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U.S. Alcohol Epidemiologic Data Reference Manual Volume 8, Number 2

 

ALCOHOL USE AND ALCOHOL USE DISORDERS IN THE UNITED STATES, A 3‑YEAR FOLLOW‑UP:

MAIN FINDINGS FROM THE 2004–2005 WAVE 2 NATIONAL EPIDEMIOLOGIC SURVEY ON ALCOHOL AND RELATED CONDITIONS (NESARC)

 

September 2010

 

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.HHSN267200800023C 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), U.S. Department of Health and Human Services. The study on which this manual is based, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), is sponsored by NIAAA, with supplemental support from the National Institute on Drug Abuse. This research was supported in part by the Intramural Program of NIAAA. Principal authors of this manual are Chiung M. Chen, M.A,. and Hsiao‑ye Yi, Ph.D., of CSR; and Deborah A. Dawson, Ph.D., Frederick S. Stinson, Ph.D., and Bridget F. Grant, Ph.D., Ph.D., of the Laboratory of Epidemiology and Biometry of NIAAA. Rosalind A. Breslow, Ph.D., of DEPR served as NIAAA's Project Officer on the above‑referenced contract and oversaw the completion 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. 10‑7677

 

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 Age at Drinking Onset

 

3.1.6 DSM‑IV Alcohol Use Disorders

 

3.1.7 Family History of Alcoholism

 

3.1.8 Alcohol Treatment

 

3.2 Other NESARC Items

 

3.2.1 Basic Demographic and Background Information

 

3.2.2 Tobacco Use Status

 

3.2.3 Drug Use Status

 

3.2.4 Medical Conditions

 

3.2.5 DSM‑IV Drug and Nicotine Use Disorders

 

3.2.6 DSM‑IV Mood and Anxiety Disorders

 

3.2.7 DSM‑IV Personality and Conduct Disorders

 

4. Data Tables

 

4.1 Percent Distribution Tables

 

4.2 Health Condition Rates Tables

 

4.3 Psychiatric Disorder Rates Tables

 

4.4 Quality of Life Scores Tables

 

5. References


List of Tables

1- Percent distribution of drinking status (since the Wave 1 interview) at Wave 2 among [variable], by sex and age group, according to selected respondent characteristics at Wave 1.

Variables:

1. Wave 1 current drinkers

2. Wave 1 former drinkers

3. Wave 1 lifetime abstainers.

1- Percent distribution of past-year status of exceeding daily and weekly low‑risk drinking limits at Wave 2 among [variable], by sex and age group, according to selected respondent characteristics at Wave 1.

Variables:

4. Wave 1 non‑current drinkers

5. Wave 1 current drinkers who did not exceed drinking limits in the past year

6. Wave 1 current drinkers who exceeded daily but not weekly drinking limits in the past year

7. Wave 1 current drinkers who exceeded weekly or both daily and weekly drinking limits in the past year

1‑ Percent distribution of past‑year DSM‑IV alcohol use disorder (AUD) transition status by Wave 2 among [variable], by sex and age group, according to selected respondent characteristics at Wave 1.

Variables:

8. Wave 1 current drinkers with no past‑year AUD

9. Wave 1 current drinkers with past‑year alcohol abuse only

10. Wave 1 current drinkers with past‑year alcohol dependence

1‑11 Percent distribution of past‑year recovery status at Wave 2 among individuals in full remission from DSM‑IV alcohol dependence at Wave 1, by sex and age group, according to selected respondent characteristics at Wave 1.

1‑12 Percent distribution of pattern of treatment‑seeking behavior for drinking problems by Wave 2 among individuals who ever had had a DSM‑IV alcohol use disorder at Wave 1, by sex and age group, according to selected respondent characteristics at Wave 1.

1‑13 Rate (%) of 1‑year (i.e., Wave 2 past year) first incidence of DSM‑IV alcohol use disorder (AUD), alcohol abuse, and alcohol dependence, by sex and age group, according to selected respondent characteristics at Wave 1.

1‑14 Rate (%) of 3‑year (i.e., Wave 1 to Wave 2) first incidence of DSM‑IV alcohol use disorder (AUD), alcohol abuse, and alcohol dependence, by sex and age group, according to selected respondent characteristics at Wave 1.

2‑ Rate (%) of selected Wave 2 past‑year health conditions among individuals without the respective past‑year health conditions at Wave 1, by sex and age group, according to [variable].

