Relationship of Age of First Drink to Child Behavioral Problems and Family Psychopathology

Altered brain cortical maturation is found in adolescents with a family history of alcoholism

Substance-naïve offspring from high-density alcohol use disorder (AUD) families exhibit altered subcortical brain volumes structurally and altered executive-functioning and emotion-processing functionally, compared with their peers. However, there is a dearth of literature exploring alterations of cortical thickness (CTh) in this population. T1-weighted structural brain MRI was acquired in 75 substance-naïve male offspring of treatment-seeking early onset (<25 years) AUD patients with high familial loading of AUDs (≥2 affected relatives) (FHP) and 65 age-matched substance-naïve male controls with negative family history from the community. Surface-based CTh reconstruction was done using FreeSurfer. Univariate general linear models were implemented at each vertex using SurfStat, controlling for age (linear and quadratic effects), and head size, to examine the main effect of familial AUD risk on CTh and its relationship with externalizing symptom score (ESS). A Johnson-Neyman procedure revealed that the main effect of familial AUD risk on CTh was seen during adolescence, where the FHP group had thicker cortices involving bilateral precentral gyri, left caudal middle frontal gyrus (MFG), bilateral temporo-parietal junction, left inferior-frontal gyrus and right inferior-temporal gyrus. Thicker cortices in left MFG and inferior-parietal lobule were also associated with greater ESS within both groups. More importantly, these group differences diminished with age by young adulthood. Familial AUD risk is associated with age-related differences in maturation of several higher order association cortices that are critical to ongoing development in executive function, emotion regulation and social cognition during adolescence. Early supportive intervention for a delay in alcohol initiation during this critical phase may be crucial for this at-risk population.

Machine-learning prediction of adolescent alcohol use: a cross-study, cross-cultural validation

BACKGROUND AND AIMS

The experience of alcohol use among adolescents is complex, with international differences in age of purchase and individual differences in consumption and consequences. This latter underlines the importance of prediction modeling of adolescent alcohol use. The current study (a) compared the performance of seven machine-learning algorithms to predict different levels of alcohol use in mid-adolescence and (b) used a cross-cultural cross-study scheme in the training-validation-test process to display the predictive power of the best performing machine-learning algorithm.

DESIGN

A comparison of seven machine-learning algorithms: logistic regression, support vector machines, random forest, neural network, lasso regression, ridge regression and elastic-net.

SETTING

Canada and Australia.

PARTICIPANTS

The Canadian sample is part of a 4-year follow-up (2012-16) of the Co-Venture cohort (n = 3826, baseline age 12.8 ± 0.4, 49.2% girls). The Australian sample is part of a 3-year follow-up (2012-15) of the Climate Schools and Preventure (CAP) cohort (n = 2190, baseline age 13.3 ± 0.3, 43.7% girls).

MEASUREMENTS

The algorithms used several prediction indices, such as F₁ prediction score, accuracy, precision, recall, negative predictive value and area under the curve (AUC).

FINDINGS

Based on prediction indices, the elastic-net machine-learning algorithm showed the best predictive performance in both Canadian (AUC = 0.869 ± 0.066) and Australian (AUC = 0.855 ± 0.072) samples. Domain contribution analysis showed that the highest prediction accuracy indices yielded from models with only psychopathology (AUC = 0.816 ± 0.044/0.790 ± 0.071 in Canada/Australia) and only personality clusters (AUC = 0.776 ± 0.063/0.796 ± 0.066 in Canada/Australia). Similarly, regardless of the level of alcohol use, in both samples, externalizing psychopathologies, alcohol use at baseline and the sensation-seeking personality profile contributed to the prediction.

CONCLUSIONS

Computerized screening software shows promise in predicting the risk of alcohol use among adolescents.

Exploring associations between early substance use and longitudinal socio-occupational functioning in young people engaged in a mental health service

Neuropsychiatric disorders (including substance misuse) are associated with the greatest burden of functional disability in young people, and contributory factors remain poorly understood. Early-onset substance use is one candidate risk factor which may inform functional prognosis and facilitate direction of interventions aiming to curtail impairment. Accordingly, we modelled associations between early-onset use of alcohol, tobacco, cannabis and amphetamine-type stimulants (ATSs) and longitudinal socio-occupational functioning (indexed by the Social and Occupational Functioning Assessment Scale) in an observational cohort presenting to early intervention mental health services. A clinical proforma collated demographic, clinical, and socio-occupational information for up to 60-months from presentation to services in young people aged 17-30. Of the wider cohort (n = 2398), 446 participants were selected with complete alcohol and substance use data. Latent class analysis was used to derive an 'early-onset' (n = 243) and 'later-onset' class (n = 203) based on age of first use of alcohol, tobacco, cannabis and ATSs. Maximum-likelihood multilevel analyses modelled functioning over time in care and tested associations with substance use latent class, age, gender and diagnosis. Membership in the 'early-onset' class (B = -1.64, p = 0.05), male gender (B = -3.27, p<0.001) and psychotic disorder diagnosis (B = -7.62, p<0.001) were associated with poorer functioning at presentation and at least one other time-point. To our knowledge, this is the first study to explore associations of early-onset substance use and longitudinal functioning in a cohort of young people with mental disorders. The identified factors may be useful for directing specific social (e.g. Social Recovery Therapy) or occupational (e.g. Individual Placement and Support) interventions to at-risk individuals, early in illness course.

Age at drinking onset, age at first intoxication, and delay to first intoxication: Assessing the concurrent validity of measures of drinking initiation with alcohol use and related problems

INTRODUCTION

Drinking at an early age (AO) and quickly progressing to drinking to intoxication (Delay=Age of Intoxication[AI]-AO) confer risk for alcohol use and alcohol-related problems. However, inconsistencies exist in the literature, which may reflect the use of different definitions of AO and AI. We evaluated whether 1) defining AO as age at first sip of alcohol (AO sip) versus age at which at least one standard drink was consumed (AO drink); and 2) defining AI as age at first "drunk" (AI drunk) versus age at first binge episode (≥5 standard drinks consumed; AI binge) resulted in different self-reported ages or differentially predicted drinking outcomes.

METHODS

248 high school students (53.6% male; 16.50[1.19] years; 71.4% White) completed anonymous surveys assessing alcohol use.

RESULTS

Participants reported a younger AO (sip) than AO (drink) and a younger AI (drunk) than AI (binge), resulting in significantly different Delay values for the four AO-AI pairings. Univariate general linear models indicated that AO-Delay pairings accounted for more variance in maximum drinks and alcohol-related problems than did the individual AO and AI variables. Pairings comprising AO (drink) and Delay (drink-binge) and AO (sip) and Delay (sip-binge), respectively, uniquely accounted for variance in both maximum drinks and problems.

CONCLUSIONS

Clearly defining AO and AI using objective definitions that reflect specific amounts of alcohol (e.g., first sip; first standard drink; first binge) appears to outperform subjective definitions of alcohol use (e.g., first drunk).

Associations of parental alcohol use disorders and parental separation with offspring initiation of alcohol, cigarette and cannabis use and sexual debut in high-risk families

BACKGROUND AND AIMS

Parental alcohol use disorders (AUDs) and parental separation are associated with increased risk for early use of alcohol in offspring, but whether they increase risks for early use of other substances and for early sexual debut is under-studied. We focused on associations of parental AUDs and parental separation with substance initiation and sexual debut to (1) test the strength of the associations of parental AUDs and parental separation with time to initiation (age in years) of alcohol, tobacco and cannabis use and sexual debut and (2) compare the strength of association of parental AUD and parental separation with initiation.

DESIGN

Prospective adolescent and young adult cohort of a high-risk family study, the Collaborative Study on the Genetics of Alcoholism (COGA).

SETTING

Six sites in the United States.

PARTICIPANTS

A total of 3257 offspring (aged 14-33 years) first assessed in 2004 and sought for interview approximately every 2 years thereafter; 1945 (59.7%) offspring had a parent with an AUD.

MEASUREMENTS

Diagnostic interview data on offspring substance use and sexual debut were based on first report of these experiences. Parental life-time AUD was based on their own self-report when parents were interviewed (1991-2005) for most parents, or on offspring and other family member reports for parents who were not interviewed. Parental separation was based on offspring reports of not living with both biological parents most of the time between ages 12 and 17 years.

