NIAAA Spectrum | Volume 1, Issue 1 | September 2009 http://www.spectrum.niaaa.nih.gov
In ThIs Issue
Alcoholism isn’t FeaTures
WhAt it Used to Be 1 Alcoholism Isn’t What
It Used To Be
2 Alcohol “Flush” Signals
“NIAAA’s goal now and for the foreseeable future is to Increased Cancer Risk
Among East Asians
develop and disseminate research-based resources for
each stage of the alcohol use disorder continuum, from CharTICle
Alcohol use disorders surpass other drug use disorders
Among U.S. adults 2.3 million have
3 Alcohol Use Disorders
over the age of 18:
primary prevention to disease management,” according
both an alcohol use
disorder and a drug
Surpass Drug Use Disorders
to acting NIAAA director Ken Warren, Ph.D.
1.9 million have a
drug use disorder
Millions more Americans have alcohol use disorders (abuse or dependence) than have
other drug use disorders. Most people who have alcohol use disorders do not have other
drug use disorders, but more than half of people with drug use disorders also have an
alcohol use disorder. (Stinson FS et al., Drug and Alcohol Dependence 80 (2005) 105-116)
he realization dawned gradually of Mental Disorders, Fourth Edition PhoTo essay
as researchers analyzed data from (DSM-IV) of the American Psychiatric
3 How Can a See-Through
NIAAA’s 2001–2002 National Association (APA). Published in 1994,
Fish Help Advance Alcohol
Epidemiologic Survey on Alcohol and DSM-IV recognizes alcohol dependence
Related Conditions (NESARC). In most by preoccupation with drinking, impaired
control over drinking, compulsive
persons affected, alcohol dependence
drinking, drinking despite physical or news From The FIeld
(commonly known as alcoholism) looks
less like Nicolas Cage in Leaving Las psychological problems caused or made 4 Estimating Blood Alcohol
Vegas than it does your party-hardy worse by drinking, and tolerance and/or Levels in Children
college roommate or that hard-driving withdrawal symptoms.
4 Lancet Series Examines
colleague in the next cubicle. Alcohol’s Impact on
Meanwhile, findings continue to
“We knew from the 1991–1992 National accumulate to challenge past perceptions
of the nature, course, and outcome of 5 How Not To Raise a
Longitudinal Alcohol Epidemiologic
alcoholism. Among those findings: College Binge Drinker
Study that alcohol dependence is most
prevalent among younger adults aged 6 “Happyhour” Gene Hints
18 to 29,” says Bridget Grant, Ph.D., • Many heavy drinkers do not have at New Alcohol Treatment
Ph.D., chief of NIAAA’s Laboratory alcohol dependence. For example,
6 Young, Tech-Savvy, and
Epidemiology and Biometry. “However, it even in people who have 5 or more
Drinking Too Much
was not until we examined the NESARC drinks a day (the equivalent of a
data that we pinpointed age 22 as the bottle of wine) the rate of developing
mean age of alcohol dependence onset.” dependence is less than 7 percent 5 QuesTIons wITh...
Subsequent analysis by Ralph Hingson, per year.
7 Dr. Bridget Grant
Sc.D., director, Division of Epidemiology • Most persons who develop alcohol
and Prevention Research, showed that dependence have mild to moderate
nearly half of people who become alcohol disorder, in which they primarily
dependent do so by age 21 and two-thirds experience impaired control. For
by age 25. example, they set limits and go over
them or find it difficult to quit or
The NESARC surveyed more than 43,000 cut down. In general, these people
individuals representative of the U.S. adult do not have severe alcohol-related
population using questions based on criteria relationship, health, vocational, or
in the Diagnostic and Statistical Manual legal problems.
2 NIAAA Spectrum | Volume 1, Issue 1 | September 2009
• About 70 percent of affected persons “These and other recent findings turn on its nih.gov) and inform secondary prevention
have a single episode of less than head much of what we thought we knew and primary care screening (http://www.
4 years. The remainder experience about alcoholism,” according to Mark niaaa.nih.gov/guide).
an average of five episodes. Thus, it Willenbring, M.D.,
appears that there are two forms of director of NIAAA’s
alcohol dependence: time-limited, and Division of Treatment
recurrent or chronic. and Recovery Research. “These and other recent findings
• Although 22 is the average age when “As is so often true in turn on its head much of what we
alcohol dependence begins, the onset
have studied the patients
thought we knew about alcoholism.”
varies from the mid-teens to middle
age. seen in hospitals and
clinics most intensively.