Variables:

1. Wave 1 past‑year drinking status

2. Wave 1 past‑year average drinking level among Wave 1 current drinkers

3. Wave 1 past‑year status of exceeding daily and weekly low‑risk drinking limits among Wave 1 current drinkers

4. Wave 1 past‑year DSM‑IV alcohol use disorder status among Wave 1 current drinkers

5. Wave 1 past‑year frequency of drinking 5 or more drinks for men or 4 or more drinks for women in a single day among Wave 1 current drinkers

6. Wave 1 past‑year frequency of drinking enough to feel drunk among Wave 1 current drinkers

7. Age of starting to drink among Wave 1 current drinkers

8. Wave 1 past‑year alcoholic beverage preference among Wave 1 current drinkers

9. Family history of alcoholism at Wave 1 among Wave 1 current drinkers

10. Having had alcoholic parents by Wave 1 among Wave 1 current drinkers

11. Having ever married/lived as if married with an alcoholic at Wave 1 among Wave 1 current drinkers

3‑ Rates (%) of 1‑year (i.e., Wave 2 past year) and 3‑year (i.e., Wave 1 to Wave 2) first incidence of selected DSM‑IV psychiatric disorders, by sex and age group, according to [variable].

Variables:

1. Wave 1 past‑year drinking status

2. Wave 1 past‑year average drinking level among Wave 1 current drinkers

3. Wave 1 past‑year status of exceeding daily and weekly low‑risk drinking limits among Wave 1 current drinkers

4. Wave 1 past‑year DSM‑IV alcohol use disorder status among Wave 1 current drinkers

5. Wave 1 past‑year frequency of drinking 5 or more drinks for men or 4 or more drinks for women in a single day among Wave 1 current drinkers

6. Wave 1 past‑year frequency of drinking enough to feel drunk among Wave 1 current drinkers

7. Age of starting to drink among Wave 1 current drinkers

8. Wave 1 past‑year alcoholic beverage preference among Wave 1 current drinkers

9. Family history of alcoholism at Wave 1 among Wave 1 current drinkers

10. Having had alcoholic parents by Wave 1 among Wave 1 current drinkers

11. Having ever married/lived as if married with an alcoholic at Wave 1 among Wave 1 current drinkers

4‑ Quality of life at Wave 1 and changes from Wave 1 to Wave 2, as measured by norm‑based scores based on the Short Form 12 Health Survey Version 2 (SF–12v2), by sex and age group, according to [variable].

Variables:

1. Wave 1 past‑year drinking status

2. Wave 1 past‑year average drinking level among Wave 1 current drinkers

3. Wave 1 past‑year status of exceeding daily and weekly low‑risk drinking limits among Wave 1 current drinkers

4. Wave 1 past‑year DSM‑IV alcohol use disorder status among Wave 1 current drinkers

5. Wave 1 past‑year frequency of drinking 5 or more drinks for men or 4 or more drinks for women in a single day among Wave 1 current drinkers

6. Wave 1 past‑year frequency of drinking enough to feel drunk among Wave 1 current drinkers

7. Age of starting to drink among Wave 1 current drinkers

8. Wave 1 past‑year alcoholic beverage preference among Wave 1 current drinkers

9. Family history of alcoholism at Wave 1 among Wave 1 current drinkers

10. Having had alcoholic parents by Wave 1 among Wave 1 current drinkers

11. Having ever married/lived as if married with an alcoholic at Wave 1 among Wave 1 current drinkers


List of Exhibits

National Epidemiologic Survey on Alcohol and Related Conditions

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

(Wave 2 Section 2A): Selected Questions on Alcohol Consumption

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

3. (Wave 1 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. (Wave 1 Section 3A): Selected Questions on Tobacco Use

7. (Wave 1 Section 3B): Selected Questions on Medicine Use

8. (Wave 1 Section 13; Wave 2 Section 14): Selected Questions on Medical Conditions


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 second publication in Volume 8 of the AEDRM series. Volume 8 is devoted to data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a household survey designed, conducted, and sponsored by NIAAA, with supplemental support from the National Institute on Drug Abuse. The NESARC is the largest and most comprehensive survey conducted on alcohol use, alcohol use disorders, and their physical and psychiatric disabilities. The first publication of Volume 8 (2006) contains main findings from the Wave 1 NESARC conducted in 2001–2002. The current manual presents data from the Wave 2 NESARC conducted in 2004–2005. To assess changes in the 3 years of follow‑up, this manual incorporates data from Wave 1 as baseline measures.

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.

Kenneth R. Warren, Ph.D.

Acting Director

National Institute on Alcohol Abuse and Alcoholism


1. Introduction

In 2001–2002, NIAAA conducted the first wave (Wave 1) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a longitudinal study that was the most ambitious and comprehensive survey of its type ever conducted. In 2004–2005, NIAAA conducted the second wave (Wave 2) of NESARC, following up on the same respondents from the first wave. 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 disorders. In addition, the survey contains a variety of questions on family history of alcoholism, alcohol treatment utilization, medical conditions, and sociodemographic information.

Findings from the Wave 1 NESARC were published in an earlier data reference manual (Volume 8, Number 1) (Chen et al. 2006). The current manual (Volume 8, Number 2) presents major findings from the Wave 2 NESARC. The two documents use a similar layout. However, the Wave 1 manual focuses on prevalence statistics among the U.S. population in 2001–2002, whereas the Wave 2 manual focuses on changes during the 3‑year period between the two waves among the baseline population.

The following sections describe the data sources as well as the variables and data tables presented in this manual.


