Alcohol use disorder is widespread, often untreated in the United States

Alcohol use disorder as defined by a new diagnostic classification was widespread and often untreated in the United States, with a lifetime prevalence of 29.1 percent but only 19.8 percent of adults were ever treated, according to an article published online by JAMA Psychiatry.

Alcohol use disorders are among the most prevalent mental health disorders worldwide, resulting in disability and contributing to illness and death. Because of the seriousness of alcohol use disorders, updated epidemiologic data are needed given the changes to the alcohol use disorder diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). The changes in the diagnostic criteria included the elimination of separate abuse and dependence diagnoses, the combination of the criteria into a single alcohol use disorder diagnosis, the elimination of legal problems, the addition 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.

Researcher Bridget F. Grant, Ph.D., of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institutes of Health, Bethesda, Md., and coauthors provide nationally representative information on prevalence, co-existing illnesses, disability and treatment from the NIAAA 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)-III. The total sample size was 36,309 adults. Researchers also assessed previous diagnostic criteria (DSM-IV) to examine changes in prevalence.

The authors found the 12-month prevalence of alcohol use disorder under DSM-5 was 13.9 percent and the lifetime prevalence was 29.1 percent, representing approximately 32.6 million and 68.5 million adults, respectively. Only 19.8 percent of adults with lifetime alcohol use disorder sought treatment or help, while 7.7 percent of those with a 12-month alcohol use disorder sought treatment.

Corresponding rates under the previous diagnostic criteria (DSM-IV) in the NESARC-III were 12.7 percent for a 12-month prevalence of alcohol use disorder and 43.6 percent for lifetime prevalence. Those rates were considerably higher than those from the 2001-2002 NESARC when the rates were 8.5 percent and 30.3 percent, respectively. The authors note more research is needed on the reason for the increase and on the discrepancies in rates.

Current study results also show that: Prevalence of alcohol use disorder was highest for respondents who were men (17.6 percent 12-month prevalence, 36 percent lifetime prevalence), who were white (14 percent 12-month prevalence, 32.6 percent lifetime prevalence) and who were Native American (19.2 percent 12-month prevalence, 43.4 percent lifetime prevalence) Prevalence was also highest among respondents who were younger (26.7 percent 12-month prevalence, 37 percent lifetime prevalence) and who were previously married (11.4 percent 12-month prevalence, 27.1 percent lifetime prevalence) or never married (25 percent 12-month prevalence, 35.5 percent lifetime prevalence). Alcohol use disorders were associated with other substance use disorders, major depressive and bipolar I disorders, as well as antisocial and borderline personality disorders.