Skip to main content Accessibility help
×
Home

Predicting persistent alcohol problems: a prospective analysis from the Great Smoky Mountain Study

  • W. E. Copeland (a1), A. Angold (a1), L. Shanahan (a2), J. Dreyfuss (a3), I. Dlamini (a4) and E. J. Costello (a1)...

Abstract

Background

Rates of alcohol disorders peak in late adolescence and decrease substantially into the mid-20s. Our aim was to identify risk factors that predict alcohol problems that persist into the mid-20s.

Method

Data are from the prospective, population-based Great Smoky Mountains Study (GSMS; n=1420), which followed children through late adolescence and into young adulthood. Alcohol persisters were defined as subjects with an alcohol disorder (abuse or dependence) in late adolescence (ages 19 and 21 years) that continued to meet criteria for an alcohol disorder at the mid-20s assessment.

Results

The 3-month prevalence of having an alcohol disorder (abuse or dependence) decreased markedly from late adolescence into the mid-20s. A third of late adolescents with an alcohol disorder continued to meet criteria for an alcohol disorder in young adulthood (37 of 144 who met criteria in late adolescence). Risk factors for persister status included multiple alcohol abuse criteria during late adolescence but no alcohol dependence criteria. Risk factors for persister status also included associated features of alcohol dependence such as craving alcohol and drinking to unconsciousness. Persister status was also associated with depression, cannabis dependence and illicit substance use, but not with other psychiatric disorders. More than 90% of late adolescents with three or more of the risk factors identified met criteria for a young adult alcohol disorder.

Conclusions

Symptoms of alcohol abuse, not dependence, best predict long-term persistence of alcohol problems. The set of risk factors identified may be a useful screen for selective and indicated prevention efforts.

Copyright

Corresponding author

*Address for correspondence: W. E. Copeland, Ph.D., Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3454, Durham NC 27710, USA. (Email: William.Copeland@duke.edu)

