Risk Factor For Heavy Drinking Research Articles

Differentiating action from inaction: Longitudinal relations among impulsive personality traits, internalizing symptoms, and drinking behavior

BackgroundImpulsive personality traits are strong, consistent risk factors for heavy drinking, and modern theories suggest that impulsive traits may also confer risk for internalizing symptoms. However, it remains unclear which specific impulsive traits are linked with heavy drinking versus internalizing symptoms, and whether heavy drinking and internalizing symptoms are mechanisms of risk for negative alcohol consequences in impulsive individuals. MethodData are from a longitudinal study of young adults (N = 448, Mage = 22.27, 43.5 % female) assessed at baseline (T1), 6 months (T2), and one year later (T3). Longitudinal path models tested whether T1 impulsive traits (i.e., lack of premeditation, lack of perseverance, sensation seeking, positive urgency, negative urgency) were indirectly associated with T3 negative alcohol consequences through heavy T2 drinking and T2 internalizing symptoms (i.e., depression, anxiety, stress). Separate models were tested for positive and negative urgency given strong correlations between these measures. ResultsAcross models, T1 lack of premeditation indirectly predicted more T3 negative alcohol consequences through heavy T2 drinking. When tested separately, T1 negative urgency indirectly predicted more T3 negative consequences through higher T2 stress and depressive (but not anxiety) symptoms, and T1 positive urgency predicted higher T2 anxiety symptoms, but T2 anxiety was unrelated to T3 negative consequences. Across models, T1 sensation seeking indirectly predicted less T3 negative consequences through decreased T2 depression. ConclusionsDistinct impulsive traits prospectively predicted heavy drinking and internalizing symptoms, both of which conferred risk for negative alcohol consequences. Findings underscore the importance of targeted interventions based on personality and suggest that decreases in drinking may be more effective prevention for those who lack premeditation, whereas decreases in internalizing, particularly depression/stress, may be critical for those high in negative urgency.

Momentary subjective responses to alcohol as predictors of continuing to drink during daily-life drinking episodes

PurposeSubjective response to alcohol’s stimulating and sedating effects is a person-level risk factor for heavy drinking and alcohol use disorder. Longitudinal and laboratory studies have demonstrated that at-risk individuals experience greater stimulation and lower sedation while drinking. While between-person subjective responses inform risk and etiology, in-the-moment assessments during daily-life drinking may elucidate the within-person processes by which stimulation and sedation may lead to heavier drinking. We aimed to characterize these momentary processes by testing momentary stimulation and sedation during drinking as predictors of subsequently continuing to drink during densely sampled, daily-life drinking episodes. Procedures113 adults (54 with borderline personality disorder and 59 community participants; 77.9% female) completed ecological momentary assessment for 21 days, reporting momentary subjective stimulation and sedation throughout drinking episodes and momentary alcohol use after drink initiation (i.e., continued drinking). FindingsGLMMs demonstrated that greater day-level stimulation (OR=1.48, 95% CI=[1.20, 1.82], p<.001), greater person-level stimulation (OR=1.63, 95% CI=[1.05, 2.53], p=.031), and lower momentary sedation (OR=0.54, 95% CI=[0.41, 0.71], p<.001) predicted continued drinking. ConclusionsAlthough greater stimulation and lower sedation have been conceptualized as individual-level risk factors for heavy drinking, our findings suggest that these associations are accompanied by processes that operate within person. Our results suggest that greater stimulation may confer risk for heavy drinking at the level of the drinking episode, possibly acting as positive reinforcement that may contribute to heavier drinking during future episodes. In contrast, lower sedation may primarily confer in-the-moment risk by contributing to momentary decisions to keep drinking within an episode.

Moderators of subjective response to alcohol in the human laboratory.

Subjective response (SR) to alcohol represents a biobehavioral risk factor for heavy drinking and for developing alcohol use disorder (AUD). Identifying moderators of SR have been hindered by small sample sizes that are often used in alcohol administration studies. This study combined data from multiple alcohol administration trials to test whether sex, family history of alcohol problems, and impulsivity (via delay discounting) predict SR to alcohol, comprised of four domains: stimulation, sedation, negative affect, and craving. Non-treatment-seeking heavy drinkers (N=250) completed a battery of self-report scales and behavioral measures of alcohol use and problems, mood, and impulsivity. All participants completed an intravenous alcohol administration session wherein SR domains were measured at baseline, 20, 40, and 60mg%. Analyses using multilevel modeling showed that male sex independently predicted higher alcohol-induced stimulation and alcohol craving, after controlling for other moderators. A family history of alcohol problems also independently predicted alcohol craving after controlling for other moderators. Using a large sample and advanced data analytic methods, this study extends the literature on alcohol administration by identifying important moderators of SR in heavy drinkers: namely, male sex and family history of alcohol problems. These findings consolidate and extend a growing body of research aimed at differentiating individuals most likely to report the SR features that confer risk for AUD.