FINDINGS

Parental AUDs were associated with increased hazards for all outcomes, with cumulative hazards ranging from 1.19 to 2.71. Parental separation was also an independent and consistent predictor of early substance use and sexual debut, with hazards ranging from 1.19 to 2.34. The strength of association of parental separation with substance initiation was equal to that of having two AUD-affected parents, and its association with sexual debut was stronger than the association of parental AUD in one or both parents.

CONCLUSIONS

Parental alcohol use disorders (AUDs) and parental separation are independent and consistent predictors of increased risk for early alcohol, tobacco and cannabis use and sexual debut in offspring from families with a high risk of parental AUDs.

A GABRA2 polymorphism improves a model for prediction of drinking initiation

BACKGROUND

Survival analysis was used to explore the addition of a single nucleotide polymorphism (SNP) and covariates (sex, interview age, and ancestry) on a previously published model's ability to predict onset of drinking. A SNP variant of rs279871, in the chromosome 4 gene encoding gamma-aminobutyric acid receptor (GABRA2), was selected due to its associations with alcoholism in young adults and with behaviors that increased risk for early drinking.

METHODS

A subsample of 674 adolescents (ages 14-17) participating in the Collaborative Study on the Genetics of Alcoholism (COGA) was examined using a previously derived Cox proportional hazards model containing: 1) number of non-drinking related conduct disorder (CD) symptoms, 2) membership in a high-risk alcohol-dependent (AD) family, 3) most best friends drank (MBFD), 4) Achenbach Youth Self Report (YSR) externalizing score, and 5) YSR social problems score. The above covariates along with the SNP variant of GABRA2, rs279871, were added to this model. Five new prototype models were examined. The most parsimonious model was chosen based on likelihood ratio tests and model fit statistics.

RESULTS

The final model contained four of the five original predictors (YSR social problems score was no longer significant and hence dropped from subsequent models), the three covariates, and a recessive GABRA2 rs279871 TT genotype (two copies of the high-risk allele containing thymine). The model indicated that adolescents with the high-risk TT genotype were more likely to begin drinking than those without this genotype.

CONCLUSIONS

The joint effect of the gene (rs279871 TT genotype) and environment (MBFD) on adolescent alcohol initiation is additive, but not interactive, after controlling for behavior problems (CD and YSR externalizing score). This suggests that the impact of the high-risk TT genotype on the onset of drinking is affected by controlling for peer drinking and does not include genotype-by-environment interactions.

Disrupted resting brain graph measures in individuals at high risk for alcoholism

Familial susceptibility to alcoholism is likely to be linked to the externalizing diathesis seen in high-risk offspring from high-density alcohol use disorder (AUD) families. The present study aimed at comparing resting brain functional connectivity and their association with externalizing symptoms and alcoholism familial density in 40 substance-naive high-risk (HR) male offspring from high-density AUD families and 30 matched healthy low-risk (LR) males without a family history of substance dependence using graph theory-based network analysis. The HR subjects from high-density AUD families compared with LR, showed significantly reduced clustering, small-worldness, and local network efficiency. The frontoparietal, cingulo-opercular, sensorimotor and cerebellar networks exhibited significantly reduced functional segregation. These disruptions exhibited independent incremental value in predicting the externalizing symptoms over and above the demographic variables. The reduction of functional segregation in HR subjects was significant across both the younger and older age groups and was proportional to the family loading of AUDs. Detection and estimation of these developmentally relevant disruptions in small-world architecture at critical brain regions sub-serving cognitive, affective, and sensorimotor processes are vital for understanding the familial risk for early onset alcoholism as well as for understanding the pathophysiological mechanism of externalizing behaviors.

Parental divorce and initiation of alcohol use in early adolescence

Parental divorce/separation is among the most commonly endorsed adverse childhood events. It has been shown to increase subsequent risk of alcohol dependence and problems across adolescence and early adulthood, but its influence on early stages of alcohol involvement has only recently been explored. In the present study, we examined whether time to first full drink was accelerated among youth who experienced parental divorce/separation. To determine specificity of risk, models controlled for perceived stress as well as family history of alcoholism, current parental drinking, and internalizing and externalizing problems. Developmental specificity in terms of timing of both parental divorce and first drink was also examined. Participants were 931 middle-school students (488 girls, 443 boys) who were enrolled in a prospective study on drinking initiation and progression (52% female; 23% non-White, 11% Hispanic). Students indicated whether and at what age they had consumed a full drink of alcohol. Parental divorce/separation was coded from a parent-reported life-events inventory and was grouped based on age experienced (ages 0-5, ages 6-9, age 10+). Cox proportional hazard models showed increased risk for onset of drinking as a function of divorce/separation, even controlling for stress, parental alcohol involvement, and psychopathology. There was no evidence for developmental specificity of the divorce/separation effect based on when it occurred nor in timing of first drink. However, the effect of parental divorce/separation on initiation was magnified at higher levels of parental drinking. Given the rates of parental divorce/separation and its association with increased risk of early drinking, investigation of the mechanisms underlying this link is clearly warranted. (PsycINFO Database Record

Comparison of Parent, Peer, Psychiatric, and Cannabis Use Influences Across Stages of Offspring Alcohol Involvement: Evidence from the COGA Prospective Study

BACKGROUND

All stages of development of alcohol use disorder (AUD) have not been equally studied. While initiation of drinking has been given considerable attention, other stages have not been as thoroughly investigated. It is not clear whether the same factors are associated consistently across early and late transitions in AUD involvement. High-risk family samples that are enriched for AUD vulnerability and transitions in AUD development offer an opportunity to examine influences across multiple stages of AUD development.

METHODS

Data from adolescents and young adults from high-risk families were used to study 4 transitions in AUD development-time to first drink, first drink to first problem, first drink to first diagnosis, and first problem to first diagnosis. Cox modeling was used to compare associations of parental AUD, parental separation, peer substance use, offspring ever-use of cannabis, trauma exposures, and internalizing and externalizing psychopathology across transitions.

RESULTS

Hazards of most transitions were elevated for those who had ever used cannabis, those who attributed substance use to their peers, those with externalizing disorders, and those with parents with AUD. Many risk factors were linked to early initiation of alcohol, particularly cannabis use. Internalizing disorders were associated with later stages. Nonassaultive trauma was associated only with early initiation; assaultive trauma was not associated with any transition.

CONCLUSIONS

In this large, ethnically diverse sample of high-risk youth, significant influences across transitions were fairly consistent, with externalizing disorders and cannabis ever-use elevating the likelihood of each stage, and peer and parental (and especially maternal AUD) influences linked to initiation and some later stages. Finally, in light of the increasingly permissive legal and social stances toward cannabis in the United States, the marked elevations of all alcohol outcomes observed for cannabis use underscore the importance of studying the underpinnings of this relationship.

Childhood Maltreatment and Development of Substance Use Disorders: A Review and a Model of Cognitive Pathways

Exposure to childhood maltreatment (CM) is associated with increased risk for developing substance use disorders (SUDs). CM exerts negative effects on cognitive abilities including intellectual performance, memory, attention, and executive function. Parallel cognitive impairments have been observed in SUDs. Hence, limited studies have examined the mediating effect of cognitive impairments in the relationship between CM and SUDs. In addition, most studies used concurrent self-report assessments in adult populations. Longitudinal studies that investigated the long-term consequences of CM on psychopathology, including SUDs, throughout childhood, adolescence, and adulthood are rare. Thus, the underlying developmental pathways between CM and SUDs are not clearly understood. In this article, we review the evidence that cognitive impairments mediate, at least in part, the relationship between CM and development of SUDs and propose a model that explains how CM increases the risk for SUDs through the development of a cognitive framework of vulnerability.

Pharmacotherapy for Alcohol Dependence: The 2015 Recommendations of the French Alcohol Society, Issued in Partnership with the European Federation of Addiction Societies

BACKGROUND

The latest French good practice recommendations (GPRs) for the screening, prevention, and treatment of alcohol misuse were recently published in partnership with the European Federation of Addiction Societies (EUFAS). This article aims to synthesize the GPRs focused on the pharmacotherapy of alcohol dependence.

METHODS

A four-member European steering committee defined the questions that were addressed to an 18-member multiprofessional working group (WG). The WG developed the GPRs based on a systematic, hierarchical, and structured literature search and submitted the document to two review processes involving 37 French members from multiple disciplines and 5 non-French EUFAS members. The final GPRs were graded A, B, or C, or expert consensus (EC) using a reference recommendation grading system.

