Alcohol use disorder has become a "highly prevalent, highly comorbid, disabling disorder that often goes untreated in the US," concludes an analysis of over 36,000 face-to-face interviews.
The study in the journal JAMA Psychiatry has measured the prevalence of alcohol use disorder (AUD), as reported by Americans in their lifetime and the last 12 months.
The existence of a drink problem was established in the study if criteria were met for the latest definition of AUD set out in the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" published in May 2013 by the American Psychiatric Association.
The main change in the diagnosis of alcohol use disorder was to merge the criteria for "abuse" and "dependence," which had been considered separately before.
Abuse criteria involve the social problems of drinking too much while the dependence criteria involve classic measures of addiction such as withdrawal and time spent consuming alcohol.
The main finding of the study was that, among Americans, there is a lifetime AUD prevalence of 29.1% - but only 19.8% of adults are ever treated.
Along with coauthors, Bridget Grant, PhD, of the US government's National Institute on Alcohol Abuse and Alcoholism, has produced the nationally representative estimates from data collected by the institute's 2012-13 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)-III - providing a total sample size of 36,309 adults in the US.
68.5 million Americans have alcohol use disorder at some point in their lives
The results mean that the proportion of American adults having AUD in the previous 12 months translates into about 32.6 million people, and for having AUD at some time in their life, about 68.5 million people.
These numbers are estimated from the prevalence figures of 13.9% for 12 months and 29.1% for lifetime.
The mismatch with treatment rates for lifetime AUD - with 19.8% of adults with seeking treatment - was worse for the more recent problems, with 7.7% of those with a 12-month alcohol use disorder seeking treatment.
The authors conclude:
"Most importantly, this study highlighted the urgency of educating the public and policymakers about alcohol use disorder and its treatments, destigmatizing the disorder and encouraging among those who cannot reduce their alcohol consumption on their own, despite substantial harm to themselves and others, to seek treatment."
Other results of the investigation include:
- The greatest prevalence figure was for men - 17.6% having AUD in the past 12 months, 36% in the lifetime
- Rates were also particularly high among Native Americans - 19.2% on the 12-month prevalence, 43.4% on lifetime - and white interview participants - 14.0% on the 12-month prevalence, 32.6% on lifetime
- Alcohol use disorders were associated with other disorders - of substance use, major depressive and bipolar I, as well as antisocial and borderline personality disorders.