Study evaluates drug, alcohol use and related conditions

A  recent study found that about 10 percent of Americans met the DSM-5 diagnostic criteria for drug use disorder at some point in their lives and about four percent of Americans met the criteria in the past year.

The study, funded by the National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health, also demonstrated high comorbidity and that the majority of those who met the criteria never received treatment.

The study, which was published in the Journal of the American Medical Association Psychiatry, was led by Bridget Grant, Ph.D., Ph.D., (doctorates in psychology and epidemiology), of the NIAAA Laboratory of Epidemiology and Biometry. Grant’s lab conducts NESARC, a series of national epidemiological surveys that evaluate alcohol use, drug use and related psychiatric conditions.

The study, based on NIAAA’s National Epidemiologic Survey on Alcohol and Related Conditions found that drug use disorder (based on amphetamine, cannabis, club drug, cocaine, hallucinogen, heroin, non-heroin opioid, sedative/tranquilizer, and/or solvent/inhalant use) was more common among men, white and Native American individuals, and those who are single or no longer married.

It also more greatly affected those who were younger and with lower income and education levels, as well as those living in the 13 Western-most states (including Alaska and Hawaii).

“Young people between 18-29 have extraordinary rates of drug use disorder, particularly at the severe level,” Grant said. “Age-appropriate treatment and prevention strategies are really needed, more so than in the past.”

According to the study – which evaluated more than 36,000 people using DSM-5 criteria – those who met the criteria for drug use disorder were also more likely to have other psychiatric disorders, including being 1.3 times as likely to experience clinical depression; 1.6 times as likely to have posttraumatic stress disorder; and 1.8 times as likely to have borderline personality disorder, when compared to people without drug use disorder.

Those with drug use disorder also had an increase in risk for both alcohol and nicotine use disorder.

“The findings suggest that whenever a person presents with drug use disorder, they should be assessed for other psychiatric comorbidity, since it’s so highly prevalent with people with drug use disorder,” Grant said. Conversely, those who present for psychiatric disorders should be assessed for drug use disorder, as well, she said.

According to the study, only about 14 percent of people who met the criteria for drug use disorder in the past year and 25 percent of people who had it at some point in their lives received some form of treatment.

“One of the major reasons is stigma,” Grant said. “People just don’t want to reveal they are having problem with drugs.”

Additionally, physicians and the general public are often not aware of how effective treatments for substance use disorder have become in the past decade, Grant said. “And a lot of people don’t know where to seek treatment,” she said.

“There is a lot of work needed in diminishing that stigma, informing people about the recent advances in treatment, and helping people find treatment for their drug use problems,” Grant said.

Grant said psychologists and other providers need to be able to identify problems that might lead to a serious disorder. “They really need to know there’s a lot of comorbidity, so if people are presenting with problems they need to ask about what substance problems they might be having,” she said.

Clinicians should also stay current on advances in treatments. “There have been a lot of advances in cognitive behavioral and motivational enhancement,” she said, in addition to success with certain medications. “We’re getting more and more clinical trials that are showing their effectiveness,” she said.