Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III
Open accessAbstract
IMPORTANCE: National epidemiologic information from recently collected data on the new DSM-5 classification of alcohol use disorder (AUD) using a reliable, valid, and uniform data source is needed. OBJECTIVE: To present nationally representative findings on the prevalence, correlates, psychiatric comorbidity, associated disability, and treatment of DSM-5 AUD diagnoses overall and according to severity level (mild, moderate, or severe). DESIGN, SETTING, AND PARTICIPANTS: We conducted face-to-face interviews with a representative US noninstitutionalized civilian adult (≥18 years) sample (N = 36 309) as the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III). Data were collected from April 2012 through June 2013 and analyzed in October 2014. MAIN OUTCOMES AND MEASURES: Twelve-month and lifetime prevalences of AUD. RESULTS: Twelve-month and lifetime prevalences of AUD were 13.9% and 29.1%, respectively. Prevalence was generally highest for men (17.6% and 36.0%, respectively), white (14.0% and 32.6%, respectively) and Native American (19.2% and 43.4%, respectively), respondents, and younger (26.7% and 37.0%, respectively) and previously married (11.4% and 27.1%, respectively) or never married (25.0% and 35.5%, respectively) adults. Prevalence of 12-month and lifetime severe AUD was greatest among respondents with the lowest income level (1.8% and 1.5%, respectively). Significant disability was associated with 12-month and lifetime AUD and increased with the severity of AUD. Only 19.8% of respondents with lifetime AUD were ever treated. Significant associations were found between 12-month and lifetime AUD and other substance use disorders, major depressive and bipolar I disorders, and antisocial and borderline personality disorders across all levels of AUD severity, with odds ratios ranging from 1.2 (95% CI, 1.08-1.36) to 6.4 (95% CI, 5.76-7.22). Associations between AUD and panic disorder, specific phobia, and generalized anxiety disorder were modest (odds ratios ranged from 1.2 (95% CI, 1.01-1.43) to 1.4 (95% CI, 1.13-1.67) across most levels of AUD severity. CONCLUSIONS AND RELEVANCE: Alcohol use disorder defined by DSM-5 criteria is a highly prevalent, highly comorbid, disabling disorder that often goes untreated in the United States. The NESARC-III data indicate an urgent need to educate the public and policy makers about AUD and its treatment alternatives, to destigmatize the disorder, and to encourage those who cannot reduce their alcohol consumption on their own, despite substantial harm to themselves and others, to seek treatment.
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- Findingown data
Lifetime DSM-5 alcohol use disorder was associated with specific phobia.
“Lifetime AUD was associated with persistent depression (except moderate severity), panic disorder (except mild severity), specific phobia, and generalized anxiety disorder (except moderate severity).”
Quote in the paperNot a substantial claim - Findingown data
Odds of 12-month and lifetime DSM-5 alcohol use disorder were greater among men than women.
“Odds of 12-month and lifetime AUD were greater among men and lower among black, Asian or Pacific Islander, and Hispanic than white respondents, regardless of severity.”
Quote in the paperNot a substantial claim - Findingown data
Odds of 12-month and lifetime DSM-5 alcohol use disorder were greater among respondents younger than 65 years.
“Odds of 12-month and lifetime AUD were greater among respondents younger than 65 years, regardless of severity level.”
Quote in the paperNot a substantial claim - Findingown data
Lifetime DSM-5 alcohol use disorder was associated with persistent depression except at moderate severity.
“Lifetime AUD was associated with persistent depression (except moderate severity), panic disorder (except mild severity), specific phobia, and generalized anxiety disorder (except moderate severity).”
Quote in the paperNot a substantial claim - Findingown data
The lifetime prevalence of moderate DSM-5 alcohol use disorder was 6.6%.
“prevalences of lifetime AUD, 8.6% (0.18%), 6.6% (0.18%), and 13.9% (0.31%), respectively.”
Quote in the paperNot a substantial claim
- Findingown data
The 12-month prevalence of severe DSM-5 alcohol use disorder was 3.4%.
“Twelve-month prevalences of mild, moderate, and severe AUD were 7.3% (0.19%), 3.2% (0.13%), and 3.4% (0.12%), respectively”
Quote in the paperNot a substantial claim - Findingown data
The lifetime prevalence of severe DSM-5 alcohol use disorder was 13.9%.
“prevalences of lifetime AUD, 8.6% (0.18%), 6.6% (0.18%), and 13.9% (0.31%), respectively.”
Quote in the paperNot a substantial claim - Findingown data
Most groups in the lowest three income levels had greater rates of 12-month and lifetime severe DSM-5 alcohol use disorder than those with the highest incomes.
“Most groups of respondents in the lowest 3 income levels had greater rates of 12-month and lifetime severe AUD than those with the highest incomes.”
Quote in the paperNot a substantial claim - Findingown data
The mean age at onset of severe DSM-5 alcohol use disorder was 23.9 years.
“which decreased with increasing severity to 30.1 years for mild AUD, 25.9 years for moderate AUD, and 23.9 years for severe AUD.”
Quote in the paperNot a substantial claim - Findingown data
The lifetime prevalence of DSM-IV alcohol use disorder in NESARC-III was 43.6%.