• Twenty years after onset This can greatly skew understanding of a New criteria to guide clinicians in
of alcohol dependence, about disorder, especially in the alcohol field, diagnosis and treatment await decisions by
three-fourths of individuals are where most people neither seek nor receive the DSM-V committee,
in full recovery; more than half treatment and those who seek it do so well expected about 2012. Both
of those who have fully recovered into the course of disease. Longitudinal, Dr. Grant and Howard Moss, M.D,
drink at low-risk levels without general population studies such as associate director for clinical and
symptoms of alcohol dependence. the NESARC permit us to translational research, represent NIAAA
• About 75 percent of persons who see the entire disease continuum from before on that committee.
recover from alcohol dependence do onset to late-stage disease.”
so without seeking any kind of help, “NIAAA’s goal now and for the foreseeable
including specialty alcohol (rehab) To Willenbring, these realizations call for future is to develop and disseminate
programs and Alcoholics Anonymous. a public health approach that targets at-risk research-based resources for each stage
Only 13 percent of people with alcohol drinkers and persons with mild alcohol of the alcohol use disorder continuum,
dependence ever receive specialty disorder to prevent or arrest problems from primary prevention to disease
alcohol treatment. before they progress. NIAAA is addressing management,” according to acting NIAAA
this need with tools to expand risk director Ken Warren, Ph.D. .
Alcohol “FlUsh” signAls increAsed
“We estimate that at least 540 million people have this alcohol-related
increased risk for esophageal cancer,” said first author Philip J. Brooks,
Ph.D., of NIAAA’s Laboratory of Neurogenetics.
ny people of East Asian descent “We estimate that at least 540 million The affected enzyme, known as aldehyde
possess an enzyme deficiency people have this alcohol-related increased dehydrogenase 2 (ALDH2), plays an
that causes their skin to redden, risk for esophageal cancer,” said first important role in alcohol metabolism.
or flush, when they drink alcohol. Scientists author Philip J. Brooks, Ph.D., of NIAAA’s Alcohol is first metabolized into
from NIAAA and Japan’s Kurihama Laboratory of Neurogenetics. “Cancer of acetaldehyde, a toxic chemical that causes
Alcohol Center now caution that heavy the esophagus is particularly deadly, with DNA damage and has other cancer-
alcohol consumption greatly increases the 5-year survival rates ranging from 12 to promoting effects. ALDH2 is the main
risk for esophageal cancer among such 31 percent throughout the world. We hope enzyme responsible for breaking down
individuals, who comprise about 8 percent that, by raising awareness of this important acetaldehyde into acetate, a non-toxic
of the world’s population. Their review of public health problem, affected individuals metabolite.
recent research on this topic appeared in the who drink will reduce their cancer risk by
March 24, 2009, issue of PLoS Medicine. limiting their alcohol consumption.”
National Institute on Alcohol Abuse and Alcoholism
NIAAA Spectrum | Volume 1, Issue 1 | September 2009 3
East Asians have two main variants of
the ALDH2 gene: one that produces an
enzyme with normal activity, and another
that results in an inactive enzyme. When
individuals with the inactive variant drink
Alcohol use disorders surpass other drug use disorders
alcohol, acetaldehyde accumulates in the Among U.S. adults 2.3 million have
body, resulting in facial flushing, nausea, over the age of 18: both an alcohol use
and rapid heartbeat. For people with disorder and a drug
two copies of the inactive variant, these use disorder
symptoms are so severe that they can drink
very little alcohol. However, individuals
with only one copy of the inactive variant 15.3 million
can become tolerant to the unpleasant have an
effects of acetaldehyde, which puts them at alcohol use
risk for alcohol-related esophageal cancer. disorder
A series of epidemiologic studies by Akira
Yokoyama and his colleagues in Japan have 1.9 million have a
shown that individuals with one copy of drug use disorder
the inactive variant are about 6 to 10 times only
Millions more Americans have alcohol use disorders (abuse or dependence) than have
more likely to develop esophageal cancer other drug use disorders. Most people who have alcohol use disorders do not have other
than are individuals with the fully active drug use disorders, but more than half of people with drug use disorders also have an
ALDH2 enzyme who drink comparable alcohol use disorder. (Stinson FS et al., Drug and Alcohol Dependence 80 (2005) 105-116)
amounts of alcohol. Dr. Yokoyama is a co-
author of the latest report.
