The National Institute on Alcohol Abuse and Alcoholism today released the first report from its National Longitudinal Alcohol Epidemiologic Survey (NLAES), including the most precise estimates to date of alcohol abuse and dependence among U.S. adults. The figures are reported by Bridget F. Grant, Ph.D., Ph.D., and colleagues in the current issue (Vol. 18, No. 3) of Alcohol Health & Research World, NIAAA's quarterly research journal.
According to the report, 13,760,000 U.S. adults (7.41 percent of persons aged 18 years and older) met standard diagnostic criteria for alcohol abuse or alcohol dependence during 1992. Although more were classified with alcohol dependence (4.38 percent) than alcohol abuse (3.03 percent), most persons with alcohol dependence also met alcohol abuse criteria.
As in earlier surveys, alcohol use disorder rates were higher among males than females and highest in the youngest age cohort (18-29 years). Gender disparity was least among young nonblacks, suggesting that alcohol use disorders may be gaining ground among young nonblack females.
"Age-related role responsibilities and perceived social acceptability of drinking may explain the disparity between male and female rates of alcohol use disorder among young blacks compared with young nonblacks," Grant said.
Young nonblack males were almost twice as likely as young black males to have an alcohol use disorder. But, while the disorders declined with age among males in both ethnic groups, they increased among black women aged 30-44 years.
Regardless of gender and ethnicity, alcohol use disorders were least prevalent among persons 65 years and older. This may or may not be the result of a true "cohort effect," according to the study authors: Other possible explanations include faulty recall by older survey respondents and reduced survival rates among alcoholics.
"Because the NLAES sample is truly representative of the U.S. population, we can be confident about generalizing its findings," said NIAAA Director Enoch Gordis, M.D.
"And, because the survey questions closely reflect strict diagnostic criteria, we know that the NLAES numbers reflect the prevalence of alcohol use disorders as syndromes rather than a loose constellation of symptoms."
"It is therefore heartening that this NLAES report confirms many of our previous conclusions about the extent of alcohol use disorders in the general population and population subgroups at increased risk."
NLAES is the first national survey to assess the prevalence of alcohol use disorders using current diagnostic criteria. Unpublished until 1994, the American Psychiatric Association's DSM-IV criteria were known and incorporated into the NLAES questionnaire in 1991.
The Bureau of the Census administered the NIAAA-designed NLAES to 42,862 respondents in the contiguous United States and District of Columbia in 1992.
The 1992 prevalence estimate (7.41 percent) reported from NLAES does not differ greatly from estimates obtained in previous surveys conducted in 1984 (8.58 percent) and 1988 (8.63 percent). However, because the previous surveys used historic diagnostic criteria, no conclusions can yet be made concerning the rates of alcohol abuse and dependence over time.
Trend analyses can be accomplished, however, once diagnostic criteria have been equalized among studies. Cross-analysis of the DSM-IV criteria used in NLAES with historic diagnostic criteria will enable the NLAES analysts soon to define trends in U.S. alcohol abuse and dependence rates across the past decade.
Future NLAES reports will address the risk for major medical conditions as a function of excessive alcohol use, the prevalence of other drug abuse and dependence in conjunction with alcohol use disorders, and the utilization of treatment services and public assistance among persons with alcohol and drug use disorders, among other subjects.
"Not only will researchers use NLAES data to point to potentially fruitful areas of study. Health care providers and policy makers also now have a rich, reliable source of alcohol information to guide programmatic and policy decisions," Gordis said.
Future reports from NLAES will be issued during 1995 and 1996, as NIAAA celebrates its 25th anniversary as the lead Federal institute for research on the causes, consequences, treatment, and prevention of alcohol abuse and dependence.
NIAAA is one of 17 institutes of the National Institutes of Health within the Public Health Service of the U.S. Department of Health and Human Services.