Studying prevalence of Diagnostic and Statistical Manual (3rd ed., rev., American Psychiatric Association, 1987) drug dependence among Americans 15–54 years old, we found about 1 in 4 (24%) had a history of tobacco dependence; about 1 in 7 (14%) had a history of alcohol dependence; and about 1 in 13 (7.5%) had a history of dependence on an inhalant or controlled drug. About one third of tobacco smokers had developed tobacco dependence and about 15% of drinkers had become alcohol dependent. Among users of the other drugs, about 15% had become dependent. Many more Americans age 15–54 have been affected by dependence on psychoactive substances than by other psychiatric disturbances now accorded a higher priority in mental health service delivery systems, prevention, and sponsored research programs.

The aim of this article is to report basic descriptive findings from new research on the epidemiology of drug dependence syndromes, conducted as part of the National Comorbidity Survey (NCS). In this study, our research team secured a nationally representative sample and applied standardized diagnostic assessments in a way that allows direct comparisons across prev-Reprinted from Experimental and C l i d Psychophamwcology, 2, 244-268. (1994). the prevalence, causes, and consequences of psychiatric morbidity and comorbidity in the United States. The NCS is supported by US. Public Health Service Grants MH 46376 and MH 49098 with supplemental support from the National Institute on Drug Abuse and W. T. Grant Foundation Grant 90135190. Research Center. We acknowledge H. Chilcoat for valuable research assistance. The National Comorbidity Survey (NCS) is a collaborative epidemiologic investigation of Preparation of this article was supported by the National Institute on Drug Abuse Addiction

Drug use and dependence are highly prevalent in the general population. The fact that there are differences in the correlates of first use, dependence among users, and persistence of dependence means that future research aimed at pinpointing modifiable risk factors must be based on disaggregated analyses of separate stages of progression.

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The purpose of this study was to describe aspects of the first alcohol-use experience, and examine the predictive relations among age of first use, context of alcohol use initiation, and problem drinking with and without controls for psychosocial risk factors. Data were from the Rutgers Health and Human Development Project, a five-wave, prospective study of substance-use behaviors in a community sample. Respondents, who were first interviewed at age 12 (1979-81) and most recently at age 30 or 31 (1999-2000) (N=371), reported on their first drinking experience, and on a range of known risk factors for alcohol abuse. Most alcohol initiation occurred during a family gathering. Regardless of initiation context, youth who drank at an early age were more likely than youth who initiated later to become problem drinkers, although the risk was relatively greater for the youth who first drank outside a family gathering. Based on multivariate logistic regressions, feeling drunk at initiation was the only onset-related variable significantly associated with problem drinking; other significant risks factors included male gender, delinquency, and family history of alcoholism. Because most initiation occurs at a family gathering, alcoholism prevention research may benefit from examining the role that drinking in family contexts could play with regard to socializing young drinkers to less risky drinking behaviors in adulthood. In particular, further research focusing on the subjective effects experienced by youth when they first drink may be merited.

This study examines rates of admission and patterns of mental health service use by persons of transition age (16-25 years) in the USA based on the nationally representative 1997 Client/Patient Sample Survey and population data from the US Census Bureau. A precipitous decline in utilization was observed at the age of emancipation: the yearly admission rate for inpatient, outpatient, and residential services was 34 per 1,000 for 16- and 17-year-olds and 18 per 1,000 for 18- and 19-year-olds. Among 20- and 21-year-olds, more were referred from criminal justice and fewer from family or friends and social services, and proportionately more were Medicaid recipients. Targeting resources to enhance shared planning between child and adult systems may facilitate continuity of care for young adult clients who are aging out of child mental health systems, as well as for those who experience their first episodes of mental disorder in early adulthood.

This study compares lifetime prevalence and age of first use (onset) for alcohol, cannabis, and other drugs in six international sites. Data from seven epidemiologic field surveys that used compatible instruments and study designs were compiled for cross-site analyses by the International Consortium of Psychiatric Epidemiology (ICPE). The world health organization's composite international diagnostic instrument (WHO-CIDI) and additional items were used to ascertain drug use in each site. Lifetime use rates were estimated for alcohol, cannabis, and other illicit drugs. Survival analyses were used to estimate age of onset. Study settings and main results: use of alcohol twelve or more times ranged in descending order from the Netherlands (86.3%), United States (71.7%), Ontario, Canada (71.6%); São Paulo, Brazil (66.1%), Munich, Germany (64.9%), Fresno, California (USA) (51.9%), to Mexico City (43.2%). Use of cannabis five or more times in a lifetime ranged from 28.8 in the United States to 1.7% in Mexico City, and other drugs ranged from United States (19.4%) to Mexico City (1.7%). Age of first use was similar across study sites. This study demonstrates the fundamental uniformity of onset patterns by age as contrasted with wide variations in lifetime prevalences across sites. Study findings suggest that drug use patterns may change among emigrating populations from low consumption nations as a consequence of international resettlement in nations with higher rates. Methodological limitations of the study along with recommendations for future international comparative research are discussed.

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