Drinking behavior among government employees in Changsha and its influencing factors.

To analyze the prevalence and influencing factors for drinking behavior and heavy drinking among government employees in Changsha and provide a basis for carrying out interventions for drinking behaviors and formulating public health promotion plans for government employees. Government employees were recruited consecutively from the Health Management Center of a general hospital in Changsha between December 2017 and December 2018. Information on sociodemograpic characteristics, drinking behaviors, life events, and psychosocial characteristics was collected using a standard set of questionnaire. Drinking behavior was defined as drinking once or more per week for the past 12 months. The differences in drinking rates and excessive drinking rates among groups with different characteristics were compared. Multivariate analysis was performed to analyze the associated factors of drinking behaviors and heavy drinking for government employees. A total of 6 190 people completed this investigation. The overall drinking rate of government employees in Changsha was 21.9%, and the rate of drinking was higher in males than that in females (44.7% vs 4.0%, P<0.01). Among the participants who drinked, the heavy drinking rates of males and females were 26.4% and 10.1%, respectively, while the harmful drinking rates of males and females were 6.0% and 2.2%, respectively. The results of multivariate logistic regression analysis showed that smoking, below high school education level, frequency of social intercourse ≥ 2 times per week, and having married or the divorced/widowed marital status were associated with alcohol drinking for male governmental employees. While aged 41 to 60 years old, frequency of social intercourse ≥ 2 times per week, life events stimulation ≥8 points were the risk factors for female; male, aged 41 to 60 years old, smoking, frequency of social intercourse≥ 2 times per week, and life events stimulation ≥1 point were the risk factors for heavy drinking. The drinking and heavy drinking rates of government employees are high in Changsha. Marital status, physical exercise, and frequency of social intercourse are the common influencing factors of male drinking behavior and female drinking behavior. The life events stimulation is the influencing factor of heavy drinking.

Quantile-Specific Heritability of Intakes of Alcohol but not Other Macronutrients.

Genetic heritability (h2) of alcohol use is reported to be greater in rural dwellers, distressed marriages, low socioeconomic status, in girls who are unmarried or lacking closeness with their parents or religious upbringing, in less-educated men, and in adolescents with peers using alcohol. However, these are all risk factors for heavy drinking, and the greater heritability could be due to quantile-dependent expressivity, i.e., h2dependent upon whether the phenotype (alcohol intake) is high or low relative to its distribution. Quantile regression showed that h2 estimated from the offspring-parent regression slope increased significantly from lowest to highest gram/day of alcohol consumption (0.006 ± 0.001 per percent, P = 1.1 × 10-7). Heritability at the 90th percentile of the sample distribution (0.557 ± 0.116) was 4.5-fold greater than at the 10th percentile (0.122 ± 0.037). Heritabilities for intakes of other macronutrients were not quantile-dependent. Thus quantile-dependent expressivity may explain the higher estimated heritability associated with risk factors for high alcohol consumption.

Heavy drinking and contextual risk factors among adults in South Africa: findings from the International Alcohol Control study

BackgroundThere is limited information about the potential individual-level and contextual drivers of heavy drinking in South Africa. This study aimed to identify risk factors for heavy drinking in Tshwane, South Africa.MethodsA household survey using a multi-stage stratified cluster random sampling design. Complete consumption and income data were available on 713 adults. Heavy drinking was defined as consuming ≥120 ml (96 g) of absolute alcohol (AA) for men and ≥ 90 ml (72 g) AA for women at any location at least monthly.Results53% of the sample were heavy drinkers. Bivariate analyses revealed that heavy drinking differed by marital status, primary drinking location, and container size. Using simple logistic regression, only cider consumption was found to lower the odds of heavy drinking. Persons who primarily drank in someone else’s home, nightclubs, and sports clubs had increased odds of heavy drinking. Using multiple logistic regression and adjusting for marital status and primary container size, single persons were found to have substantially higher odds of heavy drinking. Persons who drank their primary beverage from above average-sized containers at their primary location had 7.9 times the odds of heavy drinking as compared to persons who drank from average-sized containers. Some significant associations between heavy drinking and age, race, and income were found for certain beverages.ConclusionRates of heavy drinking were higher than expected giving impetus to various alcohol policy reforms under consideration in South Africa. Better labeling of the alcohol content of different containers is needed together with limiting production, marketing and serving of alcohol in large containers.

