Artículo emol y Alcohol use from adolescence to adulthood follows different, complex pathways (al final sólo en inglés)

 

Estudio en 1.560 hermanos gemelos:
Identifican en adolescentes los factores que determinan su consumo de alcohol a futuro

A partir de la frecuencia, intensidad y persistencia del consumo, y del contexto en que se realiza, investigadores establecieron cuál puede ser la relación con el alcohol que habrá en la adultez.  

Cristián M. González S. 

La adolescencia suele ser el período en que se inicia el consumo de alcohol en un porcentaje importante de la población. Basta considerar que sólo en Chile, un tercio de los escolares de 8º básico a 4º medio reconoce beber al menos una vez al mes, según datos del IX Estudio Nacional de Drogas en estudiantes, divulgado en 2012.

descarga 30Sin embargo, la relación que se establece con el alcohol es tan heterogénea, que investigadores de las universidades de Maastricht, en Holanda, y de Connecticut, en EE.UU., decidieron analizar cuáles son las variables que determinan qué tan problemático puede llegar a convertirse ese consumo con el paso de los años.

Para eso realizaron encuestas y entrevistas a 1.560 hermanos gemelos hombres, de 15 a 36 años, a quienes preguntaron sobre la frecuencia, intensidad y persistencia de su consumo, así como el contexto en que suelen beber.

Con esos datos pudieron identificar "trayectorias" de consumo, como explica a "El Mercurio" la psiquiatra Marieke Wichers, una de las autoras de la investigación.

"Así como algunos consumen mucho y otros pocos, hay algunos que comienzan muy precozmente y muestran un repentino alto consumo, mientras que otros lo van incrementando de manera más gradual a través del tiempo. También identificamos dos grupos que comienzan con un alto consumo, pero mientras en uno se mantiene hacia la adultez, en el otro tienden a declinar pasados unos años".

Biología y entorno

A partir de las entrevistas, pudieron determinar factores de riesgo y protectores, que inciden en cuál trayectoria va a tomar cada adolescente en su relación con el alcohol. La idea es generar intervenciones que permitan evitar o minimizar los problemas.

El consumo familiar de alcohol, el factor genético (padres alcohólicos) y la influencia de los pares aparecen como elementos comunes en quienes tienden a iniciar su consumo a menor edad y a desarrollar un consumo problemático.

El nivel de escolaridad y la accesibilidad al alcohol son determinantes en la intensidad de consumo, pero no en el inicio precoz de éste.

La edad de inicio del consumo es crucial. "El riesgo es inversamente proporcional: si una persona comienza antes de los 15 años tiene cuatro veces más probabilidades de convertirse en dependiente del alcohol que aquella que espera hasta los 21", comenta la doctora Francisca Corona, adolescentóloga de la Clínica Las Condes.

El doctor Rolando Chandía, psiquiatra y director de la Clínica de Adicciones Alfa, agrega que entre los factores de riesgo más importantes están las características de personalidad. "La impulsividad, los buscadores de novedad, así como quienes tienen un nivel de ansiedad o de inseguridad importante son más propensos a consumir para aliviar o buscar sensaciones".

El especialista agrega que un déficit atencional sin tratamiento es un factor predictor, tal como se menciona en el estudio.

Por la otra vereda, la doctora Wichers y sus colegas comprobaron que estar involucrado en actividades sociales (deportivas, comunitarias y especialmente de tipo religioso) se asocia con un inicio más tardío y menores niveles de consumo.

Al respecto, Francisca Corona agrega que una buena comunicación familiar y un estilo parental cercano, pero con normas claras y firmes, también son factores protectores. En el Estudio Nacional de Drogas se vio que el consumo de alcohol y marihuana es menor entre los jóvenes cuyos padres conversan el tema en familia.

En Chile El 64,3% de los estudiantes de 13 a 18 años reconoce tomar cinco o más tragos en una sola salida, según el IX Estudio Nacional de Drogas en Población Escolar. El 69% de los escolares dice que le es fácil comprar alcohol en lugares públicos.

