Early age at first drink has consistently been associated with elevated rates of alcohol dependence (AD)1-5. Using data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), Hingson et al.3 found that the lifetime prevalence of AD was 47% among individuals who had initiated alcohol use at age 14 years or younger compared with only 9% among those who began drinking at 21 years or older. Results confirmed findings that had been reported nearly 10 years earlier by Grant and Dawson2 using data from the National Longitudinal Alcohol Epidemiologic Survey. Over 40% of those who initiated alcohol use before age 15 met criteria for AD vs. 10% of those who started drinking at ages 21 or 22. Elevated rates of AD in early initiators have led some to conclude that the association is a causal one and that delaying first alcohol use will largely reduce risk conferred by early drinking6-7. In contrast, it has been argued that, rather than causing AD, early age at first drink is a marker for familial liability to the disorder8-10. McGue et al.
