(Jan. 1, 2006) -- A large federal epidemiological survey offers new insights into alcohol abuse–and an opportunity for psychologists to further investigate alcoholism and related disorders.

A clear and in some ways surprising picture of alcoholism is emerging from a mammoth new nationwide survey sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Its findings show that alcoholism is primarily an affliction of youth and heightens suspicion that an underlying trait predisposes people to an unfortunate trifecta of alcoholism, substance abuse and mental disorders.

About 17.6 million people in the United States–about one in every 12 adults–abuse alcohol or are alcoholic. To understand how and why they drink, and in hopes of preventing this high-risk health behavior, NIAAA developed the National Epidemiologic Survey on Alcoholism and Related Conditions, or NESARC. It's the largest longitudinal study ever conducted in the United States on alcoholism and related conditions.

"Alcoholism is not what we thought it was," says psychologist Mark Goldman, PhD, NIAAA associate director and a University of South Florida researcher.

Scientists of all stripes are welcome to use NESARC's first wave of cross- sectional data, gathered in 2001 and 2002. Longitudinal data from the 2004–2005 data-collection phase will become available in 2007. Project directors also expect to conduct a larger survey.

NESARC is surveying not only alcohol-related behaviors but a host of mental disorders, many of which are tied to alcoholism, says survey director Bridget Grant, PhD, PhD, a double-doctorate psychologist and epidemiologist.

"We need to understand [alcoholism] in relation to all these other disorders if we're ever going to understand the cause," explains Grant, who heads NIAAA's Laboratory of Epidemiology and Biometry. Accordingly, says Goldman, NESARC offers essential baseline epidemiological data that characterizes the frequency and age distribution of alcoholism and mental illnesses.

Notably, the NESARC questionnaire measures symptoms of disorders such as major depression, antisocial personality and generalized anxiety disorder along a continuum, allowing for factor analyses. That, says Grant, makes the NESARC data "perfect for psychologists because that's the way they conceptualize the world–as along a continuum of mental health from normal to abnormal."

A sizeable sample

In the past, Goldman explains, studies on alcohol use and abuse were limited by their use of clinical populations, usually middle-aged alcoholics who finally hit bottom and sought treatment. But that self-selected group distorted the true picture.

By capturing a large representative sample–43,000 U.S. adults age 18 or older–NESARC has taken an accurate cross-sectional snapshot of alcohol abusers and will follow them over time. Survey designers enlisted 1,800 U.S. Census Bureau workers to personally interview participants. Researchers in 2004–2005 reinterviewed 87 percent of the original participants–an impressive follow-up rate, says Grant.

One of the survey's most notable finding so far is that problem drinking peaks at younger ages than researchers previously thought, with the highest prevalence among young adults ages 18 to 25. The results were published in Drug and Alcohol Dependence (Vol. 77, No. 2, pages 139–150). The numbers support Goldman's idea that alcohol dependence is a developmental disorder of the young, he says.

NESARC also goes beyond basic epidemiology to study, for example, how people are treated for alcohol abuse, the demographic characteristics of people who get or don't get treatment, and barriers to treatment, especially among women, young adults and members of low-income and minority groups. Future NESARC data may bear on other critical questions, such as the impact alcoholism has on the workplace, binge drinking in college, and the line between safe and risky drinking.

continue: Comorbidities of Alcohol Dependence

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Reviewed: 03/2006