National Epidemiologic Survey on
Alcohol and Related Conditions
(NESARC): A CRITICAL REVIEW
Presenter: Amitkumar Chougule
INTRODUCTION
 National Comorbidity Survey: Baseline (NCS-1) Conducted from
1990-1992 (NCS-2) was a follow up study conduc...
National Epidemiologic Survey on Alcohol
and Related Conditions (NESARC):
 Household survey designed, conducted, and spon...
WHAT IS THE NEED FOR STUDY?
1. To determine the prevalence of alcohol abuse and dependence
in disadvantaged groups
2. Accu...
CONTINUED…
4.Recent US and international surveys deviated from DSM-IV
criteria by skipping alcohol dependence criteria if ...
NESARC’s Key Goals
1. To determine the extent of alcohol use disorders (AUDs)
and their associated disabilities in the gen...
 First wave (Wave 1) 2001-2002 : baseline assessment for
prevalence data
 Second wave(wave 2) 2004–2005: follow up data
...
Methodology
 The fieldwork for this survey was completed under NIAAA’s
direction by trained U.S. Census Bureau Field
Repr...
 The sample included 43,093 respondents ages 18 and older,
representing the civilian, non institutionalized adult
populat...
 Data collection for Wave 2 began in August 2004 and was
completed by September 2005
 The Wave 2 NESARC reinterviewed 34...
Data Coverage
 In both waves, the information was collected using the NIAAA
Alcohol Use Disorder and Associated Disabilit...
Measures used
 NESARC Alcohol Items:
Primary focus of the NESARC is ALCOHOL
Which includes:
1. Amounts and patterns of co...
 An alcoholic or problem drinker was defined for each
respondent during the interview as a person who has:
1. Physical or...
Alcohol Treatment
 A respondent’s lifetime and past-year treatment seeking
status was determined
Other NESARC Items
1. Basic Demographic and Background Information
2. Tobacco Use Status
3. Drug Use Status
4. Medical Con...
NESARC's UNIQUE DESIGN
 NESARC is unparalleled in a number of ways:
1. Large sample size of 43,093 people
2. Larger the s...
 The investigators were able to obtain data on people not
typically captured by household surveys
 To ensure that minori...
 Several sources of non sampling error could have occurred
such as:
1. Interviewers recording wrong answers
2. Respondent...
Prevalence, Correlates, Disability,
and Comorbidity of DSM-IV Alcohol Abuse
and Dependence in the United States:
Results f...
The Magnitude of the Problem and Trends
over Time
 Analysis using the data from NESARC and its predecessor
survey the 199...
 Increases in alcohol abuse were found in both men and
women, particularly among young Blacks and Hispanics
 Rates of de...
Prevalence OF AUDs
 The 12-month prevalence of DSM-IV
1. alcohol abuse - 4.7%
2. dependence - 3.8%
 12- month prevalence...
Alcohol dependence was significantly more prevalent among:
1. Men
2. Whites
3. Native Americans
4. Younger and unmarried a...
 Current alcohol abuse was more prevalent among:
1. Men
2. Whites
3. Younger and unmarried individuals
 Lifetime rates w...
 According to NIAAA’s low-risk drinking guidelines:
 Men may be at risk if they drink:
 More than 14 drinks per week or...
 The prevalence of alcohol dependence with abuse increased
in a fairly linear fashion with frequency of exceeding daily
d...
Socio-demographic and clinical
characteristics
 The risk of continued/recurrent dependence increased with:
1. Ethanol int...
Evidence for a two-stage model of
dependence
 Twin studies suggest that substance initiation and
dependence are part of a...
 Family history of drug or alcohol problems is significantly
associated with dependence even after conditioning on
factor...
 The researchers identified 5 subgroups of alcoholism:
1."Young-adult" subtype (31.5% of US alcoholics):
 Dependent on a...
3."Functional" subtype (19.4% of US alcoholics):
 middle-aged, well-educated, good jobs
 dependent on alcohol for about ...
5."Chronic-severe" subtype (9.2% of US alcoholics):
 middle-aged
 Dependent on alcohol for about 13 years
 Tend to have...
ONSET AND COURSE OF DSM-IV ALCOHOL USE
DISORDERS
 Mean ages at onset of alcohol:
1. Abuse 22.5 years
2. Dependence 21.9 y...
 Onset of drinking at a young age(< 14 years) has much
higher risk of :
1. Developing a problem with alcohol later in lif...
 PRESCRIPTION DRUG MISUSE (PDM) AND ALCOHOL
DEPENDENCE:
Alcohol dependent and cannabis-users with (PDM) were
significantl...
 The mean number of episodes among respondents with
multiple episodes of abuse and dependence was 5.2 and 5.1
respectivel...
TREATMENT FOR DSM-IV ALCOHOL USE
DISORDERS
 Those with lifetime alcohol dependence only 24.1% ever
received treatment
 T...
