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U.S. Alcohol Epidemiologic Data Reference Manual Volume 8, Number 1

 

ALCOHOL USE AND ALCOHOL USE DISORDERS IN THE UNITED STATES:

MAIN FINDINGS FROM THE 2001–2002 NATIONAL EPIDEMIOLOGIC SURVEY ON ALCOHOL AND RELATED CONDITIONS (NESARC)

 

January 2006

 

National Institutes of Health
National Institute on Alcohol Abuse and Alcoholism
5635 Fishers Lane, MSC 9304
Bethesda, MD 20892-9304


Acknowledgments

This publication was developed by CSR, Incorporated, under Contract No. N01AA32007 for the operation of the Alcohol Epidemiologic Data System (AEDS) for the Division of Epidemiology and Prevention Research (DEPR) of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institutes of Health (NIH). Principal authors of this manual are Chiung M. Chen, M.A., Hsiao-ye Yi, Ph.D., and Daniel E. Falk, Ph.D. of CSR; and Frederick S. Stinson, Ph.D., Deborah A. Dawson, Ph.D., and Bridget F. Grant, Ph.D., Ph.D., of the Laboratory of Epidemiology and Biometry of NIAAA. Michael E. Hilton, Ph.D., and Rosalind A. Breslow, Ph.D., served as NIAAA's Project Officer and co-Project Officer, respectively, on the above-referenced contract and oversaw the preparation of this manual.

 

All material appearing in this manual is in the public domain and may be reproduced or copied without the permission of NIAAA. Citation of the source is appreciated.

 

NIH Publication No. 05-5737

 

Table of Contents 

 

List of Tables

 

List of Exhibits

 

Foreword

 

1. Introduction

 

2. Data Source

 

3. Data Coverage

 

3.1 NESARC Alcohol Items

 

3.1.1 Drinking Status

 

3.1.2 Drinking Level

 

3.1.3 Exceeding Daily and Weekly Low-Risk Drinking Limits

 

3.1.4 Overall Beverage Preference

 

3.1.5 Drinking Onset

 

3.1.6 Hazardous Drinking

 

3.1.7 DSM-IV Alcohol Use Disorders

 

3.1.8 Family History of Alcoholism

 

3.1.9 Alcohol Treatment

 

3.2 Other NESARC Items

 

3.2.1 Basic Demographic and Background Information

 

3.2.2 Cigarette Smoking Status

 

3.2.3 Medical Conditions

 

3.2.4 DSM-IV Drug and Nicotine Use Disorders

 

3.2.5 DSM-IV Mood and Anxiety Disorders

 

3.2.6 DSM-IV Personality and Conduct Disorders

 

3.2.7 DSM-IV Pathological Gambling

 

4. Data Tables

 

4.1 Percent Distribution Tables

 

4.2 Health Condition Rates Tables

 

4.3 Psychiatric Disorder Rates Tables

 

4.4 Population Tables

 

5. References

 

List of Tables

 

1- Percent distribution of [variable], by sex and age group, according to selected respondent characteristics, United States, 2001–2002  

Variables:

 

1. Drinking status in the past year

 

2a. Average drinking level in the past year among current drinkers

 

2b. Average drinking level in the past year among current drinkers combined with former drinkers and lifetime abstainers

 

3. Having exceeded daily and weekly low-risk drinking limits in the past year among current drinkers

 

4. DSM-IV alcohol use disorders in the past year among current drinkers

 

5. Frequency of drinking 5 or more drinks for men or 4 or more drinks for women in a single day in the past year among current drinkers

 

6. Frequency of drinking enough to feel drunk in the past year among current drinkers

 

7. Frequency of driving after drinking 3 or more drinks in the past year among current drinkers

 

8. Frequency of getting into potentially harmful situations after drinking in the past year among current drinkers

 

9. Age of starting to drink among current drinkers

 

10. Alcoholic beverage preference in the past year among current drinkers

 

11. Family history of alcoholism among current drinkers

 

12. Having alcoholic parents among current drinkers

 

13. Having married/lived as if married with an alcoholic, among current drinkers

 

14. Having received any alcohol treatment in the past year among current drinkers

 

15. Having received any alcohol treatment in lifetime among current drinkers 

 

2- Rate per 1,000 population of selected past-year health conditions, by sex and age group, according to [variable], United States, 2001–2002

 Variables:

 

1. Drinking status in the past year

 

2. Average drinking level in the past year among current drinkers

 

3. Having exceeded daily and weekly low-risk drinking limits in the past year among current drinkers

 

4. DSM-IV alcohol use disorders in the past year among current drinkers

 

5. Frequency of drinking 5 or more drinks for men or 4 or more drinks for women in a single day in the past year among current drinkers

 

6. Frequency of drinking enough to feel drunk in the past year among current drinkers

 

7. Frequency of driving after drinking 3 or more drinks in the past year among current drinkers

 

8. Frequency of getting into potentially harmful situations after drinking in the past year among current drinkers

 

9. Age of starting to drink among current drinkers

 

10. Alcoholic beverage preference in the past year among current drinkers

 

11. Family history of alcoholism among current drinkers

 

12. Having alcoholic parents among current drinkers

 

13. Having married/lived as if married with an alcoholic, among current drinkers

 

14. Having received any alcohol treatment in the past year among current drinkers

 

15. Having received any alcohol treatment in lifetime among current drinkers

 

3- Rate per 1,000 population of selected DSM-IV psychiatric disorders, by sex and age group, according to [variable], United States, 2001–2002

 Variables:

 

1. Drinking status in the past year

 

2. Average drinking level in the past year among current drinkers

 

3. Having exceeded daily and weekly low-risk drinking limits in the past year among current drinkers

 

4. DSM-IV alcohol use disorders in the past year among current drinkers

 

5. Frequency of drinking 5 or more drinks for men or 4 or more drinks for women in a single day in the past year among current drinkers

 

6. Frequency of drinking enough to feel drunk in the past year among current drinkers

 

7. Frequency of driving after drinking 3 or more drinks in the past year among current drinkers

 

8. Frequency of getting into potentially harmful situation after drinking in the past year among current drinkers

 

9. Age of starting to drink among current drinkers

 

10. Alcoholic beverage preference in the past year among current drinkers

 

11. Family history of alcoholism among current drinkers

 

12. Having alcoholic parents among current drinkers

 

13. Having married/lived as if married with an alcoholic, among current drinkers

 

14. Having received any alcohol treatment in the past year among current drinkers

 

15. Having received any alcohol treatment in lifetime among current drinkers

 

 

4-1. Population (in 1,000s) ages 18 years and older, by sex and age group, according to selected respondent characteristics, United States, 2001–2002

 

 

4-2. Population (in 1,000s) of current drinkers ages 18 years and older, by sex and age group, according to selected respondent characteristics, United States, 2001–2002

 

 

List of Exhibits

National Epidemiologic Survey on Alcohol and Related Conditions

 

1. (Section 2A): Selected Questions on Alcohol Consumption

 

    (Section 2B): Selected Questions on Alcohol Experiences

 

2. (Section 2B): DSM-IV Alcohol Abuse and Dependence Diagnostic Criteria and Associated Questionnaire Items

 

3. (Section 2D): Selected Questions on Family History of Alcoholism

 

4. (Section 2C): Selected Questions on Treatment Utilization

 

5. (Section 1): Questionnaire Items for Selected Demographic and Background Information

 

6. (Section 3A): Selected Questions on Tobacco Use

 

7. (Section 13): Selected Questions on Medical Conditions

 

8. (Section 3C): DSM-IV Drug Abuse and Dependence Diagnostic Criteria and Associated Questionnaire Items

 

9. (Sections 4–11): Diagnosis of DSM-IV Mood, Anxiety, Personality, and Conduct Disorders

 

Foreword

The National Institute on Alcohol Abuse and Alcoholism (NIAAA), a part of the National Institutes of Health, is the primary Federal agency that conducts and supports epidemiologic, biomedical and behavioral research related to the causes, consequences, treatment, and prevention of alcohol-related problems.

The Alcohol Epidemiologic Data Reference Manuals (AEDRMs) produced by the Alcohol Epidemiologic Data System (AEDS) of NIAAA provide detailed epidemiologic data useful to researchers, health care planners, and others interested in alcohol abuse, associated illnesses and psychiatric disorders, and alcohol-related mortality.

