In support of the 2005 update of the U.S. Department of Agriculture/U.S. Department of Health and Human Services Dietary Guidelines, the National Institute on Alcohol Abuse and Alcoholism was asked to assess the strength of the evidence related to health risks and potential benefits of moderate alcohol consumption, with particular focus on the areas of cardiovascular disease, breast cancer, obesity, birth defects, breastfeeding, and aging. The findings were reviewed by external researchers with extensive research backgrounds on the consequences and benefits of alcohol consumption. This report now serves as the National Institutes of Health's formal position paper on the health risks and potential benefits of moderate alcohol use.

A developmental framework for understanding and addressing the problem of underage alcohol consumption is presented. The first section presents the rationale for a developmental approach, including striking age-related data on patterns of onset, prevalence, and course of alcohol use and disorders in young people. The second section examines the fundamental meaning of a developmental approach to conceptualizing underage drinking. The third section delineates contemporary principles of developmental psychopathology as a guide to future research and intervention efforts. Strategic, sensitive, and effective efforts to address the problem of underage drinking will require a developmentally informed approach to research, prevention, and treatment. D EVELOPMENTAL APPROACHES TO understanding and addressing the problem of underage drinking are essential, not only because this problem occurs in a developing organism but also because accumulating evidence strongly implicates the role of development in promising theories and interventions concerning this problem. It is increasingly clear that the emergence and progression of drinking behavior are influenced by development, that underage drinking has developmental consequences, that alcohol use disorders (AUDs) are developmental in nature, and that efforts to prevent or to reduce underage drinking behavior must be developmentally informed to be strategic, sensitive, and effective. Our goals in this article are to summarize the case for a developmental perspective on underage drinking and to outline a developmental framework for underage drinking, to guide future theory, research, and practice. This framework emerged from the collaborative work of an advisory group assembled by the National Institute on Alcohol Abuse and Alcoholism in 2004 as part of the Underage Drinking Research Initiative.The framework is presented in 3 sections. In the first section, we highlight the rationale for a developmental approach, including examples of data that the advisory group members found compelling as a rationale for developmental perspectives. In the second section, we discuss general developmental principles that guided our thinking, with examples of their application to drinking behavior. In the third section, we articulate principles of contemporary developmental psychopathology as applied to the problem of underage drinking. RATIONALE FOR A DEVELOPMENTAL APPROACH TO UNDERAGE DRINKING FocusWhen the evidence on drinking behavior is examined through a developmental lens, the rationale for a developmental approach to understanding and preventing this problem comes into focus. In this section, we highlight conclusions based on the most salient data supporting a developmental approach.There Are Striking Age-Related Patterns of Alcohol Use, Problems, Abuse, and Dependence Alcohol use typically begins in the second decade of life, often in early adolescence. Although some young people begin drinking in elementary school, the first use of alcohol (defined as drinking a whole drink) typ...

Background There is limited information on the validity of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol use disorders (AUD) symptom criteria among adolescents in the general population. The purpose of the present study is to assess the DSM-IV AUD symptom criteria as reported by adolescent and adult drinkers in a single representative sample of the U.S. population ages 12 years and older. This design avoids potential confounding due to differences in survey methodology when comparing adolescents and adults from different surveys. Methods A total of 133,231 current drinkers (had at least one drink in the past year) ages 12 years and older were drawn from respondents to the 2002–2005 National Surveys on Drug Use and Health. DSM-IV AUD criteria were assessed by questions related to specific symptoms occurring during the past 12 months. Factor analytic (FA) and item response theory (IRT) models were applied to the 11 AUD symptom criteria to assess the probabilities of symptom item endorsements across different values of the underlying trait. Results A one-factor model provided an adequate and parsimonious interpretation for the 11 AUD criteria for the total sample and for each of the gender-age groups. The MIMIC model exhibited significant indication for item bias among some criteria by gender, age, and race/ethnicity. Symptom criteria for “tolerance,” “time spent,” and “hazardous use” had lower item thresholds (i.e., lower severity) and low item discrimination, and they were well separated from the other symptoms, especially in the two younger age groups (12–17 and 18–25). “Larger amounts,” “cut down,” “withdrawal,” and “legal problems” had higher item thresholds but generally lower item discrimination, and they tend to exhibit greater dispersion at higher AUD severity, particularly in the youngest age group (12–17). Conclusions Findings from the present study do not provide support for the two separate DSM-IV diagnoses of alcohol abuse and dependence among either adolescents or adults. Variations in criteria severity for both abuse and dependence offer support for a dimensional approach to diagnosis which should be considered in the ongoing development of DSM-V.

Drinking frequency provides an empirically supported brief screen to efficiently identify youth with alcohol-related problems.

A more nuanced understanding of the initiation of drinking can have important implications for prevention.

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Opioid use disorder is a leading cause of morbidity and mortality among US youth. Effective treatments, both medications and substance use disorder counseling, are available but underused, and access to developmentally appropriate treatment is severely restricted for adolescents and young adults. Resources to disseminate available therapies and to develop new treatments specifically for this age group are needed to save and improve lives of youth with opioid addiction.

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