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A 5-year prospective evaluation of attributes associated with suicide attempts among alcohol-dependent persons identified factors that contributed to a small but significant proportion of the variance for future suicidal behavior.

Background All stages of development of alcohol use disorder (AUD) have not been equally studied. While initiation of drinking has been given considerable attention, other stages have not been as thoroughly investigated. It is not clear if the same factors are associated consistently across early and late transitions in AUD involvement. High risk family samples that are enriched for AUD vulnerability and transitions in AUD development offer an opportunity to examine influences across multiple stages of AUD development. Methods Data from adolescents and young adults from high risk families were used to study four transitions in AUD development –time to first drink, first drink to first problem, first drink to first diagnosis, and first problem to first diagnosis. Cox modeling was used to compare associations of parental AUD, parental separation, peer substance use, offspring ever-use of cannabis, trauma exposures and internalizing and externalizing psychopathology across transitions. Results Hazards of most transitions were elevated for those who had ever used cannabis, those who attributed substance use to their peers, those with externalizing disorders and those with parents with AUD. Many risk factors were linked to early initiation of alcohol, particularly cannabis use. Internalizing disorders were associated with later stages. Non-assaultive trauma was associated only with early initiation; assaultive trauma was not associated with any transition. . Conclusions In this large, ethnically-diverse sample of high risk youth, significant influences across transitions were fairly consistent, with externalizing disorders and cannabis ever-use elevating the likelihood of each stage, and peer and parental (and especially maternal AUD) influences linked to initiation and some later stages. Finally, in light of the increasingly permissive legal and social stances toward cannabis in the U.S., the marked elevations of all alcohol outcomes observed for cannabis use underscore the importance of studying the underpinnings of this relationship.

This article provides an overview of the characteristics of adolescent alcohol use, normative and subgroup variations in drinking behavior, and important factors associated with an increased risk for developing alcohol problems in later adolescence and young adulthood. A parental/family history of alcoholism, temperament traits, conduct problems, cognitive functioning, alcohol expectancies, and peer and other social relations are identified as influencing an adolescent's susceptibility for initiating a variety of alcohol use behaviors. The Deviance Prone Model, proposed by Sher (1991), is presented as an important tool for testing possible relationships among the various risk factors and their sequencing that leads to early adolescent alcohol and drug initiation and use. It is also possible to extend the model to allow for an examination of the complex interplay of risk factors that leads to the development of alcohol use problems in late adolescence and young adults. KeywordsAdolescents; alcohol use; vulnerability factors; deviance proneness Early adolescence is the key developmental period for the initiation of alcohol use that progresses on to regular use and problem drinking in mid-and later adolescence and young adulthood. This article provides an overview of the characteristics of adolescent alcohol use, normative and subgroup variations in drinking, and the factors associated with increased risk for developing alcohol problems. We present the Deviance Prone Model as a tool for examining the complex interactions between the risk factors reviewed. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptChild Adolesc Psychiatr Clin N Am. Author manuscript; available in PMC 2011 July 1. Figure 1 shows past year rates of drinking based on the 2007 National Survey on Drug Use and Health (NSDUH) for the U.S. population. The highest incidence and prevalence of alcohol abuse and dependence is seen in those drinkers ages 18-23, followed by ages 12-17 years 4 . Variations in Adolescent DrinkingAlcohol use behaviors vary by several sociodemographic characteristics, including ethnicity and gender, during adolescence 5 . Consequently, early onset alcohol use is associated with the early development of a variety of alcohol use problems and a more severe course of alcohol dependence [8][9][10] . Adolescent drinking behaviors appear to dependably predict later drinking and drinking problems in young adulthood 11 .Different trajectories of alcohol use (i.e., patterns of drinking overtime) have been identified among adolescents once drinking begins...

Even though the longitudinal outcomes of few empirically derived subtypes have been examined, alcoholism typologies remain a viable and potentially valuable tool for investigating etiological pathways, the effectiveness of treatments and the long-term course of alcohol use disorders.

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