Research Report: Adolescent Drinking and Adult Alcohol Use Disorder

National Study on Adolescent Drinking Follows High School Seniors From Age 18 to Age 35

 The year 2020 was challenging for everyone. When the COVID-19 pandemic arrived, no one knew what would happen. No one in the U.S. had ever experienced shelter-in-place orders, mask mandates, and social distancing guidelines before. Very few of our children and teens had experienced online learning or virtual school. Although learning online and using virtual resources was nothing new – almost every school in the country used some type of internet-based learning in limited contexts – the fact that it was the only option for almost a year was, indeed, totally new for everyone involved. No one had any idea what the impact on adolescent drinking would be, either.

We’re not mentioning the consequences of COVID-19 itself – meaning the disease – and the astounding loss of life and subsequent grief, mourning, and loss experienced by millions of people in the U.S. – that’s a topic for a different article.

This article addresses a phenomenon that existed before COVID-19 and was exacerbated by COVID-19: drinking alone.

Specifically, we’ll discuss a study on the relationship between drinking alone during adolescence and early adulthood and alcohol use disorder (AUD) in adulthood. This study is relevant now because of what we’ve all just been through: a once-in-a-century pandemic.

It’s also relevant to us as treatment providers: at FCCR Radford in Richmond Virginia, we offer the following programs for adolescents:

Adolescent Early Intervention

Intensive Outpatient Program (IOP) For Adolescents

Continuing Care Groups For Adolescents

With regards to the pandemic, and the increase in solitary drinking associated with it, we’re grateful the Centers for Disease Control (CDC) recently approved a booster vaccine for the omicron variant, and White House officials say we can now begin to think of COVID-19 the way we think of the seasonal flu: in most cases, one vaccination a year can prevent illness, hospitalization, and death.

That’s a big deal.

However, the fact that we finally caught up with this disease does not erase the trauma associated with it or negate the things we all experience in 2020 and 2021.

One thing that happened in 2020 was this: people consumed more alcohol than in previous years – and because of the circumstances relate to COVID-19, many of them drank alone.

Does Drinking Alone When You’re Young Increase Risk of Alcohol Use Disorder Years Later?

The study “Solitary Alcohol Use in Adolescence Predicts Alcohol Problems in Adulthood: A 17-Year Longitudinal Study in A Large National Sample Of US High School Students” seeks to answer that question.

Published in September 2022 in the peer-reviewed journal Drug and Alcohol Dependence, this study is one of the first to examine the effect of the context of alcohol consumption during adolescence and early adulthood – i.e. drinking socially with friends or drinking alone – on alcohol consumption and alcohol use disorder later in life.

About the MTF Survey

In the study, Researchers analyzed longitudinal data on adolescents collected from the Monitoring the Future Survey (MTF), an annual research effort conducted by the University of Michigan in collaboration with the National Institutes of Health (NIH) and the National Institute on Drug Abuse (NIDA).

The MTF is a comprehensive nationwide survey of nicotine, alcohol, and drug use among U.S. citizens, with a focus on collecting data on individuals beginning in high school and tracking their nicotine, alcohol, and drug use practices through adulthood. The size – around 45,000 participants per year – and the consistency – every year since 1976 – make the MTF one of our most valuable tools for understanding the prevalence of nicotine, alcohol, and drug use in the U.S.

Back to the Study

Participants included two groups of individuals: one group of 4,464 began participation at age 18, and one group of 4,561 began at age 23/24, to create a total sample set of 9,025 adolescents, young adults, and – by the end of the study – adults. All study participants, upon initiation, indicated they had consumed alcohol at least once in the year prior to taking the first survey.

Surveys on alcohol use were completed at the following time points:

• Initial survey data at age 18 data collected between 1976 and 2002
• Follow-up survey data at age 23/24 collected between 1981 and 2008
• Final follow-up survey data at age 35 collected between 1993 and 2019

Researchers applied advanced statistical methods to determine whether drinking alone as an adolescent (age 18) or as a young adult (age 23/24) was associated with:

• Drinking frequency
• Binge drinking frequency
• AUD symptoms at age 35

To determine the presence or absence of solitary drinking, researchers asked participants the following question:

“When you used alcohol during the last year, how often did you use it when you were alone?”