2. Data Source

All data presented in this manual are based on the 2001–2002 Wave 1 NESARC and 2004–2005 Wave 2 NESARC, with the latter being a longitudinal follow‑up to the former. The NESARC is 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. Wave 1 NESARC data were collected during 2001–2002 through computer‑assisted personal interviews (CAPI) in face‑to‑face household settings. The sample included 43,093 respondents ages 18 and older, representing 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.

Data collection for Wave 2 began in August 2004 and was completed by September 2005. The Wave 2 NESARC reinterviewed 34,653 of the 43,093 Wave 1 NESARC respondents. Of the 8,440 Wave 1 respondents who were not included in Wave 2, 3,134 were not eligible for a Wave 2 interview because they were institutionalized, mentally/physically impaired, on active duty in the armed forces throughout the Wave 2 interview period, deceased, or deported. The remaining respondents (5,306) were eligible for a Wave 2 interview but were not reinterviewed because they refused or because of the inability to reach or locate them. The household response rate for the Wave 1 NESARC was 89 percent, and the person response rate was 93 percent, yielding an overall response rate of 81 percent. The Wave 2 NESARC response rate by itself was 86.7 percent, and accounting for the Wave 1 NESARC response rate yielded an overall cumulative survey response rate of 70.2 percent (the product of the Wave 2 and Wave 1 response rates). Sampling weights are provided in Wave 2 data to reflect design characteristics of the NESARC and account for nonresponse as well as sample attrition. The weighted Wave 2 data represent the same baseline population as represented in Wave 1.

The Wave 1 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) and “Source and Accuracy Statement for the 2004–2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions” (Grant and Kaplan 2005).

Because of the complex survey design employed by the NESARC, variance estimation procedures that assume a simple random sample are not 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 2008), 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 help readers assess the precision of the estimates presented. 


3. Data Coverage

Data provided in this manual include items associated with alcohol use, alcohol use disorders, and other related mental and health conditions. The focus is on changes during the 3‑year follow‑up period between the 2001–2002 Wave 1 and 2004–2005 Wave 2 NESARC. In both waves, the information was collected using the NIAAA Alcohol Use Disorder and Associated Disabilities Interview Schedule–Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‑IV) Version (AUDADIS‑IV), a fully structured diagnostic interview instrument (questionnaire) designed for experienced lay interviewers (Grant, Dawson, and Hasin 2001). The measures used in this manual are described in the following sections. The source questionnaire items for some of the measures are shown in exhibits to provide the readers with the exact wording of the questions. However, response alternatives and skip patterns are not shown in the exhibits. The source questionnaire items are also noted for their locations in the interview instruments used for Wave 1 and/or Wave 2. If the locations of the items are the same in both waves, no specific wave is indicated.

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.

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. In Wave 1, 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. In Wave 2, abstainers since the Wave 1 interview were those who never had 1 or more drinks since the Wave 1 interview, and former drinkers were those who had at least 1 drink since the Wave 1 interview but not in the past year. Questions used to determine drinking status (Items 1 and 3 from Section 2A) are shown in Exhibit 1.

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 help respondents report 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 to 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 or more drinks;
  2. an intermediate component, Q5 x F5, where F5 = the frequency of drinking 5 or more 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 above) 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 1 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 on any day, and women may be at risk if they drink more than 7 drinks per week or more than 3 drinks on any day (NIAAA 2004b).

Wave 1 NESARC Questions 8e and 9 in Section 2A and the corresponding Wave 2 NESARC questions 4f and 4e 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 drinking 5 or more drinks at least once during the past 12 months, 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 drinking 4 or more drinks at least once during the past 12 months, 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 or 1.2 ounces of ethanol per day) for men and more than 7 drinks per week (i.e., 1 drink or 0.6 ounces of ethanol per day) for women.

3.1.4 Overall Beverage Preference

Wave 1 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 Age at Drinking Onset

Wave 1 NESARC 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 years or younger, 15 to 17 years, 18 to 20 years, and 21 years or older.

Exhibit 1. National Epidemiologic Survey on Alcohol and Related Conditions

(Wave 1 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?

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

Exhibit 1. National Epidemiologic Survey on Alcohol and Related Conditions (Continued)

(Wave 2 Section 2A): Selected Questions on Alcohol Consumption

1. Since your LAST interview in (MO/YR), have you had at least 1 drink of any kind of alcohol, not counting small tastes or sips?

3. During the last 12 months, that is, since (month one year ago) did you have a total of at least 12 drinks of any kind of alcohol?

5a. During the last 12 months, did you drink any prepackaged alcoholic coolers? By coolers, I mean wine‑based, malt‑based, and liquor‑based coolers, hard lemonade, hard cider, and any prepackaged cocktails with the alcohol and mixer already combined in the container.

5b. During the last 12 months, about how often did you drink any coolers?

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

5d. How many (units reported in 5c) of cooler did you USUALLY drink on days when you drank coolers?

6a. During the last 12 months, did you drink any beer or malt liquor? Do not count nonalcoholic beers.

