Effects of early internalizing symptoms on speed of transition through stages of alcohol involvement

Alcohol use disorders and internalizing disorders are highly comorbid in adults, but how this comorbidity unfolds over development is not well understood. Previous retrospective studies in adults have shown that internalizing problems are associated with a rapid transition from first drink and first regular drinking to the onset of alcohol dependence. Some results also suggest that internalizing is a stronger predictor of rapid transitions through later stages of alcohol involvement, but these stage-specific effects have not been explicitly tested. The present study utilized a prospective dataset to investigate effects of adolescent internalizing symptoms on speed of transition through multiple stages of alcohol involvement. Specifically, it was hypothesized that greater early internalizing symptoms would predict a later age of first drink, a slower transition from first drink to first binge, and a faster transition from first binge to first dependence symptom. The moderating effects of gender were also examined. Data were from a longitudinal study of children of alcoholics and matched controls (n = 454) followed from late childhood to mid-life. Linear regression and Cox regression were the primary analytic strategies. Covariates were externalizing symptoms, family history of alcohol use disorders, and gender. Analyses also controlled for age at which the participant entered each interval. Generally, stage-specific hypotheses concerning the effects of internalizing were not supported. Internalizing symptoms marginally predicted an earlier age of first drink and a faster transition from first binge to first dependence symptom, and significantly predicted a faster transition through the overall interval from first drink to first dependence symptom. Internalizing was a stronger predictor of rapid transitions for women, and the effects of internalizing were not specific to early or later stages of alcohol involvement among women. These results suggest that early internalizing problems are a general risk factor for a rapid transition through all stages of alcohol involvement, and this risk may be stronger for women than for men. These results have important implications for our theoretical understanding of the relationship between internalizing problems and alcohol use disorders as well as prevention and intervention efforts targeting these problems.