Alcohol Dependence or Abuse and Age at First Use

Recent research has focused on the
association between the age at which a
person first uses alcohol and alcohol
problems later in life.1 Delaying the onset of
alcohol use has been proposed as a strategy to
prevent alcohol dependence or abuse in
adulthood.2 The National Survey on Drug Use
and Health (NSDUH) asks persons aged 12 or
older to report on their age at first use of
alcohol, their use of alcohol during the past year
and in the past month, as well as their symptoms
of alcohol dependence or abuse during the past
year. NSDUH defines alcohol dependence or
abuse using criteria specified in the American
Psychiatric Association?s Diagnostic and
Statistical Manual of Mental Disorders (DSMIV),
which include such symptoms as recurrent
alcohol use resulting in physical danger, trouble
with the law due to alcohol use, increased
tolerance to alcohol, and giving up or reducing
other important activities in favor of alcohol
use.3
Age at First Use of Alcohol
In 2003, almost 74 percent of adults aged 21 or
older reported that they had started using
alcohol before the current legal drinking age of
21. This group of 74 percent consists of persons
NSDUH REPORT: ALCOHOL DEPENDENCE OR ABUSE AND AGE AT FIRST USE October 22, 2004
0% 10% 20% 30% 40%
Never Used
Alcohol
First Use At or
After Age 21
First Use Between
Ages 18 and 20
First Use Between
Ages 15 and 17
First Use Between
Ages 12 and 14
First Use Before
Age 12
White
Black
20.6
15.4
20.7
27.8
12.2
3.3
27.4
26.4
23.0
17.3
3.8
2.2
16.3
19.7
23.4
28.6
8.4
3.5
8.6
12.6
22.4
36.1
15.5
4.8
Asian
Hispanic
15.8
18.8
23.6
28.7
10.6
2.4
7.4
9.3
20.8
38.6
17.4
6.5
0% 10% 20% 30% 40%
Never Used
Alcohol
First Use At or
After Age 21
First Use Between
Ages 18 and 20
First Use Between
Ages 15 and 17
First Use Between
Ages 12 and 14
First Use Before
Age 12
Male
Female
aged 21 or older who first used
alcohol before the age of 12 (4
percent), persons who first used
alcohol between the ages of 12
and 14 (14 percent), persons
who first used alcohol between
the ages of 15 and 17 (33 percent),
and persons who first
used alcohol between the ages
of 18 and 20 (22 percent).
Among adults aged 21 or older,
12 percent reported that they
had never used alcohol, and
about 14 percent reported that
they had first used alcohol after
they had reached age 21.
Figure 1. Percentages of Age at First Alcohol Use
among Adults Aged 21 or Older, by Gender: 2003
Figure 2. Percentages of Age at First Alcohol Use
among Adults Aged 21 or Older, by Race/Ethnicity:
2003
Demographic Differences
in Age at First Use of
Alcohol
Among adults aged 21 or older,
females were more than twice
as likely as males to report
having never used alcohol
(16 vs. 7 percent) (Figure 1).
Males (83 percent) were more
likely than females (65 percent)
to report having initiated alcohol
use before age 21. Males
also were more likely than females
to report having first used
alcohol before age 15 (24 vs. 13
percent).
Among adults aged 21 or
older, Asians were more likely
to report never having used
alcohol (27 percent) and less
likely to report having initiated
alcohol use before the age of 21
(46 percent) than whites, blacks,
or Hispanics (Figure 2).4 Asians
also were less likely to have used
alcohol before age 15 (6 percent)
than members of these
other racial/ethnic groups. Of
these four racial/ethnic groups,
whites had the lowest rate of
never having used alcohol
(9 percent) and the highest rate
of initiating alcohol use before
age 21 (79 percent); whites also
had the highest rate of first
alcohol use before age 15
(20 percent).
