Laboratory of Epidemiology and Biometry

Much of the Laboratory of Epidemiology and Biometry’s work revolves around the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The Laboratory has already conducted the first two waves of the survey, and it is now designing the third wave and analyzing data from the first two. NESARC is based on the criteria of alcohol dependence and abuse used by the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV). It collects a wide range of information about alcohol use, drug use and other psychiatric conditions, along with risk factors associated with these conditions, and subjects’ treatment history. Using NESARC data, the Laboratory has reached a number of conclusions about alcoholism recovery and relapse. For example, 18-24 year old alcoholics who later become asymptomatic risk drinkers experienced the highest recurrence of alcohol use disorders (including dependence), but for older alcoholics, asymptomatic drinkers experienced lower relapse rates than abstainers. Roughly a quarter of alcoholics received treatment or participated in self-help recovery groups, and these activities quadrupled the likelihood of abstinent recovery. Other NESARC data showed that inferences from samples of treated individuals cannot be extrapolated to untreated alcoholics. The Laboratory has also worked on the development of brief screening instruments that can be used in primary care settings. One such screener (AUDIT-C) was compared with NESARC data and tested for sensitivity and specificity. The Laboratory’s results suggest that AUDIT-C did a better job of identifying alcohol use disorders in women, Whites and older individuals, while it was more effective in identifying risk drinking in men, Blacks and younger individuals. Nevertheless, the Laboratory found that AUDIT-C could be used effectively in populations whose alcohol use greatly exceeded alcohol use in the general population. Additionally, the Laboratory is involved in an effort to characterize the dimensionality of alcohol use disorders. In particular, the Laboratory found that alcohol dependence exists along a severity continuum, and that there is not a clear boundary between alcohol abuse and alcohol dependence. This has provided firm empirical evidence for the dimensional character of alcohol use disorders, and it will make it easier to assess the stage of disease for any given individual. Finally, the Laboratory has focused on two special populations: women and college-age individuals. The Laboratory has found that most women with a psychiatric disorder did not receive psychiatric care in the past year, but that pregnancy per se is not associated with the most prevalent forms of mental disorders. Furthermore, college-attending individuals were less likely to be dependent on alcohol or tobacco than their non-college-attending peers. But both groups experience roughly equivalent and high rates of psychiatric disorders.