Serious Alcohol Problems Taking Toll on More and More Americans

Serious Alcohol Problems Taking Toll on More and More AmericansNewly released findings from federal researchers point to a potentially significant increase in the number of American adults affected by diagnosable problems with alcohol abuse or alcohol dependence (i.e., alcoholism).

Under terms established in 2013, U.S. doctors now classify all diagnosable symptoms of alcohol abuse and alcoholism as indicators of a single condition known as alcohol use disorder. In a study published in June 2015 in the American Medical Association journal JAMA Psychiatry, a team of federal and university researchers used data from a long-term project called the National Epidemiologic Survey on Alcohol and Related Conditions to compare the number of people diagnosed with this condition in the 2010s to the number of people who received a separate alcohol abuse or alcoholism diagnosis a decade earlier. These researchers concluded that the rate of diagnosable alcohol problems has increased considerably, although exact reasons for the rise remain unclear.

Diagnosable Alcohol Problems

In the U.S., the standard criteria for diagnosing serious alcohol problems come from the American Psychiatric Association (APA), an organization that also sets the criteria for diagnosing all other illnesses with a primary mental health component. Up until May 2013, the APA officially viewed alcohol abuse and alcohol dependence as separate, distinct conditions. In order to receive an alcohol abuse diagnosis, an affected individual had to have at least one out of four possible symptoms indicating a non-addicted but seriously dysfunctional pattern of alcohol use. In order to receive an alcohol dependence diagnosis, an affected individual had to have at least three out of seven possible symptoms indicating an addiction to alcohol and significantly harmful lifestyle alteration related to that addiction.

For decades, researchers and practicing doctors had been gathering evidence showing that the symptoms of alcohol abuse and alcohol dependence are overlapping in a substantial number of cases. However, under the then-current APA guidelines, doctors could not simultaneously diagnose the two conditions in a single person. The American Psychiatric Association changed this situation in 2013 by establishing the alcohol use disorder diagnosis as a replacement for separately diagnosable alcohol abuse and alcohol dependence. Under the new criteria, affected individuals must have at least two out of 11 possible symptoms indicating the presence of alcohol abuse and/or alcohol dependence. Based on the number of symptoms present, alcohol use disorder has a mild, moderate or severe impact.

National Epidemiologic Survey

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) was initiated by the National Institute on Alcohol Abuse and Alcoholism in 2001/2002 as a method of gauging the extent of diagnosable alcohol problems in the U.S. population. The project was also designed to gauge the extent of other substance-related problems, as well as the extent of overlap between diagnosable substance problems and other serious mental health issues. The information included in the original version of NESARC came from interviews with a nationally representative group of 43,093 American adults. Many of these adults also participated in a follow-up survey conducted a couple of years later. A third iteration of NESARC, conducted in 2012/2013, included information from a new group of 36,309 nationally representative adults.

An Increase in Alcohol Abuse/Alcoholism?

In the study published in JAMA Psychiatry, researchers from the National Institute on Alcohol Abuse and Alcoholism, Columbia University and the Columbia-affiliated New York State Psychiatric Institute used data from the 2012/2013 version of NESARC to help determine if the number of U.S. adults affected by diagnosable alcohol problems has increased over the last decade. Specifically, the researchers sought to determine if the 2012/2013 NESARC participants qualified for an alcohol use disorder diagnosis under the current criteria more often than their counterparts in the 2001/2002 version of NESARC qualified for a separate diagnosis of alcohol abuse or alcoholism under the old criteria.

The researchers found that 13.9 percent of the new NESARC participants met the terms for diagnosing alcohol use disorder in the prior year. They also found that 29.1 percent of the participants had met the alcohol use disorder criteria over the course of their lifetimes. In contrast, 8.5 percent of the original NESARC participants met the terms for diagnosing alcohol abuse or alcoholism in the prior year, and 30.3 percent met the criteria for one of these conditions over the course of their lifetimes.

The study’s authors note that the clear increase in the number of people who qualified for an alcohol-related diagnosis in the previous year may reflect an actual increase in the number of affected individuals over the last decade. However, it may also reflect an improvement in the detection of alcohol problems under the alcohol use disorder criteria. Such an improvement was one of the motivations for creating the new criteria in 2013.

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