October 22, 2004 NSDUH REPORT: ALCOHOL DEPENDENCE OR ABUSE AND AGE AT FIRST USE
First Use
Before
Age 12
First Use
Between Ages
12 and 14
First Use
Between Ages
15 and 17
First Use
Between Ages
18 and 20
First Use
At or After
Age 21
16.0 15.5
9.0
4.2
2.6
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
Figure 3. Percentages of Past Year Alcohol Dependence or Abuse
among Adults Aged 21 or Older, by Age at First Use: 2003
The National Survey on Drug Use and Health
(NSDUH) is an annual survey sponsored by the
Substance Abuse & Mental Health Services
Administration (SAMHSA). Prior to 2002, this
survey was called the National Household
Survey on Drug Abuse (NHSDA). The 2003 data
are based on information obtained from 67,784
persons aged 12 or older, including 36,309
persons aged 21 or older. The survey collects
data by administering questionnaires to a
representative sample of the population through
face-to-face interviews at their place of
residence.
The NSDUH Report is prepared by the Office of
Applied Studies (OAS), SAMHSA, and by RTI
International in Research Triangle Park, North
Carolina. (RTI International is a trade name of
Research Triangle Institute.)
Information and data for this issue are based on
the following publication and statistics:
Office of Applied Studies. (2004). Results from
the 2003 National Survey on Drug Use and
Health: National findings (DHHS Publication No.
SMA 04-3964, NSDUH Series H-25). Rockville,
MD: Substance Abuse and Mental Health
Services Administration.
Also available online:
http://www.oas.samhsa.gov
Because of improvements and modifications to
the 2002 NSDUH, estimates from the 2003
survey should not be compared with estimates
from the 2001 or earlier versions of the survey
to examine changes over time.
U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES
Substance Abuse & Mental Health Services Administration
Office of Applied Studies
www.samhsa.gov
using alcohol before age 21.
Only 5 percent (fewer than
1million persons) of adults classified
as having past year
alcohol dependence or abuse
had started using alcohol at or
after age 21.
End Notes
1. Warner, L. A., & White, H. R. (2003).
Longitudinal effects of age at onset and first
drinking situations on problem drinking.
Substance Use & Misuse, 38, 1983-2016.
2. Grant, B. F., & Dawson, D. A. (1997). Age at
onset of alcohol use and its association with
DSM-IV alcohol abuse and dependence:
Results from the National Longitudinal Alcohol
Epidemiologic Survey. Journal of Substance
Abuse, 9, 103-110.
3. American Psychiatric Association. (1994).
Diagnostic and statistical manual of mental
disorders (4th ed.). Washington, DC: Author.
4. Due to low precision, estimates for American
Indian or Alaska Native and Native Hawaiian or
Other Pacific Islander groups are not shown.
Figure Note
Source: SAMHSA, 2003 NSDUH.
Prevalence of Past Year
Alcohol Dependence or
Abuse
In 2003, more than 14 million
adults aged 21 or older (7 percent)
were classified as having
either alcohol dependence or
abuse. Males aged 21 or older
were more than twice as likely
as females to have alcohol
dependence or abuse (10 vs. 4
percent). The rate of alcohol
dependence or abuse was lower
among Asians than among
Hispanics (5 vs. 8 percent).
Among both whites and
blacks,4 the rate of alcohol
dependence or abuse was 7
percent.
Age at First Use of Alcohol
and Prevalence of Alcohol
Dependence or Abuse
Among adults aged 21 or older
who had ever used alcohol,
rates of past year alcohol
dependence or abuse were
lowest among persons who first
used alcohol at an older age
and highest among persons
who initiated alcohol use at a
younger age (Figure 3).
Only 3 percent of persons
who first used alcohol at age 21
or older were classified as
having past year alcohol dependence
or abuse. Persons reporting
first use of alcohol before
age 15 were more than 5 times
as likely to have past year alcohol
dependence or abuse
compared with persons who
first used alcohol at age 21 or
older (16 vs. 3 percent).
Among adults aged 21 or
older who initiated alcohol use
before the age of 21, the rate of
past year alcohol dependence
or abuse was 9 percent. Among
the 14 million adults aged 21 or
older who were classified as
having past year alcohol dependence
or abuse, more than 13
million (95 percent) had started