Alcohol Use Disorder Widespread, Untreated

Research published in JAMA Psychiatry indicates that alcohol use disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) appears to be a highly prevalent, highly comorbid, and disabling disorder that often goes untreated in the United States.

Bridget F. Grant, PhD, Principal Investigator for the Laboratory of Epidemiology and Biometry in the Division of Intramural Clinical and Biological Research at the National Institute of Alcohol Abuse and Alcoholism, and colleagues sought to present nationally representative findings on the prevalence, correlates, psychiatric comorbidity, associated, disability, and treatment of DSM-5 AUD diagnoses overall and according to severity level (mild, moderate, or severe). Data were collected and analyzed on a nationally representative sample of 36,309 adults. Changes in AUD prevalence were determined by assessing DSM-4 criteria.

With changes to AUD diagnostic criteria in the DSM-5, when compared with the DSM-4, updated epidemiologic data were needed. The changes to the diagnostic criteria included the combination of abuse and dependence diagnoses into a single AUD diagnosis, the elimination of legal problems, the additions of craving to the criteria set, a diagnostic threshold of at least two criteria, and the establishment of a severity metric based on the criteria count.

The study team found a 12-month prevalence of 13.9% for AUDs and a lifetime prevalence of 29.1% based on DSM-5 criteria for patients interviewed between April 2012 and June 2013, representing approximately 32.6 million and 68.5 million adults, respectively. The highest prevalence rates were observed in men (17.6% and 36.0%, respectively), Caucasian (14.0% and 32.6%, respectively), Native American (19.2% and 43.4%, respectively), younger adults (26.7% and 37.0%, respectively), previously married (11.4% and 27.1%, respectively), and never married (25.0% and 35.5%, respectively) adults. Severe AUD had the highest 12-month and lifetime prevalence rates among those with the lowest income levels (1.8% and 1.5%, respectively). Significant disability was associated with 12-month and lifetime AUD and increased with the severity of AUD.

Despite the numbers of people reporting AUD, less than one-fifth (19.8%) of respondents with lifetime AUD had ever sought treatment or help and less than one-tenth (7.7%) of those with a 12-month AUD sought treatment.

Other substance use disorders, major depressive disorder, bipolar I disorder, and antisocial and borderline personality disorders were significantly associated with both 12-month and lifetime AUD across all severity levels, with odds ratios ranging from 1.2 to 6.4. Modest associations were observed between AUD and panic disorder, specific phobia, and generalized anxiety disorder across most AUD severity levels, with odds ratios ranging from 1.2 to 1.4.

“Most importantly, this study highlighted the urgency of educating the public and policy makers about AUD [alcohol use disorder] and its treatments, destigmatizing the disorder and encouraging among those who cannot reduce their alcohol consumption on their own, despite substantial harm to themselves and others, to seek treatment,” the study authors wrote.