References

Hide All
Angold, A, Costello, EJ (1995). A test-retest reliability study of child-reported psychiatric symptoms and diagnoses using the Child and Adolescent Psychiatric Assessment (CAPA-C). Psychological Medicine 25, 755762.
Angold, A, Costello, EJ (2000). The Child and Adolescent Psychiatric Assessment (CAPA). Journal of the American Academy of Child and Adolescent Psychiatry 39, 3948.
Angold, A, Cox, A, Prendergast, M, Rutter, M, Simonoff, E, Costello, EJ, Ascher, BH (1999). The Young Adult Psychiatric Assessment (YAPA). Duke University Medical Center: Durham, NC.
Ascher, BH, Farmer, EMZ, Burns, BJ, Angold, A (1996). The Child and Adolescent Services Assessment (CASA): description and psychometrics. Journal of Emotional and Behavioral Disorders 4, 1220.
Babor, TF, Hofmann, M, Delboca, FK, Hesselbrock, V, Meyer, RE, Dolinsky, ZS, Rounsaville, B (1992). Types of alcoholics, I: Evidence of an empirically derived typology based on indicators of vulnerability and severity. Archives of General Psychiatry 49, 599608.
Bachman, JG, O'Malley, PM, Sscheulenberg, JE, Johnston, LD, Bryant, AL, Merline, AC (2002). The Decline of Substance Use in Young Adulthood: Changes in Social Activities, Roles and Beliefs. Erlbaum: Mahwah, NJ.
Casey, BJ, Giedd, JN, Thomas, KM (2000). Structural and functional brain development and its relation to cognitive development. Biological Psychology 5, 241257.
Chen, K, Kandel, DB (1995). The natural history of drug use from adolescence to the mid-thirties in a general population sample. American Journal of Public Health 85, 4147.
Chen, K, Kandel, DB (1998). Predictors of cessation of marijuana use: an event history analysis. Drug and Alcohol Dependence 50, 109121.
Cloninger, CR (1988). Etiologic factors in substance abuse: an adoption study perspective. NIDA Research Monograph 89, 5272.
Costello, EJ, Angold, A, Burns, B, Stangl, D, Tweed, D, Erkanli, A, Worthman, C (1996). The Great Smoky Mountains Study of Youth: goals, designs, methods, and the prevalence of DSM-III-R disorders. Archives of General Psychiatry 53, 11291136.
Costello, EJ, Copeland, W, Cowell, A, Keeler, G (2007). Service costs of caring for adolescents with mental illness in a rural community, 1993–2000. American Journal of Psychiatry 164, 3642.
Costello, EJ, Mustillo, S, Erkanli, A, Keeler, G, Angold, A (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry 60, 837844.
Dawson, DA, Goldstein, RB, Grant, BF (2007). Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up. Alcoholism: Clinical and Experimental Research 31, 20362045.
Dawson, DA, Grant, BF, Stinson, FS, Zhou, Y (2005). Effectiveness of the derived Alcohol Use Disorders Identification Test (AUDIT-C) in screening for alcohol use disorders and risk drinking in the US general population. Alcoholism: Clinical and Experimental Research 29, 844854.
De Bruijn, C, van den Brink, W, De Graaf, R, Vollebergh, WAM (2006). The three year course of alcohol use disorders in the general population: DSM-IV, ICD-10 and the Craving Withdrawal Model. Addiction 101, 385392.
Delucchi, KL, Matzger, H, Weisner, C (2008). Alcohol in emerging adulthood: 7-year study of problem and dependent drinkers. Addictive Behaviors 33, 134142.
Farrington, DP (1983). Offending from 10 to 25 years of age. In Prospective Studies of Crime and Delinquency (ed. Vandusen, K. T. and Mednick, S. A.), pp. 1738. Kluwer-Nijhoff: Boston, MA.
Grant, BF, Dawson, DA, Stinson, FS, Chou, SP, Dufouf, MC, Pickering, RP (2004). The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002. Drug and Alcohol Dependence 74, 223234.
Grant, BF, Stinson, FS, Harford, T (2001). The 5-year course of alcohol abuse among young adults. Journal of Substance Abuse 13, 229238.
Guo, J, Collins, LM, Hill, KG, Hawkins, JD (2000). Developmental pathways to alcohol abuse and dependence in young adulthood. Journal of Studies on Alcohol 61, 799808.
Harford, TC, Grant, BF, Yi, HY, Chen, CM (2005). Patterns of DSM-IV alcohol abuse and dependence criteria among adolescents and adults: results from the 2001 National Household Survey on Drug Abuse. Alcoholism, Clinical and Experimental Research 29, 810828.
Harrington, DM, McBride, RS (1970). Traffic violations by type, age, sex, and marital status. Accident Analysis and Prevention 2, 6779.
Hasin, D, Grant, B, Endicott, J (1990). The natural history of alcohol abuse: implications for definitions of alcohol use disorders. American Journal of Psychiatry 147, 15371541.
Hasin, DS, Stinson, FS, Ogburn, E, Grant, BF (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 64, 830842.
Hasin, DS, Van Rossem, R, McCloud, S, Endicott, J (1997). Differentiating DSM-IV alcohol dependence and abuse by course: community heavy drinkers. Journal of Substance Abuse 9, 127135.
Hawkins, JD, Catalano, RF, Miller, JY (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: implications for substance abuse prevention. Psychological Bulletin 112, 64–105.
