Drug Use Disorders Go Untreated in Millions of Americans

Pam Harrison

November 18, 2015

Drug use disorder, as defined by the DSM-5, is common, highly comorbid, disabling, and largely goes untreated in the United States, new research shows.

"Drug use disorders (DUDs) are associated with substantial burden through impairment in major life roles and increased risk for suicidality, neuropsychological deficits, diminished quality of life and infectious disease," the investigators, led by Bridget Grant, PhD, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland, write.

"The present NESARC-III [National Epidemiologic Survey on Alcohol and Related Conditions–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," they add.

The study was published online November 18 in JAMA Psychiatry.

Using in-person interviews carried out with 36,309 adults in the 2012-2013 NESARC-III, the prevalence of drug-use disorder in the past 12 months among survey participants was determined to be 3.9%, affecting more than 9 million US adults.

The prevalence of drug use disorder during a lifetime was 9.9% among the same participants, affecting more than 23 million US adults.

Mild as well as moderate to severe drug use disorder was present in the past 12 months in approximately 2% of respondents; over a lifetime, 3.4% of respondents had mild drug use disorder, and 6.6% had moderate to severe drug use disorder.

The highest prevalence of drug use disorder was found for cannabis, opioids, and cocaine; prevalence was usually lower for other types of drugs that are typically abused.

Drug use disorder was highly associated with alcohol and nicotine use, at an odds ratio (OR) ranging from 2.5 to 4.4 across both time frames and the severity of the drug use disorder itself.

Twelve-month drug use disorder was positively associated with major depressive disorder, bipolar I disorder, posttraumatic stress disorder (PTSD), and antisocial personality disorder. It was also associated with dysthymia and borderline and schizotypal personality disorders across all levels of severity.

Lifetime prevalence of drug use disorder was also associated with major depressive disorder, bipolar I disorder, dysthymia, PTSD, borderline, and schizotypical personality disorder and antisocial personality disorder across all levels of severity.

In addition, lifetime prevalence of drug use disorder was associated with generalized anxiety disorder, panic disorder, and social phobia.

Drug use disorder included the use of sedatives and tranquilizers as well as cannabis, amphetamines, cocaine, nonheroin opioids and heroin, hallucinogens, club drugs, such as ecstasy and ketamine, and solvent or inhalant use disorders.

The odds of participants having either a drug use disorder in the past 12 months or in their lifetime across all levels of severity were generally higher among men as well as among younger participants, unmarried or previously married persons, and those with high school or less education and lower income.

Among respondents with a history of drug use disorder over the past 12 months, 13.5% reported that they had received some form of treatment.

Among those who had drug use disorder at some point in their lifetime, approximately 25% had received some form of treatment. Those who had received some form of treatment typically received it nearly 4 years after the onset of drug use disorder.

"The most common treatment health care professionals for individuals with DUDs included private health professionals, highlighting these clinicians' key roles in identifying and linking affected individuals to appropriate help," the investigators write.

On the other hand, they point out that the public is increasingly less likely to disapprove of specific types of drug use, such as the use of cannabis, or to see it as risky, which is consistent with more liberal laws now governing drug use in many parts of the United States.

"Our findings indicate an urgent need to destigmatize DUD and educate the public, clinicians, and policy makers about its treatment to encourage affected individuals to obtain help," the researchers conclude.

The authors report no relevant financial relationships.

JAMA Psychiatry. Published online November 18, 2015.

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