Maturing out or in? Demographic determinants of young adult drinking trajectories and midlife alcohol use disorder risks

Abstract Background Heavy alcohol use in young adulthood impacts future health, including alcohol use disorder (AUD). Dynamic trajectories of adolescent to adult alcohol use are understudied, as are sociodemographic correlates of trajectories. Methods We employed repeated‐measures latent class analysis to identify trajectories of age 18–30 alcohol use among participants from Monitoring the Future, a representative, ongoing national sample of US adults surveyed longitudinally from 1976 to 2020 ( N = 32,121). In each survey, participants' alcohol use was categorized as abstinence, “higher risk” (daily or binge drinking), or “lower risk” (no daily or binge drinking). We assessed how class membership was associated with sociodemographic predictors (sex, ethnoracial identity, birth cohort, and parental education) and age 35 AUD symptomatology. Results Analyses supported an eight‐class solution, characterized by three broad trajectory categories: (1) stable, (2) movement toward higher intensity drinking, and (3) movement toward lower intensity drinking. Across demographics, later birth cohorts were more likely to move toward higher intensity drinking, as well as to abstain completely. Among drinkers, those who moved from lower risk drinking to abstention across ages 18–30 had a relatively low (4%) probability of age 35 AUD symptomatology. In contrast, participants with stable higher risk drinking patterns had a 67% probability of age 35 AUD symptomatology, as did 53% of participants whose alcohol trajectories increased from lower to higher risk. Conclusions Over half of adults reported stable patterns of drinking across ages 18–30, but over half also reported at least one period of higher risk drinking. More recent cohorts are less likely to “mature out” of higher intensity alcohol use but also more likely to abstain. Even “lower risk” drinking conferred increased probability of AUD symptomatology relative to abstention. Our findings underscore the need to identify hazardous alcohol patterns during adolescence and young adulthood to prevent later life misuse and dependency.