The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002

Abstract

Background: Alcohol abuse and dependence can be disabling disorders, but accurate information is lacking on the prevalence of current DSM-IV alcohol abuse and dependence and how this has changed over the past decade. The purpose of this study was to present nationally representative data on the prevalence of 12-month DSM-IV alcohol abuse and dependence in 2001–2002 and, for the first time, to examine trends in alcohol abuse and dependence between 1991–1992 and 2001–2002. Methods: Prevalences and trends of alcohol abuse and dependence in the United States were derived from face-to-face interviews in the National Institute on Alcohol Abuse and Alcoholism’s (NIAAA) 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC: n=43,093) and NIAAA’s 1991–1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES: n=42,862). Results: Prevalences of DSM-IV alcohol abuse and dependence in 2001–2002 were 4.65 and 3.81%. Abuse and dependence were more common among males and among younger respondents. The prevalence of abuse was greater among Whites than among Blacks, Asians, and Hispanics. The prevalence of dependence was higher in Whites, Native Americans, and Hispanics than Asians. Between 1991–1992 and 2001–2002, abuse increased while dependence declined. Increases in alcohol abuse were observed among males, females, and young Black and Hispanic minorities, while the rates of dependence rose among males, young Black females and Asian males. Conclusions: This study underscores the need to continue monitoring prevalence and trends and to design culturally sensitive prevention and intervention programs.

Introduction

Alcohol use disorders are among the most prevalent mental disorders worldwide and rank high as a cause of disability burden in most regions of the world (World Health Organization, 2001). In 2003, the prevalence of alcohol use disorders was estimated at 1.7% globally, and these disorders accounted for 1.4% of the total world disease burden (World Health Organization, 2003).

Alcohol use disorders (i.e. alcohol abuse and dependence) also are among the most prevalent mental disorders in the United States and are associated with substantial personal and societal costs (Goetzel et al., 2003, Roy-Byrne et al., 2000, Sanderson and Andrews, 2002, Stewart et al., 2003). These alcohol use disorders have enormous consequences not only for the health and welfare of those afflicted with the disorders, but also their families and children, their employers, and the larger society. For example, approximately one in four children under 18 years old in the United States is exposed to alcohol abuse or alcohol dependence in the family (Grant, 2000). More than one half of American adults have a family member who has or has had alcohol dependence (Dawson and Grant, 1998). Of the 11.1 million victims of violent crime each year, almost one in four or 2.7 million report that the offender had been drinking prior to the crime (Greenfield, 1998). The economic costs of alcohol abuse and dependence were $184.6 billion for 1998 (the last year for which figures are available), or roughly $638 for every man, woman, and child living in the United States (Harwood, 1998). Thus, alcohol use disorders impose a staggering, but potentially preventable, burden.

Despite the importance of accurate prevalence information on alcohol abuse and dependence, especially on changes in the prevalence of these disorders over time, the information available to date has been surprisingly sparse. Time (secular) trends in yearly per capita alcohol consumption have been available from the founding days of the United States. However, these are not informative about whether time trends have occurred in lower or higher consumption levels, which have considerably different public health implications. Time trend data are also available on alcohol-related fatal automobile crashes, but these may reflect factors unrelated to alcohol that are not measured in large statistical reporting systems. Similarly, time trends in alcohol-related liver cirrhosis mortality may reflect the influence of causes other than alcohol. Some papers on time trends in drinking and alcohol-related problems have been published over the years (Greenfield et al., 2000, Hasin et al., 1990, Midanik and Greenfield, 2000). However, these studies did not cover abuse and dependence as defined in the standard nomenclatures, and were based on very small samples. Thus, trivial changes in numbers from one survey to the next may have given rise to misleading impressions. Finally, three earlier surveys were conducted on alcohol abuse and dependence as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association: the 1980 Epidemiologic Catchment Area Survey (ECA: Robins and Regier, 1991), the 1990–1992 National Comorbidity Survey (NCS: Kessler et al., 1996), and the 2001–2002 NCS-Replication Survey (NCS-R: Kessler and Walters, 2002). However, in addition to major difference in survey designs that preclude clear information about time trends, each of these studies was based on a different nomenclature (DSM-III: American Psychiatric Association, 1980; DSM-III-R: American Psychiatric Association, 1987; and DSM-IV: American Psychiatric Association, 1994), making between-survey comparisons for the purpose of time trend analysis impossible.

Change or stability in the prevalence of alcohol abuse and dependence has important research and pubic health implications in a number of areas. For research on the etiology of alcohol dependence (a complex disorder with both genetic and environmental influences), understanding true changes in prevalence over time may be crucial in interpreting familial aggregation and gene-phenotype associations (Rice et al., 2003). Since the distribution of risk or protective genotypes does not vary within a period as short as a decade, changing prevalence suggests changes in the level of environmental risk. Incorporation of this information into the design of genetic studies may sharpen our ability to detect genetic effects. For policy and prevention efforts, accurate information on changes in potentially vulnerable groups may highlight the need for focused planning on both the national and local level. The fact that accurate data on time trends in the prevalence of alcohol abuse and dependence have not been available reflects a major gap in public health information. The present study was designed, in part, to address this gap and provide the information.

Accordingly, this report presents data on the 12-month prevalence of alcohol abuse and dependence in the United States assessed in the National Institute on Alcohol Abuse and Alcoholism’s (NIAAA) 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC: Grant et al., 2003b). This report also presents, for the first time, trends in the prevalence of alcohol abuse and dependence between 1991–1992 and 2001–2002 using the NIAAA NESARC and NIAAA’s 1991–1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES: Grant et al., 1994) as the baseline. The 1991–1992 NLAES and 2001–2002 NESARC are the only two national surveys conducted over the last decade to use consistent diagnostic definitions of alcohol abuse and dependence, both of which were based on the most current psychiatric nomenclature, the DSM-IV.