“Rates of 12-month and lifetime DSM-IV AUDs in the NESARC-III were 12.7% and 43.6%, respectively”
Quote in the paperNot a substantial claim - Findingown data
In the 2012-2013 NESARC-III, the 12-month prevalence of DSM-5 alcohol use disorder among US noninstitutionalized civilian adults was 13.9%.
“Twelve-month and lifetime prevalences of AUD were 13.9% and 29.1%, respectively.”
Quote in the paperSubstantial claim - Findingown data
The lifetime DSM-IV alcohol use disorder prevalence in NESARC-III was higher than in the 2001-2002 NESARC.
“which are considerably higher than those of the 2001-2002 NESARC (8.5% and 30.3%, respectively).”
Quote in the paperNot a substantial claim - Findingown data
The 12-month DSM-IV alcohol use disorder prevalence in NESARC-III was higher than in the 2001-2002 NESARC.
“which are considerably higher than those of the 2001-2002 NESARC (8.5% and 30.3%, respectively).”
Quote in the paperNot a substantial claim - Findingown data
The mean age at onset of moderate DSM-5 alcohol use disorder was 25.9 years.
“which decreased with increasing severity to 30.1 years for mild AUD, 25.9 years for moderate AUD, and 23.9 years for severe AUD.”
Quote in the paperNot a substantial claim - Findingown data
The mean age at onset of DSM-5 alcohol use disorder was 26.2 years.
“Mean age at AUD onset was 26.2 years”
Quote in the paperNot a substantial claim - Findingown data
The 12-month prevalence of DSM-IV alcohol use disorder in NESARC-III was 12.7%.
“Rates of 12-month and lifetime DSM-IV AUDs in the NESARC-III were 12.7% and 43.6%, respectively”
Quote in the paperNot a substantial claim - Findingown data
The 12-month prevalence of moderate DSM-5 alcohol use disorder was 3.2%.
“Twelve-month prevalences of mild, moderate, and severe AUD were 7.3% (0.19%), 3.2% (0.13%), and 3.4% (0.12%), respectively”
Quote in the paperNot a substantial claim - Findingown data
Respondents with high school or less education had lower odds of any, mild, and moderate lifetime DSM-5 alcohol use disorder than respondents with postsecondary education.
“Conversely, respondents with educational levels of high school or less had lower odds of any, mild, and moderate lifetime AUD than those with postsecondary education.”
Quote in the paperNot a substantial claim - Findingown data
In the 2012-2013 NESARC-III, the lifetime prevalence of DSM-5 alcohol use disorder among US noninstitutionalized civilian adults was 29.1%.
“Twelve-month and lifetime prevalences of AUD were 13.9% and 29.1%, respectively.”
Quote in the paperSubstantial claim - Findingown data
Rates of DSM-5 alcohol use disorder were generally greater among previously married and never married respondents than among currently married or cohabiting respondents.
“With few exceptions, rates of AUD were greater among previously and never married respondents than those currently married or cohabitating.”
Quote in the paperNot a substantial claim - Findingown data
Odds of 12-month and lifetime DSM-5 alcohol use disorder were lower among black, Asian or Pacific Islander, and Hispanic respondents than white respondents.
“Odds of 12-month and lifetime AUD were greater among men and lower among black, Asian or Pacific Islander, and Hispanic than white respondents, regardless of severity.”
Quote in the paperSubstantial claim - Findingown data
The mean age at onset of mild DSM-5 alcohol use disorder was 30.1 years.
“which decreased with increasing severity to 30.1 years for mild AUD, 25.9 years for moderate AUD, and 23.9 years for severe AUD.”
Quote in the paperNot a substantial claim - Findingown data
The lifetime prevalence of mild DSM-5 alcohol use disorder was 8.6%.
“prevalences of lifetime AUD, 8.6% (0.18%), 6.6% (0.18%), and 13.9% (0.31%), respectively.”
Quote in the paperNot a substantial claim - Findingown data
Lifetime DSM-5 alcohol use disorder was associated with panic disorder except at mild severity.
“Lifetime AUD was associated with persistent depression (except moderate severity), panic disorder (except mild severity), specific phobia, and generalized anxiety disorder (except moderate severity).”
Quote in the paperNot a substantial claim - Findingown data
Odds of DSM-5 alcohol use disorder were generally lower in the Northeast and South than in the West.
“With few exceptions, the odds of AUD were lower in the Northeast and South than in the West.”
Quote in the paperNot a substantial claim - Findingown data
The 12-month prevalence of mild DSM-5 alcohol use disorder was 7.3%.
“Twelve-month prevalences of mild, moderate, and severe AUD were 7.3% (0.19%), 3.2% (0.13%), and 3.4% (0.12%), respectively”
Quote in the paperNot a substantial claim - Findingown data
DSM-5 alcohol use disorder was negatively associated with past-year social anxiety disorder.
“but negatively associated with past-year social anxiety disorder.”
Quote in the paperNot a substantial claim - Findingown data
Native American respondents had greater rates of severe DSM-5 alcohol use disorder than white respondents.
“Native American respondents had greater rates of severe AUD than white respondents.”
Quote in the paperNot a substantial claim - Findingown data
Odds of 12-month but not lifetime DSM-5 alcohol use disorder were greater among respondents living in urban areas.
“Regardless of severity, the odds of 12-month but not lifetime AUD were greater among respondents living in urban areas.”