This manual is the first publication in Volume 8 of the AEDRM series, presenting an extensive compilation of data from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a household survey designed, conducted and sponsored by NIAAA.  The NESARC is the largest and most comprehensive survey conducted on alcohol use, alcohol use disorders and their physical and psychiatric disabilities.  Forthcoming publications of Volume 8 will focus on alcohol-related data from future waves of the NESARC.

Other volumes of the AEDRM series include information on per capita alcohol consumption, liver cirrhosis mortality, county alcohol-problem indicators, hospital discharges with alcohol-related conditions, and State trends in drinking behaviors and alcohol-related mortality.  It is hoped that these documents will serve as a useful reference for both researchers and others interested in the alcoholism field.

 

Ting-Kai Li, M.D.

Director

National Institute on Alcohol Abuse and Alcoholism

 

1. Introduction

In 2001–2002, NIAAA conducted the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), Wave I of a longitudinal study that was the most ambitious and comprehensive survey of its type ever conducted. The NESARC includes extensive questions on patterns of alcohol consumption, as well as items designed to provide psychiatric classification of alcohol and other substance use disorders, mood and anxiety disorders, and personality and conduct disorders. In addition, the survey contains a variety of questions on family history of alcoholism, alcohol treatment utilization, medical conditions, and sociodemographic information.

This Data Reference Manual presents major findings from the Wave 1 of the NESARC. The document uses a layout similar to an earlier Data Reference Manual on findings from the 1991–1992 National longitudinal Alcohol Epidemiologic Survey (NLAES) published in 1998 (Stinson et al. 1998). The NESARC and NLAES cover similar issues in two time periods separated by 10 years. However, due to changes in the sampling universe and the definition of current drinkers, readers are cautioned against making simple, direct comparisons between data presented in the two manuals.

The following sections describe Wave 1 of the NESARC, as well as the variables and data tables presented in this manual.


2. Data Source

All data in this manual came from the 2001–2002 NESARC, a nationwide household survey designed and conducted by NIAAA. The fieldwork for this survey was completed under NIAAA's direction by trained U.S. Census Bureau Field Representatives who interviewed 43,093 respondents, 18 years of age and older in face-to-face household settings. The Wave 1 NESARC used a representative sample of the civilian, noninstitutionalized adult population in the United States, including all 50 States and the District of Columbia. Military personnel living off base and residents in noninstitutionalized group quarters housing, such as boarding houses, shelters, and dormitories, were also included. The household response rate for the NESARC was 89 percent, and the person response rate was 93 percent, yielding an overall response rate of 81 percent.

The NESARC used a multistage stratified design in which primary sampling units (PSUs) were stratified according to certain sociodemographic criteria. The sampling frame for housing units is the Census 2000/2001 Supplementary Survey (C2SS) and that for group quarters is the Census 2000 Group Quarters Inventory. The C2SS sample of 655 PSUs was selected at the first stage, including 401 self-representing (SR) and 254 non-self-representing (NSR) PSUs. All SR PSUs were selected with certainty. For the NSR sample, two PSUs were selected per stratum, with probability proportional to the size of the estimated 1996 population of the stratum.

At the second stage, housing units and group quarter units (converted to housing unit equivalents) were systematically selected within the PSUs. Non-Hispanic Black and Hispanic housing units were selected at higher rates than other housing units. At the third stage, within each household, one person was selected randomly from a roster of people living in the household. Within group quarters, respondents were selected based upon the position of their name on the list obtained by interviewers. Young adults ages 18–24 were sampled at a rate of 2.25 times that of other members of the household.

Details of the NESARC sampling design and methodology can be found in "Source and Accuracy Statement for Wave 1 of the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions"; (Grant et al. 2003b).

Because of the complex survey design employed by the NESARC, variance estimation procedures that assume a simple random sample may not be appropriate. Clustering in the NESARC sample selection typically resulted in standard errors larger than those that would be obtained with a simple random sample of equal size. Therefore, variance estimates that do not account appropriately for sample design effects can produce inaccurate estimates of statistical significance, making nonsignificant differences appear to be significant. To take into account the NESARC sample design, all standard errors of estimates presented in this manual were generated using SUDAAN (Research Triangle Institute 2004), a computer program that uses appropriate statistical techniques to adjust for sample design effects. All tables in this manual include estimates of standard errors to assist readers in assessing the precision of the estimates presented. 


3. Data Coverage

Data provided in this manual include items associated with alcohol. Other types of information are also included, as described in the following sections.

3.1 NESARC Alcohol Items

The primary focus of the NESARC is alcohol, including amounts and patterns of consumption, experiences associated with drinking, classification of alcohol use disorders, and family history of alcohol problems. The following sections describe the alcohol variables used in this manual.

3.1.1 Drinking Status

Because a substantial number of NESARC respondents were nondrinkers (either lifetime abstainers or former drinkers), NESARC included some screener questions to determine current drinking status. Only respondents who reported having at least 1 drink of any type of alcohol in the past year were considered to be current drinkers and were asked detailed questions about past-year alcohol consumption. For the NESARC, lifetime abstainers were those who never had 1 or more drinks in their life, and former drinkers were those who had at least 1 drink in their life, but not in the past year. Most of the tables in this manual are based on current drinkers only.

Questions used to determine drinking status (Items 1 and 3 from Section 2A of the NESARC) are shown in Exhibit 1. The purpose of showing NESARC questionnaire items in this and other exhibits is to assist the readers by providing the exact wording of questions. Response alternatives and skip patterns are not shown in the exhibits.

Note that the definition of current drinker used in NESARC is not consistent with that used in the NLAES, in which respondents reporting consumption of at least 12 drinks in the past year were defined as current drinkers.

3.1.2 Drinking Level

The NESARC contains detailed questions about past-year alcohol consumption. For each beverage type (coolers, beer, wine, and liquor), there are questions about the usual frequency of drinking, quantity of drinks consumed on drinking days, and size of drinks. Flashcards showing life-sized photographs of different types of glasses, with various fill levels designated in ounces, were provided to assist respondents in reporting drink size. The amount of ethanol in each drink can be calculated by using an ethanol conversion factor—the proportion of each drink that is pure alcohol. Ethanol conversion factors were derived from questions on the subtype of beverage usually consumed and additional information on the main brand. If a brand name was provided, its actual ethanol content was used, and the value for beverage subtype was edited for consistency with brand. If no brand was provided, the ethanol conversion factors were set to the average values for the beverage subtypes, as follows:

 

Coolers:

 

Wine coolers

0.050

Malt-based coolers

0.050

Liquor-based coolers

0.050

Prepackaged cocktails

0.120

Unknown

0.050

 

Beer:

 

Regular beer

0.050

Malt liquor

0.065

Lite or reduced calorie beer

0.042

Ice beer

0.055

Unknown

0.050

 

Wine:

 

Regular wine

0.125

Champagne or sparking wine

0.120

Fortified wine (including sherry, port, sake)

0.180

Low-alcohol fruit-flavored wine

0.070

Unknown

0.120

 

Liquor:

 

80-proof liquor including brandy

0.400

100-proof liquor

0.500

Liqueurs or cordials

0.271

Unknown

0.400

 

From these alcohol items, it is possible to calculate estimates of total ethanol consumption during the past year by summing beverage-specific volumes across the four individual beverage types. Dividing this annual total by 365 yields the average daily volume of ethanol intake, the key statistic used for "drinking level"; classification. As described in the NESARC Data Notes (NIAAA 2004a), the algorithm for calculating the average daily volume of ethanol intake is as follows.  

First, all the reported frequencies of drinking were converted to number of drinking days per year, using the midpoints of the categorical response options, e.g., 3–4 times a week = 3.5 x 52 = 182. (For respondents who did not drink the type of beverage in question, the frequency was set to zero.)

For respondents whose largest quantity of drinks was 5 or fewer, average daily volume of ethanol intake had two components:

  1. the usual quantity times the frequency of drinking that quantity: QU x FU, where FU = the overall frequency of drinking minus the frequency of drinking the largest quantity, and
  2. the largest quantity times the frequency of drinking the largest quantity: QL x FL.

The sum of these two products, representing the total number of drinks consumed per year, was then multiplied by the ethanol content of the drink in ounces, derived by multiplying the size of drink in ounces times the ethanol content by volume. The resulting annual volume of ethanol intake was divided by 365 to yield average daily ethanol intake of the beverage in question. These volumes were then summed across beverages to yield the overall average daily volume of ethanol intake.

