Drinking habits among older persons: findings from the NHANES I Epidemiologic Followup Study (1982-84). National Health and Nutrition Examination Survey

OBJECTIVES: To describe alcohol use and its sociodemographic correlates among persons aged 65 years and older in a US probability sample. DESIGN: Cross-sectional analysis of a national probability sample-based cohort study. SETTING: Multiple sites throughout the United States. PARTICIPANTS: A total of 3448 persons aged 65 and older who participated in the first wave of the NHANES I Epidemiologic Followup Study (1982-84). MEASUREMENTS: We describe the alcohol use behaviors and demographic characteristics of 3448 persons aged 65 and older. Least squares regression models were used to assess associations between older persons' sociodemographic characteristics and alcohol use. RESULTS: Sixty percent of the sample reported having 12 or more drinks of alcohol in at least 1 year of their lives. Seventy-nine percent of these older drinkers were currently drinking. Twenty-five percent of all drinkers drank daily (31% men, 19% women). Using gender-specific definitions (men >2 drinks/day; women >1 drink/day), 16% of men drinking alcohol and 15% of women drinking alcohol were heavy drinkers. Younger age, male gender, and higher income were associated with greater alcohol use. CONCLUSIONS: Most older persons who ever drank alcohol in their lifetimes were currently drinking. In addition, a substantial number of older persons were drinking currently at levels that may place them at risk of adverse health consequences.     

Genetic and environmental influences on the rate of progression to alcohol dependence in young women

Background: The development of alcohol dependence (AD) involves transitions through multiple stages of drinking behaviors and is shaped by both heritable and environmental influences. We attempted to capture this dynamic process by characterizing genetic and environmental contributions to the rate at which women progressed through 3 significant transitions along the pathway to AD: nonuse to initiation, initiation to onset of first alcohol‐related problem, and first problem to onset of AD. Methods: The sample consisted of 3,546 female twins from the Missouri Adolescent Female Twin Study. Participants ranged in age from 18 to 29 years. Retrospective reports of alcohol use histories were collected by telephone diagnostic interview and transition times between drinking milestones were coded ordinally. Standard genetic analyses were conducted in Mx to derive a trivariate model that provided estimates of genetic and environmental influences that were common as well as specific to the 3 transition times. Results: Heritable influences were found for rate of progression across all 3 transitions, accounting for 30 to 47% of the variance in transition times. Shared environmental contributions were evident only in rate of progression from nonuse to initiation (i.e., age at first drink). Heritable contributions to the rate of movement through successive drinking milestones were attributable to a common factor, whereas environmental influences were transition‐specific. Conclusions: The current study is unique in its use of a genetically informative design to document the rate of movement between drinking milestones in a female sample and to examine genetic contributions to multiple transition times over the course of AD development. Results indicate that an earlier report of heritability for males in rate of progression from regular drinking to AD generalizes to women and to other alcohol stage transitions. Findings also suggest the need to consider stage‐specific environmental contributions to alcohol outcomes in developing interventions.     

The performance of elements of a 'level of response to alcohol'-based model of drinking behaviors in 13-year-olds

Aim The goals of this paper are to evaluate whether drinking practices among peers mediates the relationship between a low level of response (LR) to alcohol and a person's heavier drinking and alcohol‐related problems in 12–14‐year‐olds. Design Correlations and structural equation models (SEM) were used to test a hypothesized model of the relationships among key variables in adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC), a longitudinal birth cohort study in Bristol, England. Participants These included 688 boys (40.4%) and girls who were offspring of the pregnant women who had been selected as ALSPAC participants in 1991 and 1992. The offspring were interviewed at about age 13 years, and those who had ever consumed a full drink completed the Self‐Report of the Effects of Alcohol (SRE) questionnaire indicating the number of drinks required for up to four effects early in their drinking histories. A higher number of drinks required for effects indicated a low LR per drink consumed. Findings The SEM explained 58% of the variance of the alcohol pattern, and had good fit characteristics. A low LR was related to heavier drinking and more alcohol problems both directly and as mediated partially by drinking in peers. The model performed well across the narrow age range, and applied equally well in boys and girls. Conclusions The perceived drinking practices of peers is a potentially important mediator of how a low LR to alcohol relates to drinking practices during early adolescence. The findings may be useful in developing approaches to prevent heavier drinking in this young group.     

