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fact, much of the causal structure underlying youthful alcohol use and abuse is not specific to alcohol (Kendler et al. 2003; Tsuang et al. 1998; Zucker 2006). Individual Factors That |
Influence Risk Two significant developmental processes that emerge at birth are tied to the later development of alcohol-related problems. The first process involves emotion and its control; the second involves |
behavior and attention. The ability to display emotion at varying levels of intensity, and the capacity to regulate it based on level of arousal and context, are core temperamental characteristics |
of all human beings that are uniquely expressed in each child, with differences among children observable at birth. The second developmental process involves behavior and attention. Differences in activity level |
among infants exist prenatally and are obvious immediately after birth. Infants differ in how quickly they respond to touch, sound, and light as well as in how much they move. |
Likewise, they manifest differences in the degree to which they can maintain their attention on an object and shift that attention with the presentation of new stimuli. Such differences in |
response signal differences in a child’s rudimentary behavioral regulation and control system and in a child’s attention regulation and control system. Learning, planning, and thinking ahead require the development of |
strong self-control systems. When the systems are weak, social and academic achievement become more difficult, and the risk for substance use disorders increases substantially. One theory on the development of |
alcohol use disorders proposes that the delayed or inadequate development of behavioral, emotional, and cognitive regulation is a central dysregulatory trait that plays an important role in the early emergence |
of substance use disorders (Tartar et al. 2004). This hypothesis is supported by a significant body of evidence (Caspi et al. 1996; Clark et al. 2005). The developmental processes of |
emotional, behavioral, and attentional control also are related to alcohol use and its progression into problem use. As a result, researchers have attempted to identify traits that reflect the early |
development of these processes. Over the past two decades, data from several longitudinal studies (Caspi et al. 2002; Cloninger et al. 1988; Eron et al. 1987; Masse and Tremblay 1997; |
Mayzer et al. 2002) have provided convincing evidence of the existence of two traits arising very early in life that appear to be markers for early alcohol use, heavy use, |
problem use, and alcohol use disorder years later. The two traits that have been identified are externalizing behaviors and, to a lesser degree, internalizing behaviors. Furthermore, research has shown that |
these traits remain relatively stable throughout childhood and adolescence (Fuller et al. 2003; Olweus 1979) and that those individuals exhibiting the highest persistence of self-regulatory problems are the most likely |
to have the more chronic and severe forms of substance use disorder in adulthood (Biglan et al. 2004; Campbell et al. 2000). Externalizing behaviors in children are behavior problems reflecting |
emotional, behavioral, and attention undercontrol directed outward toward others—that is, aggressiveness or refusal to comply with instructions, impulsivity, and attention deficits, which usually result in academic problems in school (Biglan |
et al. 2004; Campbell et al. 2000; Patterson et al. 1998). Children with externalizing behaviors often have the added problem of coming from a disadvantaged family. The parents of these |
children may have mental health or behavior problems, including alcohol abuse or antisocial personality. Poor discipline exists within such families, external resources are scarce (Buu et al. 2007), and the |
children often are described as exhibiting high negative emotionality or difficult temperaments. In late childhood and early adolescence, a percentage of these children disengage from school, start to associate with |
deviant peers, exhibit increasingly risky behaviors, and engage in delinquent behavior. Even before the transition to adolescence, these young people are at elevated risk for alcohol use and the behaviors |
associated with it, including early and risky sexual activities, truancy, and the like. Internalizing behaviors constitute the second trait domain implicated by the longitudinal data on risk for underage drinking. |
These behaviors already are emerging in early childhood, but they are not as easily detected in this age-group because they largely are aspects of inner experience, like anxiety, sadness, and |
depression. Only shyness and social inhibition are more readily evident to the casual observer and, thus, have been more clearly linked to later problem-drinking outcomes (Caspi et al. 1996; Kellam |