For respondents whose largest quantity of drinks was 6 or more, average daily volume had three components:

  1. the usual quantity times the frequency of drinking that quantity: QU x FU, where FU = the overall frequency minus the frequency of drinking 5+ drinks,
  2. an intermediate component, Q5 x F5, where F5 = the frequency of drinking 5+ drinks minus the frequency of drinking the largest quantity and Q5 = exp((log(max(5, QU)) + log( QL - 1)) /2), that is, the geometric mean of the band of quantities between 5 and the largest number of drinks minus 1, and
  3. the largest quantity times the frequency of drinking the largest quantity: QL x FL.

Again, this sum of products was multiplied by the ethanol content per drink (see previous pages) and divided by 365 to yield average daily ethanol intake of the beverage in question, and volumes were summed across beverages to yield the overall average daily volume of ethanol intake. Assuming that one standard drink contains 0.60 ounces of ethanol, the average daily volume can be converted to the number of drinks. Based on this measure, three categories of average drinking level were defined for current drinkers: light drinker = no more than 0.257 ounces of ethanol per day (i.e., 3 or fewer drinks per week); moderate drinker = more than 0.257 ounces and up to 1.2 ounces of ethanol per day (i.e., 3 to 14 drinks per week) for men and up to 0.6 ounces (i.e., 3 to 7 drinks per week) for women; and heavier drinker = more than 1.2 ounces of ethanol (i.e., more than 2 drinks) per day for men and more than 0.6 ounces (i.e., more than 1 drink) per day for women.

3.1.3 Exceeding Daily and Weekly Low-Risk Drinking Limits

According to NIAAA's low-risk drinking guidelines, men may be at risk for alcohol-related problems if they drink more than 14 drinks per week or more than 4 drinks per occasion, and women may be at risk if they drink more than 7 drinks per week or more than 3 drinks per occasion (NIAAA 2004b).

Questions 8e and 9 in Section 2A (see Exhibit 1) ask about the frequency of drinking 5 or more drinks for both sexes and the frequency of drinking 4 or more drinks for women, respectively. In this manual, men were considered to exceed daily low-risk drinking limits if they reported one or more occasions of drinking 5 or more drinks, or if their usual or largest ethanol intake on a single day exceeded 2.7 ounces (4.5 standard drinks). Women were considered to exceed daily limits if they reported one or more occasions of drinking 4 or more drinks, or if their usual or largest ethanol intake on a single day exceeded 2.1 ounces (3.5 standard drinks). For both men and women, exceeding weekly low-risk drinking limits has the same definition as heavier drinking (described in 3.1.2): on average, more than 14 drinks per week (i.e., 2 drinks per day) for men and more than 7 drinks per week (i.e., 1 drink per day) for women.

3.1.4 Overall Beverage Preference

NESARC questions 4a, 5a, 6a, and 7a in Section 2A (see Exhibit 1) ask about past-year consumption of coolers, beer, wine, and liquor. Relatively few respondents consumed only one of the four types of alcohol. Overall beverage preference was derived from calculations of average daily ethanol intake in the form of coolers, beer, wine, and liquor, separately. Overall beverage preference was assigned to a single type of alcohol if the respondent received at least 75 percent of past-year ethanol intake from that type of beverage. If no beverage type predominated using this rule, the respondent was categorized as having no preference.

3.1.5 Drinking Onset

Question 16a in Section 2A (shown in Exhibit 1) asks respondents to report the age when they first started drinking ("not counting small tastes or sips";). Age categories used in this manual are: 14 or younger; 15 to 17; 18 to 20; and 21 or older.

3.1.6 Hazardous Drinking

Question 12f of Section 2A (shown in Exhibit 1) asks about how often in the past year the respondent drove a car or another motor vehicle (motorcycle, boat, jet ski, or skimobile) after having had 3 or more drinks. Response categories used in this manual are never, 1 or 2 times, or 3 or more times in the past year.

Question 1b(24) of Section 2B (shown in Exhibit 1) asks about how often a respondent, while drinking or after drinking, got into a situation that increased the respondent's chances of getting hurt (e.g., swimming, using machinery, or walking in a dangerous area or around heavy traffic). Response categories used in this manual are never or at least once in the past year.

3.1.7 DSM-IV Alcohol Use Disorders

The interview instrument used to diagnose alcohol use disorders in the NESARC is the NIAAA Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV) (Grant, Dawson, and Hasin 2001). The AUDADIS-IV is based on criteria articulated in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association 1994). Exhibit 2 presents the DSM-IV criteria for alcohol abuse and dependence along with the NESARC questionnaire items from Section 2B that were used to determine whether a person meets a particular criterion (Grant et al. 2004a). Reliability and validity of the AUDADIS-IV measures for alcohol use disorders are extensively discussed elsewhere (Grant et al. 1995; Grant et al. 2003a).

A diagnosis of DSM-IV alcohol abuse requires that a person show a maladaptive pattern of alcohol use leading to clinically significant impairment or distress, as demonstrated by meeting at least one of the four abuse criteria. A diagnosis of alcohol dependence requires that a person meet at least three of the seven dependence criteria. Since the DSM-IV considers alcohol dependence a syndrome, the occurrence of symptoms comprising three or more dependence criteria has to cluster within in any 12-month period. The withdrawal criterion of the alcohol dependence diagnosis was measured as a syndrome, requiring at least two positive symptoms of withdrawal as defined in the DSM-IV, or one positive symptom of withdrawal relief/avoidance (i.e., taking a drink or medicine or drug to avoid or get over bad aftereffects of drinking). A person who meets criteria for both abuse and dependence is classified in the dependence category.

 

 

Exhibit 1. National Epidemiologic Survey on Alcohol and Related Conditions

(Section 2A): Selected Questions on Alcohol Consumption

1. In your entire life, have you had at least 1 drink of any kind of alcohol, not counting small tastes or sips?

3. During the last 12 months, did you have at least 1 drink of any kind of alcohol?

4a. During the last 12 months, did you drink any premixed alcoholic coolers? By coolers, I mean wine, malt, or liquor-based coolers or any prepackaged cocktails with alcohol and mixer already combined in the container.

4b. During the last 12 months, about how often did you drink any coolers?

4c. What was the size of the TYPICAL bottle, can or glass of cooler that you USUALLY drank during the last 12 months?

4d. How many (units reported in 4c) of cooler did you USUALLY drink on days when you drank coolers?

5a. During the last 12 months, did you drink any beer, light beer or malt liquor? Do not count nonalcoholic beers.

5b. During the last 12 months, about how often did you drink any beer or malt liquor?

5c. What was the size of the TYPICAL can, bottle, or glass of beer or malt liquor that you USUALLY drank during the last 12 months?

5d. How many (units reported in 5c) of beer or malt liquor did you USUALLY drink on days when you drank beer?

6a. During the last 12 months, did you drink any type of wine, including champagne, sparkling wine, or fortified wines such as sherry, port, or sake? Do not count wine coolers.

6b. During the last 12 months, about how often did you drink any type of wine?

6c. What was the size of the TYPICAL glass or bottle of wine that you USUALLY drank during the last 12 months? Please do not include the amount of any soda or ice that may have been added.

6d. How many (units reported in 6c) of wine did you USUALLY drink on days when you drank wine?

7a. During the last 12 months, did you drink any liquor, including mixed drinks and liqueurs? Do not count liquor-based coolers or premixed cocktails that you may have told me about earlier.

7b. During the last 12 months, about how often did you drink any liquor?

7c. How much liquor did you USUALLY have in a drink? Please do not include the amount of any soda, water, ice, cola, or juice that may have been added to your drink.

7d. How many (drinks of this size/units reported in 7c) of liquor did you USUALLY drink on days when you drank liquor?

8a. During the last 12 months, about how often did you drink ANY alcoholic beverage?

8b. Counting all types of alcohol combined, how many drinks did you USUALLY have on days when you drank during the last 12 months?

8e. During the last 12 months, about how often did you drink FIVE OR MORE drinks in a single day?

9. During the last 12 months, about how often did you drink FOUR OR MORE drinks in a single day? (Women only)

10. During the last 12 months, about how often did you drink enough to feel intoxicated or drunk, that is, when your speech was slurred, you felt unsteady on your feet, or you had blurred vision?