Participants answered on a scale of 1-5, with 1 meaning never and 5 meaning always.

To determine frequency of drinking, researchers asked participants the following question:

“How often have you consumed alcohol in the past year?”

Participants answered on a scale of 1-7, with 1 meaning never and 7 meaning 40 or more times.

To determine the presence or absence of binge drinking, researchers asked participants the following question:

“How many times have you consumed five or more drinks in a row over the last two weeks?”

Participants answered on a scale of 1-6, with 1 meaning none and 6 meaning ten or more times.

To determine the presence or absence of AUD symptoms, researchers used criteria for AUD as determined by Diagnostic and Statistical Manual of Mental Disorders, Volume 5 (DSM-V). Meeting 2-3 criteria indicated mild AUD, meeting 4–5 criteria indicated moderate AUD, and meeting 6 or more criteria indicated and severe SUD.

To learn more about alcohol use disorder, please read the following article in the blog section of our website:

Defining Alcohol Use Disorder

Before we share the results of the study, we’ll allow the researchers to remind us of their primary motivation behind their research:

“It is essential to identify and respond to early risk factors for alcohol misuse in order to reduce the prevalence and severity of alcohol use disorder (AUD) in adults.”

We’ll also share the latest data on alcohol use among adolescents and adults, in order to understand the scope of the problem – and remind anyone reading this article that alcohol use and alcohol use disorder is more prevalent than most people realize.

Alcohol Use Among Adolescents and Young Adults: Facts and Figures

We collected the following data from the 2020 National Survey on Drug Use and Health (2020 NSDUH) and the 2020 Monitoring the Future Survey (2020 MTF), and this study on solitary drinking.

These are the big picture prevalence figures for alcohol use in the U.S.

Alcohol Consumption: Any Drinking, Heavy Drinking, and Binge Drinking in 2020

• Used Alcohol:
  • Adults (18+): 136,000,000
    • ~19% reported drinking alone
  • Adolescents (12-17): 2,061,000
    • ~15% reported drinking alone
  • Heavy Alcohol Use:
    • Adults (18+): 17,592,000
    • Adolescents (12-17): 140,000
  • Binge Alcohol Use:
    • Adults (18+): 60,536,000
    • Adolescents (12-17): 1,033,000

Those numbers surprise us. We know drinking is common, but we did not expect to learn that more than 60 million adults and more than a million adolescents engaged in binge drinking in 2020. That’s another reason the study we examine in this article is important: in 2020, risky drinking increased – as did the prevalence of AUD, as indicated by this next set of statistics.

These are the big picture numbers for AUD in the U.S. during the COVID-19 pandemic.

AUD Prevalence 2020

• Adults (18+): 27.6 million total
  • 82% increase from 2019
    • 15,423,000 males
    • 12,186,000 females
  • Adolescents (12-17): 712,000 total
    • 14% increase from 2019
      • 290,000 males
      • 422,000 females

Again, those numbers are surprising, and the increase from 2019 to 2020 demonstrates the impact of COVID-19 on AUD in the U.S. Combining these figures shows that in 2020, over 28 million adolescents and adults needed treatment for AUD.

Let’s take a look at how many of those 28 million received treatment.

AUD Treatment 2020

• Adolescents 12-17: 91,000 adolescents diagnosed with AUD received treatment
  • That’s 12.8%
• Adults 18+: 2.1 million adults diagnosed with AUD received AUD treatment
  • That’s 7.6%

Those numbers tell us that 87.2% of adolescents who needed treatment for AUD did not receive the treatment they needed, and that 92.4% of adults who needed treatment for AUD did not receive the treatment they needed. That’s the scope of the problem we face: millions of people drink in amounts considered heavy, millions of people engage in binge drinking, and millions have AUD and need treatment.

Let’s return to that study.

Drinking Alone: A Warning Sign of Future Behavior?

One reason this study is significant is that drinking alone, as opposed to drinking socially, may be an indication that the individual who drinks alone uses alcohol as a coping mechanism to handle uncomfortable, overwhelming, or painful emotions. This practice – called self-medication – is well-known in the treatment community.

With that in mind, let’s take a look at the results: did solitary drinking at age 18 predict disordered drinking behavior at age 35?