Among those with 12-month alcohol dependence:
1. 7.4%received help from 12-step (self-help) groups
2. 10.0% from any healt...
 Of those with 12-month alcohol abuse:
1. 2.0% received help from 12-step groups
2. 0.0% (halfway houses) to 1.9% (any pr...
 In the NESARC, the mean age of respondents first treatment
for dependence was 29.8 years
 8-year mean lag between onset...
 Characteristics that significantly (P.05) predicted
treatment:
1. For 12-month alcohol dependence the lowest income
cate...
Reasons for not seeking alcohol
treatment
1. Should be strong enough to handle it alone
2. Thought problem would get bette...
RECOVERY
 25.0% of all US adults with prior-to-past-year (PPY) alcohol
dependence were still dependent in the past year
...
 Half of all people with PPY dependence met the criteria for
full remission
 This includes asymptomatic risk drinkers (1...
 Among people with PPY dependence who were still
dependent in the year preceding interview just 28.8%
reported having rec...
 Entry into and exit from a first marriage each increased the
likelihood of non-abstinent recovery during the first 3 yea...
 AR was more common among:
1. Blacks
2. People with relatively severe dependence
3. life-time smokers
4. People with a hi...
 There is a wide range of recovery from alcohol dependence
in the general population, from partial remission to full
abst...
RELAPSE:
 Relapse by wave 2:
1. 51.0% of the Wave 1 asymptomatic risk drinkers
2. 27.2% of low-risk drinkers
3. 7.3% of a...
CRITIQUE
 No conclusions can be drawn from findings regarding:
1. The effectiveness of treatment
2. Overall relationship ...
 Necessity of a small intensively studied sample whom the
investigator has actually met in case of confidential
informati...
 This study could not provide any guidelines concerning who
really must stop drinking in order to recover from
dependence...
 What might constitute appropriate services:
1. Public information and education showing that recovery from
alcohol probl...
ASSOCIATIONS BETWEEN DSM-IV
ALCOHOL USE DISORDERS AND
OTHER PSYCHIATRIC DISORDERS
CONTROLLING FOR SOCIODEMOGRAPHIC
CHARACT...
1. 12 month alcohol abuse remained strongly and significantly
associated with substance use disorders (OR 1.8)
2. But not ...
 12 month alcohol dependence remained strongly
associated with:
1. Substance use disorders (ORs=3.4-7.5)
2. bipolar disor...
 Lifetime DSM-IV alcohol dependence remained positively
although less strongly associated with :
1. Substance use disorde...
 Rates of any PD were greater among respondents with any
drug abuse (37.8%) and any drug dependence (69.5%) than
among re...
 Nicotine dependence was reported by 48% of the alcohol-
dependent respondents
 They reported higher lifetime rates of:
...
Probability of transitioning to substance dependence
among substance users
1. After the first year of substance use onset ...
Predictors of transition from substance use to
dependence
 Socio-demographic predictors :
1. Females were more likely tha...
Psychopathological and substance use-related
predictors
 A history of any mental disorder strongly predicted the
developm...
 Nicotine, alcohol or cannabis users diagnosed with an
anxiety disorder showed an increased risk of becoming
dependent on...
 Having a history of SUD predicted a further development of
an additional SUD
 Individuals diagnosed with nicotine depen...
 Family history of SUD increased the risk of transition from
nicotine or alcohol use to dependence
 The cumulative proba...
Cannabis use:
 Later onset cannabis use:
1. Religious and pro-social activities are negatively
associated
2. Divorce, alc...
Substance use disorders among inhalant
users:
 The lifetime prevalence of SUDs among adult inhalant users
was 96%
 Compa...
Nonmedical prescription drug use and drug
use disorders:
 The odds of nonmedical prescription drug use and drug use
disor...
Epidemiology of MOOD
Disorders
Results From the National Epidemiologic
Survey on Alcoholism and Related Conditions
Deborah...
PREVALENCE AND SOCIODEMOGRAPHIC
CORRELATES
 Prevalence rates of DSM-IV were:
 Major depressive disorder:
1. Lifetime 13....
 Women showed a significantly higher risk for MDD
 MDD had strongest risk among those 45 to 64 years old
 Risk of MDD d...
ONSET, COURSE, AND TREATMENT
 Mean age at onset of MDD was 30.4 years
 The hazard for onset of MDD increased sharply bet...
PREVALENCE OF DSM-IV AXIS I AND II
DISORDERS AMONG RESPONDENTS WITH MDD
Among those with MDD in the prior 12 months:
1. 1...
Among those with lifetime MDD:
1. 40.3% had an alcohol use disorder
2. 17.2% had a drug use disorder
3. 30.0% had nicotin...
Conclusions about MDD from NESARC
 Average duration was almost 6 months longer than the
previous estimate of 4 months
 A...
 Strong association of MDD with dependence on alcohol,
drug, and nicotine, in contrast with a weak relationship of
MDD wi...