RESULTS

The treatment of alcohol dependence consists of either alcohol detoxification or abstinence maintenance programs or drinking reduction programs. The therapeutic objective is the result of a decision made jointly by the physician and the patient. For alcohol detoxification, benzodiazepines (BZDs) are recommended in first-line (grade A). BZD dosing should be guided by regular clinical monitoring (grade B). Residential detoxification is more appropriate for patients with a history of seizures, delirium tremens, unstable psychiatric comorbidity, or another associated substance use disorder (grade B). BZDs are only justified beyond a 1-week period in the case of persistent withdrawal symptoms, withdrawal events or associated BZD dependence (grade B). BZDs should not be continued for more than 4 weeks (grade C). The dosing and duration of thiamine (vitamin B1) during detoxification should be adapted to nutritional status (EC). For relapse prevention, acamprosate and naltrexone are recommended as first-line medications (grade A). Disulfiram can be proposed as second-line option in patients with sufficient information and supervision (EC). For reducing alcohol consumption, nalmefene is indicated in first line (grade A). The second-line prescription of baclofen, up to 300 mg/day, to prevent relapse or reduce drinking should be carried out according to the "temporary recommendation for use" measure issued by the French Health Agency (EC). During pregnancy, abstinence is recommended (EC). If alcohol detoxification is conducted during pregnancy, BZD use is recommended (grade B). No medication other than those for alcohol detoxification should be initiated in pregnant or breastfeeding women (EC). In a stabilized pregnant patient taking medication to support abstinence, the continuation of the drug should be considered on a case-by-case basis, weighing the benefit/risk ratio. Only disulfiram should be always stopped, given the unknown risks of the antabuse effect on the fetus (EC). First-line treatments to help maintain abstinence or reduce drinking are off-label for people under 18 years of age and should thus be considered on a case-by-case basis after the repeated failure of psychosocial measures alone (EC). Short half-life BZDs should be preferred for the detoxification of elderly patients (grade B). The initial doses of BZDs should be reduced by 30 to 50% in elderly patients (EC). In patients with chronic alcohol-related physical disorders, abstinence is recommended (EC). Any antidepressant or anxiolytic medication should be introduced after a psychiatric reassessment after 2-4 weeks of alcohol abstinence or low-risk use (grade B). A smoking cessation program should be offered to any smokers involved in an alcohol treatment program (grade B).

Predictors of subgroups based on maximum drinks per occasion over six years for 833 adolescents and young adults in COGA

OBJECTIVE

A person's pattern of heavier drinking often changes over time, especially during the early drinking years, and reflects complex relationships among a wide range of characteristics. Optimal understanding of the predictors of drinking during times of change might come from studies of trajectories of alcohol intake rather than cross-sectional evaluations.

METHOD

The patterns of maximum drinks per occasion were evaluated every 2 years between the average ages of 18 and 24 years for 833 subjects from the Collaborative Study on the Genetics of Alcoholism. Latent class growth analysis identified latent classes for the trajectories of maximum drinks, and then logistic regression analyses highlighted variables that best predicted class membership.

RESULTS

Four latent classes were found, including Class 1 (69%), with about 5 maximum drinks per occasion across time; Class 2 (15%), with about 9 drinks at baseline that increased to 18 across time; Class 3 (10%), who began with a maximum of 18 drinks per occasion but decreased to 9 over time; and Class 4 (6%), with a maximum of about 22 drinks across time. The most consistent predictors of higher drinking classes were female sex, a low baseline level of response to alcohol, externalizing characteristics, prior alcohol and tobacco use, and heavier drinking peers.

CONCLUSIONS

Four trajectory classes were observed and were best predicted by a combination of items that reflected demography, substance use, level of response and externalizing phenotypes, and baseline environment and attitudes.

Predicting an Alcohol Use Disorder in Urban American Indian Youth

This study examines predictors of alcohol use disorders (AUDs) among an urban American Indian cohort who were followed from approximately age 11 to age 20. Approximately 27% of the sample had a lifetime diagnosis of alcohol abuse or dependence. The results indicated that externalizing, but not internalizing, behaviors, family conflict, and school liking served as significant predictors of an AUD. Neither having an alcoholic mother nor an alcoholic father was found to be significantly predictive of an alcohol use disorder at ages 19-20. Finally, early alcohol initiation is a substantial predictor of an AUD and acts as a partial mediator.

Why is adolescence a key period of alcohol initiation and who is prone to develop long-term problem use?: A review of current available data

BACKGROUND

Early adolescence is a key developmental period for the initiation of alcohol use, and consumption among adolescents is characterized by drinking in high quantities. At the same time, adolescence is characterized by rapid biological transformations including dramatic changes in the brain, particularly in the prefrontal cortex and the mesocorticolimbic dopamine system.

METHODS

This article begins with an overview of the unique neural and behavioural characteristics of adolescent development that predispose these individuals to seek rewards and take risks such as initiation of drinking and high levels of alcohol intake. The authors then outline important factors associated with an increased risk for developing alcohol problems in later adolescence and young adulthood. Thereafter they address causality and the complex interplay of risk factors that lead to the development of alcohol use problems in late adolescence and young adults.

CONCLUSIONS

A few recommendations for the prevention of underage drinking are presented.

Experiences of pediatric emergency physicians in providing alcohol-related care to adolescents in the emergency department

OBJECTIVE

The emergency department (ED) is a key clinical care setting for identifying and managing patients with alcohol-related presentations. We explored the experiences of emergency physicians in providing alcohol-related care to adolescents.

METHODS

Purposeful sampling was used to identify pediatric emergency physicians with at least 1 year of experience (n = 12) from pediatric EDs across Canada. Data were collected via telephone using a semistructured interview guide. Hermeneutic phenomenology was used to identify common and unique experiences among respondents, using Moustakas' immersion/crystallization procedures.

RESULTS

Physicians expressed frustration with patient behaviors accompanying intoxication and described providing care as a struggle; developing an effective therapeutic alliance was challenging. Physicians believed intoxicated adolescent patients required more clinical time and resources than they could offer. Although physicians described the ED as unsuitable for ensuring continuity of care and addressing the broader social issues that accompany alcohol use, they did view the ED as a place to medically stabilize the patient and initiate a discussion on alcohol use and its harmful effects.

CONCLUSIONS

Pediatric ED physicians struggled during the caring experience and were skeptical that broader, more chronic social issues that are often associated with adolescent alcohol misuse can be effectively managed in a clinical setting where they feel primarily responsible for providing medical stabilization. Physicians did believe the ED was an appropriate place to ensure medical stability of a patient and then initiate a conversation regarding alcohol use and its harmful effects.

Economic hardship and adolescent problem drinking: family processes as mediating influences

Alcohol is the most commonly used substance among adolescents in the United States, and adolescent drinking is associated with various health risk behaviors. Given the prevalence and consequences of adolescent drinking, understanding family factors that contribute to adolescent drinking is an important area for research. This study used three waves of data to evaluate a family stress model in which economic hardship is indirectly related to adolescent problem drinking through maternal psychological distress, parenting behaviors, and adolescent externalizing behaviors. Respondents included 300 mothers (71 % Black, 29 % White) and adolescents (51 % male) who were interviewed when adolescents were ages 10, 14, and 16. Structural equation modeling was used to test the hypothesized model and findings supported our hypothesized model. Economic hardship was positively related to maternal psychological distress. Maternal psychological distress was negatively associated with supportive parenting, which in turn was negatively associated with externalizing problems. Externalizing problems were positively associated with problem drinking. In support of our hypothesis regarding indirect effects, economic hardship was indirectly related to problem drinking through maternal psychological distress, parenting behaviors, and adolescent externalizing problems. The findings from this study highlight the role of family processes in adolescent problem drinking.

Gender differences in reactivity to alcohol cues in binge drinkers: a preliminary assessment of event-related potentials

Binge drinking is associated with functional brain abnormalities similar to those observed in alcoholics and can be viewed as a first step towards alcohol dependence. Adult men are twice as likely as women to develop alcoholism. This study investigates (1) the presence of alcohol cue reactivity in bingers, a feature that has been proposed to underlie the emergence of alcohol dependence; and (2) a possible higher alcohol cue reactivity in men binge drinkers which could explain their higher risk for alcohol use disorders in adulthood.The P3 component of the event-related potentials (ERPs) was recorded during a visual oddball task in which controls (n=27: 10 men and 17 women) and binge drinkers (n=29: 15 men and 14 women) had to detect infrequent deviant stimuli (related to alcohol or not) among frequent neutral stimuli. Results showed that binge drinkers, compared to light drinkers, displayed increased P3 reactivity to alcohol related cues with a greater effect among men. Our results suggest the phenomenon of alcohol cue reactivity to be a possible avenue by which a higher risk population, binge drinkers, and men in particular, are prone to develop problematic alcohol use.