et al. 1982). More generally, evidence is weaker for this internalizing pathway to early alcohol use than for the externalizing pathway, although there appears to be a link between adolescent |
depression and alcohol initiation (Kaplow et al. 2001). The evidence is considerably stronger, however, for an internalizing pathway to alcohol use disorder (Chilcoat and Anthony 1996). Other factors that can |
be identified in young children and have been associated with future alcohol problems include early childhood sleep problems (Wong et al. 2004) and deficits in attention (Molina and Pelham 2003). |
Environmental and Social Factors That Influence Risk Environmental factors influence the development of risk as well as the development of protective factors. Stress, nurturance, physical abuse, observed family conflict, and |
other aspects of social interaction affect the brain by changing the development of neural networks or by producing hormones that alter that development. These early environmental experiences affect the attention |
regulation and control system. An increasing body of evidence suggests that they also play a role in the development of drinking behavior. Early stress, for example, affects the brain areas |
and neurochemical systems that are involved in impulse control and the brain’s reward circuitry. These systems can increase the risk for alcoholism by facilitating the onset of drinking, the maintenance |
of drinking behavior, and relapse. An infant’s ability to display, as well as regulate, emotion reflects a process of social interaction between the infant and his or her caretakers (Zucker |
et al. 2000). The degree of attentiveness and responsiveness of the mother influences both the infant’s emotional display and emotional regulation. As the infant matures, the mother’s social environment, including |
her relationships with the father and with other adults in her support network, also have an influence (Eckenrode et al. 2001; Eiden et al. 2004), as does her own prior |
social experience, including a history of physical, sexual, or emotional abuse or other trauma. Fathers, too, make a contribution to this process, even early in the life of the child. |
Alcoholic fathers, for example, are less sensitive and express greater negative affect toward their children than do nonalcoholic fathers, which, in turn, lowers infant responsivity to the parents (Eiden et |
al. 2004). Paternal depression, antisocial behavior, and aggression also are associated with lower parental sensitivity. Parental responsiveness to a child’s needs gradually increases the self-regulatory capacity of the child (Calkins |
1994). Parents who are depressed, antisocial, or aggressive toward their children and who create a conflict-ridden family atmosphere reduce their children’s capacity to regulate and control their own behavior (Campbell |
et al. 2000). In addition, early exposure to alcohol and other drug use by parents and peers is a risk for underage alcohol use. By contrast, the most effective family |
environments for reducing externalizing behavior in children and adolescents (Campbell et al. 2000) and, ultimately, for reducing drug involvement in adolescence (Shedler and Block 1990), are those characterized by greater |
outside of scientific circles to mean the capacity to foretell a specific event. Scientific prediction means that there is a greater likelihood of an outcome occurring in a group where |
the “predictor” is present than in a group where it is not. In scientific research, a predictor can predict more than one outcome. A predictor states that there is, for |
example, a relationship between those people who exhibit behavior A now and those people who will exhibit behavior B later. That prediction does not mean that every person who exhibits |
behavior A now will end up exhibiting behavior B later. It does mean that in the population exhibiting behavior A now, a greater-than-expected portion will exhibit behavior B later, but |
it is not possible to identify specific members of the population who will do so. A predictor, in other words, does not foretell an individual’s destiny. Therefore, a child with |
certain predictors for alcohol abuse will not necessarily abuse alcohol later in life, just as a child not predicted to abuse alcohol later may do so. The concept of prediction |
is important, however, because it makes it possible to target specific populations in which a substantial percentage is at risk for problem behavior and to intervene in those populations. Predictors |
of Childhood-Onset Drinking (Initiation Before Age 13). The low rates of alcohol use in children (Kaplow et al. 2002; Oxford et al. 2001; Sobeck et al. 2000) have precluded the |
conduct of extensive longitudinal studies focused on that issue. Instead, longitudinal research has investigated adolescent, young adult, or adult alcohol use. When childhood initiation has been studied, the focus has |
been on more general substance use (i.e., alcohol, tobacco, or marijuana use). Significant predictors of children’s substance use initiation include less parental monitoring, fewer parental rules, lessened parent–child attachment, single-parent |