 The comorbidity of substance dependence with MDD
predicts poor outcome among patients
 Treating MDD that is comorbid wi...
Panic attacks and suicide:
 Panic attacks appear to be an independent risk factor for
suicide attempt among depressed ind...
 The presence of atypical features during an MOOD
DISORDER EPISODE (MDE) was associated with greater
rates of lifetime ps...
 MDE with atypical features was associated with:
1. Female gender
2. Younger age at onset
3. More Mood disorder episodes
...
 Variables determined to be predictors of BD I :
1. unemployment (OR = 0.6)
2. Taking medications for depression (OR = 1....
 The mean age of BD-I subjects with CVD and HTN was 14
and 13 years younger, respectively, than controls with CVD
and HTN...
Role of self-medication in the development of
comorbid mood and drug use disorders
 Self-medication with drugs among indi...
The Intricate Link Between
Violence and Mental Disorder
Results From the National Epidemiologic Survey on
Alcohol and Rela...
Results provide empirical evidence that :
 Severe mental illness is not a robust predictor of future
violence
 People w...
CRIMINAL VICTIMIZATION:
 More than 1-in-25 adults in the United States (4.1%) reported
past-year criminal victimization
...
Psychiatric disorders among foreign-born and US-
born Asian-Americans (AAs) in a US national survey
 Foreign-born AAs had...
An invariant dimensional liability model of
gender differences in mental disorder
prevalence: Evidence from NESARC
 Gende...
Pathological gambling
 Three classes (or subtypes) of gamblers:
1. Behaviorally conditioned
2. Emotionally vulnerable
3. ...
Physical Punishment and Mental Disorders:
 Approximately 2% to 5% of Axis I disorders and 4% to 7% of
Axis II disorders w...
Association Between Peptic Ulcer and
Personality Disorders:
 All seven personality disorders were associated with stomach...
CONCLUSION
 NESARC is an example of a large, random, representative
survey of adults living in the United States
 This s...
 NESARC data have several practical applications like
defining the intricate relationship between alcohol use and
comorbi...
National epidemiologic survey on alcohol and related conditions.seminar coorect
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National epidemiologic survey on alcohol and related conditions.seminar coorect

NESARC study , Critical Review
Published on: Mar 3, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - National epidemiologic survey on alcohol and related conditions.seminar coorect

  • 1. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC): A CRITICAL REVIEW Presenter: Amitkumar Chougule
  • 2. INTRODUCTION  National Comorbidity Survey: Baseline (NCS-1) Conducted from 1990-1992 (NCS-2) was a follow up study conducted between 2001 and 2002  In 1992 United States conducted the National Longitudinal Alcohol Epidemiologic Survey (NLAES)  The World Health Organization International Consortium in Psychiatric Epidemiology (ICPE), 2000  2007 National Survey of Mental Health and Wellbeing, conducted by the Australian Bureau of Statistics (ABS)
  • 3. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC):  Household survey designed, conducted, and sponsored by The National Institute on Alcohol Abuse and Alcoholism (NIAAA)  Largest and most comprehensive survey conducted on alcohol use, alcohol use disorders, and their physical and psychiatric disabilities
  • 4. WHAT IS THE NEED FOR STUDY? 1. To determine the prevalence of alcohol abuse and dependence in disadvantaged groups 2. Accurate information on comorbidity of alcohol abuse and dependence with other specific mental disorders is important 3. Comorbidity of alcohol abuse or dependence with other disorders controlling for the comorbidity of these disorders with each other has not been addressed
  • 5. CONTINUED… 4.Recent US and international surveys deviated from DSM-IV criteria by skipping alcohol dependence criteria if respondents did not satisfy alcohol abuse criteria 5.This caused about one third of 12-month cases and about 15% of lifetime cases of alcohol dependence to be missed 6.Determining whether treatment needs that were unmet in the early 1990s are now better served
  • 6. NESARC’s Key Goals 1. To determine the extent of alcohol use disorders (AUDs) and their associated disabilities in the general population 2. To estimate changes over time in AUDs 3. To determine treatment related factors 4. To determine the extent of major alcohol-related mental and physical disabilities
  • 7.  First wave (Wave 1) 2001-2002 : baseline assessment for prevalence data  Second wave(wave 2) 2004–2005: follow up data  Third wave: to be conducted…………… National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)
  • 8. Methodology  The fieldwork for this survey was completed under NIAAA’s direction by trained U.S. Census Bureau Field Representatives through computer-assisted personal interviews (CAPI) in face-to-face household settings
  • 9.  The sample included 43,093 respondents ages 18 and older, representing the civilian, non institutionalized adult population in the United States, including all 50 States and the District of Columbia  The Wave 1 NESARC used a multistage stratified design in which primary sampling units (PSUs) were stratified according to Sociodemographic criteria
