Extreme binge drinking during adolescence: Associations with subsequent substance use disorders in American Indian and Mexican American young adults

Abstract

Objective:

This study collected retrospective data on adolescent binge drinking (ABD) (5 drinks for boys, 4 for girls per occasion at least once per month) and/or extreme adolescent binge drinking (EABD) (10 or more drinks per occasion at least once per month) and tested for associations with demographic and diagnostics variables including alcohol and other substance use disorders (AUD/SUD).

Methods:

Cross-sectional data were collected from young adult (age 18–30 yrs) American Indians (AI) (n=534) and Mexican Americans (MA) (n=704) using a semi-structured diagnostic instrument.

Results:

Thirty percent (30%) of the sample reported ABD and 21% reported EABD. Those having had monthly ABD were more likely to be AI and have less education; those having had EABD were more likely to be AI, male, younger, have less education and lower economic status compared to participants without adolescent binge drinking. ABD/EABD was associated with higher impulsivity, a family history (FH) of AUD, and lower level of response to alcohol (ORs=1.0–2.0), as well as with adult AUD (OR=3.7–48), other substance use disorders (ORs=3.5–9), and conduct disorder/ antisocial personality disorder (ORs=2.0–2.6), but not with anxiety/depression. Monthly EABD further increased the odds of AUD/SUD.

Conclusions:

Although binge drinking was more common in AI compared to MA, there were little effects of race in individual risk factor analyses. Monthly ABD and EABD were common among these AI/MA as adolescents, and, as with other ethnic groups, these drinking patterns resulted in highly significant increases in the odds of developing alcohol and other substance use disorders in young adulthood.

INTRODUCTION

Alcohol use disorders (AUD) follow a neurodevelopmental trajectory, typically emerging during young adulthood following several years of heavy drinking that can begin in early adolescence.¹ Data suggest that when adolescents and young adults drink, they often report “binge drinking” (5 or more drinks for boys, 4 or more for girls per drinking occasion).² Frequent binge drinking has been linked to a number of health risk behaviors,³ including risk for developing AUD.^{4, 5}

Although binge drinking, as traditionally defined, is common among some teens, many young adults and adolescents actually drink at levels far beyond the traditional binge threshold, consuming 10+ or 15+ drinks per occasion, which has been called “extreme binge drinking” or “high-intensity drinking”.^{2, 6, 7} More than 10% of high school seniors who participated in the Monitoring the Future (MTF) study between 2005 and 2011 reported 10+ and 5.6% reported 15+ extreme-binge drinking in the past 2 weeks.² Although more recent MTF trend data through 2018 suggest rates of 10+ and 15+ drinking may be decreasing for some racial/ethnic groups such as Whites, these data emphasize the importance of assessing multiple levels of binge drinking in adolescents.^{2, 8} Such data may be particularly important for brain development, as Nguyen-Louie et al.⁹ have demonstrated that extreme-binge drinkers performed worse than moderate drinkers (≤4 drinks per occasion) on tests of verbal learning and delayed recall, whereas traditionally-defined binge drinkers did not differ from moderate drinkers on these cognitive measures.

Understanding the differences and similarities in binge and extreme-binge drinking in adolescents of different ethnic groups is important, as there could be important health disparities that need to be addressed. The monitoring the Future (MTF) studies compared drinking data based on self-identified race from 2005–2016 in high school seniors, and reported that past 2-week 10+ drinking was highest in those teens who identified themselves and White and Native Peoples (American Indian/Alaska Native or Pacific Islander) (17%) or Native Peoples (13%), followed by white (12%) and White and Hispanic (8%).¹⁰ These studies did not report differences for specific Hispanic or American Indian/Pacific Islander subgroups. Evaluating drinking levels in community samples adds complementary data to large surveys of high school teens, especially in American Indian samples that may have high rates of leaving high school before 12^th grade.¹¹ Stanley et al. compared data from AI 8^th ,10^th , and 12^th graders living on or near reservations with rates from the MTF study and found the prevalence rates for use of drugs and alcohol were higher in the AI population they studied.^12–14

Mexican Americans (MA) represent the largest subgroup of Hispanic Americans, including nearly two-thirds of the total US Hispanic population. The Hispanic Americans Baseline Alcohol Survey (HABLAS) has shown that MA and Puerto Ricans have the highest rates of binge drinking, driving under the influence of alcohol, and DSM-IV alcohol abuse, and dependence among Hispanic groups.¹⁵ Thus, understanding binge drinking patterns in AI and MA adolescents may provide important information for prevention and intervention in these high-risk youth.

