Certain early drinking experiences in teens and young adults may predict more rapid development of alcohol use disorder

Teens and young adults who experience social problems related to alcohol may be at risk of relatively rapid development of alcohol use disorder (AUD), a new study suggests. Other behaviors that meet certain diagnostic criteria may also warn of the potential for an accelerated transition from a first drink to the disorder. The Diagnostic and Statistical Manual (DSM-5), a clinical guide to psychiatric disorders, outlines 11 criteria for AUD. Anyone meeting two or more of the criteria qualifies for an AUD diagnosis.

Emerging adulthood is a critical period for the development of AUD, and understanding the transition from early drinking through increasing consumption can help identify targets for prevention and intervention. Research on the emergence of AUD criteria and their relationship to AUD onset is relatively slight and does not provide much insight into the experiences of today's youth. For a new study in Alcohol: Clinical & Experimental Research, investigators examined AUD criteria that emerged among young drinkers and explored how those related to the development of full-blown AUD.

The investigators worked with 565 young adults in Australia. The participants were aged 18–21 when the study began and reported regular drinking or semi-regular binge drinking. They were assessed five times over 2.5 years via phone interviews with clinical psychologists. Initially, they were asked at what age they had their first full drink. At each interview, they reported on their drinking and were assessed for AUD diagnostic criteria. The researchers used statistical analysis to explore alcohol use patterns linked to the emergence of AUD.

The average age at which participants had their first full drink was 15. More than half of the participants—55%—developed at least one AUD criterion over the 2.5-year study period. The median time from a first drink to the emergence of a first AUD criterion was six years. The most common AUD criteria to emerge were alcohol tolerance (28%), followed by continued drinking despite problems with alcohol (22%), and social problems related to drinking (17%). The criteria that most commonly emerged first were alcohol tolerance and social problems linked to drinking.

Over the 2.5 years, 26% of participants developed AUD. Thirteen percent developed AUD within three years of their first drink. The median time from the first criterion to an AUD diagnosis was four years. The likelihood of developing AUD was linked to which criterion emerged first. Of those who experienced social problems relating to alcohol as their first criterion, 85% developed AUD over the study period. Among those who first developed alcohol tolerance, 37% developed AUD.

Three AUD criteria were risk factors for faster transitions to AUD: alcohol-related social problems; alcohol use resulting in a failure to fulfill major obligations at work, school, or home ("major role problems"); and drinking for longer or in larger amounts than intended.

The strong link between alcohol-related social problems and the development of AUD adds to accumulating evidence that interpersonal difficulties may be a critical risk factor. Drinking might be a maladaptive response to social and interpersonal problems. Alcohol use could lead to further relationship challenges that in turn reinforce drinking as a coping method.

A similar cycle might apply to major role problems (e.g., declining performance at work or school) and alcohol use. Drinking more or for longer than planned suggests difficulties with self-regulation. This criterion might signal a shift from impulsive to compulsive alcohol use or a risk of binge drinking.

These findings have valuable implications for understanding the development of AUD among teens and young adults and could inform early intervention programs. For example, addressing social issues and self-control problems among young people may prevent or slow down the development of AUD. Additional research is needed involving larger samples.