  • 10.  Data collection for Wave 2 began in August 2004 and was completed by September 2005  The Wave 2 NESARC reinterviewed 34,653 of the 43,093 Wave 1 NESARC respondents  Response rate was 81 percent
  • 11. Data Coverage  In both waves, the information was collected using the NIAAA Alcohol Use Disorder and Associated Disabilities Interview Schedule–Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Version (AUDADIS-IV)  Fully structured diagnostic interview instrument (questionnaire) designed for experienced lay interviewers (Grant, Dawson, and Hasin 2001)
  • 12. Measures used  NESARC Alcohol Items: Primary focus of the NESARC is ALCOHOL Which includes: 1. Amounts and patterns of consumption 2. Experiences associated with drinking 3. Classification of alcohol use disorders 4. Family history of alcohol problems
  • 13.  An alcoholic or problem drinker was defined for each respondent during the interview as a person who has: 1. Physical or emotional problems because of drinking 2. Problems with a spouse, family, or friends because of drinking 3. Problems at work or school because of drinking 4. Problems with the police (like drunk driving) because of drinking 5. Person who seems to spend a lot of time drinking or being hung over
  • 14. Alcohol Treatment  A respondent’s lifetime and past-year treatment seeking status was determined
  • 15. Other NESARC Items 1. Basic Demographic and Background Information 2. Tobacco Use Status 3. Drug Use Status 4. Medical Conditions 5. DSM-IV Mood and Anxiety Disorders 6. DSM-IV Personality and Conduct Disorders
  • 16. NESARC's UNIQUE DESIGN  NESARC is unparalleled in a number of ways: 1. Large sample size of 43,093 people 2. Larger the sample size the more accurate the findings 3. Achievement of stable estimates of even rare conditions 4. Participants came from all walks of life and a variety of ages
  • 17.  The investigators were able to obtain data on people not typically captured by household surveys  To ensure that minority and special populations were well represented in the sample, NESARC oversampled Blacks, Hispanics, and young adults aged 18–24  Survey produced enough minority respondents to answer questions of race/ethnic disparities in comorbidity and access to health care services  NESARC’s unique design resulted in a rich dataset
  • 18.  Several sources of non sampling error could have occurred such as: 1. Interviewers recording wrong answers 2. Respondents providing incorrect information 3. Respondents inaccurately estimating requested information 4. Unclear survey questions misunderstood by the respondent (measurement error) 5. Missed individuals(coverage error) 6. Missing responses (nonresponse error) 7. Forms lost, and data incorrectly keyed, coded, or recoded (processing error)
  • 19. Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Alcohol Abuse and Dependence in the United States: Results from NESARC Deborah S. Hasin, PhD; Frederick S. Stinson, PhD; Elizabeth Ogburn, MS; Bridget F. Grant, PhD, PhD
  • 20. The Magnitude of the Problem and Trends over Time  Analysis using the data from NESARC and its predecessor survey the 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES) showed trends in alcohol abuse and dependence between 1991-1992 and 2001-2002  Results: 1. Alcohol abuse increased from 3.03 percent to 4.65 percent 2. Dependence declined from 4.38 percent to 3.81 percent
  • 21.  Increases in alcohol abuse were found in both men and women, particularly among young Blacks and Hispanics  Rates of dependence increased among men overall, young Black women, and Asian men  There was a decrease in the overall rate of dependence  The reasons behind this rise in rates of abuse and dependence among minority young adults were unclear and will need further investigation  This study underscores the importance of trends in alcohol abuse and dependence
  • 22. Prevalence OF AUDs  The 12-month prevalence of DSM-IV 1. alcohol abuse - 4.7% 2. dependence - 3.8%  12- month prevalence of any alcohol use disorder was 8.5%  The lifetime prevalence of DSM-IV 1. alcohol abuse- 17.8% 2. dependence - 12.5%  Total lifetime prevalence of any alcohol use disorder was 30.3%
  • 23. Alcohol dependence was significantly more prevalent among: 1. Men 2. Whites 3. Native Americans 4. Younger and unmarried adults 5. Those with lower incomes
  • 24.  Current alcohol abuse was more prevalent among: 1. Men 2. Whites 3. Younger and unmarried individuals  Lifetime rates were highest among middle-aged Americans
  • 25.  According to NIAAA’s low-risk drinking guidelines:  Men may be at risk if they drink:  More than 14 drinks per week or more than 4 drinks on any day  Women may be at risk if they drink:  More than 7 drinks per week or more than 3 drinks on any day
  • 26.  The prevalence of alcohol dependence with abuse increased in a fairly linear fashion with frequency of exceeding daily drinking limits  The prevalence of dependence alone (no abuse) and abuse alone (no dependence) peaked among persons who exceeded the daily limits twice a week and then leveled off  This data support the utility of the daily and weekly drinking limits in predicting AUDs