Solitary Alcohol Use at Age 18: Potential Consequences

• Alcohol use frequency at age 18 predicted AUD symptom likelihood at age 35:
  • Higher frequency predicted higher frequency of AUD symptoms
• Binge drinking frequency at age 18 did not predict AUD symptom likelihood at age 35
• Among solitary adolescent drinkers:
  • 8% were classified as having AUD symptoms at age 35
• Among solitary adolescent drinkers:
  • Likelihood of AUD symptoms at age 35 was 1.35 times higher than those who were not solitary drinkers as adolescents.
    • Risk of mild AUD symptoms 1.37 times higher
    • Risk of severe AUD symptoms 1.59 times higher
  • Strongest association found among females

Those results tell us clearly that yes, solitary drinking and frequent drinking at age 18 were associated with symptoms of AUD at age 35, but binge drinking was not.

Now let’s look at the next question: did solitary drinking at ages 24/25 predict disordered drinking behavior at age 35?

Solitary Alcohol Use in Young Adulthood: Potential Consequences

• Alcohol use frequency at age 23/24 predicted AUD symptom likelihood at age 35
  • Higher frequency predicted higher frequency of AUD symptoms
• Binge drinking frequency at age 23/24 predicted AUD symptom likelihood at age 35:
  • Higher frequency predicted higher frequency of AUD symptoms
• Among young adult solitary drinkers:
  • 1% were classified as having AUD symptoms at age 35
• Among young adult solitary drinkers:
  • Likelihood of AUD symptoms at age 35 was 1.60 times higher than those who were not solitary drinkers as young adults
    • Risk of mild AUD symptoms 1.33 times higher
    • Risk of moderate AUD symptoms 1.61 times higher
    • Risk of severe AUD symptoms 2.2 times higher

Those results also give us a clear answer:

Yes, solitary drinking, binge drinking, and frequent drinking at ages 24/25 was associated with symptoms of AUD at age 35.

To understand the results related to increased risk of AUD, remember that an odds ratio like 1.5 means that an event or factor has a 50 percent increased likelihood of occurring.

Therefore, when we look at the data on AUD symptoms at age 35, we see red flags. We see that solitary adolescent drinkers were 35 percent more likely to have any AUD symptoms. They were 37 percent more likely to have moderate AUD symptoms. And they were 59 percent more likely to have severe SUD symptoms, compared to adolescents who were not solitary drinkers.

When we look at the same dataset for solitary young adult drinkers, we also see red flags. At age 35, they were 60 percent more likely to have any AUD symptoms. They were 33 percent more likely to have mild AUD symptoms. They were 61 percent more likely to have moderate SUD symptoms. And they were 20 percent more likely to have severe SUD symptoms, compared to young adults who were not solitary drinkers.

How This Information Helps People At-Risk of Developing Alcohol Use Disorder

When therapists, counselors, psychiatrists, and primary care physicians screen an individual for alcohol use disorder, their assessment revolves around the presence or absence of symptoms, the relative severity of the symptoms, and the frequency of maladaptive behavior related to drinking.

One thing they don’t ask is this:

Do you drink alone or with others?

We’ll amend that: maybe some medical professionals who screen for AUD do ask that question. What we mean is that the question does not appear in the DSM-5. Which, in turn, means it’s information most clinicians don’t collect. In addition, most resources that include lists of red flags or warning signs related to alcohol consumption don’t include drinking alone or solitary drinking as behavior that may increase risk of AUD later in life.

To the medical professionals who ask this question already, we applaud you. The results of this study show it’s important and relevant information to collect. You’re ahead of the curve, and ahead of changes in the screening process for AUD that may appear soon.

We’ll allow the study authors the final word on their research:

“Our findings highlight the need to go beyond only asking about how much and how frequently young people drink to include additional evaluation of whether or not they drink alone. Understanding solitary alcohol use in young people may be critical for effective screening and intervention efforts to reduce AUD.”

We think they’re one hundred percent correct in their analysis. We’ll continue to follow the well-established, evidence-based, best practices for AUD screening. Now, we’ll also consider the phenomenon of solitary drinking – and its potential adverse consequences – when we offer support and care to anyone who seeks treatment for the disordered use of alcohol.