Natural course of alcohol use disorders from adolescence to young adulthood

Objectives: To examine the course of alcohol use disorder (AUD) and determi ne the extent to which AUD in adolescence is a risk factor for AUD and othe r psychopathology in young adulthood. Method: Nine hundred forty participan ts from a large community sample in western Oregon were interviewed twice d uring adolescence (14-18 years of age the first assessment; between 1987 an d 1991) and once at age 24 (1993-1999). Between 1995 and 1998, parents were assessed for lifetime AUD. Participants were classified into nonproblemati c use (NON), problem drinker (PROB) (symptoms of AUD but no diagnosis), and AUD groups. Results: Adolescent AUD significantly predicted AUD, substance use disorder, depression, and elevated levels of antisocial and borderline personality disorder symptoms by age 24. Compared with the NON group, adol escents in the PROB group were at increased risk for AUD, substance use dis order, depression, and antisocial personality disorder symptoms. However, t he PROB group had lower rates of future AUD and antisocial personality diso rder symptoms than the adolescent AUD group. Gender interactions were nonsi gnificant. Daily smoking and conduct/oppositional defiant disorders predict ed future AUD, when adolescent AUD and other disorders were controlled. Pat ernal, but not maternal, AUD was associated with greater risk of future AUD . Conclusions: For the majority of adolescents, AUD are not benign conditio ns that resolve over time. Assessment, treatment, and prevention recommenda tions are discussed.