  • 27. Socio-demographic and clinical characteristics  The risk of continued/recurrent dependence increased with: 1. Ethanol intake 2. People with 10 or more life-time dependence symptoms 3. Positive histories of illicit drug use and personality disorders  The risk of dependence decreased with: 1. Age 2. high-school graduation 3. reduced among women 4. non-Hispanic whites 5. married people
  • 28. Evidence for a two-stage model of dependence  Twin studies suggest that substance initiation and dependence are part of a complex two-stage process  Some genetic influences are stage-specific acting on either the transition from abstinence to initiation or on the transition from use to dependence  Family history of drug or alcohol problems is significantly associated with initiation that does not progress to dependence (i.e., conditional initiation)
  • 29.  Family history of drug or alcohol problems is significantly associated with dependence even after conditioning on factors influencing initiation (i.e., conditional dependence)  These results suggest that substance initiation and dependence involve at least partially distinct familial factors  The possibility that different genetic factors affect initiation and dependence has important implications for control group selection in case–control genetic association studies
  • 30.  The researchers identified 5 subgroups of alcoholism: 1."Young-adult" subtype (31.5% of US alcoholics):  Dependent on alcohol within 3 years of drinking onset  low rates of abuse of other substances and family alcoholism 2."Young-antisocial" subtype (21.1% of US alcoholics):  Dependent on alcohol within 3 years of drinking onset  They tend to have antisocial personality disorder, multiple psychiatric comorbidities, problems with other types of substance abuse and a family history of alcoholism
  • 31. 3."Functional" subtype (19.4% of US alcoholics):  middle-aged, well-educated, good jobs  dependent on alcohol for about 18 years 4."Intermediate-familial" subtype (18.8% of US alcoholics):  middle-aged dependent on alcohol for 15 years  family history of alcoholism and multiple comorbidities
  • 32. 5."Chronic-severe" subtype (9.2% of US alcoholics):  middle-aged  Dependent on alcohol for about 13 years  Tend to have a multigenerational family history of alcoholism  Highest rates of other psychiatric disorders
  • 33. ONSET AND COURSE OF DSM-IV ALCOHOL USE DISORDERS  Mean ages at onset of alcohol: 1. Abuse 22.5 years 2. Dependence 21.9 years  Hazard rates for onset peaked at age 19 years and decreased thereafter  Mean durations of longest episodes of alcohol abuse and dependence were 2.7 and 3.7 years
  • 34.  Onset of drinking at a young age(< 14 years) has much higher risk of : 1. Developing a problem with alcohol later in life 2. Dependence within 10 years of beginning drinking i.e before age 25 3. Multiple episodes of dependence 4. Episodes of dependence followed by non dependence 5. Delinquency and criminal activity 6. Drinking and driving
  • 35.  PRESCRIPTION DRUG MISUSE (PDM) AND ALCOHOL DEPENDENCE: Alcohol dependent and cannabis-users with (PDM) were significantly more likely to report alcohol-related “risk-taking behaviors” or “interpersonal troubles” than were those without PDM
  • 36.  The mean number of episodes among respondents with multiple episodes of abuse and dependence was 5.2 and 5.1 respectively  Mean duration of dependence episodes differed significantly (P.01) between those with one episode (3.4 years) vs multiple episodes (2.4 years)
  • 37. TREATMENT FOR DSM-IV ALCOHOL USE DISORDERS  Those with lifetime alcohol dependence only 24.1% ever received treatment  Those with 12-month alcohol dependence only 12.1% received alcohol treatment in the past year  Treatment rates were lower than treatment rates 10 years earlier
  • 38. Among those with 12-month alcohol dependence: 1. 7.4%received help from 12-step (self-help) groups 2. 10.0% from any health professional other than 12-step groups employee assistance programs, or clergy 3. 6.7% from physicians or other health professionals
  • 39.  Of those with 12-month alcohol abuse: 1. 2.0% received help from 12-step groups 2. 0.0% (halfway houses) to 1.9% (any professional other than 12-step groups, employee assistance programs, or clergy)  Lifetime professional treatment rates were 4.5% among respondents with alcohol abuse and 20.1% among respondents with alcohol dependence
  • 40.  In the NESARC, the mean age of respondents first treatment for dependence was 29.8 years  8-year mean lag between onset and treatment  The mean age of first treatment for abuse was 32.1years  10-year mean lag between onset and treatment
  • 41.  Characteristics that significantly (P.05) predicted treatment: 1. For 12-month alcohol dependence the lowest income category predicted treatment 2. For 12-month abuse those widowed, separated, or divorced, those with less than high school education were more likely to receive treatment
  • 42. Reasons for not seeking alcohol treatment 1. Should be strong enough to handle it alone 2. Thought problem would get better by itself 3. Stop drinking on my own 4. Did not think drinking problem was serious 5. Was too embarrassed to discuss it with anyone
  • 43. RECOVERY  25.0% of all US adults with prior-to-past-year (PPY) alcohol dependence were still dependent in the past year  27.3% were in partial remission  10.5% met the criteria for alcohol abuse  16.8% reported a subclinical array of dependence symptoms