6b. During the last 12 months, about how often did you drink any beer or malt liquor?

6c. 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?

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

7a. During the last 12 months, did you drink any type of wine? Do not count any wine coolers you may have told me about earlier.

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

7c. 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.

7d. How many (units reported in 7c) of wine did you USUALLY drink on days when you drank wine?

8a. During the last 12 months, did you drink any liquor, including mixed drinks and liqueurs? Do not count any liquor‑based coolers or prepackaged cocktails that you may have told me about earlier.

8b. During the last 12 months, about how often did you drink any liquor?

8c. 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.

8d. How many (drinks of this size/units reported in 8c) of liquor did you USUALLY drink on days when you drank liquor?

4a. During the last 12 months, about how often did you drink any kind of alcoholic beverage?

4b. How many drinks did you USUALLY have on days when you drank during the last 12 months?

4f. During the last 12 months, about how often did you drink FIVE OR MORE drinks in a single day?

4e. During the last 12 months, about how often did you drink FOUR OR MORE drinks in a single day? (Women only)

9a. During the last 12 months, about how often did you drink enough alcohol of any kind to feel intoxicated or drunk, that is, when your speech was slurred, you felt unsteady on your feet, or you had blurred vision?

14a. About how old were you when you first started drinking, not counting small tastes or sips of alcohol?

3.1.6 DSM‑IV Alcohol Use Disorders

The NESARC alcohol use disorders were assessed by AUDADIS‑IV questionnaire items that tap criteria articulated in the 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, 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. Because the DSM‑IV considers alcohol dependence a syndrome, symptoms comprising three or more dependence criteria have to cluster within 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 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.

3.1.7 Family History of Alcoholism

Section 2D of the Wave 1 NESARC asks questions about family history of alcoholism or problem drinking (see Exhibit 3). For these questions, an alcoholic or problem drinker was defined for each respondent during the interview 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; or problems with the police (like drunk driving) because of drinking; or a person who seems to spend a lot of time drinking or being hung over.

A 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; however, 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 Question 15 or 19 was positive.

Exhibit 3. National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1 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?

3.1.8 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 types of professionals, organizations, and/or programs offering treatment assistance with alcohol problems. For this manual, a respondent's lifetime and past‑year treatment‑seeking status as of the Wave 1 interview was defined based on Wave 1 Questions 2a and 2b, respectively. A positive response to any of the different treatment providers or settings was counted as an indication of alcohol treatment. Similarly, a respondent's treatment‑seeking status since the Wave 1 interview (i.e., during the 3 years of follow‑up) was defined by Wave 2 Question 2a.

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?  [Wave 1]

1. Since your LAST interview in (MO/YR), have you 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? [Wave 2]

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) [Wave 1]

2a. I am going to read you a list of community agencies and professionals. For each one, please tell me if you have gone there for any reason related to your drinking. Since your LAST interview, did you go to (a/an) … (Repeat phrase frequently) [Wave 2]

  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? [Wave 1]

2b. Did you go there during the last 12 months? [Wave 2]

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 Wave 1 NESARC that are included in this manual as baseline characteristics. These items include: sex, age, race/ethnicity, marital status, ever had children, children ages below 13 living in household, education, employment status, family income, U.S. nativity, family structure and various circumstances before age 18, homelessness, self‑perceived health, and health insurance coverage.

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

Selected Demographic and Background Information at Wave 1

 

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 or Latino

Hispanic or Latino

Marital Status

Married

Living with someone as if married

Widowed

Divorced

Separated

Never married

Ever had children (including step, adopted, foster)

Yes

No

Children Ages Below 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

Born in the United States

Yes

No

 

 

Family Annual Income

$0 to $19,999

$20,000 to $34,999

$35,000 to $69,999

$70,000 or more

Family Structure Before Age 18

Both biological/adoptive parents in the household

Only biological mother ever in the household (father never present)

Biological/adoptive parents divorced or not living together

Raised by relatives, by foster parents, or in an institution

 

Before Age 18, Family Received Government Assistance

Yes

No

Before Age 18, Ever in Jail or Juvenile Detention Center

Yes

No

Before Age 18, Physically Abused by Parent/Caretaker

Yes

No

Before Age 18, Saw Serious Fights at Home

Yes

No

Before Age 18, Parent/Other Adult in Home Was Alcoholic

Yes

No

Ever Had No Regular Place to Live Lasting 1+ Months

Yes

No

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.

3.2.2 Tobacco Use Status

Question 1 from Section 3A of the NESARC (see Exhibit 6) asks separately about lifetime use of the following five types of tobacco: (1) cigarettes, (2) cigars, (3) pipe, (4) snuff, and (5) chewing tobacco. In NESARC, respondents could be classified as ever users of tobacco product if they smoked at least 100 cigarettes, smoked 50 cigars or 50 pipes of tobacco, or used snuff or chewing tobacco at least 20 times. Ever users were asked question 3a, which allowed them to be classified as a current user of a particular tobacco type. A measure that summarizes the overall tobacco use status of each person in the NESARC is used in this manual, with the following three categories: (1) current user (past 12 months) of one or more types of tobacco, (2) ex‑user (not in past 12 months) of one or more types of tobacco, and (3) lifetime non‑user of any type of tobacco.