Jackson, KM, O'Neill, SE, Sher, KJ (2006). Characterizing alcohol dependence: transitions during young and middle adulthood. Experimental and Clinical Psychopharmacology 14, 228244.
Kandel, DB, Raveis, VH (1989). Cessation of illicit drug use in young adulthood. Archives of General Psychiatry 46, 109116.
Kaplow, JB, Curran, PJ, Angold, A, Costello, EJ (2001). The prospective relation between dimensions of anxiety and the initiation of adolescent alcohol use. Journal of Clinical Child Psychology 30, 316326.
Kosterman, R, Hawkins, J, Guo, J, Catalano, R, Abbott, R (2000). The dynamics of alcohol and marijuana initiation: patterns and predictors of first use in adolescence. American Journal of Public Health 90, 360366.
Kraemer, HC (1992). Evaluating Medical Tests: Objective and Quantitative Guidelines. Sage Publications: Thousand Oaks, CA.
Littlefield, A, Sher, K, Wood, P (2009). Is ‘maturing out’ of problematic alcohol involvement related to personality change? Journal of Abnormal Psychology 118, 360374.
Littlefield, AK, Sher, KJ, Wood, PK (2010). A personality-based description of maturing out of alcohol problems: extension with a five-factor model and robustness to modeling challenges. Addictive Behaviors 35, 948954.
Maggs, JL, Schulenberg, JE (2004/2005). Trajectories of alcohol use during the transition to adulthood. Alcohol Research and Health 28, 195201.
Martin, A, Srihari, V (2006). Geometrically evident: framing studies using the Graphic Appraisal Tool for Epidemiology (GATE). Journal of the American Academy of Child and Adolescent Psychiatry 45, 15211526.
Nakao, K, Treas, J (1992). The 1989 Socioeconomic Index of Occupations: Construction from the 1989 Occupational Prestige Scores. GSS Methodological Report No. 74. National Opinion Research Center: Chicago, IL.
Pagan, JL, Rose, RJ, Viken, RJ, Pulkkinen, L, Kaprio, J, Dick, DM (2006). Genetic and environmental influences on stages of alcohol use across adolescence and into young adulthood. Behavior Genetics 36, 483497.
Pirkola, SP, Poikolainen, K, Lonnqvist, JK (2006). Currently active and remitted alcohol dependence in a nationwide adult general population – results from the Finnish Health 2000 study. Alcohol and Alcoholism 41, 315320.
Rumpf, HJ, Bischof, G, Hapke, U, Meyer, C, John, U (2000). Studies on natural recovery from alcohol dependence: sample selection bias by media solicitation? Addiction 95, 765775.
Saha, TD, Chou, SP, Grant, BF (2006). Toward an alcohol use disorder continuum using item response theory: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine 36, 931941.
Sampson, R, Laub, J (2003). Life-course desisters? Trajectories of crime among delinquent boys followed to age 70. Criminology 41, 555592.
Schuckit, MA, Smith, TL, Landi, NA (2000). The 5-year clinical course of high-functioning men with DSM-IV alcohol abuse or dependence. American Journal of Psychiatry 157, 20282035.
Smart, R (2007). Natural recovery or recovery without treatment from alcohol and drug problems as seen from survey data. In Promoting Self-Change from Addictive Behaviors (ed. Klingemann, H. and Sobell, L. C.), pp. 5972. Springer: New York.
Staff, J, Schulenberg, JE, Maslowsky, J, Bachman, JG, O'Malley, PM, Maggs, JL, Johnston, LD (2010). Substance use changes and social role transitions: proximal developmental effects on ongoing trajectories from late adolescence through early adulthood. Development and Psychopathology 22, 917932.
Tarter, RE (2002). Etiology of adolescent substance abuse: a developmental perspective. American Journal on Addictions 11, 171191.
Thompson, PM, Giedd, JN, Woods, RP, Macdonald, D, Evans, AC, Toga, AW (2000). Growth patterns in the developing brain detected by using continuum mechanical tensor maps. Nature 404, 190193.
Webb, JA, Baer, PE, McLaughlin, RJ, McKelvey, RS, Caid, CD (1991). Risk factors and their relation to initiation of alcohol use among early adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 30, 563568.
Yamaguchi, K, Kandel, DB (1985). On the resolution of role incompatibility: a life event history analysis of family roles and marijuana use. American Journal of Sociology 90, 12841325.
Zucker, RA (2008). Anticipating problem alcohol use developmentally from childhood into middle adulthood: what have we learned? Addiction 103, 100108.
Zucker, RA, Fitzgerald, HE, Moses, HD (1995). Emergence of alcohol problems and the several alcoholisms: a developmental perspective on etiologic theory and life course trajectory. In Developmental Psychopathology. Volume 2. Risk, Disorder, and Adaptation (ed. Cicchetti, D. and Cohen, D. J.), pp. 677711. John Wiley & Sons, Inc.: New York, NY.

Keywords

Related content

Powered by UNSILO

Predicting persistent alcohol problems: a prospective analysis from the Great Smoky Mountain Study

  • W. E. Copeland (a1), A. Angold (a1), L. Shanahan (a2), J. Dreyfuss (a3), I. Dlamini (a4) and E. J. Costello (a1)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.