One reason that adolescents, of any ethnic group, may engage in binge and/or extreme binge drinking may be that they have a less sensitive response to alcohol and thus need to drink more to obtain the desired effect. A number of studies in a variety of human populations suggest that a low level of response to alcohol may be one of the best biologically-based risk factors for the development of alcohol use disorders.¹⁶ Estimated variation in level of response to alcohol can be measured in epidemiologically based studies using an instrument called the Subjective High Assessment Scale-E (SHAS-E). We have demonstrated, in previous studies, that retrospectively reported adolescent of binge drinking is associated with lower responses on the SHAS-E, suggesting an important relationship between early binge drinking and this important risk factor for AUD.¹⁷

The present report is part of a larger set of studies exploring risk factors for SUDs among American Indians and Mexican Americans residing in Southwest California.^17–22 The purpose of the present set of analyses was to test potential risk factors for and consequences of adolescent binge and extreme binge drinking in a community based population of AI and MA young adults. Firstly, we determined if binge and extreme-binge drinking during adolescence was significantly associated with gender, a family history of AUD, self-reported response to alcohol, psychosocial conditions, and levels of impulsivity. Secondly, we assessed whether adolescent binge and extreme binge drinking were correlated with a lifetime diagnosis of SUDs (alcohol use disorders, cannabis use disorders, stimulant use disorders, nicotine dependence), and other mental disorders co-morbid with SUDs (conduct disorder /antisocial personality disorder, and any affective or anxiety disorders), in men and women. All analyses controlled for participant demographics (age, race, current socioeconomic status, marital status) significantly associated with the focal outcome variables.

MATERIALS AND METHODS

Participants

The AI respondents resided on or near eight geographically contiguous reservations with a total population of about 3,000 individuals. They were recruited using a combination of a venue-based method and a respondent-driven procedure, as described previously.¹⁸ The AI studies include participants in a wide age range (18–82 yrs), however, the present set of analyses included only those individuals who were between 18 and 30 years of age at the time of interview.

MA participants were recruited using a commercial mailing list that provided the addresses of individuals with Hispanic surnames in 11 zip codes in San Diego County, all of which had a population that was over 20% Hispanic and were within 25 miles of the research site. The mailed invitation stated that potential participants must be of Mexican American ancestry, be between the ages of 18 and 30 years, be residing in the United States legally, and be able to read and write in English, as described previously.²¹ Based on the aims of the larger studies, for both ethnic groups, participants were excluded if they were pregnant, nursing, or currently had a major medical disorder that precluded them traveling to the research site. Participants were asked to refrain from alcohol or any other substance use for 24 hours prior to testing, and their breathalyzer blood alcohol levels had to be 0.00 g/dl to be included in the study. Approval was obtained from the Scripps Research IRB prior to conducting the studies, and yearly thereafter.

Potential participants gave written informed consent, and then responded to a screening questionnaire that was used to gather information on demographics, personal medical history, ethnicity and detailed measures of current and past substance use and use disorders, including a retrospective report of their adolescent binge drinking, using a timeline follow-back format. Each participant also completed an interview with the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA) which collected information including demographics, psychiatric disorders, and symptoms of SUDs.²³ Diagnoses of lifetime DSM-5 AUDs (mild, moderate, or severe) were generated using the SSAGA. Lifetime diagnoses of other drug dependence (cannabis, stimulants, nicotine), antisocial personality disorder/conduct disorder (ASPD/CD), any independent affective disorder (major depressive disorder, dysthymia, bipolar I disorder), and any independent anxiety disorder (social phobia, agoraphobia, panic disorder, obsessive compulsive disorder) were defined by DSM-IV criteria. Impulsivity was indexed by a score derived from the Maudsley Personality Inventory.²⁴ Family history of AUD was determined by the Family History Assessment Module, and was defined as the presence of alcoholism/AUD in a first-degree family member.

