The earlier you start drinking the greater the chance of being alcoholic

Early Onset to Begin Drinking

It is a very common theme in AA meetings and other 12 step groups about how young alcoholics started drinking. I always wondered if this had an effect on later alcoholism, although I know many alcoholics who started drinking much later in life. Looking at the research below it seems that the age a person started drinking can predict later problems with alcohol. Interestingly “disinhibited” behaviour, such as impulsiveness and not being able to “stop oneself” from engaging in certain behaviours also have a bearing on later alcohol problems, as does adverse childhood experiences   and the amount of alcoholism in the family.

The age of onset to begin regular drinking is an important predictor of age of first alcohol problem and subsequent alcohol dependence (1,2),  as well as greater severity and persistence of problems with illicit drugs (3).

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For individuals that initiated drinking prior to age 14 years, the likelihood of adult alcohol dependence was 40%, four times more likely than individuals who began drinking at 20 years or older (2) .  It was also reported that individuals that drank before age 14 years were more than twice as likely to become alcohol dependent than those trying alcohol after age 16 years (4).

A number of factors such as early adverse childhood experiences (5,6)  and familial density of alcoholism (7,8), predict earlier age of drinking onset.

Earlier onset of drinking also appears to be related to the presence of behaviors often characterized as “disinhibited”.There is also abundant evidence that behavioral under-control is an important determinant of later development of substance use disorders (SUD) (9,10). Behavioral under-control observed as early as 3 years is predictive of alcohol-related problems at 21 years (11), and in adolescents mediates the relationship between family history of alcoholism and young adult SUDs (12)

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References

1. Hawkins JD, Graham JW, Maguin E, Abbott R, Hill KG, Catalano RF. Exploring the effects of age of alcohol use initiation and psychosocial risk factors on subsequent alcohol misuse.Journal of Studies Alcohol. 1997;58(3):280–290.[PMC free article]

2. Grant BF, Dawson DA. Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey.Journal of Substance Abuse. 1997;9:103–110.

3. Kandel DB, Yamaguchi K, Chen K. Stages of progression in drug involvement from adolescence to adulthood: further evidence for the gateway theory. Journal of Studies Alcohol.1992;53(5):447–457.

4. Sartor CE, Lynskey MT, Heath AC, Jacob T, True W. The role of childhood risk factors in initiation of alcohol use and progression to alcohol dependence. Addiction.2007;102(2):216–225.

5. Rothman EF, Edwards EM, Heeren T, Hingson RW. Adverse childhood experiences predict earlier age of drinking onset: results from a representative US sample of current or former drinkers. Pediatrics. 2008;122(2):e298–e304.

6. Waldrop AE, Ana EJ, Saladin ME, McRae AL, Brady KT. Differences in early onset alcohol use and heavy drinking among persons with childhood and adulthood trauma. American Journal on Addictions. 2007;16(6):439–442.

7. Hill SY, Yuan H. Familial density of alcoholism and onset of adolescent drinking. Journal of Studies on Alcohol.1999;60(1):7–17.

8.  Hill SY, Shen S, Lowers L, Locke J. Factors predicting the onset of adolescent drinking in families at high risk for developing alcoholism. Biological Psychiatry. 2000a;48(4):265–275.

9. Stice E, Barrera M, Jr., Chassin L. Prospective differential prediction of adolescent alcohol use and problem use:examining the mechanisms of effect. Journal of Abnormal Psychology.1998;107(4):616–628

10. Zucker RA. Anticipating problem alcohol use developmentally from childhood into middle adulthood: what have we learned?Addiction. 2008;103(Suppl 1):100–108. [PMC free article]

11.  Caspi A, Moffitt TE, Newman DL, Silva PA. Behavioral observations at age 3 years predict adult psychiatric disorders. Longitudinal evidence from a birth cohort. Archives of General Psychiatry. 1996;53(11):1033–1039.

12. King KM, Chassin L. Mediating and moderated effects of adolescent behavioral undercontrol and parenting in the prediction of drug use disorders in emerging adulthood.Psychology of Addictive Behaviors. 2004;18(3):239–249.

Explaining that “warm glow” of the first drink!?

The first drink does it!?

Some structural and functional differences in affective circuitry in the brain have been found in adolescents at risk of alcoholism compared to controls, and may precede alcoholism onset and thus constitute markers of  risk.

Thus, it is reasonable to hypothesize that pre-alcoholic differences in the functioning of relevant neural systems will be related to risk for alcoholism.

One aspect of the at risk argument that struck a chord was how difficulties in the regulation of stress in the offspring of alcoholics has a pronounced affect on how alcohol effects them.

