The adolescent origins of substance use disorders

Although early use of alcohol during adolescence has been consistently associated with increased risk of alcoholism in adulthood, the specific mechanisms that underlie this association remain unclear. We describe a program of epidemiological twin-family research that shows that early use of alcohol is best conceptualized as an indicator of a more general propensity to engage in adolescent problem behavior. Adolescent problem behavior, in turn, is a risk factor for a broad range of adult externalizing disorders, of which alcoholism is but one manifestation. These findings are shown to be consistent with a dual-process model whereby early adolescent problem behavior is associated with increased risk of adult psychopathology because both are indicators of a common inherited liability and because early adolescent problem behavior increases the likelihood an adolescent is exposed to high-risk environments. We conclude with a discussion of the importance of cross-cultural research, which may be especially informative for identifying the consequences of early adolescent drinking.