About 30 percent of Americans report having some form of alcohol use disorder at some point in their lifetimes, including 17.8 percent with alcohol abuse and 12.5 percent with alcohol dependence, according to a report in the July issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Alcohol abuse and dependence are marked by patterns of alcohol consumption that contribute to significant impairment or distress, according to background information in the article. These disorders lead to a variety of negative consequences, including car crashes, domestic violence, birth defects and economic costs.
Deborah S. Hasin, Ph.D., of Columbia University Medical Center, New York, and colleagues analyzed data from face-to-face interviews conducted between 2001 and 2002 with 43,093 adults selected to represent the national population. Interviewers asked about all symptoms of alcohol abuse and dependence listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). A diagnosis of alcohol abuse required one or more of the criteria for abuse, while a diagnosis of alcohol dependence required three or more of the seven criteria for dependence. The participants were also diagnosed for depression, bipolar disorder, anxiety disorders, substance abuse disorder and other psychiatric conditions.
During the 12 months prior to the survey, 8.5 percent of adults had an alcohol use disorder, including 4.7 percent with alcohol abuse and 3.8 percent who were alcohol-dependent. "Alcohol dependence was significantly more prevalent among men, whites, Native Americans, younger and unmarried adults and those with lower incomes," the authors write. "Current alcohol abuse was more prevalent among men, whites and younger and unmarried individuals while lifetime rates were highest among middle-aged Americans." Alcohol abuse developed at an average age of 22.5, while dependence began at an average age of 21.9.
Alcohol dependence was associated with disability, and disability levels increased steadily as dependence became more severe. "On average, respondents with alcohol dependence manifested less disability than those with drug dependence and anxiety disorders, but their disability was comparable with that among respondents who had drug abuse, mood and personality disorders," the authors write.
Alcohol abuse and dependence were strongly associated with other substance use disorders, though these associations weakened somewhat when controlling for other conditions. "Significant associations between mood, anxiety and personality disorders and alcohol dependence were reduced in number and magnitude when controlling for other comorbidity," the authors write. This suggests that a unique factor may exist for alcohol and other substance abuse disorders, while the link between alcohol problems and personality and mood disorders might be attributed to factors shared among these other disorders.
Of those who had alcohol dependence during their lifetimes, only 24.1 percent ever received treatment, and 12.1 percent of those with alcohol dependence during the previous year received treatment during that time. The average age at which patients first received treatment for dependence was 29.8 years--eight years later than the average age at which they developed the condition. In addition, treatment rates are slightly lower than those found 10 years earlier, where 23.5 percent of those with lifetime dependence and 13.8 percent of those with dependence in the previous 12 months sought treatment.
"Alcohol abuse and dependence remain highly prevalent and disabling," the authors conclude. "Persistent low treatment rates given the availability of effective treatments indicate the need for vigorous education efforts for the public and professionals."
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