Prediction of alcohol-related harm from controlled drinking strategies and alcohol consumption trajectories

Aims To establish predictors of age 21 alcohol‐related harm from prior drinking patterns, current levels of alcohol consumption and use of controlled drinking strategies. Participants One thousand, five hundred and ninety‐six students recruited from an initial sample of 3300 during their final year of high school in 1993. Design Longitudinal follow‐up across five waves of data collection. Setting Post high school in Victoria, Australia. Measurements Self‐administered surveys examining a range of health behaviours, including alcohol consumption patterns and related behaviour. Findings Drinking behaviours at age 21 were found to be strongly predicted by drinking trajectories established through the transition from high school. Multivariate regression analysis revealed that alcohol‐related harms at age 21 were reduced where current levels of alcohol use fell within limits recommended in Australian national guidelines. After controlling for this effect it was found that the range of strategies employed by participants to control alcohol use maintained a small protective influence. Post‐high‐school drinking trajectories continued to demonstrate a significant effect after controlling for current behaviours. Findings revealed that over one quarter of males and females drank alcohol, but on a less‐than‐weekly basis. This pattern of alcohol use demonstrated considerable stability through the post‐school transition and was associated with a low level of subsequent harm at age 21. Conclusions Future research should investigate whether encouraging more Australian adolescents to drink alcohol on a less‐than‐weekly basis may be a practical intervention target for reducing alcohol‐related harms.     

Energy drink consumption and increased risk for alcohol dependence

Background: Energy drinks are highly caffeinated beverages that are increasingly consumed by young adults. Prior research has established associations between energy drink use and heavier drinking and alcohol‐related problems among college students. This study investigated the extent to which energy drink use might pose additional risk for alcohol dependence over and above that from known risk factors. Methods: Data were collected via personal interview from 1,097 fourth‐year college students sampled from 1 large public university as part of an ongoing longitudinal study. Alcohol dependence was assessed according to DSM‐IV criteria. Results: After adjustment for the sampling design, 51.3%_wt of students were classified as “low‐frequency” energy drink users (1 to 51 days in the past year) and 10.1%_wt as “high‐frequency” users (≥52 days). Typical caffeine consumption varied widely depending on the brand consumed. Compared to the low‐frequency group, high‐frequency users drank alcohol more frequently (141.6 vs. 103.1 days) and in higher quantities (6.15 vs. 4.64 drinks/typical drinking day). High‐frequency users were at significantly greater risk for alcohol dependence relative to both nonusers (AOR = 2.40, 95% CI = 1.27 to 4.56, p = 0.007) and low‐frequency users (AOR = 1.86, 95% CI = 1.10, 3.14, p = 0.020), even after holding constant demographics, typical alcohol consumption, fraternity/sorority involvement, depressive symptoms, parental history of alcohol/drug problems, and childhood conduct problems. Low‐frequency energy drink users did not differ from nonusers on their risk for alcohol dependence. Conclusions: Weekly or daily energy drink consumption is strongly associated with alcohol dependence. Further research is warranted to understand the possible mechanisms underlying this association. College students who frequently consume energy drinks represent an important target population for alcohol prevention.     

