The present study distinguished among milestones demarcating drinking stages, characterized the timing of milestone attainment and also identified risk factors specific to the progression through stages. Such nuanced information about early drinking behavior is critical for understanding factors leading to increased risk for development of alcohol dependence and that may be indicative of accelerated risk in those ultimately end up in substance use treatment. This information could be used to design interventions to slow progression to heavy drinking, as opposed to interventions to delay age of first drink which have shown limited effectiveness [43]. One universal prevention program demonstrated greatest effects for youth who reported already having initiated substance use [43], suggesting some value in intervening immediately after first drink. One promising area is to identify intermediate stages that might benefit from selected intervention. Harm-reduction approaches tailored to stage of alcohol acquisition have been successful [44,45]. Clearly, though, the value of targeted stage-specific approaches lies in the ability to identify risk factors that predict movement among stages [46]. Risk factors for initiation likely differ from risk factors for other transitions along the dimension of adolescent alcohol involvement [2].
