A Life Course Approach to Understanding Racial/Ethnic Differences in the Transition into and out Alcohol Dependence

Introduction: Alcohol dependence is typically highest in early adulthood (early to mid-twenties) and gradually declines thereafter. However, recent research finds that racial/ethnic minorities have an elevated risk for alcohol dependence in middle age and beyond. This study examines racial/ethnic differences in the transitions into and out of alcohol dependence from the mid-twenties to the late thirties using panel data from a nationally representative sample of U.S. youth. Applying a life course framework, we further investigate whether racial/ethnic differences in the onset, offset, and recurrence of alcohol dependence may be explained by cumulative patterns of heavy drinking and socioeconomic disadvantages, as well as transitions in social roles during early adulthood (i.e. marriage, parenthood).

Methods: This study was a secondary data analysis of the 1979 National Longitudinal Survey of Youth (NLSY79) using data from 1979 to 1994 (n=6,098).  We examined subclinical alcohol dependence (2+ DSM-IV dependence symptoms) in the past year, collected in 1989 (mean age=28; range=24-32) and again in 1994 (mean age=33; range 29-37).  Dependence patterns were categorized as no symptoms (at both time points), 1989 onset/1994 offset, 1994 onset, and recurrence of dependence (at both time points).  Accounting for the complex survey design and sample weights, multinomial regression models adjusted for age, gender, socioeconomic status (SES: education, cumulative years of poverty), alcohol use (early regular drinking, years of heavy drinking), and timing of social roles (marital, parental). 

Results: Controlling for age and gender, blacks and Hispanics were at greater risk than whites for developing dependence symptoms beyond early adulthood (AORs=1.69 and 1.27, respectively for 1994 onset vs. non-dependence at both 1989 and 1994); however, only the black-white disparity was significant. This disparity was eliminated after accounting for explanatory factors, in particular blacks’ greater cumulative poverty and heavy drinking later in life.  Blacks and Hispanics also had elevated relative risk for a recurrence (vs. offsetting) of alcohol dependence compared to whites (AORs=1.40 and 1.12, respectively), but these racial/ethnic differences were not significant. Greater cumulative poverty and contemporaneous heavy drinking were risk factors, and a later transition to parenthood was a significant protective factor, for recurring dependence. 

Conclusions: Compared to whites who appear to “age out” of alcohol dependence in their thirties, blacks appear to be at greater risk for dependence beyond young adulthood, whether new or recurring symptoms. These findings signal a need for interventions that target ethnic minorities beyond early adulthood.