Predicting early initiation of alcohol use: a prospective study of Australian children

This study explores the social, contextual and individual factors that predict early initiation of alcohol use. A state-wide representative sample of 927 fifth-grade students, in Victoria, Australia were surveyed. Students were resurveyed in the sixth and seventh grade. Risk and protective factors were measured with a modified version of the Communities That Care youth survey. Alcohol use was measured to assess transition from alcohol nonuse to use. Social contexts perceived to provide easier access to alcohol and drugs were found to be the clearest predictors of early onset alcohol use. The limitations and implications of these findings are discussed.

A model to determine the likely age of an adolescent's first drink of alcohol

OBJECTIVE

With the use of a new cohort of adolescent subjects, predictors from the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA) interview and the Achenbach Youth Self Report (YSR) were combined to model age of first drink (AFD).

METHODS

Subjects consisted of 820 adolescents (ages 14-17) drawn from the current phase of the Collaborative Study on the Genetics of Alcoholism. Three Cox proportional hazards models were considered. Model 1 contained SSAGA variables equivalent to AFD predictors from our previous study: interview age, family history of alcohol dependence, and number of conduct disorder symptoms. Model 2 incorporated 2 additional SSAGA questions (best friends drink and smoked a cigarette before a reported AFD) plus 8 YSR-derived scale scores. Model 3 was a reduced version of model 2, retaining only significant predictors.

RESULTS

Model 2 was a significant improvement over model 1. Model 3 was the best and the most parsimonious of the 3 with respect to likelihood ratio and Wald χ(2) tests and retained only 5 variables from model 2. Included variables were the following: (1) best friends drink, (2) membership in a high-risk alcohol dependence family, (3) number of conduct disorder symptoms, (4) YSR externalizing score, and (5) YSR social problems score.

CONCLUSIONS

Adding variables to those from our original study improved our ability to model the likely age of alcohol initiation. In addition to the SSAGA, the YSR appears to have utility as a research tool to predict the age of alcohol initiation.

Neurobehavioral disinhibition predicts initiation of substance use in children with prenatal cocaine exposure

BACKGROUND

In previous work we (Fisher et al., 2011) examined the emergence of neurobehavioral disinhibition (ND) in adolescents with prenatal substance exposure. We computed ND factor scores at three age points (8/9, 11 and 13/14 years) and found that both prenatal substance exposure and early adversity predicted ND. The purpose of the current study was to determine the association between these ND scores and initiation of substance use between ages 8 and 16 in this cohort as early initiation of substance use has been related to later substance use disorders. Our hypothesis was that prenatal cocaine exposure predisposes the child to ND, which, in turn, is associated with initiation of substance use by age 16.

METHODS

We studied 386 cocaine exposed and 517 unexposed children followed since birth in a longitudinal study. Five dichotomous variables were computed based on the subject's report of substance use: alcohol only; tobacco only; marijuana only; illicit substances and any substance.

RESULTS

Cox proportional hazard regression showed that the 8/9 year ND score was related to initiation of alcohol, tobacco, illicit and any substance use but not marijuana use. The trajectory of ND across the three age periods was related to substance use initiation in all five substance use categories. Prenatal cocaine exposure, although initially related to tobacco, marijuana and illicit substance initiation, was no longer significant with ND scores in the models.

CONCLUSION

Prenatal drug exposure appears to be a risk pathway to ND, which by 8/9 years portends substance use initiation.

Early life adversity reduces stress reactivity and enhances impulsive behavior: implications for health behaviors

Altered reactivity to stress, either in the direction of exaggerated reactivity or diminished reactivity, may signal a dysregulation of systems intended to maintain homeostasis and a state of good health. Evidence has accumulated that diminished reactivity to psychosocial stress may signal poor health outcomes. One source of diminished cortisol and autonomic reactivity is the experience of adverse rearing during childhood and adolescence. The Oklahoma Family Health Patterns Project has examined a cohort of 426 healthy young adults with and without a family history of alcoholism. Regardless of family history, persons who had experienced high degrees of adversity prior to age 16 had a constellation of changes including reduced cortisol and heart rate reactivity, diminished cognitive capacity, and unstable regulation of affect, leading to behavioral impulsivity and antisocial tendencies. We present a model whereby this constellation of physiological, cognitive, and affective tendencies is consistent with altered central dopaminergic activity leading to changes in brain function that may foster impulsive and risky behaviors. These in turn may promote greater use of alcohol other drugs along with adopting poor health behaviors. This model provides a pathway from early life adversity to low stress reactivity that forms a basis for risky behaviors and poor health outcomes.

Depression symptoms associated with cannabis dependence in an adolescent American Indian community sample

BACKGROUND

Depression and substance use disorders, including cannabis dependence, arise during adolescence, are frequently comorbid, and represent major health burdens in the general US population. Yet little is known about the association of depression symptoms with cannabis and other substance use and use disorders in Native American adolescents.

OBJECTIVE

To investigate the comorbidity of cannabis use and depression symptoms in Native American adolescents.

METHODS

This study used the Children's Semi-Structured Assessment for the Genetics of Alcoholism (Adolescent Version) to obtain lifetime DSM-III-R diagnoses from a community sample of 202 (98 boys, 104 girls) American Indian adolescents living on contiguous reservations.

RESULTS

Thirteen percent of boys and 38% of girls had a lifetime DSM-III-R major depression disorder (MDD) independent of substance use. Fifteen percent of boys and 41% of girls had a major depression episode (MDE) either coincident with or independent of cannabis use. MDE and several individual depression symptoms were significantly associated with cannabis dependence in boys but not in girls. The median ages of onset of MDE were the same in the boys and girls who had experienced both depression and cannabis use.

CONCLUSIONS

These findings suggest that the association of depression with cannabis dependence is more significant in boys than girls in this population of adolescents.

SCIENTIFIC SIGNIFICANCE

Understanding comorbidity between depression and cannabis use is important in order to disentangle the etiological relationship between the two and also for designing more effective treatment and prevention strategies, particularly in Native Americans who are at high risk for both disorders.

The effects of age at drinking onset and stressful life events on alcohol use in adulthood: a replication and extension using a population-based twin sample

BACKGROUND

A study by Dawson and colleagues (Alcohol Clin Exp Res 2007; 31:69) using data from National Epidemiologic Survey on Alcohol and Related Condition found earlier drinking onset age, and higher levels of past-year stressful life events (SLE) were associated with higher past-year alcohol consumption. The aims of our study were as follows: (i) to attempt to replicate this interaction; (ii) to extend it by examining sex and event dependence as potential moderators of the effect; and (iii) to estimate the roles of genetic and environmental factors in mediating the overlap of early drinking onset and SLE in their relations with alcohol consumption.

METHODS

Data were from 1,382 female and 2,218 male drinkers interviewed as part of the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. Regression models were used to evaluate the main and interactive effects of early drinking onset and moderate or severe past-year SLE on past-year drinking density (PYDD), a weighted quantity-frequency measure of alcohol consumption. Analyses adjusted for demographic covariates and were stratified by sex and whether SLE were independent or dependent on the person's actions, as rated by interviewers. Structural twin models were used to estimate the degree to which early drinking onset, SLE, and their interaction accounted for additive genetic, common environmental and individual-specific variance in PYDD.

RESULTS

We replicated the prior finding of a main effect of higher alcohol consumption among individuals reporting earlier drinking onset. Age at drinking onset accounted for about 5% of the variation in PYDD, and this association was mostly attributable to overlapping genetic influences. Evidence for an interaction between onset age and SLE was generally weak, possibly because of lower power and other methodological differences from Dawson and colleagues' study. However, there was some evidence consistent with an interaction of higher PYDD among early drinking men who experienced independent SLE and early drinking women with dependent SLE.

CONCLUSIONS

We confirmed prior findings of an association between early age at drinking onset with higher past-year drinking among young- and middle-aged adults and found limited evidence supporting a replication for higher stress-related drinking among early-onset drinkers. The association is consistent with early onset and stress-related drinking being attributable to overlapping genetic liability. Among early drinkers, our results suggest sex differences in consumption with regard to event dependence.

Neural activation during inhibition predicts initiation of substance use in adolescence

BACKGROUND

Problems inhibiting non-adaptive behaviors have been linked to an increased risk for substance use and other risk taking behaviors in adolescence. This study examines the hypothesis that abnormalities in neural activation during inhibition in early adolescence may predict subsequent substance involvement.