Los errores de diagnóstico más comunes en niños by Linda Spiro, PsyD

Señales de trauma en los niños por Child Mind Institute

12 consejos para criar niños seguros de sí mismos por Child Mind Institute

Tratornos del Espectro Autista: Síndrome de Asperger y su Repercusión en el Rendimiento Académico por Juan Carlos Calderón Reza, Lilian Reza Suárez, Gabriel Lamingo Soriano, María Loaiza Matos y Mayra Neira Vera

Cómo evitar pasarle ansiedad a sus niños por Brigit Katz

Tres características que definen el TDAH y todos pasan por alto Escrito por William Dodson, M.D. Traducido por la Dra. Elena Díaz de Guereñu

Ayudar a su hijo a manejar el enojo y la frustración por Kate Kelly

¿Por qué tienen los niños problemas con las transiciones? por Katherine Martinelli

Trastornos generalizados del desarrollo Por National Institute of Neurological Disorders and Stroke

Entender la conducta impulsiva de su hijo por Amanda Morin

Ansiedad y depresión por Centers for Disease Control and Prevention

Contact: Marieke Wichers, Ph.D.
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31-43-3884060
Maastricht University

Victor M. Hesselbrock, Ph.D.
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860-679-1316
University of Connecticut School of Medicine

Alcoholism: Clinical & Experimental Research

Alcohol use from adolescence to adulthood follows different, complex pathways

 

  • Adolescence is often a time of novelty seeking and risk taking, including the initiation of drinking.
  • Other risk factors are also involved in trajectories of alcohol use that may develop over time.
  • A new study has identified six different trajectories of alcohol use from adolescence into adulthood.

 

Adolescence is often a time of novelty seeking and risk taking, including the initiation of drinking. While heavy drinking that begins in adolescence can lead to problematic alcohol use later in life, other risk factors are also involved in trajectories of alcohol use that may develop. A study of factors predicting alcohol use and patterns of use over time has identified six distinct trajectories that concern level of alcohol use, rate of increase in use during early adolescence, and persistence of use into adulthood.

Results will be published in the March 2013 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Increased levels of exploration and risk taking seem to mark the transition from adolescence to adulthood," said Marieke Wichers, associate professor at Maastricht University Medical Centre as well as corresponding author for the study. "From an evolutionary point of view, this boost of explorative behaviour may be advantageous to adolescents in order to get to know the world around them and become independent. Thus, we see that that all over the world – on average – adolescents have higher levels of novelty seeking and are more risk taking that other age groups."

"Some teens begin adult behaviors ranging from sexual behavior to driving to taking their first job very early while others delay initiating these behaviors," added Victor Hesselbrock, professor of psychiatry at the University of Connecticut School of Medicine. "Novelty seeking is likely one of several personality factors that may influence the timing of the initiation of drinking behaviors. Many do consider teenage drinking a 'rite of passage,' given the ubiquity of the behavior across different environments and cultures."

"We tried to identify whether subgroups exist that follow similar changes in alcohol use over time," said Wichers. "This is important in order to differentiate adolescents in terms of their future course of alcohol use and identify the characteristics that may predict which course adolescents will follow."

"Most current studies of alcohol and other substance use in adolescence now use some variant of the 'developmental trajectories' approach," noted Hesselbrock. "This study is somewhat unique in that the sample size is fairly large and contains both girls and boys. Importantly, it assesses a number of relevant psychological traits and environmental factors considered either risk or protective for onset of drinking behavior. The sample also covers the age range of 15 to 36 years of age. This is important as it captures the typical age of initiation of drinking but also other drinking milestones such as first intoxication, onset of regular drinking, appearance of early drinking problems, as well as the period of time in early adulthood when drinking behaviors further diverge into different patterns."

