A survey of American adults revealed that drug use disorder is common, co-occurs with a range of mental health disorders and often goes untreated. The study, funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, found that about 4 percent of Americans met the criteria for drug use disorder in the past year and about 10 percent have had drug use disorder at some time in their lives.
“Based on these findings, more than 23 million adults in the United States have struggled with problematic drug use,” said George F. Koob, Ph.D., NIAAA director. “Given these numbers, and other recent findings about the prevalence and under-treatment of alcohol use disorder in the U.S., it is vitally important that we continue our efforts to understand the underlying causes of drug and alcohol addiction, their relationship to other psychiatric conditions and the most effective forms of treatment.”
A diagnosis of drug use disorder is based on a list of symptoms including craving, withdrawal, lack of control, and negative effects on personal and professional responsibilities. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) no longer uses the terms abuse and dependence. Instead, DSM-5 uses a single disorder which is rated by severity (mild, moderate, and severe) depending on the number of symptoms met. Individuals must meet at least two of 11 symptoms to be diagnosed with a drug use disorder.
This includes the problematic use of amphetamines, marijuana, club drugs (e.g., ecstasy, ketamine, methamphetamine), cocaine, hallucinogens, heroin, non-heroin opioids (e.g., oxycodone, morphine), sedatives/tranquilizers, and solvents/inhalants. Face-to-face interviews were conducted to diagnose drug use disorder, as well as alcohol use disorder, nicotine use disorder, and various personality disorders.
The study, based on NIAAA’s National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III), found that drug use disorder was more common among men, white and Native American individuals, and those who are single or no longer married. Younger individuals and those with lower income and education levels were also at greater risk. Regional differences were found as well, with those living in the 13 Western-most states in the U.S. (including Alaska and Hawaii) more likely to have drug use disorder during their lives.
The study was led by Dr. Bridget Grant, Ph.D., Ph.D., (doctorates in psychology and epidemiology), of the NIAAA Laboratory of Epidemiology and Biometry. Dr. Grant’s lab conducts NESARC, a series of national epidemiological surveys that evaluate alcohol use, drug use and related psychiatric conditions. More than 36,000 people were evaluated using DSM-5 criteria. The study currently appears online in the Journal of the American Medical Association (JAMA) Psychiatry.
Similar to past research, the present study showed that people with drug use disorder were significantly more likely to have a broad range of psychiatric disorders, including mood, anxiety, post-traumatic stress and personality disorders. Individuals with drug use disorder in the past year were 1.3 times as likely to experience clinical depression, 1.6 times as likely to have post-traumatic stress disorder (PTSD) and 1.8 times as likely to have borderline personality disorder, when compared to people without drug use disorder. Drug use disorder was also linked to both alcohol and nicotine use disorder, with a three-fold increase in risk.
“The prevalence and complexity of drug use disorders revealed in this study coupled with the lack of treatment speak to the urgent need for health care professionals to be trained in proper techniques to identify, assess, diagnose, and treat substance use disorders among patients in their practice,” said Nora D. Volkow, M.D., director of the National Institute on Drug Abuse, which contributed funding to the study.
Based on the results of the study, the majority of people with drug use disorder never receive any form of treatment. About 14 percent of people who had drug use disorder in the past year and about 25 percent of people who had ever had drug use disorder received care. Even among people with moderate-to-severe drug use disorder, less than 20 percent of those with past-year drug use disorder and less than one-third of those with lifetime drug use disorder received treatment.
Treatment rates for alcohol use disorder are similarly low. Earlier this year, Dr. Grant’s group found that nearly one-third of adults in the United States have alcohol use disorder at some time in their lives, but only about 20 percent receive treatment.
The authors note that low treatment rates for drug use disorder may reflect skepticism about the effectiveness of treatment, as well as insufficient resources, lack of knowledge among health care providers and barriers related to stigma. They note the need to destigmatize drug use disorder and educate the public about recent advances in evidence-based treatment and how to access help.