Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

BACKGROUND: Uncertainties exist about the prevalence and comorbidity of substance use disorders and independent mood and anxiety disorders. OBJECTIVE: To present nationally representative data on the prevalence and comorbidity of DSM-IV alcohol and drug use disorders and independent mood and anxiety disorders (including only those that are not substance induced and that are not due to a general medical condition). DESIGN: Face-to-face survey. SETTING: The United States. PARTICIPANTS: Household and group quarters' residents. MAIN OUTCOME MEASURES: Prevalence and associations of substance use disorders and independent mood and anxiety disorders. RESULTS: The prevalences of 12-month DSM-IV independent mood and anxiety disorders in the US population were 9.21% (95% confidence interval [CI], 8.78%-9.64%) and 11.08% (95% CI, 10.43%-11.73%), respectively. The rate of substance use disorders was 9.35% (95% CI, 8.86%-9.84%). Only a few individuals with mood or anxiety disorders were classified as having only substance-induced disorders. Associations between most substance use disorders and independent mood and anxiety disorders were positive and significant (P<.05). CONCLUSIONS: Substance use disorders and mood and anxiety disorders that develop independently of intoxication and withdrawal are among the most prevalent psychiatric disorders in the United States. Associations between most substance use disorders and independent mood and anxiety disorders were overwhelmingly positive and significant, suggesting that treatment for a comorbid mood or anxiety disorder should not be withheld from individuals with substance use disorders.

The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991-1992 and 2001-2002.

BACKGROUND: Alcohol abuse and dependence can be disabling disorders, but accurate information is lacking on the prevalence of current DSM-IV alcohol abuse and dependence and how this has changed over the past decade. The purpose of this study was to present nationally representative data on the prevalence of 12-month DSM-IV alcohol abuse and dependence in 2001-2002 and, for the first time, to examine trends in alcohol abuse and dependence between 1991-1992 and 2001-2002. METHODS: Prevalences and trends of alcohol abuse and dependence in the United States were derived from face-to-face interviews in the National Institute on Alcohol Abuse and Alcoholism's (NIAAA) 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC: n = 43, 093 ) and NIAAA's 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES: n= 42, 862 ). RESULTS: Prevalences of DSM-IV alcohol abuse and dependence in 2001-2002 were 4.65 and 3.81%. Abuse and dependence were more common among males and among younger respondents. The prevalence of abuse was greater among Whites than among Blacks, Asians, and Hispanics. The prevalence of dependence was higher in Whites, Native Americans, and Hispanics than Asians. Between 1991-1992 and 2001-2002, abuse increased while dependence declined. Increases in alcohol abuse were observed among males, females, and young Black and Hispanic minorities, while the rates of dependence rose among males, young Black females and Asian males. CONCLUSIONS: This study underscores the need to continue monitoring prevalence and trends and to design culturally sensitive prevention and intervention programs.

The epidemiology of alcohol-induced pancreatitis.

Although the association between alcohol and pancreatitis has been recognized for centuries, the precise magnitude of the impact of alcohol remains poorly quantified. Epidemiologic research on this condition has been seriously handicapped by several factors. Classifications are based on morphology rather than on etiology; the diagnostic differences between acute and chronic pancreatitis are imprecise and confusing; and coding by the International Classification of Diseases (ICD) has been inadequate. The current ICD (ICD-10), used in the United States since 1999, identifies alcohol-induced chronic pancreatitis as a separate code for the first time, an enhancement that will greatly improve the quality of data collected in current and future studies. Unfortunately, no code yet exists for acute alcoholic pancreatitis. Of the approximately 2.4 million deaths in the United States in 1999, pancreatitis was listed as the underlying cause for 3289 deaths, making it the 235th leading cause of death. Acute pancreatitis accounted for 84% of these deaths, and chronic pancreatitis the remaining 16%. Alcohol is a primary cause of both acute and chronic pancreatitis in most developed countries. About one-third of acute pancreatitis in the United States is alcohol-induced. In the United States and other developed countries, 60%-90% of chronic pancreatitis is alcohol induced. Both forms are more common in men. The development of chronic pancreatitis is proportional to the dose and duration of alcohol consumption (minimum, 6-12 years of approximately 80 g of alcohol per day). Autopsy studies reveal subclinical chronic pancreatitis in another 10% of alcohol abusers. Yet, since <10% of chronic alcoholics develop chronic pancreatitis, clearly other predisposing factors besides alcohol are involved. Genetic variability and environmental exposures, such as diet, are prime candidates for further investigation. To date, there have been few large epidemiological studies of alcoholic pancreatitis in the United States or other developed countries. Additional studies are needed to improve the quality of existing baseline epidemiologic data and allow better assessment of risk. Improved diagnostic precision, more complete and specific coding, and greater understanding of covariables and mechanisms would also advance the field.