12f. During the last 12 months, how often did you drive a car or another motor vehicle such as a motorcycle, boat, jet ski, or skimobile after having had 3 or more drinks?

16a. About how old were you when you first started drinking, not counting small tastes or sips of alcohol?

 

(Section 2B): Selected Questions on Alcohol Experiences

1a. I'm going to read you a list of experiences that many people have reported in connection with their drinking. As I read each experience, please tell me if this has EVER happened to you. In your ENTIRE LIFE, did you EVER

(24) Get into situations while drinking or after drinking that increased your chances of getting hurt—like  swimming, using machinery, or walking in a dangerous area or around heavy traffic?

1b. Did this happen in the last 12 months?

 

 

Exhibit 2. National Epidemiologic Survey on Alcohol and Related Conditions (Section 2B):

DSM-IV Alcohol Abuse and Dependence Diagnostic Criteria and Associated Questionnaire Items

Diagnostic Criteria for Alcohol Abuse

Diagnostic Criterion: Drinking resulting in failure to fulfill major role obligations at work, school, or home

Questionnaire Items:

  • Have a period when your drinking or being sick from drinking often interfered with taking care of your home or family.
  • Have job or school troubles because of your drinking or being sick from drinking—like missing too much work, not doing your work well, being demoted or losing a job, or being suspended, expelled or dropping out of school.

Diagnostic Criterion: Continued to drink despite social or interpersonal problem caused by drinking

Questionnaire Items:

  • Continue to drink even though you knew it was causing you trouble with your family or friends.
  • Get into physical fights while drinking or right after drinking.

Diagnostic Criterion: Recurrent drinking in situations where alcohol use is physically hazardous

Questionnaire Items:

  • More than once drive a car or other vehicle WHILE you were drinking.
  • More than once drive a car, motorcycle, truck, boat, or other vehicle after having too much to drink.
  • Get into a situation while drinking or after drinking that increased your chances of getting hurt—like swimming, using machinery, or walking in a dangerous area or around heavy traffic.

Diagnostic Criterion: Alcohol-related legal problems

Questionnaire Item:

  • Get arrested, held at a police station, or have any other legal problems because of your drinking.

 

Diagnostic Criteria for Alcohol Dependence

Diagnostic Criterion: Tolerance

Questionnaire Items:

  • Find that your usual number of drinks had much less effect on you than it once did.
  • Find that you had to drink much more than you once did to get the effect you wanted.
  • Drink as much as a fifth of liquor in one day, that would be about 20 drinks, or 3 bottles of wine, or as much as 3 six-packs of beer in a single day.
  • Increase your drinking because the amount you used to drink didn't give you the same effect anymore.

Diagnostic Criterion: Withdrawal syndrome or withdrawal relief/avoidance

Questionnaire Items:

  • The next few questions are about the bad aftereffects of drinking that people may have when the effects of alcohol are wearing off. This includes the morning after drinking or in the first few days after stopping or cutting down. Did you EVER [at least 2 of the following items a–h]
    1.  Have trouble falling asleep or staying asleep (when the effects of alcohol were wearing off).
    2.  Find yourself shaking (when the effects of alcohol were wearing off).
    3.  Feel anxious or nervous (when the effects of alcohol were wearing off).
    4.  Feel sick to your stomach or vomit (when the effects of alcohol were wearing off).
    5.  Feel more restless than is usual for you (when the effects of alcohol were wearing off).
    6.  Find yourself sweating or your heart beating fast (when the effects of alcohol were wearing off).
    7.  See, feel, or hear things that weren't really there (when the effects of alcohol were wearing off).
    8.  Have fits or seizures (when the effects of alcohol were wearing off).
  • Take a drink or use any drug or medicine, other than aspirin, Advil™ or Tylenol™, to GET OVER any of the bad aftereffects of drinking.
  • Take a drink or use any drug or medicine, other than aspirin, Advil™ or Tylenol™, to KEEP FROM having any of these bad aftereffects of drinking.

Diagnostic Criterion: Drinking larger amounts over a longer period of time than intended

Questionnaire Items:

  • Have a period when you ended up drinking more than you meant to.
  • Have a period when you kept on drinking for longer than you had intended to.

Diagnostic Criterion: Persistent Desire or unsuccessful efforts to cut down or control drinking

Questionnaire Items:

  • More than once want to stop or cut down on your drinking.
  • More than once TRY to stop or cut down on your drinking but found you couldn't do it.

Diagnostic Criterion: Important social, occupational, or recreational activities given up or reduced in favor of drinking

Questionnaire Items:

  • Give up or cut down on activities that were important to you in order to drink—like work, school, or associating with friends or relatives.
  • Give up or cut down on activities that you were interested in or that gave you pleasure in order to drink.

Diagnostic Criterion: Great deal of time spent in activities to obtain alcohol, to drink, or to recover from its effects

Questionnaire Items:

  • Have a period when you spent a lot of time drinking.
  • Have a period when you spent a lot of time being sick or getting over the bad aftereffects of drinking.

Diagnostic Criterion: Continued to drink despite knowledge of having a persistent or recurrent physical or psychological problem caused or exacerbated by drinking

Questionnaire Items:

  • Continued to drink even though you knew it was making you feel depressed, uninterested in things, or suspicious or distrustful of other people.
  • Continued to drink even though you knew it was causing you a health problem or making a health problem worse.
  • Continue to drink even though you had experienced a prior blackout, that is, awakened the next day not being able to remember some of the things you did while drinking or after drinking.

 

3.1.8 Family History of Alcoholism

Section 2D of the NESARC asks questions about family history of alcoholism or problem drinking (see Exhibit 3). For these questions, an alcoholic or problem drinker was defined during the interview for each respondent as a person who has: physical or emotional problems because of drinking; problems with a spouse, family, or friends because of drinking; problems at work or school because of drinking; problems with the police because of drinking—like drunk driving; or a person who seems to spend a lot of time drinking or being hungover.

The type of relative who has been an alcoholic or problem drinker can be either a blood or nonblood relative. Blood relatives can be further classified as first-degree or second-degree relatives. First-degree relatives are biological parents or children, and full siblings. Second-degree relatives are biological grandparents, and full siblings of either biological parent. Nonblood relatives include spouses and domestic partners.

The NESARC items shown in Exhibit 3 provide a basis on which to categorize NESARC respondents with regard to family history of alcoholism: "no family history of alcoholism,"; "only second-degree relatives alcoholic,"; "only first-degree relatives alcoholic,"; and "both first- and second-degree relatives alcoholic."; Respondents' family members are included even if they were deceased at the time of the interview; family members younger than 10 and deceased family members who died before they reached age 10 are excluded.

Questions 15 and 19 of Section 2D (see Exhibit 3) ask specifically about ever being married to an alcoholic/problem drinker or ever living with an alcoholic/problem drinker as if married. Analyses in this manual include a variable that is coded yes if the answer to either Question 15 or Question 19 was positive.

3.1.9 Alcohol Treatment

As shown in Exhibit 4, Section 2C of the NESARC asks questions designed to assess a respondent's history of contact with 13 various types of professionals, organizations, and/or programs offering treatment assistance with alcohol problems. For this manual, a respondent was classified as seeking alcohol treatment in his/her lifetime or in the past-year based on Question 2a and Question 2b, respectively. A positive response to any of the different treatment providers or settings was counted as an indication of alcohol treatment.

 

Exhibit 3. National Epidemiologic Survey on Alcohol and Related Conditions (Section 2D):

Selected Questions on Family History of Alcoholism

Now I would like to ask you some questions about whether any of your relatives, regardless of whether or not they are now living, have EVER been alcoholics or problem drinkers. By alcoholic or problem drinker, I mean a person who has physical or emotional problems because of drinking (PAUSE); problems with a spouse, family, or friends because of drinking (PAUSE); problems at work or school because of drinking (PAUSE); problems with the police because of drinking - like drunk driving (PAUSE) or a person who seems to spend a lot of time drinking or being hungover. (Repeat definition frequently.)

1. Has your blood or natural father been an alcoholic or problem drinker at ANY time in his life?

2. Has your blood or natural mother been an alcoholic or problem drinker at ANY time in her life?

3b. Was your full brother an alcoholic or problem drinker at ANY time in his life?

