Alcohol Survey Reveals 'Lost Decade' Between Ages of Disorder Onset and Treatment
At some time during their lives, more than 30 percent of U.S. adults surveyed in 2001-2002 had met current diagnostic criteria [i] for an alcohol use disorder (AUD), according to an article in the current issue of the Archives of General Psychiatry. Many of those persons never received treatment, and many others did not receive treatment until well after AUD onset.
Of those with alcohol dependence [ii], only 24.1 percent had received any type of treatment, broadly defined to include treatment either by a physician or other health professional, or by 12-step programs, crisis centers, employee assistance programs, or others. Of those with alcohol abuse [iii], only 7.0 percent had received treatment. Although average age of alcohol dependence onset was 22.5 years, average age of first treatment was 29.8—a lag time of 8 years. Average age of alcohol abuse onset was 21.9 years, but average age of first treatment was 32.1—a lag time of 10 years.
“A lost decade between AUD onset and treatment leads to personal disability and societal damage,” according to National Institute on Alcohol Abuse and Alcoholism Director Ting-Kai Li, M.D. “Today’s report signals the need for intensive efforts to educate professionals and the public to identify and address AUDs early in their course.”
Age of disorder onset, related disability, and treatment age and type are several of multiple new analyses from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a representative survey that involved 43,000 face-to-face interviews of noninstitutionalized U.S. civilians aged 18 years and older.
Conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) with supplemental support from the National Institute on Drug Abuse, the NESARC is the largest study ever conducted on the co-occurrence of alcohol use, drug use, and related psychiatric conditions among gender, age and ethnic subgroups, including minority subgroups (i.e., Asian Americans, Native Americans) not previously studied in sufficient numbers to permit comorbidity analyses. Also for the first time, the authors examine specific and some rare psychiatric conditions that frequently co-occur with AUDs, exclude other psychiatric disorders due to substance use or other medical conditions, and control for the comorbidity of disorders with each other.
“NESARC data can be used by researchers and health professionals to target preventive and treatment interventions for populations at greatest risk,” Dr. Li noted. “They also can be used by policy makers and providers to plan and allocate treatment resources, and by scientists to explore the common and independent biological and psychosocial factors that underlie AUDs and related psychiatric diagnoses.”
Conclusions from the 2001-2002 NESARC include
Sociodemographic correlates
Probability of lifetime alcohol abuse is greater among persons aged 30-64 years—the baby boom and generation X cohorts--and lower among persons who never married and have lower incomes and a high school education. Probability of lifetime alcohol dependence is greater in the youngest age groups and among unmarried persons, persons with lower incomes, and Native Americans.
Disorder onset and course
Risk for incurring AUDs is greatest at age 19 and diminishes thereafter. About 72 percent of persons with lifetime AUD experience a single episode; the remainder experience five episodes, on average, with average duration of the longest episodes 2.7 years for abuse and 3.7 years for dependence. Although AUDs can recur, recovery is possible with or without treatment (see http://www.niaaa.nih.gov/news-events/news-releases/2001-2002-survey-finds-many-recover-alcoholism-researchers-identify).
AUD-associated disability
Alcohol abuse is associated with reduced social and role emotional functioning [iv], whereas alcohol dependence is highly associated with mental disability in addition to social and role dysfunction. Disability increases steadily with alcohol dependence severity and is greatest among those who do not receive treatment. Mental disability among persons with alcohol dependence is comparable to that among persons with drug abuse, mood, and personality disorders.
Co-occurring disorders
Through statistical advances introduced in the study, NESARC researchers determined that unique factors underlie relationships between alcohol dependence and most frequently co-occurring disorders. For example, different factors explain in part the co-occurrence of alcohol dependence with bipolar disorder, specific phobia, and histrionic and antisocial personality disorder. By contrast, the co-occurrence of alcohol dependence with other affective, anxiety, and personality disorders appears to be related to common factors that underlie those other disorders.
Treatment
Treatment rates in 2001-2002 were slightly lower than rates in the predecessor survey conducted a decade earlier. [v] Although the current study did not explore reasons for the decline, the authors point to other studies that found clinical knowledge gaps, inadequate organizational support, and low clinician and patient expectations among possible explanations.
“Evidence on the effectiveness of alcohol treatment is inconsistent with these negative beliefs,” said NESARC principal investigator, Bridget Grant, Ph.D., pointing to NESARC findings that treatment and 12-step program participation significantly and substantially increase the likelihood of recovery from alcohol dependence. An important first step toward closing the treatment-need gap would be “an intensive program ... to educate the public and professionals about the signs and risks of alcohol dependence, to destigmatize the illness, and to promote understanding of the benefits of intervention.”
The NESARC data are publicly available and have produced more than 90 articles in more than 20 scientific journals. Wave 2 of the NESARC, conducted in 2005 among the individuals who participated in Wave 1, will yield longitudinal information beginning in 2008.
For an interview with Dr. Grant, Chief of the NIAAA Laboratory of Epidemiology and Biometry, please telephone the NIAAA Press Office. For an interview with lead author Deborah Hasin, Ph.D., please telephone 212/543-5035.
Reference
[i] Current diagnostic criteria for alcohol use disorders are defined according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) published in 1994.
[ii] Alcohol dependence, also known as alcoholism, is characterized by impaired control over drinking, compulsive drinking, preoccupation with drinking, tolerance to alcohol and/or withdrawal symptoms.
[iii] Alcohol abuse is characterized by failure to fulfill major role obligations at work, school, or home; interpersonal, social and legal problems; and/or drinking in hazardous situations.
[iv] Role impairment due to emotional problems
[v] The 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES) assessed the prevalence of alcohol disorders during the year prior to the survey using DSM-IV criteria.