VE
 

U.S. Department of Health

& Human Services 

National Institutes of Health 

National Institute on Alcohol Abuse 

and Alcoholism 

Number 74 January 2008 

ALCOHOL RESEARCH:
 

A LIFESPAN PERSPECTI

Alcohol use and the risk for alcohol-related problems change 

over the lifespan. College students and young adults, who 

often drink large quantities of alcohol at one time, are more 

likely to experience problems such as alcohol poisoning, 

drunk-driving crashes, and assaults; whereas, older individuals 

who drink even moderately while taking certain medications 

run the risk of harmful drug interactions. Additionally, patterns 

of alcohol use may differ across the human lifespan—for 

example, adolescents who begin drinking prior to age 14 are 

more likely to develop a serious problem with alcohol later 

in life. Understanding how alcohol influences people across 

different life stages is important, especially when designing 

effective approaches for diagnosing, treating, and preventing 

alcohol abuse and dependence and their related problems. 

In 2006, the National Institute on Alcohol Abuse and 

Alcoholism (NIAAA) published the Five-Year Strategic Plan, 

The NIAAA Strategic Plan for Research. The Five-Year Plan 

introduces a new organizing principle for alcohol research 

studies: A Lifespan Perspective. This new perspective gives 

researchers a framework within which to examine how 

alcohol affects people at different stages of development and 

how different stages of development affect drinking behaviors. 

The Five-Year Plan examines the current state of alcohol 

research—what we know about alcohol-related issues— 

within a Lifespan Perspective, and suggests opportunities for 

new research and outreach based on these findings. Since 

2006, the Five-Year Plan has been revised once, and NIAAA 

will continue to provide updates to reflect new and emerging 

research opportunities. This Alcohol Alert presents some of 

the findings and opportunities outlined in the latest version 

of the Five-Year Plan. 

“Patterns of alcohol use may 


differ across the human lifespan.” 

The Embryo and Fetus: Focus 

on Fetal Alcohol Spectrum 

Disorder (FASD) and Fetal 

Alcohol Syndrome (FAS) 

What we know—Alcohol is a leading preventable cause of 

birth defects with mental deficiency. Prenatal alcohol exposure 

can cause a variety of problems known collectively as Fetal 

Alcohol Spectrum Disorder (FASD). The most severe form of 

FASD, Fetal Alcohol Syndrome (FAS), often is characterized 

by certain physical traits, such as a flattened midface, wide-set 

eyes and slow growth, nervous system impairments, and a 

range of learning and behavioral problems. Additionally, people exposed to alcohol prenatally are at higher risk of developing an alcohol and other drug use disorder later in life. 

It has been reported that up to 1 in 100 children in the United 

States are born with FASD. Additionally, 0.5 to 3.0 children 

out of 1,000 are diagnosed with FAS.1 Research suggests that 

other factors, such as the mother’s hormone status, nutrition, 

age, the number of children she has had previously, and the 

length of time she has been drinking, as well as genetic factors 

including those affecting the way the body breaks down alcohol, 

also may contribute to the development of FASD. 

FASD can be very difficult to recognize. The symptoms are sometimes 

subtle and cover a wide spectrum of 

1 From Fetal Alcohol Syndrome: Diagnosis, Epidemiology, 

Prevention, and Treatment. Institute of Medicine, 1996. (http:// 

www.nap.edu/openbook.php?record_id=4991&page=1). 
 

 

Figure 1. Prevalence of Past-year 

DSM-IV Alcohol Dependence by Age 

in the United States 

0

2

4

6

8

0

2

4

– – – – – – – – – – –

Age

Percent

–

Source: NIAAA 2001–2002 National Epidemiological Survey on Alcohol and Related 

Conditions (NESARC) data (18–60+ years of age) and Substance Abuse and Mental 

Health Administration (SAMHSA) 2003 National Survey on Drug Use and Health 

(NSDUH) (12–17 years of age). 

problems. Symptoms also may change with 

age—for example, facial features often associated 

with FAS may be less prominent as a person 

ages. Most importantly, there is no “biomarker” 

for FASD—that is, there is no characteristic or 

distinctive biological feature that can be used 

to identify the disorder in every case. A major 

factor influencing risk for FAS and FASD is 

the timing of alcohol exposure during critical 

periods of development. 

Research opportunities—Researchers are working to diagnose FASD earlier and more accurately using complex, detailed facial imaging to 

identify subtle facial abnormalities in infants. 

These abnormalities may serve as biomarkers 

for FASD. Another promising biomarker is a 

brain structure called the corpus callosum: the 

size of the corpus callosum is much more variable in the brains of children and adults who 

have experienced prenatal exposure to alcohol. 

