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Nearly 10% of Americans have lifetime drug use disorder

Nearly 10% of Americans have a lifetime DSM-5 drug use disorder, according to analysis of a cross-sectional nationally representative survey.

“Changes in the DSM-5 definitions of [drug use disorders] included a higher threshold to diagnose [drug use disorders] (two criteria rather than one), the addition of craving, a cannabis withdrawal criterion, and the severity metric based on criterion counts. While agreement between DSM-IV and DSM-5 [drug use disorder] was good, some nonoverlap occurred in case identification between the 2 nosologic systems, suggesting that assumptions about the distribution of DSM-5 [drug use disorders] and its correlates in the general population could not be assumed a priori from older data based on DSM-IV,” Bridget F. Grant, PhD, of the National Institute on Alcohol Abuse and Alcoholism and NIH, and colleagues wrote. “Further, opinions on appropriate severity indicators for substance use disorders have varied widely, suggesting the need to establish the utility of the new DSM-5 severity metric.”

To determine nationally representative findings on prevalence, correlates, psychiatric comorbidity, disability and treatment of DSM-5 drug use disorder diagnoses overall and by severity, researchers analyzed data from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. In-person interviews were conducted with 36,309 adults.

Prevalence of 12-month and lifetime drug use disorders were 3.9% and 9.9%, respectively.

Drug use disorders were generally more common among men, white and Native American individuals, younger and previously or never married adults, those with lower education and income and those residing in the West.

Researchers found a significant association between 12-month and lifetime drug use disorders and nicotine (OR = 4.4; 95% CI, 3.8-5.19) and alcohol use disorders (OR = 2.5; 95% CI, 2-3.06).

Significant associations were also found between 12-month drug use disorders and major depressive disorder (OR = 1.3; 95% CI, 1.09-1.64), dysthymia (OR = 1.5; 95% CI, 1.09-2.02), bipolar I disorder (OR =1.5; 95% CI, 1.06-2.05), PTSD (OR = 1.6; 95% CI, 1.27-2.1), and antisocial (OR = 1.4; 95% CI, 1.11-1.75), borderline (OR = 1.8; 95% CI, 1.41-2.24), and schizotypal (OR = 1.5; 95% CI, 1.18-1.87) personality disorders. Lifetime drug use disorders had similar associations.

Further, lifetime drug use disorders were significantly associated with generalized anxiety disorder (OR =1.3; 95% CI, 1.06-1.49), panic disorder (OR = 1.3; 95% CI, 1.06-1.59) and social phobia (OR = 1.3; 95% CI, 1.09-1.64).

Twelve-month drug use disorders was associated with significant disability, which increased with drug use disorder severity.

Only 13.5% of participants with 12-month drug use disorders and 24.6% with lifetime disorders received treatment.

“With these findings now available, studies can now begin to examine the broad relationships in more detail; estimate the present-day economic and societal costs of [drug use disorders]; investigate hypotheses about etiology, chronicity, and treatment use; and provide information to policymakers for decision making about the allocation of resources for service delivery and research,” Grant and colleagues wrote. “Study results also reinforce the urgency of destigmatizing [drug use disorders] and educating the public, clinicians and policy makers about its treatments, thus enabling more affected individuals to obtain help.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.