Progression of alcohol consumption across the drinking career in alcoholics and social drinkers.

OBJECTIVE To document and compare the changes in alcohol intake over the drinking career in alcoholic (n = 273) and social (n = 152) drinkers and to relate the changes to age and to the prevalence of morning drinking. METHOD Lifetime alcohol intake was assessed in face-to-face interviews by asking subjects to report drinking patterns during different "phases" of their drinking careers, beginning with the onset of regular drinking and continuing up to the present. RESULTS Alcohol consumption began at higher quantities and higher frequencies in alcoholics (prealcoholics) and rapidly escalated within a few years to values well out of the range of moderation. The alcohol intake of social drinkers at the beginning phase was only about 70% that of alcoholics. In contrast to alcoholics, the alcohol intake of social drinkers remained relatively constant across subsequent drinking phases at about three to four drinks per drinking occasion, with only a slight increase in the frequency of drinking over sequential drinking phases. The relationship of total alcohol consumption to age in alcoholics was described best by a curvilinear function, with alcohol consumption peaking near age 40. CONCLUSIONS Gender differences in consumption were decreased with adjustment for body water content. The higher initial alcohol intakes in alcoholics may reflect a lower sensitivity to the intoxicating effects of alcohol, or, alternatively, a greater ability of alcoholics to develop tolerance. The high prevalence of morning drinking in alcoholics compared to social drinkers reinforces the usefulness of morning drinking as a diagnostic tool, particularly for female alcoholism.