Alcohol control policies and alcohol consumption by youth: a multi-national study

Aims The study examined relationships between alcohol control policies and adolescent alcohol use in 26 countries. Design Cross‐sectional analyses of alcohol policy ratings based on the Alcohol Policy Index (API), per capita consumption and national adolescent survey data. Setting Data are from 26 countries. Participants Adolescents (aged 15–17 years) who participated in the 2003 European School Survey Project on Alcohol and Other Drugs (ESPAD) or national secondary school surveys in Spain, Canada, Australia, New Zealand and the United States. Measurements Alcohol control policy ratings based on the API; prevalence of alcohol use, heavy drinking and first drink by age 13 based on national secondary school surveys; per capita alcohol consumption for each country in 2003. Analysis Correlational and linear regression analyses were conducted to examine relationships between alcohol control policy ratings and past 30‐day prevalence of adolescent alcohol use, heavy drinking and having first drink by age 13. Per capita consumption of alcohol was included as a covariate in regression analyses. Findings More comprehensive API ratings and alcohol availability and advertising control ratings were related inversely to the past 30‐day prevalence of alcohol use and prevalence rates for drinking three to five times and six or more times in the past 30 days. Alcohol advertising control was also related inversely to the prevalence of past 30‐day heavy drinking and having first drink by age 13. Most of the relationships between API, alcohol availability and advertising control and drinking prevalence rates were attenuated and no longer statistically significant when controlling for per capita consumption in regression analyses, suggesting that alcohol use in the general population may confound or mediate observed relationships between alcohol control policies and youth alcohol consumption. Several of the inverse relationships remained statistically significant when controlling for per capita consumption. Conclusions More comprehensive and stringent alcohol control policies, particularly policies affecting alcohol availability and marketing, are associated with lower prevalence and frequency of adolescent alcohol consumption and age of first alcohol use.     

Cigarette smoking and the risk for alcohol use disorders among adolescent drinkers

BACKGROUND: Cigarette smoking and alcohol use disorders (AUDs) are closely linked, but it is not clear whether higher rates of AUD among smokers are solely attributable to heavier drinking or, alternatively, whether smokers are more vulnerable to alcohol abuse and dependence than nonsmokers who drink comparable quantities. We sought to address this issue using data from a nationally representative U.S. sample of adolescents and young adults. Specifically, we analyzed the relationship between cigarette smoking, drinking, and AUDs. METHODS: Data were from the aggregated 2002 through 2004 U.S. National Survey on Drug Use and Health. Participants were randomly selected, household-dwelling adolescents and young adults (ages 12-20) from the noninstitutionalized, civilian population of the United States (N=74,836). Measurements included current DSM-IV alcohol abuse or dependence, number of drinks in the past 30 days, and past-year cigarette smoking, defined as having smoked more than 100 cigarettes across the lifetime and having smoked during the past year. RESULTS: Past-year smokers (prevalence=16.0%) drank in higher quantities than never-smokers, but were also at elevated risk for AUD when compared with never-smokers who drank equivalent quantities. The effect was observed across age groups, but was more prominent among younger adolescents. After adjusting for drinking quantity and sociodemographic variables, smokers had 4.5-fold higher odds of AUD than never-smokers [95% confidence interval (95% CI), 3.1-6.6]. Youths who reported smoking but did not cross the 100-cigarette threshold were at intermediate risk [odds ratio (OR), 2.3; 95% CI, 1.7-3.3]. Differences in AUD between smokers and never-smokers were most pronounced at lower levels of drinking. CONCLUSIONS: The results are consistent with a higher vulnerability to AUDs among smokers, compared with nonsmokers who drink equivalent quantities.     

