Developmental pathways to alcohol abuse and dependence in young adulthood

Objective: To determine if people who were diagnosed with alcohol abuse or dependence (AAD) at age 21 had different developmental patterns of alcohol use in adolescence than non-AAD individuals. Method: An ethnically diverse urban sample of 808 children was surveyed at age 10 in 1985 and followed pr ospectively to age 21 in 1996. AAD at age 21 was assessed following DSM-IV criteria. Latent Transition Analysis (LTA) was used to identify four status es of alcohol use (nonuse, initiation only, current use only, heavy episodi c drinking), as well as transition probabilities between these four statuse s from elementary school to middle school and from middle school to high sc hool among the AAD and non-AAD group. Results: The prevalence of alcohol us e statuses during elementary school was similar in the two groups. Differen ces in alcohol use emerged in middle school and became more pronounced in h igh school. In middle school, AAD individuals were more likely to have init iated or been current drinkers than non-AAD individuals. However, the two g roups did not differ in the prevalence of heavy episodic drinking in middle school. In high school, most AAD individuals were in the heavy episodic dr inking status (54%), while most non-AAD individuals were in the initiation only (33%) or current use only (34%) statuses. Conclusions:These findings s uggest preventive intervention targets for different developmental periods. Alcohol abuse and dependence at age 21 may be prevented by delaying alcoho l initiation, by reducing current use in middle school and by reducing heav y episodic drinking in high school.