There has been some blogosphere and mediasphere activity regarding the
following article (
href="http://archpedi.ama-assn.org/cgi/content/full/160/7/739">Age
at Drinking Onset and Alcohol Dependence) in Archives of
Pediatrics and Adolescent Medicine. The New York
Times picked it up (
href="http://www.nytimes.com/2006/07/04/health/04teen.html?ex=1309665600&en=64fcb20497217e6c&ei=5090&partner=rssuserland&emc=rss">permalink),
and Jake
href="http://scienceblogs.com/purepedantry/2006/07/on_the_merits_of_postponing_yo.php#more">posted
about it at Pure Pedantry.
There's also a
href="http://www.treatmentonline.com/treatments.php?id=792">good
post on the subject at Anxiety Addiction and
Depression Treatments. It was even
href="http://www.freerepublic.com/focus/f-news/1660063/posts">picked
up on the propaganda tip sheet, FreeRepublic.com.
In this post, I end up agreeing with the conclusions in the
article, but I point out that the study does not really
support one of the conclusions.
href="http://archpedi.ama-assn.org/cgi/content/full/160/7/739">Age
at Drinking Onset and Alcohol Dependence
Age at Onset, Duration, and Severity
Ralph W. Hingson, ScD, MPH; Timothy Heeren, PhD; Michael R. Winter, MPH
Arch Pediatr Adolesc Med. 2006;160:739-746.
Objective To examine whether starting to
drink at an early age is associated with developing alcohol dependence
at a younger age and chronic relapsing dependence, controlling for
respondent demographics, smoking and illicit drug use, childhood
antisocial behavior and depression, and family alcoholism history.
Design Cross-sectional survey.
Setting Nationwide face-to-face survey
with a multistage probability sample.
Participants A total of 43 093 adults
were surveyed in 2001-2002.
Main Outcome Measures Based on
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,
criteria, lifetime alcohol dependence, dependence within 10 years of
starting drinking, multiple episodes, an alcohol dependence episode in
the past year, episodes exceeding 1 year, and meeting 6 or 7 dependence
criteria.
Results Relative to respondents who
began drinking at 21 years or older, those who began drinking before
age 14 years were more likely to experience alcohol dependence ever and
within 10 years of first drinking (adjusted hazard ratios and 95%
confidence intervals [CIs], 1.78 [1.51-2.11] and 1.69 [1.38-2.07],
respectively). They also more often experienced past-year dependence
and multiple dependence episodes (adjusted odds ratios, 1.93 [95% CI,
1.40-2.64] and 3.09 [95% CI, 2.19-4.35], respectively). Among
alcohol-dependent persons, the odds were 2.62 (95% CI, 1.79-3.84) for
having at least 1 episode exceeding 1 year and 2.89 (95% CI, 1.97-4.23)
for meeting 6 or 7 dependence diagnostic criteria.
Conclusion There is a need to screen and
counsel adolescents about alcohol use and to implement policies and
programs that delay alcohol consumption.
The NYT article mentions finding from a variety of other studies, to
support the notion that drinking is particularly bad for the teenage
brain. I am not going to argue with that, although I would
like to say that it is not obvious to me that we have to spend a ton of
money to figure that out. Does anybody really think that it
is a good idea for teenagers to drink alcohol? Does anybody
really think that teenage drinkers care, or will be influenced by, the
results of such studies?
Perhaps that is a little harsh. Research on illness and
injury is generally a good thing, and not every area of research can be
expected to have direct clinical application. And who knows,
maybe the research will help some people. Maybe there are a
few teenage drinkers who will think a little bit when presented with
some actual evidence.
Sometimes, it is helpful in the course of substance abuse treatment, to
present someone with a ton of information about consequences, in order
to break down denial. Usually, no single article will have a
big impact, but the cumulative weight might make a difference.
Sometimes, there will be one particular bit of information
that seems to hit home. There is no way to tell ahead of time
which one will do the trick.
One of the
href="http://scienceblogs.com/purepedantry/2006/07/on_the_merits_of_postponing_yo.php#comment-129090">comments
after Jake's post is particularly cynical. A person calling
himself "quitter"
states:
The whole field is just filled with prohibitionists
in disguise, overinterpreting data to freak people out rather than
rationally determining what would probably be some really interesting
results.
There probably is some truth to that (although I personally would not
phrase it so stridently). It sure is a lot easier to get
funding for a study that might deter substance abuse, than it is to get
funding for a study on medical uses of cannabis.
My own cynicism leads me to comment of the conclusion in the abstract
of the JPAM article: "There is a need to screen and
counsel adolescents about alcohol use and
to implement policies and programs that delay alcohol consumption."
It would be hard to argue with those points. However, the
article does not really support the last point. While they do
show that earlier onset of drinking is associated with a worse
prognosis, that does not show that getting a kid to
delay the onset of drinking will improve the prognosis. A
completely different kind of study would be needed to show that.
- Log in to post comments
One of two possibilities seem immanent:
1)the effect of alcohol depends on the state of the brain, which changes with age. In which case, the conclusion does hold
2)those who start drinking at an early age haave different brains than those who don't. In which case, the above results don't hold.
Basically, it comes down to whether the early drinkers differ in more ways from the late drinkers than just the age of initiation.
Stridency is a sad side-effect of reading science in a particularly politicized field. Don't get me started on ES cell research.
My main problem with these studies is that since they aren't case controlled they are probably inadvertantly selecting for the conclusion they want. That is, they are studying a complex behavior, drinking in adolescents, and coming to a conclusion that's very simplistic, that early drinking leads to alcoholism. I bitched about this paper originally here. However, they don't consider that the populations that start drinking at very young ages and those that start at 21 are probably a very different set of people, and comparisons are not appropriate. This is a study that begs to be performed in a country with a lower drinking age in which there isn't an outside pressure that leads kids to avoid drinking until they're 21. Or they could prospectively identify kids at high risk of alcoholism and eliminate them from the study if they really wanted an honest comparison of the effect of drinking on teens who are more or less the same. It is clear there is a genetic component to alcoholism (and risk-seeking behaviors) which might explain why these kids are seeking out drugs at a young age, and then naturally are alcoholic as they grow up.
In short, it's a bad study from which conclusions should not be drawn. I'd be curious to see if there's a European equivalent, where they could study alcohol consumption without the effects of selecting for the more prudish, law-abiding, non-risk-taking population.
"Does anybody really think that teenage drinkers care, or will be influenced by, the results of such studies?" I don't think they will (but as a father of four teenagers I can always hope).
But parents probably will, and will be less likely to allow their teenagers to try alcohol with the argument that �it�s better they try it at home in a controlled setting�. Which is, I believe, a good thing.
When I initially read the study, my first instinct was to question whether the finding that early drinking leads to alcoholism might be a reverse correlation in disguise: that a predisposition for alcoholism (whether due to genetic, environmental, or mixed factors) leads to earlier drinking.
Also, I have to question whether younger adolescents are neurologically capable of true alcoholism, given the hypothesis tying alcoholism to frontal and prefrontal activity (I think due to excitotoxic rebound if memory serves, but I could be wrong), given that these areas are not fully developed in adolescence...or would that be a factor that might cause a greater chance of dependence?
Quitter: Please understand that I did not mean to be critical, when I said that I would be less strident. That is just my personal style.
I happen to agree with you. I've seen plenty of bias in the substance abuse literature. It bothers me to no end to see how the government can introduce bias into research, merely by manipulating the funding sources. It bothers me even more, that the research community goes along with this, but I suppose everyone has to make a living.