Self-reported response to alcohol was assessed using the Subjective High Assessment Scale-Expectations (SHAS-E). The SHAS-E consists of 14 items rated on Likert scales ranging from 0 (normal) to 36 (extreme effect). The scale queries participants as to how they would expect to feel 30 minutes after drinking 3 standard drinks for the following items: buzzed, clumsy, dizzy, drunk, effects of alcohol, energy, good, high, nauseated, sleepy, talkative, uncomfortable, terrible and great. A total score (sum of all responses) for the first 12 SHAS-E items was then calculated (SHAS-E total).

Monthly adolescent binge drinking was defined as drinking 5 or more drinks for boys and 4 or more drinks for girls, per drinking occasion, at least one time a month during their highest drinking period occurring at or before the age of 19 years. Monthly extreme binge drinking was defined as drinking 10 or more drinks per drinking occasion, at least one time a month during their highest drinking period occurring at or before age 19. We compared respondents who met criteria for binge drinking but drank less than 10+ drinks per occasion and those who met criteria for extreme-binge drinking (10+) separately, and compared each of them with the respondents who drank below binge drinking levels.

Data analyses

First, we determined if monthly binge drinking and monthly extreme-binge drinking during adolescence were significantly associated with gender, family histories of AUD, self-reported response to alcohol, socioeconomic status, and level of impulsivity. To determine associations between binge drinking levels and these potential risk/protective factors, we used analyses of variance (ANOVA) for continuous variables and Chi-square tests for dichotomous variables. Variables that were significant in the initial bivariate analyses were then added into a logistic regression analysis to determine their potential combined association with the binge drinking outcome variables. Second, we used logistic regression models to assess whether adolescent binge or extreme binge drinking were correlated with lifetime diagnosis of SUDs and other mental disorders co-morbid with SUDs. For these analyses, participants’ demographics were included if they were significantly associated with the outcome variable in bivariate analyses. To control for multiple testing, significance was set at p<0.01. Analyses were conducted in SPSS.

RESULTS

The sample consisted of AI (n=534) and MA (n=704) young adult (18–30 yrs old) participants. Demographics of the samples are shown in Table 1. There were 363 participants (30%) who reported drinking at least 4 drinks for women or 5 drinks for men but less than 10 drinks per occasion, and their mean number of drinks per occasion was 6.12. There were 261 (21%) participants who reported monthly extreme binge drinking, and the mean number of drinks per occasion was 18.82. Participants who reported adolescent binge drinking were more likely to be American Indian and have lower levels of education, compared to participants without adolescent binge drinking, and those with extreme adolescent binge drinking were more likely to be male, American Indian, have less education, be younger and have a lower economic status.

Table 1.

Demographic characteristics of adolescent binge drinking in Mexican American (n=704) and American Indian (n=534) participants according to adolescent binge drinking history

Demographic Characteristic	No Adolescent Binge (AI=169/MA=445)	Adolescent Binge (AI=160/MA=203)	Extreme Adolescent Binge (AI=205/MA=56)	Overall (n=1238)
	N (%)	N (%)	N (%)	N (%)
Gender			*
Male	244 (19.7)	149 (12.0)	145 (11.7)	538 (43.5)
Female	370 (29.9)	214 (17.3)	116 (9.4)	700 (56.5)
Married
Yes	82 (6.6)	38 (3.1)	20 (1.6)	140 (11.3)
No	532 (43.0)	324 (26.2)	241 (19.5)	1097 (88.7)
Currently Employed			*
Yes	340 (27.9)	177 (14.5)	91 (7.5)	608 (49.9)
No	269 (22.1)	177 (14.5)	164 (13.5)	610 (50.1)
Income ≥ $20,000/yr			*
Yes	421 (37.5)	251 (22.4)	131 (11.6)	803 (71.5)
No	141 (12.6)	80 (7.1)	99 (8.8)	320 (28.5)
	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)
Age (yrs)	23.14±3.7	22.83±4.0	22.25±3.9*	22.86±3.9
Education (yrs)	13.10±1.9	12.70±1.7*	11.54±1.5*	12.66±1.9