The researchers add that many ALDH2- PhoTo essay: how Can a see-Through FIsh helP
deficient university students may have
their first experiences with heavy
advanCe alCohol researCh?
drinking while in college. Therefore, it
is particularly important for university
health professionals to be aware of the
relationship between ALDH2-deficiency,
facial flushing, and alcohol-related
cancer risk. Informing ALDH2-deficient
young people of their risk of esophageal
cancer from alcohol drinking represents a
valuable and cost-effective opportunity for
Dr. Brooks and his colleagues said that a
clinician can reliably determine whether a
patient is at risk simply by asking about
previous episodes of facial flushing after
drinking alcohol. From this perspective, Why are zebrafish becoming an increasingly popular research model for exploring
they noted, the flushing response is a alcohol’s effects on biology and behavior? For one thing, they have transparent embryos
clinically useful biomarker of genetic and even a see-through adult strain that allow researchers to observe the development
susceptibility to esophageal cancer risk and function of organ systems in live animals. Additionally, zebrafish have hundreds
from alcohol. . of offspring that mature within a few months and are relatively inexpensive to keep.
And importantly, zebrafish share a remarkable number of characteristics with humans,
The article abstract can be found here: including extensive overlap in the genetic code; comparable early development processes;
The alcohol flushing response: An and similar biochemical pathways in the brain, liver, and other organs. Moreover, when
unrecognized risk factor for esophageal exposed to alcohol, zebrafish show changes in locomotion, aggression, and socialization
cancer from alcohol consumption. that mimic behavior changes in humans. NIAAA intramural scientists and grantees are
http://www.plosmedicine.org/article/ making use of this versatile animal model to discover connections between alcohol
info%3Adoi%2F10.1371%2Fjournal. exposure and changes in gene function, embryonic development, liver metabolism, nerve
pmed.1000050 cell function and activity, and behavior. .
4 NIAAA Spectrum | Volume 1, Issue 1 | September 2009
news From The FIeld
estimAting Blood Alcohol levels
According to the study’s author, John E. Donovan, Ph.D., the findings
suggest that children may experience physical and psychological effects
after drinking less than a full drink.
rink for drink, the average With the modified equation, researchers among boys aged 9 to 13 who consume 3
blood alcohol concentrations can better determine how to assess child drinks within 2 hours.
(BACs) attained by children and or adolescent binge drinking. NIAAA
adolescents are much higher than those defines binge drinking as a pattern of According to the study’s author, John E.
seen among college students or adults, alcohol consumption that brings BAC Donovan, Ph.D., the findings suggest that
according to a new study supported by to .08 grams percent or above, the legal children may experience physical and
NIAAA that appeared in the June 2009 limit for driving in all 50 States. For the psychological effects after drinking less
issue of Pediatrics. typical adult male, this pattern corresponds than a full drink. Research has shown
to consuming 5 or more drinks in about 2 that the expectation of experiencing such
Using previously published health hours (4 or more drinks for adult females). effects increases the likelihood of starting
surveys and scientific reports, researchers A drink is defined as an alcohol beverage to drink and of involvement in problem
derived total body water data and alcohol that contains 0.6 fluid ounces or 14 drinking in adolescence. .
elimination rates—key variables in grams of “pure” alcohol, the approximate
the BAC equation—for individuals content in a 12-ounce regular beer, The article abstract can be found here:
ranging in age from 9 to 17. With that 5-ounce glass of wine, or 1½ -ounce shot Estimated blood alcohol concentrations
information, researchers were able to of 80-proof distilled spirits. for child and adolescent drinking and their
modify the equation used for estimating implications for screening instruments.
