Alcohol Abuse Increases, Dependence Declines Across Decade|
Young Adult Minorities Emerge As High-Risk Subgroups
The number of American adults who abuse alcohol or are alcohol
dependent rose from 13.8 million (7.41 percent) in 1991-1992 to
17.6 million (8.46 percent) in 2001-2002, according to results from
the 2001-2002 National Epidemiologic Survey on Alcohol and Related
Conditions (NESARC), a study directed by the National Institute
on Alcohol Abuse and Alcoholism (NIAAA).
The NESARC study a representative survey of the U.S. civilian
noninstitutionalized population aged 18 years and older showed
that the rate of alcohol abuse* increased from 3.03 to 4.65 percent
across the decade while the rate of alcohol dependence**,
commonly known as alcoholism, declined from 4.38 to 3.81 percent.
The study appears in the current issue of Drug and Alcohol Dependence
(Volume 74, Number 3, pages 223-234).
NESARC survey questions are based on diagnostic criteria for alcohol
abuse and alcohol dependence contained in the American Psychiatric
Association's Diagnostic and Statistical Manual of Mental Disorders-Fourth
Edition (DSM-IV). Field work for the NESARC was performed by
the United States Census Bureau, which administered face to face
interviews with 43,093 respondents. The combined household and individual
response rate was 81 percent. Like its predecessor, the 1991-1992
National Longitudinal Alcohol Epidemiologic Survey (NLAES),
the NESARC assessed the prevalence of alcohol disorders during the
year prior to the survey. Since DSM diagnostic criteria remained
unchanged across the decade, the NIAAA research team, led by Bridget
Grant, Ph.D., Ph.D., Chief, Laboratory of Epidemiology and Biometry,
Division of Intramural Clinical and Biological Research, was able
to assess changes in the prevalence of alcohol disorders across
a 10-year period.
"Change or stability in the prevalence of alcohol disorders
has important public health implications for researchers, policy
makers, and the public," said Elias Zerhouni, M.D., Director,
National Institutes of Health.
"The NESARC report reinforces the need for ongoing research
to define genetic and environmental factors that contribute to alcohol
abuse and dependence, as well as current NIAAA initiatives for the
early identification of at-risk drinkers and the application of
research-based interventions in vulnerable populations, especially
underage drinkers," according to Ting-Kai Li, M.D., Director,
National Institute on Alcohol Abuse and Alcoholism. "The fact
that alcohol disorder rates are highest among young adults underscores
the need for concerted research on drinking patterns that initiate
Overall, the NESARC data show that rates of alcohol abuse and dependence
in 2001-2002 were substantially higher in men than women and among
younger study participants aged 18-29 and 30-44 years. Alcohol abuse
is more prevalent among whites than among Hispanics, Blacks, and
Asians. Alcohol dependence is more prevalent among Native Americans,
Hispanics, and whites than among Asians.
The availability of data from both 1991-1992 and 2001-2002 allowed
the researchers to identify constant as well as emerging risk groups
with greater clarity than in the past. As in 1991-1992, whites,
Native Americans, and men remain at high risk for alcohol abuse.
By 2001-2002, rates in other subgroups had climbed to approach those
of stable high-risk groups. Across the decade, the prevalence of
alcohol abuse increased among all race-ethnic subgroups except Native
Americans and Asians. The increases were significant for both genders
of whites, Blacks, and Hispanics. Among age groups, Black and Hispanic
men and Asian women aged 18-29 years showed significant increases.
The prevalence of alcohol dependence declined across the decade
for men but remained almost static for women, effectively narrowing
the gender gap for that diagnosis. Alcohol dependence rates decreased
significantly among whites and Hispanics overall but, at the subpopulation
level, the changes were significant only for white men overall and
for Hispanic men both overall and in the 18-29 and 45-64 age groups.
Alcohol dependence prevalence remained relatively stable among Blacks,
Native Americans, and Asians overall. In contrast, Black women and
Asian men aged 18-29 years showed significant increases in alcohol
"That rates of dependence overall decreased is not surprising
in light of other surveys that indicate a decline in heavy drinking,"
Dr. Grant said. "That alcohol abuse seems to be increasing
presents intriguing questions. What is clear is that no single environmental
cause can explain the increase. Further research is an important
public health priority."
Full text of the article is available at www.sciencedirect.com
after 12:00 AM June 10. For an interview with Dr. Grant, please
call the NIAAA Press Office.
A text description of the Prevalence of DSM-IV 12-Month Alcohol
Abuse and Dependence: 1991-1992 and 2001-2002 graphic is available
The National Institute on Alcohol Abuse and Alcoholism, a component
of the National Institutes of Health, U.S. Department of Health
and Human Services, conducts and supports approximately 90 percent
of the U.S. research on the causes, consequences, prevention, and
treatment of alcohol abuse, alcoholism, and alcohol problems and
disseminates research findings to general, professional, and academic
audiences. Additional alcohol research information and publications
are available at www.niaaa.nih.gov.
* Alcohol abuse is a condition that is characterized by failure
to fulfill major role obligations at work, school, or home, interpersonal
social and legal problems, and/or drinking in hazardous situations.
** Alcohol dependence, also known as alcoholism, is a condition
characterized by impaired control over drinking, compulsive drinking,
preoccupation with drinking, tolerance to alcohol and/or withdrawal