Exhibit 6. National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1 Section 3A):

Selected Questions on Tobacco Use

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

  1. Smoked at least 100 cigarettes?
  2. Smoked at least 50 cigars?
  3. Smoked a pipe at least 50 times?
  4. Used snuff, such as Skoal, Skoal Bandit, or Copenhagen at least 20 times?
  5. Used chewing tobacco, such as Redman, Levi Garrett, or Beechnut at least 20 times?

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

3.2.3 Drug Use Status

Question 1 from Section 3B of the NESARC (see Exhibit 7) asks separately about the lifetime use of the following nine types of medicine or drug: (1) sedatives, (2) tranquilizers, (3) painkillers (opiates not including heroin or methadone), (4) stimulants, (5) marijuana, (6) cocaine or crack, (7) hallucinogens, (8) inhalants or solvents, and (9) heroin. There also is a 10th “other drug” category. In NESARC, respondents could be classified as ever drug users if they reported having ever used at least one type of drug in these categories. Ever users were asked question 2b, which allowed them to be classified as a current user of a particular drug type. A measure that summarizes the overall drug use status of each person in the NESARC is used in this manual, with the following three categories: (1) current user (past 12 months) of any type of drug, (2) ex‑user (not in past 12 months/unknown if in past 12 months) of any type of drug, and (3) lifetime non‑user of any type of drug.

Exhibit 7. National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1 Section 3B):

Selected Questions on Medicine Use

Now I’d like to ask you about your experiences with medicines and other kinds of drugs that you may have used ON YOUR OWN—that is, either WITHOUT a doctor’s prescription (PAUSE); in GREATER amounts, MORE OFTEN, or LONGER than prescribed (PAUSE); or for a reason other than a doctor said you should use them. People use these medicines and drugs ON THEIR OWN to feel more alert, to relax or quiet their nerves, to feel better, to enjoy themselves, or to get high, or just to see how they would work.

1a. Have you EVER used any of these medicines or drugs?

  1. Sedatives, for example, sleeping pills, bar-bit-your-ates, Seconal, Kway/-ludes, or Khlor/-all Hydrate
  2. Tranquilizers or anti-anxiety drugs, for example, Valium, Librium, muscle relaxants, or Zanax
  3. Painkillers, for example, Codeine, Darvon, Per/-ko-dan, Dill-odd/-id, or Demerol
  4. Stimulants, for example, Pray-lude/-in, Benzadrine, Methadrine, uppers, or speed
  5. Mariwa/-na, hash, THC, or grass
  6. Cocaine or crack
  7. Hallucinogens, for example, Ecstasy/MDMA, LSD, mescaline, Sillosy/-bin, PCP, angel dust, or pay-o/-tee
  8. Inhalants or solvents, for example, a/-mill nitrate, nitrous oxide, glue, tol/-u- een or gasoline
  9. Heroin
  10. Any OTHER medicines, or drugs, or substances, for example, steroids, Elavil, Thorazine or Haldol

2b. Did you use (Name of drug category) in the last 12 months only, before the last 12 months only, or during both time periods?

3.2.4 Medical Conditions

Section 13 of the Wave 1 NESARC and Section 14 of Wave 2 ask about a list of medical conditions (see Exhibit 8). Respondents were categorized as having a particular medical condition in the past year if they reported having it and if a doctor or other health professional had diagnosed the condition. The medical conditions covered in the manual are (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, and (12) schizophrenia or a psychotic illness or episode.

Exhibit 8. National Epidemiologic Survey on Alcohol and Related Conditions:

Selected Questions on Medical Conditions

[Wave 1 Section 13]

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?

 

[Wave 2 Section 14]

15a. And now a few questions about your health. In the last 12 months, did you have. . .

[See list in the above Wave 1 Question 6a. Wave 2 listed six additional conditions, but the current manual only presents data for conditions that were asked about in both waves.]

15b. Did a doctor or other health professional tell you that you had (Name of condition)?

16a. In the last 12 months, did a doctor or other health professional tell you that you had schizophrenia or a psychotic illness or episode?

3.2.5 DSM‑IV Drug and Nicotine Use Disorders

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 10 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 are similar to those for alcohol abuse and dependence, but vary slightly across drugs. 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 four 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).

3.2.6 DSM‑IV Mood and Anxiety Disorders

The NESARC includes questionnaire items for the diagnosis of three mood disorders (Sections 4–5) and five anxiety disorders (Sections 6–9) according to criteria enumerated in the DSM‑IV. The mood disorders assessed include major depressive disorder, bipolar I, and bipolar II. Anxiety disorders include panic with and without agoraphobia, social phobia, specific phobia, and generalized anxiety disorder (Section 9). To receive a formal DSM‑IV mood or anxiety disorder diagnosis, a respondent needed to endorse a requisite number of symptoms pertaining to certain DSM‑IV symptom criteria which are neither substance‑induced nor due to bereavement or a general medical condition (NIAAA 2004a). Reliability and validity of the NESARC mood and anxiety disorder measures are extensively discussed elsewhere (Grant et al. 2005a; Grant et al. 2004d).