  • 44.  Half of all people with PPY dependence met the criteria for full remission  This includes asymptomatic risk drinkers (11.8%), low-risk drinkers (17.7%) and abstainers (18.2%)  Combining low-risk drinkers (Non abstinent remission NR) and (abstinent remission AR) more than one-third (35.9%) had a past-year status indicative of full recovery
  • 45.  Among people with PPY dependence who were still dependent in the year preceding interview just 28.8% reported having received treatment  Nearly one-quarter of PPY alcohol-dependent individuals had achieved NR or AR in the past year without benefit of treatment  The rate of stable natural recovery (lasting 5 years) was 20.6%
  • 46.  Entry into and exit from a first marriage each increased the likelihood of non-abstinent recovery during the first 3 years after those events occurred  The likelihood of abstinent recovery was more than doubled in the 3 years after first becoming a parent
  • 47.  AR was more common among: 1. Blacks 2. People with relatively severe dependence 3. life-time smokers 4. People with a history of treatment for alcohol problems  NR was more common among persons who: 1. Attended college 2. Reported non-dependent use of illicit drugs
  • 48.  There is a wide range of recovery from alcohol dependence in the general population, from partial remission to full abstinence  Track of this disease is not clear-cut  some people appear to recover from alcoholism without formal treatment  Others may cycle into and out of dependence throughout their lifetime despite repeated attempts to achieve sobriety
  • 49. RELAPSE:  Relapse by wave 2: 1. 51.0% of the Wave 1 asymptomatic risk drinkers 2. 27.2% of low-risk drinkers 3. 7.3% of abstainers  Abstinence represents the most stable form of remission for most recovering alcoholics  Need for better approaches for maintaining recovery among young adults in remission who are at high risk of relapse
  • 50. CRITIQUE  No conclusions can be drawn from findings regarding: 1. The effectiveness of treatment 2. Overall relationship between drinking status and treatment status  It is not clear what constituted ‘treatment’ for the NESARC respondents  There was a substantial recovery rate without treatment  About half of all recoveries involved low risk drinking rather than abstinence
  • 51.  Necessity of a small intensively studied sample whom the investigator has actually met in case of confidential information  To study the information regarding return to controlled drinking one needs to: 1. Include other informants 2. To conduct observations over time until the true information emerges 3. Can be ruled out on a case-by-case basis
  • 52.  This study could not provide any guidelines concerning who really must stop drinking in order to recover from dependence, and who can recover stably from dependence even while drinking moderately
  • 53.  What might constitute appropriate services: 1. Public information and education showing that recovery from alcohol problems without treatment is not only possible but also frequent 2. For those who are not successful the attempt may increase their readiness to seek help 3. Further study alternatives to abstinence 4. Attracting people with less serious alcohol problems to treatment 5. Training health-care providers and addiction counselors to competently provide moderation services
  • 54. ASSOCIATIONS BETWEEN DSM-IV ALCOHOL USE DISORDERS AND OTHER PSYCHIATRIC DISORDERS CONTROLLING FOR SOCIODEMOGRAPHIC CHARACTERISTICS AND OTHER COMORBIDITY
  • 55. 1. 12 month alcohol abuse remained strongly and significantly associated with substance use disorders (OR 1.8) 2. But not with other Axis I disorders 3. Was negatively associated with schizoid PD and Bipolar I disorder 4. A similar pattern was observed for lifetime abuse
  • 56.  12 month alcohol dependence remained strongly associated with: 1. Substance use disorders (ORs=3.4-7.5) 2. bipolar disorders but with lower ORs (1.9, 2.0)  Significant association with 2 Axis II disorders: 1. Histrionic PD 2. Antisocial PD
  • 57.  Lifetime DSM-IV alcohol dependence remained positively although less strongly associated with : 1. Substance use disorders 2. Most mood and anxiety disorders 3. Paranoid, histrionic, and antisocial PDs
  • 58.  Rates of any PD were greater among respondents with any drug abuse (37.8%) and any drug dependence (69.5%) than among respondents with alcohol abuse (19.8%) and alcohol dependence (39.5%)  Patients with comorbid alcohol and drug use disorders and PDs can be expected to require treatment that is more extensive and of longer duration  Modified psychoanalytic psychotherapy focused or targeted on particular features of PDs should be used
  • 59.  Nicotine dependence was reported by 48% of the alcohol- dependent respondents  They reported higher lifetime rates of: 1. Panic disorder 2. Specific and social phobia 3. Generalized anxiety disorder 4. Major depressive episode 5. Manic disorder 6. Suicide attempt 7. Antisocial personality disorder 8. All addictive disorders