Tracking drinking behaviour from age 15-19 years

Aims The aim of this paper was to assess (1) changes in drinking behaviour over time among Danish adolescents and (2) use of which alcoholic beverages and what drinking patterns would have the strongest predictive effect on later alcohol consumption. Design, setting, participants The population was a random sample of 15‐year‐olds (baseline 1990, response rate 86%, n= 847) with a first follow‐up 4 years later (response rate 85%, n= 729). Measurements Alcohol intake was assessed by experience of drunkenness, quantity and frequency of consumption. Thresholds recommended by the Danish National Board of Health were used to discriminate high from low intake. Findings At 19 years of age at least 80% drank alcohol monthly, and 24% of the men and 11% of the women had an alcohol intake above the recommended national limits, i.e. 21 weekly units of alcohol for men and 14 for women. Consumption of alcoholic beverages at age 15 increased the risk of drinking alcohol weekly at the age of 19 [odds ratio (OR)‐values from 1.11 to 3.53]. Drunkenness among the 15‐year‐old boys and the use of spirits of the 15‐year‐old girls showed the strongest predictive relationship with excessive consumption at age 19 [OR = 2.44, confidence interval (CI): 1.38–4.29, respectively, OR = 1.97, CI: 1.15–3.38]. Conclusions Alcohol consumption as early as the age of 15 predicted weekly alcohol consumption and alcohol intake exceeding the recommended amount 4 years later. Young teenagers’ high alcohol consumption was not just a passing phenomenon. It was a behaviour that tracked into young adulthood, leaving the adolescents at increased risk of being long‐term, large‐scale consumers.     

Pattern of drinking and fatal injury: a population-based follow-up study of Finnish men

AIM: To find out how the frequency of drinking one to two drinks, three to four drinks and five or more drinks of alcohol per drinking occasion predicts injury mortality in 16 years of follow-up among the Finnish 15-69-year-old male population. DESIGN: Three alcohol surveys conducted in 1969, 1976 and 1984 were pooled and linked with mortality information from the national cause of death register. METHOD: Cox proportional hazard models were used for analysing the survival time data. FINDINGS: Drinking at the level of one to two drinks, regardless of frequency, did not elevate the risk of fatal injury, nor did drinking at the level of three to four drinks. Drinking five or more drinks at a time significantly increased the risk of fatal injury in graded relation, compared with those who never drank at that level. The risk was highest for those who drank five or more drinks at a time at least weekly (RR = 5.78, 95% CI = 2.80-11.94), when adjusted for possible confounders. CONCLUSIONS: We found that besides the total volume of consumption, a drinking pattern that involves drinking occasions when consumption exceeds four drinks of alcohol at a time leads to a significant increase in the risk of fatal injury among Finnish men. The risk is highest among those who have the highest annual number of heavy drinking occasions. The finding does not support the hypothesis that alcohol tolerance would lower the risk of fatal injuries among frequent heavy drinkers.     

Drinking typography established by scheduled induction predicts chronic heavy drinking in a monkey model of ethanol self-administration

Background: We have developed an animal model of alcohol self‐administration that initially employs schedule‐induced polydipsia (SIP) to establish reliable ethanol consumption under open access (22 h/d) conditions with food and water concurrently available. SIP is an adjunctive behavior that is generated by constraining access to an important commodity (e.g., flavored food). The induction schedule and ethanol polydipsia generated under these conditions affords the opportunity to investigate the development of drinking typologies that lead to chronic, excessive alcohol consumption. Methods: Adult male cynomolgus monkeys (Macaca fascicularis) were induced to drink water and 4% (w/v in water) ethanol by a Fixed‐Time 300 seconds (FT‐300 seconds) schedule of banana‐flavored pellet delivery. The FT‐300 seconds schedule was in effect for 120 consecutive sessions, with daily induction doses increasing from 0.0 to 0.5 g/kg to 1.0 g/kg to 1.5 g/kg every 30 days. Following induction, the monkeys were allowed concurrent access to 4% (w/v) ethanol and water for 22 h/day for 12 months. Results: Drinking typographies during the induction of drinking 1.5 g/kg ethanol emerged that were highly predictive of the daily ethanol intake over the next 12 months. Specifically, the frequency in which monkeys ingested 1.5 g/kg ethanol without a 5‐minute lapse in drinking (defined as a bout of drinking) during induction strongly predicted (correlation 0.91) subsequent ethanol intake over the next 12 months of open access to ethanol. Blood ethanol during induction were highly correlated with intake and with drinking typography and ranged from 100 to 160 mg% when the monkeys drank their 1.5 g/kg dose in a single bout. Forty percent of the population became heavy drinkers (mean daily intakes >3.0 g/kg for 12 months) characterized by frequent “spree” drinking (intakes >4.0 g/kg/d). Conclusion: This model of ethanol self‐administration identifies early alcohol drinking typographies (gulping the equivalent of 6 drinks) that evolve into chronic heavy alcohol consumption in primates (drinking the equivalent of 16 to 20 drinks per day). The model may aid in identifying biological risks for establishing harmful alcohol drinking.     