Quote in the paperNot a substantial claim - Findingown data
Lifetime DSM-5 alcohol use disorder was associated with generalized anxiety disorder except at moderate severity.
“Lifetime AUD was associated with persistent depression (except moderate severity), panic disorder (except mild severity), specific phobia, and generalized anxiety disorder (except moderate severity).”
Quote in the paperNot a substantial claim - Findingown data
DSM-5 alcohol use disorder was positively associated with 12-month specific phobia.
“Alcohol use disorder was also positively associated with 12-month specific phobia”
Quote in the paperNot a substantial claim - Findingown data
Among respondents with 12-month DSM-5 alcohol use disorder, 4.5% received help from 12-step groups.
“Among those with 12-month AUD, 4.5% received help from 12-step groups; 3.6%, from health care practitioners; and 2.0% and 1.8%, from outpatient facilities and rehabilitation programs, respectively.”
Quote in the paperNot a substantial claim - Findingown data
Disability was greater among respondents with one or more positive DSM-5 alcohol use disorder criteria than among those with none.
“disability was greater among respondents with 1 or more positive AUD criteria compared with those with none”
Quote in the paperNot a substantial claim - Findingown data
Odds ratios for significant associations between DSM-5 alcohol use disorder and comorbid disorders ranged from 1.2 to 6.4.
“with odds ratios ranging from 1.2 (95% CI, 1.08-1.36) to 6.4 (95% CI, 5.76-7.22).”
Quote in the paperNot a substantial claim - Findingown data
Among respondents with lifetime DSM-5 alcohol use disorder, a higher percentage sought treatment through rehabilitation programs (9.0%) than from health care practitioners (8.7%).
“although a higher percentage sought treatment through rehabilitation programs (9.0%) than from health care practitioners (8.7%).”
Quote in the paperNot a substantial claim - Findingown data
Treatment seeking increased from mild to moderate to severe DSM-5 alcohol use disorder among respondents with lifetime alcohol use disorder (4.4% to 8.7% to 34.7%).
“and lifetime (4.4% to 8.7% to 34.7%, respectively) AUD.”
Quote in the paperNot a substantial claim - Findingown data
Any and severe lifetime DSM-5 alcohol use disorder were associated with posttraumatic stress disorder.
“Any and severe lifetime AUD were associated with posttraumatic stress disorder.”
Quote in the paperNot a substantial claim - Findingown data
Among respondents with 12-month DSM-5 alcohol use disorder, 2.0% received help from outpatient facilities.
“Among those with 12-month AUD, 4.5% received help from 12-step groups; 3.6%, from health care practitioners; and 2.0% and 1.8%, from outpatient facilities and rehabilitation programs, respectively.”
Quote in the paperNot a substantial claim - Findingown data
The mean age at first treatment for DSM-5 alcohol use disorder was 29.4 years.
“the mean age at first treatment of DSM-5 AUD was 29.4 years”
Quote in the paperNot a substantial claim - Findingown data
Among respondents with 12-month DSM-5 alcohol use disorder, 3.6% received help from health care practitioners.
“Among those with 12-month AUD, 4.5% received help from 12-step groups; 3.6%, from health care practitioners; and 2.0% and 1.8%, from outpatient facilities and rehabilitation programs, respectively.”
Quote in the paperNot a substantial claim - Findingown data
Among respondents with 12-month DSM-5 alcohol use disorder, 1.8% received help from rehabilitation programs.
“Among those with 12-month AUD, 4.5% received help from 12-step groups; 3.6%, from health care practitioners; and 2.0% and 1.8%, from outpatient facilities and rehabilitation programs, respectively.”
Quote in the paperNot a substantial claim - Findingown data
Among respondents with lifetime DSM-5 alcohol use disorder, 19.8% sought treatment or help for alcohol use disorder.
“Among respondents with 12-month and lifetime DSM-5 AUD, 7.7% and 19.8%, respectively, sought treatment or help for AUD.”
Quote in the paperNot a substantial claim - Findingown data
The study found that AUD is largely untreated.
“Despite increased AUD prevalence during the past decade, this study showed that AUD largely goes untreated.”
Quote in the paperSubstantial claim - Findingown data
Among respondents with 12-month DSM-5 alcohol use disorder, 7.7% sought treatment or help for alcohol use disorder.
“Among respondents with 12-month and lifetime DSM-5 AUD, 7.7% and 19.8%, respectively, sought treatment or help for AUD.”
Quote in the paperNot a substantial claim - Findingown data
After adjustment for sociodemographic characteristics and psychiatric comorbidity, respondents with 12-month DSM-5 alcohol use disorder had lower Mental Health, Social Functioning, Role Emotional, and Mental Component Summary scores than those without alcohol use disorder.
“respondents with 12-month AUD had significantly lower Mental Health, Social Functioning, Role Emotional, and Mental Component Summary scores than those without AUD.”
Quote in the paperSubstantial claim - Findingown data
Treatment seeking increased from mild to moderate to severe DSM-5 alcohol use disorder among respondents with 12-month alcohol use disorder (2.7% to 4.9% to 21.3%).
“treatment seeking increased from mild to moderate to severe AUD among respondents with 12-month (2.7% to 4.9% to 21.3%, respectively)”
Quote in the paperNot a substantial claim - Findingown data
Disability generally increased with greater DSM-5 alcohol use disorder severity.
