Academic journal article Alcohol Research

Comorbidity between DSM-IV Alcohol and Specific Drug Use Disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Academic journal article Alcohol Research

Comorbidity between DSM-IV Alcohol and Specific Drug Use Disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Article excerpt

Background: To date, there have been no published data on 12-month comorbidity of DSM-IV alcohol and drug use disorders in the general U.S. population. The purposes of the present study were to examine the prevalence and comorbidity of alcohol and specific drug use disorders, and to identify sociodemographic and psychopathologic correlates and treatment-seeking among three groups of respondents: (1) those with alcohol use disorders only; (2) those with drug use disorders only; (3) those with comorbid alcohol and drug use disorders. Methods: Information on 12-month alcohol and specific drug use disorders in the United States was derived from face-to-face interviews in the National Institute on Alcohol Abuse and Alcoholism's (NIAAA) 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (n = 43,093). Results: Prevalences were 7.35 percent for alcohol use disorders only, 0.90 percent for drug use disorders only, and 1.10 percent for comorbid alcohol and drug use disorders. Sociodemographic and psychopathologic correlates of these three groups were quite different, with the drug use disorder and comorbid groups significantly more likely to be young, male, never married, and of lower socioeconomic status than the alcohol use disorder only group. Associations between current alcohol use disorders and 25 specific drug use disorders were generally positive and statistically significant. The 12-month prevalence of treatment-seeking significantly increased, from 6.06 percent for those with an alcohol use disorder only to 15.63 percent for those with a drug use disorder only, and to 21.76 percent for those with comorbid alcohol and drug use disorders. Conclusions: This study provides detailed data on the homotypic comorbidity of alcohol use disorders and 25 different drug use disorders and confirms the high levels of association seen in previous studies based on lifetime measures. Implications of this study are discussed in terms of integrating alcohol and drug treatment services and refining prevention and intervention efforts. KEY WORDS: DSM-IV alcohol abuse; DSM-IV alcohol dependence; Epidemiology; Comorbidity

INTRODUCTION

Over the past 20 years, there has been a growing interest in the co-occurrence or comorbidity of psychiatric disorders. In general, comorbidity refers to the co-occurrence or overlap of two or more psychiatric disorders. The term "dual diagnosis" refers more specifically to the co-occurrence of substance (alcohol or drug) use disorders and other psychiatric disorders. Recently, both terms have been combined to produce definitions of homotypic comorbidity, the co-occurrence of disorders, within a diagnostic grouping (e.g., sedative dependence and alcohol use disorders), and heterotypic comorbidity, the co-occurrence of two disorders from different diagnostic groupings (e.g., alcohol use disorders and major depression) (Angold et al., 1999). Despite the enormous literature on heterotypic comorbidity and a substantial body of research on homotypic comorbidity among nonsubstance use disorders in recent years, relatively little is known about homotypic comorbidity between alcohol and drug use disorders. Moreover, there exists a paucity of research on the impact of this form of homotypic comorbidity on alcohol and drug treatment-seeking.

Although alcohol and illicit drug abuse are among the top 10 major risk factors in global burden of mortality and morbidity (Murray and Lopez, 1996), until recently only a few national surveys have been conducted worldwide that have assessed homotypic comorbidity of alcohol and drug use disorders. Recognizing the need for prevalence and comorbidity data on alcohol and drug use disorders, the World Health Organization (WHO) (2000) established the World Mental Health Consortium in 1998 to address, in part, such limitations. During 2000-2002, epidemiological surveys were conducted worldwide in 14 countries. However, studies conducted in Belgium, France, Germany, Italy, the Netherlands, Spain, and Ukraine collected data on alcohol, but not drug use disorders (World Health Organization World Mental Health Consortium, 2004), rendering the study of homotypic alcohol and drug use disorder comorbidity impossible. …

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