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Younger Alcohol Addicts Abstain from Treatment


BOSTON -- The younger the onset of alcohol dependence, the less the chance that a patient will seek help, according to investigators here.

BOSTON, Sept. 6 -- The younger the onset of alcohol dependence, the less the chance that a patient will seek help, according to investigators here on the basis of a national survey.

Those with alcohol dependence before age 18 were three times as likely to wait 10 or more years to seek treatment and 7% less likely to ever seek treatment than those with an onset at age 30 or older, reported Ralph W. Hingson, Sc.D., M.P.H., of Boston University, and colleagues, in the Sept.1 issue of Pediatrics.

The National Epidemiologic Study of Alcohol Related Conditions survey was conducted by the U.S. Census Bureau for the NIH's National Institute on Alcohol Abuse and Alcoholism, using face-to-face interviews with a statistical sample of 43,093 adults.

It discovered that 12.5% of U.S. adults (more than 26 million) have met DSM IV criteria for alcohol dependence at some point in their lives. Of the 4,778 respondents who were diagnosable in the study, 15% had onset before age 18, 47% before age 21, and two-thirds before age 25.

They investigators found data in the survey showing that 28% of those with alcohol dependency before age 18 ever sought treatment compared with 17% with onset between 18 and 20, and 35% who became dependent at age 30 or older.

Even controlling for the number of patients at onset meeting DSM IV alcohol dependence criteria, the odds of ever seeking help was lower with early onset compared with onset at age 30 or older:

  • 0.50 for onset before age 18 (95% confidence interval 0.35 to 0.70),
  • 0.44 for onset between 18 and 20 (95% CI 0.34 to 0.59), and
  • 0.59 for onset between 21 and 24 (95% CI 0.44 to 0.79).

Among the 25% of survey respondents who ever sought help, significantly more of those with earlier onset waited at least 10 years after onset to do so (P<0.0001):

  • 31% for those first dependent before age 18,
  • 24% between 18 and 20,
  • 28% between 20 and 24,
  • 21% between 25 and 30, and
  • 10% after 30.

After controlling for background characteristics associated with early dependence onset and whether participants ever sought alcohol-related treatment, those who were alcohol dependent before age 18 were more likely to have measures of chronic relapsing dependence compared with those with onset at age 30 or older:

  • At least two alcohol-dependence episodes (odds ratio 2.03, 95% CI 1.51 to 2.73),
  • Episodes lasting at least a year (odds ratio 10.13, 95% CI 7.38 to 13.91), and
  • Six to seven versus three to five DSM IV dependence symptoms (odds ratio 2.13, 95% CI 1.54 to 2.94).

Among the 3.8% of participants, representing eight million individuals in the United States, who were alcohol dependent during the survey year, 58% of those with onset by age 18 were drunk at least once a week compared to 19% of those first dependent at age 30 or older (P<0.0001).

Age was not a significant predictor of treatment seeking behavior in those who believed they needed help. Rather, young people were less likely to recognize their drinking problem.

Possibly "because episodes of heavy drinking are more common among youth in general, those with early dependence onset and their family and friends may be less likely to recognize their dependence," the researchers wrote.

Physicians and pediatricians in particular should consider "systematically exploring and counseling" adolescent and college-age patients about drinking behaviors, the authors suggested.

However, they cautioned that some of the criteria used in the DSM IV to diagnose alcohol dependence may be different in adolescents as increased tolerance is probably normal during development and "using more than intended" may have more to do with social influences in the young than a compulsion to drink.

"Given this concern, the relation observed between diagnosis of alcohol dependence at an early age and measures of chronic relapsing dependence is more remarkable," they noted.

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