Development and Psychopathology

Regular Articles

Prospective developmental subtypes of alcohol dependence from age 18 to 32 years: Implications for nosology, etiology, and intervention

Madeline H. Meiera1, Avshalom Caspia1a2, Renate Houtsa1, Wendy S. Slutskea3, Honalee Harringtona1, Kristina M. Jacksona4, Daniel W. Belskya1, Richie Poultona5 and Terrie E. Moffitta1a2 c1

a1 Duke University

a2 King's College London

a3 University of Missouri, Columbia

a4 Brown University

a5 University of Otago, Dunedin


The purpose of the present study is to identify child and adult correlates that differentiate (a) individuals with persistent alcohol dependence from individuals with developmentally limited alcohol dependence and (b) individuals with adult-onset alcohol dependence from individuals who never diagnose. There are 1,037 members of the Dunedin Longitudinal Study, which is a birth cohort followed prospectively from birth until age 32. Past-year DSM-IV alcohol dependence diagnoses are ascertained with structured diagnostic interviews at ages 18, 21, 26, and 32. Individuals are classified as developmentally limited, persistent, or adult-onset subtypes based on their time-ordered pattern of diagnoses. The persistent subtype generally exhibits the worst scores on all correlates, including family psychiatric history, adolescent and adult externalizing and internalizing problems, adolescent and adult substance use, adult quality of life, and coping strategies. The prospective predictors that distinguished them from the developmentally limited subtype involved family liability, adolescent negative affectivity, daily alcohol use, and frequent marijuana use. Furthermore, young people who develop the persistent subtype of alcohol dependence are distinguished from the developmentally limited subtype by an inability to reduce drinking and by continued use despite problems by age 18. The adult-onset group members are virtually indistinguishable from ordinary cohort members as children or adolescents; however, in adulthood, adult-onset cases are distinguished by problems with depression, substance use, stress, and strategies for coping with stress. Information about age of onset and developmental course is fundamental for identifying subtypes of alcohol dependence. Subtype-specific etiologies point to targeted prevention and intervention efforts based on the characteristics of each subtype.


c1 Address correspondence and reprint requests to: Terrie E. Moffitt, Suite 201 Grey House, 2020 West Main Street, Duke University, Box 104410, Durham, NC 27708; E-mail:


  We thank the Dunedin Study members, their families, the unit research staff, and the study founder, Phil Silva. The Dunedin Multidisciplinary Health and Development Research Unit is supported by the New Zealand Health Research Council. This research received support from UK Medical Research Council Grants G0100527 and G0601483, US National Institute on Aging Grant AG032282, US NIMH Grant MH077874, and US NIDA Grant P30 DA023026. Additional support was provided by the Jacobs Foundation and a Royal Society Wolfson Merit Award (to A.C.). The study protocol was approved by the institutional ethical review boards of the participating universities. Study members gave informed consent before participating.