Tuesday, July 03, 2007

Americans Drinking More and Seeking Treatment Less

NEW YORK, July 2 -- An alcohol-related disorder -- abuse or dependence--affects three of every 10 adults during their lifetimes, epidemiologists here reported.
But only 24.1% of those who develop alcohol dependence will receive treatment, according to results from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions published in the July issue of Archives of General Psychiatry.
The survey found that 17.8% of adults will abuse alcohol at some point in their lives and 12.5% will become alcohol dependent, said Deborah S. Hasin, Ph.D., of Columbia and the New York State Psychiatric Institute, and colleagues.
The treatment rate was only slightly lower than that reported in a similar survey 10 years ago revealing "a disappointing lack of progress," Dr. Hasin and colleagues wrote.
The survey consisted of face-to-face interviews with 43,093 individuals ages 18 or older. Fifty-two percent of the participants were women, 71% were white, 11% black, 2% Native American, 4% Asian, and 12% Hispanic.
Sixty-two percent were married and about 86% had at least a high school education. Almost half (47%) earned less than $20,000 a year and about 70% had annual incomes of less than $35,000. The investigators relied upon DSM-IV criteria for identification of alcohol-related disorders.
Among the findings:
Men were three times as likely as women to develop an alcohol disorder (OR 3.1, 95% CI 2.81-3.35).
Native Americans had a 40% greater risk for alcohol dependence than whites (OR 1.4, 95% CI 1.03-2.00).
The risk for alcohol dependence was greatest among adults younger than 30 who were almost seven times more likely to develop dependence than those 65 or older (OR 6.7 (95% CI 5.12-8.81)
Income was inversely related to risk of alcohol dependence, so that those earning less than $35,000 had a 60% higher risk than those who earned $70,000 or more annually (OR 1.6, 95% CI 1.28, 1.93) and those who made $35,000 to $69,999 had a 40% increase in risk (OR 1.40, 95% CI 1.15-1.71).
Alcohol disorders are often part of a constellation of disorders including major depressive disorders, bipolar disorder, any personality disorder, as well as dependence on any drug including nicotine, said the investigators.
"Of those with lifetime alcohol dependence, only 24.1% ever received treatment while of those with 12-month alcohol dependence, only 12.1% received alcohol treatment in the past year," they wrote.
Although low income was predictive of alcohol disorders, it was also predictive of the likelihood of getting treatment among those with 12-month alcohol dependence, with an odds ratio of 2.8 for those who earned less than $20,000. For those who reported lifetime abuse and dependence, low income, male gender, low income and lack of a spouse also increased the likelihood of treatment (ORs= 1.5-2.3).
The study was limited by the potential for recall bias especially when assessing comorbidities.
The authors concluded that the survey results suggest "a call to action appears indicated to educate and update the public and policy-makers about alcohol use disorders, to destigmatize the disorders, and to encourage help-seeking among those who cannot stop drinking despite considerable harm to themselves and others."
The survey was funded by the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse. The authors disclosed no financial conflicts. Primary source: Archives of General PsychiatrySource reference: Hasin D S et al "Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Alcohol Abuse and Dependence in the United States" Arch Gen Psych 2007 64: 830-842

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