This we believe may partly explain that rosy or golden glow of the first drink, which appears to often alter the perception of at risk alcoholics to such a profound effect, especially compared to those not at risk to later alcoholism.

We know that dopamine rises in relation to the “rewarding” properties of drugs and alcohol, rising in a more pronounced way in drugs such as cocaine than in alcohol so perhaps alcohol does something else to alcoholics than to non-alcoholics, perhaps it effects something other than dopamine or natural opioids or other neurochemicals in the brain, perhaps it hits us via our hearts and in reducing heightened stress levels?

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For example in terms of inherent stress regulation, offspring of alcoholics tend to have higher baseline heart rates (1,2) and show increased cardiovascular reactivity to aversive stimuli  (3-6).

In simple terms those at risk have inherent difficulties in stress regulation, react more than those not at risk,  studies have shown that cortisol (stress chemical) response to psychosocial stress is significantly increased in offspring with a family history of alcoholism compared to those with no family history of alcoholism (7,8)

Interestingly, this stress dysregulation may potentiate (heighten) the rewarding properties of alcohol as we have also seen in emotion dysregulation. Alcohol appears to not only be rewarding but is doubly so in that it provides a release from stress also.

In fact, offspring from families with alcoholics may be hypersensitive to the effects of alcohol on cardiovascular activity (3,5,9,10)

Alcohol may serve to dampen heart rate and electrodermal reactivity to stress more in young adults with a family history of alcoholism than in offspring without a family history.

Slowing of heart rate may be associated with increased perception of relaxation making alcohol more rewarding to high risk offspring.

In offspring of alcohol dependent individuals, ethanol (alcohol) consumption results in significantly lower stress chemicals like adrenocorticotropic hormone (ACTH) and cortisol levels compared to control subjects and these are  predictive of future alcoholism (11).

Initial alcohol use may have a double whammy effect on alcoholics, possibly right from the first drink. It may be the reason some alcoholics say they were alcoholic from their first drink, that the drink could do for them what they could not do for themselves.

Alcohol may involve a profound a release from self, a self prone to stress difficulties and more susceptible to the releasing, stress reducing properties of alcohol.

References

1. Harden PW, Pihl RO. Cognitive function, cardiovascular reactivity, and behavior in boys at high risk for alcoholism.Journal of Abnormal Psychology. 1995;104(1):94–103.

2. Hill SY. Absence of paternal sociopathy in the etiology of severe alcoholism: is there a type III alcoholism? Journal of Studies Alcohol. 1992;53(2):161–169.

3. Finn PR, Pihl RO. Risk for alcoholism: a comparison between two different groups of sons of alcoholics on cardiovascular reactivity and sensitivity to alcohol. Alcoholism, Clinical and Experimental Research. 1988;12(6):742–747.

4.  Finn PR, Zeitouni NC, Pihl RO. Effects of alcohol on psychophysiological hyperreactivity to nonaversive and aversive stimuli in men at high risk for alcoholism. Journal of Abnormal Psychology. 1990;99(1):79–85.

5.  Peterson JB, Pihl RO, Séguin JR, Finn PR, Stewart SH. Heart-rate reactivity and alcohol consumption among sons of male alcoholics and sons of non-alcoholics. Journal of Psychiatry & Neuroscience. 1993;18(4):190–198. [PMC free article]

6. Stewart SH, Finn PR, Pihl RO. The effects of alcohol on the cardiovascular stress response in men at high risk for alcoholism: a dose response study. Journal of Studies on Alcohol. 1992;53(5):499–506.

7. Uhart M, Oswald L, McCaul ME, Chong R, Wand GS. Hormonal responses to psychological stress and family history of alcoholism. Neuropsychopharmacology. 2006;31(10):2255–2263.

8. Zimmermann U, Spring K, Kunz-Ebrecht SR, Uhr M, Wittchen HU, Holsboer F. Effect of ethanol on hypothalamicpituitary-adrenal system response to psychosocial stress in sons of alcohol-dependent fathers. Neuropsychopharmacology.2004;29(6):1156–1165.

9. Schuckit MA. Low level of response to alcohol as a predictor of future alcoholism. American Journal of Psychiatry.1994;151(2):184–189.
10. Schuckit MA, Tsuang JW, Anthenelli RM, Tipp JE, Nurnberger JI., Jr. Alcohol challenges in young men from alcoholic pedigrees and control families: a report from the COGA project. Journal of Studies on Alcohol. 1996;57(4):368–377.
11. Schuckit MA, Smith TL. Assessing the risk for alcoholism among sons of alcoholics. Journal of Studies on Alcohol.1997;58(2):141–145.