These shortcomings also make AFD unsuitable as an indicator or marker of underlying problems such as conduct problems and academic failure. Together with unjustified causal inferences, this has led to an over-emphasis on the relevance of postponing AFD as a way to prevent problems later in life. We argue in favour of shifting the focus of alcohol research and prevention away from AFD towards a better understanding of the progression from infrequent, low-quantity drinking to more detrimental drinking patterns and the prevention of associated acute and short-term harm.

Genetic and environmental influences on the ages of drinking and gambling initiation: evidence for distinct aetiologies and sex differences

To investigate the genetic and environmental contributions to age at first drink (AFD) and age first gambled (AFG), assess their overlap and examine sex differences. Univariate twin models were fitted to decompose the variation in AFD and AFG into additive genetic, shared environmental and unique environmental factors. Bivariate genetic models were fitted to assess the genetic and environmental contributions to the sources of covariation in AFD and AFG. National Australian Twin Registry. A total of 4542 same-sex and opposite-sex twins aged 32-43 years, 42% male and 58% female. AFD and AFG were assessed via structured psychiatric telephone interviews. Age of onset was treated as both continuous and categorical (early/late onset). AFD and AFG were modestly correlated (r = 0.18). Unique environmental influences explained a substantial proportion of the variation in both AFD (0.55, 95% confidence interval [CI] = 0.50-0.61) and AFG (0.66, 95% CI = 0.59-0.72), but these influences were uncorrelated (rE = 0.01). Additive genetic factors explained a notable proportion of variation in AFG (0.21, 95% CI = 0.003-0.39), while shared environmental factors were important for AFD (0.31, 95% CI = 0.15-0.46). Among men, genetic factors influenced variation in AFG but not in AFD and shared environmental factors influenced variation in AFD but not in AFG. Among women, shared environmental factors influenced variation in both AFD and AFG, but these environmental factors were not significantly correlated (rC = 0.09). Among Australian twins, age at first drink and age first gambled are influenced by distinct unique environmental factors, and the genetic and environmental underpinnings of both phenotypes differ in men and women.

Impact of Pubertal Stage at First Drink on Adult Drinking Behavior

Early alcohol use is one of the strongest predictors of later alcohol use disorders, with early use usually taking place during puberty. Many researchers have suggested drinking during puberty as a potential biological basis of the age at first drink (AFD) effect. However, the influence of the pubertal phase at alcohol use initiation on subsequent drinking in later life has not been examined so far. Pubertal stage at first drink (PSFD) was determined in N = 283 young adults (131 males, 152 females) from an epidemiological cohort study. At ages 19, 22, and 23 years, drinking behavior (number of drinking days, amount of alcohol consumed, hazardous drinking) was assessed using interview and questionnaire methods. Additionally, an animal study examined the effects of pubertal or adult ethanol (EtOH) exposure on voluntary EtOH consumption in later life in 20 male Wistar rats. PSFD predicted drinking behavior in humans in early adulthood, indicating that individuals who had their first drink during puberty displayed elevated drinking levels compared to those with postpubertal drinking onset. These findings were corroborated by the animal study, in which rats that received free access to alcohol during the pubertal period were found to consume more alcohol as adults, compared to the control animals that first came into contact with alcohol during adulthood. The results point to a significant role of stage of pubertal development at first contact with alcohol for the development of later drinking habits. Possible biological mechanisms and implications for prevention are discussed.

Effects of Sibship Size and Composition on Younger Brothers’ and Sisters’ Alcohol Use Initiation: Findings from an Australian Twin Sample

The effects of sibship size and structure on delinquency are well established. Specifically, having a large family and many brothers has been shown to predict offending. However, despite strong links between delinquency and alcohol use, the contribution of sibship factors to drinking behaviors remains largely unexplored. The current study investigated the impact of sibship size and composition on younger brothers' and sisters' ages of drinking and intoxication onset. We employed a sample of 4,281 same-sex twins from the Australian Twin Register to examine whether (i) large sibship size facilitates earlier age at first drink (AFD) and age at first intoxication (AFI) in males and females, (ii) having many older brothers predicts earlier ages of AFD and AFI in males, and (iii) having many older brothers results in later AFD and AFI in females. We tested whether effects were moderated by parental divorce and alcohol misuse and mediated by familial religion. Sibling effects were minimal before accounting for family context. However, when parental divorce and excessive parental drinking were included as moderators, sibling effects were significantly amplified among individuals from homes of divorce, and effects were strongest when siblings were close in age. Strong close in age older sibling effects indicate that proximal sibling attitudes and behaviors about alcohol likely interact with structural factors to influence younger siblings' drinking. Sibship factors were much more influential in one population (individuals from homes of divorce) than another (respondents with a parental history of excessive drinking), suggesting that sibling effects vary depending on the type of co-occurring familial risk. Prevention efforts performed at the family level, and introduced before first use of alcohol, are likely to delay drinking initiation and help prevent future alcohol problems.

