Alcohol Disorders Common, Largely Untreated Among American Adults

Marlene Busko

July 11, 2007

July 11, 2007 — In a recent large national survey, almost one-third of American adults reported that at some point in their lives they had an alcohol-use disorder — either alcohol abuse (17.8 %) or alcohol dependence (12.5%). Few, however, had sought treatment.

The study, led by Deborah S. Hasin, PhD, from Columbia University, in New York, is published in the July issue of the Archives of General Psychiatry.

Corresponding author Bridget F. Grant, PhD, at the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, in Bethesda, Maryland, explained to Medscape that "alcohol abuse" is defined as drinking that leads to interpersonal, social, or legal problems; problems in fulfilling major role obligations in daily life; and/or drinking in hazardous situations. "Alcohol dependence" ("alcoholism") is characterized by an impaired control over drinking, compulsive drinking, alcohol tolerance, withdrawal symptoms, and/or drinking to relieve withdrawal symptoms.

She added that the main study findings are that, first, so few people with lifetime alcohol abuse or alcohol dependence received treatment: 7.0% and 24.1%, respectively. Second, there is a lag of about a decade between the time a person develops an alcohol disorder and seeks treatment.

"We need a national campaign to educate the public as well as physicians about the risks for and signs and symptoms of alcohol abuse and dependence . . . and about new available pharmacological and behavioral treatments," she said. "Through that, we're hoping that people will seek treatment earlier, before the damage gets done."

The group writes that alcohol-use disorders are associated with car crashes, domestic violence, fetal alcohol syndrome, and other serious consequences, and up-to-date epidemiological information is needed to plan research strategies and delivery of health services. The present study was designed to provide knowledge about the prevalence, comorbidity, and treatment of alcohol abuse and alcohol dependence, using data from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions.

Face-to-face interviews were conducted with a nationally representative sample of 43,093 respondents aged 18 and older. The interviewers asked about symptoms and treatment of alcohol-use disorders and about psychiatric disorders (mood, anxiety, and personality disorders). The main outcomes were lifetime and 12-month alcohol abuse and dependence, defined according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV) criteria.

"Widespread, Serious Public Health Problem"

In the United States in 2001–2002, 8.5% of adults reported experiencing alcohol-use disorders in the past 12 months (4.7% abuse and 3.8% dependence) and 30.3% reported alcohol-use disorders at some point in their lives (17.8% abuse and 12.5% dependence). "Thus alcohol-use disorders continue to present a widespread and serious public health problem in the United States," the group writes.

The study identified that lifetime alcohol dependence was significantly more prevalent among men, whites, Native Americans, younger and unmarried individuals, and those with lower incomes. The highest risk of lifetime alcohol abuse was in the baby boom and Generation X cohorts. "We need to focus in on those particularly at-risk subgroups of the population," said Dr. Grant.

Alcohol abuse developed at age 22.5 years, and dependence developed at age 21.9 years, on average, but there was an 8- to 10-year lag before these individuals sought treatment such as 12-step programs or other help from professionals. The alcohol-use disorder episodes lasted on average 2.4 to 3.4 years. Most survey respondents (72%) reported only 1 lifetime episode, but those with multiple episodes had an average of 5 episodes.

The strong, significant association between alcohol-use disorder and other drug-use disorders was reduced but still significant after researchers controlled for comorbidity, suggesting that these 2 disorders have some unique causal factors. On the other hand, significant associations between alcohol dependence and mood, anxiety, and personality disorders were reduced when researchers controlled for comorbidities, suggesting that they share causal factors.

The researchers note that compared with 1991–1992, treatment rates for alcohol-use disorders in 2001–2002 reveal a "disappointing lack of progress." They add that this differs sharply from the improved rates in the treatment of major depression in recent years and note that alcohol disorders are more highly stigmatized than mental illness.

Greater Awareness of Treatments Needed

Dr. Grant explained that many people are unaware of the advances for treatment of alcohol abuse and alcohol dependence that have been made over the past decade. "I also think that there needs to be more screening, with primary-care physicians talking to people in their practices about the risks of alcoholism and the treatments that are available," she added.

The authors urge: "A call to action appears indicated to educate and update public and policy makers about alcohol-use disorders, to destigmatize the disorders, and to encourage help-seeking among those who cannot stop drinking despite considerable harm to themselves and others."

The National Epidemiologic Survey on Alcohol and Related Conditions is funded by the National Institute on Alcohol Abuse and Alcoholism, with supplemental support from the National Institute on Drug Abuse.

Arch Gen Psychiatry. 2007;64:830-842.

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