METHODS

Thirty eight adolescents from local area middle schools, ages 12-14, with very limited histories of substance use, underwent functional magnetic resonance imaging (fMRI) as they performed a go/no-go task of response inhibition and response selection. Adolescents and their parents were then followed annually with interviews covering substance use and other behaviors. Based on follow-up data, youth were classified as transitioning to heavy use of alcohol (TU; n=21), or as healthy controls (CON; n=17).

RESULTS

At baseline, prior to the onset of use, youth who later transitioned into heavy use of alcohol showed significantly less activation than those who went on to remain non to minimal users throughout adolescence. Activation reductions in TU at baseline were seen on no-go trials in 12 brain regions, including right inferior frontal gyrus, left dorsal and medial frontal areas, bilateral motor cortex, cingulate gyrus, left putamen, bilateral middle temporal gyri, and bilateral inferior parietal lobules (corrected p<.01, each cluster ≥32 contiguous voxels).

CONCLUSIONS

These results support the hypothesis that less neural activity during response inhibition demands predicts future involvement with problem behaviors such as alcohol and other substance use.

Reporting bias in the association between age at first alcohol use and heavy episodic drinking

BACKGROUND

Given the weight placed on retrospective reports of age at first drink in studies of later drinking-related outcomes, it is critical that its reliability be established and possible sources of systematic bias be identified. The overall aim of the current study is to explore the possibility that the estimated magnitude of association between early age at first drink and problem alcohol use may be inflated in studies using retrospectively reported age at alcohol use onset.

METHODS

The sample was comprised of 1,716 participants in the Missouri Adolescent Female Twin Study who reported an age at first drink in at least 2 waves of data collection (an average of 4 years apart). Difference in reported age at first drink at Time 2 versus Time 1 was categorized as 2 or more years younger, within 1 year (consistent), or 2 or more years older. The strength of the association between age at first drink and peak frequency of heavy episodic drinking (HED) at Time 1 was compared with that at Time 2. The association between reporting pattern and peak frequency of HED was also examined.

RESULTS

A strong association between age at first drink and HED was found for both reports, but it was significantly greater at Time 2. Just over one-third of participants had a 2 year or greater difference in reported age at first drink. The majority of inconsistent reporters gave an older age at Time 2 and individuals with this pattern of reporting engaged in HED less frequently than consistent reporters.

CONCLUSIONS

The low rate of HED in individuals reporting an older age at first drink at Time 2 suggests that the upward shift in reported age at first drink among early initiates is most pronounced for light drinkers. Heavy drinkers may therefore be overrepresented among early onset users in retrospective studies, leading to inflated estimates of the association between early age at initiation and alcohol misuse.

Subcortical volumes in long-term abstinent alcoholics: associations with psychiatric comorbidity

BACKGROUND

Research in chronic alcoholics on memory, decision-making, learning, stress, and reward circuitry has increasingly highlighted the importance of subcortical brain structures. In addition, epidemiological studies have established the pervasiveness of co-occurring psychiatric diagnoses in alcoholism. Subcortical structures have been implicated in externalizing pathology, including alcohol dependence, and in dysregulated stress and reward circuitry in anxiety and mood disorders and alcohol dependence. Most studies have focused on active or recently detoxified alcoholics, while subcortical structures in long-term abstinent alcoholics (LTAA) have remained relatively uninvestigated.

METHODS

Structural MRI was used to compare volumes of 8 subcortical structures (lateral ventricles, thalamus, caudate, putamen, pallidum, hippocampus, amygdala, and nucleus accumbens) in 24 female and 28 male LTAA (mean abstinence=6.3 years, mean age= 46.6 years) and 23 female and 25 male nonalcoholic controls (NAC) (mean age=45.6 years) to explore relations between subcortical brain volumes and alcohol use measures in LTAA and relations between subcortical volumes and psychiatric diagnoses and symptom counts in LTAA and NAC.

RESULTS

We found minimal differences between LTAA and NAC in subcortical volumes. However, in LTAA, but not NAC, volumes of targeted subcortical structures were smaller in individuals with versus without comorbid lifetime or current psychiatric diagnoses, independent of lifetime alcohol consumption.

CONCLUSIONS

Our finding of minimal differences in subcortical volumes between LTAA and NAC is consistent with LTAA never having had volume deficits in these regions. However, given that imaging studies have frequently reported smaller subcortical volumes in active and recently detoxified alcoholics compared to controls, our results are also consistent with the recovery of subcortical volumes with sustained abstinence. The finding of persistent smaller subcortical volumes in LTAA, but not NAC, with comorbid psychiatric diagnoses, suggests that the smaller volumes are a result of the combined effects of chronic alcohol dependence and psychiatric morbidity and suggests that a comorbid psychiatric disorder (even if not current) interferes with the recovery of subcortical volumes.

Psychopathology in offspring from families of alcohol dependent female probands: a prospective study

BACKGROUND

Despite the importance of understanding the long-term outcome for children of alcohol dependent (AD) women, the available literature is largely based on offspring of AD fathers and few have utilized prospective designs that include child, adolescent and young adult assessments. Multiplex AD families in which multiple cases of AD are present provide an ideal setting for understanding developmental variants of the adult phenotype.

METHOD

Offspring from multiplex AD families identified through the mother or control families were evaluated multiple times during childhood and followed to young adulthood. Familial risk status and the presence of specific child/adolescent disorders were used as predictors of substance use disorder outcome by young adulthood.

RESULTS

Offspring who were members of maternal multiplex families had elevated rates of child and young adulthood disorders. High risk offspring of alcohol dependent women were at increased risk for externalizing (Conduct Disorder and ADHD) and internalizing disorders (Major Depressive Disorder (MDD) and Anxiety Disorders). By young adulthood, offspring from these multiplex families had significantly greater odds of developing alcohol abuse or dependence (odds ratio [OR] = 3.63 [CI 1.36-9.64]) and drug abuse or dependence (OR = 4.23 [CI 1.73-10.32]). The prospective design of the study revealed that specific childhood disorders (Conduct Disorder, ADHD, MDD) increased the odds of subsequent development of substance use disorder (SUD).

CONCLUSIONS

Multiplex familial risk for alcohol dependence is a significant predictor of substance use disorders by young adulthood. Familial risk and an earlier childhood disorder may set the stage for later development of SUD.

Posttraumatic stress disorder and alcohol dependence in young women

OBJECTIVE

The aim of the current study is to characterize the relationship between posttraumatic stress disorder (PTSD) and alcohol dependence (AD) in women, distinguishing PTSD-specific influences on AD from the contribution of co-occurring psychiatric conditions and from the influences of trauma more generally.

METHOD

Trauma histories and DSM-IV lifetime diagnoses, including PTSD and AD, were obtained via telephone interview from 3,768 female twins. Based on PTSD status and trauma history, participants were categorized as no trauma (43.7%), trauma without PTSD (52.6%), or trauma with PTSD (3.7%). Cox proportional hazards regression analyses were conducted using trauma/PTSD status to predict AD, first adjusting only for ethnicity and parental problem drinking, then including conduct disorder, major depressive disorder, regular smoking, and cannabis abuse.

RESULTS

Before accounting for psychiatric covariates, elevated rates of AD were evident in both trauma-exposed groups, but those with PTSD were at significantly greater risk for AD than those without PTSD. This distinction was no longer statistically significant when psychiatric covariates were included in the model, but both trauma-exposed groups continued to show elevated odds of developing AD compared with the no trauma group.

CONCLUSIONS

The elevated rates of AD in women who have experienced trauma are not accounted for in full by psychiatric conditions that commonly co-occur with AD and trauma exposure. The greater likelihood of developing AD in the subset of trauma-exposed individuals who develop PTSD may reflect higher levels of distress and/ or higher rates of psychopathology associated with traumas that lead to PTSD rather than PTSD-specific influences.

Sex differences in striatal dopamine release in young adults after oral alcohol challenge: a positron emission tomography imaging study with [¹¹C]raclopride

BACKGROUND

We used a positron emission tomography paradigm with the D2/3 radiotracer [¹¹C]raclopride and an alcohol challenge to examine the magnitude of alcohol-induced dopamine release and compare it between young men and women.

METHODS

Twenty-one nonalcohol-dependent young social drinkers completed two positron emission tomography scans on separate days following ingestion of a juice mix containing either ethanol (.75 mg/kg body water) or trace ethanol only. The extent of dopamine released after alcohol was estimated by the percentage difference in [¹¹C]raclopride binding potential (ΔBP(ND)) between days.