3c. How many of your full brothers are now, or were in the past, alcoholics or problem drinkers?

4b. Was your full sister an alcoholic or problem drinker at ANY time in her life?

4c. How many of your full sisters are now, or were in the past, alcoholics or problem drinkers?

5b. Was your natural son an alcoholic or problem drinker at ANY time in his life?

5c. How many of your natural sons are now, or were in the past, alcoholics or problem drinkers?

6b. Was your natural daughter an alcoholic or problem drinker at ANY time in her life?

6c. How many of your natural daughters are now, or were in the past, alcoholics or problem drinkers?

7b. Was your natural father's full brother an alcoholic or problem drinker at ANY time in his life?

7c. How many of your natural father's full brothers are now, or were in the past, alcoholics or problem drinkers?

8b. Was your natural father's full sister an alcoholic or problem drinker at ANY time in her life?

8c. How many of your natural father's full sisters are now, or were in the past, alcoholics or problem drinkers?

9b. Was your natural mother's full brother an alcoholic or problem drinker at ANY time in his life?

9c. How many of your natural mother's full brothers are now, or were in the past, alcoholics or problem drinkers?

10b. Was your natural mother's full sister an alcoholic or problem drinker at ANY time in her life?

10c. How many of your natural mother's full sisters are now, or were in the past, alcoholics or problem drinkers?

11. Was your natural grandfather on your father's side an alcoholic or problem drinker at ANY time in his life? By natural grandfather on your father's side, I mean your father's natural or blood father.

12. Was your natural grandmother on your father's side an alcoholic or problem drinker at ANY time in her life? By natural grandmother on your father's side, I mean your father's natural or blood mother.

13a. Was your natural grandfather on your mother's side an alcoholic or problem drinker at ANY time in his life? By natural grandfather on your mother's side, I mean your mother's natural or blood father.

13b. Was your natural grandmother on your mother's side an alcoholic or problem drinker at ANY time in her life? By natural grandmother on your mother's side, I mean your mother's natural or blood mother.

15. Were you EVER married to an alcoholic or problem drinker?

19. Did you EVER live as if married with someone who was an alcoholic or problem drinker?

 

 

Exhibit 4. National Epidemiologic Survey on Alcohol and Related Conditions (Section 2C):

Selected Questions on Treatment Utilization

1. Have you ever gone anywhere or seen anyone for a reason that was related in any way to your drinking—a physician, counselor, Alcoholics Anonymous, or any other community agency or professional?

2a. I am going to read you a list of community agencies and professionals. For each one, please tell me if you have ever gone there for any reason related to your drinking.  In your entire life, did you EVER go to (a/an)… (Repeat phrase frequently)

  1. Alcoholics Anonymous, Narcotics or Cocaine Anonymous meeting, or any 12-step meeting?
  2. Family services or other social service agency?
  3. Alcohol or drug detoxification ward or clinic?
  4. Inpatient ward of a psychiatric or general hospital or community mental health program?
  5. Outpatient clinic, including outreach programs and day or partial patient programs?
  6. Alcohol or drug rehabilitation program?
  7. Emergency room for any reason related to your drinking?
  8. Halfway house, including therapeutic communities?
  9. Crisis Center for any reason related to your drinking?
  10. Employee Assistance Program (EAP)?
  11. Clergyman, priest, or rabbi for any reason related to your drinking?
  12. Private physician, psychiatrist, psychologist, social worker, or any other professional?
  13. Any other agency or professional?

2b. Did you go there during the last 12 months ONLY, before the last 12 months ONLY or during both time periods?


3.2 Other NESARC Items

Other NESARC variables not directly related to alcohol, but used for the analyses presented in this manual, are described in the following sections.

3.2.1 Basic Demographic and Background Information

Exhibit 5 shows demographic and background items from the NESARC that are included in this manual. These items include: sex, age, race/ethnicity, marital status, ever had children, children under 13 in household, education, employment status, family income, occupation, U.S. nativity, family structure before age 18, self-perceived health, and health insurance coverage.

3.2.2 Cigarette Smoking Status

Based on question 1a from Section 3A of the NESARC (see Exhibit 6), respondents were classified as lifetime cigarette smokers if they had smoked at least 100 cigarettes in their life. In NESARC, respondents could also be classified as having other types of lifetime tobacco use if they smoked 50 cigars or 50 pipes of tobacco, or used snuff or chewing tobacco at least 20 times. Lifetime tobacco users were asked question 3a, which allowed them to be classified as a current user of a particular tobacco type. Although many types of tobacco use were assessed in NESARC, this manual only focuses on cigarette smokers.

3.2.3 Medical Conditions

Section 13 of the NESARC contains a list of medical conditions (see Exhibit 7). Respondents were categorized as having a particular medical condition in the past year if they reported having the condition (Question 6a) and if a doctor or other health professional had diagnosed the condition (Question 6b).

 

 

Exhibit 5. National Epidemiologic Survey on Alcohol and Related Conditions (Section 1):

Questionnaire Items for Selected Demographic and Background Information

 

Sex

Male

Female

 

Age

18–24 years

25–44 years

45–64 years

65 years and older

 

Race/Ethnicity1

White, Not Hispanic or Latino

Black, Not Hispanic or Latino

American Indian/Alaska Native, Not Hispanic or Latino

Asian/Native Hawaiian/Pacific Islander, Not Hispanic

Hispanic or Latino

 

Marital Status

Married

Living with someone as if married

Widowed

Divorced

Separated

Never married

 

Ever had children

Yes

No

 

Children Under 13 Living in Household

Yes

No

 

Education

11 years or less

12 years

13–15 years

16 or more years

 

Currently Employed Full Time

Yes

No

 

 

Family Annual Income

$0 to $19,999

$20,000 to $34,999

$35,000 to $59,999

$60,000 or more

 

Current/Most Recent Occupation

Executive, administrative, and managerial

Professional specialty

Technical and related support

Sales

Administrative support, including clerical

Private household

Protective services

Other services, except protective and household

Farming, forestry, and fishing

Precision production, craft, and repair

Operators, fabricators, and laborers

Transportation and material moving

Handlers, equipment cleaners, and laborers

Military

 

Born in the United States

Yes

No

 

Family Structure Before Age 18

Both biological/adoptive parents in the household

Only biological mother in the household

Biological/adoptive parents divorced or not living together

Raised by relatives, by foster parents or in an institution

 

Self-perceived Current Health

Excellent/Very good

Good

Fair/Poor

 

Currently Covered by Health Insurance

Yes

No

 

 

1The race-ethnicity variable was constructed from the Hispanic origin variable and the single classification race recode according to an algorithm developed by the Census Bureau (NIAAA 2004a). Individuals who reported Hispanic or Latino origin were coded as Hispanic or Latino regardless of race. Non-Hispanic/Latino individuals who reported multiple races were coded into a single category in the following order of priority: 1) Black, 2) American Indian/Alaska Native, 3) Asian/Native Hawaiian/Pacific Islander, 4) White.

 

 

Exhibit 6. National Epidemiologic Survey on Alcohol and Related Conditions (Section 3A):

Selected Questions on Tobacco

1. In your ENTIRE LIFE, have you ever. . .

a. Smoked at least 100 cigarettes?

3a. When was the MOST RECENT time you (smoked/used) (Name of tobacco category)? Was it within the past year?

 

 

Exhibit 7. National Epidemiologic Survey on Alcohol and Related Conditions (Section 13):

Selected Questions on Medical Conditions

6a. Now I'd like to ask some questions about your health. In the past 12 months, have you had. . .

  1. Hardening of the arteries or arteriosclerosis?
  2. High blood pressure or hypertension?
  3. Cirrhosis of the liver?
  4. Any other form of liver disease?
  5. Chest pain or angina pectoris?
  6. Rapid heart beat or tachycardia?
  7. A heart attack or myocardial infarction?
  8. Any other form of heart disease?
  9. A stomach ulcer?
  10. Gastritis?
  11. Arthritis?

6b. Did a doctor or other health professional tell you that you had (Name of condition)?

6c. Did a doctor or other health professional EVER tell you that you had schizophrenia or a psychotic illness or episode?

6d. Did this happen in the last 12 months?


3.2.4 DSM-IV Drug and Nicotine Use Disorders

In addition to alcohol abuse and dependence, Section 3C of the NESARC contains questions that allow for a diagnosis of drug use disorders according to the DSM-IV.