“and disability generally increased with greater severity”
Quote in the paperNot a substantial claim - Findingown data
There was a 3-year lag between the mean age at onset of DSM-5 alcohol use disorder and the mean age at first treatment.
“representing a 3-year lag between the mean ages at onset (26.2 years) and treatment.”
Quote in the paperNot a substantial claim - Findingown data
The study identified numerous risk factors for AUD that can guide further hypothesis-driven research.
“Numerous risk factors for AUD were identified that can lead to further hypothesis-driven investigation.”
Quote in the paperSubstantial claim - Study design and conductown data
The weighting adjustments used in NESARC-III compensated adequately for nonresponse.
“These weighting adjustments were found to compensate adequately for nonresponse.”
Quote in the paperSubstantial claim - Interpretationown data
The attenuation of these associations when only sociodemographic variables were controlled points to shared causal factors behind the pairwise comorbidities.
“That these associations were weaker than those when we only controlled for sociodemographic variables suggests common causal factors underlying the pairwise comorbid associations.”
Quote in the paperSubstantial claim - Interpretationreasoning
Emerging adulthood is becoming an increasingly vulnerable period for onset of alcohol use disorder.
“Thus, emerging adulthood is becoming an increasingly vulnerable period for AUD onset.”
Quote in the paperSubstantial claim - Study design and conductown data
Concordance between DSM-IV and DSM-5 12-month and lifetime alcohol use disorder diagnoses in NESARC-III was excellent (κ = 0.76 and κ = 0.61, respectively).
“Concordances between DSM-IV and DSM-5 12-month and lifetime AUDs in the NESARC-III were excellent (κ = 0.76 and κ = 0.61, respectively).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [23] Goldstein RB Chou SP Smith SM Nosologic comparisons of DSM-IV and DSM-5 alcohol and drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions III. J Stud Alcohol Drugs 2015 76 3 378 388 25978823 PMC4440296
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- Study design and conductcitation
Test-retest reliability of AUDADIS-5 and DSM-5 diagnoses of psychiatric disorders was fair to good.
“Test-retest reliability of AUDADIS-5 and DSM-5 diagnoses of psychiatric disorders was fair to good”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [24] Grant BF Goldstein RB Smith SM The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5): reliability of substance use and psychiatric disorder modules in a general population sample. Drug Alcohol Depend 2015 148 1 27 33 25595052 PMC5554948
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- Interpretationcitation
The high rates of alcohol use disorder among Native American respondents are consistent with regional studies showing high alcohol-related morbidity and mortality in Native Americans.
“These results are consistent with regional studies of Native Americans showing high rates of alcohol-related morbidity and mortality”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [44] Beals J Novins DK Whitesell NR Spicer P Mitchell CM Manson SM Prevalence of mental disorders and utilization of mental health services in two American Indian reservation populations: mental health disparities in a national context. Am J Psychiatry 2005 162 9 1723 1732 16135633
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- Interpretationown data
The persistence of these associations after further adjustment for comorbid disorders suggests that disorder-specific factors may also contribute.
“Moreover, that these associations remained significant after additional control for comorbid disorders indicates the possibility of unique underlying factors contributing to the disorder-specific associations.47-49”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [47] Agrawal A Lynskey MT Are there genetic influences on addiction: evidence from family, adoption and twin studies. Addiction 2008 103 7 1069 1081 18494843
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- Premisecitation
A substantial literature supports the effectiveness of AUD treatment.
“Nonetheless, a large body of literature supports the effectiveness of treatment of AUD.”
Quote in the paperSubstantial claim - Study design and conductcitation
Convergent, discriminant, and construct validity of AUDADIS-IV alcohol use disorder diagnoses were good to excellent.
“Convergent, discriminant, and construct validity of AUDADIS-IV AUD diagnoses were good to excellent”
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- Study design and conductcitation
Concordance between AUDADIS-5 and PRISM-5 for nicotine use disorder and drug use disorder diagnoses and dimensional scales was fair to excellent.
“Concordance on NUD and DUD diagnoses in the AUDADIS-5 and PRISM-5 and in dimensional scales was fair to excellent”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [26] Hasin DS Greenstein E Aivadyan C The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5): procedural validity of substance use disorders modules through clinical re-appraisal in a general population sample. Drug Alcohol Depend 2015 148 1 40 46 25604321 PMC4330104
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- Study design and conductcitation
Test-retest reliability of AUDADIS-IV and DSM-IV alcohol use disorder diagnoses was good to excellent in clinical and general population samples.
“Test-retest reliability of AUDADIS-IV and DSM-IV AUD diagnoses was good to excellent in clinical and general population samples.”
Quote in the paperNot a substantial claim0 of 5 sources checked- cites [27] Chatterji S Saunders JB Vrasti R Grant BF Hasin D Mager D Reliability of the alcohol and drug modules of the Alcohol Use Disorder and Associated Disabilities Interview Schedule–Alcohol/Drug-Revised (AUDADIS-ADR): an international comparison. Drug Alcohol Depend 1997 47 3 171 185 9306043
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- Study design and conductown data
Test-retest reliabilities for nicotine use disorder and drug use disorder diagnoses were fair to excellent.
