This study, by design, did not measure the association of AFD with lifetime incidence of AUD. By focusing on individuals who were still at risk of AUD at the time of the Wave 1 interview, it investigated the impact of AFD in what might be termed a resilient population, one that had remained free of AUD until at least 18 years of age — and until much older than that in most cases. That an association between early AFD and incidence of AUD was found in such a resilient population, and that it did not diminish with age at baseline, provides more evidence that this is an extremely robust, though modest, association. Because alcohol use disorders are so common and have such devastating consequences for affected individuals and their families, even an association of modest magnitude has major clinical and public health implications. Given that this study was unable to rule out the possibility of direct adverse effects of adolescent drinking or to identify consumption thresholds at which any such effects might occur, there is a clear need for more
