Behavioral stability of alcohol consumption and socio-demographic correlates of change among a nationally representative cohort of US adults

Aims: To estimate the probability of transitioning between different categories of alcohol use (drinking states) among a nationally representative cohort of United States (US) adults and to identify the effects of socio-demographic characteristics on those transitions. Design, setting and participants: Secondary analysis of data from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), a prospective cohort study conducted in 2001–02 and 2004–05; a US nation-wide, population-based study. Participants included 34 165 adults (mean age = 45.1 years, standard deviation = 17.3; 52% women). Measurements: Alcohol use was self-reported and categorized based on the grams consumed per day: (1) non-drinker (no drinks in past 12 months), (2) category I (women = ≤ 20; men = ≤ 40), (3) category II (women = 21–40; men = 41–60) and (4) category III (women = ≥ 41; men = ≥ 61). Multi-state Markov models estimated the probability of transitioning between drinking states, conditioned on age, sex, race/ethnicity and educational attainment. Analyses were repeated with alcohol use categorized based on the frequency of heavy episodic drinking. Findings: The highest transition probabilities were observed for staying in the same state; after 1 year, the probability of remaining in the same state was 90.1% [95% confidence interval (CI) = 89.7%, 90.5%] for non-drinkers, 90.2% (95% CI = 89.9%, 90.5%) for category I, 31.8% (95% CI = 29.7, 33.9%) category II and 52.2% (95% CI = 46.0, 58.5%) for category III. Women, older adults, and non-Hispanic Other adults were less likely to transition between drinking states, including transitions to lower use. Adults with lower educational attainment were more likely to transition between drinking states; however, they were also less likely to transition out of the ‘weekly HED’ category. Black adults were more likely to transition into or stay in higher use categories, whereas Hispanic/Latinx adults were largely similar to White adults. Conclusions: In this study of alcohol transition probabilities, some demographic subgroups appeared more likely to transition into or persist in higher alcohol consumption states.