AN IMPORTANT NEW PHENOTYPE AND SOME NEXT-STEP QUESTIONS: COMMENTARY ON SARTOR ET AL. (2007)
Addiction (2007) 102 (2), 187–188.
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AN IMPORTANT NEW PHENOTYPE AND SOME NEXT-STEP QUESTIONS: COMMENTARY ON SARTOR ET AL. (2007) [Friday, February 2, 2007 The role of childhood risk factors in initiation of alcohol use and progression to alcohol dependence ]
The paper by Sartor et al. [1] is an important extension to the work by Wagner & Anthony [2], the Minnesota group [3] and others in the articulation of the early architecture of drug involvement as a multi-stage process.
It replicates a considerable amount of work demonstrating greater risk for eventual alcohol dependence (AD) among earlier first drinkers [4,5]. It also replicates findings that risk factors in the behavioral dysregulation/undercontrol domain [conduct disorder (CD), attention deficit hyperactivity disorder (ADHD)], [3,6,7], as well as family disorganization/conflict (parent divorce, maternal AD) known to sustain such undercontrolled behavior [8,9], predict earlier drinking onset.
What is new is the elaboration of a two-stage model of progression, involving (a) risk for onset of use and (b) rapidity of progression into dependence.
The Sartor et al. [1] data indicate that these are differentiated processes, with mostly different factors predicting speed of progression into disorder.
For the latter, it remains important to clarify order of precedence of the other drug comorbidity and generalized anxiety disorder (GAD) vis-à-vis the onset of AD. At least for cannabis comorbidity precedence is likely [2], but the issue needs to be addressed.
It also would be useful to know whether those factors which predict rapidity of progression into AD also predict whether or not dependence occurs. Although the issue is not highlighted in this report, the two are not the same phenotype. Their Table 2 data on differences in the probability of meeting AD criteria suggest that this may be related more to those factors which predict onset.
