The trajectory of psychiatric problems following an adolescent vs. young adult onset of alcohol use disorder

BACKGROUND: Alcohol use disorder (AUD) most often onsets in young adulthood (YAO), but prospective studies are needed to determine whether an onset in adolescence (AO) confers a more severe trajectory of psychiatric problems (e.g., depression, antisocial behavior, and other substance use) alongside AUD in men and women.METHODS: Using a prospective approach, we compared the trajectories of psychiatric problems for men and women with an AO, a YAO, and no history of AUD from ages 17 to 29 years old. RESULTS: Both gender and AUD onset moderated linear and non-linear changes in problems from adolescence to adulthood. AO conferred the poorest adolescent and young adult adjustment relative to the same-gender control and YAO groups. Critically, onset groups were more distinct among men (i.e., AO > YAO > no AUD) than women (i.e., AO = YAO > no AUD).CONCLUSIONS: Adolescent onset of alcohol problems portends severe, broad spread problems for both men and women into adulthood. Critically, adolescent onset yields the worst psychiatric problems among men (vs. YAO) while women experience severe, persistent problems across domains irrespective of onset timing. For both genders, mitigating the long-term, cascade of problems that accompany AUD will require special attention to heterogeneity in the timing of its onset and acceleration of psychiatric problems thereafter.