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National Survey on Drug Use and Health Alcohol Dependence or Abuse and Age at First Use
October 22, 2004

Alcohol Dependence or Abuse and Age at First Use

In Brief

  • In 2003, males aged 21 or older were more likely than females to report having first used alcohol before age 15
  • Persons reporting first use of alcohol before age 15 were more than 5 times as likely to report past year alcohol dependence or abuse than persons who first used alcohol at age 21 or older
  • Among the 14 million adults aged 21 or older who were classified as having past year alcohol dependence or abuse, more than 13 million (95 per-cent) had started using alcohol before age 21

Recent research has focused on the association between the age at which a person first uses alcohol and alcohol problems later in life.1 Delaying the onset of alcohol use has been proposed as a strategy to prevent alcohol dependence or abuse in adulthood.2 The National Survey on Drug Use and Health (NSDUH) asks persons aged 12 or older to report on their age at first use of alcohol, their use of alcohol during the past year and in the past month, as well as their symptoms of alcohol dependence or abuse during the past year. NSDUH defines alcohol dependence or abuse using criteria specified in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which include such symptoms as recurrent alcohol use resulting in physical danger, trouble with the law due to alcohol use, increased tolerance to alcohol, and giving up or reducing other important activities in favor of alcohol use.3


Age at First Use of Alcohol

In 2003, almost 74 percent of adults aged 21 or older reported that they had started using alcohol before the current legal drinking age of 21. This group of 74 percent consists of persons aged 21 or older who first used alcohol before the age of 12 (4 percent), persons who first used alcohol between the ages of 12 and 14 (14 percent), persons who first used alcohol between the ages of 15 and 17 (33 percent), and persons who first used alcohol between the ages of 18 and 20 (22 percent). Among adults aged 21 or older, 12 percent reported that they had never used alcohol, and about 14 percent reported that they had first used alcohol after they had reached age 21.

Figure 1. Percentages of Age at First Alcohol Use among Adults Aged 21 or Older, by Gender: 2003

Figure 2. Percentages of Age at First Alcohol Use among Adults Aged 21 or Older, by Race/Ethnicity: 2003

Figure 1. Percentages of Age at First Alcohol Use among Adults Aged 21 or Older, by Gender: 2003 Figure 2. Percentages of Age at First Alcohol Use among Adults Aged 21 or Older, by Race/Ethnicity: 2003

Demographic Differences in Age at First Use of Alcohol

Among adults aged 21 or older, females were more than twice as likely as males to report having never used alcohol (16 vs. 7 percent) (Figure 1). Males (83 percent) were more likely than females (65 percent) to report having initiated alcohol use before age 21. Males also were more likely than females to report having first used alcohol before age 15 (24 vs. 13 percent).

Among adults aged 21 or older, Asians were more likely to report never having used alcohol (27 percent) and less likely to report having initiated alcohol use before the age of 21 (46 percent) than whites, blacks, or Hispanics (Figure 2).4 Asians also were less likely to have used alcohol before age 15 (6 percent) than members of these other racial/ethnic groups. Of these four racial/ethnic groups, whites had the lowest rate of never having used alcohol (9 percent) and the highest rate of initiating alcohol use before age 21 (79 percent); whites also had the highest rate of first alcohol use before age 15 (20 percent).


Prevalence of Past Year Alcohol Dependence or Abuse

In 2003, more than 14 million adults aged 21 or older (7 percent) were classified as having either alcohol dependence or abuse. Males aged 21 or older were more than twice as likely as females to have alcohol dependence or abuse (10 vs. 4 percent). The rate of alcohol dependence or abuse was lower among Asians than among Hispanics (5 vs. 8 percent). Among both whites and blacks,4 the rate of alcohol dependence or abuse was 7 percent.

Figure 3. Percentages of Past Year Alcohol Dependence or Abuse among Adults Aged 21 or Older, by Age at First Use: 2003

Figure 3. Percentages of Past Year Alcohol Dependence or Abuse among Adults Aged 21 or Older, by Age at First Use: 2003

Age at First Use of Alcohol and Prevalence of Alcohol Dependence or Abuse

Among adults aged 21 or older who had ever used alcohol, rates of past year alcohol dependence or abuse were lowest among persons who first used alcohol at an older age and highest among persons who initiated alcohol use at a younger age (Figure 3).

Only 3 percent of persons who first used alcohol at age 21 or older were classified as having past year alcohol dependence or abuse. Persons reporting first use of alcohol before age 15 were more than 5 times as likely to have past year alcohol dependence or abuse compared with persons who first used alcohol at age 21 or older (16 vs. 3 percent).

Among adults aged 21 or older who initiated alcohol use before the age of 21, the rate of past year alcohol dependence or abuse was 9 percent. Among the 14 million adults aged 21 or older who were classified as having past year alcohol dependence or abuse, more than 13 million (95 percent) had started using alcohol before age 21. Only 5 percent (fewer than 1million persons) of adults classified as having past year alcohol dependence or abuse had started using alcohol at or after age 21.


End Notes
  1. Warner, L. A., & White, H. R. (2003). Longitudinal effects of age at onset and first drinking situations on problem drinking. Substance Use & Misuse, 38, 1983–2016.

  2. Grant, B. F., & Dawson, D. A. (1997). Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey. Journal of Substance Abuse, 9, 103–110.

  3. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

  4. Due to low precision, estimates for American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander groups are not shown.

Figure Note

Source: SAMHSA, 2003 NSDUH.

The National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by the Substance Abuse & Mental Health Services Administration (SAMHSA). Prior to 2002, this survey was called the National Household Survey on Drug Abuse (NHSDA). The 2003 data are based on information obtained from 67,784 persons aged 12 or older, including 36,309 persons aged 21 or older. The survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence.

The NSDUH Report is prepared by the Office of Applied Studies (OAS), SAMHSA, and by RTI International in Research Triangle Park, North Carolina. (RTI International is a trade name of Research Triangle Institute.)

Information and data for this issue are based on the following publication and statistics:

Office of Applied Studies. (2004). Results from the 2003 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 04–3964, NSDUH Series H–25). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Also available online: http://www.oas.samhsa.gov.

Because of improvements and modifications to the 2002 NSDUH, estimates from the 2003 survey should not be compared with estimates from the 2001 or earlier versions of the survey to examine changes over time.

The NSDUH Report (formerly The NHSDA Report) is published periodically by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Office of Applied Studies are available on-line: http://www.oas.samhsa.gov. Citation of the source is appreciated.

This page was last updated on May 16, 2008.