Alcohol and Development in Youth : Special Populations

by National Institute of Health

(Page 3 of 5)

Risk Trajectories and Drinking Trajectories

Not only do youth begin drinking at different ages but their trajectories of risk also vary considerably, even before alcohol use has begun. Recent work following high-risk populations of children from preschool onward has shown major differences in the trajectories of externalizing and internalizing risk from preschool to early adolescence. These varied as a function of initial level of risk in early childhood, the child's age, and the level of familial risk. Particularly for the externalizing trajectory, children who started out at very high levels of individual and familial risk became indistinguishable from those at lower levels during the early school years, but as these youth moved into early adolescence, the differences reemerged and became amplified, with the highest-risk children increasing the greatest amount. Conversely, the externalizing behavior of children at the lowest level of initial risk who were exposed to the lowest level of familial risk changed the least, although even they increased in level of externalizing behavior as they moved into adolescence.

Similarly, the drinking patterns and practices youth adopt as they grow into young adults - their drinking trajectories - also vary considerably once they start to drink. No single trajectory describes the course of alcohol use for all or even most young people. Research findings provide strong evidence for wide developmental variation in drinking patterns in the population. For example, Steinman and Schulenberg identified six common trajectories among early and middle adolescents: abstinence, rare use, high school onset, early but nonescalating use, early and gradually escalating use, and consistently high use. In another study, Schulenberg and colleagues identified six trajectories of heavy drinking among young people ages 18 to 24: chronic heavy drinkers, decreased, increased, fling, rare, and never. In addition, alcohol abuse treatment and other experiences may influence drinking trajectories. Studying the developmental trajectories of drinking behavior and how various risk and protective factors influence those trajectories is critical to understanding the complexity of underage drinking.

Children of Alcoholics

Children of alcoholics are between 4 and 10 times as likely to become alcoholics themselves as children from families that have no adults with alcoholism. COAs are at elevated risk for earlier onset of drinking and earlier progression into drinking problems. Some of the elevated risk is attributable to exposure and socialization effects found in alcoholic households, some to genetically transmitted differences in response to alcohol that make the drinking more pleasurable and/or less aversive, and some is attributable to elevated transmission of risky temperamental and behavioral traits that lead COAs, more than other youth, into increased contact with earlier-drinking and heavier-drinking peers.

From a public health standpoint, according to NLAES data, approximately 9.7 million children age 17 or younger, or 15 percent of the child population in that age range, were living in households with one or more adults classified as having an alcohol abuse or dependence diagnosis during the past year. Approximately 70 percent of these children were biological, foster, adopted, or stepchildren. That is, 6.8 million children meet the formal definition of COA, although not all are exposed to the same level of risk for use, problem use, and alcohol use disorder. Given that these figures concern past-year exposure to at least one alcoholic adult, from the perspective of socialization risk, they only reflect acute exposure. Other data from NLAES provide estimates of the number of children living in a household with an adult who had abused or been dependent on alcohol at some point; the figure is 43 percent of the under-18 population, or somewhat less than half of all children. Given the size of this group, any approach to risk identification will be extremely complex.

A second important consideration is that COA status is heavily used as a proxy for "alcoholism risk" on the one hand and socialization risk on the other, but the COA designation more precisely is a proxy for multiple causal inputs, not all of which may be present in the individual case. Thus, being a COA implies elevated genetic risk, although the alcoholic genetic diatheses may not have been passed on to a particular child. One may be a COA without being undercontrolled, having an attention deficit hyperactivity disorder diagnosis, or other problems known to be associated with increased risk of alcohol dependence.

Socialization risk involves exposure, but given the high divorce rates found in this population, evaluating the level of socialization risk is complex, involving both the quantification of the length of the exposure and the identification of the developmental period during which the socialization took place. Vulnerability is greater during some developmental periods than others. In addition, a substantial amount of marital assortment occurs in alcoholic families. When assortment is present, risk exposure is multiplied, and COA effects become a function of genetic risk, individual parent risk, and the synergistic risk created by marital interaction.

Third, the potential for indirect socialization effects also is higher in COAs than in other children. Parental psychopathology has been documented as a risk factor for poorer parental monitoring, which in turn leads to a higher probability of involvement with a deviant peer group, including earlier exposure to alcohol and other drugs.

Fourth, COA risk is not simply risk for the development of AUD. Given what is known about the elevated comorbidities found among offspring of alcoholics, this designator also is a marker of elevated risk for behavioral and cognitive deficits. These include attention deficit disorder, behavioral undercontrol/conduct disorder, delinquency, lower IQ, poor school performance, low self-esteem, and other problems. Furthermore, the evidence strongly implicates some of these non-alcohol-specific characteristics as causal to both problem alcohol use and elevated risk for AUD.

These factors implicate the COA population as an important component of the underage drinking population. For the same reasons, however, it is essential to determine which components of that risk composite are the strongest mediators of the underage drinking outcome.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.