When prenatal alcohol exposure already has 

occurred (i.e., if a woman drinks before she 

realizes that she is pregnant), or if alcohol 

exposure is ongoing (i.e., a woman continues to drink during 

pregnancy), pharmacological intervention may be helpful 

in countering some of the harmful effects of alcohol. 

Although these interventions have not yet been studied 

in humans, animal studies have shown intriguing results. 

Antioxidants, anti-inflammatory agents (such as prostaglandin 

inhibitors), and the nutritional co-factor choline are some 

of the agents that may prove useful in reducing alcoholinduced fetal injury. For example, when young rats with 

prenatal exposure to alcohol were given supplements of 

choline, they became less hyperactive and showed decreased 

memory loss. 

Researchers also are exploring ways of treating children with 

FASD. Again, studies in animals suggest that behavioral interventions might improve some of the symptoms of FASD. 

When adult rats with prenatal exposure to alcohol were given 

20 days of motor skills training, their performance improved, 

suggesting that brain cells damaged by alcohol may be able to 

partially recover. Human studies using behavioral intervention 

are in the early stages but also are encouraging. 

Youth and Adolescence 

What we know—Adolescence is the period between 12 

and 17 years of age. This is a time of dramatic physical, 

psychological, and social change. The brain continues to 

develop and mature throughout adolescence and into the 

mid-20s, and studies suggest that consuming alcohol during 

this time may have lasting effects on brain development. 

For example, a region of the brain involved in learning and 

memory, the hippocampus, is smaller in adolescents who 

begin drinking at an early age. In addition, studies of adolescents who were receiving treatment for alcohol withdrawal 

showed that they were more likely to have memory problems 

than adolescents who did not drink. 

Adolescents tend to drink differently than adults. They 

are more likely to engage in risky behaviors such as heavy 

episodic (or “binge”) drinking.2 Researchers believe these 

risky behaviors are the result of certain social factors, such 

as a greater independence and pressure from peers, as well 

as biological factors. Adolescents tend to be less sensitive to 

negative effects of alcohol, such as increased sleepiness and 

lack of coordination. This may explain why they are able 

to drink so much alcohol at one time. On the other hand, 

adolescents are more likely to have trouble with complex 

tasks, such as driving a motor vehicle, making adolescent 

alcohol use especially dangerous. 

According to the National Household Survey on Drug Abuse, 

1.47 million adolescents ages 12–17 (5.9 percent of adolescents in this age-group) met the criteria for alcohol dependence or alcohol abuse in 2003. However, the survey also 

showed that only 15 percent of these respondents received 

any treatment for alcohol problems. 

2 According to the Surgeon General’s Call to Action To Prevent and Reduce Underage Drinking 

(NIAAA 2006), most college drinking studies define binge drinking as “5 or more drinks in a row 

for men and 4 or more drinks in a row for women” (NIAAA National Advisory Council). However, 

in 2004, the National Advisory Council revised the definition of binge drinking as follows: “a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08 gram percent or 

above. For the typical adult, this pattern corresponds to consuming 5 or more drinks (male) or 4 

or more drinks (female) in about two hours” (NIAAA National Advisory Council). 

2
 
According to the Five-Year Plan, preventing alcohol problems 

in adolescents poses unique challenges. Research suggests 

that they may not respond well to traditional treatment 

methods (e.g., alcoholism treatment programs and Alcoholics 

Anonymous) and that brief, alternative intervention methods that are targeted specifically toward young people are 

more effective. 

Research opportunities—Researchers continue to explore 

how the social and biological changes associated with adolescence contribute to alcohol use, as well as how alcohol 

can affect the maturing brain. Researchers also are working 

to refine current definitions of alcohol abuse and dependence 

to better diagnose and screen dangerous drinking behaviors 

in young people, because adolescent drinking patterns tend 

to differ from those of adults. Research continues to identify factors, such as certain behaviors or a family history of 

alcoholism, which may put young people at risk for later 

alcohol problems. Research also continues to explore the 

complex relationship between drinking and other biological 

factors, such as reproductive and stress hormones and sex 

differences. 

Young Adults 

What we know—Young adulthood is the period between 

the ages of 18 and 29 years. During this period many young 

people pursue postsecondary education, enlist in the military, or enter the workforce. This is a time of transition and 

of increased risk for problems with alcohol. The youngest 

segment of this population—young adults ages 18–24—are 

most at risk for alcohol problems, compared with other agegroups (see Figure 1). This group is most likely to drink heavily, regardless of their gender, ethnicity, and school or work status—that is, whether they attend college or are employed full 

time (Figure 2). Despite increased attention in recent years, 

the problem of young adult drinking continues to escalate: 

alcohol-related deaths rose 5 percent for 18- to 24-year-olds 

between 1998 and 2001. 

