Early initiation, quick escalation to high-intensity drinking can promote screening in adolescents 


According to a recently published study, identification of early initiation and quick escalation to high-intensity drinking in adolescents and young adults can increase screenings for these types of behaviors.

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Adobe Stock/pressmaster

Identification of early initiation and quick escalation to high-intensity drinking (HID) could help prevent negative outcomes among young adults, according to a recently published study.

HID is defined as consuming 10 or more drinks in a row, and is considered a potentially dangerous behavior that presents several risks such as: unintentional injuries, passing out, and unsafe driving. The path to HID, on average, is initiated in high school with a less than 2-year mean time of escalation from first drink to HID.

According to authors, “considerable variability” exists in developmental timing of alcohol use behaviors, including biological sex and race. Socioeconomic status was associated in earlier initiation in some studies, but others “found no associations,” per the study’s authors.

“Identifying factors associated with HID initiation in adolescence and how it is associated with young adulthood outcomes can inform screening and prevention,” the study authors wrote.

To determine how characteristics are associated with the initiation and escalation, and whether the characteristics were associated with weekly alcohol consumption and HID frequency, the study examined web-based survey information from US respondents who reported alcohol use in the last 30 days.

Respondents were recruited from a 2018 12th grade Monitoring the Future study, and were surveyed again from February 14 to April 17, 2020, at modal age 20 years in the Young Adult Daily Life Study. The analysis only included respondents who self-reported HID by modal age 20 years. Ultimately, 451 participants had data qualified for analysis. Of them, 62% were male, 38% were female.

Study investigators recorded the initiation year for alcohol, first binge (5 drinks or more), and HID (10 drinks or more). Additionally, weekly alcohol consumption, HID frequency, and Alcohol Use Disorders Identification Test (AUDIT) scores at 20 years were studied. Biologic sex, parental college education, race and ethnicity, college status, and family history of alcohol issues were all covariates included in the study.

Results of the study found alcohol, binge, and HID, on average, began during high school. Also, time of escalation of first drink to first HID was a mean of 1.9 years (95% CI, 1.8-2.1). The gap between first binge and HID was 0.7 years (95% CI, 0.6-0.8).

Researchers also discovered HID initiation by 11th grade corresponded with higher average weekly alcohol intake (adjusted incidence rate ratio [aIRR], 1.40; 95% CI, 1.10-1.79]), HID frequency (aIRR, 2.01; 95% CI, 1.25-3.22]), and AUDIT score (adjusted odds ratio, 1.17; 95% CI, 1.02-1.34]) at 20 years. Further, first binge to first HID within the same year (compared to more than 1 year) was linked to a higher HID frequency at 20 years, (aIRR, 1.66; 95% CI, 1.06-2.61), according to the study results.

Due to risk of HID initiation, and the potentially dangerous behavior associated with quick escalation, this study was conducted to help better identify young adults susceptible to such habits.

This study revealed that HID is generally initiated in the late stages of high school. Young adults with a family history of alcohol issues, along with those who didn’t attend a 4-year college by age 20, were at higher risk for earlier initiation. Also, males were more likely to go from first binge to first HID within the same year.

“Because of consequences associated with HID, researchers, clinicians, and policy makers must understand risk factors for young adult engagement in HID, including early initiation and faster escalation from experimenting with alcohol to HID,” authors of the study concluded.


Patrick ME, Evans-Polce RJ, Arterberry BJ, Terry-McElrath Y. Initiation of and escalation to high-intensity drinking in young adults. JAMA Pediatr. 2023;10.1001/jamapediatrics.2022.5642. doi:10.1001/jamapediatrics.2022.5642

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