Youthful Drinking Jumpstarts Later Alcohol Abuse

SAN DIEGO, Dec. 5 -- When the Marine Corps evaluated thousands of recruits, it found that young men, ages 18 to 20, were significantly more likely to become risky drinkers if they started drinking as children or young teenagers.

A study here identified 6,128 (14.8%) of 41,482 male recruits as risky drinkers, and those who had begun drinking at age 13 or younger were 5.5 times more likely to hit the bottle hard.

So reported Margaret Ryan, M.D., M.PH, of the Naval Health Research Center, and colleagues, in the December issue of the Archives of Pediatrics and Adolescent Medicine.

Compared with 35,354 (45.1%) non-risky underage drinkers or 16,661 (40.2%) non-drinkers, risky drinkers were more likely to be smokers, to come from a rural or small hometown, to have endured childhood sexual or emotional abuse, or to have experienced household alcohol abuse or mental illness, the investigators found.

Risky drinking was defined by answers to three alcohol-consumption questions derived from the Alcohol Use Disorders Identification Tests (AUDIT-C.) A score of four points on two of the questions, for example, indicated that the recruit drank daily and had 10 or more drinks on a typical day of drinking during the year before recruitment.

The researchers also found that the risky drinkers were more likely to report education beyond high school, having more close friends and relatives, and being motivated to join the military for travel or adventure or to leave problems at home.

A plausible explanation for the increase in risky drinking among those with more education may be that 20-year-old recruits with some college education have drinking experience related to college, compared with younger men who enlisted right after high school, the researchers said. As for having close friends and relatives as a drinking risk, conviviality and peer-group pressure may be a factor, they said.

By contrast, factors inversely associated with risky drinking included being married, attending religious services weekly or more often, neither parent having completed high school, not knowing parental educational achievement, and motivation to join the military "to serve my country," for education and new job skills, or for a 20-year military career.

A history of emotional neglect was also inversely associated with risky drinking, an unexpected finding because many of the recruits came from loving two-parent families, the researchers said. The findings require further study, they noted.

When the comparison group included only the 18,693 non-risky drinkers, the researchers found that men who started drinking at or before age 13 (not including "sips") had 5.5 (4.9-6.2) times the risk of becoming a risky drinker. Those who started at ages 14 to 15 had 4.7 (4.2-5.2) the risk, and those who started at ages 16 to 17 had 2.3 (2.1-2.6) times the risk.

When the comparison group included the nondrinkers, additional associated factors included childhood physical abuse and domestic violence, the researcher reported.

These findings are consistent with previous studies that found early alcohol use increases the risk of developing alcohol disorders, Dr. Ryan said, but added that to the investigators' knowledge this is the first time the relationship has been quantified in multivariable models "adding unique perspective from a population of young Marines."

Among the study limitations was its restriction to male Marine recruits, thereby limiting the ability to generalize the findings. All the data were self-reported, although the large sample size made it possible to control for many potential confounders, the investigators said.

"Our findings underscore the need for programs and policies to reduce underage drinking, such as the minimum legal drinking age of 21 years," the investigators said.

The study also reinforces the need for public health efforts to prevent tobacco use and child abuse. Whether reducing smoking will reduce risky drinking among young people is an important unexplored questions, Dr. Ryan's team concluded.

The study was supported by the Department of Defense.