The drug use disorder diagnoses assessed in the NESARC include DSM-IV diagnoses of abuse and dependence for each of ten separate categories of medicine and illicit drugs. These categories include: sedatives, tranquilizers, opiates (other than heroin or methadone), stimulants, hallucinogens, cannabis, cocaine (including crack cocaine), inhalants/solvents, heroin, and other drugs. Sedatives, tranquilizers, opiates, and stimulants were counted only if used without or beyond the bounds of a prescription.

The DSM-IV criteria for drug-specific abuse and dependence, along with the NESARC questionnaire items used to determine whether a person meets a particular criterion, are shown in Exhibit 8. At least one of the four abuse criteria is required for a drug-specific abuse diagnosis, and in general at least three of the seven dependence criteria are required for a drug-specific dependence diagnosis. The withdrawal criterion is not used for cannabis, hallucinogen, or inhalant dependence diagnosis. For data tables presented in this manual, a diagnosis of any drug abuse or dependence results from drug-specific diagnoses made for any of the 10 separate medicine/drug categories in a 12-month period.

NESARC assesses nicotine dependence in a separate AUDADIS-IV module. Section 3A contains questions that allow for a diagnosis of nicotine dependence according to DSM-IV. Nicotine dependence was assessed for any tobacco product, including cigarettes, cigars, pipes, chewing tobacco, and snuff. The withdrawal criterion was operationalized using 4 items: (1) the use of nicotine upon waking, (2) the use of nicotine after being in a situation in which use was restricted, (3) the use of nicotine to avoid nicotine withdrawal symptoms, and (4) waking up in the middle of the night to use tobacco. The "giving up activities in favor of nicotine use" criterion was assessed as (1) giving up or cutting down on activities that were important, like associating with friends or relatives or attending social activities because tobacco use was not permitted at the activity and (2) giving up or cutting down on activities that you were interested in or that gave you pleasure because tobacco use was not permitted at the activity. The "great deal of time spent using tobacco" criterion was assessed by the single symptom item, "chain smoking." The "using tobacco more than intended" criterion was operationalized as having a period when tobacco was used more than intended. (Grant et al. 2004b).

 

 

Exhibit 8. National Epidemiologic Survey on Alcohol and Related Conditions (Section 3C):

DSM-IV Drug Abuse and Dependence Diagnostic Criteria and Associated Questionnaire Items

Diagnostic Criteria for Drug Abuse

Diagnostic Criterion: Recurrent drug use resulting in failure to fulfill major role obligations at work, school, or home

Questionnaire Items:

  • Have a period when your medicine or drug use or your being sick from your medicine or drug use often interfered with taking care of your home or family?
  • Have job or school troubles as a result of your medicine or drug use—like missing too much work, not doing your work well, being demoted or losing a job, or being suspended, expelled or dropping out of school?

Diagnostic Criterion: Continued drug use despite social or interpersonal problem caused by drinking

Questionnaire Item:

  • Continue to use a medicine or drug even though you knew it was causing you trouble with your family or friends?
  • Get into physical fights while under the influence of a medicine or drug?
  • Have arguments with your spouse, boyfriend/girlfriend, family or friends as a result of your drug use?

Diagnostic Criterion: Recurrent drug use in situations where alcohol use is physically hazardous

Questionnaire Items:

  • Accidentally injure yourself while under the influence of a medicine or drug, for example, have a bad fall or cut yourself badly, get hurt in a traffic accident, or anything like that?
  • More than once drive a car, motorcycle, truck, boat, or other vehicle when you were under the influence of a medicine or drug?
  • Find yourself under the influence of a medicine or drug or feeling its aftereffects in situations that increased your chances of getting hurt—like swimming, using machinery, or walking in a dangerous area or around heavy traffic?

Diagnostic Criterion: Drug-related legal problems

Questionnaire Item:

  • Get arrested, get held at a police station or have any other legal problems because of your medicine or drug use?
 

Diagnostic Criteria for Drug Dependence

Diagnostic Criterion: Tolerance

Questionnaire Items:

  • Find that your usual amount of a medicine or drug had much less effect on you than it once did?
  • Find that you had to use much more of a medicine or drug than you once did to get the effect you wanted?

Diagnostic Criterion: Withdrawal syndrome or withdrawal relief/avoidance

Questionnaire Items:

  • Have any of the following bad aftereffects when the effects of a medicine or drug were wearing off? This includes the morning after using it or in the first few days after stopping or cutting down on it? For example, did you EVER [Note: symptoms vary by type of drugs.]
    1. Sleep more than usual?
    2. Feel weak or tired (when the effects of a medicine or drug were wearing off)?
    3. Feel depressed?
    4. Find yourself sweating or your heart beating fast (when the effects of a medicine or drug were wearing off)?
    5. Have nausea, vomiting or a stomach ache?
    6. Yawn a lot (when the effects of a medicine or drug were wearing off)?
    7. Have runny eyes or a runny nose?
    8. Eat more than usual or gain weight (when the effects of a medicine or drug were wearing off)?
    9. Feel anxious or nervous?
    10. Have muscle aches or cramps or diarrhea (when the effects of a medicine or drug were wearing off)?
    11. Have a fever?
    12. Became so restless you fidgeted, paced or couldn't sit still (when the effects of a medicine or drug were wearing off)?
    13. Move or talk much more slowly than usual?
    14. Find yourself sweating, your pupils dilating or your hair standing up (when the effects of a medicine or drug were wearing off)?
    15. Have unpleasant dreams that often seemed real?
    16. See, feel or hear things that weren't really there (when the effects of a medicine or drug were wearing off)?
    17. Find yourself shaking?
    18. Have trouble falling asleep or staying asleep (when the effects of a medicine or drug were wearing off)?
    19. Have fits or seizures?
    20. Have very bad headaches (when the effects of a medicine or drug were wearing off)?
  • Take more of the same or a similar medicine or drug to get over or avoid any of these bad aftereffects?

Diagnostic Criterion: Drug use in larger amounts over a longer period of time than intended

Questionnaire Items:

  • Often use a medicine or drug in larger amounts or for a much longer period than you meant to?

Diagnostic Criterion: Persistent Desire or unsuccessful efforts to cut down or control drug use

Questionnaire Items:

  • More than once want to stop or cut down on using any of these medicines or drugs?
  • More than once try to stop or cut down on using any of these medicines or drugs but found you couldn't do it?

Diagnostic Criterion: Important social, occupational, or recreational activities given up or reduced in favor of drug use

Questionnaire Items:

  • Give up or cut down on activities that were important to you in order to use a medicine or drug—like work, school, or associating with friends or relatives?
  • Give up or cut down on activities that you were interested in or that gave you pleasure in order to use a medicine or drug?

Diagnostic Criterion: Great deal of time spent in activities to obtain the drug, to use the drug, or to recover from its effects

Questionnaire Items:

  • Have a period when you spent a lot of time using a medicine or drug or getting over its bad aftereffects?
  • Have a period when you spent a lot of time making sure you always had enough of a medicine or drug available?

Diagnostic Criterion: Continued drug use despite knowledge of having a persistent or recurrent physical or psychological problem caused or exacerbated by the drug

Questionnaire Items:

  • Continue to use a medicine or drug even though it was making you feel depressed, uninterested in things, or suspicious or distrustful of other people?
  • Continue to use a medicine or drug even though you knew it was causing you a health problem or making a health problem worse?

 

3.2.5 DSM-IV Mood and Anxiety Disorders

The NESARC includes questionnaire items for the diagnosis of four mood disorders and six anxiety disorders according to criteria enumerated in the DSM-IV. The mood disorders assessed include major depression (Section 4A), dysthymia (Section 4C), mania (Section 5), and hypomania (Section 5). Anxiety disorders include panic, with and without agoraphobia (Section 6), social phobia (Section 7), specific phobia (Section 8) and generalized anxiety disorder (Section 9). DSM-IV key characteristics for each mood and anxiety disorder are shown in Exhibit 9. To receive a formal DSM-IV diagnosis, a respondent needed to endorse a requisite number of symptoms pertaining to certain DSM-IV criteria and report the presence of social and/or occupational dysfunction associated with the disorder. Reliability and validity of the NESARC mood and anxiety disorder measures are extensively discussed elsewhere (Grant et al. 2005a; Grant et al. 2004d).

