Alcohol use disorder, or AUD, is the medical diagnosis for problem drinking that causes mild to severe distress or harm. A new study supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, reports that nearly one-third of adults in the United States have an AUD at some time in their lives, but only about 20 percent seek AUD treatment. The study also reveals a significant increase in AUDs over the last decade. The new findings are reported online in the journal JAMA Psychiatry.
“These findings underscore that alcohol problems are deeply entrenched and significantly under-treated in our society,” said NIAAA Director George F. Koob, Ph.D. “The new data should provide further impetus for scientists, clinicians, and policy makers to bring AUD treatment into the mainstream of medical practice.”
A team of researchers led by Bridget F. Grant, Ph.D., Ph.D., of the NIAAA Laboratory of Epidemiology and Biometry, conducted more than 36,000 face-to-face interviews of U.S. adults, as part of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III). NESARC III is a continuation of the largest study ever conducted on the co-occurrence of alcohol use, drug use, and related psychiatric conditions. The original NESARC survey was conducted in 2001-2002.
In NESARC III, researchers assessed alcohol problems using diagnostic criteria set forth in the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM–5) in 2013. To allow direct comparisons with previous NESARC surveys, the researchers also assessed NESARC III participants using the previous DSM-IV diagnostic criteria. Although there is considerable overlap between DSM–5 and DSM–IV diagnostic criteria, there are several important differences. For example, while DSM–IV described two distinct disorders, alcohol abuse and alcohol dependence, with specific criteria for each, DSM–5 integrates alcohol abuse and alcohol dependence into a single disorder called alcohol use disorder with mild, moderate, and severe sub-classifications.
“We found that 13.9 percent of adults met DSM-5 AUD criteria for the previous year, while 29.1 percent met AUD criteria at some time in their life,” said Dr. Grant. “Only 19.8 percent of adults with lifetime alcohol use disorder sought treatment or help, while 7.7 percent of those with a 12-month alcohol use disorder sought treatment. Perhaps most importantly, we saw large increases in DSM-IV alcohol use disorder rates over the last decade.”
Past-year and lifetime DSM-IV AUD rates for NESARC III participants were 12.7 percent and 43.6 percent, respectively. By comparison, NESARC participants in 2001 through 2002 reported past-year and lifetime DSM-IV rates of 8.5 percent and 30.3 percent, respectively. Dr. Grant and her colleagues suspect that the past decade increases may reflect increases in heavy alcohol consumption during that period, but note the need for additional research on that question.
The researchers found that rates of AUD were greater among men than women, and that age was inversely related to past-year AUD diagnosis. Among adults between ages 18 and 29, more than 7 percent had an AUD within the past year, suggesting a need for more effective prevention and intervention efforts among young people. More broadly, the researchers note the urgent need for efforts aimed at educating the public about AUD and its treatment, as well as destigmatizing the disorder.