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From alcohol initiation to tolerance to problems: Discordant twin modeling of a developmental process

Published online by Cambridge University Press:  15 July 2016

Arielle R. Deutsch*
University of Missouri–Columbia Washington University School of Medicine
Wendy S. Slutske
University of Missouri–Columbia Washington University School of Medicine
Michael T. Lynskey
Washington University School of Medicine King's College London
Kathleen K. Bucholz
Washington University School of Medicine
Pamela A. F. Madden
Washington University School of Medicine
Andrew C. Heath
Washington University School of Medicine
Nicholas G. Martin
QIMR Berghofer Medical Research Institute
Address correspondence and reprint requests to: Arielle R. Deutsch, Department of Psychological Sciences, University of Missouri–Columbia, 112 Psychology Building, Columbia, MO 65211; E-mail:


The current study examined a stage-based alcohol use trajectory model to test for potential causal effects of earlier drinking milestones on later drinking milestones in a combined sample of two cohorts of Australian monozygotic and same-sex dizygotic twins (N = 7,398, age M = 30.46, SD = 2.61, 61% male, 56% monozygotic twins). Ages of drinking, drunkenness, regular drinking, tolerance, first nontolerance alcohol use disorder symptom, and alcohol use disorder symptom onsets were assessed retrospectively. Ages of milestone attainment (i.e., age-of-onset) and time between milestones (i.e., time-to-event) were examined via frailty models within a multilevel discordant twin design. For age-of-onset models, earlier ages of onset of antecedent drinking milestones increased hazards for earlier ages of onset for more proximal subsequent drinking milestones. For the time-to-event models, however, earlier ages of onset for the “starting” milestone decreased risk for a shorter time period between the starting and the “ending” milestone. Earlier age of onset of intermediate milestones between starting and ending drinking milestones had the opposite effect, increasing risk for a shorter time period between the starting and ending milestones. These results are consistent with a causal effect of an earlier age of drinking milestone onset on temporally proximal subsequent drinking milestones.

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Copyright © Cambridge University Press 2016 

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This work was supported by National Institute on Drug Abuse Grant DA18267 and National Institute on Alcohol Abuse and Alcoholism Grants AA07728 and AA023133. We thank Leah Richmond-Rackerd for her feedback on the manuscript; Dixie Statham for coordinating the data collection for the twins; and David Smyth, Olivia Zheng, and Harry Beeby for data management of the Australian Twin Registry. We thank the Australian Twin Registry twins for their continued participation.


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