Parenting mechanisms in links between parents' and adolescents' alcohol use behaviors

Background: Adolescence has been identified as a critical period with regard to the initiation and early escalation of alcohol use. Moreover, research on familial risk and protective processes provides independent support for multiple domains of parental influence on adolescent drinking; including parents’ own drinking behaviors, as well as the practices they employ to socialize their children. Despite this prevalence of findings, whether and how these distinct associations are related to one another is still not entirely clear. Methods: The present study used data from 4,731 adolescents and their parents to test the nature of associations between (a) parents’ frequencies of alcohol use and intoxication, and lifetime alcohol‐related problems, (b) adolescents’ perceptions of the parenting that they receive, and (c) adolescents’ prevalence of alcohol use and intoxication at 14 and 17½ years of age. As such, multiple mediation modeling was used to assess whether parental alcohol use behaviors influence adolescent alcohol use directly, or if they operate through indirect associations with various aspects of parenting that subsequently influence adolescent use. Results: Examination of simple associations demonstrated that maternal and paternal alcohol use behaviors were positively linked with adolescent use behaviors at 14 and 17½ years of age. Likewise, several parenting behaviors were independently associated with both parental and adolescent drinking. Examined collectively, multivariate path analyses indicated that associations between parents’ and adolescents’ alcohol‐related behaviors were mediated, in part, by adolescents’ perceptions of the parenting that they received, especially at 14 years of age. Furthermore, perceived parental monitoring and discipline had unique mediating capabilities, net the effects of all other parenting behaviors. Conclusions: This study demonstrates that parenting is an important mediator of the association between parental and adolescent drinking practices. An important area for future research will be to study how adolescents can avoid alcohol‐related problems despite being reared within a risk laden parenting environment and/or having parents who drink frequently.     

The relationship between patterns of alcohol use and mental and physical health disorders in two American Indian populations

AIMS: First, define alcohol use categories among two reservation-based American Indian (AI) populations based on the relationship between alcohol consumption and dependence. Secondly, examine associations between the alcohol use categories and other indicators of health status. DESIGN, PARTICIPANTS AND MEASUREMENTS: Epidemiological data on 1287 AIs aged 18-57 years who consumed alcohol during the past year. CHAID tree analysis, a hierarchical partitioning method, was used to analyze alcohol quantity (highest number of drinks consumed during 1 day) and frequency (number of days drank during the past month) data to define quantity-frequency categories distinguished by differing rates of alcohol dependence. Multivariate analyses assessed relationships between the alcohol use categories thus identified and a number of health outcomes. FINDINGS: People who reported drinking 12 or more drinks during 1 day and more than 4 days a month had the highest prevalence of alcohol dependence. Among the males who drank > 18 drinks the prevalence was 42.12% and among females who drank 12 or more drinks, 44.58%. The prevalence among males who drank > 18 drinks yet drank less frequently was also high (24.06%). Although findings differed by gender, drinkers in the highest risk category for alcohol dependence were most likely to report drug use disorders, mood/anxiety disorders, alcohol-related physical disorders and lower quality of life. CONCLUSIONS: The quantity thresholds defined to identify AIs at highest risk for alcohol dependence in this study differed by gender and were higher than typically reported for non-AIs. They are consistent with previous findings regarding the pattern of high-quantity, low-frequency alcohol consumption among AIs residing on reservations.     

