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Original Article
September 2004

The Co-occurrence of DSM-IV Alcohol Abusein DSM-IV Alcohol Dependence: Results of the National Epidemiologic Survey on Alcohol and RelatedConditions on Heterogeneity That Differ by Population Subgroup

Author Affiliations

From the Division of Epidemiology, Mailman School of Public Health,and Department of Psychiatry, College of Physicians and Surgeons, ColumbiaUniversity, New York, NY (Dr Hasin); New York State Psychiatric Institute,New York (Dr Grant); and Laboratory of Epidemiology and Biometry, Divisionof Clinical and Biological Intramural Research, National Institute on AlcoholAbuse and Alcoholism, Bethesda, Md (Dr Grant).

Arch Gen Psychiatry. 2004;61(9):891-896. doi:10.1001/archpsyc.61.9.891

Background  In DSM-IV, an alcohol abuse diagnosis is preempted by dependence, although the symptoms of each disorder are different. Consequently, little is known about the extent to which dependence occurs with or without abuse. The distinction is important because of potential heterogeneity in dependence as a phenotype in genetic research, as well as potential underestimation of alcohol dependence when surveys cover dependence symptoms only among those who screen positive for alcohol abuse.

Objective  To present the prevalence of DSM-IV alcohol dependence with and without alcohol abuse in national and population subgroups.

Design  Face-to-face interviews.

Setting  The United States, including Alaska, Hawaii, and the District of Columbia.

Participants  Household and group-quarters residents, 18 years and older, in the National Epidemiologic Survey on Alcohol and Related Conditions (N = 42 392).

Main Outcome Measures  DSM-IV alcohol dependence with and without DSM-IV alcohol abuse, assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule.

Results  Among respondents with current alcohol dependence, 33.7% did not additionally meet criteria for abuse (29.0% among men and 46.1% among women). Current dependence without abuse was especially common among minority women (48.5% among African Americans, 55.2% among Hispanics). Among respondents with lifetime diagnoses of dependence, 13.9% did not additionally meet criteria for abuse (10.1% among men, 22.1% among women): proportions were highest among minorities, eg, 29.1% among Hispanic women and 19.2% among Hispanic men.

Conclusions  Alcohol abuse does not always accompany alcohol dependence in the general population, especially among women and minorities. Dependence with and without abuse may represent heterogeneous phenotypes for genetic research. Use of alcohol abuse as a screening method for alcohol dependence in large epidemiologic studies will differentially underestimate the prevalence of dependence by subgroup, affecting time trend and comorbidity research. Such underestimation may also perpetuate a lack of services for traditionally underserved groups.