Background: The first self-reported symptoms of nicotine dependence (e.g., as craving) can appear within days to weeks of the onset of occasional use, and the appearance of symptoms predicts future consumption and dependence. We sought to determine whether craving for alcohol occurs in early stages of adolescent alcohol use, and whether it predicts future binge drinking, a prevalent and problematic behavior.
Methods: Longitudinal (30-month) four-wave study of 3415 students (M=12.5 years at baseline) from 29 German schools. Students reported five symptoms of alcohol craving on a scale developed based on well-validated measures for tobacco. Multilevel mixed-effects logistic regression was used to predict having five or more binge episodes by last follow-up, based on the number of symptoms reported before the first lifetime binge. Multiple imputation was used to address study drop-out.
Results: At baseline, 23% reported at least one symptom, increasing to 54% at wave 4. Any report of symptoms at baseline was associated with frequency of alcohol use, being present in 100% of daily, 93% of weekly, 87% of monthly, 48% of infrequent drinkers, and 16% of ever drinkers reporting no current alcohol use. Moreover, symptoms at baseline independently predicted frequent binge drinking 2.5 years later, AOR=2.08 (95% CI 1.39, 3.11; p<0.001) among baseline never-bingers, after adjusting for covariates.
Conclusions: Some early-onset drinkers reported symptoms of alcohol craving and loss of control after minimal exposure to alcohol. If replicated, an early screener could be developed to identify those at risk for frequent binge drinking.
Keywords: Adolescent; Alcohol; Alcohol use disorder; Binge drinking; Screening.
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