As shown in Figure 1A, significant associations were found between the level of adolescent binge drinking and a positive family history (FH) of alcoholism/AUD, with a higher proportion with a positive FH for those participants who reported binge drinking compared to those who did not (Chi-square=12.6,df=1, p<0.001), and for those who reported extreme binge drinking (Chi-square=52.4,df=1, p<0.001), as well as for those who reported extreme binge drinking compared to those who reported binge drinking (Chi-square =14.3,df=1, p<0.001).

Figure 1.

Adolescent binge and extreme binge compared against those with no binging in adolescence for (A) family history of alcohol use, (B) impulsivity (Maudsley), and (C) SHAS-E total. * Indicates p<0.01 significance compared to the control group of no binge. Counts of subjects endorsing a first degree relative with alcohol dependence shown for family history. Means and standard errors shown for impulsivity and SHAS-E.

As shown in Figure 1B, significant associations were found between the level of binge drinking and scores on the Maudsley impulsivity scale, with higher impulsivity scores for those who reported adolescent binge drinking (F=15.8,df=1, p<0.001), and for those who reported extreme binge drinking (F=37.4,df=1, p<0.001). As shown in Figure 1C, responses on the SHAS-E also were associated with monthly adolescent binge drinking. Lower scores for the total scale on the SHAS-E, which indicate that a person feels less drunk following a standard alcohol dose, were found for those who reported adolescent binge drinking (F=20.1,df=1, p<0.001), and for those who reported extreme binge drinking during adolescence (F=119.7,df=1,p<0.001). Binge drinking/extreme binge drinking (compared to no monthly binge drinking during adolescence) were both found to be associated with higher impulsivity, positive FH, and AI ethnicity when added into a logistic regression with all other covariates (compared to MA) (Table 2).

Table 2.

Significant odds ratios and confidence intervals from ordinal logistic regression models for adolescent binge and extreme binge drinking (compared to no binge drinking).

	Odds Ratio	95% Confidence interval		P value
Adolescent binge
Impulsivity	1.124	1.025	1.233	0.01
SHAS-E	0.997	0.995	0.999	<0.001
Extreme adolescent binge
Family history of AUD	2.046	1.332	3.143	<0.001
SHAS-E	0.993	0.991	0.995	<0.001
Years of education	0.829	0.722	0.950	0.007
Mexican American ethnicity	0.207	0.129	0.334	<0.001

SHAS-E: Subjective High Assessment Scale-Expectations

Reference group: Mexican American ethnicity compared to American Indian ethnicity

Monthly adolescent binge drinking was significantly correlated with the presence of several SUDs in young adulthood. Odds ratios from these analyses are presented in Table 3. Compared to no binge drinking during adolescence, the two levels of binge drinking were both significantly associated with all three levels of AUD (mild, moderate, severe; compared to no AUD), with overall Wald tests for the models with traditional levels of binge drinking (4+/5+ drinks for females/males, respectively) ranging from 48.1 (df=1, p<0.0001) for mild AUD to 91.8 (df=1, p<0.0001) for severe AUD. Similar patterns emerged for extreme binge drinking (≥10 drinks): mild AUD: Wald=35.1, df=1, p<00001; moderate AUD: Wald =66.7,df=1, p<0.0001: Severe AUD: Wald= 132.8, df=1, p<0.0001.

Table 3.