3.2.7 DSM‑IV Personality and Conduct Disorders

The NESARC (Section 10) includes questionnaire items for the diagnosis of the 10 personality disorders according to criteria enumerated in the DSM‑IV. Seven of the disorders were assessed at Wave 1: paranoid, schizoid, histrionic, antisocial, avoidant, dependent, and obsessive‑compulsive personality disorders. Four were assessed at Wave 2: borderline, schizotypal, narcissistic, and antisocial personality disorders. Antisocial personality disorder was the only personality disorder assessed at both waves. The Wave 2 assessment of antisocial personality disorder was used in this manual. Because a specified number of criteria for conduct disorder before age 15 are required to meet a diagnosis of antisocial personality disorder, the NESARC also includes questionnaire items for assessing conduct disorder.

Because 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 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; Grant et al. 2008).

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. 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; Grant et al. 2008).

The estimates for personality and conduct disorders presented in the data tables are based on diagnoses assessed on a lifetime basis using DSM‑IV disorder‑specific algorithms.


4. Data Tables

Four groups of data tables are included in this manual. In each table, data are shown in three column sections: for both sexes ages 18 years and older as of the Wave 1 interview, separately for males and females 18 years and older, and for both sexes in each of the four age categories (i.e., 18–24 years, 25–44 years, 45–64 years, and 65 years and older).

The numbers presented herein are estimates 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 or no respondents. For the reader's information, estimates derived from fewer than 10 respondents in the numerators are shown in the tables but are flagged by a “*”. Empty table cells are marked by a “–” symbol. Readers may use the relative standard error, calculated by dividing the standard error by the value of the estimate, as a measure of unreliability of the estimate. An estimate is conventionally considered unreliable if its relative standard error is greater than 0.3. (Klein et al. 2002).

It is 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 exceeding daily and weekly low‑risk drinking limits, respondents with missing values were kept as a separate category in the data analysis but were not presented in the tables. Therefore, the percent distribution of these variables does not always add to 100. In general, 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 the variables.

The four groups of data tables are discussed in the following sections. Numbers referenced in the examples are highlighted in bold type in the sample table portions.

4.1 Percent Distribution Tables

The first group of tables includes Tables 1‑1 through 1‑12. These tables present percent distributions of alcohol‑related outcomes at Wave 2 among subgroups categorized by the corresponding alcohol‑related antecedents at Wave 1. These tables cover a broad range of alcohol‑related outcomes, such as drinking status, past‑year status of exceeding daily and weekly low‑risk drinking limits, past‑year DSM‑IV alcohol use disorder transition status, past‑year recovery status, and pattern of treatment‑seeking behavior for drinking problems. Additionally, Tables 1‑13 and 1‑14 cover 1‑year and 3‑year first‑incidence rates of DSM‑IV alcohol use disorders. The data in each of these tables are presented for various subgroups defined by sociodemographic characteristics and a wide range of variables measured at Wave 1, including alcohol treatment utilization, family history of alcoholism, major depressive disorder, and personality disorders.

Of particular note, Tables 1‑8, 1‑9, and 1‑10 show percent distribution of Wave 2 past‑year DSM‑IV alcohol use disorder status for individuals with no AUD, abuse only, and dependence (with or without abuse) at Wave 1, respectively. According to Dawson et al. (2008a), transitions of AUD status among Wave 1 current drinkers can be described by these 12 categories:

  1. No AUD at Wave 1; remained without AUD and continued drinking at Wave 2.
  2. No AUD at Wave 1; remained without AUD and stopped drinking by Wave 2.
  3. No AUD at Wave 1; developed abuse only by Wave 2.
  4. No AUD at Wave 1; developed dependence (with or without abuse) by Wave 2.
  5. Abuse only at Wave 1; nonabstinent remission to no AUD by Wave 2.
  6. Abuse only at Wave 1; abstinent remission to no AUD by Wave 2.
  7. Abuse only at Wave 1; remained abuse only at Wave 2.
  8. Abuse only at Wave 1; developed dependence (with or without abuse) by Wave 2.
  9. Dependence at Wave 1; nonabstinent remission to no AUD by Wave 2.
  10. Dependence at Wave 1; abstinent remission to no AUD by Wave 2.
  11. Dependence at Wave 1; partial remission (abuse or subclinical dependence) at Wave 2.
  12. Dependence at Wave 1; remained dependent at Wave 2.