BACs in adults to estimate the BACs that The study determined that girls aged 9 to http://www.ncbi.nlm.nih.gov/pubmed/1948
theoretically would result after children 17 can be “legally intoxicated” after having 2748?ordinalpos=3&itool=EntrezSystem2.
and adolescents consume various numbers as few as 3 drinks in a 2-hour period. PEntrez.Pubmed.Pubmed_ResultsPanel.
of drinks. No alcohol was provided to Similarly, the study’s authors estimate that Pubmed_DefaultReportPanel.Pubmed_
children or adolescents as part of this a BAC of .08 or higher would also result RVDocSum
news From The FIeld
lAncet series exAmines Alcohol’s
impAct on gloBAl heAlth
Examines economic costs attributable to alcohol use and alcohol use
disorders, the cost-effectiveness of policies and programs to reduce alcohol’s
harm, as well as a “call to action” for reducing harm from alcohol.
n its June 27, 2009, issue, The Lancet covering the economic costs attributable to Jürgen Rehm, Ph.D., and colleagues
published a series of articles on alcohol use and alcohol use disorders, the analyzed World Health Organization
alcohol and global health, specifically cost-effectiveness of policies and programs (WHO) data and determined that,
addressing alcohol’s burden, harm- to reduce alcohol’s harm, as well as a “call worldwide, 6.3 percent of deaths in men
reduction strategies, and actions to address to action” for reducing harm from alcohol. and 1.1 percent of deaths in women are
the issue. The series features three papers attributable to alcohol. The researchers
National Institute on Alcohol Abuse and Alcoholism
NIAAA Spectrum | Volume 1, Issue 1 | September 2009 5
lAncet series exAmines Alcohol’s impAct on gloBAl heAlth, contnUed
also found that alcohol is responsible
determined that proven strategies for In addition to the articles in the series, this
for the loss of 4.6 percent of disability-
reducing harm include: taxation, drunk- issue of The Lancet also includes a study
driving legislation, from David Zaridze, M.D., and co-authors
bans on advertising, showing that alcohol was the cause of more
Worldwide, 6.3 percent of deaths limiting availability than half of deaths in Russian men between
in men and 1.1 percent of deaths in of alcohol, and 15–54 years from 1990–2001. The study of
providing help for nearly 50,000 adults in three Russian cities
women are attributable to alcohol. dangerous drinking. contributes to an explanation for the life
expectancy of 59 years for Russian men
adjusted life years around the world, and— In their call to action, Sally Casswell, Ph.D., vs. 76 years for men in the UK. .
in middle- and high-income countries—for and Thaksaphon Thamarangsi, Ph.D., argue
the loss of 1 percent of gross domestic that alcohol-related harm has received
product. less attention from WHO compared with The entire series, as well as editorials and
that of illicit drugs and tobacco. They commentary can be found here: The Lancet
Also in the series, Peter Anderson, M.D., suggest a legally-binding Framework Series on Alcohol and Global Health.
and co-authors review interventions that Convention on Alcohol Control that http://www.thelancet.com/series/alcohol-
may reduce alcohol-related harm for would be supported by nongovernmental and-global-health/
efficacy and cost-effectiveness. They organizations in concert with WHO.
news From The FIeld
hoW not to rAise A college Binge
Parental allowance of alcohol consumption in late high school was a
significant risk factor for alcohol misuse in college.
arents who allow their children to as well as on the students’ drinking habits. parents had very low limits for what they
drink alcohol in high school are Additionally, students answered questions considered acceptable drinking behavior.
not protecting their children from about their own experiences with negative The findings were true for both males and
abusing alcohol when they leave the home effects of alcohol, such as hangovers, females who participated in the study. .
for college, report researchers from the drunken driving, and risky sexual behavior
Prevention Research and Methodology as a result of drinking.
Center at Pennsylvania State University.
Parental disapproval of drinking, however, Parental allowance of alcohol consumption The article abstract can be found here:
does seem to have a protective effect in late high school was a significant The impact of parental modeling and
against alcohol misuse in college. risk factor for alcohol misuse and its permissibility on alcohol use and
consequences in college. “Specifically, it experienced negative drinking consequences
The findings, presented by the study’s appears that the limits parents set for their in college.
author, Caitlin Abar, at the annual meeting teens with regard to alcohol consumption http://www.ncbi.nlm.nih.gov/pubmed/1939
of the Society for Prevention Research are particularly important,” note the 8278?ordinalpos=4&itool=EntrezSystem2.
were published in the June–July 2009 issue authors. Teens who were permitted to drink PEntrez.Pubmed.Pubmed_ResultsPanel.