Age at First Drink Moderates the Impact of Current Stressful Life Events on Drinking Behavior in Young Adults

Recent evidence from animal experiments and studies in humans suggests that early age at first drink (AFD) may lead to higher stress-induced drinking. The present study aimed to extend these findings by examining whether AFD interacted with stressful life events (SLE) and/or with daily hassles regarding the impact on drinking patterns among young adults. In 306 participants of an epidemiological cohort study, AFD was assessed together with SLE during the past 3 years, daily hassles in the last month, and drinking behavior at age 22. As outcome variables, 2 variables were derived, reflecting different aspects of alcohol use: the amount of alcohol consumed in the last month and the drinking frequency, indicated by the number of drinking days in the last month. Linear regression models revealed an interaction effect between the continuous measures of AFD and SLE on the amount of alcohol consumed. The earlier young adults had their first alcoholic drink and the higher the levels of SLE they were exposed to, the disproportionately more alcohol they consumed. Drinking frequency was not affected by an interaction of these variables, while daily hassles and their interaction with AFD were unrelated to drinking behavior. These findings highlight the importance of early age at drinking onset as a risk factor for later heavy drinking under high load of SLE. Prevention programs should aim to raise age at first contact with alcohol. Additionally, support in stressful life situations and the acquisition of effective coping strategies might prevent heavy drinking in those with earlier drinking onset.

The Earlier the More? Differences in the Links Between Age at First Drink and Adolescent Alcohol Use and Related Problems According to Quality of Parent–Child Relationships

Various studies reported associations between age at first drink (AFD) and later problem behaviors. However, the nature and strength of these associations are less clear. The present study investigates differences in the links between AFD and later alcohol use and the ones between alcohol use and later drinking problems, based on quality of parent-child relationships. Structural equation models were estimated based on a three-wave, 2-year prospective study of 364 adolescents. AFD measured at Time 1 was related to drinking quantity at Time 2, which was related to alcohol-related problems at Time 3. However, the significant links between AFD and later alcohol use existed solely among adolescents who reported high-quality relationships with their parents. More specifically, compared with all other adolescents, only those who had a late AFD and a high-quality relationship with their parents were found to have low levels of alcohol use at Time 2 and low levels of alcohol-related problems at Time 3. By promoting a high-quality relationship, prevention efforts might trigger a spiral of healthy developments during adolescence, including family well-being in early adolescence, late AFDs, lower alcohol-use levels, and eventually fewer alcohol-related problems in late adolescence.

Age at First Drink and the First Incidence of Adult‐Onset DSM‐IV Alcohol Use Disorders

Existing studies of the association between age at first drink (AFD) and the risk of alcohol use disorders (AUD) suffer from inconsistent levels of control and designs that may inflate associations by failure to control for duration of exposure to risk. This study examined associations between AFD (ages <15 and 15-17 vs. 18+ years) and first incidence of DSM-IV alcohol dependence, abuse, and specific AUD criteria over a 3-year follow-up in a longitudinal study of U.S. drinkers 18 years of age and older at baseline (n = 22,316), controlling for duration of exposure, family history, and a wide range of baseline and childhood risk factors. After adjusting for all risk factors, the incidence of dependence was increased for AFD <15 years (OR = 1.38) and for women only with AFD at ages 15 to 17 (OR = 1.54). The incidence of abuse was increased at AFD <15 and 15 to 17 years (OR = 1.52 and 1.30, respectively). Most dependence criteria showed significant associations with AFD, but hazardous drinking and continued drinking despite interpersonal problems were the only abuse criteria to do so. All associations were nonsignificant after controlling for volume of consumption, except that AFD at all ages <18 combined was associated with a reduced likelihood of impaired control, and AFD at ages 15 to 17 was associated with lower odds of drinking more/longer than intended among heavy-volume drinkers. In a population of low-risk drinkers that excluded those with positive family histories, personality disorders, and childhood risk factors, there were strong associations between early AFD (<18) and the incidence of dependence (OR = 3.79) and continued drinking despite physical/psychological problems (OR = 2.71), but no association with incidence of abuse. There is a robust association between AFD and the risk of AUD that appears to reflect willful rather than uncontrolled heavy drinking, consistent with misuse governed by poor decision-making and/or reward-processing skills associated with impaired executive cognitive function (ECF). Additional research is needed to determine causality in the role of impaired ECF, including longitudinal studies with samples of low-risk adolescents.