To facilitate analysis, the NESARC public use data set includes a section, Section 14, which provides ready-made diagnoses for all disorders using DSM-IV disorder-specific algorithms. All diagnoses are provided for two time frames: past 12 months and prior to the past 12 months. For mood and anxiety disorders in each of these time periods, four different diagnoses are available in the data file: (1) nonhierarchical diagnoses (i.e., those that do not use the exclusionary criteria of the DSM-IV), (2) those that exclude specific mood or anxiety disorders that are substance-induced, (3) those that exclude specific mood or anxiety disorders that are due to a general medical condition, and (4) those that exclude specific mood or anxiety disorders that are either substance-induced or due to a general medical condition (NIAAA 2004a). The diagnoses in this fourth category are called independent diagnoses. For example, the NESARC data file provides the following diagnoses for major depression for all individuals:

  1. Major depression (non-hierarchical, no rule-out restrictions)1.
  2. Major depression excluding illness-induced depression. Illness-induced disorders are defined as those episodes that began to occur when the respondent was physically ill or recovering from being physically ill, with the additional stipulation that a health professional confirms the etiological relationship between the psychiatric episode and the illness (Grant et al. 2005a; Grant et al. 2004d).  
  3. Major depression excluding substance-induced depression. Substance-induced disorders are defined as episodes that began after alcohol and/or drug intoxication and/or withdrawal, but either 1) were not associated with a period of at least one month of abstinence or (2) did not persist for more than one month after the cessation of alcohol or drug intoxication or withdrawal (Grant et al. 2005a; Grant et al. 2004d).  
  4. Major depression excluding illness and substance-induced depression.

1 All major depression diagnoses ruled out bereavement.

The prevalence estimates presented in the data tables are based on past-year independent diagnoses (i.e., past year disorders that were not induced by illness or substance use).

3.2.6 DSM-IV Personality and Conduct Disorders

The NESARC includes questionnaire items for the diagnosis of seven personality disorders and conduct disorder according to criteria enumerated in the DSM-IV. Section 10 includes items to assess avoidant, dependent, obsessive-compulsive, paranoid, schizoid, and histrionic personality disorders. Antisocial personality disorder is assessed together with conduct disorder in Section 11, as they share many overlapping symptoms.  

Since personality disorders are defined as long-term patterns of functioning, respondents were asked a series of questions about how they have felt or acted most of the time throughout their lives, regardless of the situation or the people they were with. Respondents were reminded on 20 occasions throughout the personality disorder assessment sections to exclude times when they were depressed, manic, anxious, drinking heavily, using medicines or drugs, experiencing symptoms of withdrawal from medicines or drugs, or physically ill (Grant et al. 2004c, e; Grant et al. 2005a, b).

To receive a diagnosis for the DSM-IV personality disorders, respondents needed to endorse a requisite number of symptoms pertaining to a given disorder, with at least one symptom causing social and/or occupational dysfunction. Exhibit 9 displays the defining characteristic for conduct disorder and each personality disorder assessed in NESARC. Reliability and validity of the NESARC personality and conduct disorder measures are extensively discussed elsewhere (Grant et al. 2003a; Grant et al. 2004c, e; Grant et al. 2005a, b).

Section 14 of the NESARC public use data file provides ready-made diagnoses for each of 7 personality disorders and for conduct disorder using DSM-IV disorder-specific algorithms. The prevalence estimates for personality and conduct disorders presented in the data tables are derived from diagnoses assessed on a lifetime basis.

3.2.7 DSM-IV Pathological Gambling

Section 12 of the NESARC contains questionnaire items that allow for diagnosis of pathological gambling disorder according to DSM-IV criteria.  In NESARC, gambling is defined as playing cards for money, betting on horses or dogs or sports, playing the stock or commodities market, buying lottery tickets or playing bingo or KENO or gambling at a casino, including playing the slot machines. Assessment of DSM-IV diagnoses of pathological gambling based on NESARC data is discussed elsewhere (Petry et al. 2005). Section 14 of the NESARC public-use data file provides ready-made diagnoses for past-year, prior-to-past-year, and lifetime pathological gambling disorder. The prevalence estimates of pathological gambling presented in the data tables are based on past-year diagnoses.

Exhibit 9. National Epidemiologic Survey on Alcohol and Related Conditions (Sections 4–11):

Diagnosis of DSM-IV Mood, Anxiety, Personality, and Conduct Disorders

Disorder

DSM-IV Key Characteristic1

Mood Disorders

Major Depression

Depressed mood or loss of pleasure and interest for at least most of the day for at least a 2-week period

Dysthymia

Two years of depressed mood for more days than not, with no longer than 2 months without depressive symptoms

Mania

Abnormal and persistently elevated, expansive, or irritable mood, lasting at least 1 week

Hypomania

Abnormal and persistently elevated, expansive, or irritable mood, lasting at least 4 days, not severe enough to require hospitalization or cause marked impairment in social/occupational functioning

Anxiety Disorders

Panic with/without Agoraphobia

An abruptly-developed, discrete period of intense fear or discomfort that peaks within 10 minutes; diagnoses are differentiated depending on the presence of agoraphobia

Social Phobia

Marked, persistent fear of humiliation or embarrassment in social performance situations

Specific Phobia

Marked, persistent, excessive or unreasonable fear in the presence or anticipation of a specific object or situation

General Anxiety Disorder

Excessive anxiety and worry, occurring more days than not for a period of at least 6 months, about a number of events or activities

Personality Disorders

Antisocial

A pattern of disregard for, and violation of, the rights of others

Avoidant

A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation

Dependent

A pattern of submissive and clinging behavior related to an excessive need to be taken care of

Histrionic

A pattern of excessive emotionality and attention seeking

Obsessive-Compulsive

A pattern of preoccupation with orderliness, perfectionism, and control

Paranoia

A pattern of distrust and suspiciousness such that others' motive are interpreted as malevolent

Schizoid

A pattern of detachment from social relationships and a restricted range of emotional expression

Conduct Disorder

 

A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated; if over 18-years-old, individual does not meet criteria for antisocial personality disorder

1 American Psychiatric Association 1994.

4. Data Tables

Three types of data tables are included in this manual. In each table, data are shown for both sexes and all ages 18 years and older combined, separately for males and females 18 years and older, and separately for both sexes combined in each of four age categories (18–24 years, 25–44 years, 45–64 years, and 65 years and older).

The numbers presented are estimates because they are derived from a representative sample of respondents. In a sample, each respondent represents one or more people in the population to which the estimates apply. In order for readers to assess the precision of the estimates provided, each estimate is accompanied by a value for the standard error of the estimate (labeled S.E. in the tables). Multiplying the standard error by 1.96 provides a margin of error above and below each estimate. This range defines a 95-percent confidence interval that will have a 95-percent chance of including the true value being estimated. All standard errors in this manual were calculated using SUDAAN, as discussed earlier. Estimates with very large standard errors or based on very small samples can be extremely unreliable. In this manual, some of the table cells include very few respondents (e.g., heavier drinkers ages 18–24 who are widowed). Estimates derived from fewer than 10 respondents are considered unreliable and are not shown in this manual. Tables cells suppressed under this arbitrary rule are marked by a "–"; symbol. In addition, estimates with a relative standard error greater than 0.3 are flagged by a "#"; symbol. Relative standard error is a measure of the unreliability of the estimate, calculated by dividing the standard error by the value of the estimate (Klein et al. 2002).

It is also important to note how missing values (i.e., "Don't know"; and "Refusal";) were handled in generating the estimates in this manual. In general, respondents with missing values on dichotomous variables (i.e., survey items with Yes/No response categories) were included in the "No"; category. This was the case for all medical conditions and psychiatric disorders. For variables with more complex response/recoded categories, such as drinking level and frequency of drinking enough to feel drunk, respondents with missing values were kept as a separate category in the analysis but were not presented in the tables. Therefore, the percent distribution of these variables does not always add to 100. Nonetheless, the estimates are not greatly affected by missing values because, on average across subpopulation groups, only about 1–2 percent of respondents had missing data on these variables.

The three table types are discussed in the following sections. Numbers in the examples are highlighted in the tables in bold italic type.