of Addictive Behaviors. In this study, the at fairly high levels were more likely to Pubmed_DefaultReportPanel.Pubmed_
researchers surveyed 290 college freshmen drink heavily in college than their peers RVDocSum
on their parents’ attitudes toward alcohol, who were not allowed to drink, or whose
6 NIAAA Spectrum | Volume 1, Issue 1 | September 2009
news From The FIeld
“hAppyhoUr” gene hints At neW
Animals with a mutant version of the gene, dubbed “happyhour,” grow
increasingly resistant to alcohol’s sedative effects
class of drugs already approved as grow more sensitive to alcohol. What’s that come with alcohol intoxication. Those
cancer treatments might also help more, rats given the cancer-fighting drug questions will be the subject of future
to beat alcohol addiction. That’s the spontaneously consumed less alcohol that investigation. Her team is also exploring
conclusion of a discovery in flies of a gene, was freely available to them. Their taste other new gene candidates that turned up
dubbed “happyhour,” that has an important for another rewarding beverage—sugar in the fly screens. She says that several
role in controlling the insects’ response to water—was unaffected. of those appear to be tied to the EGFR
alcohol. The study was published in the pathway in different ways.
May 29, 2009, edition of the journal Cell. Earlier studies have shown that fruit flies are
a useful tool for unraveling the basis for the “It’s not yet clear how it all fits together,”
Animals with a mutant version of the gene effects of alcohol. Several genes previously she said. “But the fact that we’ve come, in
grow increasingly resistant to alcohol’s identified as playing a role in fruit flies’ an unbiased way, to molecules in the same
sedative effects, the research shows. alcohol response hold parallel roles in pathway is telling us this is really, really
The researchers report further evidence mammals. In search of similar genes in the important.” .
that the gene normally does its work by new study, the researchers screened mutant
blocking the so-called epidermal growth flies for those less sensitive to ethanol. The article abstract can be found here:
factor (EGF) pathway. That EGF pathway That screen led them to happyhour, a gene Happyhour, a Ste20 family kinase, implicates
is best known for its role in cancer, and closely related to mammalian enzymes EGFR signaling in ethanol-induced
drugs designed to inhibit the EGF receptor known as the Ste20-family kinases of the behaviors.
(including erlotinib and gefitinib) are FDA- GCK-1 subfamily. http://www.ncbi.nlm.nih.gov/pubmed/1946
approved for the treatment of non-small 4045?ordinalpos=2&itool=EntrezSystem2.
cell lung cancer. Author Ulrike Heberlein, Ph.D., said they PEntrez.Pubmed.Pubmed_ResultsPanel.
still don’t know exactly how alcohol exerts Pubmed_DefaultReportPanel.Pubmed_
Now, researchers have shown that flies its influence on the EGFR pathway or how RVDocSum
and mice treated with erlotinib also that leads to the telltale changes in behavior
news From The FIeld
yoUng, tech-sAvvy, And drinking
“Cyber Millenials,” the Nation’s tech-savvy singles and couples living in
fashionable neighborhoods on the urban fringe, have the highest rate of
risky levels of alcohol drinking.
Audience segmentation” refers to this method to find high-risk drinkers in August 2009 issue of Alcoholism: Clinical
categorizing people by their behaviors, the U.S., leading researchers to a group & Experimental Research.
attitudes, opinions, or lifestyles. It is dubbed the Cyber Millenials: the Nation’s
widely used in social-marketing efforts. A tech-savvy singles and couples living in Researchers used multiple marketing-
new study from NIAAA researchers uses fashionable neighborhoods on the urban research data sources merged with CDC’s
fringe. Results were published in the Behavioral Risk Factor Surveillance
National Institute on Alcohol Abuse and Alcoholism
NIAAA Spectrum | Volume 1, Issue 1 | September 2009 7
System database. They performed a
segmentation analysis of those individuals
who self-reported consuming 5 or more 5 QuesTIons wITh...