Risk profiles for heavy drinking in adolescence: differential effects of gender.

Abnormalities across different domains of neuropsychological functioning may constitute a risk factor for heavy drinking during adolescence and for developing alcohol use disorders later in life. However, the exact nature of such multi-domain risk profiles is unclear, and it is further unclear whether these risk profiles differ between genders. We combined longitudinal and cross-sectional analyses on the large IMAGEN sample (N≈1000) to predict heavy drinking at age 19 from gray matter volume as well as from psychosocial data at age 14 and 19-for males and females separately. Heavy drinking was associated with reduced gray matter volume in 19-year-olds' bilateral ACC, MPFC, thalamus, middle, medial and superior OFC as well as left amygdala and anterior insula and right inferior OFC. Notably, this lower gray matter volume associated with heavy drinking was stronger in females than in males. In both genders, we observed that impulsivity and facets of novelty seeking at the age of 14 and 19, as well as hopelessness at the age of 14, are risk factors for heavy drinking at the age of 19. Stressful life events with internal (but not external) locus of control were associated with heavy drinking only at age 19. Personality and stress assessment in adolescents may help to better target counseling and prevention programs. This might reduce heavy drinking in adolescents and hence reduce the risk of early brain atrophy, especially in females. In turn, this could additionally reduce the risk of developing alcohol use disorders later in adulthood.

Daily Patterns of Marijuana and Alcohol Co-Use Among Individuals with Alcohol and Cannabis Use Disorders.

The study aims were to examine daily associations between marijuana and alcohol use and the extent to which the association differs as a function of cannabis use disorder (CUD) and/or alcohol use disorder (AUD) diagnosis. Timeline Followback interview data was collected in a study of veterans (N=127) recruited from a Veterans Affairs hospital who reported at least 1day of co-use of marijuana and alcohol in the past 180days (22,860 observations). Participants reported 40% marijuana use days, 28% drinking days, with 37% meeting DSM-5 criteria for CUD, 40% for AUD, and 15% for both. Use of marijuana on a given day was used to predict a 3-level gender-adjusted drinking variable (heavy: ≥5 (men)/4 (women) drinks; moderate: 1 to 4/3 drinks; or none: 0 drinks). A categorical 4-level variable (no diagnosis, AUD, CUD, or both) was tested as a moderator of the marijuana-alcohol relationship. Multilevel modeling analyses demonstrated that participants were more likely to drink heavily compared to moderately (OR=2.34) and moderately compared to not drinking (OR=1.61) on marijuana use days relative to nonuse days. On marijuana use days, those with AUD and those with AUD+CUD were more likely to drink heavily (OR=1.91; OR=2.51, respectively), but those with CUD were less likely to drink heavily (OR=0.32) compared to moderately, nonsignificant differences between any versus moderate drinking in interaction models. Heavy drinking occurs on days when marijuana is also used. This association is particularly evident in individuals diagnosed with both AUD and CUD and AUDs alone but not in those with only CUDs. Findings suggest that alcohol interventions may need to specifically address marijuana use as a risk factor for heavy drinking and AUD.

Women's Alcohol Sensitivity Predicts Alcohol-Related Regretted Sex.

Low sensitivity (LS) to alcohol's acute effects is a known risk factor for heavy drinking and its negative consequences. However, LS could be protective due to LS drinkers being less impaired at a given level of consumption. Here, we tested whether LS is associated with differences in men's and women's reports of alcohol-related regretted sex. Eight hundred and one young adults (393 women) aged 21 to 35 (M=23.11years) recruited for a study of alcohol's effects on cognition completed self-report measures of alcohol sensitivity, typical alcohol use, and alcohol consequences (including regretted sex). Participants whose alcohol sensitivity scores classified them as LS were more likely to experience alcohol-related regretted sex than were high-sensitivity (HS) participants. However, when controlling for typical alcohol use and experience of alcohol consequences in general, alcohol sensitivity was negatively associated with risk of alcohol-related regretted sex, but only among women. At a given level of consumption, and controlling for experience of alcohol consequences other than regretted sex, reduced sensitivity to certain effects of alcohol may be a protective factor for women against risk for alcohol-related regretted sexual situations. This study provides insight on the unique risks of drinking among LS and HS women.

