The 2003 National Survey on Drug Use and Health (NSDUH) asked respondents aged 12 or older to report on their age at first use of alcohol, their use of alcohol during the past year and month, and their symptoms of alcohol dependence or abuse during the past year, such as recurrent alcohol, trouble with the law, increased tolerance to alcohol, and physical danger. This report presents findings from this survey. Report highlights include; (1) in 2003, males aged 21 or older were more likely than females to report having first used alcohol before age 15; (2) respondents reporting first use of alcohol before age 15 were more than 5 times as likely to report past year alcohol dependence or abuse than persons who first used alcohol at age 21 or older; and (3) among the 14 million adults aged 21 or older who were classified as having past year alcohol dependence or abuse, more than 13 million, or 95 percent, had started using alcohol before age 21.