families, parental tolerance of substance use, and parental drug abuse. Deviant peer affiliation, social skills deficits, peer drug use, and overactivity in the child also are predictors. A study of |
children tested at ages 4–5, 9–10, and 14 (Baumrind 1985) found that less social assertiveness was associated with earlier ages of alcohol initiation for both sexes. For girls, earlier onset |
also was related to less parental responsiveness and to less encouragement of the child’s individuality at age 4 and to less parental monitoring and lower socioeconomic status at age 9. |
Earlier onset of alcohol use for boys was related to less parental encouragement of independence and individuality at age 4 and to less individuation and self-confidence at age 9. When |
a child used alcohol for the first time in the early years of elementary school, it was generally the result of an adult—usually a parent or close family member—introducing the |
child to the substance. Later ages of initiation generally resulted from peer introductions. Childhood Predictors of Early Adolescent Drinking. A variety of studies involving both high-risk and general population samples |
have identified childhood predictors of early-onset alcohol use. (Because approximately half of the population has not used alcohol prior to age 15, use before that age is considered “early use” |
or “early-onset” drinking.) The Seattle Social Development Study (Hawkins et al. 1997) of high-risk youth found that at ages 10–11, the following factors predicted early-age initiation of alcohol use: Greater |
parental drinking; Less bonding to school; and Having more friends who drink. A study of high-risk boys from Pittsburgh (Clark et al. 1999) found that early-onset alcohol use through age |
15 (using at least one standard drink per episode as the criterion) was predicted by antisocial disorder (i.e., conduct disorder and oppositional defiant disorder). Attention deficit hyperactivity disorder (ADHD) or |
negative-affect disorder (anxiety or mood disorder), however, were not predictors. A community-based sample of high-risk families (Wong et al. 2004) identified the following predictors of alcohol use by ages 12–14: |
Mothers’ ratings of early childhood sleep problems; Trouble sleeping; and Being overtired at ages 3–5. A study of a lower-socioeconomic-status sample of boys from Montreal (Dobkin et al. 1995) found |
the following: Ratings of fighting and hyperactivity at age 6 and ratings of the boys’ aggressiveness and their friends’ aggressiveness at age 10 predicted the onset of drunkenness at age |
13. Drunkenness by age 15 was predicted by teacher ratings of higher novelty seeking and lower harm avoidance at ages 6 and 10 (Masse and Tremblay 1997). Studies of population |
samples suggest that the early initiation of alcohol use in these community groups is predicted by factors that are very similar to those found in studies of high-risk samples. Based |
on 10- to 12-year-old abstainers selected from the Minnesota Twin Family Study, predictors of alcohol initiation at age 14 included conduct disorder, oppositional defiant disorder, and any externalizing disorder (McGue |
et al. 2001). Major depressive disorder and ADHD were not predictors. Another study using the same sample (King et al. 2004) found the same externalizing factors to predict regular use, |
at least one episode of drunkenness, and heavy drinking at age 14. Other studies confirm the Minnesota findings and add the following predictors: In the Ontario Child Health Study, children |
rated by teachers as having conduct disorder at ages 8–12 were more likely to be regular drinkers 4 years later (Boyle et al. 1993). In a birth cohort study of |
New Zealand children, conduct problems at age 8 predicted the usual intake of alcohol, maximum intake of alcohol, and alcohol-related problems experienced before the age of 15. These predictors held |
even after controlling for gender, family socioeconomic status, parental illicit drug use, and parental conflict, all of which also relate to later alcohol use (Lynskey and Fergusson 1995). In the |
same New Zealand study, childhood attention deficit behaviors were not related to alcohol behaviors and problems at age 15; these findings are similar to the results found by McGue and |
colleagues (2001). In the Finnish Twin Study, less parental monitoring and a poorer home environment assessed at ages 11–12 predicted alcohol use by age 14 (Rose et al. 2001). Also |
in the Finnish Twin Study, greater behavior problems and male gender predicted alcohol use by age 14 (Rose et al. 2001). Genetic analyses from this study indicate that shared environmental |
influences are more important than heredity in drinking initiation during early adolescence. In the Great Smoky Mountain Epidemiologic Study of Youth, predictors of initiating alcohol use within 4 years after |