Positive and negative affectivity as risk factors for heavy drinking in the second half of life: a prospective cohort study.

To estimate the prospective relations between levels of propensity to experience positive affect (PA) and propensity to experience negative affect (NA) and risk of heavy drinking in a cohort of Norwegians aged 40-80years. Clustered sampling was used to draw Norwegians aged 40-79years in 2002/03 (t1). The relationship between PA and NA measured at t1 and heavy drinking measured in 2007/08 (t2) was estimated with random-intercept logistic regression. Norway. A total of 2142 (44.0% men) who consumed mean=3.07 [standard deviation (SD)=3.15] UK units of alcohol on average per week and were intoxicated less than once per week at t1. The Brief Measure of Positive and Negative Affect, quantity-frequency measure of alcohol use and frequency of drinking to intoxication. Heavy drinking at t2 (> 14units per week and/or intoxication ≥once per week) was regressed on PA and NA at t1. Controlling for alcohol consumption, gender, age, income and level of education (at t1) and change in PA and NA, there was little evidence for an association between level of PA and heavy drinking [odds ratio (OR) =0.96, 95% confidence interval (CI)=0.71, 1.29, Bayes factor=0.15]. The level of NA at t1 was associated with greater risk of heavy drinking at t2 (OR =1.40, 95% CI=1.02, 1.93). There is little evidence for an association between the propensity to experience positive affect and heavy drinking among Norwegians aged 40-80years. Norwegian adults in the second half of life with a high propensity to experience negative affect are at greater risk of heavy drinking approximately 5years later than those with a low propensity to experience negative affect.

Social factors, alcohol expectancy, and drinking behavior: A comparison of two college campuses

ABSTRACTBackground: Though college students have high rates of heavy drinking, few studies have examined the various pathways through which risks affect drinking and whether this varies by institution. We examined whether alcohol expectancy mediates the relationship between social factors (i.e., hooking up, friends drinking, Greek affiliation, entitlement) and drinking behavior comparing college students from one Midwestern and one Southeastern university. Methods: In the 2013–14 academic year, 1,482 college students (51% female) enrolled in undergraduate courses at two public universities completed a paper and pencil survey of attitudes and experiences about dating, sexuality, and substance use. Multiple group path analysis was used to compare two institutions. Results: Drinking behavior was positively associated with hooking up more often, Greek affiliation, being male, having close friends who consume more alcohol, and greater alcohol expectancies. We found unique differences in the mediating pathways for the two campuses. Conclusion: This study provides a more nuanced understanding of risk factors for heavy drinking. Moreover, it adds to the scarce body of literature concerning entitlement and drinking and the unique pathways between two college campuses. Finally, the results could lead to the development of more specific intervention strategies to reduce risky drinking among U.S. college students.

Impulsivity, working memory, and impaired control over alcohol: A latent variable analysis.

Impaired control over alcohol is an important risk factor for heavy drinking among young adults and may mediate, in part, the association between personality risk and alcohol problems. Research suggests that trait impulsivity is associated with impaired control over alcohol; however, few studies of this association have included a range of impulsivity facets. The purpose of this study was to examine specific pathways from higher order impulsivity factors to alcohol problems mediated via impaired control over alcohol. We also examined the moderating role of working memory in these associations. Young heavy drinkers (N = 300) completed 2 multidimensional impulsivity measures along with self-report measures of impaired control over alcohol, alcohol use, and alcohol problems. Working memory was assessed using a computerized digit span task. Results showed that the impulsivity facets loaded onto 2 higher order factors that were labeled Response and Reflection Impulsivity. Response impulsivity predicted unique variance in self-reported impaired control and alcohol problems, whereas reflection impulsivity predicted unique variance in heavy drinking frequency only. Further, significant indirect associations were observed from response and reflection impulsivity to alcohol problems mediated via impaired control and heavy drinking frequency, respectively. Working memory and sensation seeking were not uniquely associated with the alcohol variables, and no support was found for the moderating role of working memory. The results help to clarify associations among impulsivity, impaired control, and alcohol problems, suggesting that impaired control may play a specific role in the pathway to alcohol problems from response impulsivity but not from reflection impulsivity. (PsycINFO Database Record