For college students, brief interventions that target high-risk 

populations (e.g., freshmen, Greek organization members, 

athletes, students mandated to receive treatment) and Driving 

Under the Influence (DUI) prevention campaigns have shown 

promise. For young adults in the military, few programs have 

been formally evaluated; however, current strategies to prevent 

alcohol-related problems include regulating the availability and 

pricing of alcohol, attempting to deglamorize alcohol use, and 

promoting personal responsibility and good health. 

Nonstudent, nonmilitary personnel may be more likely to 

continue dangerous drinking patterns into adulthood. This 

population does not have access to institutionally based 

programs that typically serve college students and military 

personnel. Additionally, this population may not have 

access to mental health services, making them vulnerable to 

psychiatric conditions, such as depression and anxiety, often 

associated with dangerous drinking patterns. 

Figure 2. Percentage of Individuals Exceeding the Daily Drinking Limit for 

Ages 18–20 and 21–24, by Gender, Race-Ethnicity, and College Enrollment Status 

M

W

C ge, m C ge, m N ge

B A AN A NHOP H

W m

P t P t P t

A

Source: NIAAA 2001–2002 NESARC data. *AIAN = American Indian/Alaska Native, ** NHOPI = Native Hawaiian/Other Pacific Islander 

3
 
Research opportunities—As noted above, researchers now 

believe that the brain continues to develop into the mid-20s. 

Scientists are continuing to explore alcohol’s potentially damaging effects on the young adult brain. Using noninvasive 

brain scans, such as the electroencephalogram (EEG), which 

measures and records the electrical activity of the brain, 

researchers can study changes that occur with drinking and 

determine whether the brain can return to a normal level of 

function as young adults begin to “age out” of heavy drinking. 

Studies also can help to determine how the maturing brain 

affects a young adult’s decision to drink and how best to intervene with college students, military personnel, and young 

adults who are not enlisted in college or in the military. 

Although most young adults drink less as they transition 

into midlife, some continue to drink heavily. Research continues to explore the risk factors associated with continued 

drinking into midlife. 

Midlife: Focus on 

Detrimental Effects 

of Drinking and on 

Treatment Options 

What we know—The Five-Year Plan considers midlife as 

spanning the ages of 30–59. During this period the consequences of heavy drinking often become evident. Alcoholic 

liver disease, alcohol pancreatitis, several types of cancer, 

disorders of the heart and circulatory system, alcohol-related 

brain disorders, and other adverse effects upon the endocrine 

and immune system are most likely to emerge during this 

time. For people in midlife, research often has focused on 

how alcohol damages body tissues, as well as methods for 

better tailoring treatments and interventions to this segment 

of the population. 

Individuals in midlife are more likely to seek treatment for 

alcohol dependence. Three drugs—disulfiram, naltrexone, 

and acamprosate—have been approved for use in the United 

States to treat alcoholism. Although some patients have 

responded well to these medications, others have not. Research 

shows that a variety of factors—both biological and social— 

influence an individual’s response to therapy. 

Research opportunities—Some of the most exciting alcohol 

research focuses on developing new medications for alcoholism, targeting multiple sites. New medications could 

Alcohol and HIV/AIDS 

HIV (Human Immunodeficiency Virus), the virus that causes 

AIDS (Acquired Immunodeficiency Syndrome), is epidemic 

in the United States. As many as 950,000 people in the 

United States may be infected with the HIV virus, and 

more than 500,000 people have died from the infection. 

Eighty percent of people infected with HIV drink alcohol, 

and between 30 and 60 percent have been diagnosed 

with an alcohol use disorder. 

The relationship between HIV and alcohol is complex 

and needs further study. Drinking might make it easier for 

the HIV virus to establish an infection; additionally, alcohol 

use might actually accelerate the course of the disease. 

Alcohol also may change the way the body breaks down 

HIV medications, interfering with their effectiveness. 

In addition, it has been shown that people who drink are 

less likely to get tested for HIV. When they do test positive they are less likely to seek treatment and are less 

compliant with treatment. Drinking also is associated 

with risk-taking behaviors that might put people at 

increased risk for contracting HIV. 

Clearly, alcohol use and HIV/AIDS are closely intertwined. 

Additional research is needed to learn more about this 

complex relationship. Longitudinal studies also may prove 

helpful, providing a better understanding of how alcohol 

and HIV can interact and affect individuals over time. 

help people with alcohol dependence who do not respond 

well to existing medications. Several promising agents, 

including baclofen, rimonabant, and memantine, now are 

being evaluated for safety and efficacy in treating alcohol use 

disorders. Current research also is exploring the possibility of 

preventing or treating organ injury through the use of pharmaceuticals, as well as through the use of antioxidant- and 

cannabinoids-related agents. 