Odds ratios and confidence intervals from ordinal logistic regressions for substance use disorders (UD), antisocial/conduct disorders, and affective/anxiety disorders: Comparing associations with binge drinking and extreme binge drinking (each compared to no monthly binge drinking during adolescence)

	Adolescent binge (vs. no binge drinking)				Extreme adolescent binge (vs. no binge drinking)
	Odds Ratio	95% Confidence interval		P value	Odds Ratio	95% Confidence interval		P value
Alcohol UD
Mild
Monthly Binge	3.768	2.590	5.476	<0.001	6.025	3.327	10.912	<0.001
Age	1.105	1.052	1.161	<0.001	1.134	1.074	1.198	<0.001
Moderate
Monthly Binge	8.765	5.339	14.395	<0.001	17.413	8.767	34.570	<0.001
Age	1.136	1.065	1.212	<0.001	1.168	1.079	1.267	<0.001
Severe
Monthly Binge	11.05	6.753	18.065	<0.001	48.31	25.014	93.368	<0.001
Age	1.158	1.084	1.238	<0.001	1.277	1.169	1.394	<0.001
MA ethnicity	0.379	0.214	0.672	0.001	0.361	0.179	0.726	0.004
Cannabis UD
Mild
Monthly Binge	3.867	2.531	5.902	<0.001	4.245	2.516	7.166	<0.001
Yrs of education	0.816	0.713	0.934	0.004	0.815	0.703	0.944	0.006
Male	2.008	1.323	3.048	0.001	1.748	1.104	2.764	ns
Moderate
Monthly Binge	3.466	2.123	5.658	<0.001	4.555	2.510	8.263	<0.001
Male	2.158	1.330	3.501	0.002	1.837	1.091	3.094	ns
Severe
Monthly binge	4.773	2.806	8.119	<0.001	9.028	4.983	16.344	<0.001
Male	2.641	1.577	4.421	<0.001	1.497	0.904	2.476	ns
Stimulant UD
Mild
Age	1.177	1.055	1.314	0.004	1.117	0.987	1.263	ns
Yrs of education	0.691	0.526	0.907	0.008	0.855	0.625	1.170	ns
MA ethnicity	0.433	0.158	1.187	ns	0.139	0.032	0.604	0.009
Moderate
Age	1.139	0.999	1.299	ns	1.226	1.071	1.404	0.003
Severe
Monthly Binge	5.487	3.137	9.589	<0.001	6.879	3.849	12.282	<0.001
Age	1.157	1.083	1.237	<0.001	1.162	1.089	1.239	<0.001
Yrs of education	0.625	0.527	0.741	<0.001	0.712	0.606	0.836	<0.001
Nicotine dependence
Monthly Binge	2.683	1.683	4.278	<0.001	5.324	3.378	8.387	<0.001
Male	1.968	1.239	3.125	0.004	1.429	0.914	2.234	ns
Antisocial/CD
Monthly Binge	2.042	1.337	3.119	<0.001	2.653	1.665	4.231	<0.001
Yrs of education	0.82	0.712	0.945	0.006	0.837	0.728	0.962	0.01
Male	3.062	1.989	4.712	<0.001	2.425	1.582	3.718	<0.001
Anxiety/Affective
Male	0.633	0.486	0.825	<0.001	0.488	0.369	0.646	<0.001
MA ethnicity	1.651	1.205	2.265	0.002	1.589	1.121	2.252	0.009

ns = p-value > 0.01.

As with AUD, the two levels of binge drinking were both significantly associated with all three levels of cannabis use disorder (CUD), with overall Wald tests for the models with 4+/5+ binge drinking ranging from 39.3 (df=1, p<0.0001) for mild CUD to 33.4 (df=1, p<0.0001) for severe CUD, and from 29.3 (df=1, p<0.0001) for mild CUD to 52.6 (df=1, p<0.0001) for severe CUD in the models with extreme binge drinking. Both binge drinking levels also were significant for cocaine/stimulant use disorder (CSUD), but only in relation to severe use disorder (4+/5+ binge drinking: Wald= 35.7, df=1, p<0.001; extreme binge drinking: Wald= 42.4, df=1, p<0.001). Odd ratios showing the association of both levels of binge drinking with the different SUDs are presented in Table 3. As also seen in table 3, both levels of binge drinking were also significantly correlated with a lifetime diagnosis of nicotine dependence (adolescent binge drinking: Wald=17.2, df=1, p<0.001 gender: Wald=8.2, df=1, p<0.01), (adolescent extreme binge drinking: Wald=51.8, df=1, p<0.001).