Origins and Consequences of Age at First Drink. I. Associations With Substance‐Use Disorders, Disinhibitory Behavior and Psychopathology, and P3 Amplitude

Although an early age at first drink has been repeatedly associated with substantially elevated rates of alcoholism, the mechanisms underlying this association remain unclear. We investigated whether the association of age at first drink (AFD) with alcoholism was more consistent with the hypothesis that the former causes the latter or the hypothesis that both are manifestations of some common vulnerability. We investigated whether substance use and mental health disorders, education, IQ, and personality were associated with AFD in a sample of 2670 adults; whether P3 amplitude was associated with AFD in a sample of 1127 17 year olds; and whether indicators of disinhibitory psychopathology assessed at age 11 predicted AFD by age 14 in a sample of 1343 adolescents. In adults, AFD was associated not only with alcohol dependence, but also with a broad array of indicators of disinhibitory behavior and psychopathology including nicotine dependence, illicit drug abuse and dependence, conduct disorder, antisocial personality disorder, underachievement in school, and the personality trait of constraint. In 17 year olds, AFD was also associated with reduced P3 amplitude, a well-documented psychophysiological marker of alcoholism risk. Finally, in the early-adolescence sample, measures of behavioral disinhibition, including oppositionality, hyperactivity/impulsivity, and inattentiveness assessed at age 11 predicted drinking onset by age 14. Our findings indicated that AFD is not specifically associated with alcoholism but rather is correlated with a broad range of indicators of disinhibited behavior and psychopathology. Moreover, individuals who first drink at a relatively early age manifest elevated rates of disinhibitory behavior and psychopathology before they first try alcohol. Taken together, these findings suggest that the association of AFD with alcoholism reflects, at least in part, a common underlying vulnerability to disinhibitory behavior. Whether an early AFD directly influences risk of adult alcoholism remains unclear.

Origins and Consequences of Age at First Drink. II. Familial Risk and Heritability

The association of age at first drink (AFD) and alcoholism may reflect a common inherited vulnerability to disinhibitory behavior and psychopathology rather than a direct influence of the former on the latter. We tested the common-inherited-vulnerability hypothesis by determining whether AFD is familial and heritable. A sample of 1,232 14-year-old twins was classified according to their biological parents' AFD. Lifetime symptoms of externalizing disorders (i.e., conduct disorder and oppositional defiant disorder) were significantly higher in the sons but not the daughters of parents whose AFD came before age 15 years. Offspring symptoms of internalizing disorders (i.e., major depressive disorder, separation anxiety disorder, and overanxious disorder) were not significantly associated with parental early use of alcohol in either sons or daughters. Early use of alcohol in mothers but not fathers was associated with a significant increase in both sons' and daughters' risk of alcohol use by age 14. The contribution of genetic and environmental factors to risk of early alcohol use was investigated in a sample of 416 monozygotic (MZ) and 225 like-sex dizygotic (DZ) 14-year-old twin pairs. Twin similarity for early alcohol use was substantially greater in MZ than DZ twins in boys but about equally similar in MZ and DZ twins in girls. Estimated heritability of early alcohol use was significantly greater in boys (55%) than girls (11%), in part because the genetic factors underlying symptoms of disinhibitory psychopathology contributed more to risk of early alcohol use in boys than girls. Early use of alcohol is familial and, at least in males, heritable. The familial transmission of early alcohol use is caused in part by genetic risk for disinhibitory psychopathology in males and to shared environmental factors in girls. These results provide some support for a common-inherited-vulnerability hypothesis, and suggest that the processes underlying early alcohol use may differ in boys and girls.