Abstaining for foetal health: The fiction that even light drinking is dangerous

There is a strong ideological and political movement in the USA to convince pregnant women not to drink any alcohol. An examination of the research literature on the results of drinking during pregnancy does not provide any evidence that light drinking is harmful to the foetus. The chief defects in the research that make conclusions about the effects of ‘moderate’ or light' drinking invalid are the ways in which drinking patterns are categorized: a) usually the categories used are ‘average per day’, the different effects of bingeing and light drinking being thus confused; b) often the heaviest drinking category is described as ‘two or more drinks a day’, sometimes even ‘one or more’. Obviously, one cannot tell whether any instances of foetal damage occurring in that group came from women who drank only two drinks each day, which would be light drinking, or from those who drank ten drinks each day since “ten drinks a day” is part of the category “two or more”.     

Alcohol use in the elderly: beyond the CAGE. Part 1 of 2: prevalence and patterns of problem drinking

It has been estimated that 33% of adults age 65 and older have consumed alcohol during the preceding month; 25% of these drinkers (31% of men, 19% of women) drink daily and approximately 10% drink five drinks on one occasion. Alcohol misuse, with or without dependence, increases an older patient's risks of physical and mental problems. Yet hazardous drinking often is not identified in the elderly because ageism, denial, coexisting disabilities, and the unique pattern of late-onset drinking frequently mask its presence and complicate the diagnosis.     

A brief alcohol intervention for hazardously drinking incarcerated women

Objective To test the hypothesis that among hazardously drinking incarcerated women who are returning to the community, a brief alcohol intervention will result in less alcohol use at follow‐up relative to standard of care. Methods Eligible participants endorsed hazardous alcohol consumption—four or more drinks at a time on at least 3 separate days in the previous 3 months or a score of 8 or above on the Alcohol Use Disorders Identification Test. Participants were randomized to either an assessment‐only condition or to two brief motivationally focused sessions, the first delivered during incarceration, the second 1 month later after community re‐entry. Participants recalled drinking behaviors at 3 and 6 months after the baseline interview using a 90‐day time‐line follow‐back method. Results The 245 female participants averaged 34 years of age, and were 71% Caucasian. The mean percentage of alcohol use days in the 3 months prior to incarceration was 51.7% and heavy alcohol use days was 43.9%. Intervention effects on abstinent days were statistically significant at 3 months (odds ratio = 1.96, 95% confidence interval 1.17, 3.30); the percentage of days abstinent was 68% for those randomized to intervention and 57% for controls. At 6 months the effect of the intervention was attenuated and no longer statistically significant. Conclusions Among incarcerated women who reported hazardous drinking, a two‐session brief alcohol intervention increased abstinent days at 3 months, but this effect decayed by 6 months. Study participants continued to drink heavily after return to the community. More intensive intervention pre‐release and after re‐entry may benefit hazardously drinking incarcerated women.     

Reporting bias in the association between age at first alcohol use and heavy episodic drinking

Background: Given the weight placed on retrospective reports of age at first drink in studies of later drinking‐related outcomes, it is critical that its reliability be established and possible sources of systematic bias be identified. The overall aim of the current study is to explore the possibility that the estimated magnitude of association between early age at first drink and problem alcohol use may be inflated in studies using retrospectively reported age at alcohol use onset. Methods: The sample was comprised of 1,716 participants in the Missouri Adolescent Female Twin Study who reported an age at first drink in at least 2 waves of data collection (an average of 4 years apart). Difference in reported age at first drink at Time 2 versus Time 1 was categorized as 2 or more years younger, within 1 year (consistent), or 2 or more years older. The strength of the association between age at first drink and peak frequency of heavy episodic drinking (HED) at Time 1 was compared with that at Time 2. The association between reporting pattern and peak frequency of HED was also examined. Results: A strong association between age at first drink and HED was found for both reports, but it was significantly greater at Time 2. Just over one‐third of participants had a 2 year or greater difference in reported age at first drink. The majority of inconsistent reporters gave an older age at Time 2 and individuals with this pattern of reporting engaged in HED less frequently than consistent reporters. Conclusions: The low rate of HED in individuals reporting an older age at first drink at Time 2 suggests that the upward shift in reported age at first drink among early initiates is most pronounced for light drinkers. Heavy drinkers may therefore be overrepresented among early onset users in retrospective studies, leading to inflated estimates of the association between early age at initiation and alcohol misuse.     

