Alcohol Dependence or Abuse
and Age at First Use

In Brief

  • In 2003, males aged 21 or older were more likely than females to report having first used alcohol before age 15
  • Persons reporting first use of alcohol before age 15 were more than 5 times as likely to report past year alcohol dependence or abuse than persons who first used alcohol at age 21 or older
  • Among the 14 Million adults ages 21 or older who were classified as having past year alcohol dependence or abuse, more than 13 million (95 percent) had started using alcohol before age 21

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 aged 21 or older who first used alcohol before 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.

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). 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.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).

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. 3 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.

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 using alcohol before age 21. Only 5 percent (fewer than 1 million 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.
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