Alcohol metabolism has been shown to have an important 

role in organ damage. This is another area of research that 

is receiving attention. Other studies are examining treatment approaches that help people to change their drinking 

behavior and identifying biological and social factors that 

encourage drinking behaviors as 

well as those that increase the chances 

“

Research shows that a variety of factors— of recovery. 

both biological and social—influence 

an individual’s response to therapy.” 

Moderate drinking among adults 

is another chief area of research. 

Although heavy alcohol use is associated with the development of 

4
 
 

many diseases, some research suggests that moderate alcohol 

consumption may protect individuals from some of the 

health problems that tend to strike during midlife, including 

coronary artery disease, type 2 diabetes, dementia, and 

ischemic stroke. More research is needed to determine 

whether these potential benefits outweigh the risks of drinking. 

Senior Adults and Alcohol: 

A National Health Issue 

What we know—Senior adults tend to drink less than 

other age-groups (see Figure 1). However, research suggests 

that alcohol problems in older adults soon may become a 

national health issue. Senior adult drinking is on the rise; 

as people live longer, the number of people who drink will 

increase. Research also shows that people born in recent 

years tend to drink more than older generations, suggesting 

that as the current population ages, these individuals will 

continue to drink more. 

Older adults are at particular risk for alcohol-related problems. 

As individuals age they metabolize alcohol more slowly; as a 

result, alcohol remains in the body longer. Older adults are 

more likely to have health conditions that can be exacerbated by alcohol, including stroke, hypertension, neurodegeneration, memory loss, mood disorders, and cognitive or 

emotional problems. Additionally, older adults are more 

likely than younger people to take medications, putting 

them at risk for interactions that can be dangerous or even 

life-threatening. Alcohol also may decrease effectiveness of 

some medications. 

Research shows that treatment can be effective in older individuals. They tend to respond better to treatment that takes 

place in groups of people in their same age range. Cognitive 

behavioral therapy has been shown to be effective in older 

patients. Group family therapy also has been shown to be 

successful, perhaps because family therapy engages support 

systems that might have been lacking or even exacerbating 

the patient’s alcohol use. Although it has not been well 

studied, some research shows that medications for alcoholism 

may not work as well in older adults. 

According to the current literature, the most beneficial 

treatment for alcohol use disorders in older adults may be 

education; many seniors lack information on the dangers 

of alcohol use. The age at which they begin drinking also 

is important. Older adults who began problem drinking 

earlier in life tend to have worse treatment outcomes than 

those who began drinking later in life. 

Research opportunities—Although older adults are the 

most rapidly growing segment of the population today, very 

little alcohol-related research has been conducted among 

this age-group. Researchers continue to explore how the 

physiological and social changes that come with aging interact with alcohol use. New research is examining the effectiveness of current medications in seniors with alcohol use 

disorders, as well as developing medications that might 

work better in older individuals. Researchers are examining 

how alcohol use may impact the development of diseases 

such as Alzheimer’s, type 2 diabetes, and other age-related 

health problems. Ongoing research will reveal how changing 

demographics may affect the use, impact, and consequences 

of older adult drinking. 

Conclusion 

NIAAA’s Five-Year Plan gives researchers a framework within 

which to explore how alcohol affects individuals at different 

stages of development and how different stages of development affect drinking behaviors. This Lifespan Perspective 

offers a new approach to the age-old question: Why do some 

people drink too much? It enables researchers to conceptualize 

the complex and evolving relationship between human development and alcohol and to explore how alcohol intersects 

with biology and the environment. New insights gained 

through the Lifespan Perspective will result in more effective 

and better-targeted interventions that take into account the 

changing needs of individuals at every stage of life. 

“This Lifespan Perspective offers a 

new approach to an age-old question: 

Why do some people drink too much?” 

5
 
R e s o u r c e s 

Source material for this Alcohol Alert originally appeared in 

the National Institute on Alcohol Abuse and Alcoholism (NIAAA) 

Five-Year Strategic Plan. 

The Five-Year Plan highlights new research avenues that will 

address alcohol use across the human lifespan, emphasizing how 

drinking behavior evolves over an individual’s lifetime in response 

to biological, psychological, and social and environmental changes. 

Over time the Plan will be updated to reflect new and emerging 

research opportunities. 

The Plan is available online at http://pubs.niaaa.nih.gov/ 

publications/StrategicPlan/NIAAASTRATEGICPLAN.htm 

Full text of this publication is available on NIAAA’s World Wide Web site at www.niaaa.nih.gov. 

All material contained in the Alcohol Alert is in the public domain and may be used or reproduced 

without permission from NIAAA. Citation of the source is appreciated.
 

Copies of the Alcohol Alert are available free of charge from the National Institute on Alcohol Abuse and Alcoholism
 

Publications Distribution Center, P.O. Box 10686, Rockville, MD 20849–0686.
 

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