Impulsive Personality, Parental Monitoring, and Alcohol Outcomes From Adolescence Through Young Adulthood

PurposeWe examined the time-varying effects of sensation seeking, lack of perseverance, and parental monitoring on heavy drinking and alcohol-related harms from ages 16 to 28 years. MethodsParticipants were from the Victoria Healthy Youth Survey, followed six times, biennially, between 2003 and 2013 (N = 662; mean age at Time 1 = 15.52, range = 12–18). Analyses used time-varying effect models, which estimate how the association between a predictor and an outcome differs over time without assuming the association follows a parametric function of time. ResultsSensation seeking was a stable risk factor for heavy drinking, and lack of perseverance was stable risk factor for alcohol-related harms at each age. Parental monitoring was associated with lower rates of heavy drinking in adolescence and lower rates of alcohol harm until the age of 24 years. Moreover, high levels of parental monitoring moderated the association between personality traits and rates of harm at ages 17–20 years but only for youth high on lack of perseverance and low on sensation seeking. ConclusionsThe results provide a better understanding of age-related changes in risk and protective factors of alcohol use across the transition to adulthood. Impulsive personality traits are stable risk factors for alcohol outcomes until the late-20s despite typical age-related declines in these traits and drinking. Moreover, parental monitoring buffers the association between personality traits and alcohol harm for specific youth during the transition to adulthood. Personality-targeted interventions may be effective beyond adolescence, and parenting interventions may help reduce harm among low perseverance, low sensation-seeking youth.

The influence of parental drinking on offspring's drinking motives and drinking: A mediation analysis on 9 year follow-up data

Background and aimsThe influence of parental drinking on offspring's drinking is well-documented. However, longitudinal evidence on the mediating role of drinking motives in this relationship is lacking. This study longitudinally investigates the mediating role of drinking motives in the relationship between parental and offspring's drinking. Methods: Using a prospective design, 587 Flemish children (response 30.0%) were followed for 9 years. Parental drinking was documented during the offspring's late childhood (10 and 11 years old) through paper-and-pencil questionnaires distributed by schools. The offspring's drinking habits and -motives were documented in early adulthood (18 and 19 year old) through a web-based questionnaire; invitations were sent by letter. Motives were measured using the Drinking Motives Questionnaire Revised Short-form, and mediation analyses were conducted with the product of coefficient test using bootstrapping. Results: Half the offspring were female (53.8%) and the mean age was 19.35 (SD=0.52) years. A significant direct effect of maternal drinking during childhood on offspring drinking nine years later was found (β=0.091, t=2.071, p=0.039). However, the association turned non-significant after stratifying the model for boys and girls. No direct effect was found for paternal drinking on offspring's drinking. Nevertheless, paternal drinking indirectly affected offspring's drinking through offspring's enhancement motives (β=0.041, 95%CI[0.004, 0.082]) and maternal drinking indirectly affected male offspring's drinking through offspring's social motives (β=0.067, 95%CI[0.007, 0.148]). ConclusionThese results show that parental drinking during late childhood relates to a high level of those drinking motives among young adults that are known risk factors for heavy drinking in early adulthood.

The nonmedical use of alcohol and prescription drugs among adolescents in China

Background Few national large-scale studies on adolescents substance use have been conducted in China. This study aimed to investigate the prevalence of substance use, to better understand the characteristics of nonmedical users, and to explore the risk factors for heavy drinking and prescription drugs nonmedical use. Methods A cross-sectional study was conducted involving a total of 105 …

Alcohol cues, approach bias, and inhibitory control: Applying a dual process model of addiction to alcohol sensitivity.

Low sensitivity to the acute effects of alcohol is a risk factor for heavy drinking and related problems. However, little research has tested process explanations for such effects. The current study tested the hypothesis that low sensitivity is associated with automatic approach biases for alcohol cues, coupled with deficits inhibiting responses in the presence of such cues. Eighty-five participants varying in alcohol sensitivity completed an Alcohol-Approach Avoidance Task and a Cued Go/No-Go Task while event-related potentials were recorded. Low sensitivity (LS) individuals showed evidence of automatic approach tendencies toward alcohol cues in both tasks, and experienced deficits inhibiting prepotent responses cued by alcohol images. Additionally, the event-related potential data indicated that LS individuals experienced more conflict when attempting to inhibit alcohol-cued responses, but not nonalcohol-cued responses, compared with their high-sensitivity counterparts. Together, these data indicate that alcohol cues elicit an approach bias among LS individuals, translating into greater difficulty inhibiting behavioral responses in the presence of such cues, a pattern generally supportive of dual process models of substance use.