4.1 Percent Distribution Tables

Tables 1-1 through 1-15 show percent distributions. The portion of Table 1-1 shown on next page indicates that among the non-Hispanic White population ages 18 and older, 69.51 percent are current drinkers, 17.09 percent are former drinkers, and the remaining 13.40 percent are lifetime abstainers. These percentages add up to 100. The percent distributions shown in table 1-1 are based on the entire population represented by the NESARC sample. 

 

In a like manner, the portion of Table 1-2a shown below indicates that among non-Hispanic White current drinkers ages 18 and older, 60.92 percent are light drinkers, 21.83 percent are moderate drinkers, and 16.25 percent are heavier drinkers. These percentages add to only 99 percent, with the remainder representing a small number of current drinkers whose drinking levels are unknown.

 

 

It is important to remember that most of the percent distribution tables in this manual are based on current drinkers. As noted above, 16.25 percent of non-Hispanic White current drinkers ages 18 and older are heavier drinkers. This is not the same as saying that 16.25 percent of non-Hispanic Whites ages 18 and older are heavier drinkers. As shown in Table 1-2b on the following page, the percentage of non-Hispanic Whites ages 18 and older who are heavier drinkers is 11.29. The value of 11.29 can be obtained by multiplying the percent of current drinkers (69.51 from Table 1-1) by the percent of heavier drinkers among current drinkers (16.25 from Table 1-2a) and dividing by 100. The percents in Table 1-2b can also be derived by estimating the number of people in each cell and recalculating the percentages. Section 4.3 describes how to use percent distribution tables in conjunction with population tables (Tables 4-1 and 4-2) to calculate estimated numbers of people.

 

 

4.2 Health Condition Rates Tables

Tables 2-1 through 2-15 show rates per 1,000 population for selected past-year health conditions. In the portion of Table 2-1 shown below, the rate for chest pain or angina pectoris among women who are former drinkers is 67.83. This means that for every 1,000 women 18 years and older in the United States who are former drinkers, 67.83 reported having this condition in the past year.

In order to express the rates as percentages, simply divide the rate per 1,000 population by 10. For example, the rate per 1,000 population for chest pain or angina pectoris among women who are former drinkers (67.83) divided by 10 is about 6.78 percent, the percentage of women who are former drinkers who had chest pain or angina pectoris.

 

 

4.3 Psychiatric Disorder Rates Tables

Tables 3-1 through 3-15 show rates per 1,000 population for selected past-year psychiatric disorders. In the portion of Table 3-2 shown below, the rate for major depression among women who are light drinkers is 102.17. This means that for every 1,000 women 18 years or older in the United States who are light drinkers, 102.17 reported having major depression in the past year. The rate for panic disorder with agoraphobia among men who are light drinkers is 1.54. The rate is flagged for unreliability because its relative standard error is greater than 0.3.

In order to express these rates as percentages, simply divide the rate per 1,000 population by 10. For example, the rate per 1,000 population for major depression among women who are light drinkers (102.17) divided by 10 is about 10.2, the percentage of women who are light drinkers who had major depression.

 

 

4.4 Population Tables

Tables 4-1 and 4-2 show the populations (in thousands) represented by the percent distribution and rate estimates in the earlier tables. Table 4-1 presents the total population of the United States ages 18 years and older, and Table 4-2 shows the portion of this population who were current drinkers at the time the NESARC was conducted. Portions of each of these tables are reproduced on the following page. Data in the population tables can be used in conjunction with percent distribution tables and health condition rates tables to derive estimates of the number of people in each of the specific categories, as illustrated by the following examples.

 

 

 

As shown earlier in table 1-1, 13.40 percent of non-Hispanic White men and women ages 18 years and older were lifetime abstainers in 2001–2002. Table 4-1 indicates that the overall population for this cell was 147,367 thousand when the NESARC was conducted. Table 1-2a shows that 16.25 percent of non-Hispanic White current drinkers ages 18 years and older were heavier drinkers. With an estimated 102,434 thousand non-Hispanic White current drinkers ages 18 years and older (as shown in Table 4-2), the estimated number of heavier drinkers for this group is 16,646 thousand.

The population estimates in Tables 4-1 and 4-2 can be used in a similar way with the health condition rates in Tables 2-1 through 2-15 and with the psychiatric disorder rates in Tables 3-1 though 3-15. As mentioned above, the rate for former drinkers who were women 18 years and older with past-year chest pain or angina pectoris is 67.83 per 1,000 population (from Table 2-1). Multiplying this rate by the percent of female former drinkers (17.91 from Table 1-1) and the number of women in this age group (108,265 thousand, from the portion of Table 4-1) provides an estimate of 1,315 thousand persons with this condition among female former drinkers.

A similar calculation using data from Table 3-2 (102.17 per 1,000 population of current light drinking females with major depression), Table 4-2 (64,488 thousand women who were current drinkers at the time of the NESARC), and Table 1-2a (73.82 percent of the current female drinkers who were light drinkers) yields an estimate that 4,864 thousand women who were light drinkers had a diagnosis of major depression.


5. References

American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: APA, 1994.

Grant, B.F.; Harford T.C.; Dawson, D.A.; Chou, S.P.; and Pickering, R. The Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS): Reliability of alcohol and drug modules in a general population sample. Drug and Alcohol Dependence, 39(1):37–44, 1995.

Grant, B.F.; Dawson, D.A.; and Hasin, D.S. The Alcohol Use Disorder and Associated Disabilities Interview Schedule—DSM-IV Version. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism, 2001.

Grant, B.F.; Dawson, D.A.; Stinson, F.S.; Chou, P.S.; Kay, W.; and Pickering, R. The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): Reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug and Alcohol Dependence, 71(1):7–16, 2003a.

Grant, B.F.; Kaplan, K.; Shepard, J.; Moore, T.  Source and Accuracy Statement for Wave 1 of the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism, 2003b.

Grant, B.F.; Dawson, D.A.; Stinson, F.S.; Chou, S.P.; Dufour, M.C.; and Pickering, R.P. The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002. Drug and Alcohol Dependence, 74(3):223–234, 2004a.

Grant, B.F.; Hasin, D.S.; Chou, S.P.; Stinson, F.S.; and Dawson, D.A. Nicotine dependence and psychiatric disorders in the United States: Results from the national epidemiologic survey on alcohol and related conditions. Archives of General Psychiatry, 61(11):1107–1115, 2004b.

Grant, B.F.; Hasin, D.S.; Stinson, F.S.; Dawson, D.A.; Chou, S.P.; Ruan, W.J.; and Pickering, R.P. Prevalence, correlates, and disability of personality disorders in the United States: Results from the national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry, 65(7):948–958, 2004c.

Grant, B.F.; Stinson, F.S.; Dawson, D.A.; Chou, S.P.; Dufour, M.C.; Compton, W.; Pickering, R.P.; and Kaplan, K. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry, 61(8):807–816, 2004d.

Grant, B.F.; Stinson, F.S.; Dawson, D.A.; Chou, S.P.; Ruan, W.J.; and Pickering, R.P. Co-occurrence of 12-month alcohol and drug use disorders and personality disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry, 61(4): 361–368, 2004e.

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Grant, B.F.; Stinson, F.S.; Dawson, D.A.; Chou, S.P.; and Ruan, W.J. Co-occurrence of DSM-IV personality disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Comprehensive Psychiatry, 46(1):1–5, 2005b.

Klein, R.J.; Proctor, S.E.; Boudreault, M.A.; and Turczyn, K.M. Healthy People 2010 criteria for data suppression. Healthy People 2010 Statistical Notes (24):1–12, 2002.

National Institute on Alcohol Abuse and Alcoholism (NIAAA). NESARC Data Notes. Bethesda, MD: NIAAA, 2004a.

National Institute on Alcohol Abuse and Alcoholism (NIAAA). The Physicians' Guide to Helping Patients With Alcohol Problems (Revised). NIH Publication No. 04-3769. Bethesda, MD: NIAAA, 2004b.

Petry, N.M.; Stinson, F.S.; and Grant, B.F. Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66(5):564-74, 2005.

Research Triangle Institute (RTI). Software for Survey Data Analyses (SUDAAN) Version 9.01. Research Triangle Park, NC: RTI, 2004.

Stinson, F.S.; Yi, H.; Grant, B.F.; Chou, P.; Dawson, D.A.; Pickering, R. Drinking in the United States: Main Findings from the 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES). NIH Publication No. 99-3519. Bethesda, MD: NIAAA, 1998.