RESULTS

Alcohol administration significantly displaced [¹¹C]raclopride in all striatal subregions, indicating dopamine release, with the largest effect observed in the ventral striatum. Linear mixed model analysis across all striatal subregions of regional ΔBP(ND) with region of interest as repeated measure showed a highly significant effect of sex (p < .001). Ventrostriatal dopamine release in men, but not in women, showed a significant positive correlation to alcohol-induced measures of subjective activation. Furthermore, we found a significant negative correlation between the frequency of maximum alcohol consumption per 24 hours and ventrostriatal ΔBP(ND) (r = .739, p = .009) in men.

CONCLUSIONS

This study provides definitive evidence that oral alcohol induces dopamine release in nonalcoholic human subjects and shows sex differences in the magnitude of this effect. The ability of alcohol to stimulate dopamine release may contribute to its rewarding effects and, thereby, to its abuse liability in humans. Our report further suggests several biological mechanisms that may mediate the difference in vulnerability for alcoholism between men and women.

Parenting and maternal substance addiction: factors affecting utilization of child protective services

The purpose of this study is to identify which personal, familial, environmental, and social factors are associated with the utilization of child protection services, including parental support programs, by mothers who misuse illicit substances. Participants are 56 mothers with substance use and addiction-related problems, of whom 32 were receiving, voluntarily or otherwise, child protection services while 24 mothers had psychotropic drug use-related problems but were receiving no psychosocial services. Data were collected in the province of Quebec, Canada, between August 1998 and August 1999 . Results indicate that mothers who receive services are younger, have fewer interpersonal resources, live in lower socioeconomic conditions, and have greater family dysfunction (less parental supervision and more inconsistent discipline) than mothers who do not receive services from child protection agencies. However, there are no significant differences between groups with regards to maternal childhood trauma, psychological distress, antisocial behavior and the quality of the parent-child bond. The results of this study suggest that although both groups misuse drugs and have personal difficulties, some mothers will not need support from social services to take care of their children. Implications of these findings for prevention are discussed. The study's limitations are noted.

Trauma, posttraumatic stress symptoms, and alcohol-use initiation in children

OBJECTIVE

This study examined initiation of alcohol use among adolescents, in relation to their earlier traumatic experiences and symptoms of posttraumatic stress disorder (PTSD).

METHOD

Data were from a longitudinal study of children of Puerto Rican background living in New York City's South Bronx and in San Juan, Puerto Rico. The subsample (n = 1,119; 51.7% male) of those who were 10-13 years old and alcohol naive at baseline was used in the analyses.

RESULTS

Alcohol-use initiation within 2 years after baseline was significantly more common among children reporting both trauma exposure and 5 or more of a maximum of 17 PTSD symptoms at baseline (adjusted odds ratio = 1.84, p < .05) than among those without trauma exposure, even when potentially shared correlates were controlled for. Children with trauma exposure but with fewer than five PTSD symptoms, however, did not differ significantly from those without trauma exposure, with regard to later alcohol use.

CONCLUSIONS

PTSD symptoms in children 10-13 years old may be associated with early onset of alcohol use. It is important to identify and treat PTSD-related symptoms in pre-adolescent children.

Prenatal and postnatal cocaine exposure predict teen cocaine use

Preclinical studies have identified alterations in cocaine and alcohol self-administration and behavioral responses to pharmacological challenges in adolescent offspring following prenatal exposure. To date, no published human studies have evaluated the relation between prenatal cocaine exposure and postnatal adolescent cocaine use. Human studies of prenatal cocaine-exposed children have also noted an increase in behaviors previously associated with substance use/abuse in teens and young adults, specifically childhood and teen externalizing behaviors, impulsivity, and attention problems. Despite these findings, human research has not addressed prior prenatal exposure as a potential predictor of teen drug use behavior. The purpose of this study was to evaluate the relations between prenatal cocaine exposure and teen cocaine use in a prospective longitudinal cohort (n=316) that permitted extensive control for child, parent and community risk factors. Logistic regression analyses and Structural Equation Modeling revealed that both prenatal exposure and postnatal parent/caregiver cocaine use were uniquely related to teen use of cocaine at age 14 years. Teen cocaine use was also directly predicted by teen community violence exposure and caregiver negativity, and was indirectly related to teen community drug exposure. These data provide further evidence of the importance of prenatal exposure, family and community factors in the intergenerational transmission of teen/young adult substance abuse/use.

Development and vulnerability factors in adolescent alcohol use

This article provides an overview of the characteristics of adolescent alcohol use, normative and subgroup variations in drinking behavior, and the important factors associated with an increased risk for developing alcohol problems in later adolescence and young adulthood. Parental or family histories of alcoholism, temperament traits, conduct problems, cognitive functioning, alcohol expectancies, and peer and other social relations are identified as factors influencing an adolescent's susceptibility for initiating a variety of alcohol use behaviors. The deviance prone model, proposed by Sher in 1991, is presented as an important tool for testing possible relationships among the various risk factors and their sequencing that leads to early adolescent alcohol use and drug initiation. It is also possible to extend the model to allow for an examination of the complex interplay of risk factors that lead to the development of alcohol use problems in late adolescence and young adults.

A new definition of early age at onset in alcohol dependence

OBJECTIVE

The accurate cut-off of an early onset of alcohol dependence is unknown. The objectives of this analysis are (1) to confirm that ages at onset variability in alcohol dependence is best described as a two subgroups entity, (2) to define the most appropriate cut-off, and (3) to test the relevancy of such distinction.

METHOD

Data were drawn the Epidemiologic Survey on Alcohol and Related Conditions (NESARC). This study focused on the 4782 adults with lifetime alcohol dependence.

RESULTS

The best-fit model distinguished two subgroups of age at onset of alcohol dependence, with a cut-off point at 22 years. Subjects with an earlier onset of alcohol dependence (< or = 22 years old) reported higher lifetime rates of specific phobia, antisocial behaviors and nearly all addictive disorders.

CONCLUSIONS

The early onset of alcohol dependence is best defined as beginning before the age of 22 years.

Predicting drinking onset with discrete-time survival analysis in offspring from the San Diego prospective study

Previous research has shown that an early onset of drinking is associated with a range of problematic drinking outcomes in adulthood. However, earlier drinking is also linked to additional characteristics that themselves predict alcohol problems including male gender, a family history (FH) of alcoholism, age, race, parental alcoholism, depression symptoms, prior drug use, and conduct problems. This study tested the relationship between the age of first drink (AFD) and a range of risk factors that predict the onset of alcohol use. Participants were offspring from the San Diego Prospective Study (SDPS) who were at least 15 years old at the time of their most recent interview (n=147). Discrete-time survival analysis (DTSA) was used to relate multiple characteristics to the hazard function of alcohol onset across a relevant age range. The results demonstrated the predicted relationships to AFD for conduct problems, male gender, prior marijuana use, and a FH of alcoholism, even when these characteristics were estimated together. Furthermore, an interaction occurred such that offspring with both conduct problems and marijuana use were at substantially higher risk for alcohol use onset during this time period than would be predicted from the effect of these two risk factors alone. However, age at interview, ethnicity, parent education, and depressive symptoms did not predict the pattern of onset of drinking. Implications for future research and prevention efforts are discussed.

Neural circuitry associated with risk for alcohol use disorders

The core features of risk for alcohol use disorders (AUD), including behavioral disinhibition, affective dysregulation, and executive dysfunction, map onto distinct neural circuits that have been found to be abnormal in the offspring of alcohol dependent individuals. Components of the cerebellothalamocortical system and the extended limbic network may provide the underpinnings for the behavioral and emotional dysfunction observed in individuals at heightened risk for AUD. In addition, abnormalities in these structures appear to be altered in individuals with the predisposition for other psychiatric conditions that may share a similar genetic diathesis. This review proposes several neurobehavioral mechanisms of genetic vulnerability that may account for phenotypic characteristics in individuals at risk for AUD.

Neural plasticity, human genetics, and risk for alcohol dependence

Opportunities for advances in the neurobiology of alcohol dependence have been facilitated by the development of sophisticated neurophysiological and neuroimaging techniques that allow us to have a window on developmental changes in brain structure and function. The search for genes that may increase susceptibility to alcohol dependence has been greatly facilitated by the recognition that intermediate phenotypes, sometimes referred to as endophenotypes, may be closer to the genetic variation than is the more complex alcohol dependence phenotype. This chapter will review the evidence that the brain is highly plastic, exhibiting major postnatal changes, especially during adolescence, in neural circuits that appear to influence addiction susceptibility. This chapter will suggest that heritable aspects of brain structure and function that are seen developmentally may be an important endophenotypic characteristic associated with familial risk for developing alcohol dependence. Finally, a review of studies showing associations between brain structural and functional characteristics and specific genes will be offered.

