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General Considerations

A. Epidemiology

1. Prevalence

In the United States, according to the 2001–2002 National Epidemiological Survey on Alcohol Related Conditions (NESARC), 8.5% (17.6 million) adults had experienced a DSM-IV diagnosis of alcohol abuse (4.65%) or alcohol dependence (3.81%) in the preceding 12 months (Table 49–1). Lifetime prevalence for an alcohol use disorder was 30.3% (17.8% abuse and 12.5% dependence) (Grant et al, 2004).

Table 49–112-Month Prevalence of Alcohol Abuse and Dependence by Age Cohorts
2. Demographics

There has been minimal change over the years with respect to prevalence among age cohorts. The lowest 12-month prevalence of alcohol use disorder is among those older than 65 years (1.21% abuse and 0.24% dependence), whereas the younger cohort (18–29 years) has the highest 12-month prevalence (6.95% abuse and 9.24% dependence).

Alcohol use patterns with gender have remained the same, with males having higher prevalence of alcohol use disorders than their female counterparts. Twelve-month prevalence for men is 6.93% for abuse and 5.42 for dependence versus 2.55% for abuse and 2.32% for dependence among women.

There are also variations in prevalence of alcohol use within ethnic groups (Table 49–2). Twelve-month prevalence for alcohol use disorder is highest among Native Americans and lowest among Asians.

Table 49–212-Month Prevalence of Alcohol Abuse and Dependence by Race–Ethnicity
3. Risk of Comorbidity

Results from the NESARC study showed that 1.1% of adults reported drug use disorder and alcohol use disorder combined, whereas 7.35% and 0.9% reported alcohol use disorder alone and drug use disorder alone, respectively. Yet individuals using a combination of drugs and alcohol had a much higher rate of treatment seeking than those using drugs or alcohol alone, which may indicate a need for more integrated alcohol and drug treatment services. The highest comorbidity is with nicotine dependence. There is also a strong association between having an alcohol use disorder and any psychiatric disorder (most commonly mood and anxiety disorders) as well as personality disorders. Of individuals with an alcohol use disorder, 28.6% also have at least one personality disorder, most commonly conduct/antisocial, histrionic, or dependent personality disorder (Stinson et al, 2005).

B. Etiology

1. Neurobiology

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