Tables 1‑8, 1‑9, and 1‑10 present data for categories 1–4, 5–8, and 9–12, respectively. As examples, portions of these tables are shown below. The denominators in these tables are based on Wave 1 current drinkers and their AUD status at Wave 1. The boldfaced numbers in the portion of Table 1‑8 indicate that among male current drinkers who had no AUD at Wave 1, 75.20 percent remained without AUD and continued drinking at Wave 2. Although less prevalent, a sizable proportion (12.59 percent) stopped drinking completely. Only small percentages developed alcohol abuse only and alcohol dependence at Wave 2 (7.63 percent and 4.57 percent, respectively). The portion of Table 1‑9 indicates that 20.08 percent of female current drinkers who had alcohol abuse only at Wave 1 still had alcohol abuse only at Wave 2, and 11.82 percent developed alcohol dependence. By contrast, 61.37 percent of these individuals were in nonabstinent remission to no AUD, and 6.74 percent were in abstinent remission to no AUD.

Furthermore, as indicated by the boldfaced numbers in the portion of Table 1‑10, among non‑Hispanic White male drinkers, 42.21 percent of those who had alcohol dependence at Wave 1 remained alcohol dependent at Wave 2, whereas 37.24 percent were in partial remission. Accordingly, only small percentages of these dependent individuals were able to achieve abstinent remission to no AUD (5.28 percent) or nonabstinent remission to no AUD (15.27 percent) by Wave 2.

Table 1‑11 presents percent distribution of past‑year recovery status at Wave 2 among individuals who were in full remission from DSM‑IV alcohol dependence at Wave 1, by sex and age group. According to Dawson et al. (2007), recovery status can be defined by the categories listed below. The rationale for these categories is presented elsewhere (Dawson et al. 2005).

  1. Still dependent: Fulfilled the DSM‑IV criteria for alcohol dependence.
  2. Partial remission: Did not meet the criteria for alcohol dependence, but reported one or more symptoms of either alcohol abuse or dependence.
  3. Asymptomatic risk drinker: Did not experience any symptoms of alcohol abuse or dependence but met the criteria for risk drinking as defined in Helping Patients Who Drink Too Much, A CLINICIAN'S GUIDE, Updated 2005 Edition (http://pubs.niaaa.nih.gov/publications/practitioner/cliniciansguide2005/clinicians_guide.htm): >14 drinks per week or 5+ drinks on any day for men and >7 drinks per week or 4+ drinks on any day for women, assuming a standard drink size of 0.6 ounces of ethanol.
  4. Low‑risk drinker: Consumed alcohol but did not experience any symptoms of abuse or dependence and did not meet the criteria for risk drinking specified above.
  5. Abstainer: Did not consume any alcohol.

Individuals were classified as being in full remission at Wave 1 if they were in categories 3, 4, and 5 in the year immediately preceding the Wave 1 interview. They were counted as positive for recurrence of DSM‑IV alcohol dependence if they were alcohol dependent, or else were counted as partial remission if they were positive for recurrence of any AUD symptoms during the year immediately preceding the Wave 2 interview.

A portion of Table 1‑11 is shown below. The boldfaced numbers indicate that 3.48 percent of individuals in full remission from alcohol dependence at Wave 1 had a recurrence of alcohol dependence at Wave 2 and that 17.64 percent were in partial remission at Wave 2. Hence, the majority of those in full remission remained in full remission; most of them were current drinkers (15.20 percent asymptomatic risk drinkers and 27.37 percent low‑risk drinkers) rather than abstainers (36.32 percent) at Wave 2. Nevertheless, the percent distribution of recovery status may vary by respondent characteristics at Wave 1. For example, the percentage of low‑risk drinkers is higher in non‑Hispanic White men (25.56 percent) than non‑Hispanic Black men (11.91 percent), and the percentage of abstainers is much higher among non‑Hispanic Black women (62.80 percent) than non‑Hispanic White women (29.72 percent).

Portions of Tables 1‑13 and 1‑14 are presented below to show the rates of 1‑year and 3‑year first incidence of AUD, respectively. Following Dawson et al. (2008b) and Grant et al. (2009), individuals were counted as positive for the 1‑year incidence of abuse or dependence if they met the criteria for these disorders for the first time in the year preceding the Wave 2 interview. Similarly, individuals were counted as positive for the 3‑year incidence if they met the criteria for abuse or dependence for the first time during the 3‑year follow‑up period between the Wave 1 and Wave 2 interviews. Note that the DSM‑IV hierarchy of these disorders in which a diagnosis of dependence preempts abuse is not imposed for these estimates. Thus, individuals were eligible for the incidence of abuse even if they were concurrently or previously classified with dependence.

These 1‑year or 3‑year new incidence cases were used as numerators to calculate the incidence rates of abuse and dependence. The denominators were restricted to individuals who were at risk for first incidence of those disorders. For the 1‑year incidence, the risk groups for dependence and abuse comprised individuals who never met the diagnosis for those disorders prior to the year preceding the Wave 2 interview. For the 3‑year incidence, the risk groups for alcohol abuse and dependence comprised individuals who never met the diagnosis for those disorders prior to or at the Wave 1 interview.