Associations between lifetime diagnosis of conduct disorder and/or antisocial personality disorder (CD/ASPD) and any lifetime affective or anxiety disorder (ANX/AF) with binge drinking and extreme binge drinking during adolescence also were tested using ordinal regression (see Table 3 for odds ratios). Adolescent binge drinking was significantly correlated with CD/ASPD (Wald=10.9, df=1, p<0.001), as was male gender (Wald=25.9, df=1, p<0.001) and years of education (Wald=7.5, df=1, p=0.006). Adolescent extreme binge drinking also was significantly associated with CD/ASPD (Wald=16.8, df=1, p<0.001), as was male gender (Wald=16.5, df=1, p<0.001), but no other covariates were significant. In contrast to the other diagnoses, neither 4+/5+ binge drinking nor extreme binge drinking were associated with ANX/AF disorders; only gender (Wald=11.5, df=1, p<0.001 in binge drinking model; Wald=25.1, df=1, p<0.001 in extreme binge model) and ethnicity (Wald=9.7, df=1, p<0.002 in binge drinking model; Wald=6.8, df=1, p<0.009 in extreme binge model) were significantly associated with a lifetime diagnosis of any ANX/AF disorder.

DISCUSSION

Alcohol and other substance use, especially during early adolescence, has been linked to a number of long-term health risks,³ including elevated risk for AUD and other SUDs later in life in a number of populations, including American Indians.^{4, 14, 19} In the present study, we found reports of monthly adolescent binge drinking among AI/AN and Mexican Americans was high, with 30% of the sample reporting binge drinking of 4+/5+ drinks per occasion and an additional 21% reporting extreme binge drinking (10+ drinks). AI had higher levels of binge drinking than the MA participants. Both AI/AN and MA young adults who reported adolescent binge drinking were more likely to drop out of school and generally had lower levels of education than their peers who did not engage in monthly binge drinking during adolescence. These data suggest that prevention programs fostering school retention may lead to lower levels of binge drinking in these groups.

It is important to understand the diversity of drinking patterns both among and between different AI tribal groups. In a longitudinal study of AI youth across eight reservations, the majority of adolescents (64%) reported abstaining from drinking up to age 14.²⁵ However, in that same study, about 20% of AI adolescents displayed an early onset substance use pattern, with nearly 70% progressing to DSM-IV substance abuse/dependence by 15–17 years old, which is nearly nine times the odds of abuse/dependence among adolescents who were early abstainers.²⁵ Similar findings have been found in the AI population described in the current report. In a previous set of analyses we found that 20% of the AI participants reported having been drunk enough to have trouble walking or talking, before the age of 13 yrs.¹⁹ Eighty-six percent of individuals who reported a first intoxication at age 13 or younger also met lifetime criteria for DSM-IV alcohol dependence, whereas only 12% of the participants who reported they were first intoxicated at age 21 or older were found to meet criteria for dependence. Having been drunk at 13 or younger was also found to be associated with a mean survival time to alcohol dependence of only 9.7 years as opposed to 32.3 years for individuals who were not intoxicated until after the age of 21.¹⁹ These data suggest that prevention projects that focus on delaying age of first intoxication may also reduce AUD in these populations.