Impact of age at first drink on vulnerability to alcohol-related problems: testing the marker hypothesis in a prospective study of young adults

There is ample evidence that the early initiation of alcohol use is a risk factor for the development of later alcohol-related problems. The purpose of the current study was to examine whether this association can be explained by indicators of a common underlying susceptibility or whether age at drinking onset may be considered as an independent predictor of later drinking behavior, suggesting a potential causal relationship. Participants were drawn from a prospective cohort study of the long-term outcomes of early risk factors followed up from birth onwards. Structured interviews were administered to 304 participants to assess age at first drink and current drinking behavior. Data on risk factors, including early family adversity, parental alcohol use, childhood psychopathology and stressful life events, were repeatedly collected during childhood using standardized parent interviews. In addition, information on genotype was considered. Results confirmed previous work demonstrating that hazardous alcohol consumption is related to early-adolescent drinking onset. A younger age of first drink was significantly predicted by 5-HTTLPR genotype and the degree of preceding externalizing symptoms, and both factors were related to increased consumption or harmful alcohol use at age 19. However, even after controlling for these potential explanatory factors, earlier age at drinking onset remained a strong predictor of heavy alcohol consumption in young adulthood. The present longitudinal study adds to the current literature indicating that the early onset - adult hazardous drinking association cannot solely be attributed to shared genetic and psychopathologic risk factors as examined in this study.

Prevalence and patterns of alcohol consumption and health-risk behaviors among high school students in Thailand

BACKGROUND

Underage drinking is a significant social and public health problem in Thailand. We report the prevalence and patterns of alcohol consumption and associated health-risk behaviors using data from a 2007-2008 national school survey.

METHOD

A cross-sectional survey using a self-administered questionnaire was conducted among 50,033 high school and vocational college students from 201 schools in 40 provinces between December 2007 and February 2008.

RESULTS

The prevalence rates of past-year drinking, past-30-day binge drinking, and drinking until intoxication were 25.5, 9.5, and 17.3% in boys and 14.5, 3.7, and 7.2% in girls, respectively. Higher school levels, lower grades, living with someone other than their own parents, and having family members with substance or alcohol problems were significantly associated with all kinds of drinking. Binge drinkers were significantly more likely to have drinking consequences, e.g., driving after drinking, nausea and vomiting, and having a hangover than were nonbinge drinkers. The rates of other behavior and emotional problems were 2.5 to 6.7 times as likely in drinkers as nondrinkers, including smoking (35.1% vs. 4.9%), prescription drug misuse (17.7% vs. 6.7%), illicit substance use (17.8% vs. 2.4%), carrying a weapon (6.5% vs. 1.8%), feeling depressed (23.2% vs. 10.9%), suicidal attempt (10.5% vs. 3.8%), and sexual intercourse (30.5% vs. 5.7%).

CONCLUSION

Alcohol consumption is a serious problem among adolescents in Thailand and is strongly associated with various health-risk behaviors. Effective age- and gender-specific interventions should be implemented to discourage underage drinking and associated adverse health and social consequences.

The interaction between the dopamine transporter gene and age at onset in relation to tobacco and alcohol use among 19-year-olds

Recent evidence suggests that heterogeneity in the age at onset could explain the inconsistent findings of association studies relating the dopamine transporter (DAT1) gene with alcohol and nicotine consumption. The aim of this study was to examine interactions between two DAT1 polymorphisms and different initiation ages with regard to alcohol and tobacco consumption levels and dependence. Two hundred and ninety-one young adults (135 males, 156 females) participating in the Mannheim Study of Children at Risk were genotyped for the 40-bp variable number of tandem repeats (VNTR) and rs27072 polymorphisms of DAT1. Age at initiation was assessed at age 15 and 19 years. Information about current alcohol and tobacco consumption was obtained at age 19 years using self-report measures and structured interviews. Results suggest that age at onset of intensive consumption moderated the association of the DAT1 gene with early adult substance use and dependence, revealing a DAT1 effect only among individuals homozygous for the 10r allele of the 40-bp VNTR who had started daily smoking or being intoxicated early in life. Equally, carriers of the T allele of the rs27072 polymorphism reporting an early age at first intoxication showed higher current alcohol consumption at age 19 years. In contrast, no interaction between rs27072 and the age at first cigarette with regard to later smoking was observed. These findings provide evidence that the DAT1 gene interacts with an early heavy or regular drug exposure of the maturing adolescent brain to predict substance (ab)use in young adulthood. Further studies are required to confirm these findings.

Drinking alcohol before age 13 and negative outcomes in late adolescence

BACKGROUND

Research has shown that adolescents who begin drinking at an early stage in life are at greater risk of developing alcohol dependency, as well as a variety of negative outcomes, for instance, delinquent behavior. Most of these studies have focused on those who begin drinking in middle adolescence, but little attention has been paid to youth who initiate drinking under the age of 13. Twenty percent of adolescents have begun using alcohol by the age of 13. The purpose of the study is to examine whether initiating alcohol use before the age of 13 exacerbates negative outcomes in late adolescence.

METHODS

Data for the study were derived from 2 school-based statewide surveys conducted in Florida: the 2005 YRBS and the 2006 FYSAS. The sample included 12,352 11th and 12th grade students divided into 3 groups: students who initiated alcohol use under the age of 13, students who initiated alcohol use at age 13 or later, and students who never used alcohol.

RESULTS

Results showed that after adjusting for gender, ethnicity/race, and grade, adolescents who initiated alcohol use before age 13 were more likely to report problems with school performance and display delinquent behaviors (carrying a gun, carrying a weapon to school, and recent marijuana use).

CONCLUSION

Although no temporal relationships can be determined between drinking alcohol before age 13 and delinquent behavior outcomes, the results suggested that adolescents under the age of 13 need to be included in national epidemiological surveys on alcohol use and more efforts need to be directed toward the implementation of prevention programs early in elementary and middle schools.

Anticipating problem drinking risk from preschoolers' antisocial behavior: evidence for a common delinquency-related diathesis model

OBJECTIVE

Early first drinking (EFD) experiences predict later alcohol problems. However, the longitudinal pathway from early childhood leading to EFD has not been well delineated. Based on documented links between drinking behaviors and chronic antisocial behaviors, this article tests a common diathesis model in which precursive patterns of aggression and delinquent behavior-from preschool onward-anticipate EFD.

METHOD

Participants were 220 male children and their parents in a high risk for substance use disorder prospective study. Early first drinking was defined as having had a first drink by 12 to 14 years of age. Stacked structural equation models and configural frequency analyses were used to compare those with and without EFD on aggression and delinquent behavior from ages 3 to 5 years through 12 to 14 years.

RESULTS

Delinquent behavior and aggression decreased normatively throughout childhood for those with and without EFD, although those with EFD showed precocious resurgences moving into early adolescence. Early first drinking was associated with delinquent behavior more than aggression. Early drinkers were more delinquent at most ages-with a direct effect of preschool predisposition on adolescent behavior only within the EFD group. Early first drinking was disproportionately likely among individuals with high levels of delinquent behavior at both 3 to 5 and 12 to 14 years of age but uncommon among individuals with low levels of delinquent behavior during those two age periods.

CONCLUSIONS

Early first drinking and delinquent behavior share a common diathesis evident before school entry. Intervention and prevention programs targeting problem drinking risk should focus on dismantling this emergent primarily delinquency-related developmental trajectory.

The timing of alcohol use and sexual initiation among a sample of Black, Hispanic, and White adolescents

The goals of this study were to examine the relationship between age at first drink and age at first sex among an emergency department sample of Black, Hispanic, and White adolescents (N = 1,1110) and to assess two sexual behavior-related consequences of underage drinking. The authors used multivariable linear regression to analyze data from a self-reported survey. Age at first sex decreased linearly with decreasing age at first drink (p < .001) for all adolescents in the sample. In analyses stratified by race, significant positive trends between age at first drink and age at first sex were observed for all race and ethnic subgroups, although the relationship between age at first drink and age at first sex was not as strong for Black males and females as their White counterparts, respectively. Compared to White males, Black males were less likely to report having had sex without using a condom or birth control after drinking in the past month and during their lifetimes.

