The appropriateness of diagnosing alcohol abuse or dependence among adolescents and young adults has been debated because such diagnoses are potentially unstable in these age groups. This study examined both the stability of alcohol diagnoses from ages 18 to 25 and risk factors associated with these diagnoses in a birth cohort of 1265 New Zealanders. Subjects had been assessed annually from birth until age 16 and then at ages 18, 21, and 25 (n=1003 at the last follow-up).

• The prevalence of alcohol abuse was 14 percent at age 18, 18 percent at 21, and 10 percent at 25.  The prevalence of alcohol dependence was 6 percent, 4 percent, and 4 percent, respectively.
• Remission was very common: 57 percent to 75 percent of subjects with alcohol abuse and 50 percent to 54 percent with alcohol dependence at age 18 had no diagnosis at ages 21 and/or 25. 
• An initial alcohol diagnosis was a significant and strong predictor of a later alcohol diagnosis (odds ratios 3.4–27.6). This remained true in analyses adjusted for a variety of risk factors (e.g., cannabis use, mental illness, family history of alcohol problems).

Comments by Joseph Conigliaro, MD, MPH:

This study illustrates that as adolescents with alcohol diagnoses transition into adulthood, most (particularly those with alcohol abuse) will experience remission. A substantial number, however, will continue to meet diagnostic criteria. Because alcohol diagnoses can be unstable, healthcare providers should closely monitor their adolescent and young adult patients and adjust treatment accordingly as these patients grow older.

Reference:

Wells JE, Horwood LJ, Fergusson DM. Stability and instability in alcohol diagnosis from ages 18 to 21 and ages 21 to 25 years. Drug Alcohol Depend. 2006;81(2):157–165.

Reprinted with permission from Alcohol and Health: Current Evidence.