Pubertal maturation and the development of alcohol use and abuse.

OBJECTIVE To examine the impact of various aspects of puberty on risk of using alcohol and developing alcohol use disorder (AUD). METHODS Data come from the Great Smoky Mountains Study, a longitudinal study of a representative sample of 1420 youth aged 9-13 at recruitment. Participants were interviewed annually to age 16. A parent was also interviewed. Information was obtained about use of a range of drugs including alcohol, drug abuse and dependence, other psychiatric disorders, life events, and a wide range of family characteristics. Pubertal hormones were assayed annually from blood samples, and morphological development was assessed using a pictorial measure of Tanner stage. RESULTS Controlling for age, Tanner stage predicted alcohol use and AUD in both boys (OR 1.58, 95% CI 1.18-2.22) and girls (OR 1.62, 95% CI 1.17-2.23). The effect of morphological development was strongest in those who matured early. Early pubertal maturation predicted alcohol use in both sexes, and AUD in girls. The highest level of excess risk for alcohol use was seen in early maturing youth with conduct disorder and deviant peers. Lax supervision predicted alcohol use in early maturing girls, while poverty and family problems were predictive in early maturing boys. CONCLUSIONS Among the many biological, morphological, and social markers of increasing maturation, the visible signs of maturity are important triggers of alcohol use and AUD, especially when they occur early and in young people with conduct problems, deviant peers, problem families and inadequate parental supervision.