As an example, the boldfaced numbers in the portion of Table 1‑13 indicate that among non‑Hispanic Whites ages 18–24 years old at Wave 1, the 1‑year first‑incidence rate of alcohol abuse and of alcohol dependence were 4.29 and 4.74 percent, respectively. With respect to the 3‑year first‑incidence rates shown in Table 1‑14, the rates of alcohol use disorder demonstrate a declining trend with age; the rates dropped rapidly from 16.46 percent among the 18‑ to 24‑year‑olds to 6.50 percent among the 25‑ to 44‑year‑olds, then to 3.74 percent among the 45‑ to 64‑year‑olds, and finally to less than 1 percent among individuals ages 65 years and older.

4.2 Health Condition Rates Tables

The second group of tables includes Tables 2‑1 through 2‑11. These tables present rates (expressed as percentages) for selected past‑year health conditions at Wave 2. The denominators used in these tables are respondents who did not report the respective past‑year health conditions at the Wave 1 interview. Each table presents rates for these conditions by one of the key alcohol‑related measures.

In the portion of Table 2‑1 shown below, the rate for high blood pressure or hypertension is 15.13 percent among former drinkers who did not report having this condition for the year preceding the Wave 1 interview. This means that for every 100 former drinkers ages 18 years and older in the United States who did not have high blood pressure or hypertension in the past year of 2001–2002, approximately 15 people reported having this condition in the past year of 2004–2005.

4.3 Psychiatric Disorder Rates Tables

The third group of tables includes Tables 3‑1 through 3‑11. These tables show 1‑year and 3‑year first‑incidence rates per 100 population for selected past‑year substance use, mood, and anxiety disorders. The numerators used are the numbers of new cases (i.e., individuals who had a specific disorder for the first time in their lives) during the year preceding the Wave 2 interview for the 1‑year first incidence and during the 3 years since the Wave 1 interview for the 3‑year first incidence. The denominators are respondents who never had a diagnosis of the respective disorders prior to the year preceding the Wave 2 interview for the 1‑year first incidence or prior to or at the Wave 1 interview for the 3‑year first incidence. Each of the tables presents rates of the disorders by one of the key alcohol‑related measures. Detailed descriptions of the methods used for calculating incidence rates and the definitions of these specific disorders can be found in Grant et al. (2009).

In the portion of Table 3‑2 shown below, we observe that among light drinkers, the 1‑year first‑incidence rates for substance use disorders in general are higher among men than among women (e.g., 2.75 vs. 1.32 percent for alcohol use disorder and 4.99 vs. 3.74 percent for nicotine dependence). In contrast, the 1‑year first‑incidence rates for mood and anxiety disorders are lower among men than among women (1.54 vs. 3.52 percent for any mood disorder, and 1.16 vs. 2.25 percent for any anxiety disorder).

Note that the rate for bipolar II among men who were light drinkers is 0.12 percent. The rate is flagged with a “*” indicating that there are fewer than 10 new cases of bipolar II in that cell and the estimate is considered unreliable.

4.4 Quality of Life Scores Tables

The fourth group of tables, Tables 4‑1 through 4‑11, presents measures of quality of life (QOL) at the Wave 1 interview and the change scores between Wave 1 and Wave 2 interviews. NESARC measures QOL using Version 2 of the Short Form 12 Health Survey (SF‑12v2), which consists of 12 items designed to generate two summary scales—the norm‑based physical component summary score (NBPCS) and the norm‑based mental component summary score (NBMCS)—and eight individual scales representing physical functioning, role physical (the extent to which health interferes with regular activities), bodily pain, general health, vitality, social functioning, role emotional (the extent to which emotional problems interfere with regular activities), and mental health (Dawson et al. 2009). All scales were standardized to a mean of 50 (range 0–100) using standard norm‑based scoring techniques, with higher scores indicating better functioning.

A portion of Table 4‑4 is shown on below. The boldfaced numbers indicate that among individuals with alcohol dependence at Wave 1, the NBPCS at Wave 1 decreases with age: 55.30 among those aged 18–24, followed by 52.77 among those aged 25–44, 49.83 among those aged 45–64, and 41.48 among individuals aged 65 years and older. The deterioration of NBPCS since the Wave 1 interview (- 4.87) is particularly pronounced among the group 65 years and older. As for NBMCS at Wave 1, the scores are all below the norm of 50 for all age‑groups. The 45‑ to 64‑year‑olds had the lowest score (43.87) but the largest improvement since the Wave 1 interview (2.53).


5. References

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Chen, C.M.; Yi, H.; Falk, D.E.; Stinson, F.S.; Dawson, D.A.; and Grant, B.F. 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). NIH Publication No. 05‑5737. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism, 2006.

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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.

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Grant, B.F., and Kaplan, K.D. Source and Accuracy Statement for the 2004–2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism, 2005.

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Research Triangle Institute (RTI). Software for Survey Data Analyses (SUDAAN) Version 10. Research Triangle Park, NC: RTI, 2008.