Wichers and her colleagues obtained retrospective data from 1,560 adult male twins concerning their average monthly alcohol use, as well as risk and protective factors in their lives, through interviews and questionnaires. The age span addressed was from 15 to 36 years of age. Risk factors included parental alcohol use, poor school performance, and specific personality traits. Protective factors included religiosity, parental monitoring, and social activities.

"We found six different subgroups of individuals that could be clustered together in terms of their trajectories of alcohol use," said Wichers. "Alcohol use in these six trajectories differed in terms of, one, overall level of use, in that some subgroups used more alcohol than others, two, peak of alcohol use, in that some subgroups had a more pronounced early peak of use in early adolescence than other subgroups, and three, persistence of use, in that two subgroups were both characterized by a sharp increase in use during adolescence and high levels of use."

"Again, the sample of 15-36 years of age is important as it captures the typical age of initiation of drinking to the time of maximum consumption, typically ages 18-22," said Hesselbrock. "However, it also captures other drinking milestones into adulthood when drinking patterns further diverge, typically showing either significant decreases in alcohol consumption or a trajectory towards chronic alcoholism."

"After identifying these different subgroups, a second aim of this study was to find personal characteristics that might predict to what subgroup individuals may belong," said Wichers. "We found that a number of risks that predicted average alcohol consumption did not always predict the pattern of alcohol use over time. For instance, sensation seeking and low school performance were associated with a higher average level, but not with an early peak pattern, of alcohol use. On the other hand, peer deviance, ADHD symptoms, and genetic risk of externalizing disorders impacted on the timing of alcohol use in early adolescence. Among the most striking findings was that genetic risk for externalizing problem behavior and peer deviance was the strongest predictor of belonging to subclasses with initial high average consumption and an early peak in alcohol consumption during adolescence. In summary, this study showed that these predictors do not all influence alcohol use in the same manner: some predict increased level of use while others predict pattern of use in early adolescence or persistence of high-level alcohol use. Thus, indeed there seems to be a varied influence of certain factors at different stages in one's life."

Hesselbrock agreed. "This study clearly shows that 'one size' or one risk factor does not fit all," he said. "The importance of different vulnerability varies from latent class to latent class, with different risk factors affecting consumption levels and consumption patterns over time. Similarly, so does the importance of different well-known protective factors such as church attendance, parental attitudes, and parental monitoring."

Both Wichers and Hesselbrock said that future research is a necessity.

"Before a clinician can use these findings to construct an effective intervention, other research needs to examine whether these identified predictors are causal," said Wichers. "Then clinicians may use this knowledge to construct intervention strategies and identify individuals at risk."

"We need to determine whether behavioral, pharmacological, or both types of treatments targeted for specific classes will be more effective," said Hesselbrock. "We need to identify more specific genetic determinants that can be addressed either pharmacologically or by a behavioral intervention. It will also be interesting to see how these findings relate to quantity and patterns of use of other substances such as tobacco and marijuana, given that teens typically use a variety of substances, not just alcohol alone. Treatment providers should keep these different trajectories in mind and adjust their treatment plans as necessary as they follow their patients forward. Remember that this study is observational; the question remains whether these different class memberships and drinking trajectories can be changed with treatment."

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Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Genetic and Environmental Predictors of Latent Trajectories of Alcohol Use from Adolescence to Adulthood: A Male Twin Study," were N.A. Gillespie of the Department of Psychiatry in the Virginia Institute for Psychiatric and Behavioral Genetics at Virginia Commonwealth University School of Medicine, as well as the Queensland Institute of Medical Research in Brisbane; and K.S. Kendler of the Department of Psychiatry in the Virginia Institute for Psychiatric and Behavioral Genetics, as well as the Department of Human and Molecular Genetics, at Virginia Commonwealth University School of Medicine. The study was funded by the Dutch Medical Council, the National Institutes of Health, and the National Institute on Drug Abuse. This release is supported by the Addiction Technology Transfer Center Network at http://www.ATTCnetwork.org.