“Test-retest reliabilities were fair to excellent for NUD (diagnoses in the past 12 months, κ = 0.50; diagnoses before the past 12 months, κ = 0.87) and DUD (κ range, 0.40-0.54) diagnoses”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [24] Grant BF Goldstein RB Smith SM The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5): reliability of substance use and psychiatric disorder modules in a general population sample. Drug Alcohol Depend 2015 148 1 27 33 25595052 PMC5554948
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- Interpretationown data
Increases in DSM-IV alcohol use disorder during the past decade may partly reflect increases in heavy alcohol consumption during that period.
“Increases in DSM-IV AUD during the past decade may partly reflect increases in heavy alcohol consumption during that period”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites R.B.G., unpublished data, February 2015
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- Premisecitation
Systematic reviews and meta-analyses of randomized trials show that brief screening and intervention in primary care are effective for people with less severe alcohol problems.
“Reviews and meta-analyses of randomized trials involving thousands of patients have demonstrated the efficacy of brief screening and intervention in primary care settings among individuals whose alcohol problems are not yet severe.57-60”
Quote in the paperNot a substantial claim0 of 4 sources checked- cites [57] Bertholet N Daeppen JB Wietlisbach V Fleming M Burnand B Reduction of alcohol consumption by brief alcohol intervention in primary care: systematic review and meta-analysis. Arch Intern Med 2005 165 9 986 995 15883236
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- Premisecitation
Prior research indicates that treated individuals with AUD have less disability than those never treated.
“Prior research has shown significantly less disability among those treated for an AUD than those never treated.71,72”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [71] Dawson DA Grant BF Stinson FS Chou PS Estimating the effect of help-seeking on achieving recovery from alcohol dependence. Addiction 2006 101 6 824 834 16696626
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- Interpretationcitation
Genetic factors affecting alcohol metabolism likely contribute to lower rates of alcohol use disorder among Asian respondents.
“Although genetic factors affecting alcohol metabolism likely influence lower rates among Asian respondents”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [42] Hurley TD Edenberg HJ Genes encoding enzymes involved in ethanol metabolism. Alcohol Res 2012 34 3 339 344 23134050 PMC3756590
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- Interpretationreasoning
Because homeless individuals, prisoners, and most treated individuals were not covered, the prevalence estimates may be lower than the true AUD prevalence.
“Because some population segments were not covered (ie, homeless individuals, prisoners, and most treated individuals), estimates presented herein may underestimate the true prevalence of AUD.”
Quote in the paperNot a substantial claim- Rests on an assumption: Population segments not covered by the survey (homeless individuals, prisoners, and most treated individuals) have a higher prevalence of AUD than the covered population.
- May combine two claims. 20
- Classified as probably not a substantial claim. 9
May combine two claims.
Findingown dataRespondents with less than high school education had greater odds of severe and lower odds of mild 12-month DSM-5 alcohol use disorder than respondents with postsecondary education.
“Compared with respondents who attained postsecondary educational levels, respondents with educational levels less than high school had greater odds of severe and lower odds of mild 12-month AUD.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataDSM-5 alcohol use disorder was associated with other substance use disorders, major depressive and bipolar I disorders, and antisocial and borderline personality disorders across time frames and severity levels.
“AUD was associated with other substance use disorders, major depressive and bipolar I disorders, and antisocial and borderline PDs across time frames and severity levels”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataLifetime AUD was also significantly associated with persistent depressive disorder, post-traumatic stress disorder, panic disorder, and generalized anxiety disorder.
“Significant associations between persistent depressive disorder, post-traumatic stress disorder, panic disorder, and generalized anxiety disorder with lifetime AUD were also observed.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataAfter adjusting for sociodemographic factors and other conditions, the study found significant links between AUD (both past-year and lifetime) and several disorders: other substance use disorders, major depression, bipolar I, specific phobia, and antisocial and borderline personality disorders.
“We generally found significant associations between 12-month and lifetime AUD and other substance use disorders, major depressive disorder, bipolar I disorder, specific phobia, and antisocial and borderline PDs when we controlled for sociodemographic characteristics and other disorders.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataAll measures of current disability were strongly associated with 12-month AUD and increased with AUD severity.
“All measures of current disability were strongly related to 12-month AUD, increasing with AUD severity.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThese concerns do not apply to 12-month comorbidity associations, which had similar direction and magnitude to lifetime associations.
“However, these concerns are not relevant to 12-month comorbidity associations that demonstrated similar direction and magnitude as comorbid lifetime associations.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationFor more severe alcohol problems, effective medications include oral and extended-release naltrexone, acamprosate, and disulfiram.
“For more severe problems, effective medications include oral and extended-release naltrexone hydrochloride, acamprosate calcium, and disulfiram61-65”
Quote in the paperNot a substantial claim0 of 5 sources checked- cites [61] Lee JD Grossman E DiRocco D Extended-release naltrexone for treatment of alcohol dependence in primary care. J Subst Abuse Treat 2010 39 1 14 21 20363090
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- cites [63] Litten RZ Egli M Heilig M Medications development to treat alcohol dependence: a vision for the next decade. Addict Biol 2012 17 3 513 527 22458728 PMC3484365
Not checked in the free run.
- cites [64] Jørgensen CH Pedersen B Tønnesen H The efficacy of disulfiram for the treatment of alcohol use disorder. Alcohol Clin Exp Res 2011 35 10 1749 1758 21615426
Not checked in the free run.
