Alcohol Survey Reveals ‘Lost Decade’ Between
Ages of Disorder Onset and Treatment
Authors Call for National Campaign to Change
Public and Professional Attitudes
At some time during their lives, more than 30 percent of U.S.
adults surveyed in 2001-2002 had met current diagnostic criteria
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, 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, 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/NewsEvents/NewsReleases/Recovery.htm).
AUD-associated disability
Alcohol abuse is associated with reduced social and role emotional
functioning, 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. 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.
The National Institute on Alcohol Abuse and Alcoholism, part of
the National Institutes of Health, is the primary U.S. agency for
conducting and supporting research on the causes, consequences,
prevention, and treatment of alcohol abuse, alcoholism, and alcohol
problems and disseminates research findings to general, professional,
and academic audiences. Additional alcohol research information
and publications are available at www.niaaa.nih.gov.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov.
|