initial testing at ages 9, 11, and 13 included greater depression, less separation anxiety, and greater generalized anxiety (Kaplow et al. 2001). Multiple studies have correlated early pubertal maturation in |
girls with early-onset alcohol use (Deardorff et al. 2005; Wiesner and Ittle 2002; Wilson et al. 1994). This correlation usually is explained by the girls’ affiliation with older, drinking peers, |
but other explanations are possible. Childhood Predictors of Middle-Adolescent Drinking. Findings about childhood predictors of middle-adolescent drinking include the following: In the Woodlawn Study, teacher ratings of aggressiveness in 1st-grade |
African-American boys predicted more frequent use of alcohol at ages 16–17 (Kellam et al. 1982). That finding did not hold for girls. Similarly, a trend for shyness related to less |
alcohol use by boys but not by girls. Childhood symptoms of inattention measured at ages 5–12 predicted frequency of drunkenness and adolescent alcohol problems in a controlled study of children |
diagnosed with ADHD (Molina and Pelham 2003). Greater extraversion and deficits in reading achievement predicted earlier onset of regular drinking and drinking with negative consequences in a study of families |
at high risk for alcoholism because of a family history of alcoholism that included many relatives (Hill et al. 2000). These findings are in contrast to the findings from a |
large general population sample (Kellam et al. 1982). Childhood Predictors of Adolescent Problem Drinking. Early childhood predictors of problem drinking in adolescence have been studied in longitudinal samples involving high-risk |
youth. Two such studies found the following: In the Seattle Social Development project, being male and initiating drinking at an earlier age were the strongest childhood predictors of problem drinking |
at age 16 (Hawkins et al. 1997). The effects of parental drinking, friends’ drinking, school bonding, perceived harm of drinking, and other age 10–11 predictors were mediated by age of |
initiation. In other words, the importance of each of these factors varied depending on the age at which the child started to drink. In the Michigan Longitudinal Study, a slower |
rate of increase in behavioral control from preschool through middle childhood predicted more drunkenness and more problem alcohol use in adolescence in a study of high-risk youth (Wong et al. |
2006). Childhood Predictors of Young Adult Problem Drinking/Alcohol Dependence. Longitudinal studies that have followed children into young adulthood to assess their experience with alcohol problems have identified a variety of |
childhood predictors based on individual differences and early contextual influences. These findings include the following: Aggressiveness at age 8 predicted problem drinking at age 26 for boys, but not for |
girls, in a sample of Finnish children (Pulkkinen and Pitkanen 1994). Poor response inhibition predicted early initiation of drunkenness and problem use even when conduct problems were controlled (Nigg et |
al. 2006). Childhood aggression at ages 5–10, expressed as anger, sibling aggression, noncompliance, temper, and nonconforming behavior, was related to DSM–III–R alcohol abuse at ages 16–21 in a New York |
community sample (Brook et al.1992). A lower ability to concentrate and lower levels of school achievement at age 10 were related to hazardous use of alcohol prior to age 21 |
in a study of males from prenatal clinics in Sweden (Wennberg and Bohman 2002). “Hazardous use” consisted of public drunkenness and drunken driving ascertained from police register data and high |
levels of reported alcohol intake. Parental conflict over childrearing and maternal rejection of the child assessed when the child was age 3 were found in the New York Longitudinal Study |
to predict more severe alcohol involvement when the child was age 19 (Vicary and Lerner 1986). Childhood Predictors of Adult Alcohol Use and Alcohol Use Disorders. Studies that link childhood |
data to follow-up data on alcohol use and alcohol use disorders (i.e, alcohol abuse and/or dependence) collected after young adulthood, although rare, found the following: Boys, but not girls, from |
a birth cohort study of children from Dunedin, New Zealand, who exhibited undercontrol by being impulsive, restless, and distractible at age 3, were twice as likely as control children to |
have a diagnosis of alcohol dependence at age 21 (Caspi et al. 1996). Low conscientiousness and high sociability ratings at age 12 related modestly to alcohol involvement at ages 40–50 |
in the Terman Life-Cycle Study (Tucker et al 1995). Higher teacher ratings of extraversion and lower ratings of emotional stability among Hawaiian elementary school children were associated with greater adult |
alcohol intake when followed up at the average age of 45 (Jahoda and Cramond 1972). Higher ratings on novelty seeking and lower ratings on harm avoidance and reward dependence at |
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