The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings

Abstract

Purpose The NESARC, a “third generation” psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems, has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking. Method NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized. Result The most common disorders were alcohol and post-traumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the “gender gap”) is less pronounced than it was in previous decades. A race/ethnic “paradox” (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers. Conclusions Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests urgent need for public and professional education to reduce the stigma associated with these disorders, and increase knowledge of treatment options.

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

“…4 In the US general population, of those with MDE at baseline and subsequent episode remission, 34.7% experienced a recurrent MDE in the next 3 years. 34 In the Netherlands, a 2-year follow-up of 375 patients with MDD in remission for 3 months found recurrence in 26.8% of patients treated in primary care and 33.5% in specialized mental health care. 35 …”

Cribaje de trastornos por uso de alcohol en pacientes psiquiátricos ambulatorios: influencia de género, edad, y diagnóstico psiquiátrico

“…Parece que los TUA coexisten con varias enfermedades psiquiátricas, particularmente trastornos afectivos, trastornos de ansiedad, y trastornos de personalidad (Anthenelli, 2012;Grant et al, 2004aGrant et al, , 2004bGrant et al, , 2015Hasin y Grant, 2015;Kessler et al, 1997;Klimkiewicz, Klimkiewicz, Jakubczyk, Kieres-Salomoński, y Wojnar, 2015;Mellos, Liappas, y Paparrigopoulos, 2010;Rosenberg et al, 1998). Se han propuesto varias hipótesis diferentes para explicar la comorbilidad entre diagnósticos psiquiátricos y TUA: automedicación, aliviar la disforia, factores de riesgo psicosociales, predisposición genética, o vulnerabilidad neurobiológica compartida (Buckley, 2006;Mueser, Drake, y Wallach, 1998).…”

The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder

“…Onset of AUD is most commonly between ages 18 and 29, and men are more likely to be diagnosed with the disorder as compared to women (12-month prevalence in the United States 17.6% vs. 10.4%; Grant et al 2015). However, in recent decades, differences between men and women in patterns of alcohol use have become less pronounced (Slade et al 2016b;White et al 2015), and overall rates of AUD appear to be increasing (Grant et al 2015).…”

“…Rates of AUD in U.S. adults vary by race/ethnicity (Delker et al 2016;Grant et al 2015), with 12-month prevalence rates being highest among American Indians and Alaska Natives (19.2%) as compared with whites (14.0%), Hispanics (13.6%), African Americans (14.4%), and Asian Americans and Pacific Islanders (10.6%). Onset of AUD is most commonly between ages 18 and 29, and men are more likely to be diagnosed with the disorder as compared to women (12-month prevalence in the United States 17.6% vs. 10.4%; Grant et al 2015). However, in recent decades, differences between men and women in patterns of alcohol use have become less pronounced (Slade et al 2016b;White et al 2015), and overall rates of AUD appear to be increasing (Grant et al 2015).…”

“…In the United States, AUD has estimated values for 12-month and lifetime prevalence of 13.9% and 29.1%, respectively, with approximately half of individuals with lifetime AUD having a severe disorder (Grant et al 2015). Rates of AUD in U.S. adults vary by race/ethnicity (Delker et al 2016;Grant et al 2015), with 12-month prevalence rates being highest among American Indians and Alaska Natives (19.2%) as compared with whites (14.0%), Hispanics (13.6%), African Americans (14.4%), and Asian Americans and Pacific Islanders (10.6%). Onset of AUD is most commonly between ages 18 and 29, and men are more likely to be diagnosed with the disorder as compared to women (12-month prevalence in the United States 17.6% vs. 10.4%; Grant et al 2015).…”