Predicting Future Drinking Patterns in Adolescents

Robert Gerchalk

Robert is our health care professional reviewer of this website. He worked for many years in mental health and substance abuse facilities in Florida, as well as in home health (medical and psychiatric), and took care of people with medical and addictions problems at The Johns Hopkins Hospital in Baltimore. He has a nursing and business/technology degrees from The Johns Hopkins University.

Think you have a drinking problem?

If you suspect you might have a drinking problem, don't wait to seek help. Call our hotline now for confidential advice, support, and the first step towards understanding your relationship with alcohol and beginning your journey to recovery.

What if there was a way to tell whether or not a teenager was going to grow up and be a heavy drinker? If we knew an adolescent was going to be a heavy drinker later in life, could we prevent it from happening? A research team from the Medical University of South Carolina (MUSC) recently attempted to do so in a study published recently, and so far they’ve been successful.

Adolescent drinking is completely out of control in this country. Alcohol is the most commonly abused drug among US youth, reports the Centers for Disease Control (CDC). Nearly 5,000 underage drinkers die each year, and nearly 200,000 ER visits are linked to alcohol each year. That’s about 12 deaths and 518 hospital visits every single day from underage drinking. Adolescents consume more than one out of every ten drinks, 11%, and almost all of it is consumed while binge drinking.

Not enough tragedy for you? 1/3 of high-schoolers drink, 1/5 of them have ridden with a drunk driver, and 1/10 of them have driven drunk themselves. Even eighth-graders are drinking – one out of ten of them on average. Adolescents who drink are more likely to experience problems with school, social life, the law, physical and mental development, unwanted sexual activity, violence, memory issues, and the abuse of other substances.

And here’s the kicker. According to the CDC, “Youth who start drinking before age 15 years are six times more likely to develop alcohol dependence or abuse later in life than those who begin drinking at or after age 21 years.” In a way, this fact is a prediction in and of itself.

The MUSC research team took this idea further and (possibly) found a way to predict whether or not a child would drink as an adult. As noted in their study, not much significant research had been done up to this point on what’s called ‘risk determination’ for adolescent alcohol abuse. However, also noted is how important risk determination is when it comes to substance abuse prevention. Let’s talk about what they did, what they found out, what it means, and how it could upgrade current adolescent alcohol abuse prevention efforts.

The MUSC Study

A total of 137 children between the ages of 12 and 14 participated in the study, none of whom abused any substances (at the time). Every year, until each participant turned 18, the research team conducted neuropsychological testing as well as two types of magnetic resonance imaging (MRI). The six-year study aimed to “identify predictors of alcohol use initiation” among adolescents. Using brain testing and imaging dramatically helped achieve this goal.

According to an article on the study by the Brain & Behavior Research Foundation, “By adding imaging data and neuropsychological data such as the cognition and attention tests, the researchers were able to improve the accuracy of their model beyond those that use only demographic or behavioral data.” Of course demographic and behavioral data were still included.

During the study, 70 participants started moderate to heavy drinking, defined as having at least three drinks on three separate occasions. The other 67 participants remained alcohol-free. (With almost perfectly split groups, the research team got lucky). Then, once all participants were age 18 or older, “…classification models identified the most important predictors of alcohol use from a large set of demographic, neuropsychological, sMRI, and fMRI variables,” as written in the study.

The Results

With an incredible 74% accuracy, the team identified 34 predictors of alcohol abuse in adolescents. The complete list is unavailable without a paid prescription to the American Journal of Psychiatry. What follows are some of the predictors, split between demographic factors and neurological factors.

Demographic Predictors:

– Being male

– Being wealthy

– Dating early

– Being extraverted

– Having positive expectations of alcohol

Neurological Predictors:

– Worse-than-average executive brain function

– Lower-than-average scores on cognitive, attention and memory tests

– Having thinner-than-average cortices (physical parts of the brain)

– Having less-than-average overall brain activation

As informative as it would be to learn what the other 25 predictors are, it is already clear to see how wide of a range they fall under. According to what we know, a rich and outgoing teenage boy who started kissing girls early has a much better chance of becoming an alcoholic than a poor, shy girl who has never had a boyfriend. God forbid that boy has below-average cognitive skills and thin cortices!

Forgive a little comic relief. The implications here are huge, and the conclusions drawn by the research team are exactly what you would expect. They suggest “a mix of demographic, behavioral, neuropsychological, and neuroimaging data” when it comes to “identifying youths at risk for initiating alcohol use during adolescence.” The team goes on to say: “The identified risk factors will be useful for alcohol prevention efforts and in research to address brain mechanisms that may contribute to early drinking.”