- cites [65] Zindel LR Kranzler HR Pharmacotherapy of alcohol use disorders: seventy-five years of progress. J Stud Alcohol Drugs Suppl 2014 75 suppl 17 79 88 24565314 PMC4453501
Not checked in the free run.
May combine two claims.
Study design and conductown dataComparisons of DSM-IV 12-month alcohol use disorder diagnoses with and without the additional abuse questions yielded virtually identical prevalences (12.7% and 12.2%) and near-perfect concordance (κ = 0.98).
“Comparisons between DSM-IV 12-month AUD diagnoses with and without the additional questions yielded virtually identical prevalences (12.7% and 12.2%, respectively), with near-perfect concordance (κ = 0.98)”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataDSM-5 alcohol use disorder is a highly prevalent, highly comorbid, disabling disorder that often goes untreated in the United States.
“Alcohol use disorder defined by DSM-5 criteria is a highly prevalent, highly comorbid, disabling disorder that often goes untreated in the United States.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductcitationTest-retest reliability of AUDADIS-5 and DSM-5 alcohol use disorder categorical diagnoses was substantial (κ = 0.60 and κ = 0.62), and dimensional criteria scales had substantial reliability (ICC = 0.83 and 0.85).
“Test-retest reliability of AUDADIS-5 and DSM-5 AUD categorical diagnoses (κ = 0.60 and κ = 0.62, respectively) and dimensional criteria scales (intraclass correlation coefficient [ICC], 0.83 and 0.85, respectively) was substantial”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [24] Grant BF Goldstein RB Smith SM The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5): reliability of substance use and psychiatric disorder modules in a general population sample. Drug Alcohol Depend 2015 148 1 27 33 25595052 PMC5554948
Not checked in the free run.
May combine two claims.
Study design and conductcitationClinical reappraisal showed fair to good concordance between AUDADIS-5 and PRISM-5 alcohol use disorder diagnoses (κ = 0.49 and κ = 0.62) and excellent concordance for their dimensional counterparts (ICC = 0.81 and 0.85).
“showed fair to good concordance on AUDADIS-5 and PRISM-5 AUD diagnoses (κ = 0.49 and κ = 0.62, respectively) and excellent concordance (ICC, 0.81 and 0.85, respectively)”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [25] Hasin DS Aivadyan C Greenstein E Grant BF Psychiatric Research Interview for Substance Use and Mental Disorders, Diagnostic and Statistical Manual of Mental Disorders 2011 Columbia University, Department of Psychiatry New York, NY Fifth Edition (PRISM-5) Version
Not checked in the free run.
- cites [26] Hasin DS Greenstein E Aivadyan C The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5): procedural validity of substance use disorders modules through clinical re-appraisal in a general population sample. Drug Alcohol Depend 2015 148 1 40 46 25604321 PMC4330104
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPrevious NESARC data indicate that 12-step group participation raises the likelihood of recovery.
“Prior NESARC findings55 show that participation in 12-step groups increases the likelihood of recovery, consistent with randomized clinical trials testing the efficacy of 12-step facilitation administered by health care practitioners.56”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [55] Dawson DA Goldstein RB Ruan WJ Grant BF Correlates of recovery from alcohol dependence: a prospective study over a 3-year follow-up interval. Alcohol Clin Exp Res 2012 36 7 1268 1277 22309217 PMC3349820
Not checked in the free run.
- cites [56] Kaskutas LA Subbaraman MS Witbrodt J Zemore SE Effectiveness of making Alcoholics Anonymous easier: a group format 12-step facilitation approach. J Subst Abuse Treat 2009 37 3 228 239 19339148 PMC2746399
Not checked in the free run.
May combine two claims.
PremisecitationLack of insurance is not the main reason for untreated AUD in the US; instead, stigma and beliefs that treatment does not work are the explanations.
“Rather than lack of insurance, fears of stigmatization and beliefs that treatment is ineffective explain the lack of AUD treatment in the United States.50-54”
Quote in the paperSubstantial claim0 of 5 sources checked- cites [50] Cohen E Feinn R Arias A Kranzler HR Alcohol treatment utilization: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug Alcohol Depend 2007 86 2-3 214 221 16919401
Not checked in the free run.
- cites [51] Keyes KM Hatzenbuehler ML McLaughlin KA Stigma and treatment for alcohol disorders in the United States. Am J Epidemiol 2010 172 12 1364 1372 21044992 PMC2998202
Not checked in the free run.
- cites [52] Lawson KA Wilcox RE Littlefield JH Pituch KA Erickson CK Educating treatment professionals about addiction science research: demographics of knowledge and belief changes. Subst Use Misuse 2004 39 8 1235 1258 15461020
Not checked in the free run.
- cites [53] Yoast RA Wilford BB Hayashi SW Encouraging physicians to screen for and intervene in substance use disorders: obstacles and strategies for change. J Addict Dis 2008 27 3 77 97 18956531
Not checked in the free run.
- cites [54] Town M Naimi TS Mokdad AH Brewer RD Health care access among US adults who drink alcohol excessively: missed opportunities for prevention. Prev Chronic Dis 2006 3 2 A53 16539794 PMC1563973
Not checked in the free run.
May combine two claims.