Accidental alcohol poisoning mortality in the United States, 1996-1998.

This study examines the prevalence and patterns of mortality resulting from unintentional poisoning by alcohol (ICD-9 code E860) in the United States. Relevant data for the most recently available years (1996 through 1998) were derived from the Multiple Cause of Death public-use computer data files compiled by the National Center for Health Statistics (NCHS). Data on deaths ascribed to alcohol poisoning as either the underlying cause or as 1 of up to 20 contributing causes were selected and analyzed. The annual average number of deaths for which alcohol poisoning was listed as an underlying cause was 317, with an age-adjusted death rate of 0.11 per 100,000 population. An average of 1,076 additional deaths included alcohol poisoning as a contributing cause, bringing the total number of deaths with any mention of alcohol poisoning to 1,393 per year (0.49 per 100,000 population). Males accounted for more than 80 percent of these deaths. The rate was lower among married than unmarried people (i.e., never married, divorced, or widowed) and was inversely related to education. Among males, the alcohol poisoning death rate was higher for Hispanics and non-Hispanic Blacks than non-Hispanic Whites. Among females, racial/ethnic differences were small, but Black women had higher alcohol poisoning death rates than White or Hispanic women. Alcohol poisoning deaths tended to be most prevalent among people ages 35 to 54; only 2 percent of alcohol poisoning decedents were younger than age 21. Among deaths with a contributing cause of alcohol poisoning, almost 90 percent had an underlying cause related to some type of poisoning from other drugs.

Risks and Benefits of Alcohol Use Over the Life Span.

Especially at low and moderate drinking levels, alcohol consumption can be associated with benefits (e.g., protection against coronary heart disease) as well as risks (e.g., increased risk of accidents). These benefits and risks may change across a person's life span. To determine the likely net outcome of alcohol consumption, one must weigh the probable risks and benefits for each drinker. These assessments are based on the individual drinker's consumption levels, his or her personal characteristics (e.g., age or preexisting risk factors for coronary heart disease), and subjective values as well as on social considerations. The validity of such assessments also depends on the accuracy with which alcohol consumption and alcohol-related consequences can be measured.

Alcohol Consumption and Dietary Practices in the U.S. Population: 1987 and 1992.

Research indicates that the link between alcohol and poor nutrition is highly complex. Alcohol consumption is known to disrupt nutritional status via several mechanisms. One mechanism by which alcohol may affect nutrition is by inducing changes in dietary practices. Findings are presented based on 2 years of data from a national survey of health-related activities. The relationship between alcohol consumption and dietary practices-such as types of food consumed, whether vitamins were taken, belief that diet influences health, and frequency of eating out-is examined. The results show that associations exist between alcohol and diet after controlling for demographic and health variables. These findings have important implications for understanding the interaction between alcohol intake and nutritional status and the effect of this interaction on overall health.

Twenty-Five Years of Alcohol Epidemiology: Trends, Techniques, and Transitions.

Alcohol epidemiology has developed as a discipline only in the second half of this century. The recognition of alcoholism as a diagnosable disease has permitted extensive studies of trends in alcohol consumption and its consequences throughout the United States.

Knowledge of FAS and the Risks of Heavy Drinking During Pregnancy, 1985 and 1990.

Reducing the incidence of FAS to no more than 0.12 per 1,000 live births is a stated objective of the national agenda in Healthy People 2000. One step toward attaining this is by ensuring that all prospective mothers know what FAS is. Knowledge of FAS was elicited among respondents in two health surveys to determine how much women and men know about the risks of drinking during pregnancy, how knowledge levels have changed over time, and what the implications of these findings are with regard to reducing the level of FAS among newborns.