drinks per drinking episode at least twice
in the preceding 30 days. dr. Bridget grAnt
“We identified the top-10 audience
segments in the U.S. that engaged in twice- Bridget Grant, Ph.D., Ph.D., is the Chief
a-month, high-risk drinking,” explained of NIAAA’s Laboratory of Epidemiology
Howard B. Moss, M.D., associate director
for Clinical and Translational Research at and Biometry at NIAAA. She has directed
NIAAA. “Five of these audience segments all national NIAAA surveys since
were made up of young adults, and five
were middle-aged individuals. The young 1988 and most recently the National
adult segment we called the ‘Cyber Epidemiological Survey on Alcohol and
Millenials,’ with the highest rate of risky
levels of alcohol drinking, represented Related Conditions (NESARC) since 2001.
well-educated, ethnically mixed,
technologically sophisticated individuals In just a few sentences how would you drinking patterns, design better-targeted
who live in urban fringe areas on the West describe the NESARC project? treatments, and monitor recovery from
Coast and Middle Atlantic regions.” NESARC is a large survey of the U.S. adult alcohol use disorders in the general
population addressing all aspects of alcohol population.
One of the surprising things about this use. It includes a long list of questions NESARC’s data can also track trends in
group, added Dr. Moss, was that it is one addressing present and past alcohol the prevalence of alcohol use disorders
of the most health-conscious segments of consumption, alcohol use disorders, over time; help define the relationship
American society. “They have a lower- and use of alcohol treatment services. between alcohol use disorders and drug
than-average smoking rate, they go to the It is also the largest and most ambitious use, mood and anxiety disorders, and
gym, they consume organic produce, yet comorbidity study ever conducted, with personality disorders; and illustrate
they binge drink at a level that is clearly questions related to tobacco and illicit the trends associated with driving after
detrimental to their well-being.” drug use as well as psychiatric disorders drinking.
associated with alcohol use disorders.
“Clinicians tend to be more blasé with
younger, healthier patients, and might not Moving forward, are there any new
even ask them about their level of alcohol What are the advantages of having such ways that you would you like to see
consumption or screen them for alcohol a large survey size? NESARC used—either by different
problems,” said Dr. Moss. “Since half of The unprecedented sample size of types of researchers or for different
our top-10 high-risk drinking segments NESARC (n = 43,093) makes it possible purposes than currently?
are young adults, clinicians might want to to achieve stable estimates of even rare
‘ratchet up’ their index of suspicion when Analyses with NESARC data, especially
conditions. Its oversampling of Blacks, Wave 1 in combination with Wave 2, have
these individuals present clinically. Asking Hispanics, and youth, and the inclusion
about drinking behavior, giving advice, only just begun. As more researchers take
of Hawaii and Alaska residents, provide advantage of the richness of this data set,
or conducting a formal brief intervention enough minority respondents to make it
might save lives in the short-term, and more knowledge will be gained. That will
an ideal vehicle for addressing the critical help identify risk factors and advance
reduce the risk of later development of issue of race and ethnic disparities in
alcohol-related organ damage or alcohol treatment interventions in the alcohol field.
disease prevalence, comorbidity, and
dependence.” . access to health care services. NESARC In particular, in addition to the opportunities
is also a longitudinal survey with its first already discussed, I would hope that
wave conducted in 2001–2002 and the researchers will use NESARC to:
second wave conducted in 2004–2005.
The article abstract can be found here: The 70.9 percent overall response rate is • Estimate the size, characteristics,
Characterizing and reaching high-risk excellent. and changing nature of
drinkers using audience segmentation. special populations, including
http://www.ncbi.nlm.nih.gov/pubmed/1941 Who typically uses the NESARC individuals with alcohol use
3650?ordinalpos=1&itool=EntrezSystem2. database and what are they looking for? disorders and others who are
PEntrez.Pubmed.Pubmed_ResultsPanel. affected by the use of alcohol;
Pubmed_DefaultReportPanel.Pubmed_ NESARC’s data have several practical
RVDocSum uses. It can help us understand high-risk
8 NIAAA Spectrum | Volume 1, Issue 1 | September 2009
• Estimate changes in alcohol use disorders and their associated disabilities
over time, and identify factors associated with the natural history of such
• Determine the number of individuals receiving alcohol treatment through NIAAA Spectrum is NIAAA’s first-ever
various programs and services, including those not otherwise represented webzine. With engaging feature articles,
in surveys of treatment facilities, as well as measuring the unmet need for short news updates, and colorful graphics,
alcohol treatment services and identifying barriers to seeking treatment. NIAAA Spectrum offers accessible and
relevant information on NIAAA and the
alcohol research field for a wide range of
Your background is in epidemiology, statistics, and survey research in alcohol. If audiences. Each issue includes feature-
you were not an alcohol researcher, what other career might you have pursued? length stories, news updates from the
field, charticles and photo essays, and an
I would have pursued a veterinary medicine surgical specialty or aspired to be a
interview with an NIAAA staff member
Justice on the U.S. Supreme Court. .
