Characterizing Midlife-Onset Alcohol Dependence: Implications for Etiology, Prevention, and Healthy Aging

We evaluated the developmental epidemiology of midlife-onset alcohol dependence (AD) in the Dunedin Study ( N = 1,037), a population-representative cohort followed across 5 decades. At ages 18, 21, 26, 32, 38, and 45, past-year AD prevalence was 11.0%, 18.4%, 13.6%, 8.1%, 9.6%, and 11.3%, respectively. As expected, relative to never-diagnosed individuals, individuals with early onset AD (first diagnosis at age 18 or age 21, prevalence = 22.9%) were distinguished by a range of early life and adult correlates. Individuals with midlife-onset AD (first diagnosis at age 38 or age 45, prevalence = 5.6%) were distinguished by fewer early life correlates, but exhibited a family history of AD and adolescent dysregulation and marijuana use. They were characterized by an array of adult correlates, including internalizing disorders, mental-health-treatment contact, criminal behavior, perceived stress, coping by drinking, lower likelihood of marriage and parenthood, and reduced preparedness for old age. They also experienced more adult alcohol-related impairment than the early onset group. Results can guide efforts to reduce midlife alcohol-related problems and support healthy aging.