Social and behavioral characteristics of young adult drink/drivers adjusted for level of alcohol use

BACKGROUND: Alcohol consumption and drink/driving are positively correlated and many predictors of alcohol use also predict drink/driving. Past research has not fully distinguished the contributions of personal risk factors from the level of alcohol use in the prediction of drink/driving. As a result, the extent to which predictors are specific to drink/driving, versus due to a mutual association to alcohol use, is unclear. METHODS: This study examined the unique and shared risk factors for drink/driving and alcohol use, and examined the attributable risk (AR) associated with predictors of drink/driving while adjusting for alcohol use. Study data were from a telephone survey of 3,480 Michigan-licensed young adults who were drinkers. Four groups of drink/drivers were formed based on the prior 12-month maximum severity of drink/driving: (1) never drink/driving; (2) driving at least once within an hour of 1 or 2 drinks; (3) driving within an hour of 3 or more drinks or while feeling the effects of alcohol; and (4) drinking while driving. RESULTS: Lower perceived risk of drink/driving, greater social support for drinking and drink/driving, greater aggression and delinquency, more cigarette smoking, and more risky driving behaviors uniquely predicted drink/driving severity in models adjusted for alcohol use. The largest ARs were associated with social support for drinking and drink/driving and perceived risk of drink/driving. CONCLUSIONS: These results confirm that alcohol use and drink/driving share risk factors, but also indicate that part of the variation in these factors is specific to drink/driving. Implications for interventions to reduce drink/driving are discussed.     

Alcohol use and cognition at mid-life: the importance of adjusting for baseline cognitive ability and educational attainment

BACKGROUND: The nature of the relationship between cognition and alcohol consumption remains controversial. Studies have reported negative, positive, and nonsignificant effects of alcohol consumption on cognition. Problematic throughout the literature is that baseline cognitive ability has not been adequately controlled in previous studies, and even educational attainment is only sometimes controlled. Because such variables may be associated with both alcohol intake and later-life cognition, we hypothesize that the observed relationship between alcohol intake and cognition may change when these variables or other conditions in early life have been controlled. METHODS: We examined the relationship of alcohol intake and cognition at age 53 using the Wisconsin Longitudinal Study, which has followed Wisconsin high school graduates from 1957 to 1992. Our measures include cognitive ability test scores from the freshman and junior years of high school, educational attainment, an abstract reasoning test score at age 53, alcohol intake at age 53, and other measures. RESULTS: When no controls were used, both men and women with low levels of alcohol consumption at 53 (i.e., 0-1 drink per day) had better scores on the abstract reasoning subtest of the Wechsler Adult Intelligence Scale (WAIS-R) at age 53 than subjects who never drank or currently did not drink. However, after adjusting for adolescent-measured cognitive ability and educational attainment, men with low levels of consumption no longer had higher abstract reasoning scores than nondrinking men, but they still did have higher abstract reasoning scores than men who drank more than one drink per day. For women, adjusting for cognitive ability and educational attainment eliminated all significant effects of alcohol on cognition, and reversed the nonsignificant result that women with higher consumption had the highest cognition scores. These results demonstrate the importance of adjusting for baseline cognitive ability when attempting to study the effect of long-term alcohol use patterns on cognition, and that educational attainment cannot be considered a valid substitute for baseline cognition scores. CONCLUSIONS: Much of the apparent benefit of moderate alcohol intake on cognition in our society may well be explained by differential rates of alcohol consumption among subjects with differing baseline cognitive ability scores. Neither is there evidence that moderate alcohol intake reduces cognitive functioning.