or alcohol researcher. NIAAA Spectrum is
published three times a year.
addITIonal nIaaa resourCes
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National Institute on Alcohol Abuse and
niaaa.nih.gov for other NIAAA alcohol research and Alcoholism (NIAAA)
5635 Fishers Lane, MSC 9304
education products. Bethesda, MD 20892-9304
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Publications/AlcoholAlerts) is NIAAA’S http://www.spectrum.niaaa.nih.gov
U.S. Department of Health
& Human Services
National Institutes of Health
National Institute on Alcohol Abuse
Number 78 July 2009
A D EVELOPMENTAL
P ERSPECTIVE ON
UNDERAGE ALCOHOL USE
and school settings, undergoing puberty, gaining greater
independence, and taking on more responsibilities. These
milestones may come earlier for some individuals than others,
depending on how quickly they mature, but tend to corre
quarterly bulletin that disseminates important
research findings on a single aspect of alcohol
spond, in general, to certain ages and developmental stages:
• Prenatal: prior to birth
Dramatic developmental changes unfold as individuals mature
from birth to childhood, from childhood to adolescence, • Ages 0–10: childhood
and from adolescence to early adulthood. These include • Ages 10–15: early to midadolescence
physiological changes—such as physical growth, brain • Ages 16–20: late adolescence
development, and puberty—as well as psychological and • Ages 21–25: transition to early adulthood
abuse and alcoholism.
social changes—such as an evolving sense of self, forming
more mature relationships with friends, and transitioning Each stage in development carries risks for alcohol use and
from middle school to high school. its consequences. Studies show that alcohol use typically begins
in early adolescence (ages 12–14) (1) and that between ages 12
Developmental changes factor into underage drinking. For and 21, rates of alcohol use and binge drinking 1 increase sharply
example, as a high school student transitions to college, he before leveling off in the twenties (see figure, page 3) (2).
or she may experience greater freedom and autonomy, creating
more opportunities to use alcohol. Underage drinking also
can influence development, potentially affecting the course How Developmental Factors
of a person’s life. For example, alcohol use can interfere with Influence Drinking and Risk
school performance and/or negatively affect peer relationships. for Drinking
This Alcohol Alert examines the complex relationship between Researchers are investigating the complex relationship
underage drinking and development: how developmental between developmental factors and alcohol use to better
factors influence drinking, the social and physical conse understand how the risks for drinking and alcoholrelated
quences of alcohol use, and how various developmental problems emerge across development.
stages can be specifically targeted to design more effective
measures for preventing or treating underage drinking. Personality and Behavior. Aspects of personality/temperament
and certain behaviors that are evident early in life—often
Key Stages in Human before children enter elementary school—such as antisocial
Development behavior, poor selfregulation, poor selfcontrol, anxiety, a
tendency toward depression, and shyness may predict initia
As children mature, they achieve key developmental mile tion of alcohol use in early adolescence, as well as future heavy
stones such as changing the way they relate to parents and use and alcohol use disorders (AUDs) (3,4). Individuals with
peers, beginning school and moving through different grades the most persistent personality and behavior problems are
those most likely to experience more chronic
“Chronic heavy drinking during and severe forms of AUDs in adulthood (5).
adolescence has been linked to Family Dynamics. Family dynamics also factor
into a child’s risk for underage drinking. When
cognitive deficits and alterations parents respond well to their child’s needs,
in brain activity and structure.”
Binge drinking is defined as consuming five or more drinks in a
row for men and four or more drinks in a row for women. Source:
Alcohol Research & Health (http://www.
is NIAAA’s quarterly, peer-reviewed scientific
Rethinking Drinking (http://rethinkingdrinking.
niaaa.nih.gov) is NIAAA’s newest resources
where individuals can evaluate their own
College Drinking—Changing the Culture
created by NIAAA, is your one-stop resource
for comprehensive research-based information
on issues related to alcohol abuse and binge
drinking among college students.