PL1 * FOUR DECADES OF RESEARCH ON THE LEVEL OF RESPONSE TO ALCOHOL AS A RISK FACTOR FOR ALCOHOLISM: FROM IDEA TO PREVENTION

PL1 * FOUR DECADES OF RESEARCH ON THE LEVEL OF RESPONSE TO ALCOHOL AS A RISK FACTOR FOR ALCOHOLISM: FROM IDEA TO PREVENTION

Correlation between Shift-work-related Sleep Problems and Heavy Drinking in Japanese Male Factory Workers

To investigate the effects of shift work on increased alcohol intake associated with poor sleep quality. This cross-sectional survey evaluated the correlation between work schedule, poor sleep quality and heavy drinking among 909 factory workers aged 35-54 years in Japan. Subjects included 530 day workers, 72 shift workers who did not work at night and 290 shift workers who engaged in night work. Heavy drinking was defined as a mean volume of alcohol consumption exceeding 60 g/day. Compared with other workers, night-shift workers who suffered poor sleep quality exhibited the highest frequency of heavy drinking (17.6%). Multiple logistic regression analysis demonstrated that compared with day workers with good sleep, night-shift workers who experienced poor sleep had more than twice the odds of heavy alcohol consumption (odds ratio 2.17 [95% confidence interval (CI), 1.20-3.93]). Shift workers who did not work at night and day workers with poor sleep were not at increased odds of heavy drinking. Shift workers who engage in night work may try to modify their health behavior to cope with sleep problems. Such modification may be a risk factor for heavy drinking.

Reduced anterior cingulate cortex activity during response inhibition is associated with ad-lib alcohol consumption

Reduced P300 amplitude during response inhibition is a risk-factor for the development of alcoholism. We examined P300 fluctuations following a manipulation of response conflict during a Stop Signal task, and investigated associations between the inhibition P300 and subsequent ad-lib alcohol consumption. Sixteen participants performed a Stop Signal task under two different levels of response conflict before assessments of ad-lib drinking. EEG source dipole analysis was performed on inhibition trials and compared across conditions. Seven distinct cortical sources of activation were observed on inhibition trials during the Stop Signal task. Increased levels of response conflict led to larger P300 amplitudes associated with increased activation in the proposed site of the anterior cingulate cortex (ACC), both of which were associated with ad-lib drinking immediately after the task. Results provide the first experimental support for theoretical models which posit that reduced ACC activity and the inhibition P300 are risk-factors for heavy drinking.

Age of First Use and Delay to First Intoxication in Relation to Trajectories of Heavy Drinking and Alcohol-Related Problems During Emerging Adulthood

Using alcohol at an early age is a well-documented risk factor for heavy drinking and the experience of a range of negative social and health consequences. However, it remains unclear if early consumption of any alcohol or early drinking to intoxication confers the greatest risk. Age of onset (AO) and delay to first intoxication (delay) were examined as independent predictors of heavy drinking and the experience of alcohol-related problems (problems) in a sample of incoming college freshmen (n=1,160) who completed biannual assessments from the summer following senior year of high school through senior year of college. The sample included more women (66%) than men and a majority were Caucasian (59%). We employed latent growth curve modeling to examine self-reported AO and delay to self-defined first intoxication as predictors of the frequency of heavy drinking and problems during year 4 of college, as well as changes in these alcohol-related outcomes from high school through college. An earlier AO and/or a shorter delay was associated with increased frequency of heavy drinking and problems during senior year of college. Although individuals with a later AO and/or a longer delay were at lower risk overall, they showed larger increases in heavy drinking and problems over time. The findings highlight the importance of distinguishing between AO and delay to first intoxication. Delay accounted for unique variance in drinking outcomes relative to AO, and the effects of AO were stronger when delay was included as a predictor variable. Results are discussed with regard to potential mechanisms through which an early age of intoxication may confer unique risk relative to AO. The implications for cross-cultural differences in risk for problems attributable to early drinking are also discussed.