Study Shows Increase in Problem Drinking

Alcohol use disorder, or AUD, is the clinical term for drinking that causes mild to severe harm or distress. Excessive drinking can interfere with school, work, and relationships. It also increases the risk of many ailments, including heart disease, high blood pressure, liver disease, depression, and certain cancers. Almost 88,000 Americans died from alcohol-related causes between 2006 and 2010, making it the third-leading cause of preventable death.

Alcohol use disorder, the clinical term for drinking that causes mild to severe harm or distress, is becoming more common. Image credit: Kieferpix/Thinkstock.

Doctors and researchers diagnose AUD using criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM). The fifth version of these standards, called DSM-5, was published in 2013. DSM-5 combined 2 different disorders described previously in DSM-IV—alcohol abuse and alcohol dependence—into the single disorder of AUD.

To find out how many Americans meet the criteria for the new diagnosis, a team of researchers led by Dr. Bridget F. Grant of NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA) interviewed more than 36,000 U.S. adults. The interviews were conducted in 2012 and 2013. The study, funded by NIAAA and NIH’s National Institute on Drug Abuse (NIDA), was published online on June 3, 2015, in JAMA Psychiatry.

About 14% of the people interviewed met the criteria for AUD in the past year and 29% at some point in their lives. However, only 7.7% of the former group and 19.8% of the latter sought help with their drinking problems. AUD was more common in men than in women. It was also more common in young adults than in older adults.

To compare changes in the population over time, the researchers examined how many people met the DSM-IV’s criteria for the 2 disorders that were merged into AUD. They found that 12.7% of respondents met those criteria in the past year and 43.6% did at some point in their lives. This was a large increase from survey results in 2001 and 2002, in which 8.5% of respondents met the criteria for AUD in the past year and 30.3% at some point in their lives.

“These findings underscore that alcohol problems are deeply entrenched and significantly under-treated in our society,” says NIAAA Director Dr. George F. Koob. “The new data should provide further impetus for scientists, clinicians, and policymakers to bring AUD treatment into the mainstream of medical practice.”

The researchers say that more research is needed to figure out why rates of disordered drinking have increased. They also call for better prevention and intervention programs

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NIH study finds alcohol use disorder on the increase

Alcohol use disorder, or AUD, is the medical diagnosis for problem drinking that causes mild to severe distress or harm. A new study supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, reports that nearly one-third of adults in the United States have an AUD at some time in their lives, but only about 20 percent seek AUD treatment. The study also reveals a significant increase in AUDs over the last decade. The new findings are reported online today in the journal JAMA Psychiatry.

“These findings underscore that alcohol problems are deeply entrenched and significantly under-treated in our society,” said NIAAA Director George F. Koob, Ph.D. “The new data should provide further impetus for scientists, clinicians, and policy makers to bring AUD treatment into the mainstream of medical practice.”

A team of researchers led by Bridget F. Grant, Ph.D., Ph.D., of the NIAAA Division of Biometry and Epidemiology, conducted more than 36,000 face-to-face interviews of U.S. adults, as part of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III). NESARC III is a continuation of the largest study ever conducted on the co-occurrence of alcohol use, drug use, and related psychiatric conditions. The original NESARC survey was conducted in 2001-2002.

In NESARC III, researchers assessed alcohol problems using diagnostic criteria set forth in the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM–5) in 2013. To allow direct comparisons with previous NESARC surveys, the researchers also assessed NESARC III participants using the previous DSM-IV diagnostic criteria. Although there is considerable overlap between DSM–5 and DSM–IV diagnostic criteria, there are several important differences. For example, while DSM–IV described two distinct disorders, alcohol abuse and alcohol dependence, with specific criteria for each, DSM–5 integrates alcohol abuse and alcohol dependence into a single disorder called alcohol use disorder with mild, moderate, and severe sub-classifications.

“We found that 13.9 percent of adults met DSM-5 AUD criteria for the previous year, while 29.1 percent met AUD criteria at some time in their life,” said Dr. Grant. “Only 19.8 percent of adults with lifetime alcohol use disorder sought treatment or help, while 7.7 percent of those with a 12-month alcohol use disorder sought treatment. Perhaps most importantly, we saw large increases in DSM-IV alcohol use disorder rates over the last decade.”

Past-year and lifetime DSM-IV AUD rates for NESARC III participants were 12.7 percent and 43.6 percent, respectively. By comparison, NESARC participants in 2001 through 2002 reported past-year and lifetime DSM-IV rates of 8.5 percent and 30.3 percent, respectively. Dr. Grant and her colleagues suspect that the past decade increases may reflect increases in heavy alcohol consumption during that period, but note the need for additional research on that question.

The researchers found that rates of AUD were greater among men than women, and that age was inversely related to past-year AUD diagnosis. Among adults between ages 18 and 29, more than 7 percent had an AUD within the past year, suggesting a need for more effective prevention and intervention efforts among young people. More broadly, the researchers note the urgent need for efforts aimed at educating the public about AUD and its treatment, as well as destigmatizing the disorder.

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NIAAA to conduct clinical trial of new medication for alcohol use disorder

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) will conduct a clinical trial of gabapentin enacarbil as a potential treatment for alcohol use disorder (AUD). NIAAA estimates that the six-month trial will begin in the first half of 2015 and will enroll approximately 350 participants. The study will assess the safety and efficacy of gabapentin enacarbil in people who have been diagnosed with AUD. NIAAA is working in partnership with the biopharmaceutical company XenoPort Inc., of Santa Clara, California, which will supply the study drug.

“Current medications for alcohol dependence are effective for some, but not all, patients. New medications are needed to provide effective therapy to a broader spectrum of alcohol dependent individuals,” said George F. Koob, Ph.D., director of the NIAAA, a part of the National Institutes of Health. “Prior clinical studies of gabapentin, the active metabolite of the molecule called gabapentin enacarbil, have shown positive results in patients with AUD. We believe that the time is right to conduct a multi-site, well-controlled clinical trial.”

In a recent study supported by NIAAA, researchers at The Scripps Research Institute in La Jolla, California, found that alcohol dependent patients using gabapentin were more likely than those taking placebo to stop drinking or refrain from heavy drinking. Gabapentin is already widely prescribed to treat pain conditions and epilepsy. Scientists at XenoPort designed gabapentin enacarbil extended-release tablets to address certain limitations of drug levels in the body, which may make it a more attractive treatment option for people with AUD. The planned study will be a randomized, double-blind, placebo-controlled clinical trial, meaning that participants will receive either the study drug or placebo. Neither participants nor researchers will know who received the study drug until after the trial is completed.

Alcohol use disorders affect about 17 million people in the United States and have an estimated societal cost of $223.5 billion each year, primarily from lost productivity, but also from health care and property damage costs. Currently, three medications are approved by the FDA for treating alcohol dependence: disulfram, an older drug that blocks the metabolism of alcohol and causes nausea; acamprosate, which helps support abstinence and can ease symptoms of withdrawal; and naltrexone, which can help people reduce heavy drinking.