  • 60. Probability of transitioning to substance dependence among substance users 1. After the first year of substance use onset the probability of transition to dependence was highest for COCAINE users 2. The probability estimates of transition to dependence a decade after use onset was highest for NICOTINE users 3. Lifetime cumulative estimated probability of use to dependence was highest for NICOTINE users
  • 61. Predictors of transition from substance use to dependence  Socio-demographic predictors : 1. Females were more likely than males to transition from nicotine use to dependence 2. Males were more likely to transition from alcohol and cannabis use to dependence 3. US-born Individuals were more likely than foreign-born individuals to report transition from nicotine and alcohol use to dependence
  • 62. Psychopathological and substance use-related predictors  A history of any mental disorder strongly predicted the development of substance dependence  Nicotine , alcohol, cannabis or cocaine users diagnosed with a mood disorder or a PD were more likely to become dependent on those substances
  • 63.  Nicotine, alcohol or cannabis users diagnosed with an anxiety disorder showed an increased risk of becoming dependent on these substances  A lifetime diagnosis of a psychotic disorder increased the risk of developing nicotine dependence among nicotine users
  • 64.  Having a history of SUD predicted a further development of an additional SUD  Individuals diagnosed with nicotine dependence were more likely to develop alcohol dependence among alcohol users and cannabis dependence among cannabis users
  • 65.  Family history of SUD increased the risk of transition from nicotine or alcohol use to dependence  The cumulative probability of transition to dependence was highest for nicotine users and least for cannabis users  The transition to cannabis or cocaine dependence occurred faster than the transition to nicotine or alcohol dependence
  • 66. Cannabis use:  Later onset cannabis use: 1. Religious and pro-social activities are negatively associated 2. Divorce, alcohol and nicotine-related problems are positively associated  Social anxiety disorder (SAD) was more likely to be related to cannabis dependence than abuse
  • 67. Substance use disorders among inhalant users:  The lifetime prevalence of SUDs among adult inhalant users was 96%  Compared with substance users without a history of inhalant use inhalant users: 1. Initiated use of cigarettes, alcohol, and almost all other drugs at younger ages 2. Higher lifetime prevalence of nicotine, alcohol, and any drug use disorder
  • 68. Nonmedical prescription drug use and drug use disorders:  The odds of nonmedical prescription drug use and drug use disorders were greater among: 1. men, Native Americans, young and middle-aged 2. widowed/separated/divorced or never married  Abuse/dependence liability was greatest for amphetamines  Nonmedical prescription drug use disorders were highly comorbid with other Axis I and II disorders  The majority of individuals with nonmedical prescription drug use disorders never received treatment
  • 69. Epidemiology of MOOD Disorders Results From the National Epidemiologic Survey on Alcoholism and Related Conditions Deborah S. Hasin, PhD; Renee D. Goodwin, PhD; Frederick S. Stinson, PhD; Bridget F. Grant, PhD, PhD
  • 70. PREVALENCE AND SOCIODEMOGRAPHIC CORRELATES  Prevalence rates of DSM-IV were:  Major depressive disorder: 1. Lifetime 13.23% 2. 12-month 5.28%  Bipolar 1 lifetime and 12-month were 3.3% and 2.0%  Bipolar 2 lifetime and 12-month rates were 1.1% and 0.8%
  • 71.  Women showed a significantly higher risk for MDD  MDD had strongest risk among those 45 to 64 years old  Risk of MDD did not differ by education, region, or urbanicity
  • 72. ONSET, COURSE, AND TREATMENT  Mean age at onset of MDD was 30.4 years  The hazard for onset of MDD increased sharply between ages 12 and 16 years and continued to increase up to the early 40s when it began to decline  Among respondents with lifetime MDD a mean of 4.7 episodes was reported with median duration of 24.3 weeks for the longest (or only) episode
  • 73. PREVALENCE OF DSM-IV AXIS I AND II DISORDERS AMONG RESPONDENTS WITH MDD Among those with MDD in the prior 12 months: 1. 14.1% had an alcohol use disorder 2. 4.6% had a drug use disorder 3. 26.0% had nicotine dependence 4. 36.1% had at least 1 anxiety disorder 5. The prevalence of any PD was high (37.9%) and quite variable from PD to PD
  • 74. Among those with lifetime MDD: 1. 40.3% had an alcohol use disorder 2. 17.2% had a drug use disorder 3. 30.0% had nicotine dependence 4. 40% had an anxiety disorder 5. 30% had a PD
  • 75. Conclusions about MDD from NESARC  Average duration was almost 6 months longer than the previous estimate of 4 months  Almost half the respondents with MDD thought about suicide or wanted to die  The findings disclose higher risk for MDD among Native Americans  NESARC findings of lower risk for Hispanics and Asians contributes new information
  • 76.  Strong association of MDD with dependence on alcohol, drug, and nicotine, in contrast with a weak relationship of MDD with substance abuse  These results highlight the importance of not lumping abuse and dependence together when studying comorbidity
  • 77.  The comorbidity of substance dependence with MDD predicts poor outcome among patients  Treating MDD that is comorbid with alcohol or drug dependence is now recommended
