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Heavy binge drinking isn't just a college problem, researchers affirmed, finding that most teen alcohol use that escalated to having 10 or more drinks in a row reached that level rapidly during the high school years.

Among a sample of youth who reported drinking in the prior 30 days when surveyed in the 12th grade and who said they engaged in high-intensity drinking (HID, 10 or more in a row) when surveyed again around age 20, initiation of all three levels of alcohol use -- first drink, binging on five or more drinks in a row, and HID -- primarily occurred during high school grades 9 to 12.

And it happened fast, Megan Patrick, PhD, of the University of Michigan in Ann Arbor, and colleagues detailed in .

From first drink to HID took an average of 1.9 years, while the time from first binge to initiation of HID averaged only 0.7 years.

More than 17% of respondents started HID the same year as having their first drink, and almost half (47.6%) initiated binge drinking and HID in the same year.

"There is a lot of focus on underage drinking among young adults, but the fact that there is very heavy drinking in high school suggests that waiting until college for intervention may be too late for some people because these patterns have already started for many of them," Patrick told 乌鸦传媒 in an email.

Her group suggested the findings could be used to help facilitate screening for risky alcohol use.

"It's a relatively narrow window," from starting to drink to heavy binging, Patrick added. "Those teens who more quickly escalate to high-intensity drinking are at greater risk."

For their cohort study, Patrick and colleagues analyzed web-based survey data from respondents in the U.S. who in 2018 reported alcohol use in the past 30 days in the 12th grade Monitoring the Future study and who were surveyed again from February to April 2020, when around the age of 20, in the Young Adult Daily Life Study.

Only respondents who reported HID by age 20 were included in the analyses. Of 451 participants with data eligible for analysis, 62% were male.

Other findings linked family history of alcohol problems to earlier (lower grade or year) HID initiation, whereas current college students reported significantly later initiation.

Researchers further found that sex, race and ethnicity, and parental education were not associated with HID initiation. However, males had a shorter expected rate of escalation from first binge to initiation of HID than females (adjusted incidence rate ratio [aIRR] 0.72, 95% CI 0.57-0.91).

Additionally, Patrick and colleagues reported that initiating HID by 11th grade was associated with a relative 28-40% greater rate of average weekly drinks reported at age 20, depending on the model used, when compared with later HID initiation. It also was associated with around a twofold increase in the expected rate of past 2-week HID occasions at age 20.

Among college respondents, same-year escalation was associated with greater HID frequency (aIRR 2.04, 95% CI 1.10-3.43) at age 20, researchers found.

Further findings included that initiating HID by 11th grade was associated with a greater expected Alcohol Use Disorders Identification Test score at age 20 (adjusted OR 1.17, 95% CI 1.02-1.34).

Limitations of the study included that individuals who dropped out of high school were excluded from the study, that initiation of alcohol use was based on year in school and not biological age, and that responses were retrospective and subject to recall and social desirability biases. Additionally, analyses did not use sex-specific thresholds for binge drinking or HID.

Further limitations included that family history of alcohol problems was self-reported and that outcomes were assessed during the pandemic, researchers noted. Small sample sizes across racial and ethnic groups also required aggregating data, which limits generalizability across subpopulations.

"The age at which adolescents first engage in high-intensity drinking was an important predictor of alcohol use and problems at age 20," Patrick told 乌鸦传媒. "I think it's important to be aware of when teens start drinking and whether and how quickly they escalate to heavier drinking so we can appropriately target prevention and intervention efforts."

Ultimately, Patrick said, "Parents and clinicians can be aware of these patterns and pay particular attention to whether and how quickly an adolescent's drinking is intensifying as a gauge for how urgently intervention may be needed."

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