What they’re really saying is that using MRI and neuropsychological tests are going to greatly help identify predictors of adult alcohol abuse among children. This is not necessarily to say previous findings were wrong, however there do seem to be some notable differences between the MUSC study’s results and the results from a similar (and much larger) study completed back in 2008 (and without brain imaging/testing).

Previously Found Predictors

Nine years ago, the Society for the Study of Addiction (SSA) published the results of a very large long-term study aiming to identify childhood and adolescent predictors of adult alcohol abuse. It was an off-shoot of the National Child Development Study, a Britain-based comprehensive project involving one weeks’ worth of 1958 births, tens of thousands of people.

The SSA study involved a total of 16,009 participants. “Social background, family, academic and behavioral predictors measured at ages 7, 11 and 16 years [were used] to predict quantity of alcohol use at ages 16, 23, and 33 years and harmful drinking by age 42 years.” No brain imaging or testing was involved. Here are the predictors found by the SSA:

– Having “greater childhood and adolescent social advantage,” especially for females

– Strained family relationships

– Difficulty blending in

– Getting good grades

– Being a truant (late) person

– Having immediate plans to leave for college

Similar to with the MUSC study, there is a wide range of predictive factors. However, there are some differences in the two studies’ results. The MUSC study says males are more likely to become heavy drinkers, whereas the SSA study says females are, provided they are socially skilled. The MUSC study says being extraverted is a predictive factor, yet the SSA study says having trouble making friends is actually a factor. There are more clear differences, and probably even more considering the 25 unseen predictors from the MUSC study.

The SSA study acknowledges these paradoxes in an almost psychic fashion. In a section dedicated to the paradoxes, they explain how some evidence suggests that being introverted, getting poor grades, and being a social outcast all predict future heavy drinking. Yet other evidence suggests that heavy drinking patterns are formed by being extraverted, getting good grades, and being socially accepted.

Considering the MUSC study used the same data as the SSA study, plus used MRI and neuropsychological testing, it would seem that the MUSC study’s results are more trustworthy, even though the sample size was smaller. Let’s not forget, though, how the Medical University of South Carolina’s use of brain imaging and testing was relatively new in its field. More research must be done, it seems, in order to compile a totally accurate list of predictive factors. Still, from here on out let’s consider the MUSC study to be the real deal when it comes to predicting alcohol abuse in kids.

Evidence MUSC is Correct

The study is innovative and helpful in the world of addiction prevention, but some of the results are nothing new. For example, they found that boys are more likely than girls to abuse alcohol as adults. Science agrees, like the rest of us, but here’s more evidence:

  1. Men Drink More

According to the CDC, it’s much deeper than men simply drinking more than women. Men are more likely to:

– Drink excessively

– Take risks while drinking

– Be hospitalized due to alcohol

– Die due to alcohol

– Become violent due to alcohol

– Commit suicide due to alcohol

– Become an alcoholic

– Drive drunk

On top of all that, heavy drinking “can interfere with testicular function and male hormone production resulting in impotence, infertility, and reduction of male secondary sex characteristics such as facial and chest hair.”

  1. The Wealthy Drink More

The MUSC study also concluded that being wealthy was a predictive factor of future drinking among adolescents. According to a 2015 Gallup poll, the study is dead-on. Take a look at the image below and take note of the extreme differences in alcohol consumption among economic classes.

Nearly eight out of ten people who make good money drink regularly, whereas less than five out of ten people who struggle financially drink regularly. Don’t blame cost either, because we all know how cheap alcohol is when you don’t care what brand you buy.

  1. The Socially Skilled Drink More

This can tie together early dating and being extraverted. Common sense tells us that adolescents who date early are more than likely socially adept. They are probably outgoing and social as well. The same goes the other way around. The MUSC study suggests that these socially skilled kids are more likely to drink heavily later in life.

In 2012, Science Direct discovered “a statistically significant association between peer-nominated popularity and the probability of alcohol consumption…” They even went so far as to suggest a direct relationship between making more friends and drinking more.

Because the MRI and brain testing portion of the MUSC study was innovative of the research team, there is not too much pre-existing information to show how they were correct. We suppose you’ll have to take their word (or not) on the predictive factors regarding the brain.

In Conclusion

We believe any and all available data should be taken into account when it comes to something as important as preventing alcohol abuse in children. The majority of alcohol addictions begin before age 21, and underage drinking is a big problem here in the US. This basically makes this country a breeding ground for alcoholics.

Therefore, the more ways to predict future drinking patterns we have, the better off we will be. As science continues to improve, so will methods of determining predictive factors. For now, thank you very much to MUSC for the most accurate model to date.