A large national survey of U.S. adults in 2012-2013 suggests that nearly 10 percent of Americans, or more than 23.3 million people, have lifetime drug use disorder diagnoses arising from drug use in the past year or prior to that and many of these individuals were untreated, according to an article published online by JAMA Psychiatry.
Drug use disorders (DUDs) are associated with impairment in major life roles, increased risk for suicidality, neuropsychological deficits, diminished quality of life and infectious diseases, such as human immunodeficiency virus and hepatitis. In 2013, a new diagnostic system, the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5), replaced the previous edition that has been used to define mental disorders for more than 20 years. Changes in the DSM-5 definitions of DUDs included a higher diagnostic threshold.
Bridget F. Grant, Ph.D., of the National Institute on Alcohol Abuse and Alcoholism, Rockville, Md., and coauthors analyzed data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) to report on the prevalence and treatment of DSM-5 DUDs. The survey included in-person interviews with 36,309 adults. DUD was based on amphetamine, cannabis, club drug, cocaine, hallucinogen, heroin, nonheroin opioid, sedative/tranquilizer or solvent/inhalant use disorders.
Authors report 3.9 percent of Americans, or more than 9.1 million adults, had 12-month DUD diagnoses because of past-year drug use and 9.9 percent had lifetime diagnoses. DUD was generally greater among men, white and Native American individuals, young and previously or never married adults, those adults with lower education and income, and those individuals who live in the West, according to the study.
DUD also was associated with alcohol and nicotine use disorders; and a variety of mental health conditions were associated with 12-month DUD diagnoses, including major depressive disorder, bipolar, posttraumatic stress disorder and personality disorders. Lifetime DUD diagnoses also were associated with generalized anxiety disorder, panic disorder and social phobia, the results indicate.
Disability from DUD increased with greater severity and adults with 12-month DUD diagnoses had lower mental health, social functioning and role emotional functioning, according to the report.
While DUD is a common and disabling disorder, it is also largely untreated. Among adults with 12-month DUD, 13.5 percent received treatment as did 24.6 percent of those with lifetime DUD. The average age for first treatment of DUD was 27.7 years, nearly four years later than the average onset, the study shows.
Limitations of the study include a possible underrepresentation of DUD prevalence because the survey excluded most institutionalized individuals, including those in jails and prisons, and active-duty military personnel.
"DSM-5 DUD is prevalent among U.S. adults. The public is increasingly less likely to disapprove of specific types of drug use (e.g., marijuana) or to see it as risky, and consistent with these attitudes, laws governing drug use are becoming more permissive. However, the present NESARC-III findings on disability and comorbidity indicate that DUDs as defined by the new DSM-5 nosology are serious conditions affecting many millions of Americans," the study concludes.
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