PremisecitationUntreated AUD-related functional impairment has been linked to reduced life chances, more stressful life conditions, and greater risk and severity of other psychiatric disorders, even after remission.
“When untreated, AUD-related functional impairment also has been associated with diminished life chances, increased stressful life conditions, and increased risk for and severity of other psychiatric disorders, even after AUD remission.73”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [73] Hasin DS Grant BF Major depression in 6050 former drinkers: association with past alcohol dependence. Arch Gen Psychiatry 2002 59 9 794 800 12215078
Not checked in the free run.
May combine two claims.
Study design and conductown dataWhen respondents were compared with the total eligible sample, no significant differences were found in percentages of Hispanic, black, or Asian respondents, population density, vacancy rate, group quarters proportion, or renter proportion at the segment level.
“no significant differences were found in the percentages of Hispanic, black, or Asian respondents, population density, vacancy rate, proportion of the population in group quarters, or proportion of renters at the segment level.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe SF-12v2 is a reliable and valid measure of current impairment widely used in population surveys.
“The SF-12v2 is a reliable and valid measure of current impairment widely used in population surveys.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [41] Gandek B Ware JE Jr Aaronson NK Tests of data quality, scaling assumptions, and reliability of the SF-36 in eleven countries: results from the IQOLA Project International Quality of Life Assessment. J Clin Epidemiol 1998 51 11 1149 1158 9817132
Not checked in the free run.
May combine two claims.
PremisecitationEffective behavioral treatments include 12-step facilitation, motivational interviewing, and cognitive-behavioral therapy.
“evidence-based behavioral treatments include 12-step facilitation,56 motivational interviewing,66-68 and cognitive-behavioral therapy.68-70”
Quote in the paperSubstantial claim0 of 6 sources checked- cites [56] Kaskutas LA Subbaraman MS Witbrodt J Zemore SE Effectiveness of making Alcoholics Anonymous easier: a group format 12-step facilitation approach. J Subst Abuse Treat 2009 37 3 228 239 19339148 PMC2746399
Not checked in the free run.
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Not checked in the free run.
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- cites [68] Martin GW Rehm J The effectiveness of psychosocial modalities in the treatment of alcohol problems in adults: a review of the evidence. Can J Psychiatry 2012 57 6 350 358 22682572
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- cites [69] Irvin JE Bowers CA Dunn ME Wang MC Efficacy of relapse prevention: a meta-analytic review. J Consult Clin Psychol 1999 67 4 563 570 10450627
Not checked in the free run.
- cites [70] Magill M Ray LA Cognitive-behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials. J Stud Alcohol Drugs 2009 70 4 516 527 19515291 PMC2696292
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataRespondents included a slightly higher percentage of men, a greater percentage of those aged 60 to 69 years, and smaller percentages of those aged 40 to 49 and 30 to 39 years than the eligible sample.
“Respondents included a slightly higher percentage of men (48.1% vs 46.2%), a greater percentage of those aged 60 to 69 years (13.7% vs 12.6%), and smaller percentages of those aged 40 to 49 (18.1% vs 18.3%) and 30 to 39 (16.7% vs 17.4%) years than in the eligible sample.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenLifetime comorbid associations may be affected by recall bias and by bias in how associations vary with age at onset of comorbid disorders.
“Lifetime comorbid associations with AUD may be subject to recall bias and bias in variation of associations by ages at onset of comorbid disorders.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Interpretationnone givenThe NESARC-III is unique in offering current, comprehensive data on DSM-5 AUD and its correlates and comorbidity in the US.
“The NESARC-III is also unique in providing current, comprehensive information on DSM-5 AUD and its correlates and comorbidity in the United States.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenLike other large US surveys, the NESARC-III did not assess all psychiatric disorders.
“Similarly to other large US surveys, we did not assess all psychiatric disorders.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataDSM-5 AUD is a highly prevalent, highly comorbid, disabling disorder that is often untreated in the US.
“The DSM-5 diagnosis of AUD is a highly prevalent, highly comorbid, disabling disorder often untreated in the United States.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductnone givenStudy limitations include differences in survey methods between the 2001-2002 NESARC and the 2012-2013 NESARC-III, and suboptimal reliability for some non-AUD diagnoses.
“Potential study limitations include differences in some aspects of survey methods between the 2001-2002 NESARC and the 2012-2013 NESARC-III and less than ideal reliability for a few diagnoses other than AUD.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe NESARC-III has strengths including a large sample, reliable and valid measures of AUD and other psychopathology, and rigorous methods.
“Strengths of the NESARC-III include its large sample size, reliable and valid measures of AUD and other psychopathology, and rigorous study methods.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe NESARC-III was cross-sectional.
“The NESARC-III was also cross-sectional.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
Population segments not covered by the survey (homeless individuals, prisoners, and most treated individuals) have a higher prevalence of AUD than the covered population.
“Because some population segments were not covered (ie, homeless individuals, prisoners, and most treated individuals), estimates presented herein may underestimate the true prevalence of AUD.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Although SUDs are generally associated with more severe consequences than substance misuse, substance misuse is much more prevalent.
“Although SUDs are gen erally associated with more severe consequences than substance misuse, the latter is much more prevalent 148- 150 .”
From Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention (2023) · cites this paper as [149]
The Results > Disability and Discussion sections report that disability associated with alcohol use disorder increases with disorder severity. The Discussion also reports heavy-drinking rates higher than the 12-month AUD rate, but heavy drinking is not measured here as a separate category of substance misuse without a disorder. The paper does not establish the claim’s general comparison between SUDs and substance misuse across substances. (LLM, conf=0.84)
Experimental — accuracy not yet measuredHigh comorbidity between AUD and major depressive disorder, bipolar disorder, personality disorders, and anxiety disorders.
“A recent epidemiological study showed particularly high comorbidity between AUD and major depressive disorder and bipolar disorder and comorbidity with personality disorders and anxiety disorders (Grant et al., 2015).”
From Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development (2021) · cites this paper as Grant et al., 2015
Alcohol use disorder among firefighters is estimated at approximately 50%, nearly twice that of the general population.
“Alcohol use disorder (AUD) among firefighters is estimated at approximately 50% [7], nearly twice that of the general population [8].”
From Mindful attention training workshop for firefighters: Design and methodology of a pilot randomized clinical trial (2022) · cites this paper as [8]
In many countries, the highest prevalence of substance use problems is found among young adults, aged 18-25, and a majority of these 'age out' of excessive substance use.
“For instance, in many countries, the highest prevalence of substance use problems is found among young adults, aged 18-25 [36], and a majority of these 'age out' of excessive substance use [37].”
From Addiction as a brain disease revised: why it still matters, and the need for consilience (2021) · cites this paper as [36]
Lower socioeconomic status is correlated with both AD and age at first birth, and the current study suggests that shared genetic liabilities may be one potential mechanism for their observed relationship.
“Lower socioeconomic status is correlated with both AD41 and age at first birth42 and the current study suggests that shared genetic liabilities may be one potential mechanism for their observed relationship.”
From Transancestral GWAS of alcohol dependence reveals common genetic underpinnings with psychiatric disorders (2018) · cites this paper as [41]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Claimed highest severe-AUD rates fall below the overall rates
MajorThe abstract calls the lowest-income group's severe-AUD prevalences the greatest, yet gives 1.8% and 1.5%. The corresponding overall severe-AUD prevalences are higher, at 3.4% and 13.9%; an overall rate cannot exceed the highest income-group rate.
“Prevalence of 12-month and lifetime severe AUD was greatest among respondents with the lowest income level (1.8% and 1.5%, respectively).”
“Twelve-month prevalences of mild, moderate, and severe AUD were 7.3% (0.19%), 3.2% (0.13%), and 3.4% (0.12%), respectively; prevalences of lifetime AUD, 8.6% (0.18%), 6.6% (0.18%), and 13.9% (0.31%), respectively.”
Lifetime severe-AUD rate is below the past-year rate in the same group
MinorFor the lowest-income group, the stated lifetime severe-AUD prevalence is 1.5%, below its 12-month prevalence of 1.8%. The paper defines lifetime diagnoses to include diagnoses in the preceding 12 months, so the lifetime rate cannot be lower for that group.
“Prevalence of 12-month and lifetime severe AUD was greatest among respondents with the lowest income level (1.8% and 1.5%, respectively).”
“Lifetime DSM-5 AUD diagnoses required at least 2 of the 11 criteria in the 12 months preceding the interview or previously.”
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Epidemiology of Recovery From Alcohol Use Disorder
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An overview of alcohol and tobacco/nicotine interactions in the human laboratory
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The Epidemiology of Post-Traumatic Stress Disorder and Alcohol Use Disorder
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Reducing the Global Burden of Alcohol‐Associated Liver Disease: A Blueprint for Action
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Exercise and Alcohol Consumption: What We Know, What We Need to Know, and Why it is Important
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- Authors
- Grant, B. F., Goldstein, R. B., Saha, T. D., Chou, S. P., Jung, J., Zhang, H., Pickering, R. P., Ruan, W. J., Smith, S. M., Huang, B., & Hasin, D. S.
- Affiliations
- National Institutes of Health (US)
- New York State Psychiatric Institute (US)
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2015-08-01
- Volume
- 72
- Issue
- 8
- Pages
- 757
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC5240584
- OpenAlex
- W1839921965
- Semantic Scholar
- 6ee46a927f990bdf26640152b3c8d783f8a1d8ad
- Cited by
- 2,556
- References
- 71
- Citations by year
- 2026: 141 · 2025: 179 · 2024: 215 · 2023: 218 · 2022: 274 · 2021: 322 · 2020: 311 · 2019: 267 · 2018: 254 · 2017: 194 · 2016: 151 · 2015: 28 · 2012: 1
- FWCI
- 163.86
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (Z99‐AA999999)
- National Institute on Alcohol Abuse and Alcoholism (K05AA014223)
- National Institute on Drug Abuse
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- alcoholism, DSM-5 diagnostic criteria, prevalence, psychiatric comorbidity, substance use disorders, disability, treatment utilization, severity, lifetime prevalence, gender differences, income, marital status, personality disorders, anxiety disorders, depression, NESARC-III, United States adults, Native Americans, alcohol screening and brief intervention
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Alcoholism, Mental Disorders, Female, Health Surveys, Humans, Male, Middle Aged, Sex Factors, Socioeconomic Factors, United States, Comorbidity, Prevalence, Diagnostic and Statistical Manual of Mental Disorders, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-04.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-04.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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