AAAP 2008: NESARC Findings Changing Understanding of Alcoholism

 

Wave 2 Data Sheds Further Light on 5 Subtypes

 

December 9, 2008 (Boca Raton, Florida) — New findings from 2 waves of the National Epidemiological Study on Alcohol and Related Conditions (NESARC) community survey are changing clinicians' understanding of alcohol dependence, researchers say.

Presented here at the American Academy of Addiction Psychiatry 19th Annual Meeting and Symposium, Howard B. Moss, MD, from the National Institute on Alcohol Abuse and Alcoholism, in Bethesda, Maryland, described how NESARC data identified 5 subtypes of alcohol-dependent drinkers and the more recent wave 2 data shed light on recovery, remission, and treatment seeking.

The data show that rather than being solely a disease of middle-aged men, more than half of alcohol-dependent individuals are young adults. In addition, only half of alcoholics have a family history of the disease, said Dr. Moss

"Slightly more than half of alcohol-dependent individuals are 20-somethings, not 40-year-old men in Veterans Affairs hospitals, for which much research has been obtained," Dr. Moss told Medscape Psychiatry.

The data also revealed that young adult alcohol-dependent individuals tend not to seek treatment and have the lowest rates of recovery and full remission from alcoholism. "These young adult drinkers are flying below the radar for those of us who treat substance abuse," he said.

NESARC is a nationally representative sample of community-dwelling adults in the United States who were surveyed in wave 1 in 2001–2002 and in wave 2 in 2004–2005.

The current analysis focused on 1484 survey respondents who met criteria for alcohol dependence from the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV). Respondents had a mean age of 32 years, 68% were male, and 71% were white.

Based on factors including age, alcohol consumption, family history of alcoholism, and comorbidities, the researchers identified 5 subgroups of alcoholism:

• "Young-adult" subtype (31.5% of US alcoholics) — These individuals become dependent on alcohol within 3 years of drinking onset. They had low rates of abuse of other substances and family alcoholism.
• "Young-antisocial" subtype (21.1% of US alcoholics) — These individuals become dependent on alcohol within 3 years of drinking onset. However, they tended to have antisocial personality disorder, multiple psychiatric comorbidities, problems with other types of substance abuse, and a family history of alcoholism.
• "Functional" subtype (19.4% of US alcoholics) — These middle-aged individuals were typically well-educated with good jobs and had been dependent on alcohol for about 18 years.
• "Intermediate-familial" subtype (18.8% of US alcoholics) — These middle-aged individuals had typically been dependent on alcohol for about 15 years. They also had a multigenerational family history of alcoholism and multiple comorbidities.
• "Chronic-severe" subtype (9.2% of US alcoholics) — These middle-aged individuals consumed the most alcohol, had been dependent on alcohol for about 13 years, and also tended to have a multigenerational family history of alcoholism and the highest rates of other psychiatric disorders.

About 40% of the individuals in the chronic-severe subgroup had sought help for their drinking in the previous year, compared with only about 5% of those in the young-adult subgroup.

"Individuals in the largest subtype, the young adults, very rarely seek any assistance for their drinking behavior," said Dr. Moss. "The challenge for addiction professionals is to actually get these younger alcohol-dependent individuals into the healthcare treatment system so that we can help them with pursuing some degree of recovery," he added.

Three years after the initial survey, about 30% of drinkers in the young-adult and functional subgroups, about 40% of drinkers in the intermediate-familial and young-antisocial subgroups, and 65% of drinkers in the chronic-severe subgroups were still dependent on alcohol. Full remission had been attained by about 13% to 19% of individuals in the 5 subgroups.

Further study of NESARC data using this subgroup approach will be useful for designing future alcoholism research studies, to help identify high-risk groups in need of prevention efforts, and to evaluate treatment strategies, said Dr. Moss

The symposium was sponsored by the National Institute on Alcohol Abuse and Alcoholism. Dr. Moss reports having no financial disclosures.

American Academy of Addiction Psychiatry (AAAP) 19th Annual Meeting and Symposium: Symposium I. Presented December 4, 2008.