The full range of risk factors for binge drinking and AUD in AI/AN, as well as MA, are still to be fully elucidated.^26–29 However, there have been some important cultural factors identified that may confer differences in risk for AUD in AI and MA. For instance, historical trauma in AI³⁰ and acculturation stress in MA²¹ have been shown to increase risk for AUD in these populations respectively. However, there may also be some risk factors that are very similar among ethnic groups. Several studies, in predominantly European origin participants, have stressed the importance of impulsivity, as well as a family history of AUD in the development of problematic drinking.^{14, 31–33} It also has been suggested that FH and heightened impulsivity may have a complex inter-relationship, with heightened impulsivity being associated with FH of alcoholism/AUD as well as being a consequence of alcohol use.^{34, 35} In the present study, both FH and impulsivity were significantly associated with monthly binge drinking and monthly extreme binge drinking in AI/MA adolescents, even taking into account other significant demographic and personal characteristics, suggesting these risk factors are important in both these minority populations.

In the present study, we used the SHAS-E to test whether retrospectively reported binge drinking during adolescence was associated with self-reported responses to ethanol in young adults. Lower scores on the SHAS-E were found to be correlated with monthly binge drinking and monthly extreme binge drinking during adolescence, even after taking into account demographic and personal factors (namely, FH and impulsivity), with extreme binge drinkers reporting the lowest level of response. Since a number of studies in a variety of human populations suggest that level of response to alcohol may be one of the best biologically-based risk factors for the development of alcohol use disorders,¹⁶ it is reasonable to suggest that it also may be related to risk for and a consequence of adolescent binge drinking. However, these studies cannot determine whether a lower level of response to alcohol is a risk factor or a consequence of adolescent binge drinking.

This study also found that adolescent binge drinking was associated with a number of SUDs in young adults, with extreme binge drinking further amplifying the risk. Monthly binge drinking as traditionally defined (4+/5+ drinks) resulted in odds ratios of 11.0 for severe AUD, and extreme binge resulted in odds ratios of 48.0 for severe AUD. These numbers are in contrast to the ORs for other variables that were significant in the regression models, which only ranged from 0.4–1.3. Adolescent binge drinking was also associated with significant increases in the odds of having cannabis use disorder (ORs ranged from 3.5–9.0), severe stimulant use disorder (ORs = 5.4 binge; 7.8 extreme binge), and nicotine dependence (ORs=2.6 binge; 5.3 extreme binge). Thus, adolescent binge drinking appears to be a significant risk factor for a number of SUDs, much more so than race, age, gender, education or economic factors.

Perhaps the most significant co-morbid disorders with SUDs are the other externalizing disorders, in particular conduct disorder/antisocial personality disorder.³⁶ CD and SUD symptoms have also shown to have multiple developmental trajectories related to both early developmental risk and also to later psychosocial outcomes.^37–39 In the present study, we found modest correlations between lifetime diagnosis of CD/ASPD and adolescent binge drinking (OR= 2.0 binge; 2.7 extreme binge). Also, it is important to note that while CD/ASPD appears to be a risk factor for binge drinking, there is also evidence that substance use is a risk factor for conduct disorder.

In our study we found that adolescent binge drinking was not associated with a dichotomous indicator of lifetime diagnosis of any affective and/or anxiety disorder. This finding is consistent with several previously published studies. A recent meta-analysis of 51 prospective cohort studies from 11 countries also failed to provide any clear evidence of a relationship between anxiety disorder and later AUD.⁴⁰ Taken together, these studies suggest that relationships between internalizing diagnoses and binge drinking may follow complex trajectories that include time and cohort effects.

In conclusion, we found a significant relationship between retrospectively reported adolescent binge/extreme binge drinking and impulsivity, FH of AUD, level of response to alcohol, gender, education, and socioeconomic status in this AI and MA population of young adults. We also found adolescent binge drinking to be correlated with AUD, SUD, and CD/ASPD, but not with anxiety/affective disorders in this sample of AI/MA. There was some evidence of a dose-response relationship, with extreme binge drinking increasing the odds of AUD/SUD, lower education, and lower level of response to alcohol as compared to traditionally defined binge (4+/5+) drinking. However, these findings may be limited in that they may not generalize to other American Indians or Mexican Americans and comparisons of AI and MA need to consider a host of potential genetic and environmental variables. Also, some of the data collected was retrospective, and a longitudinal study would represent a more powerful study design.