Progression through early drinking milestones in an adolescent treatment sample

Abstract

Aims: Research using nationally representative and community samples demonstrates a robust association between early onset of drinking and increased likelihood of numerous adverse outcomes. However, little is known about the subsequent drinking that occurs early in the drinking career. The present study dissects the transition from any alcohol use to treatment entry by taking a fine-grained approach to examining the attainment and progression of drinking events in a sample of adolescents in substance use treatment.

Design/setting: Data were taken from the Drug Abuse Treatment Outcome Study for Adolescents (DATOS-A), a multi-site, community-based study of adolescents entering treatment.

Participants: Respondents included 3331 youth aged 12-18 years (mean = 15.75) admitted to treatment in 1993-95 (74% male, 52% white, 24% African American, 20% Hispanic).

Measurements: Age of attainment was obtained for five drinking-related milestones, including first drink of alcohol, first time drunk, first monthly drinking, first drank five or more drinks/day on a weekly basis and first drank five or more drinks/day on a daily basis.

Findings: Most milestones were attained at a very early age, and average progression through adjacent drinking events was relatively swift, Movement through early drinking milestones was accelerated in girls and white youth. Youth who reported their first drink at an early age (age 10 or younger) showed slower progression, suggesting the existence of distinct processes underlying early use and drinking transitions within an individual.

Conclusions: This study provides data relevant to understanding drinking progression/natural history in a large clinical sample, especially for differences by gender and ethnicity. The findings have implications for the identification of intermediate stages that might benefit from selected intervention programs.

Keywords: adolescent; drinking initiation; milestones; onset of alcohol use; progression; treatment.

Figure 1

Hazard functions (top panel) and survival functions (bottom panel) for age at which respondents reached each of the five milestones. The x-axis represents age in years. The dashed line corresponds to the timepoint at which the survivor function is .50 (the median).

Figure 2

Milestone attainment by gender (top left panel; N=149 for girls, shown in gray; N=345 for boys, shown in black), age of first drink (bottom left panel; N=184 for early onset at age 10 or less, shown in light gray; N=228 for mid onset at age 11–13; shown in medium-gray; N=82 for later onset at age 14+, shown in black), and race (top right panel; N=303 for Whites, shown in light gray; N=94 for Hispanics, shown in medium-gray; N=76 for Blacks, shown in black). Values are adjusted means that control for age at interview and (when applicable) gender and age of first drink.