g., Schulenberg et al. 2003), yet it is critical for understanding the development (i.e., etiology) of adult alcohol use disorders. Numerous studies have demonstrated that alcohol use in middle school and high school may be an important indicator of later concerning problems. For example, although most students mature out of their heavy alcohol use (Schulenberg and Maggs 2002; Schulenberg and Patrick 2012; Schulenberg et al. 1996), substance use in high school is one of the strongest predictors of substance use in adulthood. Specifically, binge drinking in 12th grade predicts symptoms of alcohol use disorders 17 years later, at age 35 (Merline et al. 2004, 2008; Patrick et al. 2011).

Furthermore, trajectories of binge drinking are predictive of alcohol use disorders during middle adulthood (Schulenberg and Patrick 2012), and continued substance use into young adulthood is associated with HIV-related risk behaviors (Patrick et al. 2012). Finally, binge drinking in high school predicts subsequent dropping out of college, although an increase in binge drinking during college is related to not dropping out (Schulenberg and Patrick 2012). Implications for Prevention and Intervention Studies on the etiology and epidemiology of alcohol use ought to go hand in hand in order to combine the broader approach of epidemiology with the more in-depth emphasis of etiology. As the discussion in this article has shown, there are both historical and developmental predictors related to adolescent AOD use that are changing over time.

Understanding the scope of alcohol use during the middle-school and high-school years, and associated long-term problems, is an important step toward effectively intervening to reduce high-risk drinking and its negative consequences. The scope of the problem is underscored by the findings that more than one in five American high-school seniors in the class of 2011 reported binge drinking in the previous 2 weeks. The documented developmental increases in alcohol use across adolescence and young adulthood make this a particularly important time for intervention. In particular, the fast escalation among adolescents from binge drinking once to binge drinking multiple times within a given 2-week period (Patrick and Schulenberg 2010) highlights the importance of preventing early initiation as well as early escalation of AOD use.

Levels of alcohol use have been declining in recent decades, suggesting that past interventions, such as increasing the minimum legal drinking age to 21, have been effective. However, although it is worth recognizing that most adolescents manage to avoid heavy alcohol use and that such use is not an inevitable developmental progression, alcohol remains the AV-951 most commonly used substance among adolescents, and its use is a leading cause of death and injury (U.S. Department of Health and Human Services 2007).