Diagnosis of alcohol dependence in epidemiological surveys: an epidemic of youthful alcohol dependence or a case of measurement error?

AIMS: To review the literature on the prevalence of alcohol dependence according to age, presenting data suggesting that the increased prevalence of alcohol dependence among young adults may be inflated because of measurement error. DESIGN: Household surveys with random selection of respondents. SETTING: General population. PARTICIPANTS: Survey respondents 12 years of age and older. MEASUREMENTS: Alcohol dependence. FINDINGS: Data for male current drinkers show that 4.6% of adolescents (aged 12-17 years) meet criteria for past year dependence, and the rate increases to 8.5% in the 18-23 age group, decreasing thereafter. Symptom level prevalence estimates indicate that younger age groups report higher rates of tolerance and withdrawal symptoms than older age groups. CONCLUSION: Young adults may be reporting tolerance and withdrawal symptoms partly because the wording of structured interview schedules leads to confusion of binge drinking and its sequelae with physical symptoms of alcohol dependence. There is a need to examine whether young adults are confusing the sequelae of acute intoxication with alcohol withdrawal, and rapid initial tolerance with the classical tolerance reported by alcoholics. Epidemiologists and clinicians need to be cautious of the tendency of structured psychiatric interviews to classify young adults as being alcohol-dependent. It may be useful to characterize individuals who meet alcohol dependence criteria at a young age (e.g. prior to age 25 years) as manifesting a form of 'adolescent alcohol dependence', which may represent a less severe form of alcohol use disorder than that observed in adults.