# Presentation: 239304

## Alcohol Use Disorders and Co-occurring Conditions

**Director**
**National Institute on Alcohol Abuse and Alcoholism**
**National Institutes of Health**
**Department of Health and Human Services**
**Complexities of Co-occurring Disorders**
**Harnessing Services Research to Improve Care for Mental, Substance Use, and Medical/Physical Disorders**
**June 24, 2004**

***Alcohol Use Disorders and Co-occurring Conditions***

## Presentation Overview

**Alcohol and Co-occurring Conditions**
**Onset of Alcohol Use and Alcohol Use Disorders**
**Screening and Brief Intervention**
**Conclusion**

***Presentation Overview***

## In the United States: 
18 million Americans suffer from alcohol abuse or dependence – 100,000 die annually
One in four children under age 18 is exposed to family alcohol problems
Between 20%-40% of hospital admissions are alcohol-related
Alcohol problems cost U.S. society an estimated $185 billion annually 

- 18 million Americans suffer from alcohol abuse or dependence – 100,000 die annually
- One in four children under age 18 is exposed to family alcohol problems
- Between 20%-40% of hospital admissions are alcohol-related
- Alcohol problems cost U.S. society an estimated $185 billion annually

***Extent of the Problem***

## Disease Burden by Illness - DALY United States, Canada and Western Europe, 200015 - 44 year olds

***Disease Burden by Illness - DALY United States, Canada and Western Europe, 2000******15 - 44 year olds***

## Cumulative Distribution of Alcohol Consumption in the United States

***Cumulative Distribution of Alcohol Consumption in the United States***

## Why Some People Drink/Do Not Drink

**	****	****Positive**
**	****	****Negative**
**Aversive Effects**
**Peer/Cultural Influences**

***Why Some People Drink/Do Not Drink***

## Negative Reinforcement

- stress dampening
***The Self-Medication Hypothesis***
**Drinking to obtain relief from:**
- stress
- anxiety
- depression
- dysphoria

***Negative Reinforcement***

## Pharmacodynamic Effects on Central Nervous System

## Co-Occurrence of Current (12-month) Alcohol Dependence and Nicotine and Any Drug Dependence

| Disorder | Alcohol Dependence |
| --- | --- |
| Nicotine dependence | 6.4 x |
| Any drug dependence | 36.9 x |

***Co-Occurrence of Current (12-month) ******Alcohol ******Dependence and ******Nicotine****** and Any ******Drug****** Dependence***

## Co-Occurrence of Current (12-month) DSM-IV Alcohol Dependence and Mood and Anxiety Disorders

| Disorder | Alcohol Dependence |
| --- | --- |
|  |  |
| Major depression | 3.7 x |
| Dysthymia | 2.8 x |
| Manic disorder | 5.7 x |
| Hypomania | 5.2 x |
| Panic (with agoraphobia) | 3.6 x |
| Panic (without agoraphobia) | 3.4 x |
| Social phobia | 2.5 x |
| Specific phobia | 2.2 x |
| Generalized anxiety | 3.1 x |

**NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003.**

***Co-Occurrence of Current (12-month)****** DSM-IV ******Alcohol****** Dependence and ******Mood ******and ******Anxiety****** Disorders***

## Co-occurrence of Current (12-month) DSM-IV Alcohol Dependence and Personality Disorders

| Disorder | Alcohol Dependence |
| --- | --- |
| Antisocial | 7.1 x |
| Avoidant | 3.8 x |
| Dependent | 6.1 x |
| Histrionic | 7.5 x |
| Obsessive-compulsive | 2.2 x |
| Paranoid | 4.6 x |
| Schizoid | 2.9 x |

***Co-occurrence of Current (12-month)****** DSM-IV Alcohol Dependence and Personality Disorders***

## Age at Onset: DSM-IV Age of First Use of Alcohol

**Percentage in each age group who begin **

**using alcohol**

**Source: NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003**

***Age at Onset: DSM-IV Age of First Use of Alcohol***

## Prevalence of Lifetime Alcohol Dependence by Age of First Alcohol Use and Family History of Alcoholism

***Prevalence of Lifetime Alcohol Dependence by Age of First Alcohol Use and Family History of Alcoholism***

## Age at Onset of DSM-IV Alcohol Dependence

***Age at Onset of DSM-IV Alcohol Dependence***

## Prevalence of past-year DSM-IV alcohol dependence: United States, 2001-2002:

**Grant, B.F. et al., *****Drug and Alcohol Dependence,***** in press 2004.**

***Prevalence of past-year DSM-IV alcohol dependence:****** United States, 2001-2002:***

## Age at Onset of DSM-IV Cannabis Use Disorders

***Age at Onset of DSM-IV Cannabis Use Disorders***

## Age at Onset: DSM-IV Tobacco Dependence

***Age at Onset: DSM-IV Tobacco Dependence***

## Age at Onset of DSM-IV Major Depression

***Age at Onset of DSM-IV Major Depression***

## Age of Onset of Brain Disorders

***Age of Onset of Brain Disorders***

## Conclusion

**Understanding the relationship of alcohol use to environmental influences (e.g., stress) and co-occurring conditions (e.g., depression) requires longitudinal studies of:**
- the relatives of singly and dually affected subjects (high-risk subjects design), and
- the developmental trajectory of these disorders and drug use disorders in children and adolescents (general population design)

***Conclusion***

## U.S. Preventive Services Task Force (USPSTF) Recommendations on Screening and Behavioral Counseling Interventions in Primary Care To Reduce Alcohol Misuse

***U.S. Preventive Services Task Force (USPSTF) ******Recommendations on Screening and Behavioral Counseling Interventions in Primary Care To Reduce Alcohol Misuse***

**The USPSTF:**
***recommends screening and behavioral counseling*** interventions to reduce alcohol misuse by adults, including pregnant women, in primary care settings** ****(B recommendation) **
***concludes*** that there is ***insufficient evidence*** to recommend interventions to prevent or reduce alcohol misuse by ***adolescents*** in primary care settings **(I recommendation)**

## New Proposed Science-Based Screening Guidelines

## AUDIT-C1

| Uses the first three AUDIT questions: |  |
| --- | --- |
|  | 1. How often do you have a drink containing alcohol? |
|  | 2. How many drinks containing alcohol do you have on a typical day when you are drinking? |
|  | 3.  How often do you have 5 (U.S.) or more drinks on an occasion? |
| The third question alone is: |  |
| 	 | sensitive for heavy drinking (79%) and alcohol abuse/ dependence (81%)  |
|  | -	specific (83%) for heavy drinking, abuse and dependence |

***AUDIT-C******1***

| 1Bush et al, Arch Intern Med. 1998;158:1789-1795 |
| --- |

## A Simple, Effective Screening Protocol (Proposed)

***A Simple, Effective Screening Protocol ******(Proposed)***

## A Simple, Effective Screening Protocol (Proposed)

***A Simple, Effective Screening Protocol ******(Proposed)***

## Conclusion

**Study interventions to prevent or reduce alcohol misuse by adolescents in primary care and other settings**

## Acknowledgements

**Bridget F. Grant Ph.D., Ph.D.**
**Charlene Le Fauve, Ph.D.**
**Brenda G. Hewitt**