  • 78. Panic attacks and suicide:  Panic attacks appear to be an independent risk factor for suicide attempt among depressed individuals with and without suicidal ideation  Assessment panic symptoms may improve prediction of suicide attempts
  • 79.  The presence of atypical features during an MOOD DISORDER EPISODE (MDE) was associated with greater rates of lifetime psychiatric comorbidity like: 1. Alcohol abuse 2. Drug dependence 3. Dysthymia 4. Social anxiety disorder 5. Specific phobia 6. Personality disorder
  • 80.  MDE with atypical features was associated with: 1. Female gender 2. Younger age at onset 3. More Mood disorder episodes 4. Greater episode severity and disability  Higher rates of: 1. Family history of depression 2. Bipolar I disorder 3. Suicide attempts 4. Larger mental health treatment-seeking rates
  • 81.  Variables determined to be predictors of BD I : 1. unemployment (OR = 0.6) 2. Taking medications for depression (OR = 1.7) 3. History of a suicide attempt (OR = 1.8) 4. weight gain (OR = 1.7) 5. Fidgeting (OR = 1.5) 6. Feelings of worthlessness (OR = 1.6) 7. Difficulties with responsibilities (OR = 2.2) 8. Presence of specific phobias (OR = 1.8) 9. Cluster C traits (OR = 1.4)
  • 82.  The mean age of BD-I subjects with CVD and HTN was 14 and 13 years younger, respectively, than controls with CVD and HTN  Adults with BD-I are at increased risk of CVD and HTN, prevalent over a decade earlier than non-BD adults
  • 83. Role of self-medication in the development of comorbid mood and drug use disorders  Self-medication with drugs among individuals with mood disorders confers substantial risk of developing incident drug dependence and is associated with the persistence of comorbid mood and drug use disorders
  • 84. The Intricate Link Between Violence and Mental Disorder Results From the National Epidemiologic Survey on Alcohol and Related Conditions Eric B. Elbogen, PhD; Sally C. Johnson, MD
  • 85. Results provide empirical evidence that :  Severe mental illness is not a robust predictor of future violence  People with co occurring severe mental illness and substance abuse/ dependence have a higher incidence of violence than people with substance abuse/dependence alone
  • 86. CRIMINAL VICTIMIZATION:  More than 1-in-25 adults in the United States (4.1%) reported past-year criminal victimization  Risks for criminal victimization: 1. Lower levels of income 2. Living in urban areas 3. Separated or divorced  Crime victims evidenced significantly increased rates of: 1. alcohol, cocaine, and opioid use disorders 2. Paranoid personality disorder, major depressive disorder, and a family history of antisocial behavior
  • 87. Psychiatric disorders among foreign-born and US- born Asian-Americans (AAs) in a US national survey  Foreign-born AAs had significantly lower risk for all classes of disorder compared with US-born AAs (OR = 0.16–0.59)  Risk for all classes of disorder was lowest for those foreign- born AAs who arrived in the US as adults  Developmental timing and the duration of experience in the US contribute to increases in risk
  • 88. An invariant dimensional liability model of gender differences in mental disorder prevalence: Evidence from NESARC  Gender differences in prevalence were systematic such that women showed higher rates of mood and anxiety disorders, and men showed higher rates of antisocial personality and substance use disorders  women showed a higher mean level of internalizing, while men showed a higher mean level of externalizing
  • 89. Pathological gambling  Three classes (or subtypes) of gamblers: 1. Behaviorally conditioned 2. Emotionally vulnerable 3. Antisocial impulsivist  Blaszczynski and Nower's (2002) pathways model may eventually contribute to the development of more reliable and valid methods of identifying people who are at risk of developing gambling problems
  • 90. Physical Punishment and Mental Disorders:  Approximately 2% to 5% of Axis I disorders and 4% to 7% of Axis II disorders were attributable to harsh physical punishment.  Harsh physical punishment in the absence of child maltreatment is associated with mood disorders, anxiety disorders, substance abuse/dependence, and personality disorders in a general population sample
  • 91. Association Between Peptic Ulcer and Personality Disorders:  All seven personality disorders were associated with stomach ulcer  Participants with ulcer were five times more likely to have more than three personality disorders than participants without ulcer
  • 92. CONCLUSION  NESARC is an example of a large, random, representative survey of adults living in the United States  This survey addressed all aspects of alcohol use—from determining when a respondent took his or her first drink to discovering whether he or she had experienced co-occurring mental health problems
  • 93.  NESARC data have several practical applications like defining the intricate relationship between alcohol use and comorbidity, to study high-risk drinking patterns, to design better-targeted treatment approaches, and to monitor recovery from AUDs  As more researchers take advantage of the richness of this dataset, more knowledge will be gained, helping to advance prevention efforts and treatment interventions in the alcohol field

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