Ethnicity and adolescent pathways to alcohol use

OBJECTIVE

This study examined the influence of ethnicity on factors affecting alcohol-use behaviors in a community sample of white, black, and Hispanic youth (N = 323). Conduct problems, positive alcohol expectancies, and socioeconomic status were expected to mediate the effect of negative affectivity and a paternal history of substance dependence on the age at onset of regular drinking and the frequency of drinking.

METHOD

Subjects ages 14-21 (57.9% female; 60.7% white) were interviewed along with their fathers at baseline (Time 1), and subjects only were interviewed again 5 years later (Time 2). A structural equation model was used to test a deviance proneness model for predicting drinking behaviors and to evaluate differences on model paths by ethnicity.

RESULTS

Ethnic group membership moderated mediational pathways linked to the onset of regular alcohol use but not to drinking frequency. An increase in the number of childhood conduct problems predicted an earlier age at onset of regular drinking for blacks, whereas more positive alcohol expectancies were associated with an earlier initiation of regular drinking for whites and Hispanics.

CONCLUSIONS

Findings from this study provide evidence that risk factors for alcohol use in adolescents and young adults vary according to ethnic group.

Impact of a preventive intervention targeting childhood disruptive behavior problems on tobacco and alcohol initiation from age 10 to 13 years

The distal impact of a school based universal preventive intervention targeting disruptive behavior problems on tobacco and alcohol use from age 10 to 13 years was explored. Second grade classrooms (children aged 7 years) were randomly assigned to the intervention or a control condition. Tobacco and alcohol use from age 10 to 13 years was available for 477 children (72% of original sample). The impact of intervention on the initial level and growth in probability of substance use was explored. Results showed that intervention children had lower probabilities of tobacco use over the ages 10-13 years. This effect remains significant when controlling for (male) sex, pre-intervention levels of conduct problems, exposure to prenatal smoking or current parental smoking. For alcohol use, no effect of intervention during childhood was found. However, intervention children reported having a lower probability in alcohol use with age among those children reporting having used in the last week. The results underscore the importance of the early prevention of disruptive behavior problems substance use initiation. Implications for prevention and research are discussed.

Alcohol-use disorders

Alcohol dependence and alcohol abuse or harmful use cause substantial morbidity and mortality. Alcohol-use disorders are associated with depressive episodes, severe anxiety, insomnia, suicide, and abuse of other drugs. Continued heavy alcohol use also shortens the onset of heart disease, stroke, cancers, and liver cirrhosis, by affecting the cardiovascular, gastrointestinal, and immune systems. Heavy drinking can also cause mild anterograde amnesias, temporary cognitive deficits, sleep problems, and peripheral neuropathy; cause gastrointestinal problems; decrease bone density and production of blood cells; and cause fetal alcohol syndrome. Alcohol-use disorders complicate assessment and treatment of other medical and psychiatric problems. Standard criteria for alcohol dependence-the more severe disorder-can be used to reliably identify people for whom drinking causes major physiological consequences and persistent impairment of quality of life and ability to function. Clinicians should routinely screen for alcohol disorders, using clinical interviews, questionnaires, blood tests, or a combination of these methods. Causes include environmental factors and specific genes that affect the risk of alcohol-use disorders, including genes for enzymes that metabolise alcohol, such as alcohol dehydrogenase and aldehyde dehydrogenase; those associated with disinhibition; and those that confer a low sensitivity to alcohol. Treatment can include motivational interviewing to help people to evaluate their situations, brief interventions to facilitate more healthy behaviours, detoxification to address withdrawal symptoms, cognitive-behavioural therapies to avoid relapses, and judicious use of drugs to diminish cravings or discourage relapses.

Personality Disorders in Alcohol-Dependent Individuals: Relationship with Alcohol Dependence Severity

The rate of axis II disorders in alcohol-dependent individuals is suggested to be high. The aim of this investigation is to assess the rate of DSM-IV axis II diagnoses in alcohol-dependent inpatients and their correlation with clinical characteristics of alcohol dependence (AD). 1,079 inpatients with DSM-IV AD from three inpatient addiction treatment centers ('qualified detoxification', open psychiatric university hospital wards) were included. Characteristics of AD were obtained using standardized structured interviews. Diagnoses of DSM-IV personality disorders (PDs) were generated with SCID-II-PQ and SCID-II interviews. Alcoholism severity was measured using the number of DSM-IV criteria endorsed and age at first drinking. Approximately 60% of the sample had at least one PD. However, rates of Axis II disorders differed significantly across centers. The most frequent PDs were obsessive-compulsive, borderline, narcissistic and paranoid PD. Diagnosis of any PD was related to a more severe clinical profile of AD. Regression analyses revealed that obsessive-compulsive PD was related to the number of DSM-IV criteria endorsed while antisocial PD was related to early age at first drinking. The majority of alcohol-dependent individuals had one or more comorbid axis II disorders. Univariate and multivariate analyses indicate that different PDs are related to age at first dinking and alcoholism severity.

Age at first drink and the first incidence of adult-onset DSM-IV alcohol use disorders

BACKGROUND

Existing studies of the association between age at first drink (AFD) and the risk of alcohol use disorders (AUD) suffer from inconsistent levels of control and designs that may inflate associations by failure to control for duration of exposure to risk.

METHODS

This study examined associations between AFD (ages <15 and 15-17 vs. 18+ years) and first incidence of DSM-IV alcohol dependence, abuse, and specific AUD criteria over a 3-year follow-up in a longitudinal study of U.S. drinkers 18 years of age and older at baseline (n = 22,316), controlling for duration of exposure, family history, and a wide range of baseline and childhood risk factors.

RESULTS

After adjusting for all risk factors, the incidence of dependence was increased for AFD <15 years (OR = 1.38) and for women only with AFD at ages 15 to 17 (OR = 1.54). The incidence of abuse was increased at AFD <15 and 15 to 17 years (OR = 1.52 and 1.30, respectively). Most dependence criteria showed significant associations with AFD, but hazardous drinking and continued drinking despite interpersonal problems were the only abuse criteria to do so. All associations were nonsignificant after controlling for volume of consumption, except that AFD at all ages <18 combined was associated with a reduced likelihood of impaired control, and AFD at ages 15 to 17 was associated with lower odds of drinking more/longer than intended among heavy-volume drinkers. In a population of low-risk drinkers that excluded those with positive family histories, personality disorders, and childhood risk factors, there were strong associations between early AFD (<18) and the incidence of dependence (OR = 3.79) and continued drinking despite physical/psychological problems (OR = 2.71), but no association with incidence of abuse.

CONCLUSIONS

There is a robust association between AFD and the risk of AUD that appears to reflect willful rather than uncontrolled heavy drinking, consistent with misuse governed by poor decision-making and/or reward-processing skills associated with impaired executive cognitive function (ECF). Additional research is needed to determine causality in the role of impaired ECF, including longitudinal studies with samples of low-risk adolescents.

The self-rating of the effects of alcohol questionnaire as a predictor of alcohol-related outcomes in 12-year-old subjects

AIMS

A low level of response (LR), or low sensitivity, to alcohol as established by alcohol challenges has been shown to predict future heavier drinking, alcohol-related problems and alcohol use disorders. To date, only one study has evaluated the predictive validity of a second measure of LR as determined by the Self-Report of the Effects of Alcohol (SRE) Questionnaire. The current analyses evaluate the ability of SRE scores as determined at age 12 to predict heavier drinking and alcohol-related problems 2 years later in a sample from the United Kingdom.

METHODS

The subjects were 156 boys (54.5%) and girls from the Avon Longitudinal Study of Parents and Children (ALSPAC) who had reported consuming one or more standard drinks by age 12 and who were followed up 2 years later.

RESULTS

The age 12 SRE scores correlated with the number of drinks per week, maximum drinks and the number of alcohol problems both at baseline and at age 14 follow-ups. In these evaluations, a larger number of drinks required for effects on the SRE (i.e. a lower LR per drink consumed) related to heavier intake and alcohol-related difficulties. Simultaneous entry multiple regression analyses revealed that the age 12 SRE score maintained a significant relationship with age 14 higher number of drinks per week and the number of alcohol problems even when the age 12 values for alcohol intake and problems were used as covariates.

CONCLUSION

The SRE scores appear to have value in predicting future heavier drinking and alcohol problems in 12-year olds that go beyond the information offered by the earlier drinking pattern alone.